Improved Water, Sanitation, and Hygiene Plans in Works for Health Facilities Across Haiti

The little things can easily be taken for granted around a clinic or hospital—like running water in exam rooms and surgical wards, clean drinking water for patients, and accessible toilets for patients and visitors. When absent, as they are in many health facilities across Haiti, the little things contribute to big problems in preventing infection and promoting dignified, quality health care for all.

That’s why Zanmi Lasante, PIH’s sister organization in Haiti, has focused on improving access to water, sanitation, and hygiene (WASH) services within the health care facilities it supports and throughout neighboring communities across the Central Plateau and lower Artibonite. Most recently, that work included an assessment of all 15 health care centers and hospitals that comprise their network to address major needs and start the necessary renovations that will ensure quality care.

“Access to WASH in health care facilities is an integral part of health systems, yet it is often lumped together with general infrastructure,” says Elizabeth Campa, chief of staff to Loune Viaud, executive director of Zanmi Lasante. A WASH expert with 20 years of experience in humanitarian response, Campa has seen first-hand its importance in health care facilities and its impact on patient mortality. “Without access, research shows time and time again how infections are more prevalent, leading to unnecessary illness and death.”

Today, more than half of the world’s population does not have access to improved sanitation, and an estimated 3 billion people do not have access to handwashing facilities with soap.

These alarming statistics are unfortunately the daily reality for many Haitians. According to the World Bank, Haiti is the most underserved country in the Americas when it comes to water, sanitation, and hygiene. The situation became even more critical after the 2010 earthquake destroyed much of existing infrastructure.  Between 1990 and 2015, the share of the population with access to potable water decreased from 62% to 52%. 

Today, more than half of the country’s rural population still lacks access to potable water, while only about one-third of Haitians have access to basic sanitation.

Neglected facilities, gaps in care

Health facilities are frequently the only points of care in remote, rural regions of Haiti. For more than 6 million Haitians living on less than 2 dollars per day, these crucial institutions promote good health practices; provide primary, maternal health, and pediatric care; and respond to infectious disease outbreaks, such as COVID-19, typhoid, and other infectious diseases.

Despite that, with only 4.3% of Haiti’s budget allocated to health care, these public facilities receive minimal government funding; more than 95% of them are in urgent need of major repair due to normal deterioration and decades of neglect. Many of them lack plumbing, improved sanitation, adequate infectious waste disposal, sterilization equipment, electricity, or access to a basic running water supply. 

This situation has serious consequences for patients, including the risk of developing a life-threatening infection during their stay at an under-resourced health facility. No less severe is the indignity suffered by patients who need to relieve themselves or bathe and have no proper place to do so.

Renovations in WASH

Zanmi Lasante clinicians and staff are acutely aware of this situation, as they work and serve patients within public clinics and hospitals every day. Still, staff’s assessment highlighted key areas of improvement. According to Dr. Ralph Ternier, director of programming at Zanmi Lasante, the sanitation infrastructure in many health care facilities is beyond renovation and must be rebuilt altogether. The geographic location of some makes it impossible to drill boreholes. Since they are not connected to the national water supply, these already severely underfunded facilities have to purchase water of questionable quality every day.

“It’s it unacceptable that in 2021, patients are faced with the dilemma of either buying their own drinking water or staying thirsty until they return home,” Ternier says. “If health care workers can't wash their hands [with soap], provide clean water for their patients, or have access to decent toilets, the facility becomes a breeding ground for disease.”

Zanmi Lasante prevents infection across its network of supported facilities by regularly supplying soap, updating existing plumbing, and replacing toilets and handwashing stations. Facilities are also constantly cleaned and maintained.

Nonetheless, much more could be done to strengthen WASH infrastructure. Zanmi Lasante leadership plans renovations to begin on a handful of facilities this summer. The many priorities include: installing new plumbing and piping systems, which will be connected to a clean water supply through underground cisterns and water tanks; adding handwashing stations with soap throughout health facilities—more important now than ever in the time of COVID-19; building handicap-accessible sanitation blocks with separate, private toilets and showers for men and women; and installing solar-powered lamps to light up pathways at night and prevent falls.

Zanmi Lasante also plans to completely revamp the electrical system in many facilities, install air conditioning in the medicine stock rooms to regulate temperature, build water tanks, repair incinerators, and improve areas dedicated to medical waste management.

The hope is that, with these improvements in WASH and other infrastructure, Zanmi Lasante clinicians and staff will be able to provide better quality of care, reduce the risk of patient infections, increase patients’ use of health services, and improve employee morale.

Model in Kay Liz

Zanmi Lasante can already point to one example at University Hospital in Mirebalais of this improved WASH model. In February 2017, it opened Kay Manmito, a maternal waiting home on the hospital’s campus that hosts women with complicated pregnancies and mothers whose newborns are in the neonatal intensive care unit (NICU). The facility houses a sanitation block with a laundry space, showers, and toilets solely dedicated for the mothers’ use.

Just next door is Kay Liz, or Liz’s House--named after Campa, a proud advocate of toilets and accessibility. The sanitation facility provides an average of 500 people each day with access to bathrooms and showers, with a regular stock of clean water and soap. This meets the needs not only of patients, but also friends and family members, who travel with them and often must stay to receive care for days and weeks at a time.

Campa is proud of Kay Liz and sees it as a model for future work in Haiti.

“Toilets have been a passion of mine since my days in the U.S. Peace Corps, over 20 years ago,” Campa says. “There is so much taboo surrounding the subject of sanitation, but by talking about it regularly, we begin to remove these negative feelings about toilets. Everyone goes to the bathroom; everyone should have the right to improved sanitation.”