By Gift Briton
Kenya has launched its first status report on infection prevention and control in healthcare facilities that will guide the country’s action plan towards scaling up basic hygiene and handwashing services assessment to cover more facilities and develop a roadmap towards completion of the Kenya healthcare facilities water, sanitation and hygiene(WASH) guidelines and standards.
This follows recommendations by the World Health Organization(WHO’s) in 2019 urging countries to invest in achieving universal coverage of basic hygiene and hand washing in health care facilities by 2030.
According to the assessment report, although over 60% of the health facilities assessed had adequate water, water was unsafe in almost half of those facilities.
Also 58% did not have adequate hand washing stations, 62% did not have functioning hygiene stations at points of care, 45% did not have dedicated decontamination area, and 21% did not have reliable sterile material supply or sterilization equipment.
This is despite the fundamental role that adequate clean water, safe sanitation and good hygiene in health care facilities play in infection prevention and control (IPC) of waterborne diseases and hospital acquired infections.
Coming at a time when the country is still dealing with COVID-19 pandemic, cholera outbreak and on high alert due to Ebola outbreak in the neighboring Uganda, Director General- Ministry of Health, Dr Patrick Amoth speaking during the report launch in Machakos County noted that development and implementation of national policies, guidelines on safe practices, training and promotion of effective messages in a context of healthy medical facilities will decrease the number of infections associated with health-care settings.
Furthermore, with the hospital acquired diseases on the rise contributing to avoidable morbidity and mortality, and unnecessary burden to health-sector, Dr Amoth urge healthcare authorities to ensure access to safe sanitation in healthcare facilities for patients, staff and caregivers, and to protect nearby communities from exposure to untreated wastewater, faecal sludge and air pollution.
“Healthcare authorities are directly responsible for ensuring that all healthcare facilities have adequate sanitation systems for staff, patients and caregivers and that there are effective procedures in place to ensure safe management of faecal waste. Decontamination and sterilization of medical equipment is impossible where water supply is insufficient in health facilities and electricity supply is erratic.,” Dr Amoth said.
Out of the counties assessed, only about 64% had adequate water supply, falling short of WHO recommendation of at least 80% by 2025. The assessment revealed that water availability increases with the level of care at 53%, 63%, 80% and 100% for Levels 2, 3 4 and level 5 respectively.
Therefore, to improve the low coverage, he called on County Governors or First ladies to take key advocacy role as County Goodwill ambassadors, adding that basic hygiene and hand washing services be integrated into the development processes such as the County Development Integrated Plans (CIDPs).
“It has been shown that for every dollar invested these basic services, there is a 15 dollars return! To achieve the national and global universal target of 80% coverage by 2025 and 100% by 2030, it has further been shown that this will require investing $0.65 (KES 78) per person,” Dr. Amoth added.
For sanitation, the report found out that only about half (50%) of the facilities assessed in Kenya had at least four toilets or improved latrines for outpatient settings or not less than one toilet per 20 users, putting at risk both individuals accessing the health facilities and those who are tasked with the responsibility of providing that necessary service.
The report notes that this could be due to inadequate resource allocation, prioritization in the CIDPs and inadequate space in the health facilities. Moreover, from this assessment, more than six in every ten facilities assessed did not have adequate hygiene stations at service delivery points.
The availability of functional hand hygiene facilities was highest at the level two facilities and lowest in level five facilities indicating that the higher the level of health care, the less the availability of functional hand hygiene facilities.
Also, about one in every four facilities (25%) of the facilities assessed had a reliable sterilization and disinfection equipment available and ready for use while more than half of them had a functional burial pit for disposal, a situation which is attributed to different levels of supervision with level five being the best covered compared to lower levels of care. Therefore, the authors recommend that supportive supervision should include waste management as a strong area of assessment.
Overall, the report highlighted availability of a functioning wastewater treatment system as the single most indicator found to be strongly associated with the level of diarrhea reported within the health facilities, implying that over 98% of the recorded cases could be explained by wastewater management levels at the health facilities.
Speaking on behalf of Dr. Diallo Abdourahmane -WHO Representative, Kenya Country Office, Nzioka Solomon noted that “WHO will continue playing her role to support the country to deliver in her commitments to her citizens, and post positive developments to the Regional and Global commitments in the area of water, sanitation and hygiene including the related Sustainable Development Goals.”