Stories
October 7, 2025 • 2 min read
In Sierra Leone’s Bombali District, a comprehensive WASH FIT assessment uncovered deep-rooted weaknesses in healthcare facilities, from unreliable water supplies to inadequate sanitation and waste management systems. Through GOAL’s WASH Systems for Health (WS4H) project, funded by the UK’s Foreign, Commonwealth and Development Office (FCDO), local communities are taking ownership of their health facilities. In towns like Masongbo and Binkolo, community members now manage cleaning schedules, maintain water systems, and ensure hygiene standards are upheld. The results are cleaner, safer healthcare environments and stronger local systems that can sustain progress long after project completion.
The Water, Sanitation, and Hygiene Systems for Health (WS4H) project, implemented by GOAL Sierra Leone, aims to strengthen water, sanitation, and hygiene systems in healthcare facilities. A district-wide WASH FIT (Water and Sanitation for Health Facility Improvement Tool) assessment conducted across 83 facilities in Bombali District revealed significant gaps: water services scored 49%, sanitation 46%, and management and workforce capacity only 28%. These results highlight systemic weaknesses that directly impact both the quality of patient care and the working conditions of health professionals.
In response, GOAL and district health teams have been working closely with communities to transition from dependency on external interventions to local ownership, fostering long-term sustainability in health service delivery.
A System in Need of Strengthening
The WASH FIT assessment did more than identify missing infrastructure; it highlighted the systemic barriers undermining healthcare delivery. Many facilities lacked consistent water supplies, adequate sanitation, and trained personnel to manage WASH services.
“The assessment opened our eyes,” said Idrissa Tarawally, District Health Superintendent of the Bombali District Health Management Team. “It helped us understand that WASH is everyone’s responsibility, not just the government’s.”
GOAL’s intervention focused on empowering healthcare staff and communities to lead change rather than depend solely on external assistance. This approach marked the beginning of a cultural shift toward shared responsibility in maintaining health facilities.
Building Ownership: Communities Take the Lead
In Masongbo, Makarie Chiefdom, community members are now co-owners of their health system. Through WS4H training, they learned how to effectively manage and maintain WASH facilities.
“We don’t have to wait anymore for others to solve minor issues,” said Gibrilla Kamara, Chairman of the Facility Management Committee. “The training showed us that running the centre is our job too.”
Local carpenters and plumbers now volunteer to fix broken water systems and toilets. Maintenance funds are raised through community donations and cost-recovery from patient contributions. The results are visible: labour wards are clean, odour-free, and medical waste is disposed of safely.
“Before the training, the facility was dirty, and patients were uncomfortable. Now, it’s clean, gowns are properly washed, and patients are happy,” said Alie Sesay, CHO in Charge at Masongbo Community Health Centre.
Resident Aminata Adama Fornah agrees: “We no longer smell blood or strong drugs inside the wards. The place feels safe and welcoming.”
From Local Action to National Impact
The success of Masongbo and Binkolo is influencing national policy. GOAL, in collaboration with the Ministry of Water Resources and Sanitation, has co-developed a 10-year National WASH Strategy (2025–2035) that embeds system strengthening and community-driven models at the centre of WASH service delivery across Sierra Leone. These local transformations show that when communities are empowered and systems are built collaboratively, sustainable change becomes not just possible, but inevitable.
