Access to safe Water, Sanitation and Hygiene (WASH) is one of the most important development issues worldwide. However, despite significant investments, lack of effective WASH services in health care facilities and communities remains a persistent challenge which has profound impacts on public health, livelihoods, education, and socio-economic development. In many developing countries, provision of the WASH in health care facilities is one of the key strategic interventions in strengthening health systems for quality health care. According to World Health Organisation (WHO), WASH in health care facilities largely refers to the provision of water, sanitation, health care waste management, hygiene and environmental cleaning infrastructure, and services across all parts of a health facility.
Undoubtedly, without adequate and safe WASH services in health care facilities, it is difficult for developing countries to achieve Universal Health Coverage (UHC) and ambitious targets of Sustainable Development Goals (SDGs) related to health and WASH. Therefore, provision of WASH is vital for ensuring patient safety and quality of care in all health facilities. Evidences suggest that promoting WASH in health care facilities reduces the risks of infection for patients, carers, health workers and communities, and significantly contributes to effective prevention of cholera, diarrheal and other water-borne diseases. Therefore, there is a new emphasis on the UHC and easy access to safe WASH services in the health care facilities.
Obviously, it is essential to ensure that health care facilities have sufficient quantities of safe water to provide health care services. Unfortunately, it is estimated that a quarter of all health care facilities have no basic water services. Furthermore, there is inadequate drinking water, hand hygiene, and reliable supplies of safe water in many rural health facilities. On the other hand, inadequate sanitation services in health care facilities are key concerns for health workers, patients and care givers.
Moreover, limited understanding of socio-cultural norms, local practices, as well as lack of gender-sensitivity and disability inclusive health infrastructure do not motivate people in seeking health care in the health facilities. Again, effective hand hygiene in health care facilities has been the cornerstone of infection prevention and control (IPC) guidelines and practices. The provision of effective WASH interventions, waste management and hygienic conditions is vital for preventing and protecting human health during all infectious disease outbreaks, including COVID-19.
In Nepal, Ministry of Health and Population (MoHP) has developed standard guidelines on WASH in health care facilities to improve the quality of health care. Similarly, health care waste management standards and operating procedures-2020 have been developed to facilitate the effective implementation of health care waste management systems in all health facilities. In this context, technical assistance from WHO, UNICEF, UN-Habitat, WaterAid and other partners is necessary to strengthen the institutional capacity of health facilities for effective implementation of these guidelines and standards at all levels.
Notably, the national initiatives such as hygiene promotion through routine immunisation, capacity building of health workers in water and sanitation for health facility improvement tool that essentially covers key aspects of water, sanitation, hand hygiene, environmental cleaning, health care waste management, and facility management. Although WASH plans at the local level are new priorities for interventions, these are not effectively integrated into local health systems and implemented for years due to limited capacity of local governments.
There is increasing focus of climate-resilient health systems that importantly urges the inclusion of WASH in health care facilities. In this context, Epidemiology and Disease Control Division (EDCD) at Department of Health Services has already started existing diseases surveillance system from a climate change perspective. This primarily includes measures to integrate meteorological data and climate-sensitive diseases data to monitor and forecast the probability of disease expansion.
Therefore, promoting WASH in health care facilities should be a priority agenda in resilient health systems to ensure quality health care at all levels. The first and foremost step is to conduct participatory situation analysis and assessment that provides evidences for existing local health and WASH policies, governance structures, health financing landscape, WASH coverage and compliance in the health facilities. Undoubtedly, this will help develop a roadmap that outlines strategic approach, key priority WASH interventions, targets and budgets for implementation plans for a specific timeframe.
Based on the country context and emerging priorities, national standards and accountability mechanisms would provide a practical basis for design, costing, implementation and operation of WASH services and help ensure that all health facilities meet the standards and guidelines. Furthermore, WASH indicators could be integrated into routine health information systems so that it is easier to monitor and measure the actual progress. Therefore, more efforts are needed to effectively coordinate and engage a range of community stakeholders while developing WASH policies, strategies and implementation plans at all levels.
Comprehensive review of WASH coverage and implementation data at all levels is critical to ensure effectiveness and efficiency of WASH interventions for improved health outcomes. In the changing context, the global recommendations primarily focus actions to enhance the capacity of health workforce in promoting safe WASH in health care facilities for quality health care. Further, it is crucial to integrate WASH into national health systems, development policies, planning, budgeting and programming. Therefore, there are critical needs of coordinated efforts to establish national roadmap, targets and budget for effective implementation of WASH in health care facilities.
(PhD in global health, Bhandari writes on health and development issues)