A zigzag path leads to the general hospital of Bac Ha district, Lao Cai province. Located in a small mountain village in the north of Viet Nam, for many years the hospital faced limited access to water and sanitation services. The volume of water here was unpredictable, and it could be contaminated.
Many hospitals cannot rely on clean water
Bac Ha is not unusual. About half of health care facilities in Viet Nam cannot rely on the quality or quantity of water they need. Some hospitals lack clean toilets; in some, patients need to bring or buy their own water to drink.
Bac Ha general hospital depended on rainwater because the mountainous terrain makes it difficult to draw groundwater.
“This is a source of concern for us,” said Dang Xuan Thuan, a Bac Ha hospital technician, “because the water source is unreliable, and we can’t rely on the water being clean enough for medical purposes, which causes the hospital many difficulties.”
Water scarcity also made it harder for the hospital to promote hand hygiene among patients, staff, and visitors to prevent communicable diseases.
Bac Ha is one of three hospitals chosen by the Government of Viet Nam, with the support of the World Health Organization (WHO), to pilot ways of enhancing their climate-resilience, with the aim of developing national guidelines on ensuring a secure supply of clean water.
Yen Thanh district general hospital in Nghe An province, in the centre of Viet Nam, also suffered from a lack of clean water. Due to a combination of scarce groundwater and its location at the end of the local water supply network, at times the hospital ran on less than a third of what it needed. Averaging over 140 000 visits, and 16 000 inpatients every year, Yen Thanh hospital plays a critical role in the health and well-being of the community.
In the south of Viet Nam, Cu Lao Minh general hospital in Ben Tre Province, is in the Mekong Delta region, an area affected by droughts, floods, and saltwater intrusion every year, diminishing supply, and forcing the facility to treat the water before it can be used. Climate change is forecast to bring more extreme weather to the Delta.
Designing tailored solutions together
In health-care facilities, a reliable source of safe water is essential for effective infection prevention and control (IPC) to prevent avoidable infections, including those caused by antimicrobial-resistant (AMR) pathogens, from harming patients, health workers and visitors.
Climate change is set to worsen water scarcity in health care facilities. With more than 3,200 kilometres of coastline and many low-lying cities and mountain areas, Viet Nam is vulnerable to climate change, which is expected to cause sea level rise as well as increased flooding, typhoons, and drought.
Recognizing the current and future risks, since 2021 the WHO Country Office in Viet Nam has been working with the Ministry of Health’s Health Environment Management Agency (VIHEMA) to pilot tailored solutions to mitigate the risks at the three hospitals.
At Bac Ha, a rainwater for drinking (RFD) system, which included catchment, storage, and treatment components, completed with support from the Institute of Environment Science and Technology (IESE), began running in December 2021.
Meanwhile, at Yen Thanh Hospital, the community had the answer. After extensive engagement, neighbours understood the problem and how it affected their health. They agreed to allow the hospital to draw water from a stream and pass water pipes over their land. Now a surface water treatment system with a capacity of 50 to 80 m3 per day supplies the facility’s needs. Eventually, though, more water will be required as the hospital’s needs grow.
Finally, in the Mekong Delta, the level of saline intrusion was higher during the dry season in 2023, but it no longer has a significant impact on the supply of clean water to Cu Lao Minh General Hospital as an upgraded saltwater filtration system is running 12 hours a day and purifying 1000 litres per hour – enough for the hospital’s needs.
Safer health care, even in an era of climate change
After nearly two years of operation, better water supplies at the three hospitals, which have all invested in staff to manage and maintain the systems, have enabled them to deliver safer health care.
Dr Angela Pratt, WHO Representative in Viet Nam said, “Unfortunately, we can expect climate change to increasingly threaten water supplies at health care facilities throughout Viet Nam, so it is critical to act quickly with adaptation measures.
“WHO is pleased to partner with the government to help pilot water supply systems at these three hospitals, so that they can keep serving their communities safely, serve as models for other health care facilities, and to develop guidance on climate and water resilience for hospitals across the country.
“Secure safe water supplies are crucial for delivering high quality care and keeping services accessible near where people live. Investing in climate-resilience can also help reduce costs and contribute to more efficient and equitable health systems.”
WHO’s work on improving water supplies at hospitals is conducted using WASH FIT, a risk-based, quality improvement tool for health care facilities, covering key aspects of WASH services: water; sanitation; hand hygiene; environmental cleaning; health care waste management; and selected aspects of energy, building and facility management.