Health-Care Facility Water, Sanitation, and Health-Care Waste Management Basic Service Levels in Bangladesh: Results from a Nation-Wide Survey

As part of Sustainable Development Goal 3.8, access to universal health coverage is a global priority whereby people are encouraged to seek health-care facility (HCF)–based health services with an emphasis on service quality (http://www.who.int/servicedeliverysafety/areas/qhc/quality-uhc/en/). Health-care facilities in low- and middle-income countries (LMICs) are often the focal point of epidemics and emerging infectious diseases, including those from antimicrobial-resistant organisms.1,2 Improving HCF water, sanitation and hygiene (WASH) facilities; environmental cleanliness; and infection control programs can reduce disease transmission, provide a safe environment, and support delivery of quality services that are people-centered. Providing policy makers with data that represent a national overview can highlight areas for attention, to advocate for HCF funding. A nationally representative study of HCFs conducted in Bangladesh in 2014 that focused on service provision reported that a small number of WASH indicators3 and other studies examining features of HCFs that impact nosocomial infections in Bangladesh have concentrated on government and tertiary care HCFs.4–6 Recently, the WHO developed a WASH ladder for HCFs and proposed survey questions for future national HCF assessment.7 To guide policy to improve service delivery in HCFs, we analyze representative cross-sectional data from Bangladesh on water and sanitation facilities and health-care waste management practices. This builds on a recent report on HCF handwashing facilities and practices.8 An observational study in three public tertiary care HCFs highlighted the high frequency of family caregivers providing patient care and their poor handwashing practices,5 suggesting that for Bangladesh and potentially other LMICs, facilities for this patient care group should also be considered during policy formulation. We report WASH facilities for patients, family caregivers, ward staff, nurses and doctors, and health-care waste management. We examine differences among rural versus urban and among government versus other (independent, private, and nongovernmental organization [NGO]) HCFs to inform resource allocation and as baseline for future HCF monitoring efforts.