Preparing for pandemics in Kenya’s healthcare facilities: The critical need for WASH

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 Susan Elliott, Department of Geography and Environmental Management

 Thelma Zulfawu Abu, Department of Geography and Environmental Management

Introduction

Availability and access to safe water, sanitation and hygiene (WASH) services are critical to development and vital to fighting viruses such as COVID-19. In sub-Saharan Africa, non-pharmaceutical interventions, such as hand hygiene, facial masking and physical distancing, became the only weapons against COVID-19, given relatively low rates of vaccination. Unfortunately, WASH services are unavailable to large proportions of the population in sub-Saharan Africa. This lack of services exacerbated the global inequities in fighting the COVID-19 pandemic where marginalized populations often do not have access to WASH at the household level and where WASH services are a major challenge for healthcare facilities.

There is limited empirical research on the role of WASH services in emergency preparedness and response in healthcare settings and the communities they serve in sub-Saharan Africa. This case study makes a contribution by exploring the impact of the COVID-19 pandemic, and in particular on the role of WASH services, on Kisumu, Kenya. Results were used to formulate recommendations for policy and practice that build resilience and strengthen basic services such as WASH, which are particularly important with global pandemics and climate change.

Methodology

The paper used a qualitative case study design to engage key informants from government and non-governmental organizations (n = 15) in Kisumu, Kenya between August and September 2020 on their experiences during the COVID-19 pandemic. All key informants were previously consulted in the authors' work on factors and processes shaping access to WASH in healthcare facilities in Kisumu prior to the pandemic.

Audio recordings of interviews were transcribed and analyzed using NVIVO 12 software using deductive and inductive approaches. Themes were developed by reviewing the literature and were particularly informed by the political ecology of health on WASH. Subthemes emerged from interview transcripts during coding.

Outcomes

Table 1 summarizes COVID-19 response measures implemented in Kisumu at the County and healthcare center levels, while Table 2 summarizes impacts of the pandemic from the interventions. Key informants indicated that a weak health system prior to the pandemic resulted in a rapid decline in indicators during the pandemic, and that lockdowns and curfews negatively impacted economic activities and increased psychosocial stress.

“I think we lost some of the lives because there were no jobs, there was no money to buy food, so you think until you burst. So, some people died because of stress, some people just went home, people moved back to rural areas, and even paying the rental for the houses was not easy for people”.

Table 1: Awareness of COVID-19 pandemic responses

Table 2. Impacts of the COVID-19 pandemic and responses

While the Kisumu County government implemented several COVID-19 response measures, key informants felt that the government was not adequately prepared for the pandemic. Residents situated in urban slums and disaster-prone areas were disproportionately impacted by the COVID-19 pandemic and some response measures. Social determinants of health, including inadequate access to basic amenities such as WASH services and poor hygiene practices, were barriers to efficiently adhering to the response measures and contributed to the widespread of the virus (Table 3).

“In the slums, the people stay in small houses … there is no access to water, there is no space when you ask people to wash their hands, where do they get the water to wash their hands, …. and the places are so small they share with 6 to 10 people, and so people can’t stay in the house the whole day, so there are areas which don’t have clean drinking water. So, if you don’t have clean drinking water, how will you wash your hands when you don’t have water to drink. So, hygiene is a problem.” 

Table 3. Barriers to implementing and adhering to the COVID-19 responses.

According to key informants, the COVID-19 pandemic was a wake-up call for governments to invest in emergency preparedness and improve basic access to utility services like access to WASH services in healthcare facilities and communities (Table 4).

“The COVID-19 occurrence has really brought us back to our conscience that the very basic things that we overlook like handwashing go into the core of managing our wellbeing. It is now that the government and others are putting in infrastructure for sanitation, supply of clean and potable water, these are things that ought to have been done much earlier, so I think moving forward, it is now imperative for most governments that they need to look at the basic supplies that their citizens need”.

Table 4. Lessons learned

Conclusions

This research explored the need for WASH in emergency preparedness and response in healthcare facilities and the communities they serve in Kisumu, Kenya during the COVID-19 pandemic. The study showed that structural and ecological factors shaped access to basic hygiene services and effectively responding to the pandemic. In health settings, inadequate access to hygiene and safety services caused psychosocial stress among workers, affected the quality of care provided and subsequently led to healthcare workers' strikes. At the community level, psychosocial stress resulted from economic challenges from job losses or declines during lockdowns. Impacts from climatic variability further amplified inadequate access to and use of WASH services during the pandemic.

The study recommends that a multidisciplinary group of stakeholders, including the community, develop holistic, context-driven and disease-focused emergency preparedness strategies and proactive emergency response plans for future scenarios. Expanding access to basic human needs such as WASH services, especially in rural and informal settlements, should be prioritized. In addition, the study identifies a need to integrate and devolve emergency preparedness across sectors to ensure efficiency in service delivery. Finally, it is suggested that emergency preparedness and response planning should be institutionalized through legislation and policy to ensure continuity, sustainability and long-term benefits.

Abu, Thelma Zulfawu and Elliott, Susan J. (2022). The critical need for WASH in emergency preparedness in health settings, the case of COVID-19 pandemic in Kisumu Kenya. Health & Place, Volume 76. https://doi.org/10.1016/j.healthplace.2022.102841

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Photo: Handwashing by Kelly via Pexels.