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Strengthening the Health System for Sustainable WASH Improvements: Adopting a Health Systems Approach at All Levels of WASH in HCF Programs

Purpose of this Webinar

Especially in developing countries, the water, sanitation, and hygiene (WASH) situation in many healthcare facilities (HCF) is far from ideal.  Many HCF face issues such as intermittent or no direct supply of clean water, sub-standard sanitation infrastructure, inadequate soap and hygiene supplies, and insufficient hygiene and infection prevention training for staff and caregivers.  Improving WASH in HCF improves responses to health emergencies, patient satisfaction, and working conditions, and decreases neonatal and maternal mortality, antimicrobial resistance, and healthcare associated infections.  Achieving sustainable improvements to WASH in HCF may require a health systems strengthening approach that focuses on partnerships and collaboration, leadership and management priorities, costing and budget allocation, and institutional and social norms regarding WASH.

Webinar Summary

The document below provides a comprehensive summary of the webinar, including challenges to adopting a health systems strengthening approach, in-country examples of programs, and important points and questions raised in the discussion portion of the webinar.

Webinar Session 1 Full Summary (PDF)

Recommended Actions

The document below provides an overview of actionable steps for a health systems strengthening approach for improved WASH in HCF.

Webinar Session 1 Action Document (PDF)

Strengthening the Health System for Sustainable WASH Improvements: Adopting a Health Systems Approach at All Levels of WASH in HCF Programs

Webinar Session 1 PowerPoint Slides (PDF)

Webinar Session 1 Full Summary (PDF)

Recommended Actions

Webinar Session 1 Action Document (PDF)

Additional Resources

  1. WASH in HCF Newsletter Sign Up – WHO, UNICEF

Use the link provided above to sign up to receive a WASH in HCF newsletter and other related updates from UNICEF and The World Health Organization.  The WHO response to the UN SG Call to Action on WASH in HCF will also be shared here.

2. Environmental Conditions in Health Care Facilities in Low- and Middle-income Countries: Coverage and Inequalities -Cronk, et.al. 2018

Recognizing an evidence gap in the understanding of WASH inequalities across HCFs, especially in LMICs, this paper focuses specifically on assessing issues related to low WASH coverage.  It compiled monitoring data to assess inequalities in environmental conditions and WASH service levels.  Findings identified significant inequalities between rural and urban HCFs.

3.  Every Child Alive: The urgent need to end newborn deaths– UNICEF, 2016

This report highlights that many maternal and newborn deaths, especially in developing nations, are due to preventable infections, which result from poor WASH in maternity wards and birthing centers.  A set of requirements needed to achieve progress is presented, and includes guaranteeing that clean, functional health facilities equipped with water, soap, and electricity are accessible to all mothers and babies

4. UNC Water and Health Side Event Report: Moving WASH in HCF from Assessment to Action– Center for Global Safe WASH at Emory University, 2018

Organized by Emory University’s Center for Global Safe Water, Sanitation and Hygiene (CGSW), this side event brought together research and practice leaders in global WASH who are working on solutions to address the gaps in WASH coverage in HCF.  This report summarizes key messages and presentations brought by meeting participants.

5. Transforming health systems – the vital role of water, sanitation and hygiene – WaterAid, 2016

This report provides a detailed outline of WaterAid’s health system strengthening approach to improve WASH in HCF.  Examples of how this approach supported sustainable improvements to WASH in HCF are included for several countries.

6. Hygiene on maternity units: lessons from needs assessments in Bangladesh and India– Cross, et al., 2016

This paper highlights sub-optimal training, policies, and protocols around infection prevention and control (IPC) in many HCF maternity wards in developing countries.  Poor IPC training and practice could contribute to hospital acquired infections for mothers and babies.  A useful conceptual framework is presented which links both individual and system level determinants for WASH with health and non-health outcomes for patients and HCF staff.

7. Strengthening Health Systems to Improve Health Outcomes-WHO’s Framework for Action– WHO 2007

This paper details a useful framework for understanding fundamental health system building blocks, developing a package of activities that can be built into that health system that relate to WASH, and translating those into a health approach to improve quality of care.  The framework is general and intended to be applied and adapted to a variety of HCF settings.

8. Standards for Improving Quality of Maternal and Newborn Care in Health Facilities –WHO, 2016

This framework paper addresses a need to focus on improving quality of care in maternity wards as a means to improve global maternal and neonatal mortality rates.  It presents a framework for improving maternity ward quality of care by implementing specific standards which should be continually monitored and improved upon.  WASH standards are an integral part of this framework.

9. Review Report for Harmonization of WASH Indicators into the National HMIS– Republic of Uganda Ministry of Health, 2018

This report includes useful insights from stakeholder meetings and other processes that facilitated the inclusion of WASH standards into Uganda’s national Health Management Information System (HMIS).