Skip to main content

Health care facilities

Harmonised baseline estimates for WASH in health care facilities will be published in 2018, including water, sanitation, hand hygiene and health care waste management.

Hospital staff at wash basin
Dominique Maison/Mali/2016

 

Achieving and maintaining WASH services in health care facilities is a critical element for a number of health aims including those linked to quality universal health coverage, infection prevention and control, patient safety, and child and maternal health, in particular the time around child delivery. WASH also extends beyond health impacts to issues of dignity and respect, staff morale, and performance and safety. Accordingly, SDG targets 6.1 and 6.2 include WASH in health care facilities as part of universal WASH access for all.

JMP monitoring of WASH in health care facilities includes tracking basic water, sanitation, hand hygiene, and health care waste. Definitions of basic services have been developed by a global task team convened by the JMP and incorporated into new JMP service ladders for WASH in health care facilities. JMP estimates for WASH in health care facilities will be based on the new harmonized core indicators.

 

Water

Health care facilities with an improved water source on-premises with water available at the time of the questionnaire or survey will be classified as having basic service. Health care facilities with an improved water source but without water available or that is off-premises are classified as having limited service, and those with unimproved or no water source will be classified as no service. In countries where basic service is already the norm, a country-defined advanced service level may be appropriate based on the national context, priorities and resources. Criteria for an advanced level might include normative elements such as water quality and water quantity.

 

  • Advanced

    To be defined at national level

  • Basic

    Water from an improved source is available on-premises

  • Limited

    Water from an improved source is available off-premises; or an improved source is on site but no water is available

  • No service

    Unprotected dug well or spring, surface water; or no water source

 

Sanitation

Health care facilities with improved latrines or toilets which are usable, separated for patients and staff, separated for women with menstrual hygiene facilities, and meet the needs of people with limited mobility are classified as having basic service. The term usable here refers to toilets or latrines that are accessible to patients and staff (doors are unlocked or a key is available at all times), functional (the toilet is not broken, the toilet hole is not blocked, and water is available for flush/pour-flush toilets), and private (there are closable doors that lock from the inside and no large gaps in the structure).

Health care facilities with improved latrines or toilets which do not meet all the criteria for basic service are classified as having limited service. Health care facilities with unimproved or no toilets are classified as having no service. In countries where an advanced service level is appropriate, elements might include toilet cleanliness, toilet lighting, or patients per toilet ratios.

 

  • Advanced

    To be defined at national level

  • Basic

    Improved facilities are usable, separated for patients and staff, separated for women and providing menstrual hygiene facilities and meeting the needs of people with limited mobility

  • Limited

    Improved sanitation facilities are present by are not usable, or do not meet the needs of specific groups (women, people with limited mobility, staff)

  • No service

    Pit latrines without a slab or platform, hanging latrines, or there are no toilets or latrines at the facility

 

Hand hygiene

Basic hand hygiene in health care facilities is defined by two main criteria: (1) either alcohol hand-rub or a basin with water and soap are available at points of care, and (2) handwashing facilities with water and soap are available at the toilets. Points of care are defined here as any location in the outpatient setting where care or treatment is delivered (i.e. consultation/exam rooms).

Health care facilities with hand hygiene materials at either points of care or the toilets, but not both are considered to have limited service, while those with no hand hygiene stations or with no cleansing materials are classified as having no service. An advanced level for hygiene might include availability of hand hygiene promotional materials near hand hygiene stations and/or the patient waiting area, or if hand hygiene facilities are accessible to all staff and patients.

 

  • Advanced

    To be defined at national level

  • Basic

    Hand hygiene materials, either a basin with water and soap or alcohol hand rub, are available at points of care and toilets

  • Limited

    Hand hygiene station at either points of care or toilets, but not both

  • No service

    Hand hygiene stations are absent; or present but with no soap or water

 

Health care waste management

Health care facilities where waste is safely segregated into at least three bins (sharps, infectious, and non-infectious) in the consultation area, and that safely treat and dispose of sharps and infectious waste are classified as having basic service. Facilities that segregate waste but do not treat and dispose of it safely, or that do not effectively segregate waste, are considered to have limited service. If waste is not segregated or safely treated and disposed of, the facility is classified as having no service. An advanced level for health care waste management might include whether functional needle cutters or hub cutters are available near sharps bins, or if bins are out of reach of patients, particularly children.

 

  • Advanced

    To be defined at national level

  • Basic

    Waste is safely segregated into at least three bins in the consultation area, and sharps and infectious waste are safely treated and disposed

  • Limited

    Waste is segregated but not disposed of safely, or bins are in place but not used effectively

  • No service

    Waste is not segregated or safely treated and disposed

 

Integrating and harmonizing data from facility surveys and censuses   

Data sources for JMP estimates on WASH in health care facilities include facility surveys, such as country-specific national surveys, the USAID Service Provision Assessment (SPA), the WHO Service Availability and Readiness Assessment (SARA) and the World Bank Service Delivery Indicator (SDI) survey. Existing national censuses such as the Health Management Information System (HMIS) or annual health facility inventory surveys may provide an opportunity to track progress toward the SDG criteria for WASH in health care facilities through existing national monitoring systems.

Data are harmonized to the extent possible based on the indicator definitions for ‘basic’ service. Based on regional scoping studies, a number of countries have data on at least some of the SDG criteria already, though further harmonization is needed to improve the cross-country comparability of data and development of regional and global coverage estimates. Harmonized core questions have been developed for use in surveys and/or national censuses. Core questions currently focus on the outpatient setting, but a set of question for the birth setting is in development as well as additional guidance for integrating the SDG indicators into national monitoring systems.