WASH in HCF Monitoring webinar

Transcription

1 WASH in HCF Monitoring webinar EST 22 June WASH in HCF: Monitoring update 22 June 2017

2 Agenda Overview of progress to date (Rick Johnston, WHO) 10 min Plans for 2018 report Core indicators in facility assessments 20 min Overview of core indicators (Arabella Hayter, WHO) Feedback and experiences of using the core indicators (Lindsay Denny, Emory University) Core indicators in national HMIS 5 min Expanded indicators 20 min Experience of using the expanded indicators in Mali (Samuel Renggli, EAWAG on behalf of John Brogan, Terre des hommes) Additional modules 20 min Developing birthing settings indicators (Pavani Ram, USAID & Anna af Ugglas, WHO Consultant) AOB, next steps and action points 10 min 2 WASH in HCF: Monitoring update 22 June 2017

3 Introduction and progress Overview of progress to date Plans for 2018 report Global Learning Event on WASH in HCF Kathmandu, March WASH in HCF: Monitoring update 22 June 2017

4 Core indicators Four core indicators Water Sanitation Hand hygiene Healthcare waste management Cleaning and disinfection moved to expanded Outpatient departments 4 WASH in HCF: Monitoring update 22 June 2017

5 Core indicators Indicator Definitions of Basic Service 1. Basic drinking water Water from an improved source is available on premises 2. Basic sanitation Improved sanitation facilities are available and usable, separated for patients and staff, separated for women and allowing menstrual hygiene management, and meeting the needs of people with limited mobility. 5 WASH in HCF: Monitoring update 22 June 2017

6 Indicator Definitions of Basic Service 3. Basic hand hygiene Hand hygiene materials, either a basin with water and soap or alcohol hand rub, are available at points of care and toilets. 4. Basic health care waste management Waste is safely segregated into at least three bins in the consultation area and sharps and infectious wastes are treated and disposed of safely. 6 WASH in HCF: Monitoring update 22 June 2017

7 1. What is the main source of water for the facility? 2. Where is the main water source for the facility? 3. Is water available from the main source at the time of the survey? QUESTION ON ALTERNATIVE SOURCE OF WATER REMOVED 4. Is there at least one usable improved toilet available for patients at the facility? 5. Is there at least one usable improved toilet designated for women and girls, which provides facilities to manage menstrual hygiene needs? 6. Is there at least one usable improved toilet designated for staff? 7. Is there at least one usable improved toilet that meets the needs of people with reduced mobility? 8. Are there functional hand hygiene stations available at points of care on the day of the survey? 9. Are there functional hand hygiene stations available at toilets on the day of the survey? 10. Is waste safely segregated into at least three labelled bins in the consultation area? 11. How does this facility treat and/or dispose of sharps waste? 12. How does this facility treat and/or dispose of infectious waste? 7 WASH in HCF: Monitoring update 22 June 2017

8 Monitoring WASH in HCF: Using the Core Indicators Lindsay Denny Center for Global Safe WASH at Emory University

9 Moving Beyond OPD Definition of facility size? Available services, patient load, WASH needs Ex: Hospital vs. non-hospital Meeting the indicator where? What is coverage?

10 Water 1: The proportion of health care facilities with basic water supply Facilities where the main source of water is an improved source (W1), located on premises (W2), from which water is available at the time of the survey (W3). OUR EXPERIENCE: Minimal interpretation Easiest of the core indicators to monitor Snapshot may not be accurate of the water supply year-round, recommend asking about seasonality.

11 Sanitation 2: The proportion of health care facilities with basic sanitation Facilities with improved toilets or latrines for patients located on premises (S1), that are functional at the time of visit, with at least one toilet designated for women/girls with facilities to manage menstrual hygiene needs (S2), at least one separated for staff (S3), and at least one meeting the needs of people with limited mobility (S4). OUR EXPERIENCE: Most detailed core indicator, however not difficult to collect data on the individual questions. Provides an adequate picture of the sanitation Usable vs. functional Gaining access to locked toilets Numbers of toilets

12 Hand Hygiene 3: The proportion of health care facilities with basic hand hygiene Facilities with hand hygiene stations including a basin with water and soap, or alcohol-based hand rubs, present at critical points of care (H1) and within 5 m of toilets (H2). OUR EXPERIENCES: Interpretation of critical points of care. Alcohol hand rub: Trolleys and pockets. Random selection per ward? Access to hand hygiene materials at all toilets?

13 Waste Management 4: The proportion of health care facilities practicing basic healthcare waste management. Facilities where waste is safely segregated in the consultation area (M1) and infectious (M2) and sharps wastes (M3) are treated and disposed of safely. OUR EXPERIENCES: Segregation question is straight forward. Treatment/disposal are the only reported responses for core indicators asking the correct individual. All bins in all wards for coverage?

14 SDG Target Drinking water Sanitation Hygiene Advanced service Advanced service Advanced service Health Care Waste Advanced service (to be defined at national level) (to be defined at national level) (to be defined at national level) (to be defined at national level) Basic service Water from an improved source on site is available at time of survey Basic service Improved facilities, separated for patients and staff, for men and women, and useable by those with limited mobility Basic service Hand hygiene facilities are available at points of care and toilets Basic service Waste is segregated into bins, and sharps and infectious wastes are safely treated and disposed. Limited service There is an improved source, but off premises or not available at time of survey Limited service There are improved facilities, but not usable or do not meet the needs of specific groups Limited service Hand hygiene stations at some, but not all, points of care and latrines Limited service Waste is segregated but not disposed of safely, or bins are in place but not used effectively No service No improved water source No service No improved toilets or latrines No service No hand hygiene stations with soap and water or alcohol based handrub No service Waste is not segregated or safely treated and disposed

15 Integrating indicators into HMIS Country updates Afghanistan undertook a quick review of questions and will be updating HMIS later in 2017 Laos, Ethiopia PNG adding to annual facility inventory survey Issues to address Frequency of data collection? 15 WASH in HCF: Monitoring update 22 June 2017

16 TdH / Christian Brun Using & Adapting Expanded Indicators in Mali (In addition to Core Indicators) WASH in HCF Monitoring Task Team 22 June 2017 John.Brogan@tdh.ch Samuel.Renggli@eawag.ch

17 WATER Expanded List adaptation summary XW1 Does the water available in the outpatient department meet national standards for E. coli, residual chlorine and Arsenic? Added questions: for Who performed the test?, and Date of most recent test. XW3 Are different water sources used for different purposes, e.g. drinking, washing and cleaning, medical procedures? Not tested XW4 Are procedures in place and followed consistently for keeping different water supplies independent and well identified? Not tested 17

18 18 WATER Continued XW5 In the last two weeks, did the outpatient department have enough water for drinking, food preparation, personal hygiene, medical activities, cleaning and laundry? Testing: In general, is there enough water available for x, y, z.? XW6 In the previous two weeks, was drinking water from the main source available for staff, patients and carers throughout each day? Testing: Is there routinely a time of the day when the facility has a severe shortage or lack of water? XW8 Drinking Water Point in the Outpatient Area? Not Tested Added: (Observation) How much functional water storage capacity is available on the facility premises in litres?

19 Sanitation XS1 Visibly clean Toilets: Added: "somewhat" with definition from WINS) XS2 Lighting: Added: (observation) Is the lighting functional? XS4 How are Fecal wastes managed in improved toilets? Split into three : 1. What type of fecal waste containment system exists? 2. How is the fecal waste in the sewerage system managed? 3. (Observation) What is the condition of the fecal waste management sewerage system? XS5b If so (flooding on grounds) were toilet blocks flooded? Not tested XS6 Were any signs of open defecation observed during the facility visit? Added: inside or within 15 meters of the facility perimeter. 19

20 Sanitation Continued Per Government of Mali Ministry of Health indicators, added observations: Distance between the toilets and a groundwater source at least 15m Are all beds in the health facility equipped with mosquito nets Doors and windows equipped with mosquito netting Also added: How frequently are toilets cleaned with detergent? 20

21 Hygiene XH0 Are the health care facility floors, surfaces and toilets cleaned at least once a day with water and detergent and/or whenever they are soiled? Tested as an open question: How often are horizontal surfaces? Also: Toilet cleaning question under Sanitation section (better survey flow) XH1: Is the outpatient area visibly clean? Not Tested XH2: Is soiled linen produced in the outpatient area pre-disinfected and washed in water? Not Tested XH3/XH4 Bed linen: Not Tested XH5: At each hand hygiene stations and/or patient waiting areas is there a hygiene promotion poster? Tested: Are hygiene promotion education materials visible in the outpatient ward? 21

22 Hygiene Continued XH6: Hand hygiene demonstration Not Tested XH7 Are all cleaners, kitchen staff and waste technicians trained in essential cleaning and infection prevention techniques? Need to add this! XH8: Are there sufficient cleaning materials at the facility? Tested (Observations): Are surface cleaning and disinfection products available (e.g. for floors, walls, equipment and beds)? and Are surface cleaning and disinfection tools available? 22

23 Waste Management We did not test Expanded indicators XM 1-8 (Waste Management); we did test: XM9 Are fenced and protected areas available for the storage of waste awaiting removal from the facility and for the disposal pits if applicable? We added (Observation) questions for: - Is there a functional sterilization apparatus? - Are the courtyard and the grounds of the health care facility free of trash on the ground? - Describe the state of the incinerators (simple or double chambered) on day of the visit: 23

24 Waste Management Continued - Is there a kit for collection and transporting wastes? - Does at least one member of the staff have Personal Protection Equipment for collecting and transporting wastes? Interest of Eawag and Terre des hommes to support the Expanded Indicator Working Group! 24

25 Monitoring WASH in Birth Settings Pavani Ram, USAID and Anna af Ugglas, WHO

26 Every Newborn Action Plan: Newborn Mortality Target 4/24/

27 Possible severe bacterial infections cause 23% of newborn deaths annually 27

28 The continuum of care for mothers and newborns in health facilities Labor and Delivery Kangaroo mother care Neonatal intensive care Antenatal care Postnatal care Special newborn care 28

29 Draft Core indicators 1: The proportion of birth settings with basic water supply Birth settings where the main source of water is an improved source (W1), located in the delivery room (W2), from which water is available at the time of the survey (W3). 2. The proportion of birth settings with basic sanitation Birth settings with improved toilets or latrines located in connection to the delivery room (S1) with at least one separated for staff (S2) and at least one meeting the needs of women with limited mobility (S3) 3: The proportion of birth settings with basic hand hygiene. Delivery room with functional hand washing stations present with water and soap (H1), water and soap within 5 m of toilets location (H2) for women to manage hygiene needs (H3) and sterile gloves available for health care providers to use at the time of birth (H4). 4: The proportion of birth settings practicing basic healthcare waste management Birth settings where waste is safely segregated (M1) and infectious wastes (M2) and placentas (M3) are treated and disposed safely. 29

30 Expanded questions General Is there a regular and sufficient supply of electricity in the birth facility to ensure lighting for women and staff? Is there a regular and sufficient supply of electricity in the birth facility to ensure a functioning water pump? Does the facility conduct regular patient satisfaction surveys including WASH and cleanliness to ensure positive patient experience? Is training on WASH included in the continuous professional development programmes for health care providers? 30

31 Delivery room Expanded questions Is drinking water available for women, families and staff in the delivery room? Are private showers available for women to use before and after birth? How frequently is the toilet in the delivery room cleaned? How is the delivery room cleaned after delivery? 31

32 Postnatal care areas Expanded questions Is basic hand hygiene available in the postnatal care area? Are visible hand hygiene instructions for health care providers in the postnatal care area? Are visible hand hygiene instructions for mothers and their families in the postnatal care area? 32

33 Next steps Consensus on the drafted indicators Piloting in selected countries Review of the indicators Incorporating into existing surveys Scale up of surveys Data collection Reporting 33

34 Next steps & action points Reinvigorate task team & establish sub-task teams? 2018 report 34 WASH in HCF: Monitoring update 22 June 2017