Zimbabwe boasts a well-connected system of rural health clinics run by the Ministry of Health and Child Care that provide services such as baby deliveries and out-patient treatments. Amalima encourages at least three prenatal visits for pregnant and lactating women; however, some of the clinics lack the necessary facilities to promote good hygiene practices for the patients. Amalima addresses the need for improved sanitation and hygiene facilities by constructing toilets, flush systems, and handwashing stations at clinics across Matabeleland North and Matabeleland South. In the Bulilma district (Ward 11), Amalima worked closely with the community, the Rural District Council, clinic staff, and the Health Center Committee to bring running water and improved sanitation facilities to the Madlambuzi clinic.
This clinic provides medical services, including out-patient treatments and baby delivery procedures, to over 5,000 people per year, an average of 20 patients per day. The clinic is also home to a medical lab which performs malaria and tuberculosis testing for patients and the three surrounding clinics. For a clinic of this size, the government recommends at least 100 liters of water available each day for the day-to-day functions of the clinic. However, in 2012 the clinic’s water system broke down. The clinic was forced to rely on water from an onsite borehole that could only pump 200 liters (about 10 buckets) of water at a time before running dry, making it necessary to wait for two hours before drawing more water. With the clinic’s day-to-day operations constrained, clinic patients had no choice but to fetch their own water from water sources that were unsafe for medical purposes. As described by clinic client Mrs. Dube, “My relatives had to walk for 30 minutes [to a nearby dam] to get a 20-liter bucket of water for my baby’s delivery.”
Moreover, the clinic only had two toilets, which were used by both clinic staff and the general public. With so many people using only two toilets and no water for handwashing, it was difficult for clinic staff to maintain good sanitation practices. When asked about the impact on hygiene and sanitation, clinic nurse Ms. Ndlovu recalls how these conditions, “compromised health standards at the clinic and negatively impacted health outcomes in our community.”
In response to the need for better facilities at the clinic, the Amalima team collaborated with local stakeholders to find a solution. Through Amalima’s Food for Assets activity, community members provided labor for constructing six new latrines and two handwashing stations at the clinic. Workers were compensated with 60 kilograms of sorghum and 4 kilograms of lentils for every 15 days of work. Since the borehole onsite could not provide sufficient water, the clinic made an agreement to source water from a well already in use at a nearby school. Amalima installed nine solar panels for the borehole pump and installed a10,000-liter tank for water storage. Villages in the surrounding area also served by the clinic each donated a roll of fencing to secure the new facilities.
Since March 2017, the clinic has had fully functional toilets, running water, and handwashing stations, and patients are no longer required to provide their own water for procedures. lients are no longer responsible There are six new toilets, including two toilets for clinic staff, and four for the clinic clients. In addition, two of the public latrines feature a wider doorway, a handrail, a toilet seat, and space for a wheelchair to turn around for clients with disabilities. Stepping stones are placed to lead the user from the latrine to the handwashing station to help remind people to wash their hands. According to the clinic’s Environmental Health Technician, Mr. Ndebele, the latrines and handwashing stations with running water “have improved our ability to prevent the spread of infection onsite at the clinic”
To support the Health Center Committee in its role to conduct ongoing maintence of the new facilities, Amalima provided training on community based management as well as operations and maintenance of water, sanitation, and hygiene infrastructure. Cmeet regularly to verify that the facilities are functioning properly, monitor water user practices, and raise any needed funds to make repairs to the facilities.
In addition to the facilities at Madlambuzi clinic, Amalima has rehabilitated WASH facilities at 27 clinics across Matabeleland North and South provinces with a total of 154 toilets, 17 flush systems, and 52 handwashing stations since 2014.