Healthcare Facility Water, Sanitation and Hygiene Service Status and Barriers in Ethiopia: Its Implication for COVID-19 pandemic and Healthcare Acquired Infection Prevention.

Background: Despite the public health significance of healthcare Water, Sanitation, and Hygiene (WASH) service in reduction of nosocomial infection and improving quality of care is paramount little is known on the status of WASH service in a health care facility at the time of pandemic and the barriers that hinder the service in the health care setting in Ethiopia. Objective: The aim of this study was to assess status of basic water, sanitation, hand hygiene, healthcare waste management, and environmental cleanliness service and its barriers at public health care facilities in the city of Addis Ababa, Ethiopia 2022. Methods: Convergent parallel mixed design was conducted among 86 public health care facilities located in Addis Ababa city. Stratified sampling technique was used to select health care facilities. A semi-structured observational checklist tool was used to measure the availability of services. For the qualitative study, semi-structured interview was conducted among 16 key informants and thematic data analysis was done to identify the barriers. Finding: This study found that no one healthcare facility had basic access to overall WASH services. The independent WASH domain analysis showed that, about 86% healthcare facilities had basic water access, 100% had limited sanitation access, 88.4 % had limited hand hygiene service, 69.8% had limited healthcare waste management service, and 97.7% had limited environmental cleaning service. Built environments of WASH infrastructure; Resource availability and allocation; leadership and stakeholder participation; inadequate training and poor behaviour; and legal issues were identified barriers to provision of basic healthcare WASH services. Conclusion and recommendation: The availability of healthcare WASH services in Addis Ababa city remains far from the pace to achieve the sustainable goal target by 2025. The limited access to WASH services makes worsening the prevention and control of COVID-19 pandemics, healthcare acquired infection in the facility. The country need to act now on more financial investment, capacity building, facilitating committed leadership, and participation of stakeholders to ensuring basic WASH services at healthcare setting.