You may be interested in our recent paper on rural healthcare water, sanitation and hygiene access in Ntcheu District (Malawi).

Highlights
• Case study explored water, sanitation and hygiene in rural village health clinics.• Observational checklist at clinics and interviews with front-line personnel.
• 99% (80/81) of clinics reported having a year-round water source.
• 100% (81/81) of clinics had pit latrines, but only 42% were improved facilities. 
• Pit latrines in this study could not be safely emptied, with human excreta mixed with medical waste, and poor latrine-construction standards. 
• 11% (9/81) of clinics had water and soap for handwashing. 


Front-line rural health clinics: Water, sanitation and hygiene access in Ntcheu District (Malawi)
By: Madalitso Mmanga, Rochelle H. Holm, Veronica Di BellaPhysics and Chemistry of the Earth, Parts A/B/C
 
Abstract
In the rural healthcare setting of low-income countries, water may be used for patients taking medication or general consumption; general clinic cleaning; handwashing for staff, patients and visitors; and dilution of chlorine solutions for disinfection. Accessible toilets and adequate supplies of soap for handwashing are also needed. The focus of this research was to explore access to water, sanitation and hygiene in rural, government front-line-village health clinics in Ntcheu District, Malawi. The study collected data from 81 clinics using an observational checklist and interviews with clinic personnel. Nearly all clinics (80/81; 99%) reported having a year-round water source. Only 11% of clinics (9/81) had water and soap for handwashing. While all clinics were observed to have pit latrines for patients, staff and visitors, only 42% (34/81) of clinics would be categorized as having improved sanitation facilities, including having a drop-hole cover, roof and privacy, but not necessarily separate facilities for staff and patients or visitors. Furthermore, pit latrines in this study could not be safely emptied, with human excreta mixed with medical waste, and poor latrine-construction standards. The results of this study demonstrate the need for understanding front-line health services offered at a permanent or semipermanent shelter, within the household of the provider, or in an open space, compared to larger healthcare facilities. While this study found that rural village health clinics generally had adequate coverage of water and sanitation, and better access than reported nationwide in rural households or schools, handwashing facilities remain an important gap to be filled. 

The full paper can be read here:  www.sciencedirect.com/science/article/pii/S1474706519300622