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Status of Health Facility WASH and its Challenges

Abayew Wassie

FMOH

Addis Ababa

Hilton Hotel

June, 2018

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Presentation out lines• Introduction

• Why we focus on HF WASH?

• Findings of the 2016 Ethiopian ServiceAvailability Readiness Assessment (ESARA)

• Success stories made to date

• Existing Challenges

• The way forward

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Introduction• The GoE has put considerable effort and

investment to facilitate a sector wide approachprogram to deliver water, sanitation and hygieneservices across all relevant sectors in generaleducation and health in particular,

• It prepares to continue efforts to expand accessto WASH services to prevent nosocomialinfections in health facilities,

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Introduction• Over the year, considerable progress has been

made in constructing health facilities,

Table, Showing total number of health facilities as of 2009 EFY

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S. No Types of Health Facilities Amount in Number

1 Health Posts 16,251

2 Health Centers 3,546

3 Primary Hospitals 167

4 General Hospitals 76

5 Referral Hospitals 36

Total 20,076

Why we focus on Health Facility WASH?

• Nowadays, the Health Care Waste generation rate issignificantly increasing in volume, and diversifying intypes or categories of waste that require properhandling and disposal,

• A significant proportion of Health Care Waste (15-20%) is infectious and must, therefore, be properlycollected, transported, and disposed to protect boththe persons handling it and the environment,

• The health facility should also be exemplary to thenear by communities in its hygiene and sanitation,

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Findings of the 2016 Ethiopia Service Availability and Readiness Assessment (ESARA),

• The 2016 ESARA tat is a cross sectional study hadassessed 705 HFs, 16% government hospitals,13% private hospitals, 23% health centers, 25%clinics and 23% health posts,

• In general; 228 hospitals, 165 HCs, 173 Clinicsand 139 Health posts were assessed,

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Findings of the 2016…• Availability and readiness was assessed for 29

areas of specific service provision, but for ourpurpose we will see WASH related findings of the705 health facilities assessed,

• 69 % of the health institutions have sanitation facilities,

• 30% the health institutions have improved water source,

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Regions Improved water sources

Sanitation facilities Total number of facilities assessed

Tigray 42% 89% 54

Afar 27% 96% 50

Amhara 36% 73% 77

Oromiya 29% 66 120

E.omali 25% 73% 67

Beni. Gumz 21% 75% 44

S.N.N.P. 20% 62% 37

Gambela 35% 62% 44

Harari 60% 96% 34

Addis Ababa 99% 99% 91

Dire Dawa 74% 99% 41

Total 30% 69% 705 8

Findings of the 2016…• In general, three in ten of the assessed health

facilities (30%) have an improved water source inthe facility,

• However, health posts are less likely than otherfacility type to have an improved water source of17%,

• About seven of ten facilities (69%), have a clientlatrine on premises that is accessible for generaloutpatient use,

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Findings of the 2016….• However, 60% health posts, are less likely to have

a client latrine on premises that is accessible forgeneral client use,

• Overall, there is a variation amongst regions inthe accessibility of improved water sources 99%in AA followed 74% by Dire Dawa and the least20% SNNP followed by Benishangul Gu. 21%

• With regard to sanitation facilities both AA andDD reaches 99% and both Gambella and SNNP62%,

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Waste Collection and Disposal Methods

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59%58%

25%

17%

0%

10%

20%

30%

40%

50%

60%

70%

Safe final disposal of sharps

Safe final disposal of infectiouswaste

Appropriate storage of sharpswaste

Appropriate storage of infectiouswaste

Findings of the 2016….• The result showed that there were differences in

safety measures/ standard requisitions/for infectionprevention among regions ranging from 34 % in Afarto 84 % in Addis Ababa ,

• Health facilities in rural and urban settings, onaverage, had 35% and 69 % mean availability ofstandards precaution for infection prevention itemrespectively,

• There is a difference in the mean availability ofstandard precautions for infection prevention itemsamong facility types with the highest 93% at referralhospital and lowest 29% at health post,

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Physical Facilities 5 Year plan

Performance up to 2010 2nd

Quarter

Performance in %

Institutional WASH (HFs)

Construction of new water supply facilities at health facilities

909 426 47

Rehabilitation of water supply facilities at health facilities

504 196 39

Construction of new improved Health facility latrines 1160 952 82

Rehabilitation of unimproved latrine to improved 765 238 31

Construction of new waste disposal facilities (Incinerators , placenta pits, septic tank & cloth washing facility constructions)

1236 1508 122

Progress to-date

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Progress to-dateCASH initiatives

• Ethiopia launched the Clean and Safe Health

• Facilities (CASH) program in 2014 with the objective ofmaking health facilities clean, safe and comfortable topatients, visitors and the staff

• National minimum standard are Implementation

• Renovation & building of toilette, kitchen, washing area

done on several hospitals & distribution laundry machines

• Alternative water sources and water storage installed

• Hospital level sustainable cleaning campaign continued14

Progress to-date

Cleanliness is every body’s responsibility

Progress to-date

3.MOH direct budget allocation

The new health post design

4. National Regional state bureau budget

5. Community support

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Progress to-dateName of Region

No of Hospitals/Health centers selected

Water connection completed

Water connection on

Progress

Budget allocated

Afar 2 2 - 828,070.40

Amhara 14 12 4 on progress 11,468,906.91

Oromia 53 - 53 on progress 26,417,024.87

Gambella 1 - on progress 660,847.50

Tigray 3 - - 1,205,864.18

Ethiopian Somali

6 - - 3,791,979.29

SNNP 9 9 ongoing process

2,684,977.61

Total 88 HFs 14 74 47,057,670.76

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Existing Challenges

• Lack of awarness on the proper utilization of existingWASH facilities

• Limitation of budget for water and sanitation fornone OWNP beneficiary woredas,

• Incomplete WASH package in some institutions dueto resource / balance/scarcity(OWNP

• Shortage of financial and material resources in thecase of (CASH)

• Turnover of skilled Staff mainly at Woreda level(health offices) is critical which mainly is due tochanging their professional streams and transfer toother areas resulting in losing program memory,

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Recommendations Behaviour change communication:• Communication for behaviour change should follow

a systematic formative study on opportunities,barriers, motivators’ social norms etc.

• The people have to be motivated and mobilized withinformation using posters, leaflets, radio messages,campaigns etc so that change in environmentalsanitation and hygiene practice will be rapid andsustained,

Advocacy:• Equally important is awareness and attitude to

service delivery, and particularly sanitation, amonglocal government, water boards and utility staff,

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Recommendations • Continuous program monitoring, evaluation and

revision based on collecting information andevidence,

• Looking forward to secure budget to reach the un reached health facilities,

• Resolving the existing human resources shortage

• Twinning partnerships enable capacity building and have aided implementing health facilities to make changes.

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Recommendations• Strengthen capacity building by involving partners and private organizations who can then provide technical support in implementation, monitoring and evaluation, training of trainers, information management.

• Improve national monitoring of CASH, quality andWASH by including audit indicators in HMIS anddeveloping quality indicators for inclusion inHMIS.

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Thank you so much

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