Kayakalp initiative was launched in 2015 to promote cleanliness, hygiene, and infection control practices in public health facilities in India [1]. This innovative tool alongwith its annual incentives has the potential to make impactful behavior change amongst health caregivers eventually leading to desired transformation [2]. It has a standardized protocol and scoring pattern on given parameters under different sections for quality assessment, first by internal evaluation, then peer and final validation by an external assessment [3].

From 2018 onwards, a new section ‘Beyond hospital boundary’ has been added to this checklist. The name itself indicates the assessment of surroundings for sanitation and other parameters of Kayakalp. The ten sub-sections added are: promotion of swachta (cleanliness) in surroundings, coordination with local institutions, alternative in financing, leadership in governance, health facility approach, cleanliness of surroundings, public amenities in surrounding area, aesthetics of surrounding area, general waste management in surroundings and maintenance of surrounding area. All subsections have a maximum of ten marks, each based on five indicators. The aggregated maximum scores are 100 for district hospital Kayakalp checklist, and 60 each for bedded and non-bedded primary health centers, comprising 1/6th of the total kayakalp score.

By introducing this section, the government is emphatically promoting community participation. Earlier it had focused mainly on behavior change amongst health staff within the premises of an institute, and its impact was tremendous with incentivization of initiatives. Now the government has included other stakeholders like community members, Panchayat Raj Institutions (PRI), Non-Government Organizations (NGO) and other public sector departments as a part of this campaign. Activities from within, like public rallies, marathons, swachhata walks, human chains, street plays/nukkad nataks/folk arts/folk-music, etc. will act as potent instruments of social advocacy and community participation. It ensures every stakeholder from outside health facility premises and communities are gradually involved for hygiene and infection control and thereby helping health promotion at the grass-root level. World Health Organization estimates that Swach Bharat Abhiyan in India would potentially have a spectacular impact on improving the sanitation of communities and thereby averting disease burden within five years of its launch [4]. The integration and extension of such activities will be another opportunity for healthcare providers to make an impact on health indicators and disease burden. Subsequently, as all stakeholders adopt these initiatives, there will be a visible and viable behavior change of the public at large.

To, summarize Beyond hospital boundary will act as a novel, innovative game-changer tool for community participation in sanitation, hygiene, and infection control.

1. Ministry of Health and Family Welfare, Government of India. Kayakalp: An initiative to promote hygiene and sanitation in public health facilities. Press Information Bureau (07-August-2015). Availale from: http://pib.nic.in/newsite/PrintRelease.aspx?relid=124554.　Accessed February 16, 2020.

2. Tiwari A, Tiwari A. Kayakalp: Impact of swachh bharat abhiyan on cleanliness, infection control and hygiene promotion practices in district hospitals of Chhattisgarh, India. IOSR-JESTFT. 2016;10:55-8.

3. Ministry of Health and Family Welfare, Government of India. Award to public health facilities kayakalp, May 2015. Available from: https://www.nhp.gov.in/sites/default/files/pdf/award_to_public_health_facilities_ kayakalp.pdf. Accessed February 20, 2020.