Improvements in water, sanitation and hygiene (WASH) and patient satisfaction following a bundled climate-resilient WASH-IPC intervention at a rural Pakistani health centre: A pre-post operational study
Mariam Ashraf, Babar Tasneem Shaikh, Bisma Imran, Nighat ImmadBackground
Water, sanitation and hygiene (WASH) services underpin infection prevention and control (IPC), yet gaps persist across Pakistan, and outcomes of comprehensive WASH-IPC delivery in rural facilities are poorly documented. This study assessed facility readiness and patient-reported experience following a bundled, climate-resilient WASH-IPC intervention.
Methods
An uncontrolled pre-post study was conducted at Rural Health Centre Nindo, Badin, Sindh. The intervention, comprising WASH infrastructure, waste management, IPC consumables, staff training and governance, was delivered during next 1 year. Readiness was scored at baseline and endline using the WHO/UNICEF Water and Sanitation for Health Facility Improvement Tool (WASH-FIT) across seven domains and classified against Joint Monitoring Programme (JMP) service ladders. At endline, external enumerators applied a 32-indicator observation checklist and surveyed 200 patients and companions. Change was expressed as percentage-point difference, and domains were compared using the Wilcoxon signed-rank test.
Results
The WASH-FIT score rose from 32.3 to 86.9%, with improvement in all seven domains (median gain 62.5 percentage points;
Conclusion
Facility readiness improved substantially. The uncontrolled design precludes attribution; the absence of a facility-level WASH budget, backup water source and complete cleaning systems threatens sustainability.