Nearly eight in 10 Indian babies are now delivered in hospitals but 343 healthcare institutions across six states often lacked basic hygiene, toilets, clean water and waste disposal, according to a new survey released by the WaterAid India advocacy.

So, despite the fact that 79 percent of babies were born in hospitals in 2011-12, up from 41 percent in 2005-06, according to government data, India continues to have the highest rate of maternal and infant mortality among emerging nations.

Water and sanitation hygiene (WASH) facilities — as they are collectively called — were often absent; if pipes were laid, water was often unavailable; and there were largely no data or national planning for such facilities in PHCs, CHCs, area and district hospitals surveyed by WaterAid over 2014 and 2016 in 12 districts of Uttar Pradesh (UP), Madhya Pradesh (MP), Andhra Pradesh (AP), Telangana, Odisha, and Karnataka.

As many as 167 Indian mothers die during every 100,000 live births, a rate higher than Cambodia with 161, and 22 infants die after every 1,000 live births, according to Ministry of Health and Family Welfare data.

We compared maternally and infant mortality data in the six states that WaterAid surveyed and found that Andhra Pradesh had the lowest percentage of toilets in health facilities with 28 percent in hospitals followed by Telangana with 47.6 percent, according to health ministry data.

More than 50 percent of healthcare facilities in the other states had toilets, but the survey indicates that these may not be maintained well or have water.

A look at the findings in each state (the survey parameters differed in many states):

Madhya Pradesh: Few toilets, medical waste dumped

The survey was conducted in Bhopal, Sehore, Panna and Tikamgarh districts across 76 public health facilities on WASH infrastructure.

Up to 27 percent of sampled CHCs in the four districts did not have a toilet in the labour room; 50 percent did not have a toilet in the post-natal ward, while 38 per cent PHCs did not have a toilet in the labour room and 60 percent did not have toilets in the post-natal ward.

Waste, including medical waste, was thrown near 40 percent of 48 borewells across the four districts. Stagnant water present around them raised the possibility of contaminated water.

Up to 75 per cent of PHCs and CHCs in Bhopal, 87 per cent in Sehore and 95 per cent in Panna had dumped waste in or near the compound walls. Less than four of 10 PHCs and CHCs in Bhopal and Sehore had soap in the labour room.

Up to 75 per cent of PHCs and CHCs in Bhopal, 87 per cent in Sehore and 95 per cent in Panna had dumped waste in or near the compound walls. Less than four of 10 PHCs and CHCs in Bhopal and Sehore had soap in the labour room.

Only 43 percent of 76 medical officers (one per facility) interviewed reported having training on preventing infections.

Odisha: Dodgy toilets, waste water released in the open

The Odisha survey was limited to 34 public health facilities and one district hospital in Ganjam district. More than 60 percent of toilet facilities were found to be unclean and non-functional.

Nearly half the facilities had never chlorinated water tanks, making them vulnerable to waterborne diseases; 73 per cent of health facilities did follow a safe filtering technique (reverse osmosis/ chemical process/ biological process) for their drinking water. Waste water was drained into open areas in almost 85 percent of health centres.

Up to 96 percent of the facilities had wash basins inside the labour room.

Karnataka: Enough cleaning equipment but dirty toilets because staff posts vacant

Up to 30, healthcare facilities were surveyed in the district of Raichur. With a maternal mortality rate of 255 per 100,000 live births, it was only slightly better than Nepal with 258; with 71 infant deaths per 1,000 per live births, the infant mortality rate was the same as Nigeria (69), according to the Zilla Parishad website.

Seven in 10 facilities had unhygienic toilets because there was no one to clean them: 76 percent of cleaning staff posts were vacant. Of 30 facilities, 12 did not have a urinal and open defecation was evident in 63 per cent.

Of 17 facilities with borewells, the area around the wells was clean in 11 facilities; in the other six, the area was filled with garbage.

Telangana and Andhra Pradesh: Water and wash-basin shortages and poor water quality

Both the states were clubbed together, with one district from each state surveyed: 81 healthcare facilities from Vizianagaram in AP and 59 facilities from Nizamabad in Telangana.

Nearly 22 per cent of toilets were either not working or were broken, 25 percent were inaccessible, 24 percent were dirty, 24 percent did not have enough water and 24 percent had no wash basins within five meters of the toilet.

In Vizianagaram, 36 percent of sampled PHCs reported inadequate water, as did 47 percent PHCs in Nizamabad. Despite reports of poor water quality, less than half the PHCs and CHCs in both districts regularly chlorinated their water.

Up to 19 percent of facilities did not have wash basins near toilets and patient-care areas and 25 per cent did not have soap.

Uttar Pradesh: Dirty first- and second-tier healthcare, poor hand hygiene in hospitals

Conducted across 63 healthcare facilities in Varanasi, Agra, Lucknow and Banda district, the UP survey was conducted on behalf of the Ministry of Health and Family Welfare. Health facilities were scored on a scale of one to 10, with 10 being the best quality.

PHCs and CHCs scored 0.83 and 3.75, respectively; most were unclean. District hospitals scored 3.75. The average hand-hygiene score in district hospitals was 4.35 and was 3.01 and 1.42 for CHCs and PHCs respectively.

(25.07.2016 – In arrangement with IndiaSpend.org, a data-driven, non-profit, public interest journalism platform, with whom Prachi Salve is an analyst. The views expressed are those of IndiaSpend. The author can be contacted at [email protected])