Indonesia has made steady progress in improving water and sanitation access for its population. However, 12% of the population aged of 3 and above have not practiced the correct defecation behavior which is the habit of defecating in the latrine and less than 50% of the population aged 10 years above have correct behavior in handwashing. [1]^,[2]This challenge has received increased attention from all levels of government in Indonesia, but implementing WASH interventions in health facilities across the country remains a monumental challenge, one that creates serious health risks and increased mortality from hygiene-related infections and diseases such as COVID-19. In Primary health centers, 14.77% of PHCs have no water services and 0.82% of PHCs no sanitation services.[3],[4]

WHO supports Indonesia to address these challenges by implementing the Water and Sanitation for Health Facility Improvement Tool (WASH FIT). WASH FIT is a risk-based management approach to improve quality of care by assessing seven domains in health care facilities, namely water, sanitation, hand hygiene, waste management, environmental cleaning and disinfection, energy and power, and management. WASH FIT enables health care facility managers to prioritize risks identified in these domains, define and implement actions for improvement, with strong considerations for gender, disability, social inclusiveness and climate.

WHO conducted a series of pre-service and ongoing in-service education and training programmes for all health care workers to manage WASH services, provide ongoing maintenance and operations and deliver appropriate and gender-responsive WASH and infection prevention and control (IPC) practices.  So far, more than 185 primary health centres in 6 regions implemented WASH FIT in 2020. Planned scale up to PHCs in two more regions (West Nusa Tenggara and East Nusa Tenggara) is ongoing in collaboration with UNICEF, Plan International Indonesia and MOH.

WHO is working to align and strengthen the collaborative efforts of stakeholders within multisectoral coordination platforms to ensure adequate financing of all aspects of WASH in health facilities. The government has issued a Roadmap on Drinking Water Quality Surveillance 2020-2030, which includes improved water quality in health care facilities and committed to developing a national roadmap for WASH in healthcare facilities in 2021.

To further strengthen WASH monitoring and reporting, WHO supports Indonesia MOH to integrate WASH FIT parameters as indicators to report WASH in national monitoring mechanisms. One aspect of this support is the ongoing upgrade of the MOH's online web-based application on data reporting from health facilities, called ASPAK, to include the critical WASH indicators. Once completed, findings will inform the costed national roadmap for WASH in health facilities, increase the knowledge base for WASH services in health facilities, and provide a robust basis for identifying priorities, making investments, and tracking progress on WASH.

Despite prevailing challenges, progress recorded through WHO support has demonstrated that universal access to WASH in health care facilities is achievable in Indonesia.

Photo caption: Health workers wash their hands with alcohol before entering the coronavirus isolation room.

Photo credit: Opan Bustan/Opn ImagesN/Barcroft Media via Getty Images