One Health Clinic at a Time, Malawi Transforms the Patient Experience

Without access to safe and sustainable water and sanitation services, it is not possible to provide quality health care services or ensure a safe operating environment for health care providers.

Reliable water and sanitation services support a dignified and respectful experience for patients; if those fundamental services are absent in health care facilities (HCFs), patients may think twice about seeking treatment. Giving birth in a clean facility with running water, drinking a glass of safe water when taking oral medications, and having access to a functional toilet are all facets of the patient experience that improve health outcomes and increase patient satisfaction. Meanwhile, sustainable water and sanitation services in HCFs also protect health care workers by supporting a safe environment for service providers to provide quality care.

But in Malawi, insufficient water, sanitation and hygiene (WASH) in HCFs compounds health risks, especially among the most vulnerable — mothers, newborns, and young children (see chart below for details). Such conditions provide fertile ground for the spread of infections, which are among the third most common cause of death for mothers and among one of the top four contributors to newborn death, globally.

Big challenges demand even bigger responses. That’s why the USAID MOMENTUM Tikweze Umoyo (Let’s Raise Health) project is tackling these issues head-on by training health care workers on infection prevention and control (IPC) measures, increasing community members’ awareness of their health care rights, and helping upgrade WASH infrastructure to address cholera outbreaks in five districts (see map for details).

Inclusive WASH training sets the stage for more effective infection prevention and control

In Malawi’s Kasungu district, home to more than 840,000 people, USAID focuses on improving WASH-related IPC — a crucial component of any high-functioning health care environment. To that end, the project is using a variety of interventions, ranging from targeted trainings to improved signage, to guide patients and staff to the appropriate waste disposal sites.

Training for health care staff has delivered significant impact. Historically, Malawian HCFs have struggled to meet global standards for IPC and WASH practices. For example, a USAID baseline assessment at 11 HCFs revealed a troubling lack of knowledge among health care workers on best practices such as proper waste segregation and disposal.

Based on these findings, USAID engaged 209 medical staff from 26 HCFs from across Kasungu district in a series of capacity-strengthening workshops to accelerate the adoption of best practices for IPC and WASH. Post-workshop assessments of the original 11 HCFs found significant improvements in IPC and WASH compliance, revealing the district’s health care staff increasingly possess the skills and motivation to apply their learnings.

Exploring a systems approach to community empowerment and more accountable health care service

Located in the central part of the country on the shores of Lake Malawi, neighboring Salima district is home to more than half a million people spread across nearly 150,000 households. In this district, USAID is embracing a systems approach for improving WASH practices by empowering patients and communities with the knowledge and tools to demand accountability from health care providers and ensure high-quality health care service delivery. 

In addition to improvements to WASH infrastructure, USAID hosts quarterly community awareness sessions across Salima that explain the roles and responsibilities of health workers and guardians, as well as outline key patients’ rights in health care settings so that patients are better able to hold HCFs accountable for delivering quality services. One critical component is increasing patient awareness about the role of the hospital ombudsman and explaining that patients have the right to express complaints related to the health services received. 

“I didn’t know that we had that privilege!” said Chief Mwanza, referring to patients’ ability to communicate with a public advocate. When concerns over patient care arose in the past, he added, “we did not know where to go.” But USAID’s outreach “has opened our eyes,” he said, “and from today onwards, we will convey our concerns to the office of hospital ombudsman.”

Dialing up more effective responses to cholera outbreaks

Beyond persistent WASH challenges in HCFs, Malawi has also struggled with large-scale public health emergencies, including cholera outbreaks. 

As part of the emergency response, USAID has worked to rehabilitate 18 community boreholes in areas hard hit by the cholera outbreak, which will safeguard the health of more than 4,500 residents. 

USAID also assists the Ministry of Health to prevent future transmission by sending out phone and radio messages about best practices for personal hygiene and by upgrading water and sanitation infrastructure in HCFs and schools, with a goal of extending safe water access to roughly 90,000 residents.

A new day dawns for Malawi’s health care facilities

District by district, USAID MOMENTUM Tikweze Umoyo’s trainings, community awareness efforts, WASH infrastructure upgrades, and disaster preparedness initiatives are helping improve health outcomes both inside and outside of HCFs.

More than 560 medical staff and more than 860 non-medical staff from 72 HCFs have already  received instructions about IPC and WASH guidelines. Routine assessments now reveal that targeted trainings are having an impact in terms of changing WASH attitudes and behaviors. 

Through these interventions, USAID MOMENTUM Tikweze Umoyo is enhancing HCFs’ ability to deliver top-notch care to their patients — setting the stage for a new era of health care provision in Malawi. Thanks to the project’s efforts to improve sustained access to clean water and dignified sanitation at health facilities, strengthen HCFs’ ability to provide quality care by building workforce capacity, and establish mechanisms for patient complaints and feedback, USAID continues to build momentum behind its broader campaign to improve primary health care around the globe.

Related Resources

• Activity Page: Malawi | MOMENTUM 2 - Tikweze Umoyo - Let's raise health
• Fact Sheet: MOMENTUM Tikweze Umoyo
• Technical Brief: WASH in Health Care Facilities: USAID Water and Development Series

About The Author

Russell Sticklor is a communications specialist, environmental journalist, and podcast producer focused on water security, climate change, and sustainable development. He has worked previously with the International Water Management Institute, USAID, and Project Drawdown, among others.