Factors influencing access to advanced sanitation service level and drinking-water quality in healthcare facilities in Addis Ababa, Ethiopia: a convergent sequential study

This study investigates factors influencing access to advanced sanitation services and drinking water quality in healthcare facilities (HCFs) in Addis Ababa, Ethiopia. Despite the critical role of sanitation and safe water in preventing healthcare-associated infections, many facilities face significant challenges. A convergent sequential study was conducted in 382 healthcare facilities, which involved observations of sanitation facilities, interviews with facility managers, and water quality tests of 382 samples. Additionally, five water samples from reservoirs and distributors were collected, and eight key informant interviews were conducted purposively. In this investigation, only 14.5% of healthcare facilities had advanced sanitation service, while 23.2% had basic sanitation services. Over half (62.3%) of the facilities provided limited sanitation services. Additionally, 22.7% of water samples tested positive for enterococci, 26% for Escherichia coli, 35% for fecal coliforms, and 38.8% for total coliforms. All samples analyzed for fluoride, conductivity, and total dissolved solids (TDS) were below permissible limits, except for 6.6% of the samples that exceeded the pH level of 8.5. In contrast, all water samples from reservoirs and distributors were free from bacterial contaminations, and their fluoride, conductivity, and TDS levels were within the standard. Factors such as having infection prevention committee (IPC)(AOR = 2.8, 95% CI: 1.07-7.52), trained managers on sanitation safety plan (AOR = 2.96, 95% CI: 1.10-7.94), managers trained in infection prevention (AOR = 3.6, 95% CI: 1.25-10.48), having sanitation standards (AOR = 3.5, 95% CI: 1.06-11.64), availability of sufficient budget for sanitation services (AOR = 3.2, 95% CI: 1.14-9.15), having specific annual sanitation plan (AOR = 3.6, 95% CI: 1.52-8.58), using updated WASH guidelines (AOR = 3.4, 95% CI: 1.05-11.20), absence of a sanitation safety plan (AOR = 0.22, 95% CI: 0.05-0.91), lack of regular monitoring and evaluation (AOR = 0.24, 95% CI: 0.07-0.83), and managers who did not involve in leading renovation of WASH infrastructure (AOR = 0.56, 95% CI: 0.35-0.70) were significantly associated with access to advanced sanitation service level. Access to advanced and basic sanitation services is low in HCFs of Addis Ababa. Several core factors affecting access to advanced sanitation service level has been identified. Many water samples from healthcare facilities were contaminated by bacteria. Enhancing training programs for healthcare managers and securing adequate funding are critical steps toward improving sanitation and water quality.