Abstract:
BACKGROUND: South Africa has unique and diverse social and economic factors that have an impact on the
provision of basic water, sanitation, hygiene and waste management infrastructure and practices at health care
facilities in ensuring patient safety and prevent the spread of diseases.
METHODS: The aim of this study was to evaluate water, sanitation and hygiene access and standards at 50
government owned public health care clinics in the rural region of the Vhembe district of South Africa during
2016/2017, using self-observation, an observation checklist, record reviews and interviews with clinic managers.
Water quality from all available water sources on the clinic compound was analysed for Total coliform and E. coli
counts using the Colilert Quanti-tray/2000 system. The prevalence of pathogenic diarrhea causing E. coli strains was
established using multiplex-Polymerase Chain Reaction.
RESULTS: The health care clinics in the Vhembe District generally complied with the basic WASH services guidelines
according to the World Health Organisation. Although 80% of the clinics used borehole water which is classified as
an improved water source, microbiological assessment showed that 38% inside taps and 64% outside taps from the
clinic compounds had TC counts higher than guideline limits for safe drinking. Similarly, EC counts above the
guideline limit for safe drinking water were detected in 17% inside taps and 32% outside taps from the clinic
compounds. Pathogenic EAEC, EPEC, ETEC and EHEC strains were isolated in the collected water samples. Although
improved sanitation infrastructures were present in most of the clinics, the sanitary conditions of these toilets were
not up to standard. Waste systems were not adequately managed. A total of 90% of the clinics had hand washing
basins, while only 61% of the clinics had soap present and only 64% of the clinics had adequate signs and posters
reminding the staff, care givers and patients to wash their hands.
CONCLUSIONS: Various WASH aspects within the primary health care system in South Africa needs to be improved
and corrected. A more rigorous system that is inclusive of all role players in the WASH sectors, with regular
monitoring and training sessions, should be used.
