The toilets in the maternity wing of Namatapa Health Centre in the populous Bangwe Township in Blantyre, Malawi’s commercial city, fell into disrepair a few years ago. So, pregnant women who come to deliver their babies and their guardians use two pit latrines.
The faulty facilities also serve as bathrooms.
Visiting the bathrooms and toilets is an act of courage, says Thokozani Paulo, who spent four days at the centre in November 2021, during the birth of her first child.
“When you want to bath or relieve yourself, the image is dreadful because half the time, there is a mess, and the stench is terrible,” she tells IPS.
At night, there is no light, and the rooms are swarming with mosquitoes.
In addition, there is not much dignity and privacy for users either. There are no doors, so women improvise using their wraps for privacy.
“So, you are bathing, and someone comes in looking to relieve themselves,” says the 23-year-old in an interview with IPS at her home. Her month-old baby girl is sleeping peacefully on her lap.
Workers at the facility clean the two toilets – but without detergent and only once every day in the morning. One day, the women in the ward and their guardians pleaded with the workers to clean the toilets at least twice a day.
“They shouted at us saying we were not the ones paying their salaries and that we should just focus on what we had gone to the health centre for,” Paulo says.
The only basin for handwashing in the ward was never supplied with soap in the four days she was at the health centre.
In November, this experience, and the experiences of many others like Paulo were top of the agenda at a meeting of health ministers from the Southern Africa Development Community (SADC) in Malawi’s capital, Lilongwe.
At that meeting, among other things, the ministers endorsed the SADC Hygiene Strategy (2021-2025).
According to the strategy developed by the SADC Secretariat, analysis of national blueprints in the region on health, water, sanitation, environmental health, and nutrition indicates there is “an enabling environment” for implementation of hygiene practices.
However, there are still considerable gaps in most of the 16 member states.
“There is still need to mainstream and integrate hygiene in most of the national policies in order to broaden the enabling environment base for effective and sustainable promotion of hygiene practices,” it reads.
The framework, therefore, challenges SADC governments to increase hygiene coverage and behaviour change across all settings. These settings include health care facilities, schools and day-care centres, workplaces and commercial buildings, prisons, markets and food establishments, transport centres and places of worship.
The key hygiene behaviours include handwashing with soap, safe drinking water management, faecal disposal, food hygiene, menstrual hygiene, and waste management.
In the case of health care centres, these need to have a safe and accessible water supply, clean and safe sanitation conveniences, hand hygiene amenities at points of care and toilets, appropriate waste disposal systems and environmental cleaning.
According to the strategy, infrastructure that supports hygiene and healthcare waste management practices helps prevent the spread of diseases within the health service facilities and in the surrounding community.
The strategy was developed with the support of UNICEF and WaterAid Southern Africa.
Maureen Nkandu, Regional Communications Manager for WaterAid Southern Africa, says the policy underlines the need for leadership, commitment, and accountability “to create a culture of hygienic behaviour and practices across all levels of society and to enable hygiene services, behaviour change and promote basic sanitation”.
“For these objectives to be effective, there will be a requirement for strong planning, financial resourcing, implementation, monitoring, and evaluation systems in each of the SADC countries,” Nkandu tells IPS.
She says WaterAid has rallied key partners, including WASH-oriented civil society and development agencies, to demand adequate resources to implement the strategy effectively.
Further, achieving sustainable hygiene behaviour across generations needs innovative behaviour change programmes of scale. This can be realised through adequate financing, coordination of relevant sectors and political leadership, Nkandu says.
For Malawi, the strategy presents an opportunity for the country to push harder towards attaining Sustainable Development Goals (SGDs) targets related to hygiene, says Maziko Matemba, a community health ambassador appointed by the Ministry of Health.
Matemba corroborates Paulo’s experience, observing that many healthcare facilities in Malawi are a source of infection for patients, guardians, and visitors because of poor hygiene.
“Sanitation and hygiene in most of our public health facilities is a serious concern. People go to hospitals to get treated, but we have cases where patients and guardians have returned home with new health conditions contracted due to poor hygiene,” he says, citing washrooms as hotspots.
Matemba argues that healthcare facilities could promote good hygiene in Malawi and SADC.
“People gather in these facilities to seek services. That’s a huge advantage to drive home awareness messages and demonstrate by own standards how people can promote good hygiene in their homes,” says Matemba, who is also Executive Director for Health and Rights Education Programme (HREP), a local organisation.
But in all this, funding is a major factor, he observes.
“Hospital administrators tell us that if they have no money for a primary commodity like drugs, hence these perennial drug shortages we see, how can mops, handwashing materials and chemicals to clean toilets with become a priority?”
Matemba tells IPS that although civil society organisations have been campaigning for ages for the government to address the critical shortage of funding to hospitals, not much has changed.
“Development budget is always inadequate. Recurrent expenditures, already less than required, are further cut, and the little that remains hardly goes to the facilities in time. Treasury always says the resource envelope is limited,” says Matemba.
He says the strategy challenges Malawi as SADC Chair to lead the way for member states to improve the hygiene situation in the region by fixing their own.
A spokesperson for the Ministry of Health, Adrian Chikumbe, tells IPS that the SADC strategy is an important approach in minimising transmission of infection in health facilities and communities.
According to Chikumbe, a recent assessment by the ministry reveals that almost a third of Malawi’s health care facilities lack running water and 80 percent of patient latrines had no associated hand washing facility.
The assessment also found that environmental cleanliness was generally below average, characterised by poor waste management practices.
He says most of the lower-level facilities in the country lack resources to maintain functional WASH infrastructure.
“The Government recognises that it cannot do everything alone. It, therefore, has plans to mobilise partner support led by district authorities to plan and prioritise water, sanitation and hygiene infrastructure in all health facilities,” he says.