Indonesia strengthens inclusive, resilient WASH services in health care facilities

Inadequate Water, Sanitation, and Hygiene (WASH) facilities in healthcare institutions can lead to dire consequences, endangering patient safety and exacerbating the issue of antimicrobial resistance (AMR). Indonesia, a country grappling with these challenges, has taken significant strides to strengthen WASH services in healthcare facilities to address critical patient safety concerns. Through collaboration between the Ministry of Health (MoH) and the World Health Organization (WHO), substantial assessments have been conducted, leading to the establishment of operational guidelines aimed at creating inclusive and resilient WASH services.

According to the 2022 Global Antimicrobial Resistance Use and Surveillance report, Indonesia faces a serious AMR challenge. It reported that 77% of E. coli samples in the country are resistant to third-generation cephalosporins, while 69% resist fluoroquinolones, two essential antibiotics in managing severe infections. Such high resistance is alarming, underscoring the necessity for improved infection prevention and control measures in healthcare settings.

Between January and July 2025, MoH and WHO conducted a comprehensive assessment of WASH services in 69 healthcare facilities across Balikpapan, Padang, and the DI Yogyakarta province. The findings revealed striking deficiencies, with only 11% of these facilities meeting the standards set by the Ministry of Health. Notably, there was a lack of standard operating procedures for WASH and AMR, and a significant number of health workers lacked the necessary skills and knowledge to address these issues. This gap highlighted the disparities between urban and rural healthcare facilities, where administrators frequently reported the absence of clear health guidelines, which impeded their capacity to manage WASH effectively.

To overcome these challenges, the MoH, with support from WHO, developed comprehensive operational guidelines on environmental health in healthcare settings. These guidelines focus on integrating infection prevention and control strategies while incorporating principles of gender equality, disability, and social inclusion—elements that are often overlooked but critical for ensuring equitable access to health services.

As part of the initiative, training programs were launched to empower healthcare professionals. To date, 56 health professionals from 38 provincial health offices and regional training institutions have participated in “training of trainers” programs designed to disseminate the new guidelines across the healthcare system. “Before the training, we didn’t fully realize how much WASH affects patient safety and staff working conditions,” noted Ms. Rinawati from the DI Yogyakarta Provincial Health Office. “Now, we’re empowered to bring real change to our facilities.”

In addition to establishing guidelines, the Directorate of Environmental Health within the MoH has developed a digital tool intended to monitor and improve WASH implementation in healthcare facilities. This tool allows health facility administrators to devise WASH action plans, aligning local budgetary and planning initiatives with national health objectives, thereby fostering a sense of shared ownership.

Dr. Lubna Bhatti, Team Lead for Healthier Populations at WHO Indonesia, emphasized the transformative nature of these new guidelines, stating, “The new guidelines are about more than the infrastructure of our healthcare facilities. They’re about embedding equity, safety, and dignity into the heart of health service delivery.” This perspective reinforces the importance of inclusive WASH services not only in enhancing safety but also in establishing a more equitable healthcare system for all communities.

Indonesia’s efforts to bolster WASH services in healthcare facilities are noteworthy, particularly in light of recent funding support from the Kingdom of Saudi Arabia and the Government of Luxembourg. These contributions are instrumental in facilitating the implementation of comprehensive health and safety protocols.

The initiative aims to address patient safety concerns, tackle AMR, and promote a fair and equitable health system for various communities across Indonesia. This holistic approach is poised to enhance healthcare quality and resilience, providing a conducive environment for both patients and healthcare workers.

In conclusion, Indonesia is taking commendable steps toward strengthening inclusive and resilient WASH services in healthcare facilities. These measures are essential not only for enhancing patient safety and addressing the growing issue of antimicrobial resistance but also for ensuring that every individual has equitable access to quality healthcare. By embedding inclusive principles into healthcare delivery, Indonesia is laying the groundwork for a healthier future, prioritizing safety, dignity, and equity in the process.

As these initiatives unfold, the impact of enhanced WASH services in healthcare settings will be closely monitored, providing valuable insights and lessons for other nations grappling with similar challenges. The collaborative framework established through partnerships between local and international organizations serves as a beacon of hope for improved health outcomes in Indonesia and beyond, fostering an environment where every patient can receive care without the fear of acquiring infections or worsening AMR.

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