Maternity wards and other health care facilities (HCFs) all over Tajikistan are being improved to ensure they all have adequate provisions for water, sanitation, and hygiene (WASH). The country has reviewed the situation in HCFs and identified gaps that are now addressed through improving infrastructures, building national capacity and coordinating efforts to ensure that WASH becomes standard practice in every health care service.
Globally, 1.8 billion people use facilities that lack essential water services, 800 million use facilities with no toilets, and one in four HCFs worldwide still lacks access to basic water services, which puts patients and health workers at constant risk. One third of HCFs does not have basic provisions to clean hands where care is provided, and 10% have no sanitation services. The extent of this problem remains hidden because significant gaps in data persist.
Quality water, sanitation and hygiene in HCFs are necessary provisions for infection prevention control, reductions in antimicrobial resistance, and safe health services for all. The COVID-19 pandemic exposed the key vulnerabilities in these provisions. Often taken for granted, WASH services in HCFs are needed more than ever to protect both patients and health workers.
Driving forward progress on essential WASH services, the Second High-level International Conference on the International Decade for Action on “Water for Sustainable Development”, 2018–2028 took place on 6–9 June in Dushanbe, Tajikistan. At the conference countries agreed on prioritizing universal access to safe and affordable water and adequate and equitable sanitation and hygiene, particularly in HCFs, as vital for child, maternal and patient health. They also discussed how to build longer-term strategies for increasing pandemic prevention, preparedness and response, including the current COVID-19 pandemic, by investing in water supply, sanitation and hygiene infrastructure, wastewater and waste management, and consistently promoting good WASH practices.
“WASH services must be a priority, particularly in health facilities,” said WHO Director-General, Dr Tedros Adhanom Ghebreyesus, in a message for the Conference. “With sustainable public investment, responsible management, and accountable governance, we can make safe water, sanitation and hygiene a reality worldwide. This no-regrets investment will help to save more than one million lives, contribute to human rights and gender equality, and bring substantial economic returns.”
The UN Group of Friends in Support of WASH in Health Care Facilities, launched in 2021 by UN Permanent Representatives of Hungary and the Philippines in cooperation with WHO, is pushing for greater action and international cooperation to improve WASH conditions in HCFs everywhere.
During this event Tajik authorities shared their experience in implementing eight practical steps to enhance WASH services in HCFs. WHO and UNICEF recommend implementing costed national roadmaps with appropriate financing; monitoring and regularly reviewing progress in improving WASH services, practices and the enabling environment; developing capacities of the health workforce to sustain WASH services and promote and practice good hygiene, and integrating WASH into regular health sector planning, budgeting and programming to deliver quality services, including COVID-19 response and recovery efforts.
Action on WASH is a national health priority in Tajikistan
In 2018 the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan conducted a situational analysis of the enabling environment for WASH in HCFs in collaboration with the WHO European Centre for Environment and Health. As a follow-up action from the outcome of the analysis, a survey was conducted in 2020 of around 350 HCFs all over the country on their provision of drinking-water, sanitation, hand hygiene, waste management and environmental cleaning. The survey showed significant gaps in service provisions for all WASH dimensions and a particular need for attention to hand hygiene, environmental cleaning, and sanitation.
This work has helped authorities and partners to plan how to improve and sustain WASH in HCFs and put the recommendations into practice right away. Coordination groups to strengthen WASH and infection prevention control policies, practices and monitoring have been implemented. In addition, provisions of water, sanitation and hygiene are now a target within the National Health Strategy for 2030, thereby increasing the visibility, accountability and, ideally, financing for such services. Improvement projects are under way, such as the renovation of maternity wards and reconstruction of other health facilities in the country, integrating these WASH recommendations.
The hope is that the experiences shared at the Dushanbe Conference will drive home the point that accelerating WASH in HCFs is necessary, urgent, and, given the political will, also very achievable.