A Foundation Helped Bring a Quiet Global Health Crisis Out of the Shadows

When the GE Foundation decided to adapt and test a water treatment system that GE Water had developed at 10 healthcare facilities in Ghana and Honduras, I doubt they expected to uncover a Pandora’s box of global health troubles. In doing so, the health of millions of men, women and children are better for it.

The GE Foundation (GEF), the philanthropic arm of General Electric, had teams pursuing nearly 30 special projects in the foundation’s “Developing Health Globally” program back in 2006. Among them was a pilot project to see if specially designed GE water treatment technology could sustainably provide clean water inside healthcare facilities.

GEF began this project with a quite reasonable assumption—that healthcare facilities had water but needed better treatment systems to make sure it was clean. What GEF and its implementing partner, Assist International, found on the ground was a very different reality.

The water treatment systems that GEF began installing and testing were not always functioning correctly. Not because the technology was bad, but because healthcare facilities were operating without enough water, or at times, without any water at all. Water infrastructure was nonexistent or not functional: Dilapidated sinks were falling off the walls, faucets were broken, pumps rusted and pipes broken. The situation was a mess—and dangerous to patients and staff.

Notably, GEF’s desire to treat water inside healthcare facilities was ahead of its time. It wasn’t until last year that the first global baseline study was released assessing water, sanitation and hygiene (WASH) in healthcare facilities around the world. The 2019 WHO/UNICEF report surveyed data from 560,000 healthcare facilities in 125 countries. The situation it documented is terrible: Seventeen million women in least-developed countries give birth in healthcare facilities without adequate WASH each year. Two billion people must use facilities that lack basic water services, with 45% of the healthcare facilities in least developed countries lacking basic water services. Basic water services just means water is present, and does not account for whether or not the water is clean, so the situation is likely more dire.

But back in 2006, when GEF began installing its water treatment system, these data were unknown, and GEF would learn firsthand how desperate the water situation was in the five countries where it launched—Ghana, Rwanda, Uganda, Honduras and Cambodia. Not one healthcare facility had a well-functioning and sustainable water system. Back then, there were also no funders in this water and healthcare space. To its credit, GEF did not walk away. Instead, it enlisted more help to better understand and address the problem.

GEF approached researchers from the Center for Global Safe WASH at Emory University because GEF was interested in improving the sustainability of new water systems in resource-limited contexts. To do so, they needed to invent metrics and evaluation tools that did not exist. Emory expanded the scope beyond water to WASH because healthcare facilities needed all three components to provide safe and dignified care.

As the project grew, GEF was more than willing to provide funding beyond testing its water treatment system. It was unwilling to back a “drop and go” program. The foundation became much more critical of what it was doing, as it moved from a focus on its treatment technology to an emphasis on strengthening the long-term sustainability of water systems and investigating the status of WASH in healthcare facilities. This was a new frontier, and GEF was open to leading and learning together with our team at Emory, Assist and other WASH partners.

It was innovation in real time, with GE engineers creating different versions of the water treatment system that might meet the challenges of these high-need, low-income and hard-to-reach rural health facilities. Former GE Water staff donated their time to work in the field alongside Assist, and after every installation, relevant experts came in to evaluate and improve the key goal: sustainable access to clean and safe water.

We made incremental breakthroughs in this uncharted area. Early water system prototypes offered improved installation techniques in 11 facilities in Ghana and Honduras. We took what we learned to Rwanda, where we successfully adapted and installed water systems in another 10 healthcare facilities.

To extend the benefits of clean water beyond the healthcare facility, GEF also tried out a kiosk system in Rwanda where people could purchase clean water from a water kiosk on or near hospital grounds. Consultants were employed to figure out a plausible business model, marketing, pricing, etc. In the end, we ascertained that the kiosk project was only moderately viable from a business perspective, but this openness to experimentation and possible failure was invaluable.

From Rwanda, we moved to facilities in Uganda and Cambodia. The Cambodia program was a turning point, and catalyzed a nascent movement to improve WASH in healthcare facilities. GEF stepped up again with funding to support in-country advocacy to get WASH into healthcare facilities. It was 2015. Few national governments were engaged in WASH as a health issue, and no national guidelines existed for getting WASH into healthcare facilities in developing contexts. Emory drafted the guidelines that helped form the first national policy for WASH in healthcare facilities, and the Cambodian government became the first country to adopt such national guidelines. This advocacy funding also opened up the opportunity for the Emory team to collaborate with WHO, UNICEF and WaterAid alongside the Cambodian government.

We’ve come a long way since 2006, thanks to GEF’s investment in growing, learning and changing, well beyond the installation of its water treatment systems. In the spring of 2018, the U.N. Secretary General issued a global call to action to get WASH into all healthcare facilities by 2030. A global resolution followed, unanimously passed by all 194 member states of the World Health Assembly, that lays out the eight practical steps for meeting the 2030 goal. Since the summer of 2019, there’s been an outpouring of more than 90 private-sector commitments—financial, technical and advocacy. The fall of 2019 brought in commitments to national plans in 18 developing countries. And now, the WHO has named WASH in healthcare facilities as one of the top 13 global challenges for the decade.

The road ahead remains long, but sometimes, it is good to pause and take a look back.

GE Corporation prides itself as an innovator. The GE Foundation was a pioneer private funder that recognized this major global health gap—one that continues to impact everything from maternal and child health and pandemic prevention, to the escalating antimicrobial resistance threat. Though water is no longer a part of GEF’s portfolio since GE sold off its water business in 2017, there is no doubt that GEF’s decade of risk-taking, innovative partnerships and funding played a catalytic role on this issue that is still being felt from urban hospitals to rural clinics around the world today.

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Joanne A. McGriff, MD, MPH, JM is Assistant Research Professor in the Hubert Department of Global Health at the Rollins School of Public Health at Emory University and the Associate Director of the Center for Global Safe WASH at Emory. Dr. McGriff and colleagues have been engaged in WASH in healthcare facility research and projects for over a decade in collaboration with GE Foundation and other partners.

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