Diagnostic Assessment of HCWM and WASH in HCFs in Madesh and Gandaki Provinces, WHO
Duration:
The duration of this contract will be for a total of 6 months which will be performed
intermittently, starting from 1 April and ending 30th Sep 2023.
Background:
Water, sanitation, and hygiene (WASH) in health care facilities are prerequisites for quality
health service and people-centered care. If the health care facilities are clean and provide safe
health-care facilities, it increases trust and demand for services, improve the experience of care,
strengthen staff morale and performance, and emphasize the role of staff as a role model for the
community for setting community hygiene norms. Addressing the problems on WASH in HCF,
World Health Organization released the Essential Environmental Health Standards in Health
Care in 2008; subsequently WHO and UNICEF along with several partners launched the Global
Action Plan on WASH in Healthcare Facilities in 2015, to increase momentum around the issue.
In 2018, the United Nations (UN) Secretary-General issued a Global Call to Action to elevate
the importance of and prioritize action on WASH in all health care facilities. The call recognizes
the important role WASH plays in preventing infections and saving lives. As such, UN agencies,
Member States, and partners are now mobilizing resources to invest more in this fundamental
element for providing universal, quality care. In 2019, considering the JMP 2019 SDG baseline
report for WASH in health care facilities, WHO and UNICEF published practical steps to
achieve universal access to quality care. Among eight suggested practical steps, conduct
situation analysis and assessment, is the basic and fundamental step need to fulfill by member
states to move ahead for further steps to achieve universal access to quality care.
Nepal’s commitment to accelerate Universal Health Coverage (UHC) to ensure equitable access
to quality health service through different cycles of Nepal Health Sector Strategy (NHSS)
depends on the improved quality of care at service delivery points. Inevitably, the delivery of
quality health care to more people generates greater amounts of waste. The health sector itself is
a major contributor and producer of hazardous waste, if not segregated and treated and managed
properly, will give threaten to public health and environment. But still now in many healthcare
facilities, safe water, improved sanitation and proper waste management services are lacking,
especially in remote areas of Nepal. Based on the public health service Act 2075 article 64, and
public health service regulation 2077 article 11, Nepal has endorsed national standards for
WASH in health care facilities. Additionally, Nepal has endorsed national health care waste
management standards and operating procedure 2020, which explicitly recommends non-burn
technologies like autoclaves are more feasible and sustainable technologies to treat major
hazardous wastes produced in the hospitals. The COVID-19 pandemic has led to large increases
in healthcare waste, straining under-resourced healthcare facilities and exacerbating
environmental impacts from solid waste. It shall be the duty of the Provincial and Local Level
to comply with the standards developed by the federal government, so that each health institution
shall manage the risk-free and risky waste by separating them pursuant to the prescribed
standards.
WHO UNICEF JMP report 2019 shows that WASH in healthcare facilities in Nepal is not
satisfactory, specially HCWM situation is very pathetic, covering only 1% health care facility
have basic HCWM service. An estimated 2.09 million (7.31 %) Nepali people still use health
care facilities with no water service and 2.31 million (8.06%) use facilities with no sanitation
services. There is insufficient data on hygiene and cleaning, and it is likely that many more
people are served by health care facilities lacking hand hygiene facilities and regular cleaning
services. However, after the COVID 19 many development partners are supporting to improve
the WASH situation in Nepal.
Health related Ministries mostly in all provinces have shown commitment to upgrade existing
healthcare waste management system of hospitals by allocating considerable amount of budget
on healthcare waste management for their provincial hospitals. However, none of the provinces
(except province 1) has adequate data on the situation assessment and analysis, that is
prerequisite for further plan of improvement. Development partners like GIZ, KFW are
supporting provinces Lumbini, Karnali and Sudurpaschim, but no one is suspprting Madesh and
Gandaki for such type of assessment. And hence, this proposal in collaboration with provincial
ministries aims to conduct rapid diagnostic assessment for WASH and HCWM in 8 hospitals (
federal, provincial and local) of Madhesh Province and 12 provincial hospitals of Gandaki
provinces. Additionally, this activity will provide technical support on design of HCW treatment
Centre along with implementation plan including monitoring and supervision framework.
The technical support is requested for 20 hospitals, 8 selected from the following list of Madesh
province and 12 from Gandaki:
Madhesh province ( Final List):
1) Siraha Haspital
2) Jaleshwor Hospital Mahottari
3) Malangawa Hospital Sarlahi
4) Ram Uma Smarak Hospital Lahan
5) Pokhariya Hospital – Pokhariya Parsa (Primary)
6) Bardibas Hospital Mahottari (Primary)
7) Chandranigahapur Hospital (Primary)
8) Bhardaha Hospital Saptari (Primary)
Gandaki Province ( Final List)
1) Infectious and Communicable Disease Hospital Pokhara
2) Tuberculosis treatment Center Pokhara
3) Parbat Hospital ( Primary)
4) Madhyabindu Hospital, Nawalpur ( Sec-A)
5) Syanja Hospital ( Primary)
6) Maitri Shishu Miteri , Batulechour, Kaski
7) Manang Hospital (Primary)
8) Mustang Hospital (Primary)
9) Sisuwa Praimary Hospital, Kaski ( Primary)
10) Lamjung Hospital ( Sec-A)
11)Beni Hospital, Mygdi ( Sec-A)
12) Damauli Hospital ( Primary)
Objective of the assignment:
The objective of this assignment is
• Conduct rapid diagnostic assessment for WASH and HCWM in 8 hospitals of
Madesh province and 12 provincial hospitals of Gandaki provinces.
• Provide technical support for design of HCW treatment center along with
implementation plan including monitoring and supervision framework.
Description of Duties:
The broader tasks of the party would be following, but not limiting to:
1. Participate introductory/consultation meeting with the MoHP/ MD DOHS and the
existing technical working group (TWG) and share the plan of the work.
2. In coordination with other partner organization, who is going to bear the cost of the
meetings, conduct inception workshop.
3. Collect existing assessment tool for HCWM, tools for WASH and in consultation with
MD/DoHS, finalize the tool for assessment. Tool should be in line with the national
standards, guidelines and SOP.
4. For HCWM, conduct 7 days rapid diagnostic assessment of healthcare waste
management system in selected 8 hospitals of Madesh Province and 12 hospitals of
Gandaki Province. Prepare short brief individual report of each hospital of rapid
diagnostic assessment of healthcare waste management system and WASH
facilities/services.
5. Individually provide a plan/ design drawings including cost estimation for a treatment
centre including an environment friendly technology in line with government of Nepal
applicable policies and guidelines.
Scope of the Work:
The scope of this assessment is to follow the existing tool of diagnostic assessment
and national or WHO’s tool for WASH in health care facilities. For WASH, assessment
will be done to target basic level WASH services as per the national standards 2021
and existing tools for water, sanitation, and hygiene in health-care facilities, as
available.
