Improving WASH in Health Care Facilities
In Ghana, one place apart from home to feel cared for is a Health Care Facility (HCF). Not only are the health personnel professional, but most importantly, the health care institution must have functional Water Access, Sanitation and Hygiene (WASH) facilities including toilet facilities, handwashing stations and clean drinking water stations. Unfortunately, the Ghana Joint Monitoring Programme (JMP) report in 2016 estimated that 30% of HCFs lack access to basic water services and of health facilities do not have improved sanitation. This disturbing revelation motivated Global Communities to partner with an International NGO Water4 through its local implementing partner Access Development to improve the WASH status of 30 HCFs in the Wassa East District of the Western Region of Ghana.
Background
Global Communities in partnership with Water4 and its local implementing partner Access Development in the Wassa East in the Western Region, is working to promote Water, Sanitation and Hygiene (WASH) in HCFs for six months. In recent times, there has been a call for all stakeholders to support Water, Sanitation and Hygiene programs in HCFs principally to curtail preventable infections and make the facilities more user-friendly for both staff and clients. After a baseline assessment of these institutions, the outcome was fused into a one-week training session for about 90 stakeholders including leadership of the Wassa East District Health Directorate, staff of the HCFs and community members. Posters and documented guidelines on improving WASH statuses in HCFs have been distributed to all the HCFs in the Wassa-East District.
Current Status of the Earmarked Health Care Facilities
Two months after the training, all 30 HCFs have made significant progress. They have either improved their sanitation facilities or constructed new ones, and improved their hygiene conditions and gained access to sustainable water sources for drinking and for cleaning. After the training sessions, some HCFs have been very motivated to do even better by improving their WASH status. Three of such institutions are: Plantation Socfinaf Ghana (PSG) Health Center, Sekyere Krobo Community Clinic and Atieku Health Center.
Plantation Socfinaf Ghana (PSG) Health Center
According to Godson Adu-Agyei, the Physician Assistant of PSG Health Center, “The training exposed a few loopholes in our WASH status and we are determined to be the best clinic in every aspect.” For example, though the health center is excellent in health care delivery, prior to the WASH training, it lacked essential sanitation.
and sharp objects
Additionally, provision for a toilet facility has been made for the Out Patient Department (OPD). One highlight of the facility is the creation of space in the female washroom for Menstrual Hygiene Management (MHM). Generally, the staff have a positive attitude to change and are eager to ensure their WASH is as excellent as their medical delivery.
Atieku Health Center
If ‘walk the talk’ were an institution, Atieku Health Center would be it. They have installed a handwashing facility each in the delivery, labor, recovery and laying in wards, consulting room and Ante-Natal Care (ANC) and laboratory. According to Senior Midwifery Officer Francisca Ametefe, “Some of the wards previously used veronica buckets for handwashing but within a period of six months sinks have been installed. All these were made possible when we successfully lobbied for water connection to the health center. The nudge we had from the training moved us to fast-track the lobbying process.”
Also, washroom facilities that were previously unlabeled and unsegregated have been labeled and segregated according to gender for both staff and clients. These steps have proven that successful interventions do not require only direct provision of amenities; they also require the right training and a willing leadership.
Sekyere Krobo Community Clinic
Located in a small community of Sekyere Krobo, this community clinic has shown great commitment at improving their WASH status, especially by providing safe water to the client. They are among the first institution to acquire and label their drinking water station.
“To improve the hygienic us of the station they have implemented a policy requiring all clients to visit the facility with their personal drinking cup. This way they incur less cost purchasing disposable cups and prevent the spread of diseases through the use of common drinking cups. However, provision I made for emergency cases” says the nursing officer of the clinic, Eric Asare-Asino. This is the story of a small community clinic making giants steps to advance their WASH status.
Future of the Partnership and Intervention
Global Communities’ vision for this partnership is for all Ghanaians, regardless of the location of HCF staff and clients, to have sustainable access to dignified, safe and improved water supply and sanitation, and the knowledge, attitudes, and behaviors needed to properly and hygienically use these facilities to meet their basic needs and stay healthy. The partnership will also create an enabling environment that influences government and citizens alike to hold themselves and each other accountable for realizing sustainable change in HCFs.
A Household Gets A Veronica Bucket After Handwashing Sensitization In School
The WASH for Health (W4H) project has been promoting handwashing as a key hygiene behavior among Ghanaians households and basic school students since its inception in 2015. Increasingly, handwashing has become the new normal lifestyle in Ghana and beyond, primarily as a result of efforts to protect against the COVID-19 pandemic. WHO continues to emphasize handwashing as one of the sure ways to prevent the spread of the virus. As a result of continuing efforts from W4H involving sensitization and education, a girl in Dambai named Isabella influenced her mother to purchase a Veronica bucket (a handwashing facility invented by a Ghanaian retired nurse, Veronica Bekoe, made of a bucket affixed with a small tap at the bottom) for their home.
Impact of handwashing sensitization
According to Isabela’s mother Patricia Haruna, a local food vendor, “Isabela has been educating us on the importance of handwashing as taught her in school. She has been telling us to wash our hands at the critical times of the day and the need to get a handwashing facility especially during the pandemic to serve as a reminder to constantly wash our hands.” Patricia adds that this has motivated her family to buy a veronica bucket for the family. As a result of her occupation, she is handling food and receiving money from several different people every day. “Handwashing with soap under running water makes my hands clean to cook and serve people with food,” she says.
Holy Rosary Junior High School under the WASH for Health
Handwashing Sensitization in Schools
Isabella Okemagye is a 13-year-old Junior High School pupil of Dambai Holy Rosary Roman Catholic Junior High School in the Oti Region. Having practiced handwashing with soap under running water in school, she now encourages her parents to buy a veronica bucket at home for her siblings and parents to also practice handwashing and make it a regular habit in their daily lives. According to Isabella, “I have been taught that is important to wash my hands at critical times of the day including after visiting the washroom and before eating. Due to the coronavirus, I have recently been taught to wash my hands after touching surfaces.”
WASH for Health Project – Institutional Latrine Construction
The WASH for Health (W4H) project has been providing latrine and handwashing facilities to schools including Dambai Holy Rosary Roman Catholic Junior High School in the Krachi-East district in the Oti Region. Thanks to the project, they are happy with three 4-seater latrines that were constructed in July 2017. As part of the sustainability strategy of the project, the pupils and staff are trained on how to maintain the facilities. The school was also sensitized on key hygiene behaviors with emphasis of handwashing. The most recent sensitization training was conducted for the 119 students who were authorized to be in school during the COVID-19 pandemic.
Improving Health Service Delivery Through Provision Of WASH Facilities
“At about 12 midnight in June 2019, a baby boy was born to a young couple at the Tutukpene Health Center in the Oti Region. Unfortunately, there was no water to wash the mixture of blood and amniotic fluid off the baby and the equipment used for the delivery. Relatives of the newborn’s mother had to save their congratulatory wishes until after they fetched water from the nearby community, about 15 minutes away, on foot. Thankfully the baby survived,” recounted Monica Hwanompe, the Senior Community Health nurse, who doubles as a midwife at the Health Center.
Provision of Water Supply
This scenario was a common trend in some Health Centers and Community-based Health Planning Services (CHPS), community-based health care facilities in the Savannah and Oti Regions until recently. In June 2020, nine facilities benefitted from mechanized boreholes under the USAID funded-WASH for Health Project, implemented by Global Communities. A mechanized borehole uses electric submersible pump to pump water into an elevated tank connected to stand pipes and/or taps. The nine health care facilities that were earmarked for water supply are Soma, Kulmasa, Nahari, Saru, Gbeniyiri – in the Savannah Region; Nabu, Lakpor, Pusupu CHPS compounds and Tutukpene Health Center – in the Oti Region. These water facilities will serve the entire community in which they exist. Global Communities’ WASH for Health team, during the COVID-19 pandemic, were motivated by the plights of the health care facilities and others like it, to provide mechanized boreholes, hence working tirelessly whiles observing COVID-19 safety protocols.
Handwashing Facility
Each facility has been provided with a sink in the delivery rooms for handwashing and washing equipment. Previously, according to Abigail Appiah, the midwife- in-charge of the Kulmasa CHPS compound, “Only one Veronica bucket served the delivery room which sometimes accommodates two to three deliveries at a time, but with the provision of the sink with constant water flow, they are relieved of the undue pressure.” Doreen Smith, the nurse-in-charge at Soma CHPS, added: “With this water facility readily available, convulsion and high temperature cases can be better managed.”
Provision of Solar Power
Four out of the nine health care facilities which were not connected to the national grid (Soma, Saru, Gbeniyiri and Nabu CHPS compounds) currently have functional solar power installed as part of the project. The solar power source will power the submersible pump and illuminate the entire CHPS compound including the delivery rooms. Until the intervention, some of these health care facilities were using torchlights and candles to provide services at night.
Maintenance of Facilities
The midwives and staff pledged to keep the water facility clean, use the water judiciously and report anomalies immediately to the Water Sanitation Management Teams (WSMTs) that will seek professional assistance. “We will ensure the facilities are well maintained and cleaned because we know how it felt to be deprived of these facilities,” Juliet said.
Other Water Interventions
Aside from these mechanized boreholes for the CHPS, there are other water facilities under construction for communities in these two regions. Currently 22 boreholes have been drilled and are at various levels of completion. Two small town water supplies systems are also under construction at Kalba and Tinjase in the Savanah and Oti regions, respectively. Upon completion, each facility, which is made up of a pump house, (WSMT) office, an elevated tank and standpipes will serve about 16,000 residents altogether.
Holistic Menstrual Hygiene Managment in Ghana
An All-Inclusive-Holistic Approach To Menstrual Hygiene Management Interventions in Ghana
For a visually or hearing impaired girl in a deprived community, menstruation is not just the monthly flow of blood. It is a burden of understanding why she has to bleed, communicating her discomfort associated with the bleeding, accessing user-friendly and hygienic sanitary materials, and determining when next ‘Miss Red’ will rear her head. Girls without these physical challenges encounter similar constraints in addition to stigma from their male compatriots. Some parents, the primary caregivers of these adolescents continue to transfer misconceptions on menstruation.
All these have been factored in Global Communities’ all-inclusive and holistic approach to Menstrual Hygiene Management (MHM) interventions in Ghana.
MHM Interventions
In January 2020, over three hundred basic students in the Central Region, including visually and hearing impaired females, benefitted from MHM education and products. These beneficiary were adolescent girls, boys, their parents and teachers of the Cape-Coast School for the Blind and Deaf and Ayifua St. Mary’s Anglican Basic schools. These interventions were undertaken as part of the USAID-funded WASH for Health project – Caterpillar Partnership implemented by Global Communities.
The MHM team from Global Communities with assistance from the Ghana Education Service (GES) organized a day session each, for the two schools. The education for the girls span from reproductive health through to the management of menstrual discomfort. Proper dieting during menstruation was not left out. They were advised on taking more iron-based foods to replenish the blood discharged. The boys were educated on MHM to support the girls instead of stigmatizing them.
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The students received Be Girl PeriodPanties and SmartCycle, designed by an American-Based company. The Be Girl PeriodPanties are re-usable panties with absorbent towels to absorb the flow. The Be Girl SmartCycle is an easy-to-use cyclical device for tracking menstrual flow.
The students were excited about the products since most of them could not afford sanitary pads every month. Most of them were unable to track their menstrual cycle, leading to blood stains on their uniforms. The holistic MHM intervention boosted the confidence of the girls present and positively influenced the perception of their male counterparts
MHM at Cape-Coast School for the Blind and Deaf
At the Cape-Coast School for the Blind and Deaf, over one hundred girls with visual and hearing impairment benefitted from the MHM interventions. The education was communicated to the students via sign-language, posters and demonstrations. Each girl received two Be Girl re-useable panties with four re-useable towels and a Be Girl smart cycle for calculating their menstrual cycle. The girls took turns to try their hands on the usage of the panties and the calculation of their cycle with the calendars. They were admonished to be more expressive with their trained teachers about their period. At the end of the session, some of the deaf girls expressed, “No More ‘Ghana Map’ stains on our uniforms,” where Ghana Map means blood stains on their uniforms.
MHM at Ayifua St. Mary’s Anglican School
Menstrual Hygiene education is usually limited to girls, however stigmatization of girls at puberty is championed their male counterparts. A holistic MHM education was organized for boys, girls and their parents at the Ayifua St. Mary’s Anglican school. Over two hundred students and their parents received MHM education.
The girls also received two Be Girl panties with four towels each, and booklets on MHM. The boys also received the booklets. After being enlightened o MHM, they promised to be champions of MHM both in school and at home. A discussion was held with the parents for targeted education on MHM. They left the session enlighten and willing to provide the needed support for their adolescent girls.
Additionally, the school received various educational posters on MHM. The girls were excited about both the intervention and the renewed position of their male comrades. The teachers were also very much appreciative of the complimentary education that the MHM team gave to their pupils.
Both schools were full of praise for USAID and Global Communities’ all-inclusive and holistic approach to MHM interventions. Government and organizations are encouraged to adopt this approach.
MHM during COVID19
During this period of COVID 19 there has been advocacy on various platforms for the provision of menstrual hygiene materials by government, organizations and individuals. Key messages are currently being crafted in collaboration with government agencies, and Pro-MHM organizations, to be disseminated in communities, on mass and new media.
WASH for Health Project and MHM
Under the six-year WASH for Health project, MHM has been promoted in project schools in six out of the nine project regions in Ghana, namely: Savannah, Central, Western, Greater Accra, Volta and Oti Regions. Close to five thousand girls, boys and parents from 35 schools have so far benefitted from the MHM interventions since 2017.
Prior to intervention
The two schools lacked improved toilet facilities, posing a sanitation and health threat to the students and staff. At the Cape-Coast school for the blind and deaf, only a 4-seater toilet facility served the entire school. An existing 8-seater pit latrine was in a dilapidated state raided by reptiles and other harmful insects. Construction of a toilet facility was started but has been left derelict for some time due to inadequate funding. The problem called for urgent attention because over 15% of the over five hundred students are visually impaired.
The Ayifua St. Mary’s Anglican school had access to an 8-seater toilet facility. Unfortunately, only four of them were fully functional: two of them were being used by the tutors’ whiles the students use the remaining two.
Sanitation intervention
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Toilet facility for Ayifua St. Mary's Anglican School |
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Toilet facility for Cape-Coast School for the Deaf and Blind |
In collaboration with the Caterpillar Foundation, Global Communities’ WASH for Health team constructed two 8-seater improved toilet facilities with changing rooms for girls in puberty in 2019, one for each school. For sustainability of these facilities, Facility–user trainings are organized for the school authorities and SHEP members. These trainings included the maintenance of the facility, behavior change education on key hygiene behaviours including handwashing after visiting the washroom and Menstrual Hygiene Management (MHM).
Asuohyiam Goes an Extra Mile in Providing Sanitation
In some communities in 21st century Ghana, pupils miss classes to attend to natures call and never return, for lack of toilet facilities in their schools. Some children and adults are still oblivious of the need for hand washing after visiting the toilet and before eating. And you are likely to go back home to ease yourself when you visit a loved one at a health facility, for lack of toilet facilities. To curb these disturbing realities, communities and developmental organizations need to collaborate and find sustainable solutions.
So as part of the USAID funded WASH for Health Project by Global Communities, rural communities are benefiting from various WASH interventions through the Small Grant Program. One of the five beneficiary communities in the Western region that exhibited exceptional commitment to the development of the community is Asuohyiam. This community, spearheaded by the headmaster of the Asuoahyiam District Assembly (D/A) basic school, Mr. Emmanuel Arthur, has constructed washrooms for the school. They went the extra mile to build a four-seater Ventilated-Improved Pit (VIP) latrine (washroom) instead of the proposed three, a urinal and purchased a water storage tank for handwashing to serve the over 600 pupils and staff.
The grant was awarded to the school to build a three-seater improved latrine. The grant of US$2,000 (GH¢8,836.40) catered for 75% of the cost of constructing the three-seater latrine for the school. The community member pledged their support and contributed GH¢3,651, approximately $826, which is the equivalent of 25% of the cost, to complete the project. Considering the population of the school, the community decided to include an additional seater and urinal (for both males and females) to the proposed latrine and purchased a water storage tank for hand-washing.
The Headmaster of the school, Mr. Emmanuel Arthur was excited about the grant and its foreseen impact of reducing absenteeism. “This support from USAID through Global Communities to build a latrine in the school is such a relief to me. Now pupils do not run away from school to attend nature’s call and not return” he said.
In preparation for the commencement of this project, a communal labor was organized to clear the site of weeds and trees for the construction of the facility. The trees felled were used for the roofing of the latrine. The show of solidarity and commitment towards the construction of an improved latrine for the Asuohyiam DA basic school by the community is remarkable.
The facility which took 13 months to construction commenced in April, 2018, with consistent monitoring by Global Communities, is fully functional and in use by the pupils and staff of Asuohyiam DA basic school.
Located in the Amenfi West District of the Western region with a population of about 1500, Asuohyiam is predominantly a cocoa farming community settled by people from various parts of Ghana and neighboring countries including Ivory Coast. The people are noted for their hospitality. The name Asuohyiam was coined from ‘Asuo hyia me’ meaning (I’m being met by river Asuo). That was a phrase constantly uttered by one of the early settlers who recounted his experience of crossing the Asuo River several times while he journeyed through the vast forest until arriving at a suitable settlement. This goes to prove their verve for going all lengths to get or be the best.
The Small Grants Program, which ended in September 2018, is a sub-component of the WASH for Health Project that supports local organizations to facilitate sustainable, innovative, community-driven projects that improve sanitation, water and hygiene for individuals, households and communities. The Program supports 75% of the proposed projects and awards a maximum of $2,000 (GH¢8,836.40) to successful applicants (organizations/groups), whilst the people contribute an additional 25%, to complete their proposed project within six months.
The Program, like WASH for Health, targeted communities in nine regions in Ghana; Greater Accra, Volta, Oti, Western, Western-North Central and Northern, Savannah and North East Regions. Nine communities, organizations and institutions of five (Western, Western-North, Central, Volta and Oti regions) were awarded grants.