@article{96c1684f00c24f4a825295651db0f61a,
title = "Estimating the cost of interventions to improve water, sanitation and hygiene in healthcare facilities across India",
abstract = "Introduction Despite increasing utilisation of institutional healthcare in India, many healthcare facilities (HCFs) lack access to basic water, sanitation and hygiene (WASH) services. WASH services protect patients by improving infection prevention and control (IPC), which in turn can reduce the burden of healthcare-associated infections (HAIs). However, data on the cost of implementing WASH interventions in Indian HCFs are limited. Methods We surveyed 32 HCFs across India, varying in size, type and setting to obtain the direct costs of providing improved water supply, sanitation and IPC-supporting infrastructure. We calculated the average costs of WASH interventions and the number of HCFs nationwide requiring investments in WASH to estimate the financial cost of improving WASH across India's public healthcare system over 1 year. Results Improving WASH across India's public healthcare sector and sustaining services among upgraded facilities for 1 year would cost US 354 million in capital costs and US 289 million in recurrent costs from the provider perspective. The most costly interventions were those on water (US 238 million), linen reprocessing (US 112 million) and sanitation (US 104 million), while the least costly were interventions on hand hygiene (US 52 million), medical device reprocessing (US 56 million) and environmental surface cleaning (US 80 million). Overall, investments in rural HCFs would account for 64.4% of total costs, of which 52.3% would go towards primary health centres. Conclusion Improving IPC in Indian public HCFs can aid in the prevention of HAIs to reduce the spread of antimicrobial resistance. Although WASH is a necessary component of IPC, coverage remains low in HCFs in India. Using ex-post costs, our results estimate the investment levels needed to improve WASH across the Indian public healthcare system and provide a basis for policymakers to support IPC-related National Action Plan activities for antimicrobial resistance through investments in WASH. ",
keywords = "disease, disorder, health economics, health policy, health systems, or injury, other infection, public health",
author = "Tseng, {Katie K.} and Jyoti Joshi and Susmita Shrivastava and Eili Klein",
note = "Funding Information: Findings from our study highlight the urgent need to invest in WASH, particularly at the primary care level, which required the greatest proportion of WASH investment. Substandard WASH has impacts not only in PHCs, but also across the healthcare system as HAI pathogens can rapidly spread as patients move between facilities and communities. Moreover, because of the dichotomy between preventative services (provided by PHCs) and curative services (provided by some CHCs and most DHs), substandard WASH provision in PHCs can harm public perception of the value of preventative healthcare. In India, Panchayat Raj Institutions, a three-tiered system of local, self-governing bodies funded by state grants and local taxes, are responsible for the establishment of PHCs and the provision of essential services (eg, drinking water). To direct more funding towards WASH in PHCs, engaging Panchayat Raj Institutions is critical as they can help generate funds at the village level to support upkeep of WASH facilities in primary healthcare. Funding Information: The estimated first year cost to implement WASH improvements across the Indian public health sector would be roughly US$354 million and US$289 million in capital and recurrent costs, respectively. These costs are comparable to other national health schemes like Pradhan Mantri Jan Arogya Yojana (PMJAY), which seeks to provide free healthcare coverage for 40% of India{\textquoteright}s population. PMJAY was budgeted roughly US$936 million for 2019–2020,62 suggesting that improving WASH in HCFs could be affordable if prioritised by the MoHFW. However, these improvements would need to be a coordinated effort for investments to be sustainable. While the construction of WASH facilities in HCFs is supported by the MoHFW{\textquoteright}s National Health Mission and fully funded by the central government, ongoing maintenance of health services (including WASH) is the responsibility of the state government. Thus, long-term political and financial commitment must come from all levels of government. At the facility level too, establishing and maintaining WASH provision require interfacility cooperation and support from top management, especially in large, multidepartment facilities. Despite these challenges to implementation, the consequences of poor WASH provision and compromised IPC on AMR pose a unique opportunity for policymakers to strategically address the need for WASH and IPC investment within the framework of India{\textquoteright}s National Action Plan on AMR in an effort to gain greater support from high-level officials. In particular, as LMICs like India scale up their AMR-National Action Plans, AMR sensitive interventions, which indirectly help contain AMR but are primarily for other objectives like improving WASH in HCFs,63 will be critical to addressing the burden of resistance. Funding Information: Funding This work was supported by the Centers for Disease Control and Prevention (Contract No: 200-2016-91774).",
year = "2020",
month = dec,
day = "21",
doi = "10.1136/bmjgh-2020-003045",
language = "English (US)",
volume = "5",
journal = "BMJ Global Health",
issn = "2059-7908",
publisher = "BMJ Publishing Group",
number = "12",
}