Progress towards Universal Health Coverage in Mali: the vital role of water, sanitation and hygiene
On the first ‘Universal Health Coverage Day’ since it was officially designated by the UN, Alassane Maiga, WaterAid Mali’s Head of Programmes and Advocacy, shares the progress so far in their project to improve WASH in healthcare facilities as an essential part of universal health coverage, and the challenges that still remain.
As I sit here in the WaterAid Mali office in Bamako, the capital city of Mali, I am pleased to reflect on the hard work and achievement of our efforts to improve the health of the most vulnerable Malians.
From 2015 to March this year, WaterAid Mali – in collaboration with the Ministry of Health, the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC Atlanta) and local partners – implemented a project to improve the provision of water, hygiene and sanitation (WASH) in 23 health centres in the districts of Bla (Ségou region) and Koro (Mopti region). The project was realised with US$4.4M co-funded by the Conrad N. Hilton Foundation (CNHF).
Universal health coverage is impossible without WASH
Governments around the world have set themselves an ambitious Sustainable Development Goal (SDG) to achieve universal health coverage (UHC) – in other words, health services for all citizens everywhere – by 2030.
Our project here in Mali was based on the recognition that UHC cannot be achieved in our country while so many healthcare facilities lack the essential foundations of clean drinking water, adequate sanitation and the facilities and good practices required to maintain hygiene standards. Without these building blocks, providing quality healthcare is impossible, outbreaks of dangerous diseases cannot be prevented or controlled, and citizens cannot fulfill their human rights to health.
In Mali, we learned through a diagnostic study in health centres in 2015 just how challenging the situation was. 61% of health centres did not have drinking water. 68% did not practise handwashing with soap. 89% of health centres did not treat their medical waste in a safe way. Perhaps most shockingly, 100% of latrines were not functional because they were unclean and lacked handwashing facilities with soap. It was clear to us that this was a national crisis, and one that we had to help tackle.
Progress beyond the project
Earlier this year we reviewed the three-year project and reflected on the progress and the challenges. We are pleased that our joint efforts have improved access to WASH in the 23 health centres covered.
Throughout the project, all actors developed and agreed a minimum package of WASH interventions in healthcare centres. This package will serve as a blueprint for future interventions to improve WASH facilities in healthcare centres across Mali, to be applied alongside a national strategic plan.
The success has gone beyond just the healthcare facilities where we improved services directly. It has also influenced and helped the Ministry of Health to develop and validate a National Strategy and Taskforce to Integrate WASH in Health. As the short film below shows, Professor Samba Sow, the Minister of Health, has welcomed the close partnership with WaterAid Mali and recognizes the vital importance of scaling up and maintaining WASH in all healthcare facilities across the country.
In our review, we reflected carefully on the factors contributing to the success of the project, and I hope these will be useful for others seeking to work in this field. We viewed the key factors as being:
- The commitment and remarkable leadership of the National Health Directorate.
- The strong partnership with the Ministry of Health and the experts of the National Directorate CDC Atlanta.
- Strengthening the health sector during project implementation. The project was an opportunity to build the capacity of partners; it made the health sector very strong in terms of collaboration and working together. It also revitalized the national task force, which was a platform through which to learn from each other, especially lessons learned from the project.
The challenges left
We also considered the remaining major challenges to expanding WASH in healthcare facilities and progressing towards UHC in Mali. For example, most community-level health centres in Mali are run by an Association de Santé Communautaire (Community Health Association – ASACO). Improving the financial sustainability of ASACOs, strengthening their governance and expanding the number of trained health workers is a major challenge facing our country. We will be working closely with the Ministry of Health and our project partners to address these issues during the current ‘consolidation phase’ of our work and into 2019.
We know there is a long way to go to achieve quality healthcare for all in Mali, and to secure the WASH services necessary to support that. But I believe our project shows that real progress is possible with well thought through sector-strengthening approaches, with great partnerships, and crucially with the ownership and leadership of the government.
This winter WaterAid UK is aiming to raise £1.5 million, enough to transform over 20 health centres around the world with clean water, decent toilets and good hygiene.