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6 Important Lessons On Improving Global Healthcare

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By Upama Adhikari Tamang: 

To mark World Health Day, Upama Adhikari Tamang, Health and Advocacy Officer at WaterAid Nepal, shares six reflections from the recent Global Learning Event (GLE) on water, sanitation and hygiene (WASH) in healthcare facilities.

Happy World Health Day! Although WaterAid may be more commonly associated with World Water Day or World Toilet day, through our work on WASH and health integration more and more people are getting to know us through the lens of healthy lives. Whilst I’d want the world to be talking about health every day, I’ll use today to share more on what WaterAid is doing on integrating health and WASH, and to report back from an important event last week in Nepal.

WaterAid’s global campaign Healthy Start is dedicated to fostering closer working between the WASH and health sectors in low- and middle-income countries. Through this, we want to improve the health outcomes of under-fives and their mothers. An important part of this is making sure that women deliver their children in a safe and dignified manner, especially when using a healthcare facility (HCF). Across WaterAid’s 37 countries, dozens of colleagues are working with partners to achieve this. To read just one account, here’s a great blog from my colleague Channa in Cambodia.

L-R Arundati Muralidharan, Natasha Mwenda, Channa Sam Ol and Upama Adhikari Tamang at the Global Learning Event in Nepal. Source: Upama Adhikari Tamang, WaterAid

What’s The Plan?

We are far from the only organisation working on improving access to WASH in HCFs. However, we do bring a specialised perspective as one of the few international non-governmental organisations (INGOs) dedicated solely to WASH. As such, we’re delighted to be part of the growing number backing the World Health Organisation (WHO) and UNICEF-led Global Action Plan. The Plan has been a rallying call to organisations working on WASH in HCFs and sets out a clear set of conditions to achieve change based on research from facilities worldwide.

The Plan has just had its second birthday. To take stock and plan ahead, several colleagues and I have just spent a week in Kathmandu at a Global Learning Event (GLE). As a Nepalese citizen, this was in my ‘backyard’ but I was pleased to meet representatives from INGOs, governments and academic institutions from more than a dozen countries. Although our focus is on low- and middle-income countries, the challenges of preventing and controlling healthcare-associated infections to ensure quality of care are well known to health professionals around the world.
The learning event was first and foremost an opportunity to….learn. No surprises there. But, more importantly, it’s helped participants to think, challenge and reflect.

I gathered my colleagues’ reflections and share six here.

1. It’s All About Quality

We’re used to our own ‘language’ in the WASH sector (and we definitely like an acronym). Working with health professionals, it’s been a learning curve on how to use ‘their’ language appropriately. Attending the event, all the WaterAid delegates were reminded how important it is to frame WASH as an imperative for delivering ‘quality of care’. We still have a way to go from it being seen as a tick-box exercise of ‘Is there WASH present?’ to ‘Can this facility deliver quality of care without WASH?’ Already included in the WHO’s standards for improving the quality of maternal and newborn care in health facilities, the challenge for many of those participating is how to make this question a reality at a facility level. One solution may be increasing demand…

2. Demand Matters

While it’s not a ‘silver bullet’, a consistent theme was whether service-users and indeed staff fully understand the value of WASH facilities and that they are something they should expect in a facility. My colleagues in Malawi and India presented on this issue, and many participants agreed more programmes need to take into account the importance of community awareness raising and empowerment.

3. How To Mobilise Resources

There were some strong sentiments and discussion on whether the assembled stakeholders for WASH in HCFs are paying sufficient attention to the enabling environments needed to achieve change. Blockages for WASH in HCFs can take many forms, from financing to human resource to sector leadership. Participants agreed that achieving scale is going to be a real challenge but that breakthroughs such as agreed policies and written guidelines distributed across facilities could be a first step. Several presenters showed that these help to institutionalise change – e.g. agreed policies on coordination, clear roles and responsibilities of the stakeholders involved stopped facilities from sliding backwards.

4. Measurement, Meaning And Monitoring

A good part of the GLE was spent on issues around measuring progress. We’re moving beyond the ‘why’ of WASH in HCFs to the ‘How’ stage, and, unsurprisingly, many questions came up. Later this year we’ll see the first reporting from WHO and UNICEF’s Joint Monitoring Programme (JMP) on water and sanitation access since the Sustainable Development Goals were adopted. This will for the first time include very limited WASH in HCF statistics. This led to conversation on how to adapt the JMP indicators for WASH in HCFs to country contexts.

The meanings of different terms came up a lot. ‘Access to’ water was contrasted with ‘usage of’ water in the context of facilities where a source is available but not used (perhaps because of distance). As we start discussing whether facilities have ‘access’ to water, many participants suggested a close eye needs to be kept on usage as well.

Monitoring was a topic of interest to many. From the micro level of who should be in charge of monitoring WASH access in facilities, through to the macro level of how WASH is effectively incorporated into national health management information systems, all agreed this warranted more attention.

5. Engaging Government

The GLE is not just your usual meeting of INGOs. It was fantastic to see government representatives speaking openly about challenges, and the need for INGOs to be enablers and critical friends. One thing noted from my colleague Natasha from Malawi’s presentation was how much WaterAid was leading on interacting with governmental stakeholders, particularly those in legislatures. It’s no surprise that Natasha returned to Malawi and immediately travelled to a recently rehabilitated facility to show it to a group of interested parliamentarians. All agreed that we need to be doing more to involve legislators in our work for achieving scale and sustainability.

6. Leave No One Behind

On a final note, I was surprised to see relatively little discussion during the week on ensuring facilities were accessible for people with disabilities. It seems that facilities which take account of the needs of everyone are still a way off. WaterAid will continue to put equity and inclusion at the heart of our WASH in HCFs work.

The test of the GLE will be whether it builds attendees’ capacities to direct change. For myself, I was certainly buoyed by the discussion. In fact, my WaterAid Nepal colleagues and I went straight into a national meeting on WASH in HCFs the very next day. WaterAid’s Healthy Start campaign and work on WASH in HCFs continues apace, so look out for more on this in the coming months. Wishing you the best of health on this important day!

Upama Adhikari Tamang is Health and Advocacy Officer at WaterAid Nepal. You can follow her on twitter @AdhikariUpama. For more information, please log in to and

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

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Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

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MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

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A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

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As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

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A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform, demanding that the Government of Assam install
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