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Published on: 08/10/2020

“We normally tell the patients to first ease themselves before they come here because there is nothing for them to use at the health centre. For us [health workers] we use the facilities at the nearby parish” – Kabasinguzi, nurse in charge, Bwanika HCII.  

This has been the absurd state of Bwanika Health Centre II (HCII) in Kicwamba Sub-County, Kabarole in Western Uganda, for a couple of years since its establishment. Only until last month, the healthcare centre did not have a sanitation facility for patients and clients. A health centre II in Uganda is the immediate healthcare access facility in the community serving the parish population on an out-patients basis.

Assessment report on healthcare facilities

Bwanika HCII was one of 40 government facilities reached in the 2018 assessment of WASH in Healthcare Facilities in Kabarole District, a collaborative initiative between the Kabarole District Local Government, IRC and Centers for Disease Control and Prevention (CDC), and with funding support from the Conrad N. Hilton Foundation. The assessment report released in 2019 revealed varied deficiencies in the access and quality of water, sanitation, hygiene and environmental cleanliness, according to the Joint Monitoring Report indicators of WASH basic services for a healthcare facility.

Bwanika HCII was found to be in a particularly dire situation, with no sanitation facility at all on the premises for staff and patients.

Kabarole Hand Pump Mechanics and Sanitation Association installs sanitation facility

Working with the district leadership, IRC Uganda contracted the Kabarole Hand Pump Mechanics and Sanitation Association (KAHASA) to construct a sanitation facility with all required WASH elements for Bwanika HCII.  The process was supervised from the onset up to completion by the district technical officers as well as community leaders, including the Senior Health Inspector, Senior Engineer, the nurse in charge of Bwanika Health Centre, and the Chairperson Health Unit Management Committee.

Bwanika HCII is located in Bwanika parish, Kicwamba sub-county, a rocky area on the slopes of the Rwenzori mountains in Kabarole. The construction could therefore not commence before deep excavation through 6 feet of rocky layers to achieve the desired depth of 14 feet. KAHASA followed the professional processes and technical guidance with precision from the excavation until the completion of the four-stance, emptiable ventilated improved pit latrine. 

The new latrine at Bwaninka Health Centre

New latrine at Bwanika Health Centre II

The latrine facility has two stances dedicated to females and separated by a concrete wall from the other two for male patients. All stances are fitted with lockable metal doors and give private access to each gender from either side.

The walls have been made smooth with cement and vinyl paint, and the pits fitted with SATO pans, making the facility easier cleanable with water. A handwashing station is fitted near the latrine and connected with gutters to harvest rainwater for washing hands and cleaning the facility. A soak-pit for the urinal and inspection chamber/manhole with cover have been installed. 

Budgeting for WASH in healthcare facilities

On 18th September 2020, IRC Uganda officially handed over the new VIP facility at Bwanika Health Centre to the district. Officiating at the commissioning of the facility, the District Chairman Hon. Richard Rwabuhinga appreciated IRC for partnering with the district in ensuring quality and adequate WASH services in the healthcare facilities. 

Kabarole district chairperson the Hon. Richard Rwabuhinga cuts the tape to officially open the first sanitation facility at Bwanika Health Centre II

Kabarole District Chairman Hon. Richard Rwabuhinga cuts the tape to officially open the first sanitation facility at Bwanika Health Centre II

He particularly applauded IRC’s ingenuity in the cost-saving initiative that delivered a sanitation facility with better quality standards than have been achieved before with double the budget, as well as supporting community businesses through trusting the Hand Pump Mechanics Association with the job.

"This four-stance modern latrine in such a rocky location cost only 25 million shillings yet a five-stance VIP constructed at Karago on soft ground cost 60 million! Thank you, IRC and KAHASA for using little resources to do a wonderful job," remarked Hon. Rwabuhinga. 

Martin Watsisi, Regional WASH Advisor and project lead of the WASH in healthcare facilities initiative at IRC Uganda appreciated the district political and technical arms for embracing collaboration to improve WASH in healthcare facilities and owning the process from the onset.

“We commend the Kabarole District Executive and political leadership at the various levels for cultivating a conducive environment to ensure improvement of WASH services and therefore creating far-reaching impact in quality of life of the people through prevention and control of Healthcare Acquired Infections, and leaving no one behind,” said Watsisi.  “This is a great step forward in achieving the objectives of the Kabarole District WASH master plan 2018-2030.  Much more can be achieved if deliberate planning and budgeting for WASH in healthcare facilities is considered,”  he added. 

IRC Uganda has this year with support from the Conrad N. Hilton Foundation supported Kabarole District to respond to the gaps identified by the assessment, through renovation of 12 sanitation facilities, improving hand hygiene through awareness and manufacturing of hand sanitizer, and provision of safe drinking water stations to 30 healthcare facilities. Construction of a sanitation facility from scratch was only done for Bwanika Health Centre II, at a cost of 25,924,600 Ugandan shillings (7,000 USD).


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