Sustainability Evaluation of Water Treatment Systems in Nine Cambodian Hospitals 公开
Salvaggio, Erin (Spring 2020)
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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