Sanitation for Millions Approach to One Health in Health Care Facilities

GIZ / J. Kiyimba
Publicado: 14 Noviembre 2023
Última edición: 14 Noviembre 2023
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The global pandemic has shown societies’ vulnerability to highly infectious diseases and nosocomial infections due to AMR. It has revealed critical weaknesses in primary HCFs, such as inadequate infection prevention and control, lack of proper waste management and infrastructural deficits. Improper excreta disposal and medical waste management in HCFs are linked to the spread of vectors, vermin, and other germs. They have been associated with spreading pharmaceutical residues that contribute to increased antimicrobial resistance. This is the point of departure of Sanitation for Millions towards applying One Health through a WASH in HCFs approach. The project has designed a framework for its interventions based on GIZ knowledge, experience in partner countries, the Joint Monitoring Programme of WHO/UNICEF, and national policies. It is based on capacity building, promoting hygiene management, creating awareness, and designing an enabling environment that targets the reduction of health risks and the protection of human health.


Asia Central y del Norte
África Occidental y Central
Scale of implementation
Buildings and facilities
Ecosistema urbano
Actores locales
Gestión de residuos
Incorporación de la perspectiva de género
Mantenimiento de infraestructura
Marco legal y normativo
One Health
Salud y bienestar humano
Tratamiento de aguas residuales
Species Conservation and One Health Interventions
Comunicación de riesgos, participación de la comunidad y cambio de comportamiento
Mecanismo de coordinación de One Health
One Health
Aspectos sanitarios ligados a factores socioeconómicos, tales como: La pobreza, la educación, las estructuras de seguridad social, la digitalización, los sistemas de financiación y el desarrollo de la capacidad humana
Agua, saneamiento e higiene
Urban and Disaster Risk Management
Sustainable urban infrastructure and services
Enfermedades por vectores o relacionadas con el agua
Contaminación (incluida la eutrofización y la basura)
Gestión ineficaz de los recursos financieros
Desarrollo de Infraestructura
Falta de acceso a financiación a largo plazo
Falta de infraestructura
Falta de conciencia del público y de los responsables de la toma de decisiones
Deficiente vigilancia y aplicación de la ley
Desempleo / pobreza
Sustainable development goals
ODS 3 - Salud y bienestar
ODS 5 - Igualidad de género
ODS 6 - Agua limpia y saneamiento


Pakistan | Pakistan


One of the most serious issues facing global health is the lack of safe WASH in HCFs. Safe water, functioning sanitary facilities, and soap must be present in all HCFs around the world in order to provide safe and dignified care, protect women and new-borns during childbirth, prevent infections in patients and staff, carry out safe surgery, and prevent and contain pandemics and antibiotic resistance. As the majority of healthcare workers and those utilizing healthcare services are women, the lack of WASH in HCFs disproportionately affects them.


Globally, 3.85 billion people lack a basic hygiene service at their HCF, 1.7 billion people lack a basic water service at their HCF, and 780 million people have no improved toilets at their HCF. Furthermore, the extent of the problem remains hidden because major gaps in data persist. To address growing waste challenges create the neccesity for investment additional waste treatment capacity and systems to ensure their sustained operation.


Beneficiaries are all who get treatment or work at the HCFs (inpatients, outpatients, staff). In total, about 1.8 Mio persons (about 800.000 in Uganda and about 1 Mio in Pakistan) have benefited from the interventions of Sanitation for Millions at HCFs so far.

¿ Cómo interactúan los building blocks en la solución?

In high traffic and populated HCFs, patients and healthcare workers need appropriate and user-friendly WASH facilities. Sanitation for Millions strengthens good hygiene practices through a unique model that focuses on a ‘WASH needs-based’ combination of infrastructure, awareness and practice-oriented measures. This model responds to the individual needs of the users of the HCFs, including women and girls, people with disabilities and other vulnerable population groups. 

Sanitation for Millions employs a combination of construction of toilets, handwashing stations and hospital waste management facilities to promote improved access to safe and equitable sanitation and hygiene. These measures are accompanied with awareness campaigns and training support to foster improved WASH knowledge and practices with a focus on infection prevention and control (IPC).

The combination of

(1) access to appropriate WASH facilities,

(2) proper facility usage,

(3) functional O&M mechanisms,

(4) regular monitoring in terms of cleansing plans,

(5) hospital waste segregation, and

(6) functional and effective WASH/ IPC committees at the HCFs,

guarantees that the beneficiaries have sustained access to safe and equitable conditions while being at the HCFs. 


It is Sanitation for Millions’ goal to safeguard the health of patients, visitors, staff, and the adjacent community, including plants and animals in the immediate environment. Since HCFs are complex units, it is important to consider interfaces to other sectors, mainly health, waste, and environment. Environmental soundness in terms of safe wastewater and excreta disposal combined with resource recovery is one pillar. Appropriate waste management, and the supply of potable water in sufficient quantity and quality, are addressed as well. To protect human health, Sanitation for Millions considers the occupational health risks that exist at HCFs by emphasizing personal protective equipment and personal hygiene to safeguard the medical staff. Procedures in place reduce medical harms and ill health in case of accidents and emergencies. Respiratory hygiene and cough etiquettes are essential to avoid infections and nosocomial diseases and need to be supervised by the hospital management. Furthermore, in this area of intervention, safe hand hygiene, the control of water- and vector-borne and nosocomial diseases, as well as hygiene education are the main tasks for mitigating health risks. Increased support for effective and sustainable IPC programmes at HCFs is crucial to reduce the risks posed by infection outbreaks to global health and to ensure safety for patients, healthcare workers and the adjacent community.


Sanitation for Millions Uganda

Sanitation for Millions implemented best practices in selected health care facilities (HCFs) in Apac cluster in Uganda, including construction of sanitary, handwashing (HWFs), and hospital waste management facilities, and systems for reliable water supply. Hardware was complemented by extensive awareness campaigns and trainings on water, sanitation, and hygiene (WASH) to foster improved knowledge and practices by patients and healthcare workers (HCWs), with a special focus on Infection Prevention and Control (IPC). The management was strengthened by adapting WHO/UNICEF’s standard tool WASHFIT and local guidelines for improved practices. Over the years valuable experiences and results on various levels were gathered.

District Health Officer Mr. Moses Ngura highlights: "As a cluster, we recognize substantial improvement in access to improved sanitation across all HCFs. This alongside awareness measures has triggered improved community health-seeking behavior.”

Capacity-building measures have prompted prioritization of WASH budgeting by the local government and have resulted in a change of attitude, mindset, and practices by both patients and HCWs. Health assistant Isabella Adongo states: “The IPC committee in our facility has been revitalized. I am proud to mention that it is fully functional and committed towards supporting WASH aspects which wasn’t the case before.”

Through regular health education coupled with attractive infrastructure, hygiene practices are improved on the patients’ side, proven by better toilet etiquette and the highly embraced hand washing practice. Outpatient Oruk Felix at Alenga Mission HCF notes: “The improvements in WASH have led to a cleaner facility, making it more attractive to patients compared to the time before”. This results in increased outpatient attendance. Ms. Jane Anyinge, a midwife in Aduku commends: “The trainings and the improved waste management facilities have made health care waste management practices more efficient, considering the referral facility handles over 90% of maternal deliveries in the Aduku cluster towns”.

The programme has indirectly improved the livelihoods of the skilled caretakers (Hausmeisters) that were trained in basic operation and maintenance of WASH infrastructure. This is attested by Ogwal Tom: “With the new skills, I support and rectify maintenance issues at several institutions and households, increasing my income streams to provide for my family better.”

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Teresa Häberlein Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH