On-site Capacity. Subdomains for on-site capacity include organization and communication, training and capacity strengthening, maintenance, and repairs (Figure 20). Sustainability ratings for on-site capacity showed variability with average scores ranging 0.5 to 2.6. Overall, Axim hospital was the only hospital to meet to cut off for sustainability with an average score of 2.6.
On-site Capacity. Axim was the only hospital that met and exceeded the cut-off for sustainability in this domain. Most hospitals struggled with the subdomains related to on-site capacity. In Bole hospital, the maintenance staff did not have the technical knowledge to repair the water treatment system therefore system repairs were outsourced. Outsourcing system repairs can undermine the sustainability of the water system because this requires additional hospital funds. Additionally, outsourcing maintenance repairs does not allow the maintenance staff to develop institutional knowledge. However, as a last resort, having access to external technical support for water system repairs can be critical for hospitals that do not have that capacity on site. Though the maintenance staff in most hospitals is adequately trained, they do not fully understand their roles and are incapable of carrying out major repairs for the system without frequent help from the GE technical ambassador. As evidenced by the research conducted by Saboori et al. on sustaining school hand washing and water treatment programs in Kenya, easy accessibility of parts for needed repairs and increased knowledge of major system repairs are needed to ensure uninterrupted operations and sustained use of water systems. 50 In all hospitals, inconsistencies were observed between capacity and training, and existing organizational structures. In Mampong for example, there appeared to be a clear organizational structure, but the structure is not reflected in the capacity and training of those responsible for the upkeep of the water treatment system was still inadequate. In all hospitals, meetings between maintenance staff, administrators and directors were not regularly scheduled and often happened informally. Therefore key issues were not always communicated and follow- through on assigned responsibilities rarely occurred. The laboratory technicians in all six hospitals were trained multiple times on how to perform chlorine residual testing and provide feedback on chlorine levels to maintenance and administrative staff. However, this did not occur on a routine basis. The directors in all hospitals believed that their staff had the knowledge and capacity to perform basic repairs. However, communication between the administrator, director, and maintenance staff was not streamlined, and there was a lack of follow-through by administrators to ensure key system repairs are completed. Maintaining water pumps and adequate water p...
