4 Ways to Approach WASH Challenges in Health Care Facilities during the COVID-19 Pandemic

Published on March 19, 2021

Emmanuel Attramah/PMI Impact Malaria

One way to keep mothers and babies healthy is ensuring they have access to clean and safe water. However, the latest global estimates show that 785 million people do not have access to safe drinking water, and 2 billion do not have access to basic sanitation services.1 Lack of access to safe water and sanitation not only occurs in households, but water, sanitation, and hygiene (WASH) services also are not available in places where people seek medical care.

According to a 2020 WHO-UNICEF report on WASH, globally, a quarter of health care facilities have no basic water services, 10 percent do not have sanitation services and one in three do not have adequate handwashing facilities.2

In 47 countries with the least access to resources, the situation is more challenging. Half of health care facilities lack basic water services, and 60 percent have no sanitation services. Economic consequences of COVID-19 restriction measures threaten to widen this gap.3

Lack of access to WASH services can be particularly harmful to women and children.4,5 Up to 15 percent of maternal deaths in low- and middle-income countries can be linked to poor hygienic conditions during labor, birth, and postnatal care at home and in facilities.6 Globally, an estimated 21 percent of newborn deaths are caused by severe bacterial infections, which could be averted through preventive measures such as improving hygiene practices and ensuring timely care-seeking.

As we respond to the COVID-19 pandemic, these concerns have intensified in health care settings without essential resources, where according to the WHO, the inability to provide clean facilities and proper hand hygiene will lead to further spread of the virus.8 WASH services in health care facilities—often taken for granted—are needed more than ever to protect vulnerable health workers and patients.

What can we do differently?

Invest more in sustainable WASH interventions.

Rather than regard it as just an infrastructure issue, WASH should be viewed as a cost-effective public health intervention. Inadequate WASH in health care facilities has been linked to the spread of infections acquired in health care settings, placing patients and health care staff at risk of serious infections that are often resistant to antibiotic treatments.9 Effective infection prevention and control is far less expensive than treating these infections.10, 11 

MOMENTUM will work with countries to strengthen policies and provide technical guidance to sector institutions and local stakeholders to implement and support investment in sustainable WASH interventions in health facilities.

Here a staff nurse prepares for a tubal ligation procedure.
Mubeen Siddiqui/MCSP

Gather more evidence to address WASH needs.

Lack of data has become a barrier to understanding and addressing WASH challenges in health care facilities. Conducting research to demonstrate the cost-savings that infection prevention interventions afford patients, families, and health care systems can prove valuable. Last year, MOMENTUM developed infection prevention and control assessments for health care facilities in five countries to identify needs and prioritize improvements, providing facility readiness support in health facilities that deliver maternal, newborn, and child health care. Preliminary findings revealed that basic water services and waste disposal remain major challenges at most targeted health facilities. The analysis highlights the support facilities need in infection prevention and WASH and provides guidance on prioritizing improvements.

Karen Kasmauski/MCSP

Improve health systems.

Health systems often lack policies, protocols, and regulations to acquire and maintain basic WASH services. Improvements require strong monitoring mechanisms for facilities and ministries of health to hold themselves accountable, along with policies, standards, and reward systems that support clean and safe care. MOMENTUM is focusing efforts on developing and scaling interventions that improve infection prevention and control and encourage proper hygiene behavior among staff, caregivers, and patients, all of which are crucial to making progress.

Kate Holt/MCSP

Scale up health worker capacity.

Without water to wash their hands, health workers and patients are at higher risk of becoming infected with COVID-19. MOMENTUM plans to work with ministries of health and international and local NGOs to use evidence from prior research and activities to implement WASH programs. These activities will include using tools to promote infection prevention and control in health facilities, assess health worker capacity,12 strengthen worker training and on-the-job mentorship,13 and track community-based health worker performance.14 

MOMENTUM will build the evidence base on successful approaches to support health facility staff in making and sustaining incremental improvements in infection prevention and WASH services.15,16 

Karen Kasmauski/MCSP

For every woman and child to receive high-quality and safe care, each health facility must have essential WASH infrastructure. To achieve this goal, we will need to coordinate and align efforts at the global and country level, integrating WASH into health strategies, policies, guidelines, and monitoring systems. But that’s not all: Global efforts to provide improved water and sanitation still experience gaps in funding which continue to hamper progress. For meaningful change to occur, greater investment from countries and commitment from international partners and key stakeholders will be needed.


Tools Used to Improve WASH in Health Care Facilities

WASH Facility Improvement Tool (FIT):  WASH FIT Digital is a free, open-access digital tool, based on the WASH FIT guide developed by WHO and UNICEF. WASH FIT is designed to help health care facilities improve the quality of care through improved water, sanitation, and hygiene (WASH).

Clean Clinic Approach: This two-page brief explains the USAID Maternal and Child Survival Program’s Clean Clinic Approach, a programmatic tool that encourages health facilities to establish WASH goals and make incremental improvements toward “Clean Clinic” status.

WASH in Health Care Facilities: Practical Steps: This WHO document presents eight practical steps that United Nations Member States can take at the national and sub-national level to improve WASH in health care facilities.

TEACH CLEAN Toolkit: The London School of Hygiene and Tropical Medicine’s TEACH CLEAN helps address a lack of formal training for those who clean and promote IPC and WASH standards for a safer environment.

Best Practices in Environmental Cleaning: This document provides guidance from the Centers for Disease Control and Infection Control Africa Network on environmental cleaning procedures and programs in healthcare facilities in resource-limited settings.

World Health Assembly 2019 Resolution on WASH in Health Care Facilities: In 2019, this World Health Assembly Resolution on WASH in health care facilities outlined concrete actions that countries can commit to.

About the MOMENTUM Projects Supporting WASH

MOMENTUM Country and Global Leadership project works in tandem with country governments and local nongovernmental organizations to provide targeted technical and capacity development assistance and contribute to the global technical leadership and policy dialogue on improving measurable outcomes for maternal, newborn, and child health; voluntary family planning; and reproductive health care.

MOMENTUM Integrated Health Resilience works to improve access to and availability of high-quality, respectful, and person-centered MNCH/FP/RH care in fragile and conflict-affected settings. This project enhances coordination between development and humanitarian organizations and strengthens the resilience of individuals, families, and communities, supporting countries.

Water, Sanitation, and Hygiene

Lack of access to or unsafe WASH services can lead to poor health outcomes for mothers, newborns, and children at home and when seeking care at health facilities. To fight this, we're working to increase access to safe water and sanitation resources and encourage proper hygiene behaviors.

References

1.       Progress on household drinking water, sanitation and hygiene 2000-2017. Special focus on inequalities. New York: United Nations Children’s Fund (UNICEF) and World Health Organization, 2019. https://www.unicef.org/media/55276/file/Progress%20on%20drinking%20water,%20sanitation%20and%20hygiene%202019%20.pdf
2.       Global progress report on water, sanitation and hygiene in health care facilities: fundamentals first. Geneva: World Health Organization, 2020. https://washdata.org/sites/default/files/2020-12/WHO-UNICEF-2020-wash-in-hcf.pdf
3.       Global progress report on water, sanitation and hygiene in health care facilities: fundamentals first. Geneva: World Health Organization, 2020. https://washdata.org/sites/default/files/2020-12/WHO-UNICEF-2020-wash-in-hcf.pdf
4.       World Health Organization and the United Nations Children’s Fund, WASH in health care facilities: Global Baseline Report 2019, WHO and UNICEF, Geneva, 2019. https://apps.who.int/iris/bitstream/handle/10665/311620/9789241515504-eng.pdf?ua=1
5.       Partnership for Maternal, Newborn and Child Health. Knowledge Summary #30. Water, sanitation and hygiene – the impact on RMNCH*. 2014. https://www.who.int/pmnch/knowledge/publications/summaries/ks30.pdf?ua=1
6.       Partnership for Maternal, Newborn and Child Health. Knowledge Summary #30. Water, sanitation and hygiene – the impact on RMNCH*. 2014. https://www.who.int/pmnch/knowledge/publications/summaries/ks30.pdf?ua=1
7.       Healthy Newborn Network. Severe infections including pneumonia. https://www.healthynewbornnetwork.org/issue/severe-infections-pneumonia/
8.       McGriff, JA and L. Denny. 2020. “What COVID Reveals about the Neglect of WASH within Infection Prevention in Low-Resource Healthcare Facilities.”  Am J Trop Med Hyg 103(5): 1762–1764. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7646795/
9.       Global progress report on water, sanitation and hygiene in health care facilities: fundamentals first. Geneva: World Health Organization, 2020. https://washdata.org/sites/default/files/2020-12/WHO-UNICEF-2020-wash-in-hcf.pdf
10.   Global progress report on water, sanitation and hygiene in health care facilities: fundamentals first. Geneva: World Health Organization, 2020. https://washdata.org/sites/default/files/2020-12/WHO-UNICEF-2020-wash-in-hcf.pdf
11. Stemming the Superbug Tide: Just A Few Dollars More. Paris: Organisation for Economic Co-operation and Development, 2018. https://www.oecd-ilibrary.org/social-issues-migration-health/stemming-the-superbug-tide_9789264307599-en
12.   UNICEF Sanitation Marketing Learning Series. Guidance Note 6. Enabling Environment. https://www.unicef.org/wash/files/Guidance_Note_6_-_Enabling_Environment.pdf
13.   Monitoring the Building Blocks of Health Systems: a Handbook of Indicators and Their Measurement Strategies. 2010. Geneva, Switzerland: World Health Organization. https://www.who.int/healthinfo/systems/WHO_MBHSS_2010_full_web.pdf?ua=1
14.   UNICEF. Community Health Worker Assessment and Improvement Matrix (CHW AIM): Updated Program Functionality Matrix for Optimizing Community Health Programs. 2018. https://www.unicef.org/media/58176/file
15.   Water and Sanitation for Health Facility Improvement Tool (WASH FIT). Geneva: World Health Organization; 2017. https://www.washinhcf.org/wp-content/uploads/2019/04/9789241511698-eng.pdf
16.   Maternal and Child Survival Program. Clean Clinic Approach Brief. USAID. October 2016. https://www.mcsprogram.org/resource/clean-clinic-approach-brief/

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