Strengthening WASH in health care facilities key to COVID-19 prevention in Kenya

Hand hygiene is the first line of defence in preventing the spread of disease in health care facilities. Yet, according to the World Health Organization (WHO), up to 90% of health care workers are not able to clean their hands regularly.
Kevin Mwanza
Nurse in Kenya scans through a register as mother looks on
A nurse in Kenya reads through a register as mother looks on at a Post-Natal health care facility. ©WSSCC/Amref Kenya
Nurse in Kenya scans through a register as mother looks on
A nurse in Kenya reads through a register as mother looks on at a Post-Natal health care facility. ©WSSCC/Amref Kenya

Data collated by UNICEF further indicates that in sub-Saharan Africa about half of the health care centres do not have access to basic water services.

To address this issue, the Kenya Sanitation and Hygiene Improvement Programme (K-SHIP), through its implementing partners, has been working to support water, sanitation and hygiene (WASH) in health care facilities across 11 of the country’s 47 counties as a component of the broader rural sanitation and hygiene programme.

WASH in health care facilities has been at the core of K-SHIP interventions before and during COVID-19 to help address the need for both infrastructural improvements, such as construction and rehabilitation of toilet and handwashing points and behavioural change that would help reduce the likelihood of the spread of infections at the centres.

“With the advent of the COVID-19 pandemic, it has become even more important for the programme to support the adoption of appropriate hand hygiene behaviours and hand hygiene protocols,” said Ms Beverly Mademba, K-SHIP Programme Officer.

“We can’t stress enough the importance of observing hygiene protocols in times of COVID-19, not only to prevent health care-acquired infections but also because hand hygiene is a critical method for the prevention of the further spread of the virus,” she said.

Kenya has already registered more than 22 053 confirmed COVID-19 infections and some 369 related deaths as of 03 August 2020, according to the World Health Organisation data, raising the need for proper and effective cleanliness measures at health care institutions.

Innovations in WASH critical for healthcare
Innovative handwashing facilities in healthcare facilities ensure hand-hygiene for everyone


In the face of challenges such as inadequate capacity, staffing needs and lack of constant water access at health facilities, K-SHIP has applied innovative approaches to the standard sanitation and hygiene protocols intended to accelerate positive behaviour change.

Ms Abigail Torosian from the Community Health Partners (CHP) in Narok County said that facilities within areas facing semi-arid conditions in the county were utilizing innovative practices such as water harvesting to ensure adherence to hygiene protocols.

“In Narok, some places are semi-arid, and there is no adequate water, or the water available is not safe for use. Some facilities harvest water during the rainy season and can use it for a while,” Ms Torosian said.

K-SHIP implementing partners collaborate with water service providers in improving the availability of water and ensuring the access required to support hand hygiene.

According to Ms Torosian, apart from safe, clean water, health care facilities also need proper sanitation facilities including toilets and to be able to ensure proper infectious waste disposal protocols are thoroughly followed at all times.

A study of 14 county hospitals, carried out in 2019 by the Kenya Medical Research Institute (KEMRI), the University of Amsterdam and the University of Oxford, showed that they lacked adequate toilets, piped water and safe storage facilities for drinking water.


K-SHIP implementing partners also apply an innovative approach called institutional triggering that focuses on sensitizing decision-makers and duty bearers on the magnitude of the sanitation and hygiene problems within their jurisdictions, which prompts them to take necessary actions.

“The aim of institutional triggering is to motivate local health centre managers and key decision-makers to mobilize more resources for water, sanitation and hygiene purposes,” said Mr David Maganya of the Chuodho Women Group in Migori County.

“We are working with infection, prevention and control committees in these health care facilities so that we have a concerted and well-coordinated effort to address WASH challenges,” he said. “If they lobby well they will be able to avail the tanks, put up the gutters in rural health centres and install piped water in those near urban areas.”

The K-SHIP program prioritizes the impact of behaviour change for hand hygiene and hygiene protocols.

Ms Enureta Chebet from the Catholic Diocese of Muranga, a K-SHIP implementing partner, said infection, prevention and control committees (IPCCs) are crucial in pinpointing the sanitation short-comings in the facilities and coming up with ways to engage other stakeholders in resolving them for the benefit of the communities they serve.

The work at healthcare facilities is complemented by sensitization of community members through radio campaigns and through targeted community social mobilization, which reinforces adherence to WASH guidelines.

Since March, and with K-SHIP’s support, implementing partners have also distributed handwashing equipment, sanitizers and thermo-guns to healthcare facilities to assist in the COVID-19 response activities in all 11 of the K-SHIP target counties.