Promoting inclusive water, sanitation and hygiene services in healthcare facilities in Cambodia
To coincide with International Day of Persons with Disabilities, Channa Sam Ol, WASH and Health Program Manager for WaterAid Cambodia, explains the journey towards their new 'User-friendly water, sanitation and hygiene in healthcare facilities (WASH in HCFs) participatory tool'.
To meet the health coverage needs of Cambodia’s 16 million people, there are 1,100 health centres providing integrated quality promotion, preventive and basic curative and delivery services. Each of these health centres covers 8,000-10,000 people. Around 100 referral hospitals and nine national hospitals provide secondary and tertiary care, and act as referral hubs for the health centres. With a focus on people-centred care, Cambodia’s Ministry of Health has put effort into improving the quality of health service delivery, accessibility and equity.
Things are improving...
In my work with the health sector here, I can see that things are improving: more and more women are now giving birth at healthcare facilities rather than at home; and families with lower incomes and people with disabilities can access these health services thanks to government subsidies. But a great deal more needs to be done. This is why WaterAid Cambodia have been focusing on the concept of ‘user-friendly’ services, and how we can contribute to the country’s progress towards universal health coverage (UHC) by ensuring water, sanitation and hygiene (WASH) services in healthcare facilities are user-friendly and inclusive for all.
...but more needs to be done
In my 15 years of experience with NGOs in Cambodia, women’s and children’s health have always been at the heart of my work. During each trip to rural healthcare facilities, I always question whether the services meet people’s needs. To reach the ambitious Sustainable Development Goal (SDG) of UHC by 2030, I have seen that we still need to improve even the basics in facilities, such as availability of water, sanitation and hygiene; and infection prevention and control. Without these crucial foundations, UHC will be impossible.
Why user-friendly WASH in healthcare facilities is needed
I remember one visit to a rural health centre particularly well. As I was testing the health centre’s services at using our ‘user-friendly tool’, I interviewed a woman who had just given birth. She told me about her postpartum experience at the health centre. She said little about using the WASH facilities at the centre, unwilling to provide much detail. After talking with her, we conducted an observation of the latrine, handwashing station and bathing facilities near to the post-partum room. The toilet room was 10m away and had a small squat toilet without hand-bars. There was a tall water basin with little water inside, making it difficult to scoop water out. While we watched, the woman I had spoken to walked to the toilet then returned to the post-partum room; she asked her mum to help her in the toilet because she couldn’t scoop water to flush the toilet on her own.
Another story from our partner Rainwater Cambodia also struck me. Rainwater Cambodia implements WASH in six rural health centres in Tbong Khmom by applying the Water and Sanitation for Health facilities improvement tool (WASH FIT) created by WHO and UNICEF. This management tool enables health facilities to perform self-assessments, identify risks, and improve planning and monitoring. During their monitoring trip to one of the health centres, Broher Khleng, they met a man, Mr Cham, who was there for a consultation. He was in a wheelchair and had just spent 20 minutes rolling his wheelchair from his home to the health centre. While he was waiting for his consultation, he needed to use the toilet. As there was no accessible toilet in the health centre, Mr Cham had to return home and then come back to the health centre, which took him another hour.
These two examples show just how much people with limited mobility, including pregnant women, elderly people, and people with physical disabilities face added challenges in using WASH facilities while at health centres, and how much this compromises their quality of care.
Our response: the user-friendly WASH in HCFs participatory tool
A study by Cambodia’s National Institute of Public Health of public healthcare facilities in five provinces found that water supply conditions were good, while hygiene and sanitation facilities and services needed further improvement. The study also showed that many facilities are inaccessible and fail to meet the needs of people with limited mobility, as well as women and girls’ menstrual hygiene needs.
As a result, our team decided to focus on accessibility and discussed how to address it strategically. Drawing on a global scoping study by the University of Melbourne’s Nossal Institute for Global Health, we learned that no tools existed to fully identify healthcare facility users with mobility challenges or to really engage them in voicing their needs. So, together with stakeholders, WaterAid Cambodia drafted the ‘Accessible water, sanitation and hygiene in healthcare facilities audit tool’. We shared the tool with expert groups from the WASH, health and disability sectors for review. Finally, we organized a consultation workshop with NGO partners, government representatives and Provincial Health Department staff, and proceeded to test the tool in Kompong Thom province. That consultation stage resulted in suggestions of more appropriate technical designs for adoption by healthcare facilities, and WaterAid Cambodia worked with Humanity and Inclusion (HI) to review and document the technical designs. All of this input, consultation and testing enabled us to refine our work, producing the final 'User-friendly water sanitation and hygiene in healthcare facilities (WASH in HCFs) participatory tool'.
We plan to pilot the tool and the proposed technical designs for user-friendly WASH in healthcare facilities. The feedback from this pilot will enable us to advocate for more user-friendly healthcare facilities, bringing the experiences of patients and communities to decision-makers to ensure that no one is left behind from the progress towards UHC by 2030.
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