The Indonesian Ministry of Health (MoH) and World Health Organization (WHO) are intensifying action to strengthen water, sanitation and hygiene (WASH) services in health care facilities, with the aim of improving patient safety, preventing and controlling antimicrobial resistance (AMR), and increasing equitable access to quality health services.
Globally, inadequate WASH in health care facilities is a major cause of health care-associated infections (HAI), which contribute significantly to AMR. An estimated 15 out of every 100 patients in low- and middle-income countries and 7 out of every 100 in high-income countries acquire at least one HAI during their hospital stay. Many of these infections are resistant to commonly used antibiotics, making them harder – and sometimes impossible – to treat.
In Indonesia, inadequate WASH in health care facilities continues to endanger patient safety and accelerate AMR. The 2022 Global Antimicrobial Resistance Use and Surveillance report showed that 77% of E.coli samples in Indonesia are resistant to third-generation cephalosporines and 69% to fluoroquinolones – two critical antibiotics for treating serious infections.
In response, between January and July 2025, MoH and WHO conducted assessments of WASH services in 69 health care facilities across Balikpapan, Padang and DI Yogyakarta province. Results showed major gaps, including the absence of standard operating procedures for WASH and AMR and insufficient health worker capacity. Only 11% of facilities met MoH standards. Disparities were often linked to differences between urban and rural areas, and hospital administrators frequently cited a lack of clear health guidelines.
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A health worker assists a patient in a wheelchair with hand hygiene upon arrival at a health facility. Credit: WHO/Pixelite
To address these challenges, MoH – with WHO support – developed comprehensive operational guidelines on environmental health in health care facilities, which address infection prevention and control and AMR, and also embed gender equality, disability and social inclusion principles – a crucial but often overlooked need. To date, 56 health professionals from 38 provincial health offices and regional training institutions have taken part in “training of trainers” programmes, which will help implement the guidelines country-wide.
“Before the training, we didn’t fully realize how much WASH affects patient safety and staff working conditions,” said Ms Rinawati from DI Yogyakarta Provincial Health Office. “Now, we’re empowered to bring real change to our facilities.”
In addition to the guidelines, the Directorate of Environmental Health, MoH, has developed a digital tool to help monitor and improve WASH implementation in health care facilities, while MoH and WHO are supporting health facility administrators to develop WASH action plans. The aim is to align local planning and budgeting with national goals and build shared ownership.
“The new guidelines are about more than the infrastructure of our health care facilities. They’re about embedding equity, safety and dignity into the heart of health service delivery,” said Dr Lubna Bhatti, Team Lead for Healthier Populations at WHO Indonesia. “Inclusive WASH is essential to building people-centred health systems that protect every patient coming into the health care facilities from acquiring any additional infections and stops the emergence and spread of AMR.”
With clear standards, digital tools and empowered health workers, Indonesia is strengthening patient safety, addressing AMR, and building a fairer, more equitable health system for every community.
These activities are supported financially by the Kingdom of Saudi Arabia and the Government of Luxembourg.
Written by Indah Deviyanti, National Professional Officer (Environmental Health and Climate Change), WHO Indonesia; Nora Arista, National Professional Officer (Antimicrobial Resistance), WHO Indonesia; and Itsnaeni Abbas (Consultant, Environmental Health), WHO Indonesia