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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 Service
Availability 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 approach
program to deliver water, sanitation and hygiene
services across all relevant sectors in general
education and health in particular,
• It prepares to continue efforts to expand access
to WASH services to prevent nosocomial
infections in health facilities,

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 Introduction
• Over the year, considerable progress has been
made in constructing health facilities,
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

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

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Why we focus on Health Facility WASH?
• Nowadays, the Health Care Waste generation rate is
significantly increasing in volume, and diversifying in
types or categories of waste that require proper
handling and disposal,
• A significant proportion of Health Care Waste (15-
20%) is infectious and must, therefore, be properly
collected, transported, and disposed to protect both
the persons handling it and the environment,
• The health facility should also be exemplary to the
near 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 had
assessed 705 HFs, 16% government hospitals,
13% private hospitals, 23% health centers, 25%
clinics and 23% health posts,
• In general; 228 hospitals, 165 HCs, 173 Clinics
and 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 our
purpose we will see WASH related findings of the
705 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 Sanitation facilities Total number of
sources 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 in
the facility,
• However, health posts are less likely than other
facility type to have an improved water source of
17%,
• About seven of ten facilities (69%), have a client
latrine on premises that is accessible for general
outpatient 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 for
general client use,
• Overall, there is a variation amongst regions in
the accessibility of improved water sources 99%
in AA followed 74% by Dire Dawa and the least
20% SNNP followed by Benishangul Gu. 21%
• With regard to sanitation facilities both AA and
DD reaches 99% and both Gambella and SNNP
62%,
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 Waste Collection and Disposal Methods
70%

60% 59%
58%

50% Safe final disposal of sharps

Safe final disposal of infectious

40%
waste

Appropriate storage of sharps

30%
waste
25%

Appropriate storage of infectious

20% waste
17%

10%

0%

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 Findings of the 2016….
• The result showed that there were differences in
safety measures/ standard requisitions/for infection
prevention among regions ranging from 34 % in Afar
to 84 % in Addis Ababa ,
• Health facilities in rural and urban settings, on
average, had 35% and 69 % mean availability of
standards precaution for infection prevention item
respectively,
• There is a difference in the mean availability of
standard precautions for infection prevention items
among facility types with the highest 93% at referral
hospital and lowest 29% at health post,
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Physical Facilities
Progress to-date 5 Year Performance Performance
plan up to 2010 2nd in %
Quarter

Institutional WASH (HFs)

Construction of new water supply facilities at health 909 426 47
facilities

Rehabilitation of water supply facilities at health 504 196 39

facilities

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 1236 1508 122

(Incinerators , placenta pits, septic tank & cloth washing
facility constructions)
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 Progress to-date
CASH initiatives
• Ethiopia launched the Clean and Safe Health
• Facilities (CASH) program in 2014 with the objective of
making health facilities clean, safe and comfortable to
patients, 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 continued
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 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-date
Name of No of Water Water Budget allocated
Region Hospitals/Health connection connection on
centers selected completed Progress

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 6 - - 3,791,979.29
Somali
SNNP 9 9 ongoing 2,684,977.61
process
Total 88 HFs 14 74 47,057,670.76
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 Existing Challenges
• Lack of awarness on the proper utilization of existing
WASH facilities
• Limitation of budget for water and sanitation for
none OWNP beneficiary woredas,
• Incomplete WASH package in some institutions due
to resource / balance/scarcity(OWNP
• Shortage of financial and material resources in the
case of (CASH)
• Turnover of skilled Staff mainly at Woreda level
(health offices) is critical which mainly is due to
changing their professional streams and transfer to
other 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 with
information using posters, leaflets, radio messages,
campaigns etc so that change in environmental
sanitation and hygiene practice will be rapid and
sustained,
Advocacy:
• Equally important is awareness and attitude to
service delivery, and particularly sanitation, among
local government, water boards and utility staff,
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 Recommendations
• Continuous program monitoring, evaluation and
revision based on collecting information and
evidence,
• 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 and
WASH by including audit indicators in HMIS and
developing quality indicators for inclusion in
HMIS.

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 .

Thank you so much

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