Today, as we celebrate World Health Day, our health care workers are at the forefront of the world’s COVID-19 response. Every day, global tributes for our health care workers fill our newsfeeds. Quite simply, as the World Health Organization (WHO) reminds us today – without our health care workers, there would be no response.
The World Health Assembly has designated 2020 the Year of the Nurse and the Midwife. It coincides with the launch of the WHO State of the World’s Nursing Report during World Health Day 2020. The WHO outlines five key investment areas  to make decent and safe work conditions for our nurses and health care practitioners a reality. This comes one year after the release of the ground-breaking WHO/JMP global baseline report, WASH in health care facilities.
Nurse in Savannakhet, Lao PDR tests disability-inclusive entrance ramp
Nurse in Punakha, Bhutan takes patient's blood pressure
A WASH response is a health response
A WASH response enables health care workers to practise safe hygiene behaviours and infection prevention and control (IPC) in their health care settings. Though IPC is an area of attention in the health care sector, many IPC measures are not possible without basic WASH services. WHO has reaffirmed the importance of WASH measures to realise the provision of adequate care for patients and the protection of patients, staff, and caregivers from infection risks in the COVID response. In its updated technical brief, WHO reaffirmed the following as particularly important in the context of COVID-19: (i) managing sanitation safely, including ensuring that no one comes into contact with it and that it is treated and disposed of correctly; (ii) engaging in frequent hand hygiene using appropriate techniques; (iii) implementing regular cleaning and disinfection practices; and (iv) safely managing health care waste.
An area-wide and multi-sectoral health response
Rightfully so, larger facilities and hospitals are the priority of COVID-19 interventions. But there are basic and remote health care facilities (HCFs) that are also likely to be the first point of contact for COVID-19 treatment and care for the communities they serve.
Prior to the COVID-19 pandemic, it was already clear that limited data is available for ‘lower-level’ facilities, e.g., quality of care, waste management, etc. Within our ongoing urban and rural WASH programmes,  we are looking at entry points to support our health partners to intensify efforts that align with WHO and national guidance. And, to address risks related to cleaning (e.g., through protocols), social/physical distancing, handwashing with soap and health care waste management that will support the critical work of health care workers as frontline measures.
Permanent water supply and soap are essentials for appropriate handwashing
Proper solid waste management matters for infection prevention control
A systems response to secure healthy futures
In our efforts to support our government partners, we see the importance and intersections of people, institutions and systems. Many of the barriers for HCF maintenance and cleanliness are not simply facility related. These are also related to roles, responsibilities, and systems.
In rural areas for example, many rural HCFs depend on sub-national entities (local governments or deconcentrated health agencies) for their operations, for example in planning, budgeting, and supply chains. Although arrangements vary for different types of facilities, higher levels of HCFs may have greater financial autonomy, in-house capacity and/or in-house treatment than lower levels, it is not uncommon that resources are limited and basic facilities may not receive the required budget or support.
For many rural HCFs, the combination of dependency, low priority and remoteness means that people in-charge can feel alone and disempowered. Simply enforcing standards and providing training will not address the issue. Longer-term and comprehensive efforts to strengthen systems are needed to support our health workers and the quality of care in the future. This means reinforcing the importance of ensuring local government prioritisation of WASH in HCFs to realise access for all.
Photo credits: All photos in Savannakhet (including banner photo) by SNV in Lao PDR/Bart Verweij | Photo in Punakha, Bhutan by SNV in Bhutan/Aidan Dockery | Photos of tap and soap and sharps by SNV in Nepal. Photos are financed by the Australian government-funded Beyond the Finish Line project of SNV.
 International Council of Nurses, ‘2020 International Year of the Nurse and Midwife: a catalyst for a brighter future for health around the globe’, Nursing now Press Information, Geneva, ICN, 30 December 2019.
 WHO, ‘Key facts,’ World Health Day 2020: support nurses and midwives, WHO, n.d.
 SNV and ISF-UTS, WASH in rural health care facilities: proceedings of an SNV Sustainable Sanitation and Hygiene for All (SSH4A) learning event, The Hague, SNV, n.d.
 A potential starting point is to revisit the WHO/UNICEF publication, ‘WASH in health care facilities: practical steps to achieve universal access to quality care,’ which presents 8 steps for action.