WASH in Health Care Facilities

Global baseline report

Tom Slaymaker (UNICEF)Rick Johnston (WHO)

UNICEF/WHO JMPinfo@washdata.org

www.washdata.org

WHO/UNICEF Joint Monitoring Programmefor Water Supply, Sanitation and Hygiene

Back to Basics: Practical Steps for Countries to Ensure Universal Access to WASH in HCF

June, 2019

Global goals and targets related to WASH in health care facilities

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WASH in HCF: 2018 Call to ActionVision

Every health facility has the necessary WASH services and practices in order to provide essential, quality

health services for everyone, everywhere.

Targets

At least 50% of all health care facilities globally and in each SDG region have basic WASH services by 2022, and 80% by 2025, with the ultimate aim of 100% by 2030.By 2020, all countries have completed and reported baseline WASH in HCF assessments, have set national targets that identify and act to reduce sub-national

disparities and are developing or have developed and are implementing national standards.

WASH in HCF global reports

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WATER SANITATION HYGIENE WASTEMANAGEMENT

ENVIRONMENTALCLEANING

BASI

CSE

RVIC

EWater is available froman improved source on the premises.

Improved sanitationfacilities are usable,with at least one toilet dedicated for staff, atleast one sex-separatedtoilet withmenstrual hygiene facilities,and at least one toiletaccessible for peoplewith limited mobility.

Functional handhygiene facilities (withwater and soap and/or alcohol-based handrub) are availableatpoints of care,and within five metres oftoilets.

Waste is safelysegregated into atleast three bins,and sharps and infectiouswaste are treatedand disposed ofsafely.

Basic protocols forcleaning are available,and staff with cleaningresponsibilities have all received training.

LIM

ITED

SERV

ICE

An improved watersource is within 500 metres ofthepremises, but notall requirements forbasicservice are met.

At least oneimprovedsanitation facility isavailable, but notall requirements for basicservice are met.

Functional handhygiene facilities areavailable either atpoints of care or toilets but not both.

There is limitedseparation and/ or treatment and disposal of sharps and infectiouswaste, but not allrequirements forbasic service are met.

There are cleaningprotocols and/or atleast some staff have received training oncleaning.

NO

SERV

ICE

Water is taken fromunprotected dug wellsor springs, or surface water sources; oranimproved source that ismore than 500metresfrom the premises;orthere is no watersource.

Toilet facilities areunimproved (e.g. pit latrines without a slabor platform, hanginglatrines, bucketlatrines) or there areno toilets.

No functional handhygiene facilities

are available either at points of care ortoilets.

There are noseparate bins for sharpsorinfectious waste,and sharps and/orinfectious waste arenot treated/disposedof safely.

No cleaning protocolsare available and nostaff have receivedtrainingoncleaning.

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New JMP country files for WASH in health care facilities

• All national data sources

– Facility surveys, MIS…

– Data extracted into global harmonized categories

• Show estimates– Years 2000-2016

– Stratifiers (urban-rural, hospital, non-hospital, govt-non-govt + service areas)

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Highlights1. Basic drinking water

Highlights

Country Facility Improved & Usable

& Dedicated for Staff

& Sex-separated

& Menstrual hygiene

& Limited mobility Basic

Kuwait 100 100 100 100 100 100 100 100

Czechia 100 100 100 98 95 95 - 95

Montenegro 100 100 100 100 100 100 85 85

Serbia 100 100 100 100 100 73 73 73

Ethiopia 96 76 76 71 59 - - 59

Azerbaijan 100 100 98 48 100 100 - 48

Armenia - 81 62 87 42 42 41 41

Paraguay 100 88 63 31 26 - - 26

Zimbabwe 100 100 72 89 97 32 17 17

Lebanon 96 83 83 70 59 31 16 16

Maldives 100 100 99 80 15 30 57 15

Nigeria 84 59 49 46 - 31 12 12

Uganda 100 91 88 - 28 - 12 12

Peru 97 90 83 86 64 - 7 7

United Republic of Tanzania 99 51 51 5 36 - 5 5

Liberia 76 76 76 31 54 - 3 3

Comoros - 51 38 43 9 2 7 2

Honduras 100 96 84 78 70 - 1 1

2. Basic sanitation

Highlights: Hygiene

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3. Basic hygiene

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Highlights: Waste management

• 27% of health care facilities in Least Developed Countries had basic health care waste management services.

• In sub-Saharan Africa, 60% of hospitals and 38% of other health care facilities had basic waste management services. Seven out of ten government health care facilities (71%) and half of non-government health care facilities (55%) safely segregated waste

4. Basic health care waste management

Highlights: environmental cleaning

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100

80

43

18

15

49

38

5 8

44

20

40

60

80

100

San Marino Montenegro Tunisia Maldives

No service

Limited

Basic

5. Basic environmental cleaning

Additional indicators

• Many service elements not captured in basic indicators– Water quantity, quality, piped water

– # of toilets, wastewater management

– # of handwashing facilities, handwashing practices

– Off-site waste treatment, ash management

– Cleaning practices, logs, supplies, budgets

• Ward-specific data (e.g. delivery rooms)

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Next steps

• Harmonize definitions

• Address data gaps

• Establish baselines

• Eliminate ‘no services’

• Prioritise universal basic

• Progressively improve service levels

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Water Sanitation HygieneHealth

care

waste

Environ-mental

cleaning

Advanced Advanced Advanced Advanced Advanced

Basic Basic Basic Basic Basic

Limited Limited Limited Limited Limited

No service No service No service No service No service

Thank You!

washdata.org

Questions for discussion

• How can we work together to strengthen national data on WASH in health care facilities?

• How can we maximize the accessibility of JMP data for decision makers at national, regional and global levels?

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“Do not call it a health care facility if there is no WASH”

Back to basics: practical steps to ensure universal access to WASH in

health care facilities

Emory Webinar Series26 June 2019

Maggie Montgomery, World Health Organization

Responding to the UN Secretary General’s global call to action on WASH in HCF

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“WASH in health facilities are the most basic

requirements of infection prevention and

control, and of quality care.

They are fundamental to respecting the dignity

and human rights of every person who seeks

health care.”António Guterres, UN Secretary General

Global Targets

Practical steps for improving and sustaining services

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Examples of country-led steps

25/06/2019 4

Embedding WASH standards in national quality effortsCambodia, Ethiopia, Kenya, Ghana,

India, Tanzania

Risk-based WASH improvements

Cox’s Bazaar, Liberia, India, Indonesia, Lao PDR, Philippines, Madagascar,

Zambia

Monitor and review dataBhutan, Egypt, Ghana, Hungary, India,

Indonesia, Lebanon, Mali, Uganda, Serbia

Engage communitiesEthiopia, Ghana, Mali

Trigger• Environmental interventions could prevent 90% of

outpatient visits• Major updates to health, health financing and quality

strategiesWhat

• Intersectoral working group established; joint IPC/WASH focal lead

• National strategy on WASH in HCF developed with targets; 80% funded domestically

Results• National WASH in HCF standards updated with

performance benchmarks and environmentally friendly waste technologies

• WASH included in DHMIS 2; regularly reviewed• Citizen engagement through local radio, community

scorecards

Challenges and opportunities• Coordination (i.e. 71 training institutes for health)• Safe management of health care waste underfunded

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Ghana: national strategy on WASH in HCF and links to quality

Trigger• Regional commitments through Water and Health

Protocol• Data and policy gaps revealed through GLAAS Survey

What• Updated surveillance programme to align with JMP

indicators• Defined criteria for “higher levels of service”

Results• Regular tracking and review of progress on achieving

WASH in HCF targets; immediate improvements for sanitation

• More in-depth analysis and focus on primary and rural facilities (those most left behind)

Challenges and opportunities• Quality of surveillance data• Dissemination of WASH data among health colleagues

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Serbia: national strategy on WASH in HCF and links to quality

Ministries of health commit to take action in 2019 World Health Assembly Resolution

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• Conduct comprehensive national assessments

• Develop and implement a national roadmap with targets and monitor progress

• Set and implement standards with a focus on addressing inequities

• Integrate WASH in HCF into health programming

• Establish strong multisectoral coordination mechanisms

• Have procedures and funding in place to maintain WASH services

https://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_R7-en.pdf

WHO and UNICEF• Leadership, implementation of global plan of action

and monitoring, technical supportMinistry of Health• Standards, monitoring, staffing, programming

Ministry of Water/Sanitation• Expertise, technologies, maintenance

President/Prime Minister• Funding, implementation, roadmap, evaluation

Health and development partners• Technical expertise, advocacy, financial support

Financing institutions• Resource mobilization, investment

Private sector• Innovation, investment, technology

I commit to better WASH, better quality of care

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Over 100 organizations have pledged support for WASH in HCF and urged WHO/UNICEF and countries to do more.

• Support implementation of the WHA resolution

• Understand the data: https://washdata.org

(global, regional, country)• Share your commitments, tools and learning https://www.washinhcf.org

• Join upcoming webinars, regional and global events (Zambia, Sept 2019)• Email: washinhcf@who.int ; Tweet: @wash_for_health

Learn more, share your story, commit now

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