• Bismillah Sehar University Institute of Public Health, The University of Lahore, Lahore, Pakistan
  • Muhammad Yaqoob University Institute of Public Health, The University of Lahore, Lahore
  • Asif Hanif University Institute of Public Health, The University of Lahore, Lahore
  • Ali Saad R. Alsubaie Department of Public Health, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
  • Falak Zeb Department of Nutrition and Dietetics, National University of Medical Sciences, Islamabad- Pakistan


water, health care facilities, sanitation, hygiene, WASH


Background: Water, sanitation, and hygiene (WASH) practices play vital role for ensuring quality of health care with the prevention of infections. Low- and middle-income health care settings have very limited WASH services and practices. Pakistan is still fighting with the burden of communicable diseases that can be prevented by health education on WASH services and their practices which is the elementary requirement for achieving national developing targets. Methods: This was the cross-sectional study conducted at 10 rural health centres (RHCs) of district Bagh by using purposive sampling technique. The duration of the study was 3 months from March to May, 2020. The tool used for the assessment of WASH services and practices was WASH FIT (Water Sanitation for Health Facility Improvement Tool) by WHO which had three categories for assessment in five different domains. Results: The findings showed that none of the facility was meeting the national standards of water quality. 50% of the facilities had separate male and female toilets while none of them have managed the menstrual hygiene needs. Only 10% of toilets facilitates the people with limited and reduce mobility. Only 10% of the facilities had well trained personal for health care waste management. None of the facility had or provided suitable protective measures for the waste management personals. Hand hygiene compliance activities were in 40% of the facilities. Conclusion: The improvement of WASH in health care centres plays a fundamental role in the prevention of infections, but none of them had WASH assessment tools to monitor the status of WASH.

Author Biography

Falak Zeb, Department of Nutrition and Dietetics, National University of Medical Sciences, Islamabad- Pakistan

Assistant Professor


WHO. Water and Sanitation for Health Facility Improvement Tool (WASH FIT): a practical guide for improving quality of care through water, sanitation and hygiene in health care facilities. 2017. [Internet]. [cited 2021 Jan 17]. Available from:

Hone T, Macinko J, Millett C. Revisiting Alma-Ata:what is the role of primary health care in achieving the Sustainable Development Goals? Lancet 2018;392(10156):1461–72.

Saif-Ur-Rahman K, Mamun R, Anwar I. Identifying gaps in primary healthcare policy and governance in low-income and middle-income countries: protocol for an evidence gap map. BMJ 2019;9(2):e024316.

Malik SM, Bhutta ZA. Reform of primary health care in Pakistan. Lancet 2018;392(10156):1375–7.

United Nations. Transforming our world: The 2030 agenda for sustainable development. General Assembley 70 session. 2015.

WHO. A vision for primary health care in the 21st century: towards universal health coverage and the Sustainable Development Goals. Geneva: World Health Organization. 2018.

Ikhlaq H, Ahmad S, Kalim I. Water, Sanitation and Hygiene in Pakistan: An Assessment of the support of the World Bank and the Asian Development Bank(2000-2016). Glob Reg Rev 2018;3(1):32–45.

Kamran MA, Shafique R, Amjad M, Azad AA. Self-Reported Hand Hygiene Practices Among Dentists In Various Dental Institutes Of Pakistan. Pak Oral Dent J 2017;37(1):114–8.

WHO. WASH in health care facilities: global baseline report 2019. 2019.

Gakidou E, Afshin A, Abajobir AA, Abate KH, Abbafati C, Abbas KM, et al. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390(10100):1345–422.

Kohler P, Renggli S, Lüthi C. WASH and gender in health care facilities: the uncharted territory. Health Care Women Int 2019;40(1):3–12.

Bartram J, Lewis K, Lenton R, Wright A. Focusing on improved water and sanitation for health. Lancet 2005;365(9461):810–2.

WHO, Unicef. Water, sanitation and hygiene in health care facilities: status in low and middle income countries and way forward 2015.

Saeed RR. Issues of Sanitation in Pakistan and post 2015 agenda. September 2013. [Internet]. [cited 2021 Jan 17]. Available from:

Daud MK, Nafees M, Ali S, Rizwan M, Bajwa RA, Shakoor MB, et al. Drinking Water Quality Status and Contamination in Pakistan. Biomed Res Int 2017;2017:7908183.

Zahid J. Impact of Clean Drinking Water and Sanitation on Water Borne Diseases in Pakistan. Sustainable Development Policy Institute, 2018. [Internet]. [cited 2021 Jan 17].

WHO. WHO global water, sanitation and hygiene: annual report 2018. World Health Organization, 2019.

Unicomb L, Horng L, Alam MU, Halder AK, Shoab AK, Ghosh PK, et al. Health-care facility water, sanitation, and health-care waste management basic service levels in Bangladesh: results from a nation-wide survey. Am J Trop Med Hyg 2018;99(4):916–23.

Khader YS. Water, sanitation and hygiene in Jordan’s healthcare facilities. Int J Health Care Qual Assur 2017;30(7):645–5.

Bennett SD, Otieno R, Ayers TL, Odhiambo A, Faith SH, Quick R. Acceptability and use of portable drinking water and hand washing stations in health care facilities and their impact on patient hygiene practices, Western Kenya. PLoS One 2015;10(5):e0126916.

Huttinger A, Dreibelbis R, Kayigamba F, Ngabo F, Mfura L, Merryweather B. Water, sanitation and hygiene infrastructure and quality in rural healthcare facilities in Rwanda. BMC Health Serv Res 2017;17(1):517.