Safer care for babies and rust-free equipment: In Viet Nam, WHO supports climate-resilient and environmentally sustainable health-care facilities

Almost half of health-care facilities in Viet Nam do not have a reliable supply of safe water, which is essential for safe health care. Climate change is heightening the risks, by making current water supplies less secure and less reliable. In Vinh Long Province in the Mekong Delta, the World Health Organization (WHO) has helped a hospital upgrade its water supply, save money on electricity and more, to serve its community better and more safely.

^{Cu Lao Minh Hospital can now treat up to 50% more patients a day, thanks to improvements supported by WHO.
Photo: WHO Viet Nam}

Every day, Cu Lao Minh Area General Hospital treated 400 inpatients and at least 1000 outpatients from its farming community of 500,000 people, in Vinh Long Province (formerly Ben Tre Province) 100km south-west of Ho Chi Minh City.

Its ambition: to be a clean, green and beautiful hospital.

Located in the Mekong Delta, however, salinization or saltwater intrusion is a significant challenge. Climate change, along with water and riverbed management practices, is worsening the problem, bringing rising sea levels and altered rainfall patterns, along with droughts and floods.

^{Cu Lao Minh Hospital Director Dr Ngo Van Tuoi said enhancements to the supply and quality of water had lowered infection rates for babies and other patients, and increased the number of people it could care for.
Photo: WHO Viet Nam}

"Clean water is crucial for preventing infections and keeping patients, staff, visitors and the community safe", Cu Lao Minh Hospital Director Dr Ngo Van Tuoi said.

But in a drought in 2016, the hospital staff noticed that the hospital's water supply from Mo Cay River, which flows from the Mekong River, was becoming increasingly salty, a particular concern for babies' delicate and sensitive skin.

"We need clean water when we take care of patients, especially babies, whose skin is thin and young. The saltwater affects the baby's skin.”

^{Cu Lao Minh Hospital Vice-Head of the Section of General Planning Dr Nguyen Phuong Nghi said in the past, salty water had made it harder to clean and maintain medical instruments.
Photo: WHO Viet Nam}

Saltwater is also not ideal for cleaning medical equipment, said Dr Nguyen Phuong Nghi, Vice-Head of the Section of General Planning.

“It was very difficult to clean medical instruments. They would not be as clean. And it was easy for them to rust or be damaged. They didn’t last as long.”

Strengthening health care through climate resilience

Almost half of health-care facilities in Viet Nam do not have a reliable supply of quality water, according to WHO’s Global Progress Report on Water, Sanitation and Hygiene in Health-Care Facilities. Sufficient supplies of safe water are essential for quality health care. Despite the risk of climate change, many hospitals also lack adequate backup power, cooling systems and structural resilience to withstand climate shocks. This has been especially evident during heatwaves, floods and typhoons.

To help make health services more climate resilient, WHO has been working with the Viet Nam Administration of Disease Prevention (formerly the Ministry of Health’s Health Environment Management Agency, VIHEMA) since 2021 to pilot WHO's Climate Resilient and Environmentally Sustainable Health-Care Facilities (CRESHCF) global operational framework in 3 hospitals including Cu Lao Minh Hospital. The pilots focus on 4 elements: the health workforce; water, sanitation, hygiene and health-care waste management; sustainable energy services; and infrastructure, technologies and products.

At Cu Lao Minh Hospital, WHO funded the upgrade of a water desalination plant; supported capacity building of key health staff to run the plant and test the water to detect pathogens so they could prevent health care-associated infections; improved toilet and handwashing facilities for patients and staff; and helped engage the private sector to supply solar panels to power the desalination system and other essential services, ensuring reliable and sustainable energy access. 

Since 2023, the upgraded saltwater filtration system has been capable of running 12 hours a day and purifying 1000 litres per hour – enough for the hospital’s needs. With the water less salty, it has been easier to sterilize medical equipment by steam.

Dr Ngo said the changes had lowered the rate of infections for babies and adults, and the cleaner facilities had drawn more patients, who in the past might have travelled to higher level hospitals.

"The hygiene of the hospital is better, much, much better than before. 

“It has also attracted patients. The outpatient examinations have increased a lot. In the past, it may have been about 1000. Now, sometimes it is up to 1500 patients a day. 

“Patients here are also generally very satisfied with the hygiene of the toilets compared to before.”

^{Diabetes patient Huynh Thi Lien, 51, said she faces a lack of water at home, but Cu Lao Minh Hospital has plenty of water and looks clean.
Photo: WHO Viet Nam}

Diabetes patient Huynh Thi Lien, 51, has been visiting the hospital for 8 years as an outpatient for checkups for her condition, a common noncommunicable disease (NCD). 

“At home, there's a drought and a lack of water, but the hospital provides everything patients need. The hospital doesn't have water cuts. Nothing is missing. The water supply is normal and plentiful. 

“The hospital is clean,” she added.

Savings from solar energy invested to improve quality 

Solar energy and encouraging staff to conserve electricity, for example by switching off air conditioning 30 minutes before the end of the working day, has saved 20% of the hospital’s energy costs, Dr Ngo said.

“I can accumulate those funds, then I can give staff higher salaries, invest in medical equipment and upgrade equipment to improve the quality of service. The purpose is to improve the quality of service, to be better and better so that I create trust for patients, then they will come here. If we want to improve service quality, we have to invest in people with expertise and medical equipment simultaneously.”

The benefits of quality, local health care are enormous, especially for low-income farmers in the hospital’s catchment, Dr Ngo said.

“Patients here are farmers and relatively poor. People's situation is very difficult.”

People rely on health care that is closest to their homes, starting with commune health stations that aim to provide primary care services and public health services. All grassroots health-care facilities need an adequate supply of potable water. But when people need more specialized care or have severe conditions, it is important to have a hospital nearby.

“By staying closer to home, people can avoid the expense of travel, food and accommodation at higher level hospitals. If the hospital is close to home, the community can take care of the sick more easily, such as helping with housework. If you travel to the provincial hospital, you can't do those things. So, I think it is much better for people to be treated at a medical facility that is much closer to home,” he said.

Alignment with Viet Nam’s targets

Viet Nam has demonstrated strong commitment to developing climate-resilient health infrastructure and reducing the carbon footprint of its health-care system, as well as to strengthening grassroots health care through transforming the commune health system. 

Viet Nam’s Ministry of Health has joined WHO’s Alliance for Transformative Action on Climate and Health (ATACH) following COP26, to help the health system contribute to the country’s target of achieving net-zero carbon emissions by 2050. The country serves on the ATACH Steering Committee as the representative for the Western Pacific Region. 

^{WHO Representative Dr Angela Pratt, centre, with WHO National Professional Officer Ton Tuan Nghia, left, and hospital staff, said improving climate-resilience and environmental sustainability helps health-care facilities offer safer health care in their communities.
Photo: WHO Viet Nam}

Visiting Cu Lao Minh Hospital, WHO Representative in Viet Nam Dr Angela Pratt said, “We know that health care cannot be provided safely unless health-care facilities have a reliable supply of clean water. Yet the ability of health-care facilities to secure clean water is getting more difficult with climate change. 

“This is why this work is so important. It not only strengthens the ability of hospitals like Cu Lao Minh Hospital to offer safe health care, despite the effects of climate change. The experiences of this pilot project can also be a model that informs and inspires hospital leaders around Viet Nam, to make changes that enable them to keep providing safe health care,” she said. 

“Our ambition is to take lessons from the improvements that have been made to this hospital and scale up around the country. 

“These experiences will feed into guidance that the Government is developing, with WHO technical advice, thanks to the generous support of the Government of Australia, on climate resilience for hospitals across the country. And it will help contribute to Viet Nam’s overall national and international climate change and sustainability commitments.”

More investment needed 

Dr Pratt called for greater investment by the Government and development partners in climate-resilient and environmentally sustainable health care. 

“It’s amazing to see that a relatively small financial investment is making a major impact. The risk of infections is down, the quality of services has improved and the hospital director told me that patients are much, much happier.

“Finance will be crucial to sustaining the impacts – and rolling them out across other hospitals in the country.”

Despite demonstrated impact, and 25% of the global disease burden being linked to environmental risk factors, just 0.5% of multilateral climate finance goes to health. Resilient health systems not only reduce mortality and morbidity during disasters, but also lower long-term costs of response and recovery. According to the World Bank, every dollar invested in resilience saves up to $4 in disaster response.

“Cu Lao Minh Hospital’s work to ensure safe, climate-resilient health care for the provincial communities that it serves not only improves health outcomes and equity now. It is also an investment in a safer and healthier future for Viet Nam in a changing climate,” Dr Pratt said. 

Better health care for all 

^{Cu Lao Minh Hospital Vice-Head of the Section of General Planning Dr Nguyen Phuong Nghi showed WHO Representative Dr Angela Pratt the water system, which has improved the quality of care at the facility.
Photo: WHO Viet Nam}

Dr Nguyen said the changes have resulted in better health care and deeply enhanced the experience of patients, whether they are older people who are preventing and managing NCDs – or mothers and their newborn babies.

“It has been a very big change. When patients enter the hospital, they have a cooler, cleaner and more beautiful space, just as they have toilets that are available, more hygienic, cleaner. It creates a good relationship between patients and the hospitals. 

“Our working environment is also much improved, through activities such as taking care of trees. It can create excitement for the employees to work here. Of course, the quality of the work is better.

^{Patients like Nguyen Thi Lieu, 70, said changes to the hospital have made it cleaner.
Photo: WHO Viet Nam}