This post is part of a series authored by the BASICS (Bold Action to Stop Infections in Clinical Settings) team. BASICS is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%.
Written by Alison Macintyre, Health Technical Lead – WaterAid
Having spent a lot of my childhood in and out of hospitals, I believed that hospitals were a place where you go to get better, get well; where you leave feeling more positive and healthier than when you arrived. And, I still do.
As I embarked on my career in the field of water, sanitation and hygiene (WASH), I realized for most of the world, that isn’t true. We, the global health community, are currently failing to achieve the absolute basics. Right now, we can’t ensure we are, at an absolute minimum, doing no harm to the millions of people who use health care systems every day. Too many health care facilities operate without water, without toilets that everyone can use, and without water and soap to stop the spread of infection.
This failure is what motivates me. We will only see dramatic, sustained changes in health if we get the basics right.
Early in my WASH career I was in Papua New Guinea, undertaking a study on the role of WASH during childbirth for women. Most of the women I interviewed were unable to reach a facility to give birth and had to deliver their babies, often alone, on coffee plantations, in pig pens or on the side of the road.
As part of the study, we also visited health facilities. I had hoped that they would provide a potential solution for improving maternal and newborn mortality in these remote communities. One facility has always stuck in my mind.
Despite the newness of the facility (it was only five-years old), water, sanitation and hygiene were not available. A refrigerated, fully stocked drug cabinet was present, but gloves and soap were not. There was a sophisticated rainwater collection system, but the pump to distribute the water to the facility was broken and they weren’t able to fix it. There were two modern toilets, but they were locked and reserved for staff – patients had to go out to a hole dug in the back of the facility, passing an open waste pit on the way, to relieve themselves.
The lack of water also meant women were turned away if they arrived in labour. The next hospital was 2 hours away on a treacherous road.
How did a hospital have sophistical equipment, but couldn’t fix a water supply and women weren’t able to deliver their babies? How were antibiotics kept cold-chain with a reliable supply, yet soap and gloves were not available?
I left the facility angry, wondering how health systems neglected WASH in so many ways.
This visit made me realize that when statistics show us that health care facilities do not have basic WASH services, it doesn’t always mean the infrastructure is completely absent. Often, it may not suitable (for instance in the case of toilets not being accessible to people of limited mobility) or it is not functioning, or basic commodities like soap are not part of general supply lists.
I also realized that it is the system that’s broken, not just the infrastructure. Health systems that have monitoring and budgets for WASH, trained operation and maintenance staff, in-service and pre-service training on hygiene and cleaning, WASH standards and accountability mechanisms, are uncommon. This should be the norm.
That’s why I’m excited about the prospect of leading the WASH element of BASICS (Bold Action to Stop Infections in Clinical Settings), on behalf of WaterAid. Through the work I’ve done, I have learned the importance of integrating basic WASH into broader patient safety and infection prevention control programes. Without such integration, a system-wide approach is not possible and WASH will never become part of the day-to-day routine of health center operations.
BASICS brings together NGOs, researchers and the private sector to support health systems to sustainably address WASH and patient safety. The BASICS team has a wealth of expertise on health, WASH and evidence-based behavior change. This combination is essential for improving patient safety, health and the quality of health care facilities for all.
To learn more about BASICS (Bold Action to Stop Infections in Clinical Settings) is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%, visit savethechildren.org.