Abstract
There is a paucity of information on the state of water, sanitation, and hygiene (WASH) at health care facilities in Uganda. A survey on WASH service availability was conducted at 50 health care facilities across 4 districts of rural southwestern Uganda between September and November 2015. The main water points at the majority (94%) of the health care facilities were improved sources, while improved toilets were available at 96% of the health care facilities visited. Hospitals had the poorest toilet to patient ratio (1 : 63). Only 38% of the health care facilities had hand washing facilities at the toilets. The lack of hand washing facilities was most prominent at the level IV health centre toilets (71%). Hand washing facilities were available at other points within most (76%) of the health care facilities. However, both water and soap were present at only 24% of these health care facilities. The poor toilet to patient/caregiver ratios particularly in the high volume health care facilities calls for the provision of cheaper options for improved sanitation in these settings. Priority should also be given to the sustainable provision of hygiene amenities such as soap for hand washing particularly the high patient volume health care facilities, in this case the level IV health centres and hospitals.
Highlights
WASH services provide for water availability and quality, presence of sanitation facilities, and availability of soap and water for hand washing [1]
A joint WHO/UNICEF report shows that globally, provision of WASH services in health care facilities is low, and the current levels of service are far less than the required 100% coverage by 2030. e report notes that large disparities in WASH services in health care facilities exist between and within countries [2]
It has been reported that large variations have been observed at subnational level, by settings and by type of health care facility within the same country, with smaller facilities in rural areas having disproportionally fewer WASH services compared to larger facilities in urban areas [2]
Summary
WASH services provide for water availability and quality, presence of sanitation facilities, and availability of soap and water for hand washing [1]. Provision of water is lowest in the African Region, with 42% of all health care facilities lacking an improved source on-site or nearby. Provision of sanitation services was much better with only 16% of all health care facilities in the African Region lacking access to improved sanitation [2]. Poor water and sanitation infrastructures and hygiene practices at health care facilities affect health care seeking behavior among catchment communities due fear of contracting infections [8]. E responsibility for delivery of WASH interventions in Uganda is shared between the Ministries of Education (WASH in schools), Health (community sanitation), and Water and Environment (infrastructure and public sanitation plus sewerage services). E data available for coverage for WASH at health facilities in Uganda were previously derived from a Service Provision Assessment conducted in 2007 [2]. There continues to be a paucity of information on status of WASH at health care facilities in Uganda. is study evaluates availability of WASH services at government-owned health facilities in a rural context, almost a decade after the first assessments were made in 2007. e JMP Post-2015 Working Group proposes that by 2030 all health centres provide all users with basic drinking water supply, adequate sanitation facilities, and hand washing and menstrual hygiene facilities [16]. e WHO suggests that it is important to first understand the extent of the problem and subsequently prioritize action where needs are greatest [2]. e study findings will contribute to decision-making processes for the implementation of WASH standards at health facilities in Uganda
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