Healthy Start Campaign - WaterAid India About Healthy Start - WaterAid India
Healthy Start is our campaign to ensure that every child and mother gets the water, sanitation and hygiene they need.

About Healthy Start

With 174 maternal deaths per 100,000 live births and 28 newborn deaths per 1000 live births , India has one of the highest rates of maternal and infant mortality in the world.
Studies have shown that many deaths in the first month of life result from diseases and conditions that are preventable. One in five newborn deaths within first month of the birth, could be prevented by ensuring access to clean water and providing clean birthing environment . For example, sepsis, is one of the leading cause of infection in newborns, long-associated with poor hygiene at birth.
Burden of neonatal sepsis in India is enormous, hospital-based studies suggest an incidence of 30 per 1000 live births, while community-based studies indicate an incidence of 2.7-17 per cent of all live births.
Though the link between lack of safe water, sanitation and hygiene (WASH) and disease was made 150 years ago yet most of India's healthcare facilities don't have adequate WASH facilities. Almost 140,000 children under five die every year from causes linked to lack of clean water and adequate sanitation, and poor hygiene practices

Photo Credit: WaterAid/Ronny Sen

Why healthcare facilities?

In Sub-Saharan Africa and South Asia around one in five deaths in the first month of life are caused by sepsis, meningitis and tetanus. In those two regions in 2013 these infections together killed over 400,000 new babies. Of these, sepsis is the most dangerous, leading to 18-20% of neonatal deaths.
In those 80 countries with high neonatal mortality rates, which together account for nearly nine out of ten deaths globally, sepsis accounts for 40% of late neonatal deaths (those between seven and 27 days of life). To be able to infect a human being, bacteria need a transmission route – a way to pass from one human being to another. The transmission route for these three bacterial infections is strongly linked to unhygienic conditions and practices at birth. This is why it is so crucial for babies to be given a Healthy Start; beginning life in a hygienic setting and cared for safely.

Photo Credit: WaterAid/Ronny Sen

About Sepsis

Sepsis is an invasive infection normally caused by bacteria. The bacteria that cause neonatal sepsis are acquired shortly before, during, and after delivery. They can be obtained directly from mother's blood, skin, or birth canal before or during delivery, or from the environment during and after delivery. Clean water, safe sanitation and hygienic practices of healthcare staff and mothers in birth facilities can reduce the risk of infection in both cases. Clean delivery practices and handwashing during delivery, and handwashing by healthcare providers after delivery are necessary for reducing the risk of sepsis. Infections can also be easily transmitted if dirty implements are used to cut the umbilical cord, and by contaminated surfaces such as beds and other objects. A failure to make sure that a woman has a clean place to give birth, that a midwife, birth attendant or doctor
has clean hands when helping her deliver and that the blade which separates the child from his mother by cutting the umbilical cord is clean puts a baby at risk of contracting sepsis.

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Water, toilets and hygiene in healthcare facilities

With no readily available source of clean water to clean the wards or hands, healthcare facilities can become harbours for dangerous bacteria with health workers unknowingly transmitting disease from one patient to the next. A review in 2011 of healthcare acquired infections showed that in some developing countries up to one in every two patients (45.6%) left hospital with an infection they had not had on arrival.
In most countries, the current approach towards infections in babies is focused on treatment with antibiotics, rather than preventing infections occurring in the first instance.
Recent efforts to improve maternal and newborn health have tended to overlook the importance of giving a baby a healthy start in life, focusing instead on increasing the number of skilled attendants or emergency obstetric care.
WaterAid wants everyone, everywhere to have access to clean water, sanitation and hygiene by 2030. For the world to achieve this goal, WaterAid believes that all healthcare facilities must be equipped with water and sanitation facilities as a matter of urgency, and health systems must be held to account for ensuring these standards are met.
Everyone must work together to ensure that the most vulnerable members of society do not have their life expectancy reduced to mere weeks, just because there is no clean water in which to bathe them or soap to clean the hands of their carers. At every level of the health service, from individual health workers through to hospital managers, Ministry of Health officials and ministers, and international health organisations, there must be individual and collective accountability for maintaining hygienic conditions in health centres. Efforts to prevent and control infections must be placed at the heart of efforts for overall provision of quality healthcare.

Photo Credit: WaterAid/Ronny Sen

Healthy Start Objectives

WaterAid will increase access to WASH secure services in healthcare in India.
In particular, WaterAid will aim to increasing access to WASH services in healthcare from an average of about 25 % to 100 % in at least half of the 32 districts in which it works, and aim to contribute to an overall increase in WASH access across India by 2020.
Change the narrative on health
Contribute to changing the perceived narrative on priority health interventions amongst health decision makers and other stakeholders by:

  • Challenging the perception / narrative by health decision makers that curative should take priority over preventative healthcare
  • Increasing awareness and understanding amongst health decision makers of the role that secure WASH could contribute in reducing neonatal deaths
Improve the system to ensure WASH in healthcare facilities
  • Strengthening national, state, district and local policies, standards and systems to ensure effective delivery of WASH in health facilities, for example by ensuring implementation of Indian Public Health Standards, Kayakalp, ensuring adequate financing for WASH in healthcare facilities and ensuring that all Rogi Kalyan Samiti (Patient Welfare Committees) in WaterAid Districts are functioning and accountable for WASH.
  • Strengthening the Training course: Improve training of healthcare professionals by ensuring that government-run training programmes include the role of WASH in health and healthcare facilities, as well as their roles as leaders in ensuring the processes and systems run effectively to ensure secure WASH.
Increase demand for WASH in healthcare facilities by
  • trengthening the social status (both at the self-assessed confidence and as perceived by others) of sanitation workers engaged in healthcare: contribute to improving hygiene standards in health facilities and / by strengthening the status of sanitation workers in health facilities and improving training for sanitation workers (see objective on training, above).
  • Community monitoring: Strengthen or create a role for health users, patients, elected representatives (particularly at district level), other stakeholders and communities to monitor the status of WASH in healthcare facilities and work with the government to ensure improvements.

Photo Credit: WaterAid/Ronny Sen

Healthy Start Campaign in India –
A Call to Action

  • To ensure effective implementation of Kayakalp guidelines in all primary, secondary and tertiary healthcare centres
  • To ensure WASH secured and infection free birthing environment in all places - home, community and institutions
  • Doctors, nurses, midwives, support staff, pregnant women and care givers to be informed and empowered to practice adequate hygiene measures
  • Appropriate and adequate provision and utilisation of budget by the government to ensure access to adequate and safe WASH in all healthcare facilities at all levels
  • No new healthcare facilities to be commissioned without adequate access to safe and sustainable water, sanitation and hygiene services
  • Healthcare providers are trained and equipped to include good hygiene practice and promotion in their professional training, plans and actions

Photo Credit: WaterAid/Ronny Sen