The World Health Organization and its member states are actively working on improving the practices of safe water, sanitation, and hygiene (WASH) in health facilities around the world.

The basic idea behind UN’s Sustainable Development Goals, 2015 is to provide Universal Health Coverage to people. Modern day challenges of urbanisation and lifestyle changes, people are more succumb to diseases and infections. These diseases and infections cause serious health risks.

Thus, WASH is closely monitored as part of UN Sustainable Goals.

Hospitals or any health care facility is an institution where people go to meet their health care needs. What will happen when these health care institutions become a critical source of health & hygiene?

Currently, one in four health facilities lacks basic water facilities. It affects two billion people around the globe. Further, there is one in five facilities that have no provision for sanitation affecting 1.5 billion people. There are many which lack the provision for basic health hygiene.

Globally 15% of the patients develop one or more infections during their stay in hospitals. Further, with growing emergence of antimicrobial resistance, the infections transmitted during the hospital stay can cause havoc if not attended with serious preventive measures.

India, with its enormous population size and a long chain of patients in health care facilities, especially in public health care settings, it becomes very important to prioritize WASH.

According to a study, lack of sanitation and water facilities at health care facilities discourage women to use a health facility.

A report by the WHO and the UNICEF in 2015, for the first time, have looked upon the global assessment of WASH facilities in health care settings. The assessment draws the data from over 65,000 facilities from 54 low and middle-income countries. It was found that 38% of the facilities lack even the basic WASH facility.

It is important for the national health policies to engage more with these kinds of programs to build a safe environment for people and also to engage institutions at a local level.

India, back in the year 2006 had taken an initiative to reduce healthcare-associated infection, affirming India’s commitment to “Clear Care is Safer Care” initiative by the WHO. The initiative included good hand hygiene practices, water and, sanitation, etc. However, still there is a large disparity seen in the public health care facilities.

It is very important to understand the health-seeking behavior of people in using a health facility. Based on a systematic review to assess this relationship, it was found that WASH provision was associated with patients’ dissatisfaction with the infrastructural facilities and the quality of care. The prevalence of healthcare-associated infections, or hospital infections is 15.5 per 100 patients in lower-middle-income countries as and when compared with Europe (7.1) and The United States of America (4.5). The review also points out that improving the WASH condition will surely decrease patient dissatisfaction and improve health outcomes.

In India, the programs like The National Quality Assurance Programme, Kayakalp, Swachhata have shown that both the government and people are getting involved in cleanliness and hygiene as preventive care. It is reported that Madhya Pradesh has shown some promising results when over 1000 health care workers have attended training in implementing WASH at various health facilities. Still, many infections persist even today from the health care providers to patients. For example, the percentage of birth attendants who had washed their hands before conducting a delivery was as low as 24%.

In India, where there is a high burden of maternal & child mortality, newborn dying because of sepsis, & other infections, proper hand wash practices in hospitals become an integral part of every hospital and of every health care provider. Building signboards within hospitals signaling hand wash basins at every nook and corner will build the environment for safety and hygiene for both the patients and doctors. A recent assessment study done by the Water Aid in 343 health care facilities in 12 districts across India during the period 2014–2016 has found that even though with the presence of WASH infrastructure there were issues. It lacks an adequate supply of services, lack of accessibility, lack of storage and drinking water, poorly equipped soap hand stations & disinfectants, uncleared water tanks, etc.

It is concluded that besides having a structural aid, it is important to motivate both the staff and patients to have a sound knowledge of hygiene.

“WASH” practices in Indian Health Care Facilities
by Neeti Goutam, Communication Associate, Sanrachana