According to a report on ‘WASH in health care facilities: initiatives, challenges and lessons from Nepal post emergencies’ by Loughborough University Institutional Repository, the Department of Health Services has initiated a number of projects to address some challenges in order to improve the status of WASH facilities in healthcare facilities.

WASH stands for Water, Sanitation and Hygiene, and is a key public health issue with international development. Access to WASH includes safe water, adequate sanitation and hygiene education.

After the World Health Organization declared COVID-19 as a global pandemic on March 11, 2019, frontline health workers in Nepal were trained on advising patients about practising good hygiene to control the spread of the virus through effective Infection Prevention and Control (IPC) procedures.

Hence, healthcare facilities must have water, sanitation and hygiene (WASH) services in order to enable health workers perform their jobs in a safe manner as well as to protect the patients.

Implementation of WASH standards and guidelines at HCFs is important to not only keep healthcare workers and patients healthy by reducing the risk of infections, but also for the prevention of healthcare associated infections to newborn babies and birthing women.

According to a draft on the National Standards on WASH in HCFs set by the Management Division under the Department of Health Services, every HCF must have a functional water collection point and water use facility should be available to allow convenient access to water for drinking, handwashing, toilets, personal hygiene, food preparation, laundry, cleaning, gardening and medical purposes.

Image via Ministry of Health and Population

Similarly, the standards instruct drinking water to be available and accessible to staff, caregivers and patients at all times; presence of adequate functional and accessible improved sanitation facilities for health care workers, support staff, patient and caretakers; availability of functional hand hygiene facilities in all critical areas such as OPD, IPD, Emergency, waiting area, lab, maternity unit and all toilets; and accessible hand washing facilities for children and persons with limited mobility in or nearby toilets, waiting area, and maternity unit.

Basic WASH facilities are sometimes met, but most times missed by HCFs, especially at the time of a pandemic when they are overwhelmed with patients and understaffed.

According to the 2019 Global Baseline Report on WASH in health care facilities has showed that 7% healthcare facilities in Nepal do not have water services, 10% hospitals do not have water services, 6% government healthcare facilities do not have water services and 12% non-governmental healthcare facilities do not have water services.

Most government-run healthcare facilities (HCFs) across the country, including the central capital Kathmandu, still fail to ensure WASH facilities mostly due to the crunch of budget and human resources.

Moreover, the already ill-equipped and overcrowded government healthcare facilities are taking a hit as the country’s total COVID-19 caseload stands at 19,547 as of July 30 and 55 deaths as of July 31. Similarly, the central government’s hesitance in division of authority for information dissemination to provincial governments has added to the information gap.

Lack of timely decisions regarding WASH at HCFs, updates, reports, monitoring to ensure implementation of WASH, and preparations to procure testing kits and personal protective equipment has put the citizen’s health at the risk of uncertainty.