Abstract
Several deaths and the spread of infectious diseases particularly in healthcare facilities have been linked to poor WASH services all over the world, and this has been proven to be more intense in rural healthcare settings in developing countries. This problem gets exacerbated by intermittent water supply in these facilities, which increases the rate at which healthcare-acquired infections (HCAIs) spread. Moreover, the quality of drinking water is poor in most African countries, severely in rural areas, and HCFs in rural settings, which presents a threat to human health. Studies focussing on WASH in rural HCFs in South Africa are limited. As a result, the current study was carried out to evaluate access to WASH services and water quality in rural healthcare clinics within Albert Luthuli Municipality, in the Mpumalanga province in South Africa. The standardized WHO checklist for assessing WASH in HCFs was used in the current study, together with semi-structured interviews with the clinics’ facility managers to obtain information on WASH aspects of the clinics. The drinking water samples collected from the clinics were analysed on-site for pH, temperature, electrical conductivity, turbidity, total dissolved solids, free and total chlorine, while microbial indicators (Total Coliforms and E. coli) were analysed at the laboratory. The results showed limited-service access to WASH in 82% of the clinics. Water was not always accessible from the clinics’ improved water sources, and when accessible it was not sufficient for use. Sanitation and hygiene indicators were not met at the required basic level. The quality of water was poor as the results presented varying degrees of non-compliance of the parameters to the WHO guidelines and the South African National Standards for drinking water. There was at least one waterborne pathogenic strain of E. coli in 70,6% of the clinics. Based on the results of this study, it is recommended that the municipality improves water supply in the clinics to improve health outcomes. Water should be treated effectively to improve its quality and kill microbes. There should be regular WASH monitoring for improvements to occur continually in the clinics. Training and educational programmes should also be prioritised for both patients and healthcare workers in the clinics to expand the knowledge base on the importance of WASH and compliance with Infection Prevention and Control Protocols (IPCPs).