Working collaboratively to improve WASH systems in Bhutan's health care facilities

A woman at a health care facility in Bhutan bends down to get water from a water filter in a green hallway with windows into rooms

Above, drinking water for staff and patients at a point of care in a Health Care Facility (HCF) in Punakha district, Bhutan (SNV/Aidan Dockery)


On World Water Day we reflect on water’s value to communities, economies, and the environment. Water underpins everything we do to achieve the SDGs and create a safe, stable, and prosperous region.


When it comes to valuing water, Health Care Facilities (HCFs) are a critical point of care that rely on safe and accessible water at all times.


Despite the role HCFs play in communities around the globe, there remain many concerning gaps in HCF water, sanitation and hygiene (WASH) infrastructure and systems that must be addressed if we are to achieve SDG6 - water and sanitation for all.


"one third of health care facilities do not have what is needed to clean hands where care is provided; one in four facilities have no water services, and 10% have no sanitation services. This means that 1.8 billion people use facilities that lack basic water services and 800 million use facilities with no toilets. Across the world’s 47 least-developed countries, the problem is even greater: half of health care facilities lack basic water services." 

From WHOs Global Progress Report on WASH in Health Care Facilities, December 2020


Improving the systems and processes in a Health Care Facility, can have resounding impacts on the community as a whole - we must address the fundamentals first.


In 2018, the UN presented worrying trends and gaps in access to WASH in health care facilities (HCFs). Disconcertingly the world began to understand that few countries accounted for WASH within HCF improvement plans, and vice versa – to the detriment of health practitioners, facility staff and patients.


In the context of the COVID-19 pandemic, during the 73rd World Health Assembly, the world’s leaders amplified calls to urgently take appropriate measures to support access to safe water, sanitation and hygiene, and ensure infection prevention control.


In Bhutan, our partner SNV is answering that call and is working collaboratively with stakeholders in country to improve WASH in HCFs in Bhutan.


It starts with good data


It started in 2019, with SNV technically supporting the Ministry of Health with the first national survey on WASH in HCFs to provide baseline data that could inform the country’s response for action. The data found that despite achieving 100% water supply coverage country-wide, a remaining 5% of HCFs in Bhutan did not have water at all times, and 15% had contaminated water.


Similarly, although toilet coverage was high (99%) in HCFs, only 84% reported hygienic use; 30% had gender segregated toilets; and 31% were accessible. Hand hygiene at points of care was 73%, while only 36% of HCFs segregated waste properly.


Reliable data informs effective action


Following these findings, and in collaboration with SNV and WHO, the Ministry of Health initiated activities in 2018-2019 to develop sustainable and scalable interventions that could potentially minimise risks of infection and disease spread in HCFs.


Part of this effort has been to adapt the WASHFit methodology and its tools – designed by WHO with support from DFAT – making these more relevant in Bhutan’s context. As well to develop the capacity of health and local government officials to apply the adapted WASHFit.


"Involving and engaging local leaders in the joint assessment of our BHUs has definitely helped local governments to plan, budget and support health care facilities better (in improving access to WASH facilities and services)."

Locally elected sub-district leader, Punakha District


Achieving outcomes together


To date, 26 stakeholders comprising district health officers, health assistants, and support staff from nine HCFs in Punakha district have been trained by SNV advisors in collaboration with WHO/PHED. An outcome of these trainings activities has been the formation of a multi-stakeholder partnership tasked to champion WASH improvements in Punakha’s HCFs.


Trained health assistants have committed to organise regular core group committee meetings to revisit action plans developed during the 1st WASHFIT assessment. Management of HCFs have agreed to set in place more regular intervals to review and update their action plans. District health officers have pledged to continue its monitoring role, and to facilitate WASH infrastructure and services improvements. To facilitate Punakha’s HCF alignment with national sanitation and hygiene goals, SNV and PHED have also reiterated their commitment to provide technical and monitoring support.


With this collaborative effort, it is clear Bhutan's HCFs are in good hands and taking important steps to improve their systems at this critical point of care.


SNV's work in Bhutan is supported by the Australian Government, through their Water for Women project, Beyond the Finish Line: Sustainable Sanitation and Hygiene for All.


The value of water is about much more than its price – in communities, households, schools and workplaces, water means health, hygiene, dignity, productivity and more.


Throughout March, for International Women's Day and World Water Day, we are celebrating the value of women and the value of water. Both are critical to building healthy and climate-resilient communities. 


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