From curative to preventive health: Bunyangabu’s big steps

Abwooli Atugonza, 32, a resident of Kiyombya village in Kiyombya sub-county, Bunyangabu district, beams with a smile. 

She is one of the residents who received gifts at the end of a home improvement campaign.

Like all her colleagues, Atugonza did not hold a fancy trophy. She walked away with plastic containers, such as basins, Jerrycans, and tanks. Atugonza can now harvest more water to keep her home even cleaner.

Her milestone symbolises how far Bunyangabu has come in empowering the residents to secure better health. 

"It feels good to win because we have worked hard for it. This is a matter of life; as we all know; health is the real wealth. We must stay alive to thrive,” Atugonza says.

The home improvement campaign is part of a protracted intervention in Bunyangabu to prevent disease and sustain a clean environment.

The campaign has become the way of maintaining healthcare in this part of the country where government departments, communities and civil society partners are working together to reduce the disease burden through Water, Sanitation and Hygiene (WASH) approaches.

Sarah Kobusingye, the assistant water and sanitation officer for Bunyangabu district, says: “We are rewarding people who have built model homes for the public to copy and maintain. We want them to learn by seeing and doing”.

Model homes

Authorities are now pushing for model homes from which other residents take a leaf. An ideal household must have an exclusive latrine, a clean kitchen, a house, a drying rack for kitchen utensils, a clean compound, a bathing shelter and a separate shelter for domestic animals.

This is contained in the National Sanitation and Hygiene Guidelines issued by the health ministry in 2017. Atugonza says they have been taught how to avoid getting sick from preventable diseases.

“We wash our hands with soap all the time, dispose of human faeces in a latrine, clear away all waste and keep kitchens and main houses clean,” she says.

Richard Obeti, the Bunyangabu District Health Officer, says working with partners has helped to give priority to WASH in healthcare services.

Atugonza’s goats, chicken and rabbits are free from ticks and fleas because their shelters are cleaned every day. This implies that she spends less money on the animals, and they fetch a good price when they are ready for the market.

Kobusingye adds: "We covered the whole of Kiyombya sub-county, but we mostly rewarded Nyakatuzi parish, where we have most of the interventions because it was doing badly on sanitation."

Disease prevention

Many health centres in Bunyangabu are now implementing disease prevention and control measures. They emphasise hand hygiene for health workers, ensuring that patients do not spread diseases to the health workers and vice versa.

At Kiyombya Health Centre III, health workers proved that they are not only preaching to their clients to change their ways, but they are also leading by example.

“We take measures to prevent spreading diseases or hospital-acquired infections to our incoming patients,” says Julius Ategeka, the in charge of Kiyombya Health Centre III.

Martin Watsisi, the International Water and Sanitation Centre (IRCWASH) Regional Manager in Fort portal, observes; “After delivery, a baby must be bathed. You can imagine washing a newborn baby with contaminated water; they can get sepsis from the umbilical cord.”

Challenges

However, healthcare facilities are not immune to WASH service delivery challenges. According to Ategeka, Kiyombya experiences water shortage.

The borehole at the health centre is largely unused. “When it is not completely dry, it pumps dirty, smelly water to the chagrin of our clients as well as people from the community,” says Jane Balinda, an Enrolled Nurse at Kiyombya Health Centre III.

Every health centre must have sanitation facilities, with toilet or latrine stances for clients separated from those of medics, according to the World Health Organisation guidelines for WASH in healthcare facilities. Male and female facilities should also be separated. 

Bunyangabu has partnered with organisations such as IRCWASH to mobilise funding for the construction of model sanitation facilities for select health centres.

The latrines are now emptiable and, therefore, more sustainable as they can be used again and help to prevent contamination of underground water, says Ategeka.

Separation of waste

All government health centres in Bunyangabu now have three clearly marked dustbins to separate waste; the highly infectious waste goes to the red bucket and is considered dangerous. The brown bucket is for infectious waste such as blood. A yellow bucket holds the non-hazardous waste, which includes paper wrappings.

Rwimi Health Centre III has taken additional measures and have a medical waste incinerator. Previously, the health centre disposed of its waste in an open pit. This was problematic, as scavenging dogs would scatter the waste in the health centre compound.

Though the incinerator was welcome progress, it did not come free from challenges. Private healthcare providers from the nearby Rwimi Town illegally dump unsorted waste at the entrance of the incinerator.

“People bring unsegregated waste, which is mixed with sharps, syringes and gloves,” says Jane Mbabazi, a porter at the Health Centre.

Mbabazi says that even though the health inspector called the private sector players to a meeting over this matter, it did not produce good results. “Everybody was blaming the other for abandoning unsorted medical waste here,” says Mbabazi.

Richard Obeti, the Bunyangabu District Health Officer, says working with partners has helped to give priority to WASH in healthcare services.

"We conducted an assessment, especially at the lower local government levels. It is because of our evidence-based advocacy that we have had the district allocate more money to WASH in healthcare facilities than in previous budgets,” says Obeti.

According to Obeti, Uganda is yet to meet the commitments of the 2001 Abuja Declaration  in which African Union governments agreed to commit 15% of their national budgets to improve health care.

“As a country have never hit the target spelt out in the Abuja declaration,” says Obeti, adding that Bunyangabu’s annual budget for WASH is about Sh30b, but they receive only Sh5b.

The work of Obeti and his colleagues in the health sector is cut out: they must save lives. But without adequate safe water, sanitation and hygiene services in healthcare facilities, this will remain a pipe dream.