Water and sanitation systems in Bangladesh's healthcare facilities remain below the global average.
A recent global survey has found that at least one out of every seven healthcare facilities has no water services in Bangladesh, while globally it is one out of 10 that do not have such services.
It means that those healthcare facilities either use tap water, water from a tube well, from some such improved source which is sometimes over half a kilometre away or they use surface water from a pond or river. Sometimes there is no water at all.
The report titled “Wash in Health Care Facilities, Global baseline Report 2019” conducted by the WHO/UNICEF Joint Monitoring Programme (JMP) for water supply, sanitation and hygiene indicates that wash services in healthcare facilities are sub-standard in every region.
The report focused on three aspects -- water, sanitation and hygiene of the healthcare facilities but data scarcity was a major barrier for getting the actual picture of the situation.
Regarding basic water services, only 38 countries had sufficient data while Bangladesh could not provide sufficient data. Bangladesh could not provide sufficient data on sanitation services while only 18 countries have enough data. In hygiene, Bangladesh could not provide sufficient data.
“In the report we have seen that we have limitations in data. So government must have focused on data collection and should formulate policy analyzing the data on a regular basis,” Khairul Islam, country director for WaterAid, told The Daily Star yesterday.
The report represents a compilation and analysis of existing monitoring data that countries have already collected and reviewed.
The new JMP global database on WASH in healthcare facilities includes national data from 125 countries. Data was extracted from 260 nationally-representative facility assessments and mapped to a standardised set of global indicators for water, sanitation, hygiene, waste management and environmental cleaning services in healthcare facilities.
Contacted, Prof Abul Kalam Azad, Director General of Directorate General of Health Services (DGHS), said to The Daily Star, “In Bangladesh there are around 14,000 community clinics where we set up tube wells for water supply. So the facilities of a community clinic, or Dhaka Medical Hospital or any Upazila health complex will not be same. Is it possible to run any upazila health complex or any medical college without water service?”
He said people usually come to community clinics or health centres with minor problems and they leave the clinic soon after treatment. “I think the report compares both community clinics and other healthcare facilities together. It is not a right comparison.”
The report also said an estimated 896 million people use healthcare facilities with no water and 1.5 billion lack access to sanitation services. It is likely that many more people are served by healthcare facilities lacking hand hygiene facilities and safe waste management.
The report said 79 percent of hospitals in Bangladesh had an improved water source located inside for general use, but only 59 percent had drinking water for patients and staffers from a comparable source.
It also said 70 percent healthcare facilities had basic water service from an improved water source located on premises while it is 74 percent globally.
According to the report, seven percent heathcare facilities in Bangladesh lack toilets facilities while it is 21 percent globally.
In Bangladesh 54 percent healthcare facilities had hand hygiene materials at points of care while it is 58 percent globally.
“Bangladesh government is taking various steps to improve the water and sanitation situation in healthcare points. For example, the government has already formulated a guideline in community clinics on water and sanitation usage,” Khairul said.
“But the alarming point is that the waste management system of healthcare facilities is not good. Disease outbreak from those places and in hospitals is very risky.”
The report cited a 2014 national assessment in Bangladesh which found that toilet cleanliness may vary by different types of users within a health care facility: 96 percent of toilets for doctors and 93 percent for staff were observed to be clean, while 64 percent of patient toilets was clean.
The report said it surveyed nearly 5,000 hand hygiene opportunities at health care facilities in Bangladesh and found that while 69 percent of hospitals had hand hygiene facilities at points of care, only 17 percent of health care workers washed their hands with soap after touching patients or wounds, and only 2 percent washed their hands with soap before patient contact or aseptic tasks.
“In Bangladesh any doctor has to handle a number of patients simultaneously. So it may not be possible for doctors all the time to wash their hands every time before interacting with a patient. But we are always careful about cleanliness and safety of the doctors and patients,” DGHS Director Azad said.