Best Investment for a Healthier World


Want to support frontline health workers? Invest in WASH.

Gloria Mkukawa cleans the maternity ward at Ntosa Health Center. Courtesy WaterAid/Dennis Lupenga.

Gloria Mkukawa cleans the maternity ward at Ntosa Health Center. Courtesy WaterAid/Dennis Lupenga.

Better water, sanitation and hygiene in health facilities can help health workers protect themselves and their patients.

By Natasha Mwenda and Abigail Nyaka, WaterAid Malawi

For 23 years, Gloria Mkukawa has cleaned the maternity ward at the Ntosa Health Center in Nkhotakota, Malawi.

She takes out the trash. She mops the floors. And as part of her job, she and other ward attendants make at least five trips per day to a borehole at a school nearby to collect water. The borehole is the main water point for the community, and the only source the health center has to access water for providers, for patients, and for cleaning.

Gloria may not be the first person that comes to mind when you say “frontline health worker.” But she very much is, and she plays a very important role in ensuring the mothers and newborns who come to the ward have sanitary conditions and remain free from infection.

As the health center is short-staffed, she often takes on other tasks as well.

“One morning I went to the labor room to clean it up and I found a lady on the floor screaming,” Gloria recounts. “The baby was already on the way, I could see the head. There was no time to go call the nurse. I helped deliver the baby. That was it. That was the day I started delivering babies.”

Ward attendants and cleaners like Gloria – alongside doctors, nurses, midwives, and other frontline health workers – put themselves at risk every day taking care of their patients and making sure health facilities are clean and safe. Lack of water, sanitation, and hygiene (WASH) not only makes it harder for them to do their jobs, but it also puts them at greater personal risk every time they come to work.

Sadly, the situation at Ntosa Health Center is not unique. A recent study found half (50%) of health facilities in low and middle-income countries lack access to piped water while a third (33%) are without access to improved toilets. Even more (39%) do not have facilities for washing hands with soap. A sampling of six countries showed that only 2% of facilities provide a combination of piped water, improved toilets, decent handwashing facilities and adequate waste management.

A lack of adequate WASH contributed to more than 800 health workers contracting Ebola during the 2014-2016 West Africa epidemic – resulting in more than 500 health worker deaths. Beyond the implications for infectious disease transmission, unsafe and unhygienic conditions in health facilities negatively impact health worker attendance, morale, retention and safety. Think about it: would you want to work in a clinic that didn’t have access to a decent toilet or soap and water to wash your hands?

Governments need to prioritize and fund WASH in health facilities not only for the safety of patients, but for the protection of frontline health workers who deal with unsafe conditions day in and day out. We need to value all health workers – be they clinicians, nurses, cleaners, health educators, or volunteers – and make sure they have the supplies and training they need to practice good hygiene, prevent infections, and safely dispose of waste.

In Malawi, WaterAid has partnered with the Ministry of Health to train health workers at Ntosa and other clinics in infection prevention and control, and is implementing a comprehensive package of WASH improvements – including a solar-powered water supply system and inclusive bathrooms.

When properly trained, health personnel like Gloria become the first line of defense against infections and outbreaks of disease. And they can also be strong advocates for improved WASH in health facilities, as they have experienced firsthand what care is like without it.

The bottom line is that better water and sanitation services make for a better, safer, working environment and a healthier and happier workforce. Health workers around the world put themselves on the line every day to take care of others. World Health Worker Week is a timely reminder that it’s time we speak up and take care of them as well.

WaterAid America is a member of the Frontline Health Workers Coalition, and produced this blog in partnership with colleagues in Malawi.