A New Year's wish for WASH and maternal health

Nearly two years since my daughter was born the memory of sitting at home alone ten days afterwards, waiting for an ambulance and bleeding like a tap turned on, is still with me. I remember thinking what the experience would have been like if I was in, say, Sierra Leone.

All sorts of things contributed to me surviving the experience – an ambulance, roads, a hospital, trained midwives and surgeons. But one thing I didn’t even think about was whether there would be water, toilets and a sewage system in the hospital – of course, I took this for granted.

It seems obvious, doesn’t it? The world’s mothers and midwives should not be giving birth or working in facilities without the basics – and yetnearly 40% of health-care facilities worldwide do not have access to water, let alone to safe water. I can’t imagine what it would be like trying to keep disease spreading to mothers and newborns when there’s no soap or water to wash hands or to clean a ward with.

Campaigning at all levels

One of the most inspiring conversations I’ve had recently was with Rose Mlay, a campaigner from Tanzania who has been working for years in maternal health. She ran a campaign to increase women’s access to emergency pregnancy, childbirth and newborn care in the Rukwa region, which resulted in 81 MPs supporting the cause and 16,500 people signing a petition for ‘emergency care near our homes’.

Rose and many others also worked with local government to support them to respond to the campaign, dealing with the many blockages stopping them from delivering emergency care. Just a year later and, as a direct result of the campaign, the President of Tanzania has directed all 169 district councils to develop a budget and strategy to deliver this care, and recent research shows real progress is now being made in Rukwa.

This sort of campaigning – working from outside government to highlight the problem, from the inside to unblock challenges to delivery, and doing all of it at scale to reach more people at district and regional level – is extremely effective. WaterAid takes this approach in many of its country programmes, and we want to do so more in future, particularly when it comes to getting water and toilets into health facilities.

Integration, integration, integration

I was talking to Rose at the Global Maternal Newborn Health Conference in Mexico, where it was clear that water and toilets are finally on the global agenda. In fact, ‘integration’ – which we are very keen on at WaterAid – was a buzzword at the conference.

But even these maternal and newborn health experts are confused about what this ‘integration’ looks like in practice, and are looking for evidence on how to do it well and the impact it has. Simply talking about whose responsibility it would be to fix a toilet or a water point in a hospital helps with thinking about integration – although the hospital itself is responsible, ultimately it’s about the health and water ministries working together to make sure the basics are there, and being used, in the first place.

Proper, effective integration will require ego-free leadership – a willingness to give up power and work well with others. These are intangible but really important skills. The water, sanitation, hygiene and maternal and newborn health sectors will need to work together far more than we have done so far, supporting governments to deliver integrated policies and plans. What gets counted is what counts – governments need to be held accountable and joint indicators need to be developed and monitored to succeed in improving WASH and maternal and newborn health.

2016 is almost upon us. I am ending the year full of hope, excited about the Global Goals and willing our leaders to take forward the Paris agreement on climate change. This year, however, I will also be thinking about the women everywhere giving birth, hoping they have the ambulances, hospitals, midwives – and water and toilets – that I had.