Uganda: IRC promotes collective action to promote WASH in healthcare facilities


Under the decentralization policy as provided for by the Local Government Act, 1997, the district local government has the mandate to deliver services including healthcare to the people, adhering to minimum national standards and guidelines. Yet, healthcare facilities and services are not complete without water, sanitation and hygiene services.

The Kabarole District faces numerous challenges including dependence on the central government for water and sanitation conditional grants mainly focused on community health education and primary healthcare. The grants are too limited to address WASH services in healthcare facilities (HCF). There is no designated office, human resources or budget for WASH in healthcare facilities. Additionally, there is no documented evidence to understand and therefore address the intricacies of WASH in healthcare facilities as well as high turn-over of healthcare workers. This laissez-faire arrangement for WASH in healthcare facilities further compounds the problems of Healthcare Acquired Illnesses (HAI), health workers absenteeism and low motivation among the population to seek healthcare services. In Uganda, many people prefer to self-medicate or deliver their children at home, rather than expose themselves to the healthcare-associated infections which occur when water, sanitation and hygiene services are poor or absent from healthcare facilities.

To combat these issues for WASH in HCFs, IRC Uganda saw an opportunity to build upon the experiences and expertise from all stakeholders at the district level to push for change through collective action.

Leaning on the strong partnership and collaboration with the Kabarole District over the past 10 years, IRC Uganda in their hub role engaged partners to address some of the challenges of WASH in healthcare facilities.

Partnerships for evidence creation and advocacy

It is important to start with an understanding of the severity of the problem before identifying the way forward. IRC supported an assessment of WASH in HCFs  to ascertain the extent of the problem in Kabarole. This assessment was a collaborative effort between the Kabarole District Health Office, IRC Uganda, Mountains of the Moon University School of Public Health and the Center for Disease Control and Prevention (CDC) in Atlanta USA, each bringing different but much-needed expertise to the project.

IRC’s longstanding relationship with the district facilitated the processes to discuss findings and disseminate results with stakeholders from HCFs, the District Water Officer, Secretary of Works and the Local Media. The input and contributions from all the stakeholders throughout the process were essential to ensure the results were used in decision making.

The assessment provided a basis for advocacy, planning and resource mobilisation for WASH in healthcare facilities in Kabarole. Implementing partners including development agencies and NGOs now discuss investment plans for WASH in HCFs collaboratively with the District prior to implementation.

Partnership for capacity building and institutional strengthening

In addition to the other challenges faced by HCFs, there was a gap in infection prevention and control (IPC) responses. WASH plays a key role in IPC and should be incorporated into everyday knowledge and practices of healthcare workers and healthcare facility staff. Therefore, a Training of Trainers for the District Infection Prevention and Control team on WASH in HCFs and IPC was done in collaboration with CDC, the Infectious Diseases Institute (IDI) and the District Health Office (DHO). Fifteen Environmental Health Workers were trained to conduct additional training on IPC and WASH in 30 HCFs for both healthcare workers and cleaners.

This collaborative effort yielded many positive changes including increased distribution of communication materials on WASH in healthcare guidelines including proper waste management and handwashing at the healthcare centers. Also, because of their training, they were ready to support the pandemic response. The team previously trained formed the COVID-19 core team that was able to provide additional COVID-19 specific training and response.

Partnership to boost local entrepreneurship and sustainable home-grown solutions

In an attempt to boost local private sector engagement in WASH in HCFs, IRC Uganda leveraged their long-standing relationship with the Hand Pump Mechanics Association (HPMA) to bridge the gap between the Kabarole District Local Government and Hand Pump Mechanics Associations to improve sanitation in HCFs. HPMAs are locally based WASH artisans from each of the Sub Counties that come together under one association at the district level.

This collaboration led to the renovation of latrines in HCFs. Supervised by the District Engineer and Health Inspector coupled with resources from IRC Uganda, the handpump mechanics were contracted to renovate 12 latrines in 12 healthcare centers.  These renovations helped ensure the latrines met the required standard for privacy, gender segregation, access for people with mobility challenges, handwashing stations, cleanable floors and SATO pans. These renovations, including pit emptying and construction of full sanitation facilities at healthcare centers where there were none, helped increase access and reduce latrine (stance ratio) deficit.

Partnership for COVID-19 response

Partnership was key to mitigating the severity of COVID-19 and contribute to a joint response. In healthcare crises such as the COVID-19 pandemic, responses can be fragmented and disorganized but working in coordination and collaborating with stakeholders helps ensure this does not happen. For IRC Uganda, it was important to contribute to this collective response which was done in several ways.

Together, the DHO, IDI, Baylor College of Medicine and Children’s Foundation Uganda, and IRC Uganda pooled resources to provide personal protective equipment for health workers in Kabarole when the pandemic was first announced in Uganda. This initiative substantially reduced chances of healthcare workers transmitting COVID-19 and other diseases.

Through the collaboration and technical expertise of IDI and CDC, paired with IRC’s coordination role and DHO’s mandate, the team was able to produce and distribute alcohol-based hand sanitizer, which greatly improved hand hygiene among healthcare workers in the 30 HCFs in Kabarole.

Lessons from partnerships

There are significant deficiencies when looking at the levels of service delivery of WASH in healthcare facilities in Uganda, yet there are many untapped partnership opportunities that pool knowledge, resources, innovations and skills to ensure the safety of health workers and improve health services for the population.

IRC Uganda’s collaborative efforts came with valuable lessons including the following:

  • there are low-cost solutions at home which if given a boost can produce high impact results;
  • interventions in WASH in HCFs have a ripple effect on the push toward universal access not only for health, but for other sustainable development targets and the overall quality of life of people;
  • partnerships can raise the profile of WASH in healthcare facilities by demonstrating to power centers, other sectors, and investors the pivotal role of WASH in infection prevention and control, in primary healthcare as well as in the quality of health services; and
  • collaborative efforts make stronger, sustainable impact in ensuring full coverage of WASH in healthcare facilities leaving no one behind.

IRC Uganda will continue to work collectively with partners in Kabarole District as well as across the country to improve WASH in HCFs.