Quality, Equity, Dignity

A Network for Improving Quality of Care
for Maternal, Newborn and Child Health


Standard 8, Quality statement 8.1: Water, energy, sanitation, hand
washing and waste disposal facilities are functional, reliable, safe and
sufficient to meet the needs of staff, women and their families (1).

Global situation of WASH in health- Action plan activities are centred around four main
areas: advocacy/leadership, monitoring, evidence,
care facilities and facility-based improvements, which have
a strong focus on nationally and locally driven
In 2015, for the first time, the World Health
solutions (4).
Organization (WHO) and the United Nations
Children’s Fund (UNICEF) assessed the status of
water, sanitation and hygiene (WASH) in health- Links between WASH and the
care facilities in low- and middle-income countries
(2). With nearly 40% of facilities lacking improved
Quality of Care agenda
water, and nearly 20% without sanitation, WHO, Achieving and maintaining adequate WASH services
UNICEF and partners committed to address the in health-care facilities is critical for meeting several
situation at a global meeting, with the aim of targets under Sustainable Development Goal
achieving universal access in all facilities, in all (SDG) 3 (good health), especially 3.1 and 3.2 on
settings by 2030 (3). reducing maternal and neonatal mortality and 3.8

Photo: Children take water from water filters, at Zilla Parishad Higher Primary School in Bhatari, India, in June 2012. ©UNICEF/Vishwanathan

Prepared for the Network launch meeting, 14–16 February 2017, Lilongwe, Malawi

supported by cross-sectional studies in Bangladesh and India. improve the experience drinking water and hand hygiene facilities (6. SDG 7 (clean energy) most highly correlated with satisfaction. and comply with treatment.7). improvements bring emergencies under control when they occur. while the newborn health to ensure specifically targeted interpersonal behaviour of the caregiver was the efforts in quality improvement in this area. availability of and demand for services. a systematic review of 54 studies on in the Quality of Care framework for maternal and quality of maternity services found that. allow effective responses to emergencies To ensure that increasing demand and use of services (including natural disasters and outbreaks) and is met with quality service provision. India in October 2009. Such services also strengthen the health-care provider. Orissa. © UNICEF/Sampson 2 . WASH is included For example. Photo: Schoolboys wash their hands at a ceremony to celebrate Global Handwashing Day in Bhubaneswar. These findings are services in health-care facilities. of care. where the patient rating of services was Clean and safe health-care facilities increase trust in highly correlated with clean toilets. Patients who are satisfied with their experience and reinforce the role of staff in setting societal are more likely to trust and cooperate with their hygiene norms.on universal health coverage. in WASH services and hygiene practices in health- care facilities must be addressed. resilience of health systems to prevent disease outbreaks. strengthen staff morale and performance. cleanliness and SDG 13 (climate change) provide further and availability of functioning toilets and drinking momentum and resources for comprehensively water were also important factors influencing addressing environmentally sound infrastructure perceptions of quality (5).

primary health care facilities in low- and middle-income settings through a continuous cycle of improvement. are change. demands of the facility and auditing and recognizing high-performing • Written. usable and accessible. maintained by staff and in health care (8). WASH FIT is a framework to guide small. competent staff on site. While impact studies are ongoing. and defining specific. For example. the time of childbirth. incremental changes to improve the cleanliness and safety of a facility. uptake of services. patients and visitors. with WASH with quality-of-change clear descriptions of their responsibilities improvement activities • Sufficient funds for rehabilitation. and sufficient been noted as particularly instrumental in driving in number for staff. in particular feeding into Infection Prevention and Control (IPC) and specific quality-of-care improvement activities. A similar inclusive national model sanitation and hygiene facilities and safe waste is being implemented in India under the name management “Kayakalp” and engagement with communities • Sanitation facilities on premises that are to demand and seek safe and clean facilities has available. staff accountability. with water and soap (or (CASH) campaign in Ethiopia launched in 2015 alcohol-based hand rub) in all wards has significantly improved WASH in 249 health- care facilities through training. hospitals. WHO and UNICEF developed the Water and continuous operation of maintenance of WASH services and Sanitation for Health-care Facility Improvement tool (WASH FIT) (9). Tanzania in April 2014. sanitation and hygiene quality statements • Preventive risk plan for managing and improving build on existing WHO standards for water. but with a specific focus around regulated by a competent authority. resulting in improved health outcomes and a better experience of care. and include at least one toilet that meets the needs for menstrual hygiene management WASH FIT: A tool for integrating • Sufficient trained. WASH services sanitation and hygiene in health-care facilities • Energy management plan supported by an detailed in Essential environmental health standards adequate budget. These actions are integrated into a facility’s existing activities. the “Clean and Safe Hospitals” • Hand hygiene stations. report improvements in satisfaction and significant hand hygiene. separated by gender. ©UNICEF/Kate Holt 3 . up-to-date protocols and awareness. operating and maintaining water. staff raising materials on cleaning and disinfection. innovative technologies back-up power source) to meet electricity and their management by the private sector. targeted actions.Quality statements linked to WASH • A fuel management plan and local buffer stock as required Water. WASH FIT encourages small.1. To reach Quality Standard 8. • Sufficient energy infrastructure (including a community engagement. Improvements are made with the long-term aim of reaching health-based targets and meeting standards included in national accreditation Photo: Women hold their babies in the paediatric unit of the regional hospital in Zanzibar. improvement In 2015. prioritization of risk. through assessments. the following inputs What are countries doing to must be realized: improve WASH in health-care • Protected water source at the facility which provides water to meet demands of the facility facilities? • Waste disposal bins in all treatment areas Many countries are taking action to improve WASH to allow segregation of waste at point of in health-care facilities as part of the quality of generation care.

Hasan A.int/ maternal_child_adolescent/documents/improving. Health Organization. Geneva. accessed 2 February 2017).050401. Meeting report.who. Faculty of Graduate Studies.87(4):271–8. Switzerland. pdf?ua=1. exchange and further mobilize global.qualityofcarenetwork. 2016 (http://www. Malawi and doi:10. Patient satisfaction with MCH services among mothers attending the MCH training institute in Dhaka. A knowledge portal has been established to share. national and in a number of African countries. and hygiene in health care facili- ties: status in low.washinhcf. Nakhonpathom. Kenya. Geneva: January 2017).07. 17–18 March 2015. Indian J Public Health. Bleich SN. including Chad. New York: Unit- ed Nations Children’s Fund. Chartier Y. Global meeting. nization.who.who. int/water_sanitation_health/publications/ehs_hc/en/. Water. accessed 2 February 2017). Design: Inis Communication – www. sanitation and hygiene in health care facilities – urgent needs and actions. Özaltin E. Standards for improving quality of maternal and gal – an overview.int/iris/bitstre am/10665/154588/1/9789241508476_eng. Notes and references 7. Geneva: World Health Organization. 8. 2011. To date. newborn care in health facilities. Essential envi- maternal-newborn-care-quality/en/. local action relating to the global action plan (https:// Liberia. accessed 30 ronmental health standards in health care. 2015. Water.org .pdf?ua=1. editors. United Nations Children’s Fund. WHO. 6. Adams J. Bartram J. 2007. Additional training www.who. 3. Basu SS. World Health Organization. How does satisfaction of other countries. WASH FIT has been implemented 4.85235. (http://www. Thailand: Mahidol University. Murray CJ. including Cambodia. WASH FIT is currently being published and will be and way forward.int/ water_sanitation_health/facilities/wash-in-hcf-geneva. Lao People’s Democratic Republic. 2.schemes. Tajikistan.iniscomunication. Geneva: World Health Orga.washinhcf. Madagascar and Mali. Tanzania in April 2014. (http://apps.com sanitation. with the health-care system relate to patient expe- rience? Bull World Health Organ. 2015. Geneva: World doi:10. Basu AK. An assessment of rural health care delivery system in some areas of West Ben- 1.and middle-income countries 9.2471/BLT. Ray SK.4103/0019Ð557X.55(2):70. available at www.org). 2009. accessed 2 February 2017). Photo: Gift Moses holds her newborn baby girl in the Mbeya Regional Hospital in Mbeya. and WASH FIT activities are planned in a number 5.org in March 2017. 2008 (http://www. ©UNICEF/Kate Holt www. Bangladesh [thesis].