Improving WASH services in health care facilities

Improving WASH services in health care facilities (iWASH) project is a three year initiative designed to improve water, sanitation and hygiene services in health care facilities in the Barouéli Health District of the Ségou Region in Mali.

The project responds to critical national gaps in WASH access in health facilities, where only 26 percent of facilities have access to water and just 5 percent have adequate sanitation, far below national household averages. In the Barouéli district, 78 percent of health care facilities do not meet national norms and quality standards for water and sanitation services. These deficiencies increase the risk of infection, compromise maternal and child health outcomes, and weaken the overall resilience of the health system.

With funding of 1.5 million CAD over 36 months, the project focuses on four community health care facilities and aims to directly benefit approximately 8,000 people, including 5,600 women and 2,400 men. Particular attention is given to women, newborns and young children, who are especially vulnerable to poor WASH conditions.

The project is structured around four complementary outcomes.

First, WASH services in target health care facilities will be improved through infrastructure development and rehabilitation in line with Mali’s national minimum WASH package for health facilities. This includes construction of reliable water supply systems with storage capacity for at least 24 hours, installation of distribution points throughout care units, construction of gender segregated ventilated improved pit latrines for patients, carers and staff, sanitation facilities for maternity wards, wastewater and excreta management systems, and biomedical waste treatment infrastructure including incineration areas. Facilities will also be rehabilitated through tiling, painting, mosquito screening, solar powered lighting systems, and the provision of hygiene kits and protective equipment. Functional handwashing stations will be installed in all key service areas to strengthen infection prevention and control.

Second, health workers and facility users will adopt improved hygiene practices. The project integrates a strong social and behaviour change component that develops and disseminates hygiene promotion materials, trains cleaners and technicians in biomedical waste management and infection prevention and control, and empowers women’s groups to promote hygiene messages within facilities and surrounding communities. International WASH days will be used as advocacy and awareness platforms to reinforce behaviour change and citizen engagement. This component strengthens both immediate hygiene practices and the long term sustainability of infrastructure investments.

Third, the project strengthens governance and accountability for WASH services. It supports community health associations known as ASACOs, municipal authorities, and local stakeholders to improve management of health facilities and resource mobilization. A participatory monitoring system for WASH indicators will be established using WaterAid Mali’s Sac Gouv tool, which focuses on equity, inclusion and rights based governance. Facilities will adapt and implement the WASH FIT tool, a risk based quality improvement approach that addresses water, sanitation, hand hygiene, environmental cleaning and health care waste management. Mutual accountability mechanisms between ASACOs and municipal authorities will be developed to improve transparency and performance.

Fourth, the project contributes to strengthened national government commitment to prioritize and integrate WASH in the health sector. Building on the World Health Assembly resolution on WASH in health care facilities and Mali’s national action plan, the project supports implementation of the WHO workplan, the national WASH in health roadmap, and advocacy and influencing strategies. Evidence and lessons generated in Barouéli will be used to support national scale up and policy influence.

The intervention is guided by a combined approach of service delivery, capacity building and influence. It emphasizes evidence, learning and innovation to develop inclusive and scalable models. Partnerships are central, particularly with the local NGO APPROFEM, municipal authorities, the Directorate General of Health and Public Hygiene, the Regional Directorate of Health, the Referral Health Centre, and the World Health Organization. A human rights based approach underpins the project, focusing on equity, participation, accountability and gender equality.

Sustainability is embedded from the outset through local ownership, participatory monitoring, integration into municipal development plans, and strengthened capacity of service providers and governance structures. Through this integrated model, the project aims to create resilient, inclusive and sustainable WASH systems in health care facilities that improve public health outcomes and contribute to a stronger health system in Mali.