Dear Elisabeth,

Thanks for pointing us to this 2019 publication: Water, sanitation, and hygiene in health care facilities practical steps to achieve universal access to quality care

This appears to complement well the new 2021 publication 'Understanding barriers to quality of care: An approach for conducting a situational analysis of water, sanitation and hygiene (WASH) and quality in health care facilities'. 

I would be interested to hear from WASH specialists the strengths and limitations of these publications. To what extent are they useful in (a) situational analysis, and (b) taking practical steps for improvement? What other publications do WASH professionals find useful?

Best wishes, Neil

Hi Neil,
Your post prompted me to take another look at the 2019 WHO publication in order to understand: what are the barriers to providing WASH in health care facilities? (as it seems like such a no brainer, that clean water and sanitation are paramount for health care facilities to be effective)

I found them listed on page 14 here :

• Incomplete standards
• Inadequate monitoring
• Disease-specific budgeting
• Disempowered workforce
• Poor WASH infrastructure

Each of those factors are explained in more depth in the document. 

Furthermore, the document talks about "Eight Practical Steps to Improve and Sustain WASH in Health Care Facilities" in Section 3:

 1. Conduct situation analysis and assessment
 2. Set targets and define roadmap
 3. Establish national standards and accountability mechanisms
 4. Improve and maintain infrastructure
 5. Monitor and review data
 6. Develop health workforce
 7. Engage communities
 8. Conduct operational research and share learning.

Point 4 in that list is probably the hardest one and requires the most funds!

Regards,
Elisabeth

P.S. I have also updated the Wikipedia article on WASH with this information, see here:
en.wikipedia.org/wiki/WASH#Health_facilities

Dear all,
This new publication was posted on HIFA.org forum and will be of interest to SuSanA members too:

With thanks to Shams Syed, WHO (one of the authors). WHO and Unicef have just published: Understanding barriers to quality of care: An approach for conducting a situational analysis of water, sanitation and hygiene (WASH) and quality in health care facilities apps.who.int/iris/bitstream/handle/10665...789240022577-eng.pdf

SELECTED EXTRACTS
This document describes an approach for conducting a national situational analysis of water, sanitation and hygiene (WASH) as a basis for improving quality of care (herein referred to as quality, as defined in Box 1). A situational analysis is the first of the eight practical steps recommended by WHO and UNICEF as a means to trigger action to improve and sustain WASH in health care facilities, a prerequisite for providing quality care (1).

The availability of water, sanitation and hygiene (WASH) services in health care facilities, especially in maternity and primary-care settings where they are often absent, supports core aspects of quality, equity and dignity for all people. Recent data from WHO and UNICEF show that globally, one in four health care facilities lack basic water services, one in ten have no sanitation services and one in three have neither hand hygiene facilities at the point of care nor systems to segregate waste1. In Least Developed Countries, the gaps are even greater, where twice as many facilities lack basic water and sanitation services.

For a full explanation of the practical steps and case studies which illustrate them, refer to WHO & UNICEF. 2019 WASH in health care facilities: Practical steps for universal access to quality care. www.who.int/water_sanitation_health/publ...-care-facilities/en/ --

Neil Pakenham-Walsh,
HIFA Coordinator