What is the impact of water sanitation and hygiene in healthcare facilities on care seeking behaviour and patient satisfaction? A systematic review of the evidence from low-income and middle-income countries

Abstract

Patient satisfaction with healthcare has clear implications on service use and health outcomes. Barriers to care seeking are complex and multiple and delays in seeking care are associated with significant morbidity and mortality. We sought to assess the relationship between water, sanitation and hygiene (WASH) provision in healthcare facilities (HCF) and patient satisfaction/care seeking behaviour in low-income and middle-income countries. Pubmed and Medline Ovid were searched using a combination of search terms. 984 papers were retrieved and only 21 had a WASH component warranting inclusion. WASH was not identified as a driver of patient satisfaction but poor WASH provision was associated with significant patient dissatisfaction with infrastructure and quality of care. However, this dissatisfaction was not sufficient to stop patients from seeking care in these poorly served facilities. With specific regard to maternal health services, poor WASH provision was the reason for women choosing home delivery, although providers’ attitudes and interpersonal behaviours were the main drivers of patient dissatisfaction with maternal health services. Patient satisfaction was mainly assessed via questionnaires and studies reported a high risk of courtesy bias, potentially leading to an overestimation of patient satisfaction. Patient satisfaction was also found to be significantly affected by expectation, which was strongly influenced by patients’ socioeconomic status and education. This systematic review also highlighted a paucity of research to describe and evaluate interventions to improve WASH conditions in HCF in low-income setting with a high burden of healthcare-associated infections. Our review suggests that improving WASH conditions will decrease patience dissatisfaction, which may increase care seeking behaviour and improve health outcomes but that more rigorous research is needed.

Purposeful Design of a Survey Tool to Evaluate the Adequacy of Hospitals’ Water Sanitation and Hygiene and Allocate Responsibility for Action – from Wash FIT to Wash Fast

“…WASH FIT entails five main tasks as part of a continuous improvement cycle, namely; (1) assembling a team; (2) conducting a facility assessment using a qualitative scoring system for each domain indicator; (3) undertaking a risk and hazard assessment; (4) developing an improvement plan; and (5) undertaking a continuous evaluation process. This study only carried out the first two steps, assembling a team and facility assessment.…”

“…Improving WASH in healthcare facilities (HCFs) is linked to specific benefits, including reductions in hospital associated infections and antimicrobial resistance; better management and control of disease outbreaks, improved staff morale and a reduction in healthcare costs (2) (3). It also influences communities – as health staff model proper hygiene practices (4) – and may improve patients’ trust in and experience of care and subsequently their satisfaction with and uptake of health services (5) (6).…”

Budgeting for Environmental Health Services in Healthcare Facilities: A Ten-Step Model for Planning and Costing

“…Maintaining a hygienic healthcare environment is critical for safe care provision in healthcare facilities (HCFs). Inadequate environmental conditions can reduce care seeking [1] and increase the risk of healthcare-acquired infections (HAIs) [2,3]. HAIs are estimated to affect 15% of all hospitalized patients in low-and middle-income countries (LMICs) [4,5] and are the leading cause of death among hospitalized patients [6].…”

Assessment of Water, Sanitation and Hygiene Services in Healthcare Facilities in the Greater Kampala Metropolitan Area, Uganda

“…Inadequate WASH compromises safety and quality of health care services, and places a huge preventable risk to both health providers and clients (3). Mothers and new-borns are at greater risk.…”

“…Mothers and new-borns are at greater risk. Given the profound impact of WASH on patient dissatisfaction and quality of care (3), there is growing attention towards WASH in HCFs. WASH has for instance been recognised as key to the attainment of universal health coverage (1).…”