WaSH, an acronym for water, sanitation and hygiene is essential to ensure the health and wellness of a nation. WaSH Assessment System for Hospitals (WASH), is an online tool newly developed by Swasti, a Health Resource Centre. This is a real-time monitoring and decision support system to encourage and enforce mandatory WaSH practices in health facilities.The system consists of a mobile and web application to create accountability and transparency around hospital practitioners towards clean water, sanitation, and hygiene.
What are the circumstances that led to the app? Please, can you give me a background?
The recent World Bank data on Maternal Mortality Rate for India reported in 2015 is 174 per 100, 000 live births and Infant Mortality Rate at 38 per 1000 live births.
When Swasti was approached by various national and international agencies to conduct studies in hospitals at different levels from primary health center up to State level hospitals for gaining accurate evidence linking poor water, sanitation and hygiene conditions in hospitals to deaths of mothers and infants during delivery, we realised the need for a real-time monitoring system than a one-off assessment.
From the assessment of WaSH in over 100 government health care facilities in various states across the country, we found that the poor WaSH practices led to poor treatment outcomes like infection and disease and ultimately death. There is a lack of management systems to monitor and support WaSH in hospitals
although there are Government of India-issued guidelines.
There was a lack of accountability and transparency to ensure that the existing infrastructure is consistently maintained and proper cleaning services provided. In most facilities, the toilets were nonfunctional, wash basins were unhygienic to be used and water sources were contaminated. For eg. 15% of sampled hospitals looked at in Odisha did not have an adequate water supply. 29% of facilities in one district in Karnataka had insufficient drinking water, and. 30% of facilities sampled in MP didn’t have enough water to maintain hygienic practices.
Since there is a direct link between treatment outcomes to Water, sanitation, and hygiene in hospitals, we realized that multi-layered accountability across the health facilities is required, particularly since these issues are easily fixable yet unprioritized. We felt it’s better to empower the hospital administrators and decision-makers with a tool rather than having an external agency to monitor the WaSH status and help in making evidence-informed decisions for improvement. This is aligned with Swasti’s strategy to strengthen the health systems in a sustainable manner so that positive health outcomes are experienced, particularly for the poor who use the public health system. This led to us developing this application with our technology partner- Converbiz Technologies, Bangalore.
WaSH Assessment System for Hospitals is a simple yet effective mobile and web-based solution to improve evidence, accountability and real-time transparency to aid in making decisions to improve Water, sanitation and hygiene status of health facilities.
Can you offer an insight into the app?
WaSH Assessment System for Hospitals consists of an Android app and web platform that helps hospitals monitor and execute healthy wash practices. The app is being launched to provide healthcare facilities and higher administration real-time access to WaSH information. Simply put, the app enables hospitals to monitor and execute healthy WaSH practices at different levels through informed data-driven decisions. With regular real-time monitoring resulting in enhanced WaSH standards maintained in healthcare facilities, the quality of health services will eventually improve. This would inevitably prevent infection and thereby reduce maternal and neonatal morbidity and mortality.
Please throw light on the app. What are its benefits, is it multilingual and what is the expected outcome?
The WASH App has been made in accordance with the Government of India’s
Kayakalp Guidelines prepared for healthcare facilities. The medical officers or the hospital superintendents can install the app on the mobile phones. The users will have a unique user id and password. The multilingual app has a simple and iconized user interface. It has configurable functionalities including addition, deletion or modification of questions and indicators as per requirement.
The anticipated outcome is that the insightful analytics will hopefully lead to a timely and accurate response. The adoption of appropriate WaSH habits within healthcare delivery systems on a real-time basis is expected to reduce delay in action when issues are reported, save time, money and most importantly, save lives.
How does WaSH offer real-time access to healthcare facilities and how does it double up as a decision support tool?
An app is a tool that ensures the necessary validation at different levels. Algorithms are built in to calculate the key performance indicators. These vital analytics help hospital administration prioritize activities.
This is how it works. The WaSH conditions of the hospital will be monitored and details like biomedical and hazardous waste management, personal protection practices, cleaning activities in the facility etc. will be filled into the survey form every quarter by the hospital administrator or Officer-In-Charge. When the data is collected and fed into the various sections of the form, the key performance indicators will be auto-calculated and the dashboard will show the WaSH performance of the facility. The dashboard is customisable at all levels of hierarchy including district and facility level to view several layers of information and indicate a subsequent set of actions. Thereby, the system reveals the performance of the hospitals at a block level, performance of blocks at district level and performance of districts at the state level and upwards. This monitoring helps states gauge the fund and techno-management support requirements in its districts and so on. Hence making the WaSH system both a visibility and accountability tool.
What according to you is the challenge faced by healthcare providers in India and how do you feel it needs to be overcome?
Hospital infections are spread through poor quality water, sanitation, and hygiene practices
resulting in poor treatment outcomes and in worse cases, death. The challenge lies in bringing a positive change in attitude and discipline to maintain strict hygiene conditions. A lack of awareness and in most cases inconsistent positive behaviors among staff has often led to high infection rate in labor rooms and operation theaters. Health care providers can overcome this, once they realize that their treatment outcomes are closely dependent on WASH practices and that they have the power to enforce practices across the hospitals. Resources can be garnered and autonomy provided by using this application and exhibiting the status and hence the requirements to meet the WASH needs of the hospital.
Who is the target group for the app and how do you plan to market it? What is the desired outcome?
As of now, the app is ready to be implemented. We are targeting hospitals, donors, and state governments. Patients are its beneficiaries.
The application is only developed and has not been fully piloted. Hence there is no demonstrable impact yet. Adoption requires a strong sense of accountability and transparency from within the public sector and from development partners.
Even though the current app is mainly developed in the Indian context, WaSH issues across the world are very similar and the app can be configured into the context of any country/ region according to the needs. It can be customised in any of the Indian local languages as required and the key performance indicators can be modified if necessary.
An application of this kind has probably never existed in India till now. Since the app has a multi-level support system, many of the WaSH practices which are either forgotten or forgone will have to be taken seriously. This application has been piloted and working well. We have received interest from several development partners including those from the UN but it is yet to take off or be implemented by a department.
The expected outcome is that precious lives will be saved. The adoption of appropriate WaSH practices within healthcare delivery systems on a real-time basis will lead to a reduced delay in action when issues are reported, save both time, money and lives.