Proposed Expansion of Kisii Hospital Water Supply
Situation Summary - The 200 bed Kisii District Hospital, in the western Kenya highlands, was built in 1916 and has expanded through the years to accommodate 332 in-patients and a daily average of 500 out-patients. Bed occupancy ranges from 130% to 230% during the past ten years and has gon...
Proposed Expansion of Kisii Hospital Water Supply
Situation Summary - The 200 bed Kisii District Hospital, in the western Kenya highlands, was built in 1916 and has expanded through the years to accommodate 332 in-patients and a daily average of 500 out-patients. Bed occupancy ranges from 130% to 230% during the past ten years and has gone as high as 550% during times of malaria outbreaks.
Current Demand – 180,000 LPD (i.e., 180 cubic meters per day - CMD), and existing sources (totaling 40 cm/day, or only 22% of current demand) are – 15 CMD from a borehole, 10 CMD from water harvesting (does this mean rainwater catchment or gray-water recycling?) , and 15 CMD from the municipal water system. Constant breakdowns of water supply further complicate the situation.
Water Demand Calculation - According to WHO standards for domestic use in emergency situations (which may or may not apply in this situation), water demand for Health Centers is: 5 liters per out-patient; and 40-60 liters per In-patient. For hospitals (with laundry facilities) the demand is 220-300 liters per bed. So for this situation, with 332 beds (presumably same as the number of in-patients) the total demand is somewhere between 73 – 100 CMD. Go for the high side to be safe. Then if you assume that the 500 out-patients consume half that amount per capita, add another 55-75 CMD for a high-side total of 175 CMD (or 175,000 liters) per day. Therefore, their demand estimate is right on for the current situation, but does not appear to include further demand growth over time. However, the proposed incremental source with a measured capacity of 300 CMD is more than adequate for future expansion. Question – is the proposed source not currently being used? Who owns the source? Who can guarantee that it might not be developed by some other agency or company in the near future? Confirm the long term availability of and legal access to the source, if this has not already been done.
Recommendation for the proposed water system addition – Two Thumbs Up (as they say in the movie reviews). Do it, and if the situation is such that the hospital itself may expand its patient capacity over the short-medium term, then the system planners should take that fully into account in designing the currently proposed expansion.
Other Issues to Consider
A water demand management (i.e., conservation) program, including automatic shutoff valves, low flow toilets and showers, grey water recycling, etc. to minimize the need for expensive additional capacity.
Rainwater catchment as a potentially important supplemental source of water during and shortly after the rainy season.
Promoting hand washing with soap among both staff and patients.
Financial sustainability – So far it seems that only capital investment costs are being considered. It is important to also plan for O&M, repair, replacement and possibly further expansion costs. Who will pay for these costs? You can't expect the government to do much here, and the patients are unlikely to be able to afford even basic medical service costs. The proposal should specify how these costs will be covered. Otherwise the system will fail financially.
Having visited several hospitals that are probably like this one, I guess that I don't really want to know much detail about the “outdoor latrinesâ€Â, but I would imagine that they are a significant disease vector. A basic hand-washing (with soap) campaign would likely provide significant health benefits at a relatively low cost. The World Bank Regional Water and Sanitation Program (RWSP) in East Africa (http://www.wsp.org/07_Africa.asp) and numerous other donor and NGO organizations have ready-to-use IEC materials on promoting handwashing in Kiswahili and English (and possibly even some of the local languages). The proposed program should make a concerted effort to at least disseminate these materials for the health car providers.