Below the Surface: Finding A Clear Path to Clean Water

The Kabarole District of Western Uganda is a place of natural beauty, fittingly described by the local government as "a beautiful district with prosperous and harmonious people." At the heart of the district’s vision of prosperity is a focus on providing safe and dignified healthcare.

Though healthcare delivery looks different in each community, some aspects remain constant. No matter what hospital, clinic, city, or country you are in, access to water, sanitation and hygiene (WASH) is essential in healthcare facilities. WASH services are critical for preventing healthcare-associated infections through adequate cleaning and hand hygiene.

WASH in healthcare facilities is also a health equity issue, with inequalities experienced both across and within countries. A 2020 report by the World Health Organization on the status of WASH in healthcare facilities found that, in the world’s lowest income countries, half of healthcare facilities lack basic water access, over 60 percent lack basic sanitation and 70 percent lack basic healthcare waste management. Additionally, historically marginalized groups like women, girls and people with disabilities are more likely to suffer the ill effects of poor WASH in healthcare facilities, which may affect health-seeking behaviors. Without action, limited access to clean water and sanitation in healthcare facilities will worsen existing inequities for these groups.

Since 2010, the International Rescue Committee (IRC) International Water and Sanitation Centre has worked with the Kabarole District government to strengthen local WASH services. In 2018, with funding from the Conrad N. Hilton Foundation, the CDC Foundation collaborated with the Centers for Disease Control and Prevention’s (CDC’s) Global WASH Epidemiology Team to strengthen WASH services in Kabarole’s healthcare facilities.

In August 2021, leveraging long and fruitful partnerships to improve WASH in healthcare facilities in the district, IRC Uganda and the Kabarole District Health Office (DHO) designated five “Model Healthcare Facilities” to serve as an example for other facilities. To support these facilities, the implementing team, including CDC and CDC Foundation staff, used the Water and Sanitation for Health Facility Improve Tool (WASH FIT) approach developed by the World Health Organization and UNICEF to guide facilities through the process of making incremental improvements to WASH infrastructure and services.

After initial successes using the WASH FIT approach in the model healthcare facilities, IRC Uganda and the DHO sought to expand the approach throughout the district. The partners began by organizing a three-day Root Cause Analysis workshop, bringing together 21 individuals from the health, education and infection prevention and control sectors to identify and analyze problems within the district’s current WASH systems.

Using the results of the district-wide WASH FIT assessment, the group focused on several key issues: lack of safe drinking water, inappropriate healthcare waste management, unsuitable toilets for people with limited mobility and insufficient menstrual hygiene management services. Though the root causes varied, inadequate infrastructure and supplies, inadequate funding allocation and gaps in knowledge and skills among frontline workers were identified as common root causes.

The group identified feasible solutions to address these structural, financial and educational challenges and concluded the workshop with a commitment to implementing the identified solutions. By improving water, sanitation and hygiene in healthcare facilities throughout the district, the people in Kabarole can fully realize their vision of health and prosperity across their district.



Carrie Ripkey
Carrie Ripkey, MPH is a field employee at the CDC Foundation.