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United Nations Department of Economic and Social Affairs Sustainable Development

Improving access to WASH services in health facilities for rural areas in the Democratic Republic of the Congo (DRC) and refugee settlements in Thailand

Malteser International (MI), in its capacity as the relief and development organization of the Sovereign Order of Malta

    Access to safe water, hygienic sanitation, adequate handwashing points, and waste disposal systems are crucial to ensure quality health care, which prevent the spread of diseases among patients, health care workers, and surrounding communities upholding human rights standards and dignity. According to the Joint Monitoring Program (JMP 2022) for water supply and sanitation, the state of WASH services in health care facilities is far from adequate. Only 78% of health care facilities have basic water supply, and about 51% have basic hygiene services. Moreover, only 21% of health care facilities in LDCs (Least Developed Countries) had a basic sanitation service. Particularly women and girls are disproportionally affected by inadequate, poor, and unsafe health care structures, and the negative impact of health and dignity on displaced persons and other vulnerable groups (elderly, persons with disabilities) is further exacerbated. Strengthened gender equality and empowering women and girls means that improved access to WASH must include a gender-sensitive and gender-transformative lens as it reduces maternal mortality and morbidity, decreases WASH-related illnesses during pregnancy stage for mother and child and prevents child death. With safe and gender-segregated WASH facilities, adolescent girls and women will manage their menstrual hygiene in dignity and safety. Inadequate and unsafe health care facilities pose a significant threat to public health, particularly in resource-limited settings like rural areas in DR Congo or refugee camp settings in Thailand, which are two settings highlighted in this commitment. MI has been providing WASH in health services to Myanmar refugees in two camps in Thailand and rural health services in the DRC since 1994. In Thailand, MI operates and run their own health facilities in Mae Ra Ma Luang and Mae La On refugee camps and covers all aspects of health care facilities. The health facilities have access to safe water supply, gender-segregated toilets, hygiene promotion and education including menstrual hygiene management, handwashing points with soap, and a medical waste disposal system. Additionally, in a soap production unit in Mae La Oon camp trained refugee community volunteers produce soap for health facilities in the camps as well vulnerable refugee households. In the DR Congo, health and WASH activities have been supported since 1994, and increased by convincing the main donors to integrate it better in their funding. In this context, more than 120 health facilities have been supported with infrastructure, equipment and WASH facilities since 2018. This included construction of water systems, gender segregated latrines and medical waste management facilities. In both locations WASH has become pivotal in advancing gender equality as women and girls are empowered to actively contribute to the provided WASH services, build their capacities and gain access to economic opportunities. The soap production in the camps in Thailand for instance is mainly run by women and girls. Malteser International’s current commitment is to continue WASH services in health facilities in Thai refugee camps until May 2026, whereas in the DRC such projects are in the pipeline until 2025, with further projects in the planning to be added in the future.

    Expected Impact

    The main objectives of the WASH for Health facilities interventions in the DRC are the reduction of morbidity and mortality from communicable diseases in the population. This requires that in the health centers the WASH facilities are improved and ownership by the health center management is promoted to improve sustainability. Such activities are expanded with hygiene and sanitation promotion activities in the adjacent communities of the centers. The main expected impact of improving WASH infrastructure of health facilities in both the resource limited refugee camp settings in Thailand as well as in the rural context in the DRC is to reduce the risk of spreading diseases from hospital to patients, hospital staffs and surrounding households. The safe and clean sanitation facilities and hand washing points with soap put in place in the health facilities prevent spreading of diseases. Moreover, appropriate WASH services in health facilities improve the quality of health care services and is directly serving to achieve several health-related goals like those linked to maternal mortalities, and under 5, and neonatal mortalities. WASH in health care facilities is part of the 2030 Sustainable Development Goal (SDG) targets related to WASH. The SDG targets 6.1 and 6.2 are citing universal and equitable access water and sanitation for all. The term of “universal” can be applied to all settings covered by the health facilities in the refugee camps as well as rural context. Hence, this activity facilitates the acceleration of SDG 6. Moreover, SDG target 3.8 aims to achieve universal health care coverage including access to essential health care services, and target 3.1, aiming to reduce the maternal mortality. Therefore, improved WASH services in health facilities are supporting to reach the targets to SDG 3 as well. A recent impact study on “Integrated primary health care services in two protracted refugee camp settings at the Thai-Myanmar border 2000-2018: trends on mortality and incidence of infectious diseases” (Mohr et al.) was conducted in 2021. Major findings included that, despite the continuous drain of trained health care workers, the volatile influx of refugees, and the isolated location of the two camps, the initial basic curative health care developed into an integrated and comprehensive Primary Health Care project including a SPHERE-compliant water, sanitation and hygiene program. Malaria, LRTIs (Lower Respiratory Tract Infections), watery diarrhea, and dysentery morbidity dropped twelve, three, two, and fivefold respectively over the 18-year period evaluated while the health services utilization dropped from 7.1 to 2.9 consultations per refugee per year. Malteser International now plans to undertake a similar study in the DRC to evaluate the impact of its Health and WASH interventions there.


    Direct implementation by Malteser International (MI) of WASH in health facilities: - in refugee camp settings in Thailand through MI-run health care facilities involving trained camp-based refugee staff - in rural areas in the DRC through supporting health care facilities managed by local health authorities.

    Goal 3

    Ensure healthy lives and promote well-being for all at all ages

    Goal 3


    By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births

    Maternal mortality ratio


    Proportion of births attended by skilled health personnel


    By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births

    Under-five mortality rate


    Neonatal mortality rate


    By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases


    Number of new HIV infections per 1,000 uninfected population, by sex, age and key populations


    Tuberculosis incidence per 100,000 population


    Malaria incidence per 1,000 population


    Hepatitis B incidence per 100,000 population


    Number of people requiring interventions against neglected tropical diseases


    By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being

    Mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease


    Suicide mortality rate


    Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol


    Coverage of treatment interventions (pharmacological, psychosocial and rehabilitation and aftercare services) for substance use disorders


    Alcohol per capita consumption (aged 15 years and older) within a calendar year in litres of pure alcohol


    By 2020, halve the number of global deaths and injuries from road traffic accidents

    Death rate due to road traffic injuries


    By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes


    Proportion of women of reproductive age (aged 15-49 years) who have their need for family planning satisfied with modern methods


    Adolescent birth rate (aged 10-14 years; aged 15-19 years) per 1,000 women in that age group


    Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all


    Coverage of essential health services


    Proportion of population with large household expenditures on health as a share of total household expenditure or income


    By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination

    Mortality rate attributed to household and ambient air pollution


    Mortality rate attributed to unsafe water, unsafe sanitation and lack of hygiene (exposure to unsafe Water, Sanitation and Hygiene for All (WASH) services)


    Mortality rate attributed to unintentional poisoning


    Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate

    Age-standardized prevalence of current tobacco use among persons aged 15 years and older


    Support the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health, which affirms the right of developing countries to use to the full the provisions in the Agreement on Trade-Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health, and, in particular, provide access to medicines for all


    Proportion of the target population covered by all vaccines included in their national programme

    Total net official development assistance to medical research and basic health sectors

    Proportion of health facilities that have a core set of relevant essential medicines available and affordable on a sustainable basis


    Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States

    Health worker density and distribution


    Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks


    International Health Regulations (IHR) capacity and health emergency preparedness


    Percentage of bloodstream infections due to selected antimicrobial-resistant organisms

    Goal 6

    Ensure availability and sustainable management of water and sanitation for all

    Goal 6


    By 2030, achieve universal and equitable access to safe and affordable drinking water for all


    Proportion of population using safely managed drinking water services


    By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations


    Proportion of population using (a) safely managed sanitation services and (b) a hand-washing facility with soap and water


    By 2030, improve water quality by reducing pollution, eliminating dumping and minimizing release of hazardous chemicals and materials, halving the proportion of untreated wastewater and substantially increasing recycling and safe reuse globally


    Proportion of domestic and industrial wastewater flows safely treated


    Proportion of bodies of water with good ambient water quality


    By 2030, substantially increase water-use efficiency across all sectors and ensure sustainable withdrawals and supply of freshwater to address water scarcity and substantially reduce the number of people suffering from water scarcity

    Change in water-use efficiency over time


    Level of water stress: freshwater withdrawal as a proportion of available freshwater resources


    By 2030, implement integrated water resources management at all levels, including through transboundary cooperation as appropriate


    Degree of integrated water resources management 


    Proportion of transboundary basin area with an operational arrangement for water cooperation


    By 2020, protect and restore water-related ecosystems, including mountains, forests, wetlands, rivers, aquifers and lakes

    Change in the extent of water-related ecosystems over time


    By 2030, expand international cooperation and capacity-building support to developing countries in water- and sanitation-related activities and programmes, including water harvesting, desalination, water efficiency, wastewater treatment, recycling and reuse technologies

    Amount of water- and sanitation-related official development assistance that is part of a government-coordinated spending plan


    Support and strengthen the participation of local communities in improving water and sanitation management


    Proportion of local administrative units with established and operational policies and procedures for participation of local communities in water and sanitation management

    Goal 10

    Reduce inequality within and among countries

    Goal 10


    By 2030, progressively achieve and sustain income growth of the bottom 40 per cent of the population at a rate higher than the national average


    Growth rates of household expenditure or income per capita among the bottom 40 per cent of the population and the total population


    By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status


    Proportion of people living below 50 per cent of median income, by sex, age and persons with disabilities


    Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and practices and promoting appropriate legislation, policies and action in this regard


    Proportion of population reporting having personally felt discriminated against or harassed within the previous 12 months on the basis of a ground of discrimination prohibited under international human rights law


    Adopt policies, especially fiscal, wage and social protection policies, and progressively achieve greater equality


    Labour share of GDP


    Redistributive impact of fiscal policy


    Improve the regulation and monitoring of global financial markets and institutions and strengthen the implementation of such regulations


    Financial Soundness Indicators


    Ensure enhanced representation and voice for developing countries in decision-making in global international economic and financial institutions in order to deliver more effective, credible, accountable and legitimate institutions

    Proportion of members and voting rights of developing countries in international organizations


    Facilitate orderly, safe, regular and responsible migration and mobility of people, including through the implementation of planned and well-managed migration policies


    Recruitment cost borne by employee as a proportion of montlhy income earned in country of destination


    Number of countries with migration policies that facilitate orderly, safe, regular and responsible migration and mobility of people


    Number of people who died or disappeared in the process of migration towards an international destination


    Proportion of the population who are refugees, by country of origin


    Implement the principle of special and differential treatment for developing countries, in particular least developed countries, in accordance with World Trade Organization agreements

    Proportion of tariff lines applied to imports from least developed countries and developing countries with zero-tariff


    Encourage official development assistance and financial flows, including foreign direct investment, to States where the need is greatest, in particular least developed countries, African countries, small island developing States and landlocked developing countries, in accordance with their national plans and programmes

    Total resource flows for development, by recipient and donor countries and type of flow (e.g. official development assistance, foreign direct investment and other flows)


    By 2030, reduce to less than 3 per cent the transaction costs of migrant remittances and eliminate remittance corridors with costs higher than 5 per cent


    Remittance costs as a proportion of the amount remitted

    Goal 11

    Make cities and human settlements inclusive, safe, resilient and sustainable

    Goal 11


    By 2030, ensure access for all to adequate, safe and affordable housing and basic services and upgrade slums


    Proportion of urban population living in slums, informal settlements or inadequate housing


    By 2030, provide access to safe, affordable, accessible and sustainable transport systems for all, improving road safety, notably by expanding public transport, with special attention to the needs of those in vulnerable situations, women, children, persons with disabilities and older persons

    Proportion of population that has convenient access to public transport, by sex, age and persons with disabilities


    By 2030, enhance inclusive and sustainable urbanization and capacity for participatory, integrated and sustainable human settlement planning and management in all countries

    Ratio of land consumption rate to population growth rate


    Proportion of cities with a direct participation structure of civil society in urban planning and management that operate regularly and democratically


    Strengthen efforts to protect and safeguard the world’s cultural and natural heritage


    Total per capita expenditure on the preservation, protection and conservation of all cultural and natural heritage, by source of funding (public, private), type of heritage (cultural, natural) and level of government (national, regional, and local/municipal)


    By 2030, significantly reduce the number of deaths and the number of people affected and substantially decrease the direct economic losses relative to global gross domestic product caused by disasters, including water-related disasters, with a focus on protecting the poor and people in vulnerable situations


    Number of deaths, missing persons and directly affected persons attributed to disasters per 100,000 population


    Direct economic loss attributed to disasters in relation to global domestic product (GDP)


    (a) Damage to critical infrastructure and (b) number of disruptions to basic services, attributed to disasters


    By 2030, reduce the adverse per capita environmental impact of cities, including by paying special attention to air quality and municipal and other waste management


    Proportion of municipal solid waste collected and managed in controlled facilities out of total municipal waste generated, by cities


    Annual mean levels of fine particulate matter (e.g. PM2.5 and PM10) in cities (population weighted)


    By 2030, provide universal access to safe, inclusive and accessible, green and public spaces, in particular for women and children, older persons and persons with disabilities

    Average share of the built-up area of cities that is open space for public use for all, by sex, age and persons with disabilities


    Proportion of persons victim of physical or sexual harassment, by sex, age, disability status and place of occurrence, in the previous 12 months


    Support positive economic, social and environmental links between urban, peri-urban and rural areas by strengthening national and regional development planning


    Number of countries that have national urban policies or regional development plans that (a) respond to population dynamics; (b) ensure balanced territorial development; and (c) increase local fiscal space


    By 2020, substantially increase the number of cities and human settlements adopting and implementing integrated policies and plans towards inclusion, resource efficiency, mitigation and adaptation to climate change, resilience to disasters, and develop and implement, in line with the Sendai Framework for Disaster Risk Reduction 2015-2030, holistic disaster risk management at all levels


    Number of countries that adopt and implement national disaster risk reduction strategies in line with the Sendai Framework for Disaster Risk Reduction 2015–2030


    Proportion of local governments that adopt and implement local disaster risk reduction strategies in line with national disaster risk reduction strategies


    Support least developed countries, including through financial and technical assistance, in building sustainable and resilient buildings utilizing local materials

    Name Description

    Thailand: Continue to maintain adequate and appropriate WASH infrastructures in health facilities in two refugee camps

    Thailand: Increasing the trained camp staffs for improve cleanliness both in and outside the health facilities

    Thailand: Adopt more effective information collection and monitoring mechanism

    DRC: Ongoing identification and expansion of WASH for Health facilities interventions, to be reported on

    Staff / Technical expertise
    In Thailand, own MI Health and WASH teams working closely with trained camp-based staffs, providing basic and refresher training. Data collection and reporting. In DRC professional MI Health and WASH Teams continue supporting health facilities and commun
    Financing (in USD)
    European Commission in Thailand and the DRC plus German Government funds in the DRC. Fundraising in both countries is an ongoing process which will be reported on.
    No progress reports have been submitted. Please sign in and click here to submit one.
    Action Network
    water logo
    01 January 2013 (start date)
    31 May 2026 (date of completion)
    Malteser International (MI), in its capacity as the relief and development organization of the Sovereign Order of Malta
    1. Africa
    2. Asia and Pacific
    Other beneficiaries

    In Thailand, around 20,000 refugees fled mainly from the Karen state in Myanmar. Host communities living around the camps also benefiting from Health and WASH services delivered to 2 refugee camps. In the DRC, beneficiaries of 120+ health facilities in Ituri, Upper Uele, Kasai Central and Lower Uele provinces. Total population of the intervention area is 1,000,000 people. In addition, it should be noted that MI undertakes similar WASH for health services interventions in other countries worldwide with a focus on Africa and Asia.

    Democratic Republic of the Congo
    Democratic Republic of the Congo
    Contact Information

    Arno, Global WASH Advisor