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Water, sanitation and hygiene in health care facilities - Status in low and middle income countries and way forward

WHO, UNICEF (2015)

Published in: 2015
Pages: 52

World Health Organization (WHO), Geneva, Switzerland, ISBN 978 92 4 150847 6


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This report presents for the first time a multi-country review of water, sanitation and hygiene (WASH) services in health care facilities in 54 low- and middle-income countries. WASH services provide for water availability and quality, presence of sanitation facilities and availability of soap and water for handwashing. The main focus of the results is on water availability as there were very limited data on water quality, sanitation and hygiene. In addition, a brief summary of data on the safe disposal of health care waste is provided.

The report provides an alarming picture of the state
of WASH in health care facilities. First, there are limited
data on WASH in health care facilities, both in regards
to geographic scope and in describing the types of services
that do exist. Second, the data that are available indicate
that many health care facilities do not have access to water
sources or sanitation facilities, irrespective of how well these
facilities function. In the few assessments that do examine
this issue, many of the WASH services are not safe or reliable,
and are inadequate for the needs of patients, health care
staff and visitors.

In addition, training and capacity building
to ensure there are sufficient resources and personnel to
operate and maintain WASH facilities and enable health
care staff to deliver hygiene behaviour change messages is
urgently needed. While the situation appears bleak, there are
a number of global initiatives for which WASH in health care
facilities is a foundational element and examples of national
governments taking the initiative to improve standards,
implementation and monitoring. Through coordinated,
global action, with leadership from the health sector,
ensuring that all health care facilities have WASH services is
an aim that can be realized.

The document was authored by Mr Ryan Cronk and Prof Jamie Bartram of the Water Institute at the University of North Carolina at Chapel Hill, USA.

Content - Summary

The report is organized in two main sections. The first focuses on the method employed to obtain the estimates
on WASH in health care facilities and the derived estimates. It also summarizes the status of national policies and targets on WASH in health care facilities. The second section highlights the way forward and particular elements
important in improving WASH in health care facilities. The elements are based on outcomes of global
discussions which took place at a WHO/UNICEF global strategic meeting on WASH in health care facilities hosted
by UN-Water and the Spanish Government in Madrid in 2014. At the meeting, required actions were identified and
• national policies and standards;
• targets;
• improving and managing WASH services;
• monitoring and operational research (see Annex G for further details).
These elements are not exhaustive and will be furtherm developed as part of a global action plan for WASH in health care facilities-

Bibliographic information

WHO, UNICEF (2015). Water, sanitation and hygiene in health care facilities - Status in low and middle income countries and way forward. World Health Organization (WHO), Geneva, Switzerland, ISBN 978 92 4 150847 6

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English Practitioners Recommended by SuSanA (other than SuSanA publications) Sustainable WASH in institutions and gender equality (WG7)


Water, sanitation and hygiene in health care facilities

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