Establishing a WASH and water quality monitoring system in Solomon Islands with UNICEF

Solomon Islands is a nation of 900 mountainous and volcanic islands. Of the 600 inhabited islands, only 345 have health care facilities (HCFs). In total, 355 HCFs serve the country's population of 620,000. In 2019, the Ministry of Health and Medical Services (MHMS) teamed up with UNICEF, the University of North Carolina at Chapel Hill (UNC) and Akvo to establish a system for monitoring WASH services in HCFs.

Above: Enumerators testing water quality using Akvo Caddisfly in Solomon Islands.

The challenge

Many public health issues in Solomon Islands are attributed to limited access to clean water and sanitation, as well as poor hygiene practices. Further, data on WASH services in HCFs is scarce. Although MHMS aims to ensure HCFs are equipped to prioritise patient safety, challenges are often vast and complex - from unreliable resource suppliers, coordinating complicated geographical logistics, absence of water quality testing systems, insufficient funding, and limited technical skills within communities. These issues may inhibit HCFs from providing basic levels of services.

MHMS has identified the lack of relevant and quality data as the main bottleneck to determining and tracking the status of WASH in HCFs. Without relevant and quality data, programme interventions may not be effectively designed to address specific targets, and measuring progress is a major challenge.

The partnership

MHMS, UNICEF, the University of North Carolina at Chapel Hill (UNC) and Akvo have worked to establish a data system for generating, measuring, analysing, and monitoring data on WASH in HCF indicators. The system is designed in alignment with the UNICEF/WHO Joint Monitoring Programme (JMP) for WASH in HCF standard. The JMP standard sets forth priority indicators for examining services related to water, sanitation, hygiene, waste management, and environmental cleaning. Additionally, the standard provides a scoring system called a “service ladder” to classify service levels as: basic, limited, or no service. The service levels are presented in the image below. The standard also provides guidance on how to analyse data and generate reports. For each theme, JMP service level indicators focus on:

Water services

  • Water quality: presence / no presence of E.Coli
  • Type of water source: improved / unimproved
  • Availability of water on premises

Sanitation services

  • Type of sanitation facility: improved / unimproved
  • Existence of a toilet dedicate for staff
  • At least one sex-separated toilet with menstrual hygiene facilities

Hygiene services

  • Existence of functional hand hygiene facilities available at one or more points of care and within 5 metres of toilets

Health care waste management

  • Waste is safely segregated in consultation areas
  • Sharps and infectious wastes are treated and disposed of safely

Environmental cleaning

  • Existence of protocols for cleaning
  • Staff with cleaning responsibilities have all received training on cleaning procedures

Global JMP WASH in HCF scoring classifications for basic, limited or no service is presented in the table below. Note “Advanced service” has not been defined in the Solomon Islands context:

Above: Global JMP WASH in HCF scoring classifications for basic, limited or no service.

More details of the WASH in HCF standard may be found in the Akvopedia survey library Standard Specification Form.

Though Solomon Islands has only had eight confirmed cases of Covid-19 (and zero deaths), the baseline survey includes a Covid-19 preparedness checklist. The checklist is designed to gain further insight into how HCF water supply, excreta disposal, liquid waste, showers and laundry statuses, handwashing station presence, solid waste management, and infection prevention and control (IPC) may be improved to ensure patient safety during the global pandemic.

After completing survey design, MHMS, UNICEF and Akvo facilitated numerous data collection preparation workshops for 40 enumerators. During the workshop sessions, all 40 enumerators provided feedback on the survey, practised conducting the E.Coli field test with the Aquagenx CBT bag, and finalised logistics for teams to travel in groups to the 355 HCFs throughout the 345 islands. Data collection commenced in August 2020.

The change

As of November 2020, the 260 HCFs demonstrated below have successfully completed and submitted the baseline survey.

Above: Geopoints of 260 Solomon Islands HCFs that have completed the baseline survey for WASH in HCF/Covid-19 Preparedness assessment. Data visualised with Akvo Lumen.

In many cases, enumerators embarked on boats to outer islands later than originally planned due to Covid-19. The 95 remaining HCF surveys are set to be completed before the end of 2020. Upon completion of data collection, analysis and visualisation will be developed by the University of North Carolina Water Institute, Chapel Hill. Data will be analysed according to the Joint Monitoring Program (JMP) standard, and then recommendations for improving WASH in HCF in Solomon Islands will be proposed.

Improving WASH in HCF requires clear policies, effective sector coordination, harmonised change processes, improved organisational capacities, commitments to finance interventions, and iterative performance monitoring systems that always inspire active participation of national WASH partners. As Epeli Hau’ofa explains in Our Sea of Islands, islands in Oceania are a community of migration, wealth, people, skills, arts and information that continue to circulate endlessly. Progress and development does not have boundaries. With the ocean as a connector, Solomon Islands government will use this baseline data - and experience gained during the process - to make decisions and establish a plan for the continuous improvement of all Solomon Islands HCFs. Change will be systematised, and continuous measuring and monitoring of progress on national WASH in HCF indicators will begin.