Lack of proper handwashing facilities impacts health care facilities in Nepal

A rural hospital in Nepal is painfully demonstrating the negative impact of inadequate handwashing facilities as medical workers are forced to fill water jars up to ten times a day while trying to fight COVID-19 and provide necessary care to their patients. But a sanitation programme employs a survey to identify the gaps in sanitation and hygiene.
Renu Kshetry

Explaining the repercussions of lack of handwashing facilities, Dr Kapil Gautam, Medical Officer at Arghakhanchi District Hospital in Sandikharka, 460 kilometres west of Kathmandu, says, “Hand hygiene is the most effective way to prevent infections and especially during this pandemic, every health care providers are at risk of infections while they are treating patients.”

This month, to improve this bottleneck, the executing agency of WSSCC’s Global Sanitation Fund (GSF) supported the hospital to install a handwashing station. It’s now being used by close to 300 patients and visitors. 

GSF/UN-Habitat supported foot operated hand washing station at Arghakhanchi district hospital of Nepal. Photo: Rajan Bhushal.

GSF/UN-Habitat supported foot operated hand washing station at Arghakhanchi district hospital of Nepal ©WSSCC/Rajan Bhushal

“After installing this, even we (frontline health workers) feel secure, and this is indeed huge support to contain the spread of coronavirus and other infectious diseases,” said Dr Gautam. 

Arghakhanchi District Hospital is just one of many health care facilities (HCFs) that are struggling with inadequate handwashing infrastructure.

Survey highlights gaps in handwashing facilities

Earlier in May, the GSF team in Nepal conducted a survey with 305 HCFs. Preliminary results reveal that around 4% of the HCFs in 50 palikas (municipalities) lack proper handwashing facilities. The survey report also showed that 9% of HCFs do not have toilet facilities and 4% have toilets that are not operational, due to the pit being full, structural collapse, or an overflow of faecal sludge, for example.

The survey was conducted in hospitals, primary health centres, health posts, basic health care centres and birthing centres, to assess the Water, Sanitation and Hygiene (WASH) status of HCFs in the GSF working areas and identify possible WASH facility gaps. 

Due to the restrictions of the COVID-19 lockdown, the survey was conducted through telephone communication utilizing KOBO Collect mobile application.

“This preliminary assessment has helped us find the gaps, especially regarding operationality and functionality of handwashing and toilet facilities. This will help us to improve the facilities along with providing 192 handwashing stations in 50 palikas of our total 16 coverage districts,” said Ms Sudha Shrestha, acting Chief Technical Advisor of UN-Habitat, the executing agency of the GSF. 

In addition, the survey uncovered further gaps in HCFs, showing only 11% of HCFs have disabled-friendly toilets and some 22% of HCFs have no waste segregation practices. 

The survey also found that HCFs in the Terai districts of Rautahat, Parsa, Siraha and Dhanusha do not have safe toilets, relying upon single pit toilets. Furthermore, 45% of the HCFs is not treating its drinking water, either through filtration, chlorination or boiling. 

GSF/UN-Habitat handed over WASH and clinical materials to Menuka Kafle, chairperson of Kamal Rural Municipality, Jhapa of Nepal

GSF/UN-Habitat handed over WASH and clinical materials to Menuka Kafle, chairperson of Kamal Rural Municipality, Jhapa of Nepal ©WSSCC/Som Acharya

Out of 305 HCFs, 63% were also found to not address menstrual health management, through the availability of sanitary pad disposal bins or the availability of sanitary pads.

More encouraging results included 65% of HCFs found to be practicing regular cleaning of facilities, and 87% of HCFs have separate allocated handwashing facilities. In the 305 HCFs where the survey was conducted, there were 525 handwashing platforms, which shows good overall access to handwashing. Some districts, such as Nuwakot, Morang and Bhaktapur, showed higher numbers of handwashing facilities, while Jhapa District has shown to have the lowest numbers.

 “Since UN-Habitat is also involved in providing technical support to the concerned palikas in its working areas in planning WASH guidelines and sanitation plan, this survey will help us strengthen our intervention strategy,” explained Ms Shrestha.

Filling the gaps

Responding to the gaps uncovered by the survey, the GSF/UN-Habitat has provided 11 out of a total 30 foot-operated handwashing stations to health care facilities in four districts – Arghakhanchi, Bardiya, Bhaktapur and Nuwakot. 

The GSF/UN-Habitat also provided WASH packages to the HCFs in 50 palikas in all 16 working districts. Each package includes 500 masks, 240 soaps, 102 gloves, 10 liquid soaps, two wastebaskets, two buckets and two mugs, 240 sanitary pads and two sets of thick rubber gloves for cleaning in.

An Assessment Report on the results of the survey has also been prepared to inform partners and government officials on the key gaps and needs in this area.

“This preliminary survey report helps us to be better prepared to combat emerging health threats on time,” concluded Ms Shrestha. “We will share this report with the concerned local government officials to take urgent action together.”