Hygiene nightmare in public hospitals

It is 4 O’clock in the afternoon. 24-year-old Janet Levison takes to the veranda of the maternity waiting shelter of Chizolowondo Health Centre in Traditional Authority (T/A) Chakhaza in Dowa to admire the beauty of the sun as it dissolves into dark clouds.

A few other pregnant women and guardians have also gathered outside the just-refurbished shelter to share experiences while others are chattering about social and political issues, including the ongoing elections case.

“This is my third pregnancy. I delivered my first two babies at Mponela Rural Hospital because this facility had no water and sanitation facilities befitting a maternity wing,” Levison says as she scratches the ground with a stick.

She is among scores of pregnant women and guardians who have been shunning Chizolowondo Health Centre and would cover dozens of kilometres to seek antenatal and post-natal services at Mponela Rural Hospital.

Chizolowondo Health Centre had no functioning water, sanitation and hygiene (Wash) facilities.

According to the World Health Organisation, unsafe water and poor hygiene practices in healthcare facilities lead to health-care acquired infections.

Globally, improving water, sanitation and hygiene has the potential to prevent at least 9.1 percent of the disease burden or 6.3 percent of all deaths.

Thus, the availability of Wash services at healthcare facilities is essential for preventing and treating disease and, therefore, directly reduces the disease burden.

Inadequate drinking water, sanitation and hygiene in non-household settings, such as schools, healthcare facilities and workplaces impact the health, education, welfare and productivity of populations, particularly in low- and middle-income countries such as Malawi.

Public health experts say Wash plays a crucial role in improving maternal health outcomes during pregnancy, delivery and postpartum periods.

But, Wash services and behaviours are the least prioritised areas among policy makers and service providers in Malawi.

Of course, Malawi has made strides towards achieving fair distribution of healthcare services around the country.

However, the country continues to score poorly in ensuring adequate provision of Wash facilities in these health care facilities.

Spot checks in selected health facilities in Chitipa, Dowa and Zomba by the White Ribbon Alliance for Safe Motherhood in Malawi (WRASM) showed that there is a serious lack of safe water supply, functional toilets and hand-washing facilities in health care facilities.

Misuku Health Centre, one of the public health facilities in Chitipa District, is among those that have, for years on end, operated without adequate Wash facilities.

Located in a mountainous area about 67 kilometres northeast of Chitipa District Hospital, the facility has been operating without running water because the plumbing system had a fault that needed maintenance.

When the WRASM team visited the facility early 2019, the pit latrines and bathrooms were dirty, without someone being assigned to clean them because the staff did not know whose responsibility it was between the ward attendants and the ground workers.

“The post-natal ward was spacious, but had no linen. And the room was very dirty with blood stains on the mattresses and cobwebs all over. The grounds were very dirty, with no dustbins and no rubbish pits. Refuse was just dumped behind the facility,” the report reads.

The situation was the same at Thonje Health Centre, which is located 41 kilometres away from Dowa District Hospital.

The general surrounding of the facility was poor and deserted as there was tall grass on the footpath to the latrine as well as to the placenta pit.

The facility personnel have been drawing water in buckets for use. Additionally, the sluice room had not been functioning due to the same problem.

“The placenta pit was full, but they are still using it. The incinerator was badly damaged but they are still using it because they do not have an alternative. There was one pit latrine that was used by both staff and patients and was not cleaned such that it was full of urine,” the WRASM report adds.

WRASM National Coordinator, Nancy Kamwendo, says provision of Wash services in healthcare facilities does not only contribute to prevention of infections and the spread of diseases, but also uphold dignity of vulnerable populations, including pregnant women and the new-borns.

Kamwendo states that the revelations prompted them to engage local communities, district health offices and the Ministry of Health to find a lasting solution to the poor sanitation and hygiene in public health facilities.

“Engagement of local communities to actively participate in planning, governance and quality improvement processes is crucial in achieving improved and comprehensive health package.

“The local leaders who were part of the project were also capacitated on different aspects of Wash. These leaders played a very important role in generating demands for Wash facilities as well as hygiene promotion in their respective communities,” she explains.

She adds that with much of advocacy at national level as part of the sectoral initiative, the targeted facilities have seen improvement in attainment of Wash services.

Dowa Director of Health and Social Services, Peter Makoza, admits that participation of service users in planning, governance and quality improvement processes has helped make health services and health professionals more responsive to the needs of their clients.

Makoza says in some facilities, community leaders, led by their health advisory committees, have mobilised resources to maintain broken water and sanitation facilities.

“Additionally, in other health facilities, communities have constructed new pit latrines. And one of the facilities that have seen great improvements in Wash services is Chizolowondo Health Centre where the community approached a businessman and philanthropist to help them renovate the facility,” Makoza says.

Levison is impressed with the improvements made to the facility so far which she states are crucial to motivating pregnant women to deliver at the clinic.

“I have been here for the past two weeks and I am impressed with the environment under which we are waiting to deliver our babies. The facility is very clean, with safe and clean drinking water flowing every day. This was not the case a few months ago when waiting here was a nightmare,” Levison says.