WHO-UNICEF JMP launched “Global Progress Report on WASH in Healthcare Facilities: Fundamentals First” last week. The report comes amidst of an unprecedented pandemic which has stripped off the inefficiencies of the health systems across the globe, exposed vulnerabilities to inadequate infection prevention and control and delay in designing country-specific and population-specific responses for spread of Covid-19. WHO and UNICEF’s Joint Monitoring Programme for Water Supply, Sanitation and Hygiene has been publishing data persistently on WASH services in healthcare facilities. WASH services covered in the report include Water, Sanitation, Hand Hygiene at Points of Care, Basic Healthcare Waste Management and Environment Cleaning. Total number of countries covered in 2020 survey were 165, whereas healthcare facilities surveyed include 794,000 public and private health centres.
Here are 5 key takeaways from the report:
1. A quarter of health care facilities lack basic water services, exposing 1.8 billion people, including health care workers and patients, to greater risk of infections
A ‘basic water service’ means that the health care facility has water available from an improved water source which is located within the premises. Improved water sources are those which by nature of their design and construction have the potential to deliver safe water. These include piped water, boreholes or tubewells, protected dug wells, protected springs, rainwater, and packaged or delivered water. According to the report, only three of the eight SDG regions and 52 countries had sufficient data to estimate coverage of basic water services in health care facilities in 2019.
Out of the 52 countries included in the report, one fourth lack basic water facilities which means 712 million people have no access to water when they use healthcare facilities. These countries are located in SDG regions where prevalence of communicable diseases such as sepsis is very high. Sepsis disproportionately affects neonates, pregnant or recently pregnant women, and people living in LMICs. Sepsis mortality is often related to suboptimal quality of care, inadequate WASH and health infrastructure, and poor IPC. Therefore, it is pertinent to look WASH as a prerequisite for infection, prevention and control without which resistant microbes will continue to spread.
2. Across the world’s 47 LDCs, an estimated half of the health care facilities do not have basic water services
Commission for Social Development constituted by United Nations Economic and Social Council has classified 47 countries as Least Developed Countries, they are especially vulnerable to economic and environmental shocks and have sub-optimal health indicators along with low levels of human assets. The reports sheds light on the dismal performance of LDCs pertaining to WASH indicators in healthcare facilities. Most of these LDCs are situated in Sub-Saharan Africa and South-East Asia. The lack of basic water facilities highlights low priority of governments towards strengthening healthcare facilities and extending healthcare access to all. It is crucial for governments and those in power to address WASH as a human rights, dignity and social justice issue.
3. Two thirds of health care facilities in LDCs lack basic sanitation services.
The ‘basic sanitation services’ indicator requires that health care facilities have improved and usable sanitation facilities. Many countries collect this information and it is estimated that 72% of health care facilities worldwide had access to improved and usable sanitation facilities in 2019. However, one in ten health care facilities globally, and three out of ten in sub-Saharan Africa, had no sanitation service in 2019. According to the JMP group healthcare facilities are classified as having a basic sanitation service if they also have separate facilities for staff and visitors. Further sex-separated toilets, those for the use of women and girls should also have facilities related menstrual hygiene and management such as bin with a lid to dispose used menstrual hygiene products, etc. The report highlights the WASH service constraints during Covid-19 witnessed by nurses and midwives in India and Uganda. In the absence of toilets in healthcare centres, they have to squat in open fields and are often seen as hypocrites that preach importance of handwashing in community to prevent spread of covid-19 virus.
4. One in three health care facilities do not have hand hygiene facilities at the point of care.
The `basic hand hygiene services’ indicator calls for information about hand hygiene facilities at two types of locations: points of care and toilets. Because of the lack of information about handwashing facilities at toilets, only 21 countries and one SDG region could report on basic hand hygiene services in 2019. More countries had data on hand hygiene facilities at points of care, since most facility assessments ask about the presence of hand hygiene facilities. Out of the 71 countries with data available (only for few components of hand hygiene), in 12 countries less than half of health care facilities had hand hygiene facilities at points of care in 2019. If hand hygiene facilities were required to be available at all points of care assessed, coverage figures would be much lower.
5. Most countries in the world do not have sufficient data to report on basic WASH services in health care facilities
Despite reported progress, critical gaps remain. Only one third of countries responding to the World Health Assembly resolution have developed roadmaps for action, and just over 10% have integrated WASH indicators into regular national health system monitoring. Filling data gaps and setting baselines should be an immediate priority. The absence of data availability on WASH indicators in health facilities highlights that WASH services in healthcare facilities are taken for granted or as the report sheds light-outright neglected.
Conclusion: Provision of adequate WASH services in health care facilities serves to prevent infections and spread of disease, uphold the dignity of vulnerable populations and to protect the healthcare staffs. It may bepertinent to highlight that in India, there are guidelines that stress upon the need for adequate WASH services in health facilities and in response to this, SBM introduced Kayakalp Award to Public Health Facilities, 2015 and Kayakalp National Guidelines for Clean Hospitals, 2015. Both these guidelines expounds on the processes of maintaining adequate sanitation and hygiene in all areas of hospitals and health facilities including toilets. We really hope that such initiatives are implemented on ground in true sense and the provision of adequate WASH services at the health facilities becomes a reality.
 There is a paucity of data available on WASH in healthcare facilities in India. Therefore, India’s position on these indicators in inconclusive. However, Sufficient data were available to produce regional estimates for 3 out of 5 basic WASH services (water, sanitation and waste management) in Sub-Saharan Africa.