Student Dissertation

Agency : WASH Compliance; Water & Sanitation Hygiene; Labor Room; Maternity Operation Theatre; Labour Room Quality

Objective : To assess the provision of WASH services and practices in labor room in the state of Gujarat. To identify WASH-related gaps and key interventions to fill up the gaps identified at the healthcare facilities in the State of Gujarat.”

Background : Unimproved hygiene, inadequate sanitation, and insufficient& unsafe drinking water account for about 7% of the total disease burden and 19% of child mortality worldwide. Globally, around 2.4 million deaths (4.2% of all the deaths) could be prevented annually if everyone practiced appropriate hygiene and had good, reliable sanitation and drinking water.”

Methodology : This study design will be appropriate as this is an observational study that analyses data collected from a population, or a representative subset, at a specific point in time- that is cross-sectional data. Government of India has recently launched LaQshya project in the country. In Gujarat, it is in the preparatory phase only where gap assessments of all the labor rooms are conducted hence the size of available data is limited therefore the sample size is approximately equal to entire data available.” The main source of information for this study is based on the secondary data collected from the labor room assessment by the District Quality Assurance Medical Officer of all the districts. The data is taken from various healthcare facilities of State of Gujarat i.e. Medical College & Hospitals, All; District Hospitals, All; Sub- District hospitals, All; Community Health Centers, all; Primary Health Centers, All.” As per district reporting to the state, deliveries are being conducted in approximately 1609 facilities. However, the assessment revealed that in reality deliveries were being carried out in a smaller number of facilities. The reasons are various, the main one being a shortage of resource and trained HR to conduct deliveries. The baseline assessment was conducted in 1563 delivery points covering all 33 districts of Gujarat and included 15 Medical College and Hospitals (MCH), 22 District Hospitals (DH), 36 Sub-divisional Hospitals (SDH), 366 Community Health Centers (CHC) and 1473 Primary Health Centers (PHC).”

Findings : Observations INDICATOR N (%) Assigning responsibility amongst staff for Monitoring and supervision • LR- 93.10% • OT- 81% Water availability • LR- 95.34% • OT- 92.84% Functional toilets • LR- 84.4% Handwashing station • LR- 90.55% • OT- 88.98% Biomedical Waste management • LR- 96.77% • OT- 93.66% Dirty Utility area • LR-88% • OT- 89.53% IEC of 6 steps of Handwashing • LR- 91.42% • OT- 90.63% Three bucket system • LR- 78.18% • OT- 83.74% Elbow operated Tap • LR- 60.41% • OT- 79.61% Availability of trained staff • LR- 90.18% • OT- 94.19%

Recommendations : • Water supply was available in almost all the health centers while regular maintenance of water purifier and water tank need to be viewed and monitored. • Lack of formal supervision system for the WASH was observed. • Very few health centers have an insufficient number of bags and bins for BMW segregation and disposal due to a lack of clarity about local purchasing power and irregular distribution from the stores. • A good number of the health centers were having functional toilets for Labor Room while maintenance needs to be regularly monitored. • A quite large number of Labor Rooms and OTs don’t have elbow operated taps installed at the hand washing station. • Most of the health centers have IEC material displayed for handwashing steps above the handwashing station in Labor Rooms and OT but IEC needs to be cleaned properly and rugged IEC needs to replace as they can be the source of infection in LR and OT. • Almost 1/5th of the facilities don’t practice three bucket system or there was unavailability of the same

A key area of Interventions: • Support and motivation amongst the staff • Understanding of the importance of hygiene amongst the staff • Rainwater Harvesting system to be installed to tackle Seasonal water supply problem • Cleaning schedule to be made available • Regular purchase of soap or dispensers to be done • Availability of three bucket system in the facility to be ensured • Periodic training of the staff