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Writer's pictureDennis M. Njunge

Besides WASH in households, How is WASH in our Healthcare Facilities?

Health is a critical indicator and determinant of the performance of a nation and society (Amzat and Razum, 2018). Its provision remains an emotive issue in high, middle, and low-income countries. Despite its invaluable role, healthcare facilities are faced with a wide array of problems (Geleto et al., 2018). These challenges range from infection and diseases contracted at healthcare facilities lack of equipment, inadequate financial and human resources, and utilities such as electricity, water, and sanitation (Mara et al., 2010, Kuwawenaruwa et al., 2017, Wiedenmayer et al., 2020). Their impact on the overall health of a population is detrimental. Smiddy et al. (2013) established that the prevalence of infection associated with healthcare facilities is estimated at 7.5% in developed countries and 5.9% to19.1% in developing countries, not to mention that these infections account for 16% and 11% of global neonatal and maternal deaths respectively (UNICEF, 2019). It is also evident that the lack of critical facilities and utilities places the achievement of Universal Health Coverage(UHC) at risk (Dalinjong et al., 2018).


Nevertheless, the economic loss due to ill health is responsible for the downward slide into poverty, particularly in low-income countries (Parkinson, 2010). Specifically, the lack of WASH services in healthcare facilities directly links to maternal mortality. At the same time, endemic healthcare-associated infections have partly been found to be caused by poor environmental hygiene conditions (Benova et al., 2014, Huttinger et al., 2017). As such, WASH in healthcare facilities has been identified as a paramount service towards better healthcare provision (Guo et al., 2017). WASH in healthcare facilities has been recognized as a critical area of development in achieving the SDG 2030 agenda (WHO, 2019). These services enhance the level of care in maternity and primary settings supporting core universal health aspects of quality, equity, and dignity for all people (UNICEF, 2019). They increase staff and patients' confidence and satisfaction (Bouzid et al., 2018). Moreover, with the advent of COVID-19, access to and proper use of WASH services was identified as a major infection deterrent (World Bank, 2020).


Under the Sustainable Development Goals, the global target for basic WASH access in healthcare facilities is at least 60% by 2022. 80% by 2025 and 100% WASH services access by 2030 (WHO and UNICEF, 2019). In this light, the World Health Organisation Member States are tasked with developing and implementing road maps, policies, and strategies towards achieving these targets. Consequently, monitoring is vital to understand the status and performance of WASH in healthcare facilities and identify the constraints and opportunities for action.


Global and regional monitoring data is collated from country-specific national estimates delivered from national surveys (WHO, 2018). The process is hierarchical, where country-specific estimates are aggregated to calculate regional and global estimates. According to the 2019 JMP Global baseline report, an estimated 896 million people worldwide have no water service in healthcare facilities. 21% and 16% of HCFs lacked sanitation and hygiene services, while data is insufficient to calculate coverage estimates for sanitation, hygiene, water management, and environmental cleaning. This creates a serious gap in decision-making.


In Africa, the provision of healthcare services remains a big challenge. Rural areas are widely neglected, yet most of the population lives there (ILO, 2015). While healthcare facilities are widely non-existent, particularly in a rural setting, those available lack basic services such as medicine, electricity, water, sanitation, hygiene, and waste management facilities (Esamai et al., 2017). Consequently, basic water coverage in healthcare facilities in Sub-Saharan Africa stands at 51%- 23% lower than the global coverage. 23% of healthcare facilities have basic sanitation, while 40% have basic waste management. Coverage is unavailable for environmental cleaning in healthcare facilities due to data challenges (WHO, 2019). Even though some countries have policies to guide WASH-related intervention, there are no specific guidelines on WASH in healthcare facilities. At the same time, the lack of implementation and enforcement of policies is a great setback toward achieving set targets in most African states. These limitations, coupled with many other WASH-unrelated challenges, contribute to the highest healthcare-associated infections, which are twice as high as in any other region (Allegranzi et al., 2011). Furthermore, they are partly associated with the region's high maternal and child mortality rates (Guzman, 2018, WHO, 2019).


In Sub-Saharan Africa, Kenya is one of the countries with the highest neonatal and maternal mortality rates, partly associated with inadequate WASH services (Souza et al., 2013). It has been recorded to be among 10 countries that comprised 58% of global maternal deaths contributing to 2% of these deaths (WHO, 2013).

JMP National estimates indicated that 65.6%, 17.6%, and 16.8% of healthcare facilities have basic, limited, and no water services. Overall coverage data on basic and limited sanitation service levels are unavailable, while 14% of facilities have no sanitation services. No sufficient data is provided under hygiene and environmental cleaning, while 33.1%, 62.1%, and 4.8% of healthcare facilities have basic, limited, and no waste management services.


On the other hand, the monitoring of WASH in healthcare is based on multi-country national surveys. The most recent data sources include the 2016 Service Availability and Readiness Assessment(SARA). Similarly, national estimates since 2004 have been drawn from a variety of surveys, including; the service provision assessment (2004), service delivery indicator survey (2012), and performance monitoring for accountability (2015), among others. On the one hand, these data can be considered outdated. At the same time, comparatively, these estimates can be misleading, considering that huge inequalities and disparities exist at the sub-national level in the different parts of the country and amongst rural and urban settings.





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