Assessment of water, sanitation and hygiene services in Montenegrin health care facilities
In May 2019, the World Health Assembly resolution (WHA72.7) on water, sanitation and hygiene (WASH) in health care facilities was adopted. The resolution draws attention to the fundamental importance of adequate WASH services for providing safe, people-centred health care and achieving universal health coverage. Addressing and integrating efforts for WASH can catalyse improvements in service delivery, staff moral and performance, health care costs, disaster/outbreak resilience, infection prevention and control, as well as reductions in antimicrobial resistance. The resolution calls upon Member States to improve WASH in health care facilities through conducting, among others, comprehensive assessments of WASH conditions according to national context, on the basis of which follow-up interventions—at policy and practical levels—should be identified and prioritised.
How did Montenegro do it, and how did the WHO Secretariat support Montenegro?
WHO supported Montenegro in executing an assessment of WASH in health care facilities, including the process of prioritisation and planning of activities, providing international experts and instruments for capacity building and for conducting the assessment. WHO supported the adaptation of international definitions and recommendations to the Montenegrin context and provided state-of-the art tools relevant for the national context. In addition, WHO served as an experienced guide for the country in the evaluation of the assessment results and identification of priorities and improvement action relevant for the local context while ensuring that these build on existing systems and structures and are based on national health-priorities.
Specific activities which the Institute of Public Health of Montenegro undertook in partnership with WHO included an analysis of existing policies and the broader enabling environment as well as a survey of the actual situation in facilities, using internationally recognized indicators for basic and advanced WASH indicators established by the WHO/ United Nations Children's Fund (UNICEF) Joint Monitoring Programme for Water Supply, Sanitation and Hygiene. The overall objective of the survey was to establish a baseline of prevailing conditions of WASH in health care facilities to inform policy-making and national target setting, and to identify progressive improvement interventions. The WHO European Centre for Environment and Health in Bonn, Germany, and the WHO Country Office in Montenegro provided technical and financial support in undertaking the assessment. In the video “Who cares about toilets?”, Enisa takes you on a journey through her work assessing sanitation services in health care facilities in Montenegro.
The outcomes inform on strengths and gaps and will help to develop targeted recommendations for improvement interventions – at the governance level and in practice at the facility level – for example, for strengthening the national surveillance system and developing the capacity of medical and non-medical staff. The outcome of the project also supports national reporting at the global level towards monitoring progress on implementation of Sustainable Development Goal 3, Sustainable Development Goal 6 and on implementation of World Health Assembly resolution (WHA72.7) on WASH in health care facilities and World Health Assembly resolution (WHA73.1) on the COVID-19 response.
The assessment was key to raising awareness on important provisions related to WASH for ensuring quality of care, showing possible entry points and ways to take action and improve coverage of WASH provisions. Immediate actions following the outcome of the assessment will be the inclusion (as of 2022) of water quality control within the regular surveillance programme. Also planned is the integration of provisions related to WASH operation and maintenance in legislation and the development of a programme dedicated to private health care facilities to enhance capacity building.
The assessment also supported the drafting of a list of indicators that could be used for the development of a national definition of advanced level for WASH in health care facilities in Montenegro which will guide national target setting (for example, under the Protocol on Water and Health) and improvement of national monitoring systems. WHO’s facilitation of the evaluation of the results and the support in translating it into concrete policy action by the Ministry of Health resulted in planned improvements of the surveillance system and development of targets, including creating a roadmap for action and ensuring sustainability of the initiative.
Photo Credits: © WHO/ Meinborn und Weber GbR
Photo Caption: Field data collector inspecting a patient’s toilet in a health care facility in Montenegro.