Healthy Start in Tanzania
whilst the training provided the workers with
skills in hygiene promotion. The intervention in
Singida was part of the Deliver Life appeal in the
UK, which saw midwives and staff from Kiomboi
Hospital take part
in the training.
The project further
engaged senior and
influential leaders in
the government.
What has been
achieved so far?
The project was
developed with
A broken water heater and sink
Health & WASH
in the delivery room in one of
experts in Zanzibar the facilities in the project
and Mainland
Tanzania and the improvements in the facilities
across the country can already been seen to be
making a huge difference:
Participants at the launch of the training programme for frontline Health Care workers who are in charge of WASH
facilities in health care centres in Kiomboi-Iramba District.
Since April 2015, WaterAid Tanzania, in
collaboration with WASH & Health stakeholders
have been carrying out a WASH in Healthcare
Facilities (HCF) project, aimed at strengthening
rights and improving the health of 60,000
women, girls and children in the Singida Region
and areas in Zanzibar, through access to WASH.
According to a report, only 24% of delivery
rooms across Tanzania were found to have an
improved water source at the facility, running
water within the delivery room, soap for hand
washing and a functional latrine for clients. This
has particularly affected expecting mothers, who
are discouraged from going to hospital due to
the poor facilities.
Whilst the project aimed to provide taps and
toilets to healthcare centres in the districts,
there was also a need to train the health
workers on hygiene practices, as it was found
there was a big gap in knowledge around
hygiene behaviours. Subsequently, WaterAid
Tanzania and other stakeholders saw the need
to establish a guideline that will contribute to a
hygienic environment in the maternal wards, but
also practices that will be escalated across the
facilities. This WASH in HCF guideline is currently
being piloted and will be used to train health
workers across the country.
The WASH in HCF project in Singida in Tanzania
Mainland and Unguja and Pemba in Zanzibar
is part of WaterAid’s Healthy Start advocacy
priority to reduce maternal and new born
mortality, by advocating for WASH to be
included in national health policies and facilties
to be installed in health care centres. The
campaign is also in line with the government’s
plan which aims to improve maternal and
newborn health. The development of the new
guideline began with an assessment of WASH
services in a maternity ward in Zanzibar and
Singida funded by the Share Consortium (DFID)
and Swedish postal code lottery (SPCL), with
technical collaboration from the MoH Zanzibar,
WaterAid, Soapbox, LSTMH and Mariestopes
Tanzania.
The project aimed to install new WASH facilities
and train the frontline health workers in charge
of the facilities and so far, 21 health centres in
Singida and 10 health centres in Zanzibar have
benefitted from the project. The rehabilitation
and construction of WASH facilities has included
new toilets, taps and hand washing stations;
Hygiene promotion
As part of the initial stage of the project,
WaterAid Tanzania conducted a study in various
health care facilities and found that there is a
gap of knowledge and practice around WASH in
health care workers, especially those dealing
with WASH services in health care facilities.
This significantly contributes to the increase
in infections in the hospital subsequently
impacting on maternal and newborn mortality.
Therefore, it was crucial for the project to include
a training element which will integrate both
infection prevention and control (IPC) together
with water, sanitation and hygiene. A training
guide and hand book targeting the health
workers has been developed and is due for
official endorsement by the Ministry of Health in
Zanzibar for wide use. UNICEF, WHO, UNFPA have
all expressed interest in working with the health
sector to mainstream the using of this resource
across IPC interventions in the country.
• The main operating theatre at Singida regional Project learnings...
hospital, can now function on a 24/7 schedule • Working with the health sector to build a
because water is available for cleaning linen and strong partnership is important for sustainability
theatre equipment
• The health sector has experts in sanitation
and hygiene, who are key allies in taking forward
• Safe and hygienic biomedical waste disposal
WASH innovation into the sector.
from the delivery department is now possible
• Mothers have access to safe and clean washrooms. The midwives, nurses, mothers and
their attendants have access to improved handwashing stations with running water.
• Government officials and leaders in both
the mainland Tanzania and Zanzibar can bear
testimony for the immediate improvements
and are now the target agents of change and
advocacy for better WASH services in health care
facilities across Tanzania
•The Ministry of Health of Tanzania Mainland
through its research arm, the National Medical
Research Institute (NMRI), is also undertaking
another assessment in health care facilities
within 7 districts that will form the basis for
further intervention across the whole country.
This is being facilitated by UNICEF and the tools
that were developed by WaterAid Tanzania and
other stakeholders are the ones that have been
adopted for this assessment as well.
• IPC in HCF can be strengthened by
incorporating basic WASH interventions into the
existing guidelines
• Frontline health workers need training,
support and empowerment
What are our recommendations?
• Ministries of health, sector development
partners and expects should be targeted as
collaborators and change agents for WASH in
health care facilities.
• WASH Infrastructure development should
always go hand-in hand with practical skills
training and sanitation & hygiene behavioural
change interventions for frontline health
workers, mothers and care takers.
Albert Mwangaza, Programme Coordinator Grant
and Compliance, WaterAid Tanzania