In 2015, the union government of India took an initiative to encourage Primary Health Centres (PHCs) to excel in standards for cleanliness and hygiene through Kayakalp award. The award is endowed to any health facility on certain parameters, such as hospital/ facility upkeep, sanitation and hygiene, waste management, infection control, support services, and hygiene promotion amongst others. During May 2018, WaterAid India’s intervention area, Pusapatirega Primary Health Centre in Vizianagaram district of Andhra Pradesh, was awarded as the ‘Best PHC’ under Kayakalp at the district level.
In 2016, a number of awareness activities and capacity building sessions were organised to promote WASH in health facilities based on Kayakalp guidelines.
Discussions were initiated with the PHC staff and Hospital Development Society (HDS) members on challenges faced by them, such as the unsafe deposit of waste, the unhygienic condition of washrooms, and unsafe collection of catheters and unhealthy practice of dressing. A series of training sessions were also organised to build the capacity of PHC staff and HDS members on handwashing, segregation of waste, management of bio-medical waste, cleaning of critical areas and so on. Additionally, to achieve total sanitation various activities, like the capacity building of frontline workers, Shram Daan (voluntary work), creating awareness amongst school children, and tree plantation were organised.
Following are some of the initiatives undertaken:
- A schedule to ensure regular cleaning of critical areas, such as operation theatres and delivery rooms.
- Testing of water at all water sources in the PHC, and improving the operation and maintenance (O&M) of overall WASH services.
- Training sessions with local Sarpanch (head of the village), to improve the participation of local Panchayati Raj
- Representatives from 15 panchayats and Village Health Sanitation and Nutrition committees (VHSNCs) participated in this training and oriented on their roles and responsibilities for the development of WASH indicators at the PHC level.
- Initiatives were also taken to regularise meetings by Hospital Development Society members and build a federation of VHSNCs at the PHC level.
- With the support of HDS members, drinking water facilities were improved.
- The toilets were repaired and western toilets with commodes were installed for pregnant women and the elderly.
- A rainwater harvesting structure was also constructed in the hospital premises for water conservation.
The HDS Chairperson along with other members and health officials monitored the PHC activities on a daily basis. Following the assessment, a meeting of Infection Control Committee was organised in which the gaps found during the assessment were discussed. After discussions, the committee took initiatives for pest control, overhead tank cleaning and chlorination, plantation, and garbage cleaning. The HDS also entered into an agreement with a third party for management of bio-medical waste.
In addition, the Health Educator and HDS Chairperson took a lead to train the staff on cleaning of critical areas, handling of bio-medical waste, maintaining sanitation, and so on. The PHC also reached out to educational institutions for awareness building on WASH in health. Subsequently, another internal assessment was undertaken in which the PHC scored 98.7%. On 23 May 2018, the PHC received the Kayakalp Award from District Collector of Vizianagaram, Andhra Pradesh.
The achievement of Pusapatirega PHC is one of the best examples of community ownership and team effort. The PHC has inspired the local administration to promote WASH in health care facilities under Kayakalp, and also replicate the model through community participation.