WASH in health care facilities
Clean water, sanitation and hygiene in health care facilities saves lives
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One in four health care facilities around the world lacks basic water services, impacting over 2 billion people, according to a report by the World Health Organization (WHO) and UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP).
The report found that 1 in 5 health care facilities lacks sanitation services, impacting 1.5 billion people, and also revealed that many health centres lack basic facilities for hand hygiene and safe segregation and disposal of health care waste.
These services are crucial to preventing infections, reducing the spread of antimicrobial resistance, and providing quality care, particularly for safe childbirth.
Many health facilities in India, particularly pre-and post-natal wards currently experience a high burden of nosocomial infections due to lack of clean toilets in proportion to the patient and staff load, general cleanliness, bio-medical, solid, and liquid waste management, and poor hygienic practices. Lack of adequate sanitation in health care facilities leads to a high incidence of maternal and neonatal sepsis; which also has a high fatality.
Due to the lack of access to water and sanitation, women are further discouraged from institutional delivery or they delay health-seeking advice.
In India, only 19.2 per cent of labour rooms and 3.2 per cent of post-natal care wards across 3 tiers of health facilities have functional toilets. Healthcare-associated infections affect hundreds of millions of patients every year with 15 per cent of patients estimated to develop one or more infections during their hospital stay. Source(UN Report and Allegranzi et al., 2011 )
However, risks from infectious diseases contracted in unhygienic health care facilities do not end when newborn children and mothers are brought home to a community that lacks toilets.
Amid the COVID-19 pandemic, these concerns have intensified in low-resource healthcare facilities, where according to the WHO, the inability to decontaminate hands and surfaces will lead to greater transmission of the coronavirus, which in turn will cause serious illness and loss of life among patients and medical personnel.
To effectively address WASH in the healthcare setting, it is important to equip healthcare staff on infection prevention and control (IPC), hand hygiene, quality of care, operation and maintenance of infrastructure, and bio-medical waste management.
Ensuring clean and hygienic hospitals
The 2011 Global Antibiotic Resistance Partnership report concluded that a large proportion of hospital-acquired-infections in India are preventable with increased infection control, including stepping up hygiene practices such as frequent hand washing.
An inclusive focus on WASH in health care facilities is a unique opportunity to encourage safe water management, toilet use, and handwashing with soap among mothers and their young children.
UNICEF works closely with the Government of India on increasing WASH in health care facilities and our approach is evidence-based. Our work includes gap assessment, demonstration of workable models on the ground, and assistance in planning, management, and monitoring to scale up successful institutional WASH models.
In 2015, the Ministry of Health and Family Welfare (MoHFW) with support from UNICEF instituted the KAYAKALP scheme to recognize and reward the excellence of health facilities in promoting cleanliness, thereby improving the quality of health care services.
KAYAKALP is a scheme for rewarding best-performing health facilities at all levels based on an external assessment by a team constituted by the health department in each state.
In 2016, UNICEF along with the MoHFW and the erstwhile Ministry of Drinking Water and Sanitation (now Ministry of Jal Shakti) instituted the Swacch Swasth Sarvatra (SSS) scheme.
The SSS aims to optimize the benefits of Swacch Bharat Mission and the Kayakalp schemes by motivating the blocks which have become Open defecation-free to ensure the nearby community health centers in becoming KAYAKALP compliant and the KAYAKALP awarded health care facilities in motivating villages for sustaining their open defecation free status.
UNICEF supports the capacity building of the state, district, and block-level stakeholders to share knowledge and information on the need to focus on WASH in healthcare facilities. This includes guidance on how to conduct a needs assessment of WASH in HCF infrastructure, biomedical waste management, handwashing, and gCOVID-19 protocols.
The gap assessments inform the development of facility improvement plans which is followed by supportive supervision during the plan’s implementation. UNICEF’s technical support has been successful instrumental for 40 high-priority districts to come up with concrete action plans to institutionalize WASH in healthcare facilities during 2019-20.
UNICEF supports continued monitoring of WASH infrastructure and practices in healthcare facilities to ensure sustainability. We also support the process of assessments of the conditions of the WASH facilities in healthcare facilities, which are carried out with the involvement of state and district level staff of the health department.
“When a baby is born in a health facility without adequate water, sanitation, and hygiene, the risk of infection and death for both the mother and the baby is high,” said UNICEF Executive Director Henrietta Fore. “Every birth should be supported by a safe pair of hands, washed with soap and water, using sterile equipment, in a clean environment.”