Recently, the Department of Health hosted the first national workshop on Integrated Healthcare Waste Management (IHCWM) and Water And Sanitation Hygiene (WASH) in healthcare facilities in Nepal. The three-day event held from 10 December, 2019 had 33 speakers, around 400 participants and was supported by reputed organizations working for WASH including Wateraid, UNICEF, and WHO, among others.

The objective of the workshop was to “exchange learning on sustainable practices of healthcare waste management and WASH in HCFs that ensures the equitable access to quality healthcare services by reducing infections and adverse impacts on public health and environment”, according to the Department of Health Services.

At a time when healthcare professionals were saying that there is an acute lack of workshop and training sessions regarding WASH at healthcare facilities, the government’s move to host such a workshop was much appreciated.

According to a report on ‘WASH in health care facilities: initiatives, challenges and lessons from Nepal post emergencies’ by Loughborough University Institutional Repository, in order to improve the status of WASH facilities in healthcare facilities, the Department of Health Services together with UNICEF, WHO and selected organizations have initiated a number of projects to address some of challenges. However, several government-run healthcare facilities in Kathmandu still don’t get adequate budget or human resources to implement the WASH guidelines and policies.

Typical WASH facilities include clean running water, wash basin, clean toilets, soaps and dustbins. These facilities at a healthcare center help in prevention of infections and spread of diseases, protection of staff and patients, and upholding the dignity of vulnerable populations including pregnant women and the disabled.

Moreover, the Nepal Health Sector Strategy III has recognized promotion of healthy lifestyle and healthy environment through multi-sectoral actions by expanding access to clean water, water conservation, including waste management while building code of health facilities. Free counseling services on hygiene and sanitation is also part of the strategy.

Further, the Hospital Management Strengthening Program 2015-2016 has developed a checklist for minimum service standards for district hospital, where water, sanitation, hygiene and infection prevention control has been stated as minimum standards for any districts level government hospitals.

However, lack of coordination between various state departments and communication with the managerial staff as well as negligible awareness among the public often put the importance of WASH on the back burner.

Sheela Pradhan, a new mother admitted for parturition at the Paropakar Maternity and Women’s Hospital, was struggling to wash clothes at the hospital’s stingy bathroom. She said, “I have to wash mine and my new born baby’s clothes, but the hospital does not have adequate water supply. Neither does the hospital have a proper clothes-washing facility for patients like me.”

Director of Kanti Children’s Hospital Dr RP Bicha said, “Implementation of WASH policies and guideline is extremely important and fruitful for any healthcare facility to prevent the spread of infection. But, the policies and guidelines should be drafted with the involvement of concerned stakeholders and experts from local as well as federal levels. The government’s habit of merely drawing guidelines without consultation with stakeholders makes it difficult for the implementing agencies to execute such guidelines.”

Bicha added, “Adequate budget allocation for the implementation of WASH guidelines is almost always overlooked by the government. Regular monitoring, training programs, and communication with staffs of all levels would help in strict implementation of WASH guidelines.”

Chudamani Bhandari, Chief of the Environment Health and Healthcare Waste Management System at the Management Division of the Department of Health under the Ministry of Health and Population, was of the opinion that the government should prioritize resource allocation so as to ensure implementation of WASH policies at healthcare facilities. “Policy makers as well as implementing agencies should internalize the value of WASH and should inform the concerned management staff of the same. Instead of inaction due to inadequate budget allocation, healthcare facilities should use their in-house resources to follow WASH related guidelines.”

Bhandari further shared, “It is true that the government should facilitate implementation of WASH guidelines and policies, but the hospital management should also make independent efforts towards the same.”

The 2019 WHO and UNICEF report on Tracking Universal Health Coverage states that 38% of health care facilities in Nepal do not have an improved water source, 19% do not have improved sanitation and 35% do not have water and soap for handwashing.

The report further states that in terms of safe water sources, 84% of the hospitals have safe protected source, over 51.6% have acceptable source and 16% have water supplies from badly protected. Similarly, regular monitoring of water safety and drinking water treatment system lies only in 9.68% health-care facilities whereas 25% of the hospitals did not have any water safety monitoring mechanism at all and 45.16% of hospitals have relatively good number of toilets.

“Even though most of them having adequate access of water but did not have other cleaning materials. There was also absence of regular repair, maintenance and cleaning system in place,” the report reads.

Meanwhile, 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.

Similarly, in terms of sanitation services, 8% healthcare facilities do not have sanitation services, 9% hospitals do not have sanitation services, 7% government healthcare facilities do not have sanitation service and 12% of non-government healthcare facilities do not have sanitation service.

Likewise, in terms of hand hygiene, 46% of healthcare facilities have handwashing facilities available at point of care, 70% hospitals have handwashing facilities available, 43% government healthcare facilities have handwashing facilities available and 73% non-government healthcare facilities have handwashing facilities available at point of care.

The data paints a grim picture of WASH status at Nepali healthcare facilities. Regular assessment of health care facilities on WASH services, dedicated fund for WASH, identifying gaps on WASH facilities, construction of WASH facilities, providing orientation to health care professionals on WASH counseling and including WASH curriculum in training packages can prove to be productive in making the public as well as health care workers understand the importance of WASH in health care facilities.