Sustainability Evaluation of Water Treatment Systems in Nine Cambodian Hospitals Öffentlichkeit

Abstract

Background: Sustainable water, sanitation, and hygiene (WASH) services in health care facilities (HCFs) are critical for providing safe, quality healthcare. The Sustainable Development Goals (SDGs) set in 2015 demonstrate the motivation to expand the scope of safe WASH from the traditional home setting to also include institutions such as HCFs. The General Electric (GE) Foundation donated nine decentralized water treatment systems to nine hospitals in Cambodia. There is a need to assess the sustainability of these systems in order to guide evidence-based decisions on policy and investments for more effective and efficient interventions for WASH in HCFs.

Objective: A rigorous sustainability evaluation was conducted in order to provide a deeper understanding of the environment needed to sustain access to, and provision of, safe water at Cambodian hospitals operating GE water treatment systems.

 

Methodology: An explanatory mixed-methods study design was conducted using surveys, water quality testing, and observations. Data collection activities occurred three times between 2015-2019 to assess the change in sustainability over time. Scores were calculated using the Safe Water Sustainability Metric (SWSM) and ranged from 0 to 4 in four sustainability domains: technical feasibility, on-site capacity, accountability, and institutional engagement. Following the SWSM assessment in 2019, in-depth interviews were conducted with leadership from four case study hospitals to understand what affected the sustainability outcomes.

Principal Findings: Five out of the nine systems were no longer functional or used at the time of the 2019 assessment. Major barriers to sustainability included: lack of access to major repair parts, staff turnover and lack of trained staff for operation and maintenance, lack of repeated training on how to operate and maintain the system, and a lack of satisfaction and commitment by the hospital director. Major enabling factors included: dedicated staff for operation and maintenance, source of internal funding for operation and maintenance costs for the system, and satisfaction and commitment by hospital director.

Conclusion: The SWSM effectively identified the key limiting and enabling factors within the sustainability domains and these findings can be used to inform future interventions and trainings. Furthermore, this information can help fill the gaps in knowledge for sustaining access to and provision of safe water in HCFs in LMICs.

Table of Contents

INTRODUCTION AND BACKGROUND                                                         1

LITERATURE REVIEW                                                                                     3

HEALTH-CARE ACQUIRED INFECTIONS                                                   3

GLOBAL ACCESS TO SAFE WATER                                                             4

WATER SYSTEMS                                                                                           7

WASH IN HCFs                                                                                                8

BARRIERS AND FACILITATORS TO SUSTAINABILITY OF WASH SYSTEMS IN HCFs            10

RESEARCH CONTEXT                                                                                    13

GENERAL ELECTRIC FOUNDATION AND PROVISION OF SAFE WATER IN HCFs              13

PROBLEM STATEMENT                                                                                14

PURPOSE                                                                                                       14

RESEARCH OBJECTIVE                                                                                14

RESEARCH QUESTIONS                                                                              15

SIGNIFICANCE STATEMENT                                                                      15

METHODS                                                                                                        17

STUDY SETTING                                                                                            17

OVERVIEW OF DATA COLLECTION ACTIVITIES                                   19

SUSTAINABILITY EVALUATION                                                                22

SUSTAINABILITY SCORING                                                                        24

QUANTITATIVE DATA MANAGEMENT AND ANALYSIS                       25

QUALITATIVE FOLLOW UP                                                                         25

QUALITATIVE DATA MANAGEMENT AND ANALYSIS                          26

HUMAN SUBJECTS AND ETHICAL CONSIDERATIONS                        27

RESULTS                                                                                                    28

QUANTITATIVE SUSTAINABILITY EVALUATION                                  28

WATER QUALITY                                                                                           45

QUALITATIVE SUSTAINABILITY EVALUATION OF 4 CASE STUDY HOSPITALS              52

DISCUSSION                                                                                              62

WATER QUALITY                                                                                      62

SUSTAINABILITY                                                                                      64

STUDY STRENGTHS AND LIMITATIONS                                             70

STUDY IMPLICATIONS AND RECOMMENDATIONS                        73

CONCLUSION                                                                                           75

REFERENCES                                                                                           

APPENDICES                                                                                            

APPENDIX 1: MASTER SWSM SCORING METRIC                                                            

APPENDIX 2: FULL SCORING GUIDE FOR ALL HOSPITALS                                        

APPENDIX 3: DOMAIN SCORE COMPARISON PER HOSPITAL RADAR PLOTS                       

APPENDIX 4: SUB-DOMAIN SUSTIANABILITY SCORES RADAR PLOTS                                 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Stichwort	Cambodia WASH Sustainability
Committee Chair / Thesis Advisor	Christine L. Moe, PhD, Emory University
Committee Members	Gloria D. Sclar, MPH, Emory University

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