In 2018, the UN Secretary General and World Health Organization Director-General both declared that the crisis of inadequate water, sanitation, and hygiene (WASH) in health care facilities (HCFs) demanded global attention. Centers for Disease Control and Prevention (CDC) was recently awarded a grant by the Conrad N. Hilton Foundation to provide technical support to ministries and NGOs implementing WASH in HCFs using a "district-wide approach" designed to cover all HCFs in at least one district in target countries to serve as a model toward achieving Sustainable Development Goal 6.
When responding to outbreaks of cholera, typhoid fever, Ebola virus, and other infectious diseases the Centers for Disease Control and Prevention (CDC) often works with partners to improve drinking water safety and hygiene in health care facilities (HCFs). Typical engagements include distributing locally made, portable handwashing and drinking water stations; providing education; and supplying soap for handwashing and products for onsite chlorination of drinking water. More recently, these inexpensive provisions have also included color-coded bins for triage of sharps, infectious and noninfectious health care waste, as well as barriers to separate HCF waste pits from local populations. These short-term interventions address acute deficiencies until more definitive long-term interventions—such as water supply, hygiene, and sanitation (WASH) infrastructure—and more effective waste disposal technology can be planned and built.
To help reach Sustainable Development Goal 6 (SDG 6), which calls for clean water and sanitation for all people, and achieve universal access to WASH in HCFs, the Conrad N. Hilton Foundation provided grants to CDC and other partner NGOs to implement a model “district-wide approach” in Uganda and five other countries. The purpose was to bring together governments, NGOs, communities, and international partners in each country to plan, implement, maintain, and sustain interventions in all public sector HCFs in target districts. The district-wide approach would serve as an example and catalyst for the participants’ respective national efforts to reach SDG 6. In Kamwenge and Kabarole Districts of Uganda, the Ugandan Ministry of Health joined Water For People, International Red Cross WASH, and CDC to engage communities, district health offices (DHOs), and local governments to implement the program. At each HCF, CDC identified WASH deficiencies through baseline assessments to help guide procurement and implementation activities.
CDC also provided technical assistance to partner organizations to ensure that program implementation addresses acute deficiencies in HCFs and identifies longer-term infrastructure needs. To ensure local engagement in Uganda, DHO staff were included in data collection activities, and, along with HCF staff, jointly made decisions about the interventions. By using basic WASH service level indicators defined by the World Health Organization/UNICEF Joint Monitoring Programme, project partners can assess their respective progress toward achieving SDG 6. Long-term interventions will be initiated by project partners in both districts in 2019. Innovations, such as local production and district-wide distribution of alcohol-based hand sanitizer and water treatment technologies to HCFs, will be field-tested by project partners in Kaborole District as part of the operational research agenda for WASH in HCFs. Following completion of the district programs, CDC will evaluate overall progress toward SDG 6, and join with partners to disseminate program results within Uganda and among the other partner countries in support of WHO and UNICEF's Global WASH in Healthcare Facilities Initiative.