Improvements in water, sanitation and hygiene (WASH) and patient satisfaction following a bundled climate-resilient WASH-IPC intervention at a rural Pakistani health centre: A pre-post operational study

Background Water, sanitation and hygiene (WASH) services underpin infection prevention and control (IPC), yet gaps persist across Pakistan, and outcomes of comprehensive WASH-IPC delivery in rural facilities are poorly documented. This study assessed facility readiness and patient-reported experience following a bundled, climate-resilient WASH-IPC intervention. Methods An uncontrolled pre-post study was conducted at Rural Health Centre Nindo, Badin, Sindh. The intervention, comprising WASH infrastructure, waste management, IPC consumables, staff training and governance, was delivered during next 1 year. Readiness was scored at baseline and endline using the WHO/UNICEF Water and Sanitation for Health Facility Improvement Tool (WASH-FIT) across seven domains and classified against Joint Monitoring Programme (JMP) service ladders. At endline, external enumerators applied a 32-indicator observation checklist and surveyed 200 patients and companions. Change was expressed as percentage-point difference, and domains were compared using the Wilcoxon signed-rank test. Results The WASH-FIT score rose from 32.3 to 86.9%, with improvement in all seven domains (median gain 62.5 percentage points; p = .016). Gains were greatest for sanitation (16.7% to 100%), hand hygiene (10.0% to 90.0%) and waste management (28.1 to 93.8%). Water quality compliance rose from none to full after ultra-filtration plant installation, and the facility advanced three JMP ladders. All 32 observation indicators were met. Mean satisfaction was 4.29/5 for WASH facilities, 4.17/5 for IPC and 4.37/5 overall; all respondents would recommend the facility. Conclusion Facility readiness improved substantially. The uncontrolled design precludes attribution; the absence of a facility-level WASH budget, backup water source and complete cleaning systems threatens sustainability.