Project Background
This report provides an overview of the key achievements, impacts, lessons learnt and challenges faced as we embarked on our new project to improve water, sanitation and hygiene in rural Cambodian healthcare facilities (HCF’s). As per the original plan, the project is progressing well and is on budget.
WaterAid is pleased to share our progress and acknowledges the generosity of all those who have contributed in helping us to make a start on our journey towards improving and upgrading facilities and hygiene knowledge in healthcare facilities across Kampong Chhang, Kampong Thom and Thbong Khmom provinces in Cambodia.
In October 2014, in partnership with the World Health Organisation (WHO) WaterAid Australia undertook research in two rural provinces in Cambodia, to understand the status of water, sanitation and hygiene in healthcare facilities, particularly those that provide services in maternal and newborn health. We found:
- Almost no facilities provided drinking water for patients
- Pregnant women were unable to access proper toilets
- There was a lack of handwashing facilities or soap in maternity wards
- Many doctors and nurses were not washing their hands properly or practising proper infection control
- There were no proper bio-medical waste systems.
With these findings in mind, WaterAid has embarked on this new project with an overall goal of protecting the health and safety of mothers and their newborn babies when accessing services in a Cambodian healthcare facility.
Project Partners and Collaboration
In order to make significant and sustainable improvements to water, sanitation and hygiene in healthcare facilities, we have worked hard to establish strong relationships with government partners.
Starting with a formal meeting with the Secretary of State for the Ministry of Health, His Excellency Professor Eng Huot was presented with a clear message that WASH in healthcare facilities is essential to basic quality of care and a fundamental part of infection prevention control. He not only agreed with its importance for improving health in Cambodia but also reinforced it, stating, “Without water, healthcare facilities can’t reach the infection prevention control standard.”
This initial meeting led to an official memorandum of understanding between WaterAid Cambodia and the Ministry of Health to work in partnership towards the goal of jointly improving healthcare facilities. We are now working with government and are taking the first steps to assess HCF’s across the following five standards:
- Basic water supply facilities
- Basic sanitation facilities
- Basic hand hygiene facilities
- Cleaning routines
- Healthcare waste management
Project Impact; What We've Achieved
Water, sanitation and hygiene activities to improve the standards of care in Cambodian hospitals and healthcare facilities included:
- Assessing 117 HCFs across five provinces. By understanding their gaps and needs, this will allow the healthcare facilities to draw up plans and work towards bringing their facility to a proper and unified standard.
- Inviting local authorities and healthcare facility staff to participate in the Safety and Accessibility workshop. At the workshop, staff gained a better understanding of the barriers disabled people and pregnant women face when accessing toilets at a healthcare facility. After completion of the workshop, modifications and improvements were made to a healthcare facility toilet block. As a result, disabled people and pregnant women are now able to use the toilet during their stay.
- Overseeing sustainability and regular water testing at 10 referral hospitals who have received new water filtration systems.
- In the same 10 hospitals, conducting a training needs assessment in WASH and infection prevention and control. Training was delivered to staff at each hospital and an evaluation completed. Staff now have a greater awareness around the importance of washing hands to prevent cross infection.
- Facilitating training of 2 Ministry of Health staff and 2 Local NGO staff in partnership with the World Health Organisation. Staff will now go on to train other staff in HCFs around infection control and proper hygiene.
- Launching the Healthy Start – Youth Campaign. To create more understanding and public demand for cleaner healthcare facilities, three youth groups were selected to develop and implement micro-campaigns in their community with the message of improving WASH in healthcare facilities. This is the first time youth groups have been engaged to campaign on these issues.
Challenges Faced
The process of contextualising a standardised WASH assessment to fit the Cambodian context required more time than we envisaged. There was an expectation that the global assessment tool would be fit for purpose in Cambodia but in reality, changes were needed.
Once the assessment tool was modified, steps were taken to create leadership/ownership with Ministry of Health staff, this also took more time and investment than we first thought and required considerable amounts of orientation, learning initiatives and training at both the national and sub-national level.
Case Study: Nurse Aranhya Peu
“It is very good now we have the clean water because we can use the water to clean the materials. Before, we used water from the well and it was not safe to clean materials with this water because it had viruses. So it’s very good for me now I have access to use clean water here.
“When we used the water from the well, patients often became sick but now they are less sick. And, they have more money because they don’t have to spend money to buy bottled water. We always inform the patients that they can drink this water. It makes me very happy.”
What's Next?
The ‘Putting the lives of mothers and babies in safe (clean) hands’ project will continue to work in partnership with the Ministry of Health, National Institute for Public Health, World Health Organisation, Nossal Institute and other research partners and local and international NGO’s. This joint effort will bring sanitation, water and hygiene standards in health care facilities to a minimum standard in Cambodia.
Project Background
In Cambodia, a majority of rural hospitals and healthcare facilities are poorly equipped. Most have limited access to safe clean water, handwashing stations and proper toilets. All this means the hygienic conditions in maternity wards are extremely poor, increasing the spread of infection and risk of deadly disease for babies and mothers.
As Cambodia, grapples to assist the 8.1 million people living in extreme poverty, public health continues to remain an important challenge and development priority for Cambodia.
- 170 women per 100,000 die in childbirth each year
- 79% of the Cambodian population do not have access to a safe and clean water supply
- 58% have no access to a toilet or hand washing facilities
The links between dirty hands, dirty water and unclean facilities during birth with a link to infant and maternal mortality are well established. Access to clean water, toilets and improved hygiene practices in hospitals is fundamental for reducing the spread of infection. While a hygienic and safe hospital environment increases the experience of care and trust, thus ensuring more women choose to deliver their baby in a healthcare facility instead of delivering at home.
The WHO estimates that healthcare associated infections cause up to 56% of all neo-natal deaths amongst babies born in developing countries and that 11 % of maternal deaths are linked to unhygienic conditions.
In October 2014, in partnership with the World Health Organisation (WHO), WaterAid Australia undertook research in two rural provinces of Cambodia, Kampong Speu and Prey Veng to understand the status of water, sanitation and hygiene in health care facilities who provide services in maternal and newborn health. Results showed:
- Almost no facilities provided drinking water for patients
- Pregnant women were unable to access a suitable toilet
- There were limited hand washing facilities or soap in maternity wards
- Many doctors and nurses were not washing their hands properly or practicing proper infection control measures
- There were no proper bio-medical waste systems in place and most parents were required to dispose of their own placentas.
Project Objective
The project has two main goals:
- Support the Cambodian Ministry of Health to prioritize policies , guidelines and standards to improve and monitor water, sanitation and hygiene in healthcare facilities throughout Cambodia
- Improve water, sanitation and hygiene at 60 health care facilities and provincial hospitals in rural Cambodia (30 in year one and 30 in year two)
To achieve the project goals, WaterAid will:
- Lead and coordinate advocacy plans that will result in improved policies and guidelines for improved water, sanitation and hygiene (WASH) in healthcare facilities at a local, district and national level
- Work with healthcare staff to identify the WASH challenges that are unique to their facilities
- Support healthcare staff to plan and implement WASH improvement strategies
- Work with training institutions to improve infection prevention and control training for midwives and other medical staff
- Invest in the replacement and installation of improved water, sanitation and hygiene infrastructure (i.e. taps, toilets and hand washing stations)
- We will share successes with the Camobdian Government, World Health Organisation (WHO) and research institutes to encourage a wider spread of WASH improvements in healthcare facilities
What's covered in project costs
Footprints funding will contribute to supporting healthcare facilities and provincial hospitals to plan for improved water, sanitation and hygiene solutions that benefit patients and staff.
Project Beneficiaries
Sixty rural healthcare facilities will have access to safe clean water, sanitation and hygiene. This will help reduce the risk of deadly infections and improve the experience of care for up to 1,800 mothers and their babies.
In addition, approximately 200 staff, including doctors, nurses, midwives and cleaners will benefit from working in a safer and more hygienic environment.
Dr Voeun, Director of the Boeung Kontout Health Centre | Photo credit: WaterAid/Tom Greenwood
Case Study: Dr Voeun - Boeung Kontout Health Centre
"My health centre only has one source of water. Water quality testing shows a high concentration of arsenic. Patients must not drink this water, so we tell them to buy their own.
"We have no toilets for women on the maternity ward, this means pregnant women have to walk outside the building to go to the toilet. This is a terrible challenge for these women. I also know staff and patients are not cleaning their hands properly after using the toilet because we have no soap. I worry this will spread infection.
I want to improve the water and sanitation at my centre and make it safer for my patients, but I cannot find a way to do it."
How does this project fit into a larger strategy?
The ‘Putting the lives of mothers and babies in safe (clean) hands’ project is aligned with the government of Cambodia’s new five-year strategy to improve access to equitable and quality health services by 2025. WaterAid is working in partnership with the Ministry of Health, local and international NGO’s and research partners to prioritize and inform new government policies that aim to reduce disease and improve patient care by improving water, sanitation and hygiene in all Cambodian hospitals and healthcare facilities.