The critical need for WASH in emergency preparedness in health settings, the case of COVID-19 pandemic in Kisumu Kenya.

The devastating effects of inadequate basic utilities such as water, sanitation, hygiene, waste management and environmental cleaning (WASH) is underscored by the current global pandemic declared on March 11, 2020. This paper explores the experiences of key informants (n = 15) ie government and non-government organization officials on the impacts of the COVID-19 pandemic in health care facilities (HCFs) and the role of WASH in emergency preparedness in health settings and the communities they serve using Kisumu, Kenya as a case study. The results from interviews with the key informants indicate socioecological challenges shaping access to hygiene services in HCFs and related disparities in social determinants of health such as WASH that serve as barriers to the pandemic response. All participants indicated the healthcare system was ill-prepared for the pandemic. Health care workers experienced such severe psychosocial impacts due to the lack of preparedness that they subsequently embarked on strikes in protest. These situations influenced citizens' perceptions of the COVID-19 pandemic as a hoax and resulted in a surge in other population health indicators (e.g., increased maternal mortality; decreased vaccination rates for other illnesses such as measles). We recommend authentic partnerships among all stakeholders to develop and implement context-driven sustainable solutions that integrate WASH and emergency preparedness in HCFs and the communities they serve across all spatial scales, from the global to the local.

When It Is Not Measured, How Then Will It Be Planned for? WaSH a Critical Indicator for Universal Health Coverage in Kenya.

The quality and safety of healthcare facility (HCF) services are critical to achieving universal health coverage (UHC) and yet the WHO/UNICEF joint monitoring program for water supply, sanitation and hygiene report indicates that only 51% and 23% of HCF in Sub-Saharan Africa have basic access to water and sanitation, respectively. Global commitments on improving access to water, sanitation, hygiene, waste management and environmental cleaning (WaSH) in HCF as part of implementing UHC have surged since 2015. Guided by political ecology of health theory, we explored the country level commitment to ensuring access to WaSH in HCFs as part of piloting UHC in Kisumu, Kenya. Through content analysis, 17 relevant policy documents were systematically reviewed using NVIVO. None of the national documents mentioned all the component of WaSH in healthcare facilities. Furthermore, these WaSH components are not measured as part of the universal health coverage pilot. Comprehensively incorporating WaSH measurement and monitoring in HCFs in the context of UHC policies creates a foundation for achieving SDG 6.

What If Your Husband Doesn't Feel the Pressure? An Exploration of Women's Involvement in WaSH Decision Making in Nyanchwa, Kenya.

Access to water, sanitation and hygiene (WaSH) is a major challenge in sub-Saharan Africa (SSA). Women and girls suffer the main burden of a lack of access to WaSH because they are primarily responsible for collecting water for their homes. However, they are often excluded from WaSH decision-making and implementation processes. This research sought to explore women's experiences in participating in WaSH decision-making through a case study in Nyanchwa, Kenya. Twelve (12) key informant interviews were conducted with community leaders and members regarding challenges and possible measures for enhancing women and girls' participation in WaSH decision-making. From this research, it is evident that economic challenges and cultural factors such as male dominance, greatly inhibit women and girls' participation in WaSH decision-making and implementation processes. Other factors such as time constraints and low literacy rates also emerged. The paper concludes with a call for collaboration among women's groups to enhance collective action for improved access to WaSH. This will undoubtedly lead to enhanced community health and wellbeing (Sustainable Development Goal 3, SDG3) through the empowerment of women (Sustainable Development Goal 5, SDG5).