Report on the deployment of the WASHCon Tool in Hoima ...washconhcf.org/wp-content/uploads/2017/10/Final-WVU-WASH...Paper surveys were also printed and used in case of technical issues

Report on the deployment of the WASHCon Tool in Hoima District of Uganda

From 14th - 24th November 2016

November 23rd 2016 ! i

Contents

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Contents ii ...........................................................................................................................................

List of Tables v ...................................................................................................................................

List of figures vi .................................................................................................................................

Abbreviations viii ...............................................................................................................................

Executive Summary ix ........................................................................................................................

1.0 Introduction ................................................................................................................................. i ..........................................................................................................................................................

1.1 Purpose of the Activity i ......................................................................................................

2.0 Methodology................................................................................................................................. i ..........................................................................................................................................................

2.1 Data Collection i ..................................................................................................................

2.1.1 Interview with the HCFs In-charge ii ...........................................................................

2.1.2 Administrative Data Form iii ........................................................................................

2.1.3 Observations iii ............................................................................................................

2.1.4 Water Quality Analysis v ..............................................................................................

2.2 Data Management vi ............................................................................................................

3.0 Provisional Results: WASH Conditions Assessment of the HCFs in Hoima District ................ viii ......................................................................................................................................................

3.1 WASH Conditions assessment viii ......................................................................................

3.2 Water quality results and some observations by sub-county xi ...........................................

3.2.1 Buhimba Sub-county xi ................................................................................................

3.2.2 Kabwoya Sub County xiii ............................................................................................

3.2.3 Kigorobya Sub County xv ............................................................................................

3.2.4 Kyabigambire Sub County xviii ...................................................................................

3.2.5 Kizirafumbi Sub County xx ..........................................................................................

3.2.6 Bugambe Sub County xxi .............................................................................................

3.1.7 Kyangwali Sub County xxii .........................................................................................

3.2.8 Kitoba Sub County xxv ................................................................................................! iii

3.2.9 Buseruka Sub County xxvii ..........................................................................................

3.2.10 Hoima Municipality xxix ..............................................................................................

4.0 Challenges and lessons learnt ...................................................................................................... xxxi ....................................................................................................................................................

4.1 Feedback from the enumerators xxxii ..................................................................................

5.0 Conclusion ................................................................................................................................... xxxiii..................................................................................................................................................

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List of Tables

Table 1: Traffic Light Scorecard Definitions 7 ...................................................................................

Table 2: Water Quality Analysis Results for Buhiimba Sub County 12 .............................................

Table 3: Water Quality Analysis test Results for Kabwoya Sub County 14 .......................................

Table 4: Water Quality Analysis test Results for Kigorobya Sub County 16 .....................................

Table 5: Water Quality Analysis test Results for Kyabigambire Sub County 17 ...............................

Table 6: Water Quality Analysis Results for Kizirafumbi Sub County 19 .........................................

Table 7: Water Quality Analysis results for Buseruka Sub County 19 ...............................................

Table 8: Water Quality Analysis results for Kyangwali Sub County 22 ............................................

Table 9: Water Quality Analysis results for Kitoba Sub County 23 ...................................................

Table 10: Water Quality Analysis results for Buseruka Sub County 25 .............................................

Table 11: Water Quality Analysis results for Hoima Municipality 26 ................................................

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List of figures

Figure 1: Interview with the HCFs In-charge. 3 .................................................................................

Figure 2: Ward Observations 4 ...........................................................................................................

Figure 3: Toilet Observations 4 ..........................................................................................................

Figure 4: Water Quality Collection and Analysis for presence E. Coli 6 ...........................................

Figure 5: WASHCon Assessment Tool Architecture 8 .......................................................................

Figure 6: Traffic Light Dashboard 9 ...................................................................................................

Figure 7: The overall average score of the HCFs in Hoima district as per domain 10 ......................

Figure 8: Toilet facilities at Lucy Bisereko HC III 10 ........................................................................

Figure 9: Water sources at Kitoole Health Center II 11 ......................................................................

Figure 10: Toilet Facilities at Kyehoro HC III 12 ..............................................................................

Figure 11: Non-functional Hand-washing facilities at Sebagoro HC III 13 .......................................

Figure 12: Waste disposal around the hand washing station at Kibiro HC II. 15 ...............................

Figure 13: Clinical Staff demonstrating hand washing procedures in Hoima District. 15 .................

Figure 14: Water sources and storage containers at the HCFs in Hoima District. 17 ........................

Figure 15: Routine cleaning at Kikuube HC IV 18 ............................................................................

Figure 16: Non-functional Water storage at Kyangwali Sub County 20 ............................................

Figure 17: Inaccessible Toilet facility at Kyangwali Sub County 21 .................................................

Figure 18: Bathing facilities at Buhuuka HC III. 21 ..........................................................................

Figure 19: Toilet facilities for persons with disabilities in Hoima 23 ................................................

Figure 20: Waste Disposal at the HCFs in Hoima District. 24 ...........................................................

Figure 21: Power Sources in Hoima District. 25 ................................................................................

Figure 22: Percentage of Samples that Met the Uganda National Guidelines for Safe Drinking Water per sub-county (<1 E. coli MPN/100ml) 27 .............................................................................

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Abbreviations

E. Coli - Escherichia Coli

CGSW - Emory University Center for Global Safe Water, Sanitation and Hygiene

HC - Health Center

HCFs - Health Care Facilities

Lab - Laboratory

mg/l - milligram / liter

MPN - Most Probable Number

OPD - Out Patient Department

T. C - Total Coliform

WASH - Water, Sanitation and Hygiene

WASHCon - WASH Conditions

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Executive Summary

The data collection using the WASHCon tool in Hoima District was conducted from 14th – 23rd

November 2016 in conjunction with World Vision Uganda. The data was collected using

Commcare application on android mobile devices. The data collection included surveys,

observations and water quality analysis on chemical and bacteriological parameters specifically

E. coli and free chlorine.

During the bacteriological analysis of the water, aseptic methods were used to avoid

contamination of the sample. Test for Escherichia Coli (E.Coli) using the IDEXX Quanti-tray

method with Collilert 18 as the reagent and measured using Most Probable Number (MPN) per

100 milliliters (ml) of water. Chemical tests were done using the portable HACH chlorine test kit

to measure free chlorine in milligram / liter (mg/l). The data collected from the five domains i.e.

water supply, sanitation, waste management, cleaning routine and hand washing facilities was

evaluated using the Emory University Center for Global Safe Water, Sanitation and Hygiene

(CGSW) scorecard and color coded either red, yellow or green to illustrate the status of

conditions.

7.6% of the HCFs i.e. Buhuuka, Buseruka, Lucy Bisereko and Kaseeta were the worst

performing HCFs in regards the five domains with an average of ≤1.8: indicating the absence of

WASH services or presence of unimproved services. Only 3.8% of the 52 HCFs i.e. Kasonga and

Bujumbura had basic WASH services and majority of the HCFs i.e. 88% had limited WASH

services. In all, seventy eight (78) sampling points from the fifty two (52) HCFs analyzed,

twenty four (24) i.e. 30.76% of them tested positive for E.Coli. All the sampling points from all

the HCFs in Kyabigambire Sub County had no traces of E. Coli while all those from Buseruka

sub county had E.Coli. Most of the water at the HCFs was either rain water or borehole water

with no traces of free chlorine and as such only three (3) HCFs i.e. 3.85% had free chlorine

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levels that were within the acceptable range as per Uganda National standards for portable

drinking water.

The high number of HCFs with poor WASH conditions and presence of E.Coli exposes both the

patients and staff in the 52 HCFs in Hoima to preventable nosocomial infections thus weakening

the health outcome and overall worse experience of care for especially pregnant women.

Ultimately increasing the risk of maternal mortality and preventable neonatal deaths and general

health.

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1.0 Introduction

The WASH conditions of fifty two (52) Health Care Facilities (HCFs) in Hoima District was

assessed from 14th -23rd November 2016. This assessment was conducted in ten (10) sub counties

in the district. Data collection was conducted using the WASH Conditions (WASHCon) tool on a

Commcare mobile application comprised of surveys, observations and water quality analysis.

The observations and surveys were conducted by trained enumerators using a mobile device and

generally took less than three hours with one enumerator per HCF site to complete (depending

on the size of the facility). Ten (10) HCFs were assessed for observations and surveys by ten (10)

enumerators per day for 5 days i.e. one (1) HCF per enumerator per day for 5 days. In addition,

at-least four (4) HCFs were analyzed for water quality by two (2) analysts per day for ten (10)

days.

1.1 Purpose of the Activity

• To assess the Water, Sanitation and Hygiene (WASH) conditions of fifty two (52) HCFs

in Hoima District, Uganda for World Vision Uganda

2.0 Methodology

The WASH conditions assessment of the fifty two (52) HCFs in Hoima District were done using

surveys, observations and water quality sampling and analysis and submitted using the

CommCare mobile app. Enumerators were trained on the WASHCON tool for four (4) days.

They were subsequently divided into two groups, each with a group leader to ensure collection of

complete and accurate data.

2.1 Data Collection

The enumerators formally introduced themselves to the director / in-charge and administrator of

the HCFs and obtained verbal consent before proceeding with data collection. In addition,

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permission was sought before the enumerator moved through the wards to conduct observations

and collect water samples.

Once the data was collected via a mobile device, the information was uploaded onto the

WASHCON Commcare app, into a pre-programmed dashboard via a wireless internet network.

The app was updated and forms synchronized daily by each enumerator. Paper surveys were also

printed and used in case of technical issues with the mobile devices. In such incidences, the filled

in paper surveys were later transferred onto a functional mobile device and then uploaded.

2.1.1 Interview with the HCFs In-charge

Before the interview, the enumerators introduced themselves and explained the purpose of the

survey. They described the various sections of the survey, the areas of the facility that needed to

be observed during the visit and when/where water sampling would occur. The enumerators

further explained that the assessment was to be conducted on a mobile device and asked the

director if s/he was willing to be interviewed. After receiving verbal consent, they proceeded

with the interview. Figure 1 shows some of the interactions with HCF in-charge.

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Figure 1: Interview with the HCFs In-charge.

2.1.2 Administrative Data Form

Information was gathered from HCF administrative records and through survey questions. After

interviewing the In-charge, the enumerators provided him/her with a list of the information that

was required from the data records.. The In-charge either assigned an administrative staff

member to collect the various data records or he collected it himself / herself. Questions related

to HCF services and populations served were among the information collected.

2.1.3 Observations

Key wards such as the Out-Patient Department (OPD), Maternity, Pediatric, and Inpatient or

General wards were observed for waste management, infection control supplies such as

disinfectant, clean birthing requirements among others. Toilet facilities were also observed for

access, quality and quantity. (See figure 2 and 3 for toilet and ward observations).

Figure 2: Ward Observations

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Figure 3: Toilet Observations

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2.1.4 Water Quality Analysis

Water was analyzed for E. coli and residual (free) chlorine. E. coli is an indicator of fecal

contamination, that is to say it is a way of measuring if water has come into contact with human

feces. It is the best way to measure if the water source is protected from poor sanitation

conditions on the HCF premises. Water may be contaminated near the source, in the storage tank,

in the piped network or in buckets used to store water in the wards. Free chlorine is the residual

chlorine after chlorination required to make water sufficient quality to drink. . In appropriate

dosage, chlorine kills bacteria, protecting the water from the point of treatment to the point of

consumption.

Before starting water sample collection, the director /in-charge at the HCF was informed and

explained to about what parameters would be tested and permission to collect water samples for

analysis was sought. Water samples were either taken from all the wards at the HCFs or from key

wards depending on the level of service provided.

Free chlorine testing was only carried out in HCFs with a municipal / town council chlorinated

water source or a chlorinated onsite water source. Chlorine testing was completed immediately

the water sample was collected. The water sample was collected directly from the tap / jerrycan

into the testing tube. Water samples being tested for E. coli were collected in Whirl-Pak bags

with sodium thiosulfate and stored in a cooler on ice until they are analyzed within six hours.

(See figure 4 below for water quality collection and analysis).

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Figure 4: Water Quality Collection and Analysis for presence E. Coli

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2.2 Data Management

The data collected was evaluated using the CGSW scorecard. Objectively each response to a

question was assigned a score of 1 to 3.

● A score of a 3 indicates basic service

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● A score of a 2 indicates limited service

● A score of a 1 indicates unimproved or no service

The scores from the individual questions were then averaged to determine the sub-domain

scores, which are in turn averaged to calculate the domain score. Each subdomain was weighted

equally within the domain. The final HCF score is an average of the five domain scores.

The scores were then color coded either red, yellow or green (like a “traffic light”) to illustrate

the status of conditions. The dashboard (figure 6) displays a traffic light color for each of the

domains, as per HCF. Table 1 describes the meaning of each of these scores. The traffic light

color allows for easy representation of the status of WASH conditions in the 52 HCFs in Hoima.

Figure 5 shows the architecture of the tool, including the process of data collection and scoring.

Table 1: Traffic Light Scorecard Definitions

Score Traffic Light Criteria

3.0 – 2.8 Basic Service HCF has achieved the WASH in HCF targets or is on track to achieve them / high level of WASH infrastructure and resources

2.7 – 1.8 Limited Service

HCF has made some progress toward achieving the target but is not on track to achieve it / moderate level of WASH infrastructure and resources

1.7 – 1.0 Unimproved or No Service

HCF has made little or no progress toward achieving the target / low level of WASH infrastructure and resources

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Figure 5: WASHCon Assessment Tool Architecture

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3.0 Provisional Results: WASH Conditions Assessment of the HCFs in Hoima District

3.1 WASH Conditions assessment

Figure 6 shows the traffic light score dashboard for the 52 HCFs in Hoima district. The

dashboard was automatically populated based on the data collected in the HCFs in Hoima

district. Figure 7 shows the minimum, maximum and average scores of each domain for all the

HCFs.

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Figure 6: Traffic Light Dashboard

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Figure 7: The overall average score of the HCFs in Hoima district as per domain

Facility Water Supply Sanitation Cleaning Routines Handwashing Facilities Waste Management Overall ScoreAzur 2.3 2.9 3.0 2.8 2.9 2.7Bacayaya 2.3 2.3 2.3 2.3 2.4 2.3Bararu 2.1 2.3 2.3 1.8 2.4 2.1Bombo 2.1 2.2 2.4 1.7 2.6 2.1Bugambe Tea 2.0 2.4 2.3 1.5 2.2 2.0Bugambe 2.3 2.5 2.0 2.0 2.6 2.3Buhanika 2.1 1.8 2.0 1.8 2.6 2.0Buhimba 2.3 2.3 3.0 1.8 2.5 2.2Buhuuka 2.2 1.8 1.0 1.5 1.1 1.6Bujalya 2.0 1.6 2.4 2.0 2.7 2.1Bujugu 1.4 2.3 2.5 2.3 2.5 2.3Bujumbura 3.0 2.5 3.0 2.5 2.8 2.8Buseruka 1.6 1.4 1.3 1.3 2.5 1.7Butema 2.0 2.8 2.1 2.7 2.7 2.5DHO Clinic 1.7 1.5 1.7 2.3 2.4 2.0Dwoli 1.7 2.4 3.0 1.5 2.5 2.0Kabaale 2.0 2.4 1.8 1.8 2.5 2.1Kabwoya 2.0 2.5 3.0 3.0 2.5 2.5Kapaapi 2.3 2.3 1.6 1.0 2.2 2.0Karongo 1.5 2.2 2.0 1.7 2.5 2.0Kaseeta 1.7 1.6 1.7 1.0 2.2 1.6Kasomoro 1.6 2.1 2.0 2.0 2.4 2.0Kasonga 2.9 2.8 2.3 3.0 3.0 2.9Kibaire 2.2 2.1 2.8 2.3 2.3 2.2Kibiro 1.3 2.3 3.0 1.7 2.4 1.9Kigorobya 1.7 1.8 3.0 2.3 3.0 2.2Kihuukya 2.9 2.4 2.0 2.3 2.7 2.6Kikuube 1.7 2.2 1.8 1.6 2.8 2.1Kisaaru Tea 2.9 1.8 2.5 3.0 2.5 2.5Kisabagwa 2.0 2.6 1.7 2.0 2.6 2.3Kiseke 2.0 2.4 2.2 2.0 2.2 2.1Kisiiha 1.4 2.6 3.0 2.3 2.5 2.2Kitana 2.7 2.2 2.8 2.0 2.3 2.3Kitoole 1.4 2.2 2.1 1.5 2.4 1.9Kyabasengya 1.7 2.4 2.3 3.0 2.4 2.4Kyakapeya 2.0 2.4 1.0 1.5 2.4 2.1Kyangwali 1.8 2.2 2.3 1.5 2.7 2.0Kyehoro 1.7 2.3 2.1 2.0 2.3 2.3Lucy Bisereko 1.7 1.6 1.2 1.5 2.5 1.8Mbarara 1.7 2.2 2.5 2.0 2.2 2.2Mparangasi 2.0 2.2 1.3 1.5 2.5 2.0Muhwiju 1.7 2.4 2.8 1.5 2.6 2.2Mukabara 2.2 2.4 1.6 2.0 2.6 2.3Munteme 2.0 2.3 3.0 2.0 3.0 2.3Ngurwe 1.7 2.1 3.0 3.0 2.3 2.3Nsozi 2.3 2.3 2.4 2.5 2.6 2.4Police Clinic 3.0 2.0 3.0 2.3 3.0 2.6Prisons Clinic 1.7 2.8 3.0 2.7 2.5 2.4Rwenyawawa 1.9 2.3 2.5 1.5 2.3 2.0Sebigoro 2.3 2.5 2.3 2.3 2.5 2.4Tonya 1.5 2.5 2.3 2.3 2.6 2.2Wambabya 2.0 2.3 2.7 2.0 2.8 2.3Overall Scores 2 2.34 2.28 2.01 2.49 2

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Only 9.62%, 7.69%, 11.54%, 28.8%, 15.38% of the HCFs had basic water supply, sanitation,

handwashing facilities, cleaning routines and waste management facilities respectively.

3.2 Water quality results and some observations by sub-county

They were seventy eight (78) water sampling points from the key wards of the 52 HCFs. In all

out of the 78 samplings points, twenty four (24) and 30.76 % of the points tested positive for

E.coli, only three (3), 6% HCFs had free chlorine levels that were within the acceptable national

standards for portable drinking water.

3.2.1 Buhimba Sub-county

Six (6) HCFs i.e. Buhimba HC III, Muwhiju HC III, Bujalya HCIII, Lucy Bisereko HC III,

Kitoole HC II and Kisiiha HC II were assessed in Buhimba Sub County.

Figure 8: Toilet facilities at Lucy Bisereko HC III

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All the HC III had OPD and maternity wards only except for Muhwiju that had an additional

ward (inpatient). All the HC II had only OPD. The main water source was either borehole or rain

harvested water or both. Water samples from the wards were collected and tested for coliforms

and free chlorine (see table 1 for the Water Quality Analysis results).

Figure 9: Water sources at Kitoole Health Center II

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Table 2: Water Quality Analysis Results for Buhiimba Sub County

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The highlighted cells (red) are the results that are not in range with the Uganda National standards for portable drinking water.

The National Standards are: <1 for E. Coli and T.C; and between 0.2 – 5 for free chlorine.

Seven (7) sampled points i.e. 63.6% of the sampled water had no presence of E. Coli and only

10% had free chlorine samples that was within the required standards for drinking water. Water

Quality Analysis results indicate that E. Coli was only detected in Bujalya, Buhimba and Lucy

Bisereko and free chlorine was only detected in Lucy Bisereko’s drinking water. The drinking

water was treated with safe guard which explains the presence of free chlorine.

3.2.2 Kabwoya Sub County

The sub county had five (5) HCFs (see table below) of which Kabwoya HC III served

approximately 47% of the population. Most of the toilet facilities at these HCFs were dirty with

urine while some had non-functional hand washing stations.

Figure 10: Toilet Facilities at Kyehoro HC III

HCFs Sample Location

Free Chlorine (mg/l)

Total Coliform (MPN) E. Coli (MPN)

Muhwiju HC III Maternity 0 2419.6 0OPD 0 2419.7 0

Bujalya HC III Maternity 0 2419.6 275.5OPD 0 2 0

Lucy Bisereko HC III OPD/ Maternity 0 2419.6 64.6OPD/ Maternity (drinking water) 0.2 54.1 9.3

Kitoole HC II OPD (Rain Harvest) 0 770.1 0OPD (BoreHole) 0 0 0

Kisiiha HC II OPD 0 1299.7 0

Buhimba HC III OPD 0 2419.6 34.5Maternity 0 2419.6 0Negative Control 0 0

PARAMETERS

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Figure 11: Non-functional Hand-washing facilities at Sebagoro HC III

Water samples were collected from the wards that had water at the HCFs. Below are the Water

Quality Analysis results for each HCFs per sample location.

Table 3: Water Quality Analysis test Results for Kabwoya Sub County

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28.5% of the sampled water had traces of E. coli. The sampled water had traces of E. coli

detected in Kyehoro and Kisaaru OPD. And none of the samples had any free chlorine.

3.2.3 Kigorobya Sub County

Some of the Clinical staff were aware of the hand-washing moments and procedures. Other

HCFs had poor waste disposal habits with used sharps, gloves and other wastes in and under

hand washing stations. (See figures below). Water quality samples were collected and analyzed

from OPD, maternity and in-patient / general wards at the HCFs in the sub county (see table

below).




PARAMETERS

Kabwoya HC III OPD 0 0 0Maternity No water No water No water

Kaseeta HC III Maternity No water No water No waterOPD 0 2419.6 0

Kyehoro HC III Maternity 0 63.4 38.1OPD No water No water No water

Sebigoro HC III Maternity 0 325.5 0OPD 0 1046.2 0

Kisaaru Tea HC III OPD 0 686.7 111.2Inpatient 0 517.2 0Negative Control 0 0

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Figure 12: Waste disposal around the hand washing station at Kibiro HC II.

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Figure 13: Clinical Staff demonstrating hand washing procedures in Hoima District.

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Table 4: Water Quality Analysis test Results for Kigorobya Sub County

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! The highlighted cells (red) are the results that are not in range with the Uganda National standards for portable drinking water.





PARAMETERS

Kigorobya HC IV OPD No water No water No waterMaternity 0 248.1 0General 0 5.2 0

Kibiro HC II OPD 0 4.1 2

Bombo HC II OPD 0 2419.6 0

Kapaapi HC III OPD 0 2419.6 151.5Maternity 0 2419.6 0

Kitana HC II OPD / Maternity 0 2419.6 14.6In Patient 0 2419.6 1Negative Control 0 0

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50% of the sampled water had E. Coli levels that were within the acceptable Uganda National

standards for portable drinking water. And none of the samples had free chlorine.

3.2.4 Kyabigambire Sub County

The water in most of these HCFs was purchased from outside the HCFs and stored in jerricans.

Other HCFs rain harvested the water after which it was stored in containers at the various wards.

Water samples were collected from the water storage containers from each ward and below are

the some of the storage containers and water quality analysis results as per ward and HCF.

Figure 14: Water sources and storage containers at the HCFs in Hoima District.

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Table 5: Water Quality Analysis test Results for Kyabigambire Sub County

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PARAMETERS

Kisabagwa HC III OPD 0 140.8 0

Mparagasi HC III OPD 0 1 0Maternity 0 165 0

Buraru HC III OPD 0 101 0Maternity 0 2419.6 0

Kibaire HC II OPD 0 6.3 0

Kasomoro HC III OPD 0 2419.6 0Negative Control 0 0

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Despite the fact that all the sampled water had no presence of free chlorine, 100% of them met

the Uganda National standards for portable drinking water for E. coli.

3.2.5 Kizirafumbi Sub County

The HCFs in Kizirafumbi were cleaned routinely some with soap, water and disinfectant. See a

cleaner at kikuube HC IV carrying out routine cleaning of the male inpatient ward.

Figure 15: Routine cleaning at Kikuube HC IV

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Water quality samples were collected from the various wards at the respective HCFs in the Sub

County and results shown in table 7.

Table 6: Water Quality Analysis Results for Kizirafumbi Sub County

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50% of the sampled water met the Uganda National standards for portable drinking water for E.

coli and 100% of the sampled water did not have any free chlorine.

3.2.6 Bugambe Sub County

The HCFs in this sub county had only OPD and maternity wards. These HCFs used either rain

harvested water or borehole after which the water was stored in a container. Below are the Water

Quality Analysis results for the sub country.

Table 7: Water Quality Analysis results for Buseruka Sub County




PARAMETERS

Muteme HC III OPD / Maternity / Peadiatric 0 2419.6 7.4

Kikuube IV Maternity 0 0 0OPD 0 2419.6 44.5

Mukabara HC III OPD 0 2419.6 2Maternity 0 1553.1 0

Wambabya HCII OPD 0 2419.6 0

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The National Standards are: <1 for E. coli and T.C; and between 0.2 – 5 for free chlorine.

Only 33.3% and 16.6% of the sampled water had traces of E. coli and free chlorine respectively.

3.1.7 Kyangwali Sub County

Despite the blocked pit latrines and non-functional water facilities (see figure below), water

samples were collected from water storage containers from each ward in Kyagwali and see table

below for the results as per location.

Figure 16: Non-functional Water storage at Kyangwali Sub County




PARAMETERS

Bugambe HC III Maternity 0 4.1 0OPD 0 1119.9 0

Bugambe Tea HC III Maternity 0 41.9 5.2OPD 0.2 0 0

Bujugu HC III Maternity 0 0 0OPD 0 186 1

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Figure 17: Inaccessible Toilet facility at Kyangwali Sub County

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In-addition to the non-functional water facilities, the sub county had HCFs with bathing facilities

that were filled with blood, dirt among others (see figure below).

Figure 18: Bathing facilities at Buhuuka HC III.

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Table 8: Water Quality Analysis results for Kyangwali Sub County

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The National Standards are: <1 for E. coli and T.C; and between 0.2 – 5 for free chlorine.

Despite the absence of free chlorine, approximately 92% of the water samples had no E. coli.

3.2.8 Kitoba Sub County

The HCFs in Kitoba used harvested rain water as there source of water, which was stored in

either jerrycans or containers. Samples were collected from these storage facilities to provide the

water quality results as shown in table 10. Toilet facilities were present at the HCFs in the sub

county, see figure 19 for toilet facilities in Hoima for persons with disabilities.




PARAMETERS

kyangwali HC III OPD 0 435.2 0In-Patient 0 1046.2 0Maternity 0 60.5 0

Buhuuka HC II OPD 0 5.2 0Maternity 0 2419.6 0

Nsozi HC III OPD 0 2419.6 0Maternity 0 2419.6 0

Rwenyawawa HC III OPD 0 27.9 0Maternity 0 3.1 0

Kasonga HC III OPD 0 2419.6 44.8

Ngurwe HC II OPD 0 665.3 0Negative Control 0 0

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Figure 19: Toilet facilities for persons with disabilities in Hoima

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Table 9: Water Quality Analysis results for Kitoba Sub County

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The highlighted cells (red) are the results that are not in range with the Uganda National standards for portable drinking water. The National Standards are: <1 for E. coli and T.C; and between 0.2 – 5 for free chlorine.




PARAMETERS

Dwoli HC III OPD 0 1413.6 0Maternity 0 2419.6 1299.7

Kiseke HC II OPD 0 2419.6 1

Kyabasengya HC II OPD 0 648.8 0

Mbarara HC II OPD 0 15.5 0NEGATIVE CONTROL 0 0

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Approximately 40% and 0% of water samples in HCFs showed presence of E. Coli and free

chlorine respectively.

3.2.9 Buseruka Sub County

Most of the infectious waste was disposed by open burning without any kind of fencing. Figure

below shows areas where such waste was disposed in Buseruka and other sub counties in the

district. The Water Quality Analysis results for Buseruka are also shown below.

Figure 20: Waste Disposal at the HCFs in Hoima District.

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Table 10: Water Quality Analysis results for Buseruka Sub County

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None of the sampled water met the Uganda National standards for portable drinking water for

either E. coli or free chlorine.

3.2.10 Hoima Municipality

The main water sources are either town council water or rain harvested water. HCFs in the

municipality used solar panels, utility power and generators as the main power sources (see

figure 21 and table below for the Water Quality Analysis results for the municipality).

Figure 21: Power Sources in Hoima District.

Table 11: Water Quality Analysis results for Hoima Municipality




PARAMETERS

Buseruka III OPD / Maternity 0 2419.6 235.9

Kabaale III OPD 0 1986.3 21.6

Tonya III OPD 0 2419.6 285.1

Butema III OPD / Mataernity 0 2419.6 1

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Despite the fact that most of the water samples had no presence of free chlorine, only 16.6% of

the sampled water did not meet the Uganda National guidelines for portable safe drinking water

for lack of E. coli.

Figure below shows the various percentages of the sampled water per Sub County for those that

met the Uganda national guidelines for safe drinking water for E. coli.




PARAMETERS

Kyakapeya HC II OPD 0 1046.2 9.8

Azur HC IV OPD 0.1 0 0Maternity 0 2 0Paediatric 0 1 0

Bujumbura HC III OPD 0 6.3 0Maternity 0 13 0General 0 29.9 0

Karongo HC II OPD 0 2419.6 0

Bucayaya HC II OPD 0 1986.3 7.3

Prisons HC II OPD 0.4 0 0

Police Clinic III OPD 0.1 101.7 0

Buhanika HC III OPD 0 7.3 0

DHO Clinic HC II OPD 0 2 0

Kihuukya HC II OPD 0 0 0NEGATIVE CONTROL 0 0

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Figure 22: Percentage of Samples that Met the Uganda National Guidelines for Safe Drinking Water per sub-county (<1 E. coli MPN/100ml)

! Only the sampled water from Kyabigambire Sub county (100%) met the Uganda National

standards for portable drinking water for E. Coli <1 MPN/ 100ml.

4.0 Challenges and lessons learnt

• The enumerators did not have an introduction letter from the District, World Vision and

Office of the Prime Minister (OPM) for this assessment which led to time wastage

especially at the HCFs in the refugee camp. It was imperative to have all the necessary

introductory documentation before data collection.

HOIMA MUNICIPALITY

KITOBA

BUSERUKA

KYABIGAMBIRE

KIGOROBYA

KABWOYA

BUHIMBA

BUGAMBE

KIZIRAFUMBI

KYANGWALI

0 25 50 75 100

T.C WestE. Coli

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• The Techno Y2 phones that were used for data collection couldn’t record the GPS

readings as a result all the GPS readings were recorded using the nexus 5. It was essential

to check if all the necessary functions needed for data collection were effectively

operational before heading to the field, and it also emphasized the need for a backup

android device with the team leader.

• Some HCFs were not open by 10:45 hours while others were closed at 15:00 hours thus

the enumerators had to revisit these facilities on another day. This stressed the need to

communicate (preferably by voice call) with the in-charge of the HCFs a day before data

collection.

• There was poor internet connection thus data was not uploaded on time. It was therefore

preferable to load data bundles on each data collection phone.

• Data collection was done as per sub-county. This wasted a lot of time as some HCFs were

on opposite directions. Therefore all the HCFs needed to be mapped to ensure that data

collections was done depending on the same route and not per Sub County.

• The Director / In-charge and records personnel were not available at some HCFs so the

enumerators had to wait for them to arrive or had to return to the HCFs at another time.

This was avoidable by communicating with the in-charge before the data collection

informing him/her about the visit and the need of the records personnel.

• Even after updating the app some mobile devices did not show the updated HCFs so

paper surveys were used. Thus, papers surveys should always be available in case of any

technical issues with the mobile devices.

4.1 Feedback from the enumerators

• The questions were well understood by the interviewee.

• Commcare was easy to use as compared to ODK.

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5.0 Conclusion

Approximately, 69.24% and 3.85% of the sampled water met the Uganda National standards for

portable drinking water in regards E. coli and free chlorine respectively. Only the sampled water

from Kyabigambire Sub county met the Uganda National standards for portable drinking water

for E. Coli <1 MPN/ 100ml. Buseruka sub county had all its sampled water having traces of E.

Coli. The free chlorine was less than the required in most of the sub counties. Only 2 of the 52

surveyed HCFs had an overall basic service level for WASH while the rest either had limited,

unimproved or no WASH services exposing both the patients and staff to preventable nosocomial

infections especially during wound care, surgical procedures and patients in the intensive care

unit.

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Documents

Report on the deployment of the WASHCon Tool in Hoima ...washconhcf.org/wp-content/uploads/2017/10/Final-WVU-WASH...Paper surveys were also printed and used in case of technical issues