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Promoting hand hygiene in Tanzanian prisons during COVID-19
Promoting hand hygiene in Tanzanian prisons during COVID-19

A case study from Water Mission

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Updated over a week ago

Country and region: Tanzania, Dar es Salaam

Organisation: Water Mission

Point person and Role: Julia Sherry, Program Evaluation Specialist

Population served by the programme: 7,583 people including 4,250 prisoners, 1,865 prison staff, 1,468 visitors

Unique characteristics of the setting: Prisons in the Dar es Salaam region in Tanzania are densely populated with staff and prisoners and there are also hundreds of daily visitors who go in and out. When COVID-19 broke out, these populations were particularly vulnerable as they also lacked basic hygiene infrastructure.

Number of cases and deaths due to COVID-19 at time of publishing: 509 cases and 21 deaths on November 25th, 2020

A prison staff member washing hands with soap at a Water Mission handwashing station in a prison in the Dar es Salaam region, Tanzania

Briefly describe the key components of your COVID-19 response programme.

Our emergency hand hygiene intervention in prisons in the Dar es Salaam region is part of a broader COVID-19 response programme encompassing the installation of more than 1,000 handwashing stations in healthcare facilities, the delivery of hygiene promotion activities and materials to health facility staff and the general population, and efforts to increase community-based water access and build local maintenance and monitoring capacity.

Screenshot of a chart on our mWater monitoring platform showing where Water Mission has installed the handwashing stations in response to the COVID-19 pandemic within Tanzania

Our work in prisons involves two main components:

  • Installation of handwashing stations: in partnership with the Poul Due Jensen Foundation, we have installed 35 handwashing stations, each complete with clean water, soap, and proper drainage, across four prisons in the Dar es Salaam region, serving the prisoners, prison staff and visitors. The handwashing stations were first implemented at healthcare facilities across Dar es Salaam, and were adapted for the prison setting. The prisons’ stations were designed to be durable under frequent use and accompanied by behavioural information promoting physical distancing in front of the station. We initially provided soap for all stations, before securing sustained provision of soap and water from the Chief Commandant of Prisons to continue throughout the pandemic. The goal of this intervention is to make handwashing stations accessible where needed in a prison setting, including at the prison entrance, in dormitories, at dining halls, in the infirmary, the recreation centre, and guard stations.

  • Training of handwashing station operators: we have worked with prison staff members to identify, among them, handwashing station operators. These responsible people have been trained on station maintenance and disinfection protocols to ensure the sustainability of the stations and appropriate practice of hand hygiene behaviour.

Table showing the number of prisoners, staff members, and visitors benefiting from Water Mission’s handwashing stations at four prisons in the Dar es Salaam region, Tanzania

What process did you use when designing your COVID-19 response programme?

We originally learned of the needs in prisons through the Dar es Salaam Region Chief Medical Officer, who we had been in contact with as we installed the handwashing stations in health facilities around Dar es Salaam. He connected us with the Chief Commandant of Prisons in Dar es Salaam. We worked with the Chief Commandant and prison staff members to define the needs of the prisons and the scope of our intervention. We used our learnings and best practices from previous handwashing station programmes as well as inputs from prison staff to develop our intervention. For instance, we adapted our original handwashing station design based on prison staff’s comments. Instead of our usual taps, we opted for a reinforced ball-valve tap to increase the durability of our handwashing stations under frequent use.

What is one thing that has been working really well so far and is there something other programmes could learn from this?

According to an initial needs assessment we conducted with prison officials and staff, the fear of COVID-19 transmission and spread was really high among staff, prisoners and visitors. The timely provision of the handwashing stations therefore met an urgent need within the prisons and provided the opportunity to increase hand hygiene and promote COVID-19 preventive behaviours. Our station design had already been tested in healthcare facilities and was fine-tuned based on lessons learned from health facility staff (e.g. type of informational posters needed, size of water tank to be used, etc). Based on prison staff members’ comments, we only had to change the model of taps, which were replaced by a more durable, locally available option.

In the areas of the prisons that we could access, our team installed the handwashing stations in collaboration with prison staff. In high-security areas which could not be accessed, the installation of the stations was done by trained prison staff. We supported those staff members remotely using phones during the entire installation process. We ensured all stations were properly installed and functional and were serving the intended populations as part of our on-going monitoring programme.

A prison staff member and a visitor washing hands with soap at the entrance of a prison in the Dar es Salaam region, Tanzania

What is one challenge that you have encountered and how are you trying to overcome this?

Due to security concerns, it has been impossible for our staff to access secure areas of the prisons and to involve prisoners in the design or the monitoring of our intervention. We have also been unable to conduct the hygiene promotion activities we typically conduct to complement these handwashing facilities. Instead we have relied on informational posters placed on the facility to prompt and encourage good handwashing practices. The staff we trained are also able to promote handwashing with soap among prisoners.

How have you been engaging communities throughout your programme and what feedback have you received?

We are planning to monitor this intervention for a year from June 2020 to June 2021 via our mWater monitoring platform and through monthly follow-up surveys and reports. Each day, wash station operators are trained to ensure water and soap availability and carry out disinfection measures at each station. Each month, we are conducting an in-depth phone-based survey with each station operator to assess the functionality of each handwashing station in the prisons and recording operational issues. We are also collecting data on maintenance of hygiene promotion and physical distancing promotion posters in front of the stations. This data is collated into a monthly report for further analysis. In addition, we remain in regular and informal contact with trained operators to answer any question they might have using phone-based apps.

To date, overall feedback from operators has been highly positive. They have reported that all wash stations are being used daily by prisoners and staff members and very few functionality problems have been documented.

We have unfortunately not been able to assess satisfaction among prisoners nor gather reliable data on station use by prisoners beyond the positive anecdotal evidence received from prison staff members.

Screenshot of the mWater monitoring platform used to track handwashing installation and maintenance in the countries and settings Water Mission is active in

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