Water, Sanitation and Hygiene Improvements Are Key to Sustaining Healthcare’s Ascendency in Cambodia

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 Channa Sam Ol, Manager, Water, Sanitation and Hygiene (WASH)
and Health Programs, WaterAid Cambodia

Over the past 20 years, Cambodia has made remarkable progress in improving health care, as evidenced by declines in maternal mortality from 900 to 170 per 100,000 live births and infant mortality from 115 to 35 per 1,000 live births.

Ongoing health system reforms have addressed the quality of care, access and affordability. The government has supported these reforms by introducing schemes that make care free for families with limited incomes and subsidize health facilities and the women who use them to give birth. This latter scheme has helped to dramatically increase the number of women delivering their babies in facilities, from 22% in 2004 to 83% in 2014[1].

But challenges still cast a shadow on the very positive trajectory that has been established. This manifests in the limited progress in newborn health when compared to the improvements in maternal health. It is much safer for a woman to deliver her baby in a Cambodian health center or hospital today than it was 20 years ago, but it is not as safe as it should be for a newborn baby. The United Nations estimates 1 in 6 newborn deaths are associated with blood infections during delivery and an unhygienic environment after birth[2].

While previous Cambodian health policies and standards rarely mentioned water, sanitation and hygiene (WASH)[3], the current National Health Strategy is the first to set targets for improving WASH. Despite this, many health facilities still do not have sufficient WASH infrastructure and lack good hygiene practices.

Most facilities have a water supply, but only half have enough water for use year-round. Fewer than half of facilities have three adequate latrines. Only 15% have handwashing stations at points of care and only 10% perform basic waste management.

According to a 2016 assessment of WASH in public healthcare facilities in five provinces conducted by the country’s National Institute of Public Health in collaboration with the Department of Hospital Services and health partners, the lack of knowledge and commitment to WASH and infection prevention control were a challenge among healthcare workers and cleaners.  

Neglecting these essentials and improving rural health services is hampering progress towards safe, clean healthcare for all. Without improving the basics, Cambodia will not achieve the objectives set in its health strategy, nor will it see improvements in health as it has in the past.

Clean healthcare is something every patient expects – and it is achievable, as these examples demonstrate.

WaterAid first visited the Peus Pi health centre in Tbong Khmom Province in late 2017. The facility didn’t meet basic hygiene or sanitation requirements. What did that mean? Handwashing stations or alcohol hand sanitizers weren’t available at points of care such as outpatient consulation rooms, near toilets or in the waiting area. Toilets weren’t accessible for all, didn’t have separate facilities for men and women, and there were no facilities supporting menstrual hygiene management or postpartum bleeding.

Waste was not being separated and waste bins were not color-coded according to the national standard for health care waste management. Moreover, most staff were reluctant to share about hand hygiene practices and their knowledge of infection prevention and control.

In collaboration with the Ministry of Health and the provincial health department, we have  been working to upgrade the centre’s facilities and build staff knowledge to improve infection prevention control.

Rodiya, a mother who uses the Peus Pi centre, told us about the significant change compared to how it was several years ago. To Rodiya, the “health centre looks cleaner, has more equipment and materials and staff pays more attention to patients.” And now she can use the latrine and handwashing station inside the postnatal room. These improvements gave her the  confidence to choose the centre when it came time to deliver her third child.

 

 

[1] Cambodia Health Demographic Survey 2004 and 2014

[2] UN Inter-Agency Group for Child Mortality Estimation. Levels and Trend in Child Mortality; UN Inter-agency Group for Child Mortality Estimation: New York, NY, USA, 2017

[3] Por, Ir (2015). Towards Safer and Better Quality Health Care Services in Cambodia: A Situation Analysis of Water, Sanitation and Hygiene in Health Care Facilities. Phnom Penh, Cambodia: WaterAid.