|**Country**|**Title**|**Findings **|**Comment**|**Source**|
|---|---|---|---|---|
|||worse than expected for 7%<br>and 26%, respectively.|||
|Uganda|Developing<br>hospital<br>accreditation<br>standards in Uganda|Among accreditation items (1)<br>physical infrastructure and (2)<br>infection control and HCWM<br>are relevant to WASH. 27.5%<br>(11/40) hospitals were not<br>tracking infection rates and<br>32.5% (13/40) had functional<br>sterilisation equipment.|Good performance was measured<br>in equipment and running water, 24<br>hours staff calls systems, clinical<br>guidelines and waste segregation.<br>Poor performance was measured in<br>care for the vulnerable, staff living<br>quarters, physician performance<br>reviews, patient satisfaction surveys<br>and sterilising equipment.|Galukande et<br>al (2016)|
|Uganda|Quality of antenatal<br>care services in eastern<br>Uganda:<br>implications<br>for interventions|74.6% (217/291) respondents<br>rated the ANC service as<br>satisfactory. Infection control<br>was available in 73.4% (11/15)<br>facilities.<br>Cleanliness<br>was<br>dissatisfactory<br>for<br>4.1%<br>(12/291), fairly satisfactory<br>for<br>25.8%<br>(75/291)<br>and<br>satisfactory<br>in<br>70.1%<br>(204/291).|Data collected to gauge infection<br>control: existence of piped running<br>water, water buckets or basins,<br>hand washing soap, disposable<br>hand drying towels, waste bins,<br>sharps containers, disposable latex<br>gloves and disinfection solution.<br>The variables associated with high<br>satisfaction<br>were<br>provider’s<br>attitude (87.6%) and examination<br>room privacy (83.5%).|Tetui<br>et<br>al<br>(2012)|
|Uganda|Challenging logics of<br>complex<br>intervention<br>trials:<br>community<br>perspectives<br>of<br>a<br>health<br>care<br>improvement<br>intervention in rural<br>Uganda|Many health centers lacked<br>running water and electricity.<br>Improvements in antimalarial<br>drug availability were noted<br>but<br>community<br>members<br>were disappointed with the<br>quality<br>of<br>care<br>received.<br>Patients continued to seek<br>care at health centers they<br>considered inadequate.|The intervention targeted malaria<br>control to the exclusion of other<br>diseases or basic infrastructure such<br>as in-patient facilities or clean<br>water. Requests by patients to<br>increase the health workers, expand<br>building space, provide clean water<br>and electricity, in-patient services,<br>and clean toilets were reported.|Okwaro et al<br>(2015)|

Source: adapted from Bouzid et al (2018) Beyond the 9 focus countries, two articles identified in Bouzid et al (2018) review were reviews of low- and middle-income countries. Srivastava et al (2015) concludes that a good physical environment was significant in women’s positive assessment of the health facility and maternal care services. In Bangladesh, mothers who rated the availability of services at the facility (a composite of waiting area, drinking water, clean toilet and waiting time) as ‘good’ were significantly more satisfied with care than those who rated the services as ‘poor’. Cleanliness, good housekeeping services and maintenance of hygiene were reported as determinants of satisfaction in Bangladesh, Gambia, Thailand, India and Iran. Interpersonal behavior was the most widely reported determinant, particularly around provider behavior in terms of courtesy and non-abuse.

Gabrysch and Campbell (2009) found that shortcomings in medical care are often coupled with shortcomings in hygiene. Women criticize dirty toilet facilities, lack of water and aseptic practices as well as lack of drugs. Perceived quality of care has an important influence on care seeking behavior. Poor personal and medical quality of care, clash with culture and fear of procedures may decrease use.

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