Ghana prioritized the built environment, materials and equipment for infection prevention and control (IPC Core Component 8) to help ensure a clean and hygienic environment for health care delivery. It has also adopted a behaviour-change led strategy, making changes in policies, standards, training curricula, programmes and monitoring.
This approach showed clear improvement: according to the 2021 analysis, the proportion of health facilities with basic water services increased from 48% in 2018 to 67% in 2021, while half of the health facilities had basic sanitation in 2021, up from only 38% three years previously.
More than 20 partners now collaborate within the National IPC/WASH programme and space, supporting various capacity building activities and using a behaviour-change led approach for implementation.
Clear strategic direction
In 2016, Ghana established a joint IPC/WASH Taskforce to provide greater leadership and a clearer strategic direction. The Taskforce adapted and implemented WASH FIT, a quality improvement tool, and worked to include IPC/WASH standards in to key national strategies and policies, specifically the National Healthcare Quality Strategy (2017–2021).
In 2021, the Ghana Health Service, Ministry of Health and partners initiated the merging of IPC and WASH policies into a single policy document and a single programme with explicit linkages between IPC and antimicrobial resistance, patient safety, health worker safety, and others. IPC indicators were also defined and updated within the national health information system, providing the Ministry a more accurate measure of their own progress and identification of gaps for improvement.
The Ghana National Healthcare Quality Strategy calls for putting in place the fundamentals of WASH infrastructure, as well as ensuring the availability of IPC materials and equipment to support effective IPC implementation by frontline workers.
Costed strategy to support IPC efforts
To support these efforts, a national, costed strategy on WASH in health care facilities, with a comprehensive blueprint for coordination and implementation, was published in 2020. This strategy lays out the legal and regulatory framework needed, including quality, IPC, WASH and health care waste standards.
It also links WASH in health care facilities to national activities to reduce maternal mortality, and specifically, the work of the Quality of Care Network, which aims to improve quality of care for mothers and newborns in selected districts. Costs for IPC/WASH infrastructure are set out in the strategy. This is also reflected in incorporating WASH into health care facility budgets.
Hospital construction and infrastructure development policies now explicitly require new health facilities to have health care waste-management systems and equipment. They should also have a main and back-up water supply, including a reservoir, borehole or rain gutter system to harvest rainfall, and piped water from Ghana Water Company.
Integrating IPC in health workers' training
Ghana has strengthened professional training and capacity building and has taken steps to institutionalize monitoring and quality control. IPC/WASH training have been incorporated into pre-service curricula and in regular in-service training for facility staff.
Additionally, regular supportive supervision and annual peer review systems have been introduced and have strengthened the observance of standards, including environmental or climate-smart WASH solutions. IPC focal persons have been appointed in all regions and most facilities.
This has contributed to the continued introduction of new IPC/WASH programmes and quality improvement in existing ones.