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
#SDGAction50777
Description
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.
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. https://doi.org/10.1017/S1463423622000044 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.
SDGS & Targets
Goal 3
Ensure healthy lives and promote well-being for all at all ages
3.1
3.1.1
Maternal mortality ratio
3.1.2
Proportion of births attended by skilled health personnel
3.2
3.2.1
Under-five mortality rate
3.2.2
Neonatal mortality rate
3.3
By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases
3.3.1
Number of new HIV infections per 1,000 uninfected population, by sex, age and key populations
3.3.2
Tuberculosis incidence per 100,000 population
3.3.3
Malaria incidence per 1,000 population
3.3.4
Hepatitis B incidence per 100,000 population
3.3.5
Number of people requiring interventions against neglected tropical diseases
3.4
3.4.1
Mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease
3.4.2
Suicide mortality rate
3.5
Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol
3.5.1
Coverage of treatment interventions (pharmacological, psychosocial and rehabilitation and aftercare services) for substance use disorders
3.5.2
Alcohol per capita consumption (aged 15 years and older) within a calendar year in litres of pure alcohol
3.6
3.6.1
Death rate due to road traffic injuries
3.7
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
3.7.1
Proportion of women of reproductive age (aged 15-49 years) who have their need for family planning satisfied with modern methods
3.7.2
Adolescent birth rate (aged 10-14 years; aged 15-19 years) per 1,000 women in that age group
3.8
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
3.8.1
Coverage of essential health services
3.8.2
Proportion of population with large household expenditures on health as a share of total household expenditure or income
3.9
3.9.1
Mortality rate attributed to household and ambient air pollution
3.9.2
Mortality rate attributed to unsafe water, unsafe sanitation and lack of hygiene (exposure to unsafe Water, Sanitation and Hygiene for All (WASH) services)
3.9.3
Mortality rate attributed to unintentional poisoning
3.a
3.a.1
Age-standardized prevalence of current tobacco use among persons aged 15 years and older
3.b
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
3.b.1
Proportion of the target population covered by all vaccines included in their national programme
3.b.2
3.b.3
Proportion of health facilities that have a core set of relevant essential medicines available and affordable on a sustainable basis
3.c
3.c.1
Health worker density and distribution
3.d
Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks
3.d.1
International Health Regulations (IHR) capacity and health emergency preparedness
3.d.2
Percentage of bloodstream infections due to selected antimicrobial-resistant organisms
Goal 6
Ensure availability and sustainable management of water and sanitation for all
6.1
By 2030, achieve universal and equitable access to safe and affordable drinking water for all
6.1.1
Proportion of population using safely managed drinking water services
6.2
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
6.2.1
Proportion of population using (a) safely managed sanitation services and (b) a hand-washing facility with soap and water
6.3
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
6.3.1
Proportion of domestic and industrial wastewater flows safely treated
6.3.2
Proportion of bodies of water with good ambient water quality
6.4
6.4.1
Change in water-use efficiency over time
6.4.2
Level of water stress: freshwater withdrawal as a proportion of available freshwater resources
6.5
By 2030, implement integrated water resources management at all levels, including through transboundary cooperation as appropriate
6.5.1
Degree of integrated water resources management
6.5.2
Proportion of transboundary basin area with an operational arrangement for water cooperation
6.6
6.6.1
Change in the extent of water-related ecosystems over time
6.a
6.a.1
Amount of water- and sanitation-related official development assistance that is part of a government-coordinated spending plan
6.b
Support and strengthen the participation of local communities in improving water and sanitation management
6.b.1
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
10.1
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
10.1.1
Growth rates of household expenditure or income per capita among the bottom 40 per cent of the population and the total population
10.2
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
10.2.1
Proportion of people living below 50 per cent of median income, by sex, age and persons with disabilities
10.3
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
10.3.1
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
10.4
Adopt policies, especially fiscal, wage and social protection policies, and progressively achieve greater equality
10.4.1
Labour share of GDP
10.4.2
Redistributive impact of fiscal policy
10.5
Improve the regulation and monitoring of global financial markets and institutions and strengthen the implementation of such regulations
10.5.1
Financial Soundness Indicators
10.6
10.6.1
Proportion of members and voting rights of developing countries in international organizations
10.7
Facilitate orderly, safe, regular and responsible migration and mobility of people, including through the implementation of planned and well-managed migration policies
10.7.1
Recruitment cost borne by employee as a proportion of montlhy income earned in country of destination
10.7.2
Number of countries with migration policies that facilitate orderly, safe, regular and responsible migration and mobility of people
10.7.3
Number of people who died or disappeared in the process of migration towards an international destination
10.7.4
Proportion of the population who are refugees, by country of origin
10.a
10.a.1
Proportion of tariff lines applied to imports from least developed countries and developing countries with zero-tariff
10.b
10.b.1
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)
10.c
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
10.c.1
Remittance costs as a proportion of the amount remitted
Goal 11
Make cities and human settlements inclusive, safe, resilient and sustainable
11.1
By 2030, ensure access for all to adequate, safe and affordable housing and basic services and upgrade slums
11.1.1
Proportion of urban population living in slums, informal settlements or inadequate housing
11.2
11.2.1
Proportion of population that has convenient access to public transport, by sex, age and persons with disabilities
11.3
11.3.1
Ratio of land consumption rate to population growth rate
11.3.2
Proportion of cities with a direct participation structure of civil society in urban planning and management that operate regularly and democratically
11.4
Strengthen efforts to protect and safeguard the world’s cultural and natural heritage
11.4.1
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)
11.5
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
11.5.1
Number of deaths, missing persons and directly affected persons attributed to disasters per 100,000 population
11.5.2
Direct economic loss attributed to disasters in relation to global domestic product (GDP)
11.5.3
(a) Damage to critical infrastructure and (b) number of disruptions to basic services, attributed to disasters
11.6
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
11.6.1
Proportion of municipal solid waste collected and managed in controlled facilities out of total municipal waste generated, by cities
11.6.2
Annual mean levels of fine particulate matter (e.g. PM2.5 and PM10) in cities (population weighted)
11.7
11.7.1
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
11.7.2
Proportion of persons victim of non-sexual or sexual harassment, by sex, age, disability status and place of occurrence, in the previous 12 months
11.a
Support positive economic, social and environmental links between urban, peri-urban and rural areas by strengthening national and regional development planning
11.a.1
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
11.b
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
11.b.1
Number of countries that adopt and implement national disaster risk reduction strategies in line with the Sendai Framework for Disaster Risk Reduction 2015–2030
11.b.2
Proportion of local governments that adopt and implement local disaster risk reduction strategies in line with national disaster risk reduction strategies
11.c
Support least developed countries, including through financial and technical assistance, in building sustainable and resilient buildings utilizing local materials
SDG 14 targets covered
| Name | Description |
|---|
Deliverables & Timeline
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
Resources mobilized
Partnership Progress
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Entity
Region
- Africa
- 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.
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Contact Information
Arno, Global WASH Advisor