WATER SUPPLY AVAILABILITY AND ACCESSIBILITY AS DETERMINANTS OF HEALTH SERVICE DELIVERY IN HEALTHCARE FACILITIES IN UPPER NILE STATE, SOUTH SUDAN

This study assessed the status of Water, Sanitation, and Hygiene (WASH) services and their impact on health service delivery in healthcare facilities in Upper Nile State, South Sudan. The study was guided by four objectives: to assess the availability and accessibility of water supply services; examine sanitation services; evaluate hygiene and waste management systems; and determine how WASH conditions influence healthcare service delivery. The study was conducted in 20 government healthcare facilities; including 16 Primary Health Care Centres (PHCCs) and 4 hospitals in a conflict-affected setting characterized by weak infrastructure and limited public services.A concurrent triangulation mixed methods design was employed, integrating both quantitative and qualitative approaches. Quantitative data were collected using questionnaires administered to 20 healthcare facility administrators, while qualitative data were obtained through key informant interviews with 24 health workers, 20 inpatients, and 18 lactating mothers. Observations, documentary review, and water quality testing complemented primary data collection. Quantitative data were analyzed using SPSS version 27 through descriptive statistics, Pearson correlation, chi-square tests, t-tests, logistic regression, and Structural Equation Modeling (SEM). Qualitative data were analyzed thematically using Open Code 4.02.The findings revealed that only 35% of healthcare facilities had basic water services, while 35% had no water service and 30% had limited services. Hospitals had significantly better water access than PHCCs (p = 0.003). Facilities lacking on-premise water supply, water quality testing, and those relying on surface water were significantly more likely to experience water shortages. Poor WASH conditions negatively affected infection prevention, maternal healthcare, patient satisfaction, and overall healthcare quality.The study concluded that inadequate and inequitable WASH services, particularly in rural PHCCs, remain a major barrier to effective healthcare delivery in Upper Nile State. The study recommends increased government and donor investment in on-premise water infrastructure, routine water quality monitoring, strengthening WASH policies, and integrating WASH into health sector planning and emergency response systems.