Implementation and effectiveness of Swachhata Pakhwada activities by a tertiary care hospital in improving the health and hygiene promotion

INTRODUCTION

The Swachh Bharat Mission (SBM) a restructured version of the Nirmal Bharat Abhiyan (2009), launched by the government of India on October 2, 2014, is aimed to make India free from open defecation and achieve 100% scientific management of municipal solid waste across 4,041 statutory towns.¹

On October 1, 2021, SBM-U 2.0 was introduced with a five-year plan to achieve "garbage free" status for all cities by 2026 and to institutionalize 'Swachh' behaviour among citizens. Implemented by the ministry of housing and urban affairs (MoHUA) through states and union territories in all statutory towns, the mission seeks to contribute to the sustainable development goals (SDG) 2030, ultimately enhancing the quality of life and ease of living for urban populations, leading to urban transformation.²

In alignment with the objectives of SBM, the Swachhata Pakhwada initiative was introduced to mainstream sanitation across all ministries and departments of the government of India. Launched in April 2016, Swachhata Pakhwada designates specific fortnights to various ministries to conduct cleanliness drives and related activities, thereby fostering a culture of hygiene and sanitation nationwide. During which extensive awareness campaigns were carried out to educate people about the use of bio-toilets, avoiding single-use plastic, and observing cleanliness habits.³

These concerted efforts under SBM and Swachhata Pakhwada have significantly contributed to improving sanitation and hygiene across India, with active participation from various sectors, including healthcare institutions. Ministry of health and family welfare (MoHFW) provides comprehensive guidelines for Swachhata Pakhwada, detailing activities aim to foster a culture of cleanliness and hygiene within healthcare institutions.⁴

At AIIMS Rishikesh, these guidelines are meticulously implemented through organizing various initiatives such as cleanliness drives, educational programs, and community engagement activities to promote hygiene practices among staff, patients, and the surrounding community, aligning with the MoHFW's directives. This paper reviews the guidelines provided by the ministry and how they have been implemented, the effectiveness, progress in a tertiary healthcare institute and its achievements in generating awareness on cleanliness.

SWACHHATA PAKHWADA AND OTHER RELATED ACTIVITIES UNDER SBM

There has been a regeneration of Swachhata in India over the past years following the launch of the largest sanitation drive, SBM. The growing awareness and commitment towards making the nation clean have resonated across the country. Swachhata Pakhwada and other Swachhata-related activities have significantly boosted sanitation initiatives in both rural and urban India.

Responding to the prime minister’s call during Mann Ki Baat, citizens collectively participated in 'Ek Tareekh Ek Ghanta Ek Saath' on 1^st October at 10 AM as a tribute to Mahatma Gandhi on the eve of his Jayanti.⁵

The MoHFW in India has been actively promoting cleanliness and hygiene through various initiatives under the SBM. MoHFW observes Swachhata Pakhwada from April 1^st to 15^th, Swachhata Hi Seva (SHS) from 15^th September to 2^nd October. Additionally, 2^nd October is celebrated as Swachh Bharat Diwas. Special campaigns are also conducted from October 2nd to October 31^st of every year.⁶

Below is a year-wise overview of themes of Swachhata campaigns from 2020 onwards: 2020: Theme: “Swachhta in cross-section of society”. 2021: Theme: "Importance of Swachhta in COVID-19 scenario." 2022: "Mera Bharat Swachh Bharat." 2023: "Garbage free India." 2024: "Swabhav Swachhata, Sanskar Swachhata."

OBJECTIVES OF SWACHHATA PAKHWADA IN HEALTHCARE INSTITUTIONS

Health facilities will act as catalysts, driving visible changes and making a widespread impact. The objectives of implementing Swachhata Pakhwada in health facilities includes:

To take efforts that will primarily focus on fostering a culture of "Swachhata" to ensure that the goals and objectives of the 'Swachh Bharat Abhiyaan' are achieved and sustained.

Health departments and hospitals should undertake dedicated cleanliness drives to maintain hospital premises and surrounding areas in an impeccable condition.

Collaboration with various stakeholders, including schools, local civic bodies, PWD, private hospitals, professional associations, as well as the non-government organisations, should be encouraged to enhance the effectiveness of the initiative.

The ultimate goal of this event is to inoculate a culture of 'Swachhata' among healthcare staff and improve the cleanliness levels of healthcare facilities and to generate awareness about the significance of hygiene and sanitation.⁷

GUIDELINES FOR IMPLEMENTATION OF SWACHHATA PAKHWADA

The department of drinking water and sanitation under the ministry of Jal Shakti publishes the Swachhata Pakhwada calendar for various ministries, aligning it with special occasions relevant to each ministry. The department of health and family welfare and the department of health research under the MoHFW are designated to observe Swachhata Pakhwada from 1 to 15 of April, as world health day is observed on the 7^th of April.⁸

As per MoHFW directives this 15 days’ events to be built and planned around a theme such as, awareness drive, cleanliness drive and sustenance devoting 5 days on each of the theme. Focus areas include ensuring Divyang access to toilets, maintaining hygiene, reducing single-use plastic, and introducing sustainable Swachhata mechanisms. Apart from suggestive list of actions, state health departments and hospitals are encouraged to plan other innovative activities in achieving objectives of 'Swachh Bharat Abhiyan. The steps in implementing Swachhata Pakhwada are:

Ministries/departments will nominate a joint secretary as the nodal officer. All associated organizations and institutions should plan and implement Swachhata Pakhwada activities. The action plan should be submitted to DDWS two months in advance and uploaded on Swachhata Samiksha portal. Activities must follow a structured, date-wise plan, with senior officers overseeing implementation. Virtual meetings should be conducted for preparedness reviews. Union Ministers, MPs, and dignitaries should be involved in the activities. Activities undertaken during the 'Pakhwada' should be documented with high resolution photographs and videos. Daily reporting of activities in Swachhata Samiksha and MyGov portals is mandatory through this link.⁹ All Health departments and hospitals are encouraged to share the activities on platforms such as health department websites, national health M/Kayakalp websites as well as extensive branding should be done through electronic, print, and social media channels such as Facebook and twitter. Ministries/departments in coordination with ministry of information and broadcasting, should publicize initiatives in the media. Swachhata awards/ranking should be conducted among organizations. Achievements must be highlighted through press releases and conferences. A final report, including activities, media coverage, and award details, must be submitted to DDWS for onward submission to the cabinet secretary and prime minister office (PMO).¹⁰

AIIMS RISHIKESH IN IMPLEMENTING SWACHHATA PAKHWADA AND OTHER SWACHHATA ACTIVITIES

AIIMS Rishikesh always takes efforts to follow the ministry’s guidelines and observes Swachhata Pakhwada every year. Apart from Swachhata Pakhwada, AIIMS Rishikesh also observes other related initiatives under ministerial directions. These include Swachhata Hi Sewa, special campaigns, Gunvatha Pakhwada, and Karmayogi Saptah. These initiatives further reinforce the commitment to cleanliness, quality healthcare services, and staff capacity building within the institute.

The following table provides a year-wise comparison of the key activities undertaken during Swachhata Pakhwada at AIIMS Rishikesh. It highlights the efforts made each year in areas such as awareness programs, waste management, community engagement, and institutional improvements and allows a better understanding of the hospital’s progress over time.

Accomplishments of AIIMS Rishikesh through Swachhata activities for the year 2024

Health check-ups for sanitation staff

Over 350 out-sourced sanitation staff members completed basic health check-ups, including CBC, LFT, KFT, viral markers, X-ray, ECG, blood grouping and RH typing, along with OPD consultations in medicine, surgery, ophthalmology, dentistry and gynaecology.

More than 350 sanitation staff received assistance with Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) card applications and the ABHA ID creation.

Green initiatives and targeted cleanliness

Composite pit built to recycle kitchen waste into compost.

Specific hospital zones were identified for cleaning, beautification, and infrastructure improvements.

Public awareness campaigns

A campaign conducted on hand hygiene and biomedical waste disposal management, educating over 300+ patients, relatives, and healthcare professionals.

School awareness programs

School health awareness programs were conducted at Shri Bharat Mandir Inter college school and Kendriya Vidyalaya, Rishikesh, reaching 1000+ students through interactive Nukkad natak performances with practical demonstrations.

Extended hospital cleanliness

Special cleaning campaigns were implemented in neglected hospital areas, including OPD, IPD, and biomedical waste (BMW) store areas.

Sessions on general waste management awareness

A large hands-on activity on wet and dry waste management was organized in the OPD areas of AIIMS Rishikesh, where over 300 people were educated on waste segregation and disposal practices.

Competitions

Various creative competitions held, including innovation contest, waste-to-art, poster making and wall painting competitions to promote environmental awareness.

Engaging the community

Swacchathon, a large-scale cleanliness drive, were participants gather at gate no. 1 of AIIMS Rishikesh and walk through Asthapath marine drive, covering 3 km of the Ganga riverbank while picking up trash.

Community awareness campaigns

A community awareness campaign on waste management was conducted at Raiwala-UPHC and Chandreshwer Nagar-social outreach Cell of AIIMS Rishikesh, educating over 100 community members.

Internal evaluation and recognition

The best clean and green unit award was presented to the department with the highest cleanliness standards to encourage healthy competition.

The best performing housekeeping staff were recognized and awarded under the Swachhata Pakhwada initiative.

A senior official from the MOHFW visited AIIMS Rishikesh to supervise as well as appreciate the successful implementation of the Swachhata Pakhwada 2024.

BENEFITS OF IMPLEMENTING SWACHHATA ACTIVITIES IN TERTIARY HEALTH CARE INSTITUTES

The SBM has been instrumental in transforming India's approach to cleanliness and sanitation.

These campaigns focus on specific cleanliness, such as digital cleanliness and physical space optimization, ensuring issues beyond routine activities are addressed effectively.

By improving file management, clearing backlogs, and optimizing physical spaces, government offices have become more efficient.

Notably, special campaign 3.0 resulted in the removal of 2.4 million files and freed up 16.4 lakh sq. ft. of space, repurposed for essential uses like parking and wellness centres.¹¹

Periodic drives reinforce the principles of the SBM throughout the year, ensuring continuous attention to cleanliness and hygiene rather than relying solely on annual events.

Initiatives such as health education and outreach programs actively involve the public, fostering a sense of ownership and responsibility towards maintaining long-term hygiene practices.

Special campaigns encourage eco-friendly waste disposal, digital record-keeping, and infrastructural improvements, contributing to environmental sustainability.

CHALLENGES AND SUGGESTIONS TO OVERCOME CHALLENGES

Beyond these benefits, the introduction of annual Swachhata Pakhwada, Special Campaigns has specific challenges, affecting the mission's impact.

Low engagement from the public and administrative bodies due to inadequate promotion and awareness. Institutional and community-level resistance to adopt new cleanliness protocols can hinder the effectiveness of these initiatives.

Ensuring alignment with routine institutional activities it requires additional planning and coordination in allocating sufficient manpower, funds, and materials for frequent campaigns can be challenging, especially in resource-limited settings.

Without proper evaluation mechanisms, maintaining and analysing the long-term impact of these campaigns can be difficult.

SOME SUGGESTIONS TO OVERCOME THESE CHALLENGES

Providing customised content apart from banners, like posters, pamphlets and IEC display videos through portals, will make easier for presenting through local media, and community-based activities to promote campaigns, increasing engagement and public interest by digital platforms.

Allocate dedicated budgets and personnel for campaign execution and sustainability, possibly by integrating efforts with existing programs to optimize resource use. For e.g. Implementing a Swachhata cell in each health care institute and dedicated personals will take care of these activities.

Conduct training sessions to personals involved in implementing to keep them updated and provide incentives to motivate offices to adopt improved hygiene practices, addressing resistance through education and positive reinforcement.

Implement regular audits, feedback mechanisms, and impact assessments to measure effectiveness and guide improvements.

By addressing these challenges with targeted strategies, the Swachhata campaigns can significantly enhance cleanliness, administrative efficiency, and public health across India.

CONCLUSION

The implementation of Swachhata Pakhwada at AIIMS Rishikesh has significantly contributed to improving institutional hygiene, public health awareness, and sustainable waste management practices. The integration of special campaigns like Swachhata Hi Seva, Gunwatta Pakhwada, and Karmayogi Saptah has further strengthened efforts towards maintaining high standards of cleanliness. Despite challenges such as resource limitations, engagement gaps, and sustainability concerns, the structured execution of Swachhata Pakhwada has demonstrated measurable improvements in hospital and community hygiene. Future efforts should focus on strengthening monitoring mechanisms, increasing participation through digital engagement, and fostering a culture of sustained hygiene practices beyond the designated campaign periods. By addressing these aspects, Swachhata Pakhwada can continue to be an effective model for promoting health, hygiene, and environmental sustainability in healthcare institutions.

ACKNOWLEDGEMENTS

Authors would like to thank to ministry of health and family welfare for this great initiative. Also, to AIIMS Rishikesh for organizing these campaigns promoting health and hygiene.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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