Assessment of water, sanitation and hygiene service availability in healthcare facilities in the greater Kampala metropolitan area, Uganda

Denis Kayiwa,John Bosco Isunju,Jane Sembuche Mselle,Joanne A Mcgriff,Richard K Mugambe,Brenda Wagaba,Najib Lukooya Bateganya,Winnifred K Kansiime ,Yuke Wang,Emily Namanya,John C Ssempebwa,Martin Othieno Radooli,Esther Buregyeya,Rawlance Ndejjo,Constance Bwire,Aisha Nalugya,Ceaser Kimbugwe,Jude B Zziwa ,Tonny Ssekamatte,Solomon Tsebeni Wafula,Habib Yakubu

doi:10.1186/s12889-020-09895-9

Abstract

BackgroundImproved Water, Sanitation and Hygiene (WASH) in Healthcare facilities (HCFs) is of significant public health importance. It is associated with a reduction in the transmission of healthcare acquired infections (HAIs), increased trust and uptake of healthcare services, cost saving from infections averted, increased efficiency and improved staff morale. Despite these benefits, there is limited evidence on availability of WASH services in HCFs in the Greater Kampala Metropolitan Area (GKMA). This study assessed the availability and status of WASH services within HCFs in the GKMA in order to inform policy and WASH programming.MethodsA cross-sectional study was conducted in 60 HCFs. Availability of WASH services in the study HCFs was assessed using a validated WASH Conditions (WASHCon) tool comprising of structured interviews, HCF observations and microbial water quality analysis. Data were analysed using Stata 14 software and R software.ResultsOverall, 84.5% (49/58) and 12.1% (7/58) of HCFs had limited and basic WASH service respectively. About 48.3% (28/58) had limited water service, 84.5% (49/58) had limited sanitation service, 50.0% (29/58) had limited environmental cleanliness service, 56.9% (33/58) had limited hand hygiene service, and 51.7% (30/58) had limited waste management service. About 94.4% of public HCFs had limited WASH service compared to only 68.2% of private not for profit facilities. More health centre IIIs, 92.5% and health centre IVs (85.7%) had limited WASH service compared to hospitals (54.5%).ConclusionsOur findings indicate that provision of water, sanitation, hand hygiene, environmental cleanliness, and health care waste management services within HCFs is largely hindered by structural and performance limitations. In spite of these limitations, it is evident that environmental cleanliness and treatment of infectious waste can be attained with better oversight and dedicated personnel. Attaining universal WASH coverage in HCFs will require deliberate and strategic investments across the different domains.

Highlights

Improved Water, Sanitation and Hygiene (WASH) in Healthcare facilities (HCFs) is of significant public health importance
Our findings indicate that provision of water, sanitation, hand hygiene, environmental cleanliness, and health care waste management services within HCFs is largely hindered by structural and performance limitations
Though existing literature on WASH in HCFs in low resource settings indicates limited access to improved water sources, this study found out that almost all the HCFs in the Greater Kampala Metropolitan Area (GKMA) had access to an improved water source, access rates remain below the World Health Organization (WHO) target of 100% coverage

Summary

Introduction

Improved Water, Sanitation and Hygiene (WASH) in Healthcare facilities (HCFs) is of significant public health importance. It is associated with a reduction in the transmission of healthcare acquired infections (HAIs), increased trust and uptake of healthcare services, cost saving from infections averted, increased efficiency and improved staff morale. Despite these benefits, there is limited evidence on availability of WASH services in HCFs in the Greater Kampala Metropolitan Area (GKMA). In terms of access to sanitation, over 21% of HCFs worldwide depend on unimproved toilets or have no toilets at all while in subSaharan Africa only 23% of HCFs have basic sanitation [1]

Methods

Results

Discussion

Conclusion