Deliveries in health institutions have now reached 75% globally, and in low- and middle- income countries (LMICs) the corresponding increased pressure on facilities has impacted both the quality of care provided and the hygiene standards of the birth environment.
From our inception in 2012, Soapbox has set out to understand the drivers of poor hygiene in maternity units and the opportunities for improvement. In collaboration with our partners, we have conducted assessments of water, sanitation and hygiene (WASH) and infection prevention control (IPC), including environmental hygiene, in maternity units in a number of diverse LMICs – India, Bangladesh, Zanzibar and The Gambia. We are delighted to share the publication of these studies in Global Health Action this month:
The assessments took a mixed methods approach to capture evidence of the status and drivers of WASH and IPC on maternity units. A questionnaire gathering information on the healthcare organisation and operations, (human) resources, and IPC and healthcare practices generated data from fifty-six facilities across the four countries and semi-structured interviews were conducted with over one hundred stakeholders including management, healthcare professionals and cleaning staff. Facilities surveyed ranged from community health centres, primary health centres, clinics, district, and sub-district hospitals and included both private and public facilities, all conducting deliveries.
While not the primary focus of the assessments, common themes emerged consistently pointing to institutional neglect of cleaning and cleaners.
On average, less than a third of the facilities surveyed across India, Bangladesh, The Gambia and Zanzibar delivered formal training to their cleaning staff.
The paper highlights how low status within facilities, wider societal marginalisation, lack of training, and poor pay and working conditions contribute to the lack of prioritisation placed on health facility environmental hygiene. Yet within health facilities, staff who clean are the interface between WASH and IPC. They work in environments where healthcare-associated infections (HAIs) are unacceptably high and the widespread use of antibiotics due to unclean, unsafe environments is driving the threat of antimicrobial resistance.
The neglect of this invisible workforce highlights a missed opportunity for improvement of environmental hygiene, as a key component of quality care, and it is imperative that the neglect of this healthcare cadre is addressed to enable sustainable reductions in HAIs in maternity units.
“Health workers who clean are environmental health champions”
We propose that provision of and improved training can enable the recognition of the valuable role cleaning staff play, as well as equipping these staff with the tools required to perform their job to the highest standard. In addition to training, wider systems changes are necessary to establish improvements in environmental hygiene and the role of cleaning staff, including addressing resource availability, supportive supervision, and an increased emphasis on preventative healthcare.
Soapbox’s TEACH CLEAN package is targeted towards this invisible workforce and presents information and materials required to deliver comprehensive, participatory training on safe environmental cleaning, applying aspects of essential IPC for these tasks. You can learn more about TEACH CLEAN and request a copy of the training package here.