Hospital Water Systems
hospital water systems
General Electric Foundation
OVERVIEW
The General Electric Foundation donated decentralized water treatment systems to 6 hospitals in Ghana in 2005. In order to help The General Electric Foundation assess the success of their donations, a sustainability assessment was conducted. Research showed that operating a system that was built for pristine waters of the US was difficult in Ghana due to differences in water quality and access to repair parts.
More resilient water systems and supportive expertise can ease some of the burden associated with managing these systems in Ghana.
ROLE
user research
PROJECT TYPE
master's thesis
PROCESS
evaluative research
TEAM
Christine Moe, Principal Investigator
Mia Gallegos, Project Manager
Kwame Akorsa, GE Ambassador
background
Decentralized water treatment technology is a solution for hospitals that rely on intermittent or low-quality water sources. In many low-income countries, piped water sources are subject to pipe intrusions and poor drinking water quality, a crucial need for health care facilities.
In 2005, the General Electric Foundation donated decentralized water treatment systems to six hospitals in Ghana.
The systems donated by The General Electric Foundation use small membrane filtration to filter bacteria and viruses. At each site, water from the purification system is piped to taps within the hospital. The systems require membrane filters to be backwashed and filtered water to be treated with chlorine. These processes require proper operation and routine maintenance, and maintenance staff at each hospital are expected to perform these tasks.
The team I was working with at the Center for Global Safe WASH at Rollins School of Public Health at Emory University wanted to conduct a follow-up assessment, to assess water quality and see how well staff were able to maintain the systems they were given.
process
In the summer of 2014, we conducted a mixed-methods assessment in six hospitals in Ghana. They were located in Apam, Axim, Bole, Kete-Kratchi, Kintampo, and Mampong.
Hospital sites in Ghana with General Electric water filtration technology. (2014)
Knowledge, Attitudes, and Practice (KAP) Surveys
KAP surveys were administered to patients and visitors, general staff, and clinical staff in each hospital to assess perceptions of water quality. We wanted to know if maintenance staff talked to them about the water system or if they did anything differently when they knew the hospital was using one.
In-depth Interviews
Interviews were conducted with laboratory staff, administrators, directors, maintenance staff, and procurement officers in each hospital. We asked them about their awareness of the system and what water sources they used to do their work.
Water Use Survey
Water use surveys were used to determine water use practices in the hospital. Questions were asked to determine the types of water that were used for activities like handwashing and taking medications.
Site Observations
Tap observations were conducted at each hospital to assess tap functionality, leaks, and the presence of soap.
Water Quality Testing
Water samples were tested for total coliforms, E. coli, and P. aeruginosa, chlorine residual and turbidity.
Sustainability Metric
The sustainability metric we used was a five-point scoring system with scores ranging from 0-4, with a score of 2 defined as the cutoff for sustainability of the system and its operation. A score of 4 indicated evidence of a strong environment that would support system sustainability. Four key domains were addressed: accountability, technical feasibility, on-site capacity, and institutional engagement and support.
A General Electric decentralized membrane filtration system with chlorine doser (center)
A concrete water storage unit (left) that connects to the water filtration system (right).
A Veronica bucket (right), a water storage container used for handwashing in a hospital waiting room.
Signage at the entrance of the the hospital located in Kete Krachi.
insights
In total, 290 water samples were collected and 11 in-depth interviews and 118 surveys were analyzed. 3 of 6 hospitals were operating their water systems sustainably.
strong communication & value
In hospitals that maintained their water systems well, communication among key staff members was frequent. When maintenance staff were not subject to a strict hierarchy or were valued within the hospital, they were able to communicate with the hospital director about the system directly. If hospital leadership prioritized system management, maintenance staff were likely to be just as engaged.
clear roles and responsibilities
When nurses and cleaning staff were responsible for cleaning water storage buckets in the hospital as a part of their shift work, water samples contained less biofilm.
pain points
The system was too expensive to maintain and operate. Hospitals could fund small system repairs but had difficulty funding recurring expenses like regular chlorine for the system. Often hospital budgets did not include line items for tools needed for system maintenance. Obtaining foreign parts was even more costly.
Maintaining a decentralized water treatment system doesn't end with the system. Sourcing the water for the system was also a process. If hospitals were not connected to a municipal system, water had to be collected from elsewhere, and that was time consuming. One director wanted the hospital be connected to the municipal water supply so he wouldn't have to deal with operating the system.
Support was limited. A GE Ambassador and technician assisted maintenance staff at each hospital. He was a master at problem-solving and repairing the systems, but there were limits on how often he could travel to each hospital. In his absence, the systems were often inoperable.
The water systems were designed to be used in fresh, pristine waters. Groundwater sources in Mampong contained minerals like iron and zinc in high concentrations challenging the integrity of the membrane filters. Axim Hospital is on the coast of Ghana, and the water system was rusting due to salt water exposure. All hospitals received the same membrane filtration systems despite varying water sources and landscapes.
challenge
Maintaining a water system in Ghana comprised exclusively of parts made and sold outside of the country presents challenges for hospital maintenance staff.
How might hospitals in Ghana with decentralized water filtration technology be supported to better manage their on-site water systems?
solution
The General Electric Foundation donated new systems to each hospital.
The new systems:
were more resilient against beachfront landscapes and mineral-rich water sources.
had an automatic chlorine doser to treat filtered water.
The Center for Global Safe WASH also conducted safe water trainings with maintenance staff and hospital administration.
At the trainings:
hospital staff shared best practices for safe water management within the hospital.
GE Ambassador assisted maintenance staff in creating routines for managing the system.
reflections
forcing responsibility
The hospitals that received a decentralized water system were in need of a safe, reliable water source, but their pain points should have been considered. At the hospitals studied, operating the water system was costly in every way imaginable.
The GE decentralized water filtration systems were new to Ghana. They had not been tested within the country's varying landscapes, but hospital maintenance staff were still responsible for operating them in addition to their standard tasks.
The Ghanaian government did not have a national regulatory authority in place to monitor water quality within hospitals in Ghana. Without government support, expecting individual hospitals to manage this process may have been unrealistic.
