Ensuring clean hands are within reach for healthy healthcare facilities in PNG

Sister Anna celebrates the official opening of new water, sanitation and hygiene facilities at Boikin Healthcare Facility (WaterAid Wewak team / Issac Thomas) 

“ … Water hasn’t been available for any sanitation and hygiene practices, like toilet flushing, handwashing and other hygiene practices since 2013, when a manual water pump that we were using become nonfunctional," says Theresia, a community health worker and the Officer in Charge of clinical operations and management at Boikin Healthcare Facility (HCF) in East Sepik Province, in Papua New Guinea’s (PNG) Wewak District.

This busy HCF sees an average of 400 to 600 patients a month and serves a catchment of some 17,000 to 18,000 people. Boikin HCF provides general outpatient services and has a maternity wing. Since the water pump broke, Theresia explained that HCF staff had been collecting water by, “carrying water buckets for handwashing and general hygiene practices like cleaning, and all these after treating patients, including women in our mini labor ward.”

Adequate water, sanitation and hygiene (WASH) in HCFs is critical to the delivery of high-quality and safe care, yet throughout PNG, many HCFs lack access to basic WASH, including clean water and soap for handwashing at patient points of care and toilets. A situation analysis of WASH in HCFs in PNG conducted by WaterAid in 2022 found that many lacked basic services across all domains of WASH, waste management and environmental cleaning, with rural areas having much less access to basic services than urban areas.

According to the World Health Organization (WHO) and UNICEF report Progress on WASH in Healthcare Facilities 2000-2001, nine out of 10 HCFs in PNG rely on non-piped water supplies, which are heavily impacted by climate change. The report notes that HCFs should ideally have a continuous water supply, but this is difficult without piped water into the building or compound. Complex challenges to access and the sustainability of WASH services in HCFs exist due to the geographical remoteness of communities, fragile water sources, natural disasters and limited infrastructure.

Supported by Australia through Water for Women, WaterAid is working to address this crisis in healthcare settings in PNG like Boikin HCF by improving access to climate-resilient and inclusive WASH services and systems in Wewak District. Through the Water for Women project Strongim WASH Kominiti Projek, WaterAid is partnering with the Wewak District Development Authority, East Sepik Provincial Health Authority, East Sepik Council of Women, East Sepik Disabled Person’s Agency and communities to address climate change impacts on inclusive WASH services and strengthen the systems that underpin their delivery.

At Boikin HCF, recently completed infrastructure works supported through this partnership mean that patients, visitors and staff now have access to separate inclusive toilets for men and women, with basins and clean water and soap for handwashing, as well as showers. Medical waste is now treated and disposed of hygienically with a new waste disposal system for medical and non-medical grade waste. Previously, medical waste such as the placenta from birth was placed in a garbage bag and given to the patient to take away and bury. And a new piped water service now provides ready access to clean, safe water on-site.

“We haven’t seen any changes like that since establishment and operations of the facility …. we haven’t received any important service like this. Therefore, I’m excited and happy for this good development happening at the moment….. The new water facility currently will really help and relief [sic] us from carrying water buckets. We also have shower and hygiene stations where patients and staff will wash and clean themselves up inside the facility and that’s something really new and also very much help for us… The infrastructure is also kind of different from the existing facilities, because its designs and structure are inclusive with handrails, concrete paths, hand basin, etc. for PWDs [persons with disabilities], and even disadvantaged people including pregnant mothers compared to what we already have at the HCF facility.”

- Theresia, Boikin HCF Officer in Charge

A patient and local mother of Boikin village also expressed her gratitude: “I am pleased and excited because I’m going to use a new facility never like before and, I’m so glad this project has come here.”

Climate change represents an existential challenge to both the resilience and sustainability of WASH services in Wewak District. Climate change and poor access to WASH in HCFs disproportionately affects women, girls, people with disabilities and the elderly. Strongim WASH Kominiti Projek is being delivered in Wewak District to improve inclusive WASH service delivery, with added focus on building climate resilience by addressing the threats climate change represents to strong WASH systems, services and livelihoods.

This project is drawing on and accelerating momentum from WaterAid’s previous Water for Women project Implementing Inclusive WASH for the People of Wewak, completed in 2022. It aims to directly benefit 15,178* people living in Wewak District by the end of 2024, including more than 6,900 women and girls and 1,500 people with a disability, through improved access to climate-resilient and inclusive WASH in HCFs, schools and communities.