Water and Sanitation for Health Facility Improvement Tool ...€¦ · Water and Sanitation for Health Facility Improvement Tool (WASH FIT˜ A practical guide for improving quality

CONTACTWater, Sanitation, Hygiene and Health Unit Department of Public Health, Environmental and Social Determinants of Health World Health Organization 20 Avenue Appia 1211-Geneva 27 Switzerland http://www.who.int/water_sanitation_health/en/

Water and Sanitation for Health Facility Improvement Tool (WASH FIT)A practical guide for improving quality of care through water, sanitation and hygiene in health care facilities


Water and Sanitation for Health Facility Improvement Tool (WASH FIT)

ISBN 978-92-4-151169-8

© World Health Organization 2017. Updated cover and introduction in 2018.

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I I I

ContentsForeword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v

Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi

Abbreviations and acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii

I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Why focus on WASH in health care facilties? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2. Overview of WASH FIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Why use WASH FIT? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Who should use WASH FIT? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4What areas of a facility does WASH FIT cover? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4In what type of facilities should WASH FIT be used? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5How can WASH FIT be adapted for other types of facilities and settings? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5What role does leadership play in WASH FIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

3. The WASH FIT process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Task 1: Assemble a WASH FIT team and hold regular meetings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Task 2: Conduct an assessment of the facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Task 3: Undertake hazard and risk assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Task 4: Develop an improvement plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Task 5: Monitor the progress of the improvement plan and make revisions as necessary . . . . . . . . . . . . . . . 26

4. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

5. Tool templates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31Tool 1A: WASH FIT team list . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32Tool 1B: WASH FIT team meeting record sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Tool 2A: Indicators assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35Tool 2B: Record of assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53Tool 2C: Sanitary inspection forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Sanitary inspection form 1: Dug well with hand pump . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55Sanitary inspection form 2: Deep borehole with motorized pump . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57Sanitary inspection form 3: Public/yard taps and piped distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58Sanitary inspection form 4: Rainwater harvesting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60Sanitary inspection form 5: Storage reservoirs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

Tool 3: Risk assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63Tool 4: Improvement plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

Annex 1: Guidance for national or district level implementers and policymakers . . . . . . . . . . . . . . . . . . . . 69WASH FIT external follow-up visit questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72Activity planning example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

Annex 2: Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

WAT E R A N D S A N I TAT I O N F O R H E A LT H FAC I L I T Y I M P R O V E M E N T TO O L WA S H F I T

Nurse at primary health care centre, Ségou, Mali.

V

ForewordWorld leaders recently declared that universal health coverage (UHC) and access to high quality, integrated “people centred” health services, are essential to health for all and to human security.1 Yet, e�orts to accelerate UHC and quality of care will be undermined because fundamental infrastructure and hygiene in health facilities are not in place. A WHO/UNICEF 2015 global review reported that nearly 40% of facilities lack water supplies, 19% are without sanitation and 35% do not have any hand hygiene materials.2 Indeed, UHC may be an empty promise without adequate attention to quality, and quality initiatives will fail without adequate attention to water, sanitation and hygiene (WASH).

The lack of WASH services compromises the ability to provide safe and quality care, places both health care providers and those seeking care at substantial risk of infection-related morbidities and mortality, and poses a signi�cant economic and social burden. Pregnant women, who are increasingly giving birth in health care facilities, and their newborns, are especially vulnerable to the consequences of poor WASH services. Among hospital-born babies in developing countries, health care associated infections are responsible for between 4% and 56% of all causes of death in the neonatal period, 75% of which occur in South-East Asia and sub-Saharan Africa.3

To address this major gap in services, in 2015, WHO and UNICEF (along with health and WASH partners from across the globe) committed to the vision, that by 2030, every health care facility, in every setting, should have safely managed, reliable water, sanitation and hygiene facilities and practices that meet sta� and patient needs.4 One output from this commitment has been the development of WASH FIT.

WASH FIT is a risk-based approach for improving and sustaining water, sanitation and hygiene and health care waste management infrastructure and services in health care facilities in low- and middle-income countries (LMIC). WASH FIT is an improvement tool to be used on a continuous and regular basis, to �rst and foremost help health care facility sta� and administrators prioritize and improve services, and, second, to inform broader district, regional and national e�orts to improve quality health care.

The WASH FIT guide contains practical step-by-step directions and tools for assessing and improving services. It is adapted from the water safety plan (WSP) approach recommended in the WHO Guidelines for drinking-water quality (WHO, 2011) and goes beyond water safety to include sanitation and hygiene, health care waste, management and sta� empowerment.

WASH FIT provides an opportunity to improve WASH through a health lens. Improving WASH in health care facilities helps reduce maternal and newborn mortality and improves the quality of care so that women can deliver with dignity, further bene�ting holistic health aims. Emerging and growing threats from antimicrobial resistant infections and infectious disease outbreaks can also be signi�cantly reduced by improving WASH services. Country piloting and implementation of WASH FIT have focused on the above and evidence is emerging on how WASH FIT can strengthen, especially at the facility level, services in countries such as Cambodia, Chad, Ethiopia, Liberia and Mali.

Long-term facility improvements require national-level commitment and leadership from both WASH and health actors. WASH infrastructure and service improvements ought to be prioritized, budgeted and implemented as part of wider health systems strengthening e�orts and supported with appropriate national policies and standards. Multisectoral collaborations prior to, during and following the WASH FIT implementation are especially important for implementing and institutionalizing WASH practices in health care facilities and beyond.

There is a free digital version of WASH FIT which uses the mWater digital monitoring platform to help perform assessments, track hazards and improvement actions and visualize progress over time. To use WASH FIT Digital visit https://wash�t.org/#/ or the Google Play store.

1 World Bank, WHO, UNICEF, JICA and UHC 2030 International Health Partnership (2017). Tokyo Declaration on Universal Health Coverage. December 2017. http://www.who.int/universal_health_coverage/tokyo-decleration-uhc.pdf?ua=1

2 WHO/UNICEF (2015). Water, sanitation and hygiene in health care facilities: Urgent needs and actions. Meeting report. http://www.who.int/entity/water_sanitation_health/facilities/wash-in-hcf-geneva.pdf?ua=1

3 WHO. Health care associated infections. Fact sheet. http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf?ua=14 For more information on the global action plan, visit www.washinhcf.org


https://washfit.org/#/

http://www.who.int/universal_health_coverage/tokyo-decleration-uhc.pdf?ua=1

http://www.who.int/universal_health_coverage/tokyo-decleration-uhc.pdf?ua=1

http://www.who.int/entity/water_sanitation_health/facilities/wash-in-hcf-geneva.pdf?ua=1

http://www.who.int/entity/water_sanitation_health/facilities/wash-in-hcf-geneva.pdf?ua=1

http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf?ua=1

www.washinhcf.org

V I

AcknowledgementsArabella Hayter (WHO) and Alban Nouvellon (independent consultant) drafted the original guide, with leadership and guidance from Fabrice Fotso, Lizette Burgers, Nabila Zaka and Irene Amongin (UNICEF), and Maggie Montgomery and Bruce Gordon (WHO).

Appreciation is extended to the attendees (more than 50 individuals) representing WHO, UNICEF, ministries of health and water and WaterAid from Chad, the Democratic Republic of Congo, Ghana, Guinea, Liberia, Mali, Senegal and Sierra Leone who participated in the 2016 WASH FIT West Africa workshop and provided critical inputs to this guide. Some 150 participants who attended WASH FIT training workshops in Chad, the Lao People’s Democratic Republic, Liberia, Madagascar and Mali also helped to re�ne and improve the tool.

Thanks also go to Jeanine Beck, Vivien Stone and Corinne Shefner-Rogers who edited the guide and to Lesley Robinson and Geraldine Scott-Scrivens who provided secretarial and administrative support throughout the development process and at related meetings and workshops.

WHO and UNICEF gratefully acknowledge the �nancial support provided by the Hilton Foundation, the OPEC Fund for International Development and General Electric, the United Kingdom Department for International Development (DFID) and the United States Agency for International Development (USAID), which was used for developing, piloting and implementing WASH FIT.

HEALTH CARE FACILITIESWASH IN

FOR BETTER HEALTH CARE SERVICES

V I I

Abbreviations and acronyms

AMR antimicrobial resistanceHMIS health monitoring information systemsHWTS household water treatment and safe storageIPC infection prevention and control JMP WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and HygieneLMIC low- and middle-income countriesMRSA methicillin-resistant Staphylococcus aureusNGO nongovernmental organizationSDGs Sustainable Development GoalsSI sanitary inspectionSOP standard operating procedureUHC universal health coverageUNICEF United Nations Children’s FundWASH water, sanitation and hygiene WASH FIT Water and Sanitation for Health Facility Improvement ToolWHO World Health OrganizationWSP water safety plan


1

Why focus on WASH in health care facilities?

1. IntroductionWASH in health care facilities is a fundamental prerequisite for achieving national health goals and Sustainable Development Goals (SDGs) 3 (ensure healthy lives and promote well-being) and 6 (ensure availability and sustainable management of water and sanitation). Safe water, functioning hand washing facilities, latrines, and hygiene and cleaning practices are especially important for improving health outcomes linked to maternal, newborn and child health, as well as carrying out basic infection prevention and control (IPC) procedures necessary to prevent antimicrobial resistance (AMR).

In order to provide quality of care and reduce infections, health care facilities must have the appropriate infrastructure and sta� capacities to provide safe, e�ective, equitable and people-centred services (see Figure 1.1). WASH services strengthen the resilience of health care systems to prevent disease outbreaks, allow e�ective responses to emergencies (including natural disasters and outbreaks) and bring emergencies under control when they occur.

* WASH in health care facilities includes water supply, sanitation, hygiene and health care waste management.

Figure 1.1 Bene�ts of improved WASH in health care facilitiesBene�ts of improved WASH in health care facilities

• Reduced health care associated infections

• Reduced antimicrobial resistance

• Improved occupational health and safety

• Improved outbreak prevention and control (e.g. cholera, Ebola)

• Improved diarrhoeal disease prevention and control

• Improved satisfaction and ability to provide safe care

Health and safety

Climate change and

disaster resilience

Disease prevention

and treatment

People-centred care

Community WASH

Sta� morale and

performance

Heath care costs

• Increased uptake of services, e.g. facility births, vaccinations

• Health sta� model good hygiene behaviour

• Improved hygiene practices at home

• More e�cient services• Disease/deaths averted

• Facilities better prepared to continue to provide WASH in disasters, including climate-related events


3

Why use WASH FIT?

2. Overview of WASH FIT WASH FIT is a multistep, iterative process to facilitate improvements in WASH services, quality and experience of care. The speci�c purposes of using WASH FIT are:

To provide a framework to develop, monitor and continuously implement an improvement plan and prioritize speci�c actions when resources are limited.

To identify areas for quality improvement in facilities, including strengthening WASH and IPC policies and standards that will lead to lower infection rates, better health outcomes for patients and improved sta� safety and morale.

To facilitate the development of an enabling environment by bringing together all those who share responsibility for providing services, including legislators/policymakers, district health o�cers, hospital administrators, water engineers and community WASH and health groups.

To improve the day-to-day management and operation of facilities, by systemizing the process of managing WASH services.

To engage community members in advocating for and demanding better WASH services and in triggering positive changes in hygiene practices in households.

Figure 2.1 Impacts associated with WASH FIT

Immediate and long-term impacts

Using WASH FIT �ndings to develop or upgrade WASH infrastructure in order to provide safe and reliable infection prevention and control services

Using WASH FIT to assess WASH in

health care facilities, making necessary

improvements, and sustaining quality

WASH infrastructure services

Using WASH FIT �ndings to develop sta� capacity (including cleaning sta�) and help patients use correct WASH practices, in order to reduce sta� and patient infections

WATER HYGIENESANITATION



Healthier, more productive families and communities

Improved outbreak response and resilience

Improved newborn care and health outcomes, and lower neonatal mortality rates

Digni�ed and safe pregnancy, delivery and postpartum care, improved health outcomes, lower maternal mortality rates

Immediate impacts

Impr

oved

infr

astr

uctu

re a

nd s

ervi

ces

Qua

lity,

equ

ity,

dig

nity

More e�cient use of resources

and lower health care

costs

Improved infection

prevention and control, and

antimicrobial resistance

Improved sta� morale and

performance


4

Who should use WASH FIT?

WASH FIT is designed for use by health care facility managers and sta� to make improvements in settings where resources are limited. Sta� may include the chief medical o�cer, �nancial administrator, doctors, nurses and persons in charge of managing water and waste. It requires a team e�ort.

Facility managers may want to involve people from outside of the facility to participate in the WASH FIT process. For example:

Local, district and regional WASH and/or public works authorities in the area.

Representatives from the community (both male and female) who can provide inputs from a facility user perspective (including change agents/in�uencers).

Local and regional government authorities involved in implementing national quality health care, IPC and maternal, newborn and child health strategies for improving pregnancy-related outcomes.

Partners, e.g. donors, nongovernmental organizations (NGOs), who can support infrastructural improvements and help ensure sustainability of WASH services.

What areas of a facility does WASH FIT cover?

WASH FIT covers four broad areas: water, sanitation (including health care waste management), hygiene (hand hygiene and environmental cleaning) and management (Figure 2.2). Each area includes indicators and targets for achieving minimum standards for maintaining a safe and clean environment. These standards are based on global standards as set out in the WHO Essential environmental health standards in health care (WHO, 2008) and the WHO Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level (WHO, 2016a).

Figure 2.2 The four domains of WASH FIT

HYGIENE*

SANITATION*SANITATION*SANITATION* MANAGEMENT

* Hygiene includes hand hygiene and environmental disinfection. Sanitation covers faecal waste management, storm water and health care waste.

WATER



5

In what type of facilities should WASH FIT be used?

WASH FIT is primarily designed for use in primary health care facilities (e.g. health centres, health posts and small district hospitals) that provide outpatient services, family planning, antenatal care, maternal, newborn and child health services (including delivery). It can be adapted to more advanced facilities and/or used in conjunction with broader quality improvement e�orts (e.g. improving quality of care for mothers and newborns).

How can WASH FIT be adapted for other types of facilities and settings?

WASH FIT is a framework and can be adapted for use in any type of facility. All users are encouraged to adapt the tool to suit their needs in order to meet quality improvement cycles and mechanisms implemented to improve quality of care. The broad WASH FIT process and methodology should remain the same, but the indicators and assessment (Tool 2A) can be modi�ed to re�ect local priorities and/or national standards (where they exist). This can be done in a number of ways (for more guidance, see Tools 2A, 2B and 2C: Instructions for use.

Reduce the number of indicators: Some aspects of WASH may not be applicable in very small facilities (such as health posts where waste is treated o� site) and a large number of items to monitor could be daunting for a small team. Indicators that are not relevant (the “advanced indicators”) can be removed and only the “essential” set of indicators (shown in bold) assessed.

Focus on only one domain: For facilities with limited capacity, starting by focusing on only one domain (such as health care waste management) may be more realistic than trying to monitor and improve all areas of a facility at once. In such cases, a facility may begin with assessing just one domain and once the WASH FIT process is established and sta� feel more con�dent, WASH FIT can be scaled up to address other priority areas.

Add indicators: Additional indicators may be added as necessary, to represent a higher level of service and/or to cover services provided in larger facilities.

Change indicators: The indicators should be adapted to re�ect national standards.

Integrate indicators: Insert indicators into existing service assessments and monitoring mechanisms used in a facility, rather than introducing an additional, completely new tool.

Assess the facility by service area not domain: For larger facilities, the assessment can be reordered to group indicators by service area (e.g. outpatients, delivery room) rather than domain. This can help to streamline the assessment so the team can assess all relevant indicators for a given room in one go.


6

What role does leadership play in WASH FIT?

Leadership and political commitment at every level are essential for improving WASH in health care facilities. If not already in place, developing and implementing a set of national policies and standards along with accountability mechanisms that support health care facilities to improve WASH infrastructures and services is important. This requires that governments provide dedicated budgets for WASH infrastructure and services and regularly monitor WASH in health care facilities in national health monitoring information systems (HMIS).

Creating an enabling environment may require conducting advocacy activities to raise awareness about the need for WASH improvements and the value of WASH FIT in health care facilities. Local and district-focused work ought to be accompanied by national e�orts. Discussions with multiple government sector leaders can result in collaborations that work synergistically to improve the standards in health care facilities and the health of all citizens.



7

3. The WASH FIT process

The WASH FIT process has �ve tasks that should be implemented sequentially (Figure 3.1). This section outlines the �ve tasks. Each task includes a description of the steps necessary to complete the task, a list of “dos and don’ts” to consider and instructions for using the templates. Section 5 includes a set of blank templates to use to complete each stage of the process.

Before starting to use WASH FIT, it is important to understand the context or enabling environment in which any improvements will take place. At the start of the process, conduct a review of existing national WASH and health policies, standards, guidelines and research. In addition, identify current WASH in the health care facilities and broader related health initiatives, including those on quality care, IPC, AMR, maternal and newborn health and emergency preparedness.

Such a review should involve discussions with key stakeholders and experts to understand the priorities and challenges related to WASH in health care facilities and to determine whether there are any political, economic, social or cultural factors that may help or hinder e�orts. Given the intersectoral nature of WASH, and speci�cally the links with health, creating an enabling environment may require prolonged policy discussions to achieve national level and sector wide endorsement and intersectoral cooperation and collaboration.


ENABLING ENVIRONMENTLeadership, political commitment and community engagement

2. Conduct an assessment of

the facility

1. Assemble and train the

WASH FIT team and

hold regular meetings5. Continuously

evaluate and improve the

plan

4. Develop and implement an improvement

plan

3. Undertake hazard and risk

assessment and note

according to seriousness

HEALTH-BASED OBJECTIVESMake improvements to meet accreditation scheme or national quality standards

MO

TIVA

TIO

N, V

ISIO

N A

ND

ACC

OU

NTA

BIL

ITY M

OTIVATIO

N, V

ISION

AN

D A

CCOU

NTA

BILITY

Figure 3.1 WASH FIT framework and tasks

Undertaking a WASH FIT Assessment, WASH FIT Training, Bong County, Liberia.

Task

1

Task 1Assemble a WASH FIT team and hold regular meetings

The �rst task in the WASH FIT process requires assembling a committed team with leadership skills that can drive the process. Box 1 provides an example of two types of WASH FIT teams. It is important that all team members engage in the process and in joint decision-making. WASH FIT is a long-term process, so it is useful to create a team with a long-term vision and commitment.

9

Objectives for Task 1 To assemble a team that has support from the facility's administration and is committed to meeting regularly, implementing WASH FIT and following through with a plan for improving WASH in the facility.

Steps Create a one-page brief to explain the purpose and process of WASH FIT for team members when inviting individuals to be members of the team (refer to the Introduction).

Invite individuals to be on the team. Using Tool 1A, record members of the team, their role and

responsibilities and contact details. Hold regular team meetings. Using Tool 1B, document discussion items, decisions made and action

points at each meeting.

Tools 1A and 1B: Instructions for use

To record team members, their roles and responsibilities and contact details. Tool 1B provides a guide for recording WASH FIT team meetings. For each WASH FIT meeting, use the meeting sheet to record the main decisions, including important follow-up actions to take. This makes it possible to keep a record of progress and the key decisions that have been agreed. It is also possible to use a simple notebook to document the meeting notes.

Task

1WAT E R A N D S A N I TAT I O N F O R H E A LT H FAC I L I T Y I M P R O V E M E N T TO O L WA S H F I T

10

Dos and don'ts DO

Do nominate a leader to drive the process Leaders should have vision and commitment. They should be trusted by the sta� and have the support of facility administration and district health o�cials. The role of the leader is to ensure that the speci�c tasks and tools are being completed correctly and in a timely manner, meetings are held on a regular basis and that decisions are acted upon so that the WASH assessment progresses and leads to actions that improve WASH and health outcomes in the health care facility.

Do involve a range of people who are committed to creating a safe and clean facility

The team should include facility managers, health care workers (of di�erent levels), cleaners and maintenance sta�, environmental health sta�, local partners (e.g. district health o�cers) and at least one community representative (preferably someone well known in the community who can act as a champion and change agent). Local government representatives may also be involved so that they understand the process and can help to facilitate actions. Involving diverse people with a range of experiences with WASH and IPC will contribute to better problem-solving and a range of potential solutions for WASH improvement issues in the facility.

Do involve senior management at the facility and district levels The senior management of a facility is the gateway to changing WASH

in health care facilities. Senior managers can facilitate infrastructural repairs and service enhancements by earmarking funding for such activities as �xing boreholes and adding toilets and hand washing stations.

Box 1. Examples of WASH FIT teams

Team in a small rural facility1. Manager (acts as team leader) 2. Nurse 3. WASH technician from the nearby community4. Member of community health or water committee5. Maintenance or cleaning person

Team in a district hospital 1. Chief medical director or facility administrator2. Two members of the IPC committee, including one responsible for health care waste management3. Nurse4. Technician responsible for maintaining equipment5. Member of community health or water committee6. District health o�cer7. Maintenance or cleaning sta� representative



Task

1

11

Do involve external partners for additional support in small facilities with limited sta� Potential partners include the district health o�ce, local NGOs and local WASH experts, as well as IPC experts or sta� from larger facilities. Involving external partners will contribute to overall health system strengthening.

Do include female sta� and women on the team and seek female perspectives, including from women who have given birth at the facility

Women should be involved, represented and consulted in all planning and decision-making discussions and activities to ensure women’s and girls’ needs are met throughout the facility.

Do specify the role and responsibilities of each team member at the start

It is important that all team members understand the importance of water, sanitation, hand hygiene and hygiene practices (cleaning and disinfection) for preventing and controlling infections that may otherwise lead to disease and death. Each team member should be able to identify and evaluate potential WASH hazards and risks. Together, using the WASH FIT tools, team members can inspect a facility and report on the state of the infrastructure and services throughout the facility, the management and maintenance of the facility and the WASH behaviours of sta�, patients and their families who visit the facility. The team meetings can be forums for reporting �ndings from the assessments and identifying and prioritizing actions necessary to improve WASH in the facility.

Do meet regularly as a team to discuss the day-to-day operation and management of WASH

Regular communication between team members is important for completing the tasks, identifying and addressing key challenges and setting priority actions for the time between meetings. It is useful for the team to agree on decision-making processes and communication (e.g. meeting minutes, distribution of completed tools and reports) in the �rst meeting. Ideally, the team will meet once every week at the start (e.g. while the �rst facility assessment is being conducted) and at least once a month thereafter.


Task

1

12

DON’T Don’t create a new team if there is already an established group

in charge of managing quality improvements and/or an IPC committee WASH FIT tasks can be incorporated into the responsibilities of an existing, functional facility management or oversight team. If the existing team does not have enough representatives with WASH expertise, additional team members can be invited to join the existing team.

Don’t forget to involve cleaning and maintenance sta� Cleaning and maintenance workers (whether or not they are considered “sta�” in the facility) are familiar with the ins and outs of the facility infrastructure, how WASH services are used and which WASH sites and products are most or least used in a facility. They are a crucial part of managing a health facility and are often overlooked in decision-making processes.



Task

1

13

Objectives for Task 2 To use WASH FIT Tools 2A, 2B and 2C to assess a facility according to national and global standards for WASH, as a basis for making improvements.

Steps Review all areas of Tool 2A and decide which indicators will be assessed and monitored, which need to be adapted to national standards and whether additional indicators will be included.

Use Tool 2A to conduct a comprehensive assessment of the facility using the agreed list of indicators; record whether each indicator meets ( ), partially meets ( ), or does not meet ( ), the minimum standards.

Use Tool 2B to record the percentage of indicators which meet, partially meet or do not meet the standards in the summary tables and calculate the overall facility score (the percentage of all indicators meetings the standards), to make comparisons over time.

Use Tool 2C to conduct the sanitary inspection (SI) and determine the level of risk from water and sanitation sources at the facility.

Review the assessment form to ensure all information is clear and correct and all members of the team agree.

As part of the assessment, review hygiene promotion materials, WASH and IPC guidelines and budget, make observations of infrastructure and sta� behaviours (for example, whether sta� respect protocols) and take pictures of the facility (if a camera is available). A series of pictures taken over time can be useful to show where improvements have been made. It can also help explain things about the facility to somebody who has not seen it.

Repeat the assessment every six months, or more often as needed. Use a blank form for each assessment and clearly number them accordingly – Assessment “1”, “2”, “3” and so on.

Task 2Conduct an assessment of the facility


Task

2

14

Tools 2A, 2B and 2C: Instructions for use Tool 2A: Indicators assessment:

This includes a list of indicators for each of the WASH domains (water, sanitation/health care waste, hygiene and management). In the �rst column, the core “essential” indicators to be assessed, regardless of the size of facility, are highlighted in bold text. The remaining “advanced” indicators can be considered for assessment, depending on the team’s capacity. For each indicator, decide whether the facility meets the target ( ), partially meets the target ( ) or does not meet the target ( ). Record additional information in the notes column, for example, the reasons why a particular indicator does not meet the target. Box 2 provides suggestions for how to adapt the indicators in Tool 2A.

The indicators assessment will need to be redone every six months (or more often) to re-assess the facility and monitor how well the improvement plan is working. This continuous assessment will highlight where additional improvements are needed or if new problems have arisen. Ideally, the same people should conduct the indicators assessments each time to ensure consistency.

Some of the indicators require calculations to be made (for example, calculating the adequacy of water storage requires estimating how much water is needed each day and dividing it by the amount that can be stored; or measuring the width of the toilet door to determine if it is accessible for someone in a wheelchair). Make a note of the raw data used in these calculations in the notes column in order to refer back to them later. Ask for external support if the information needed is not available at the facility (e.g. the local health o�ce or water supply o�ce may have information on the quality of the facility’s water or on speci�c national WASH or IPC guidelines).

Please note, the sanitary inspection forms (Tool 2C) are needed to answer indicator 1.2.

Box 2. Suggestions for adapting Tool 2A1. Add additional indicators as appropriate. For example, indicators for other environmental

health issues or for other departments in larger facilities, such as surgical areas and laboratories, that require more detailed assessment.

2. Remove indicators that are not relevant, particularly for smaller facilities which provide limited services. For example, if there is no inpatient department, remove 2.1 (number of toilets for inpatients). Record the total number of indicators in your assessment in the summary sheet (Tool 2B).

3. Adapt indicators to �t national standards. For example, you may have national water quality testing requirements which are not adequately covered in the current indicators.

4. The rating system could be changed to stars, numbers or a tra�c light system (i.e. green, yellow, red).



Task

2

15

Tool 2B: Record of assessment:

This is a table for recording your �ndings from Tool 2A. You should tally the percentage of indicators that met the standards ( ), partially met the standards ( ) and did not meet the standards ( ) for each WASH area. At the bottom of Tool 2B, you will be able to record the overall score for the facility. By calculating the overall percentage of indicators that meet the minimum standards, the facility can be given an overall score, for each example if 40 indicators are assessed and 30 meet the minimum standards, the facility would score 75%. This can be used to show changes over time and to make comparisons between facilities using WASH FIT.

If there were any problems with the assessment, record these in the notes box. For example, if some questions could not be �lled in, make a note of why not and set a date when the indicators will be calculated. Record when and who conducted the assessment.

Tool 2C: Sanitary inspection forms:

These are a set of �ve forms, each with a checklist of speci�c questions to assess the typical risk factors associated with a respective abstraction technology or supply step (for example, the presence of animals, accumulation of faecal material, design �aws or lack of protective infrastructures). There are di�erent options available, according to the type of water system in a facility:

SI 1: Dug well with hand pump SI 2: Borehole with motorized pump SI 3: Public/yard taps and piped distribution SI 4: Rainwater harvesting SI 5: Storage reservoirs (which can be used in combination with any

abstraction methods).

The SI forms are made up of yes/no questions, so that a “yes” answer indicates a potential risk and a “no” answer indicates no or a very low risk. At the end of each form, the number of “yes” answers should be tallied. All answers should be based on visual on-site observation and interviewing community members and/or operators by the team. Each of the �ve forms has a page of explanatory notes that provides descriptions for what to look for during an assessment. Note, SI forms may also be known as “sanitary surveys”.


Task

2

16

Dos and don'ts DO

Do visit all areas in the facility, including consultation rooms, outpatient and inpatient services (if applicable) and communal and waiting areas Be sure to look at sanitation services, water abstraction sites, water collection points and storage facilities, hand hygiene stations and waste collection, storage and destruction sites. Ask facility sta� if there are any other WASH-related areas that might have been missed.

Do walk through the facility and make observations as a team The assessment must be completed in person by walking through the facility and seeing all WASH-related areas in person. Doing a walk through as a team will allow the team to discuss the assessment on site and ensure that nothing is missed.

Do use the assessment information to feed into other reporting systems Share the assessment results with facility management and sta� and with policy and decision-makers. The information collected can help to support surveillance at the facility, district and national levels.

Do carry out sanitary inspections on a regular basis (e.g. quarterly) to assess contamination risks to the water supply Sanitary inspections can identify potential hazards, hazardous events and problematic conditions related to water abstraction facilities, distribution systems and storage reservoirs and improvement needs in a facility’s water system. Sanitary inspections should always be done whenever any water quality testing is done to better characterize health risks associated with faecal or other types of water contamination.

Do view the assessment as a learning opportunity Remember that the aim of the assessment is to identify areas for improvement and not as a means for criticizing or laying blame within the facility.

DON’T Don’t be afraid to ask questions when conducting the assessment

It is important to understand how the people that work in or use the facility feel about the WASH infrastructure and services. Ask sta�, caregivers and patients about their WASH-related experience within the facility. Questions should be asked in such a way that does not steer the person to a more positive or negative response.



Task

2

Undertaking a WASH FIT assessment, WASH FIT training, Savannakhet Province, Lao People's Democratic Republic.

Task

2

Task 3Undertake hazard and risk assessment

Objectives for Task 3 To identify WASH-related hazards or problems; the associated risks that these hazards present to sta�, general patients, pregnant mothers, newborns, caregivers and possibly the community; and the areas for improvement in the facility.

Steps Review all the information collected in Task 2. Using Tool 3, record the speci�c hazards (problems) (column 1) and

associated risks (column 2). Grade each risk according to the seriousness of the hazard and

feasibility of addressing it (column 3). Additionally, all hazards and risks can be plotted on a master grid to help identify priorities and inform the improvement plan.

Record the actions to be undertaken at the facility/community and/or district/regional levels.

Tool 3: Instructions for use

This tool provides a table for recording the hazards and risks associated with each WASH area in the health care facility; the level of risk versus the feasibility of addressing a problem; and the actions to be taken at the facility/community and/or district/regional.

18

Box 3. De�nitions of hazard and riskDe�nitionsA hazard is de�ned as a "condition, event or circumstance that could lead to or contribute to an unplanned or undesirable event." It may also be referred to as a problem. Any indicators that do not meet the target should be considered a potential hazard.

A risk is the potential of a set of unwanted circumstances or events occurring as the result of the hazard. All hazards have associated risks. Example A blocked toilet is a hazard. The associated risk is that users may have to defecate in the open, contaminating the environment and creating a very unappealing health care facility. Users may also su�er health consequences from not being able to relieve themselves of a bowel movement or urine.



Task

3

19

There are three actions to complete for the risk assessment:

1. De�ne the hazard(s): Table 3.1 below gives examples of how to de�ne hazards and risk. Determine what is a “hazard” by asking questions such as: “What services and infrastructure are lacking?” “What could go wrong with the existing infrastructure?” “Is anything being done to maintain services?”

Write a detailed description of the hazards in column 1 of Tool 3, including the number of the indicator (from Tool 2A) to which you are referring.

List the risks associated with each hazard in column 2 of Tool 3. Think of potential risks to sta�, patients, caregivers, visitors and the community.

Table 3.1 Examples of hazards and risks for WASH

2. Determine the seriousness of the hazard/risk (high, medium, low, unknown): The risk assessment can be done using the scale in Figure 3.2, or using risk categories (e.g. low/medium/high or less important/important/very important). The names and de�nitions of each category should be de�ned by the WASH FIT team. Some sample de�nitions are provided below as a guide. Box 4 provides questions to keep in mind when completing the risk assessment. Assessing the level of risk for each problem is context-speci�c and there is no right or wrong answer. The risk assessment should be undertaken by several individuals within the team to increase the validity of the risk assessment. Each individual conducting the risk assessment should share their conclusion about the level of risk. The team should consider each individual’s conclusion to arrive at a single overall risk level.


Task

3

HAZARDS (problems) RISKS

WATER 1.1, 1.2, 1.6, 1.13: Water not available within treatment rooms, near toilets or for showering (only available from communal tap within grounds of facility).

Women cannot wash themselves after delivery, negatively impacting their dignity and comfort and increasing infection risks.

Di�cult for sta�, patients and their families to easily follow hand hygiene procedures, thus increasing risks of transmitting infections.

Di�cult to clean �oors, surfaces, utensils and bed linen putting all users at risk of infection from poor environmental hygiene and accidents.

SANITATION 2.13: Waste is not correctly segregated at waste generation points.

2.22: Appropriate protective equipment for sta� in charge of waste treatment and disposal is not available.

Sta�, patients, visitors and community members at risk of infection from health care waste, including needle stick injuries and exposure to contaminated �uids.

Sta� at risk of infection during treatment and disposal of health care waste.

HYGIENE 3.1: No functioning hand hygiene stations at points of care.

Increased risk of patients acquiring health care associated infections, for example, newborns acquiring neonatal sepsis.

Increased risk of sta� acquiring infections such as methicillin-resistant Staphylococcus aureus (MRSA) from not washing hands during key moments and generally unclean areas in the facility.

SANITATION

20

The hazard/problem very likely results in injuries,

acute and/or chronic illness, infection or an inability to provide essential services. Immediate actions need to

be taken to minimize the risk.

HIGHRISK

The hazard/problem likely results in moderate health

e�ects, discomfort or unsatisfactory services, for

example unpleasant odours, unsatisfactory working

conditions, minor injuries. Once the high risks issues

are addressed, actions should be taken to minimize

medium-level risks.

MEDIUMRISK

No major health a�ects anticipated. These risks should be addressed as

resources become available and should be revisited in the future as part of the

review process.

LOWRISK

Further information is needed to categorize the risk. Some action should

be taken to reduce the risk while more information is

gathered.

UNKNOWNRISK

Figure 3.2 Descriptions of levels of risk

3. Weigh the level (or seriousness) of the risk (high/medium/low/unknown) in relation to how easy or di�cult it will be to take action to address the problem: Some hazards may be easier to address than others depending on the resources currently available and/or the time it will take to �x a problem. For example, it may be relatively quick and inexpensive to install hand hygiene stations at a facility, but more complex to maintain them (�lling them with water each day, ensuring soap is available and that they do not drain into public areas).

Not every hazard can be addressed immediately. Column 3 in Tool 3, provides a visual way to categorize the risks and the feasibility of addressing them to help prioritize the actions to be taken. The “window” in column 3 has four squares. The top left square represents problems that are low risk, but di�cult to address. The top right square is for problems that are high risk and di�cult to address. The bottom left square represents problems that are low risk and easier to address, the bottom right square is for problems that are high risk, but easier to address. Figure 3.3 provides an example how to �ll in the “window” for speci�c problems.



Task

3

Figure 3.3 Categorizing problems and risks by the level of di�culty to address the problem/risk

Problems/hazards1.1 No piped water system in facility 2.7 No record of cleaning visible in latrines2.10 Lighting in latrines is insu�cient 2.14 Waste burial pit is full 3.1 No hand hygiene stations at points of care 3.2 No hygiene promotion posters at latrines and

hand hygiene stations 4.2 An annual WASH budget for the facility is not

available

Higher riskMore di�cult to address

Higher riskEasier to address

Lower riskMore di�cult to address

Lower riskEasier to address

1.1

2.14

4.2

2.10

2.7

3.2

3.1

Di�

cult

y of

add

ress

ing

prob

lem

Seriousness of risk

Seriousness of risk

Di�

cult

y of

add

ress

ing

prob

lem

21

Box 4. Questions to keep in mind when completing the risk assessment

Do seasonality and/or climate change a�ect WASH services and are there plans in place to cope with this?

Where in the facility are the key areas where infections are most likely to occur due to inadequate WASH?

What sta� behaviours and attitudes contribute to delivering good WASH services? What sta� behaviours and attitudes contribute to delivering poor WASH services?

Is there a protocol in place to ensure that a hazard/problem is managed e�ciently? What do sta� and patients �nd most important/di�cult about the WASH hazard in question? Have all sta� been formally trained on IPC, waste management and other WASH areas as per

their job descriptions?


Task

3

22

DON’T Don’t focus only on the negatives

It is important to recognize good WASH practices within the facility, improvements that have already been made and where standards have already been met. It is useful to learn from successes within the facility and consider those successes when making recommendations for other similar facilities.

Don’t worry that ranking risks is context-speci�c Di�erent people will rank risks di�erently and that is okay. It is more important that all facility stakeholders (sta�, patients, families and community members) have an opportunity to share their opinions and that the process of deciding which problems and risks are the most important is collaborative.

Dos and don'ts DO

Do consider all the potential problems and constraints relating to the facility Problems can be related to infrastructure (for example, lack of water storage capacity, blocked latrines or a broken incinerator) or to operation and maintenance (for example, cleaning and servicing equipment, such as respirators and incinerators), a shortage of cleaning sta� or inadequate budget to buy supplies.

Do think about problems that might happen in the future Consider all the potential problems that could occur and whether there are procedures and protocols in place to �x them when they happen. Problems could be one-o� occurrences (for example, seasonal water shortages or a hand pump breaking) or long-term issues (for example, no access to water within the facility).

Do consider all facility users when determining the level of risk Depending on how often an issue arises and how severe the consequences are, the risk to public health will vary. The WASH FIT team will need to have detailed discussions about which risks are considered more important than others. Remember that the relative importance of individual risks is di�erent for every facility and for di�erent users.



Task

3

Task

3

Task 4Develop an improvement plan

Objectives for Task 4 To prioritize which hazards/problems will be addressed and develop a detailed action plan outlining what improvements will be made within a given timeframe.

The WASH improvements could be achieved through a number of di�erent mechanisms, including building new infrastructure or repairing existing infrastructure, coordinated dialogue with district and national authorities for new/revised infrastructure, writing standards and protocols to improve behaviours, training sta� in a new technique or initiative and/or improving management methods.

It is important to consider the level of di�culty or ease with which the improvements can be made. For example, which changes can be made within the facility without external support, what can be done with minimal external support, and what will require substantial inputs and support at the local, district, regional or national levels.

Steps Review the Task 3 actions agreed upon by the team to be undertaken at the facility/community and/or district/regional levels.

Decide on the number of actions that are feasible to implement given the allotted resources.

Using Tool 4, record the actions and �ll in details (what, who, what resources, when) for each action.

Finalize Tool 4 and seek the necessary approvals for the improvement plan.

Tool 4: Instructions for use

This should be used to record the speci�c WASH improvement actions to be taken toward eliminating or reducing the hazard(s); the person or group responsible for implementing the action(s); the resources needed to accomplish the action(s); the expected date for completing the action(s); the actual completion date; and the monitoring process for each action item.

24



Task

4

DON’T Don’t focus only on the short term

Some actions are immediate, while other actions or system upgrades may take more time and money (for example installing a water �ltration unit to address microbial contamination in the water system). Think about what kind of facility and environment there should be in six months/one year/�ve years and even further in the future. Long-term thinking will help the team to be more ambitious and realistic. Remember, WASH FIT is a continuous process in which improvement takes place step by step over time.

Dos and don'ts DO

Do make the actions as speci�c as possible Specify who is responsible for ensuring the action is completed, when it will be completed and what resources are needed. The resources could be �nancial, technical (such as external support specialists) or someone’s time. Make sure each activity is realistically achievable with the resources and time available.

Do think of improvements and preventive measures that can be made with limited resources Consider, for example, ensuring that a latrine or toilet and area around it are clean, providing soap and water or alcohol-based handrubs at all hand hygiene stations or putting up a poster with pictures and diagrams describing basic hand hygiene principles.

Do remember that no change is too small Whatever positive actions are taken will make a di�erence. For those action items that are more di�cult to address (e.g. installing a water supply), think of small actions you can take to begin the process of change (e.g. presenting a case for a new water supply to the district authorities).

Do use the improvement plan as a basis for seeking �nancial or other support for larger upgrades and improvements A detailed plan could be used to approach the government, donors or NGOs for additional support.

25

Task

4


Task 5Monitor the progress of the improvement plan and make revisions as necessary

Objectives for Task 5 To continuously monitor the progress of the improvement plan toward reaching the essential (and advanced) target indicators for each WASH area and make changes to the plan as necessary to keep progress on track.

Monitoring involves using quantitative and/or qualitative methods (for example completing tracking forms or conducting observations/inspections of facility WASH sites) on a regular basis to determine to what degree the team has achieved the WASH improvements they set out to make.

Steps As a team, review the improvement plan to determine whether all actions are being implemented, how far along the actions are toward completion and what further steps need to be taken to ensure that the action item will be completed by the expected completion date.

Conduct a full WASH assessment using the WASH FIT guide every six months to evaluate the improvement in the facility using the indicators selected in Tool 2A (the list of indicators can be revised as necessary for each subsequent WASH assessment).

Discuss the improvement plan at regular sta� meetings as well as holding more detailed, regular discussions every six months with the community and wider health and WASH stakeholders.

Tool There is no speci�c tool for Task 5. Use the last two columns in Tool 4 to record any revisions made to the plan. Box 5 provides a list of questions to consider when reviewing a WASH FIT improvement plan.

Dos and don'ts DO

Do build monitoring into sta� job descriptions and divide the tasks between sta� members Cleaners, for example, should routinely inspect latrines every day, while senior management may be responsible for budgeting and supplies and should review the budget at the end of each month.

26



Task

5

Do discuss the results of monitoring observations at each team meeting Ask each team member to provide feedback on the area for which they are responsible. Focus on the problems/hazards and risks identi�ed for improvement, what remains to be completed and how best to make sure that the actions are all completed on time. If little or no progress is being made, the team should review the plan and brainstorm ideas to address any problems.

Do re-do the risk assessment when new problems arise If monitoring reveals that new problems have arisen, the team should conduct a risk assessment for the new problems, put them into context with the existing problems being addressed and re-prioritize all problems as necessary. The team should then revisit the improvement implementation plan and revise as necessary. Do record all team discussions and decisions using a team meeting sheet (Tool 1B).

27

Task

4

Box 5. Questions to consider when reviewing the WASH FIT improvement plan

Are there any new team members since WASH FIT began? Do existing team members need a refresher or more detailed technical training? Is additional support from other partners required? Is the information in the assessment up to date? Has the facility changed in any signi�cant way since the last assessment was conducted? What has hindered progress and why? Are there new hazards and associated risks? What improvement actions have already been completed? What targets have been reached? What have been some of the greatest successes? What still remains challenging? Should other improvements be prioritized?

DON’T Don’t be discouraged when improvement progress seems slow

Use the team review meetings to determine where the bottlenecks are that are slowing progress and create action items to unblock the bottlenecks.


28

WHO (2008). Essential environmental health standards in health care. Geneva: World Health Organization (http://www.who.int/water_sanitation_health/publications/ehs_hc/en/, accessed 24 January 2018).

WHO (2011). Guidelines for drinking-water quality. Fourth edition. Geneva: World Health Organization (http://www.who.int/water_sanitation_health/publications/2011/dwq_guidelines, accessed 24 January 2018).

WHO (2014). Safe management of wastes from health-care activities. Second edition. Geneva: World Health Organization (http://www.who.int/water_sanitation_health/publications/safe-management-of-wastes-from-health care-activities/en/, accessed 24 January 2018).

WHO (2016a). Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level. Geneva: World Health Organization (http://www.who.int/gpsc/ipc-components/en/, accessed 24 January 2018).

WHO (2016b). Global guidelines on the prevention of surgical site infection. Geneva: World Health Organization (http://www.who.int/gpsc/ssi-guidelines/en/, accessed 24 January 2018).

WHO (2016c). Standards for improving quality of maternal and newborn care in health facilities. Geneva: World Health Organization (http://www.who.int/maternal_child_adolescent/documents/improving-maternal-newborn-care-quality/en/, accessed 24 January 2018).

WHO/UNICEF (2015). Water, sanitation and hygiene in health care facilities: Urgent needs and actions. Meeting report. Geneva: World Health Organization (http://www.who.int/water_sanitation_health/facilities/wash-in-hcf-geneva.pdf, accessed 24 January 2018).

Further readingGovernment of Liberia (2015). WASH and Environmental Health Package for Health Care Facilities. (http://www.washinhcf.org/case-studies/liberia/, accessed 24 January 2018).

WHO (2009). WHO guidelines on hand hygiene in health care. Geneva: World Health Organization (http://www.who.int/gpsc/information_centre/hand-hygiene-2009/en/, accessed 24 January 2018).

WHO (2009). Water safety plan manual: Step-by-step risk management for drinking-water suppliers. Geneva: World Health Organization (http://apps.who.int/iris/bitstream/10665/75141/1/9789241562638_eng.pdf, accessed 24 January 2018).

WHO (2010). Water safety plan: A �eld guide to improving drinking-water safety in small communities. Copenhagen: WHO Regional O�ce for Europe (http://www.euro.who.int/__data/assets/pdf_�le/0004/243787/Water-safety-plan-Eng.pdf?ua=1, accessed 24 January 2018).

WHO (2010). WHO-recommended handrub formulations. Geneva: World Health Organization (http://www.who.int/gpsc/information_centre/handrub-formulations/en/, accessed 24 January 2018).

WHO (2012). Safety planning for small community water supplies: Step-by-step risk management guidance for drinking-water supplies in small communities. Geneva: World Health Organization (http://apps.who.int/iris/bitstream/10665/75145/1/9789241548427_eng.pdf, accessed 24 January 2018).

WHO (2014). Ebola virus disease: Key questions and answers concerning health care waste. Geneva: World Health Organization (http://www.who.int/csr/resources/publications/ebola/health-care-waste/en/, accessed 24 January 2018).

WHO (2014). Ebola virus disease: Key questions and answers concerning water, sanitation and hygiene. Geneva: World Health Organization (http://www.who.int/csr/resources/publications/ebola/water-sanitation-hygiene/en/, accessed 24 January 2018).

4. References



http://www.who.int/water_sanitation_health/publications/ehs_hc/en/

http://www.who.int/water_sanitation_health/publications/ehs_hc/en/

http://www.who.int/water_sanitation_health/publications/2011/dwq_guidelines

http://www.who.int/water_sanitation_health/publications/2011/dwq_guidelines

http://www.who.int/water_sanitation_health/publications/safe-management-of-wastes-from-healthcare-activities/en/

http://www.who.int/water_sanitation_health/publications/safe-management-of-wastes-from-healthcare-activities/en/

http://www.who.int/gpsc/ipc-components/en/

http://www.who.int/gpsc/ssi-guidelines/en/

http://www.who.int/maternal_child_adolescent/documents/improving-maternal-newborn-care-quality/en/%20

http://www.who.int/maternal_child_adolescent/documents/improving-maternal-newborn-care-quality/en/%20

http://www.who.int/water_sanitation_health/facilities/wash-in-hcf-geneva.pdf

http://www.who.int/water_sanitation_health/facilities/wash-in-hcf-geneva.pdf

http://www.washinhcf.org/case-studies/liberia/

http://www.washinhcf.org/case-studies/liberia/

http://www.who.int/gpsc/information_centre/hand-hygiene-2009/en/

http://www.who.int/gpsc/information_centre/hand-hygiene-2009/en/

http://apps.who.int/iris/bitstream/10665/75141/1/9789241562638_eng.pdf

http://www.euro.who.int/__data/assets/pdf_file/0004/243787/Water-safety-plan-Eng.pdf?ua=1

http://www.euro.who.int/__data/assets/pdf_file/0004/243787/Water-safety-plan-Eng.pdf?ua=1

http://www.who.int/gpsc/information_centre/handrub-formulations/en/

http://www.who.int/gpsc/information_centre/handrub-formulations/en/



http://www.who.int/csr/resources/publications/ebola/health-care-waste/en/

http://www.who.int/csr/resources/publications/ebola/water-sanitation-hygiene/en/

29

WHO (2015). Infection prevention and control guidance for care of patients in health-care settings, with focus on Ebola. Geneva: World Health Organization (http://apps.who.int/ebola/publications-and-technical-guidelines/infection-prevention-and-control-guidance-focus-ebola, accessed 24 January 2018).

WHO (2015). Sanitation safety planning: Manual for safe use and disposal of wastewater, grey water and excreta. Geneva: World Health Organization (http://www.who.int/water_sanitation_health/publications/ssp-manual/en/, accessed 24 January 2018).

WHO (2016). WHO International Scheme to Evaluate Household Water Treatment Technologies. List of products and disclaimers. Geneva, World Health Organization (http://www.who.int/water_sanitation_health/water-quality/household/list-of-products/en/, accessed 9 February 2018).

WHO (2016). Results of Round 1 of the International Scheme to Evaluate Household Water Treatment Technologies. Geneva: World Health Organization (http://www.who.int/water_sanitation_health/publications/household-water-treatment-report-round-1/en/, accessed 24 January 2018).

WHO/UNICEF (2015). Water, sanitation and hygiene in health care facilities: Status in low- and middle-income countries and way forward. Report. Geneva: World Health Organization (http://apps.who.int/iris/bitstream/10665/154588/1/9789241508476_eng.pdf, accessed 24 January 2018).

WHO/UNICEF (2016). Expert Group meeting on monitoring WASH in health care facilities in the Sustainable Development Goals. WHO/UNICEF Joint Monitoring Programme for water supply and sanitation (https://washdata.org/report/jmp-2016-expert-group-meeting-winhcf, accessed 24 January 2018).

WHO/UNICEF Joint Monitoring Programme (2016). Core indicators for monitoring WASH in health care facilities (https://www.washinhcf.org/documents/161125-FINAL-WASH-in-HCF-Core-Questions.pdf, accessed 24 January 2018).

WHO/UNICEF (2016). Water and sanitation for health facility improvement tool (WASH FIT) regional workshop. 6–8 June 2016. Dakar: Senegal (https://www.washinhcf.org/documents/WASH-FIT-Dakar-Workshop-report_v4_EN_�nal.pdf, accessed 24 January 2018).

Useful websitesBabyWASH Coalition: http://babywashcoalition.org/

UNICEF, Water, Sanitation and Hygiene: http://www.unicef.org/wash/

USAID, Maternal and Child Survival Program, WASH in Health Care Facilities: https://washforhealthcare.mcsprogram.org/

WHO, Global Learning Laboratory for Quality Universal Health Coverage: http://www.integratedcare4people.org/communities/global-learning-laboratory-for-quality-universal-health-coverage/

WHO, Infection prevention and control (implementation tools and resources): http://www.who.int/infection-prevention/tools/en/

WHO, Water sanitation hygiene: http://www.who.int/water_sanitation_health/en/

WHO, Water sanitation hygiene (International Scheme to Evaluate Household Water Treatment Technologies): http://www.who.int/water_sanitation_health/water-quality/household/scheme-household-water-treatment/en/

WHO/UNICEF, Quality of Care Network for Maternal, Newborn and Child Health: http://www.who.int/maternal_child_adolescent/topics/quality-of-care/network/en/

WHO/UNICEF, WASH in Health Care Facilities: www.washinhcf.org


http://apps.who.int/ebola/publications-and-technical-guidelines/infection-prevention-and-control-guidance-focus-ebola

http://apps.who.int/ebola/publications-and-technical-guidelines/infection-prevention-and-control-guidance-focus-ebola

http://www.who.int/water_sanitation_health/publications/ssp-manual/en/

http://www.who.int/water_sanitation_health/water-quality/household/list-of-products/en/


http://www.who.int/water_sanitation_health/publications/household-water-treatment-report-round-1/en/

http://www.who.int/water_sanitation_health/publications/household-water-treatment-report-round-1/en/



https://washdata.org/report/jmp-2016-expert-group-meeting-winhcf

https://washdata.org/report/jmp-2016-expert-group-meeting-winhcf

https://www.washinhcf.org/documents/161125-FINAL-WASH-in-HCF-Core-Questions.pdf

http://www.washinhcf.org/fileadmin/user_upload/documents/WASH-FIT-Dakar-Workshop-report_v4_EN_final.pdf

http://www.washinhcf.org/fileadmin/user_upload/documents/WASH-FIT-Dakar-Workshop-report_v4_EN_final.pdf

http://babywashcoalition.org/%20

http://www.unicef.org/wash/

https://washforhealthcare.mcsprogram.org/

https://washforhealthcare.mcsprogram.org/

http://www.integratedcare4people.org/communities/global-learning-laboratory-for-quality-universal-health-coverage/

http://www.integratedcare4people.org/communities/global-learning-laboratory-for-quality-universal-health-coverage/

http://www.who.int/infection-prevention/tools/en/

http://www.who.int/infection-prevention/tools/en/

http://www.who.int/water_sanitation_health/en/

http://www.who.int/water_sanitation_health/water-quality/household/scheme-household-water-treatment/en/

http://www.who.int/water_sanitation_health/water-quality/household/scheme-household-water-treatment/en/

http://www.who.int/maternal_child_adolescent/topics/quality-of-care/network/en/

http://www.who.int/maternal_child_adolescent/topics/quality-of-care/network/en/

http://www.washinhcf.org

Drinking water station and poster installed as a result of WASH FIT, health care facility in N'Djamena, Chad.

31

5. Tool templates

Tool 1A: WASH FIT team list. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Tool 1B: WASH FIT team meeting record sheet . . . . . . . . . . . . . . . . . . . . . . . 33

Tool 2A: Indicators assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Tool 2B: Record of assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Tool 2C: Sanitary inspection forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Tool 3: Hazard and risk assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Tool 4: Improvement plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67


32

Tool

1A

: WA

SH F

IT te

am li

st

Date

: . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. .

Nam

eJo

b tit

le an

d or

gani

zatio

n

(e.g

. fac

ility

man

ager

)Ro

le an

d re

spon

sibili

ty on

the W

ASH

FIT t

eam

(e.g

. tea

m le

ader

, res

pons

ible

for

coor

dina

ting W

ASH

FIT)

Cont

act d

etai

ls (p

hone

num

ber a

nd, i

f av

aila

ble,

emai

l)



To

ol 1

A

33

Tool

1B:

WA

SH F

IT te

am m

eeti

ng re

cord

she

et

Date

: . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. .

Nam

es of

team

mem

bers

par

ticip

atin

gKe

y iss

ues t

o be d

iscus

sed

in th

e m

eetin

gLis

t the

dec

ision

s and

outc

omes

of ea

ch is

sue d

iscus

sed

and

actio

ns to

be t

aken

, in

cludi

ng re

spon

sible

per

son(

s) an

d tim

elin

e (us

e an

extr

a she

et if

nec

essa

ry)

Date

and

time o

f nex

t tea

m m

eetin

g in

four

wee

ks


To

ol 1

B

34

Tool

1B:

WA

SH F

IT te

am m

eeti

ng re

cord

she

et e

xam

ple

Date

: 15

Mar

ch, B

ongo

r Hea

lth C

entre

Nam

es of

team

mem

bers

par

ticip

atin

gKe

y iss

ues t

o be d

iscus

sed

in th

e m

eetin

gLis

t the

dec

ision

s and

outc

omes

of ea

ch is

sue d

iscus

sed

and

actio

ns to

be t

aken

, in

cludi

ng re

spon

sible

per

son(

s) an

d tim

elin

e (us

e an

extr

a she

et if

nec

essa

ry)

Date

and

time o

f nex

t tea

m m

eetin

g in

four

wee

ks

1. Re

sults

of ba

selin

e fac

ility

asse

ssme

nt, co

nduc

ted on

26

Septe

mber

. 2.

Disc

ussio

n of m

ajor h

azar

ds an

d co

mplet

ion of

Tool

3.

3. H

ow to

invo

lve th

e dist

rict le

vel

and e

xtra

supp

ort n

eede

d.4

. How

to in

volve

comm

unity

in

proce

ss, to

incre

ase b

uy-in

of

WASH

FIT.

1.Some

infor

mationw

asmissing

onthea

ssessm

ent.T

eamtofillinga

ps,in

cludin

gco

nduc

ting s

anita

ry in

spec

tions

and r

eass

essin

g wate

r sup

ply.

2.E

milytoaskd

istrictofficeforadditio

nalte

chnic

alsupport,includ

ingpo

ssible

traini

ng on

clea

ning a

nd ha

nd hy

giene

.3.

Gith

u to g

ive a

pres

entat

ion on

WAS

H FI

T an

d the

impo

rtanc

e of W

ASH

serv

ices a

t nex

t mee

ting o

f com

munit

y wom

en’s g

roup

and p

rovide

feed

back

at

next

WAS

H FI

T me

eting

.



To

ol 1

B

35


1W

ater

* See

asso

ciate

d no

te

Mee

ts ta

rget

Part

ially

mee

ts

targ

et

Does

not

mee

t ta

rget

Does

indi

cato

r mee

t the

targ

et?

Mar

k /

/ No

tes

(use

addi

tiona

l pag

es if

nec

essa

ry)

Asse

ssm

ent n

umbe

r: __

__

ESSE

NTI

AL

IND

ICAT

ORS

1.1*

Impr

oved

wat

er su

pply

pip

ed in

to

the f

acili

ty or

on p

rem

ises a

nd

avai

labl

e

Yes,

impr

oved

w

ater

supp

ly

with

in fa

cility

and

avai

labl

e

Impr

oved

wat

er

supp

ly on

pre

mise

s, (o

utsid

e of f

acili

ty

build

ing)

and

avai

labl

e

No im

prov

ed w

ater

so

urce

with

in

facil

ity g

roun

ds, o

r im

prov

ed su

pply

in

pla

ce b

ut n

ot

avai

labl

e

1.2*

Wat

er se

rvice

s ava

ilabl

e at a

ll tim

es an

d of

su�

cient

qua

ntity

fo

r all

uses

Yes,

ever

y day

an

d of

su�

cient

qu

antit

y

Mor

e tha

n �v

e da

ys p

er w

eek o

r ev

ery d

ay b

ut n

ot

su�

cient

qua

ntity

Fewe

r tha

n �v

e day

s pe

r wee

k

1.3*

A re

liabl

e drin

king

-wat

er st

atio

n is

pres

ent a

nd ac

cess

ible

for s

ta�,

pa

tient

s and

care

rs at

all t

imes

an

d in

all l

ocat

ions

/war

ds

Yes,

at al

l tim

es/

war

ds an

d ac

cess

ible

to al

l

Som

etim

es, o

r onl

y in

som

e pla

ces o

r no

t ava

ilabl

e for

all

user

s

Not a

vaila

ble

1.4*

Drin

king

-wat

er is

safe

ly st

ored

in

a cle

an b

ucke

t/tan

k with

cove

r an

d ta

p

Yes

All a

vaila

ble

drin

king

-wat

er

poin

ts ar

e saf

ely

stor

ed

Not s

afel

y sto

red

in

any w

ater

poi

nts o

r no

drin

king

-wat

er

avai

labl

e

AD

VAN

CED

IND

ICAT

ORS

1.5Sa

nitar

y ins

pecti

on ris

k sco

re (u

sing

sanit

ary i

nspe

ction

form

3)Lo

w ris

kM

edium

risk

High

or ve

ry hi

gh ris

k

Tool

2A

: Ind

icat

ors

asse

ssm

ent

Date

of as

sess

men

t: . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

Mem

bers

of te

am co

nduc

ting

asse

ssm

ent:

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .. .

. . . .

. . . .

. . . .

. . . .

. . . .

. .

Note

s: . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

.. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . ..

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

. . . .

. . . .

. . . .

. . . .

. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .. .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. .. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .. .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. .. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

To

ol 2

A

36



1W

ater

* See

asso

ciate

d no

te

Mee

ts ta

rget

Part

ially

mee

ts

targ

et

Does

not

mee

t ta

rget

Does

indi

cato

r mee

t the

targ

et?

Mar

k /

/ No

tes

(use

addi

tiona

l pag

es if

nec

essa

ry)

Asse

ssm

ent n

umbe

r: __

__

1.6Al

l end

point

s (i.e

. tap

s) ar

e con

necte

d to

an av

ailab

le an

d fun

ction

ing w

ater

su

pply

Yes,

all ar

e con

necte

d an

d fun

ction

ingM

ore t

han h

alf of

all

endp

oints

are

conn

ecte

d and

fu

nctio

ning

No, le

ss th

an ha

lf of a

ll en

dpoin

ts co

nnec

ted

and f

uncti

oning

1.7W

ater

serv

ices a

vaila

ble th

roug

hout

th

e yea

r (i.e

. not

a�ec

ted b

y se

ason

ality,

clim

ate c

hang

e-re

lated

ex

trem

e eve

nts o

r oth

er co

nstra

ints)

Yes,

thro

ugho

ut th

e ye

arW

ater

shor

tage

s for

on

e to t

wo m

onth

sW

ater

shor

tage

s for

th

ree m

onth

s or m

ore

1.8*

Wat

er st

orag

e is s

u�cie

nt to

mee

t the

ne

eds o

f the

facil

ity fo

r two

days

Yes

Mor

e tha

n 75%

of

need

s met

Less

than

75%

of

need

s met

1.9*

Wat

er is

trea

ted a

nd co

llecte

d for

dr

inking

with

a pr

oven

tech

nolog

y th

at m

eets

WHO

perfo

rman

ce

stand

ards

Yes

Treat

ed bu

t not

re

gular

ly No

t tre

ated

1.10*

Drink

ing-w

ater

has a

ppro

priat

e ch

lorine

resid

ual (

0.2m

g/L o

r 0.5m

g/L

in em

erge

ncies

) or 0

E. co

li/10

0 ml

and i

s not

turb

id

Yes

Chlor

ine re

sidua

l ex

ists,

but i

s <0.2

mg/

L No

t tre

ated

/do n

ot

know

resid

ual/d

o not

ha

ve ca

pacit

y to t

est

resid

ual/n

o drin

king-

wate

r ava

ilable

1.11*

The f

acilit

y wat

er su

pply

is re

gulat

ed

acco

rding

to na

tiona

l wat

er qu

ality

sta

ndar

ds (m

ark n

ot ap

plica

ble if

no

stand

ards

exist

)

Yes,

and w

ater

mee

ts na

tiona

l sta

ndar

dsYe

s, re

gulat

ed bu

t wa

ter d

oes n

ot m

eet

stand

ards

No re

gulat

ion or

te

sting

take

s plac

e or

no st

anda

rds e

xist

1.12

Ener

gy is

avail

able

for h

eatin

g wat

er

(mar

k if n

ot ap

plica

ble)

Yes,

alway

sYe

s, so

met

imes

Neve

r

Tool

2A

: Ind

icat

ors

asse

ssm

ent

To

ol 2

A

37


To

ol 2

A

1W

ater

* See

asso

ciate

d no

te

Mee

ts ta

rget

Part

ially

mee

ts

targ

et

Does

not

mee

t ta

rget

Does

indi

cato

r mee

t the

targ

et?

Mar

k /

/ No

tes

(use

addi

tiona

l pag

es if

nec

essa

ry)

Asse

ssm

ent n

umbe

r: __

__

1.13

Ener

gy is

avail

able

for p

umpin

g wat

er

(mar

k if n

ot ap

plica

ble)

Yes,

alway

sYe

s, so

met

imes

Neve

r

1.14*

At le

ast o

ne sh

ower

or ba

thing

area

is

avail

able

per 4

0 pat

ients

in inp

atien

t se

tting

s and

is fu

nctio

ning a

nd

acce

ssible

Yes

Show

ers a

vaila

ble, b

ut

no w

ater

or in

disre

pair

or sh

ower

s ava

ilable

bu

t few

er th

an on

e pe

r 40

No sh

ower

s

1.15

Show

er(s)

are a

dequ

ately

lit,

includ

ing at

nigh

tYe

sLig

hting

infra

struc

ture

ex

ists,

but n

ot

func

tionin

g

Not a

dequ

ately

lit

or no

light

ing

infra

struc

ture

Perc

enta

ge of

indi

cato

rs m

eetin

g ta

rget

s for

WAT

ER

Perc

enta

ge of

indi

cato

rs p

artia

lly m

eetin

g ta

rget

s for

WAT

ER

Perc

enta

ge of

indi

cato

rs n

ot m

eetin

g ta

rget

s for

WAT

ER

Tool

2A

: Ind

icat

ors

asse

ssm

ent

38



* Not

es: W

ater

The i

ndica

tors

in b

old

are “

esse

ntia

l” an

d sho

uld be

com

plete

d by a

ll fac

ilities

using

WAS

H FIT

. Oth

er in

dicat

ors a

re co

nside

red o

ption

al an

d can

be in

clude

d if t

he fa

cility

has t

he ca

pacit

y to a

ssess

them

.

1.1

Impr

oved

wat

er so

urce

s in

heal

th ca

re se

ttin

gs in

clude

pip

ed w

ater

, bor

ehol

es/tu

be w

ells,

pro

tect

ed w

ells,

pro

tect

ed sp

rings

, rai

nwat

er an

d pa

ckag

ed or

del

ivere

d w

ater

. Th

is re

fers

to th

e wat

er su

pply

for g

ener

al p

urpo

ses,

inclu

ding

drin

king

, was

hing

and

clean

ing.

1.2

For a

n in

term

itten

t pip

ed-w

ater

supp

ly, e.

g. av

aila

ble e

ight

hou

rs p

er d

ay.

Wat

er n

eeds

will

vary

dep

endi

ng on

the t

ype o

f fac

ility

and

num

ber o

f pat

ient

s. To

calcu

late

the f

acili

ty’s w

ater

requ

irem

ents

, add

up

the f

ollo

win

g re

quire

men

ts or

appl

icabl

e nat

iona

l sta

ndar

ds:

Outp

atie

nts (

5 L/co

nsul

tatio

n) +

inpa

tient

s (40

–60 L

/pat

ient

/day

) + op

erat

ing

thea

tre or

mat

erni

ty u

nit (

100 L

/inte

rven

tion)

+ d

ry or

supp

lem

enta

ry fe

edin

g ce

ntre

(0.5

–5 L/

cons

ulta

tion

depe

ndin

g on

wai

ting

time)

+ ch

oler

a tre

atm

ent c

entre

(60 L

/pat

ient

/day

). So

urce

: Ess

entia

l env

ironm

enta

l sta

ndar

ds in

hea

lth ca

re (W

HO, 2

008)

.1.

3Ac

cess

ible

mea

ns w

ith ra

iling

s, a s

eat a

nd w

ater

acce

ss.

1.4

For m

ore i

nfor

mat

ion

on sa

fe st

orag

e, se

e: h

ttp:

//ww

w.w

ho.in

t/wat

er_s

anita

tion_

heal

th/p

ublic

atio

ns/to

olki

t_m

onito

ring_

eval

uatin

g/en

/1.8

See 1

.2 fo

r wat

er st

orag

e nee

ds. T

o calc

ulate

the f

acilit

y’s w

ater

stor

age r

equir

emen

ts, ad

d up t

he fo

llowi

ng re

quire

men

ts ne

eded

for 2

4 hou

rs or

appli

cable

natio

nal s

tand

ards

and m

ultipl

y by t

wo to

get t

he to

tal fo

r 48 h

ours:

Outp

atien

ts (5

L/co

nsult

ation

) + in

patie

nts (

40–6

0 L/p

atien

t/day

) + op

erat

ing th

eatre

or m

ater

nity u

nit (1

00 L/

inter

vent

ion) +

dry o

r sup

plem

enta

ry fe

eding

cent

re (0

.5–5 L

/cons

ultat

ion de

pend

ing on

wait

ing ti

me)

+

chole

ra tr

eatm

ent c

entre

(60 L

/pat

ient/d

ay).

Sour

ce: E

ssent

ial en

viron

men

tal s

tand

ards

in he

alth c

are (

WHO

, 200

8).

Acce

ptab

le sto

rage

met

hods

inclu

de: c

lean,

cove

red a

nd w

ell-m

ainta

ined c

onta

iners

which

prev

ent c

onta

mina

tion f

rom

ente

ring a

nd ar

e fre

e fro

m an

y cra

cks,

leaks

, etc.

Such

cont

ainer

s sho

uld al

so al

low fo

r wat

er to

be

extra

cted w

ithou

t han

ds or

othe

r pot

entia

lly co

ntam

inate

d sur

faces

from

touc

hing t

he w

ater

(i.e.

thro

ugh u

se of

a ta

p).

1.9Su

ch te

chno

logies

shou

ld m

eet o

ne of

WHO

’s hou

seho

ld wa

ter t

reat

men

t and

safe

stora

ge (H

WTS

) per

form

ance

cate

gorie

s and

gene

rally

invo

lve �l

ters,

boilin

g, so

lar, c

hlor

ine (f

or no

n-tu

rbid

wate

r) or

coag

ulatio

n/�o

ccula

tion.

Hi

gher

perfo

rming

tech

nolog

ies (i

.e. tw

o or t

hree

star

s inc

luding

mem

bran

e �lte

rs, U

V and

coag

ulant

s/�oc

culan

ts) ar

e rec

omm

ende

d for

vuln

erab

le gr

oups

(i.e.

thos

e with

HIV

or yo

ung i

nfan

ts) an

d whe

re th

e spe

ci�c

path

ogen

of co

ncer

n is n

ot kn

own.

A lis

t can

be fo

und h

ere:

http

://ww

w.wh

o.int

/wat

er_s

anita

tion_

healt

h/wa

ter-q

ualit

y/ho

useh

old/li

st-of

-pro

ducts

/en/

and f

urth

er in

form

ation

foun

d at t

he W

HO ho

useh

old w

ater

trea

tmen

t sit

e: ht

tp://

www.

who.i

nt/w

ater

_san

itatio

n_he

alth/

wate

r-qua

lity/

hous

ehold

/en/

Drin

king-

wate

r mee

ts W

HO Gu

idelin

es fo

r drin

king-

water

quali

ty (2

017)

or na

tiona

l sta

ndar

ds: h

ttp://

www.

who.i

nt/w

ater

_san

itatio

n_he

alth/

publi

catio

ns/d

rinkin

g-wa

ter-q

ualit

y-gu

idelin

es-4

-inclu

ding-

1st-a

dden

dum

/en/

1.10

Evide

nce o

f doc

umen

ted c

hlor

ine re

sidua

ls sh

ould

be av

ailab

le fro

m pr

eviou

s tes

ting.

1.11

Drink

ing w

ater

mee

ts W

HO Gu

idelin

es fo

r drin

king-

water

quali

ty (2

017)

or na

tiona

l sta

ndar

ds: h

ttp://

www.

who.i

nt/w

ater

_san

itatio

n_he

alth/

publi

catio

ns/d

rinkin

g-wa

ter-q

ualit

y-gu

idelin

es-4

-inclu

ding-

1st-a

dden

dum

/en/

1.14

Glob

al gu

idelin

es on

the p

reven

tion o

f sur

gical

site i

nfec

tion (

WHO

, 201

6b):

http

://ww

w.wh

o.int

/gps

c/ssi-

guide

lines

/en/

To

ol 2

A

http://www.who.int/water_sanitation_health/publications/toolkit_monitoring_evaluating/en/


http://www.who.int/water_sanitation_health/water-quality/household/en/

http://www.who.int/water_sanitation_health/publications/drinking-water-quality-guidelines-4-including-1st-addendum/en/



http://www.who.int/gpsc/ssi-guidelines/en/

39


2Sa

nita

tion

and

heal

th ca

re

was

te* S

ee as

socia

ted

note

Mee

ts ta

rget

Part

ially

mee

ts

targ

et

Does

not

mee

t ta

rget

Does

indi

cato

r mee

t the

targ

et?

Mar

k /

/ No

tes

(use

addi

tiona

l pag

es if

nec

essa

ry)

Asse

ssm

ent n

umbe

r: __

__

Part

A: S

anit

atio

nES

SEN

TIA

L IN

DIC

ATO

RS

2.1*

Num

ber o

f ava

ilabl

e and

us

able

toile

ts or

impr

oved

la

trin

es fo

r pat

ient

s

Four

or m

ore

(out

patie

nts)

and

one p

er 20

user

s (in

patie

nts)

Su�

cient

num

ber

pres

ent b

ut no

t all

func

tionin

g or

insu�

cient

num

ber

Less

than

50%

of

requ

ired n

umbe

r of

latrin

es av

ailab

le an

d fu

nctio

ning

2.2

Toile

ts or

impr

oved

latr

ines

cle

arly

sepa

rate

d fo

r sta

� an

d pa

tient

s

Yes

Sepa

rate

latri

nes a

re

avail

able

but n

ot

clear

ly se

para

ted

No se

para

te la

trine

s

2.3

Toile

ts or

impr

oved

latr

ines

cle

arly

sepa

rate

d fo

r mal

e and

fe

mal

e

Yes

Latri

nes a

re

sepa

rate

d for

male

an

d fem

ale, b

ut no

t cle

arly

sepa

rate

d

No se

para

te la

trine

s

2.4*

At le

ast o

ne to

ilet o

r im

prov

ed

latr

ine p

rovi

des t

he m

eans

to

man

age m

enst

rual

hyg

iene

ne

eds

Yes

Yes,

but t

oilet

is no

t cle

an or

in di

srepa

ir No

Tool

2A

: Ind

icat

ors

asse

ssm

ent

Date

of as

sess

men

t: . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

Mem

bers

of te

am co

nduc

ting

asse

ssm

ent:

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .. .

. . . .

. . . .

. . . .

. . . .

. . . .

. .

Note

s: . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

.. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . ..

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

. . . .

. . . .

. . . .

. . . .

. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

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. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .. .

. . . .

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. . . .

. . . .

. . . .

. . .

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. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. .. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

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. . . .

. . . .

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. . . .

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. . . .

. . . .

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. . . .

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. . . .

. . . .

. . .. .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. .. . .

. . . .

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. . . .

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. . . .

. . . .

. . . .

. . . .

To

ol 2

A

222Sa

nita

tion

and

heal

th ca

re

* See

asso

ciate

d no

te* S

ee as

socia

ted

note

40



2Sa

nita

tion

and

heal

th ca

re

was

te* S

ee as

socia

ted

note

Mee

ts ta

rget

Part

ially

mee

ts

targ

et

Does

not

mee

t ta

rget

Does

indi

cato

r mee

t the

targ

et?

Mar

k /

/ No

tes

(use

addi

tiona

l pag

es if

nec

essa

ry)

Asse

ssm

ent n

umbe

r: __

__

2.5*

At le

ast o

ne to

ilet m

eets

the

need

s of p

eopl

e with

redu

ced

mob

ility

Yes

Yes,

but n

ot

avail

able

or in

dis

repa

ir

No to

ilets

for

disab

led us

ers

2.6*

Func

tioni

ng h

and

hygi

ene

stat

ions

with

in 5

m of

latr

ines

Yes

Pres

ent,

not

func

tionin

g or n

o wa

ter o

r soa

p

Not p

rese

nt

AD

VAN

CED

IND

ICAT

ORS

2.7*

Reco

rd of

clea

ning t

oilet

s visi

ble

and s

igned

by th

e clea

ners

each

da

y

Yes

Toile

ts cle

aned

but

not r

ecor

ded

No re

cord

/toile

ts cle

aned

less

than

on

ce a

day

2.8*

Was

tewa

ter is

safel

y man

aged

th

roug

h use

of on

-site

trea

tmen

t (i.

e. se

ptic

tank

follo

wed b

y dr

ainag

e pit)

or se

nt to

a fu

nctio

ning s

ewer

syste

m

Yes

Pres

ent b

ut no

t fu

nctio

ning

Not p

rese

nt

2.9*

Grey

wate

r (i.e

. rain

wate

r or

wash

wate

r) dr

ainag

e sys

tem

is in

pla

ce th

at di

verts

wat

er aw

ay fr

om

the f

acilit

y (i.e

. no s

tand

ing w

ater

) an

d also

prot

ects

near

by ho

useh

olds

Yes

Yes,

but n

ot

func

tionin

g and

ob

vious

pools

of

wate

r

Not p

rese

nt

2.10*

Latri

nes a

re ad

equa

tely

lit,

includ

ing at

nigh

tYe

sLig

hting

inf

rastr

uctu

re ex

ists,

but n

ot fu

nctio

ning

Not a

dequ

ately

lit

or no

light

ing

infra

struc

ture

Tool

2A

: Ind

icat

ors

asse

ssm

ent

To

ol 2

A

222Sa

nita

tion

and

heal

th ca

re

* See

asso

ciate

d no

te* S

ee as

socia

ted

note

41

2Sa

nita

tion

and

heal

th ca

re

was

te* S

ee as

socia

ted

note

Mee

ts ta

rget

Part

ially

mee

ts

targ

et

Does

not

mee

t ta

rget

Does

indi

cato

r mee

t the

targ

et?

Mar

k /

/ No

tes

(use

addi

tiona

l pag

es if

nec

essa

ry)

Asse

ssm

ent n

umbe

r: __

__

Part

B: H

ealt

h ca

re w

aste

ESSE

NTI

AL

IND

ICAT

ORS

2.11

A tr

aine

d pe

rson

is re

spon

sible

fo

r the

man

agem

ent o

f hea

lth

care

was

te in

the h

ealth

care

fa

cility

Yes,

pres

ente

d and

ad

equa

tely

traine

dAp

point

ed bu

t not

tra

ined

Not a

ppoin

ted

2.12

*Fu

nctio

nal w

aste

colle

ctio

n co

ntai

ners

in cl

ose p

roxi

mity

to

all w

aste

gen

erat

ion

poin

ts fo

r:• n

on-in

fect

ious

(gen

eral

) was

te• i

nfec

tious

was

te• s

harp

s was

te

Yes

Sepa

rate

bins

pres

ent

but l

ids m

issing

or

mor

e tha

n thr

ee

quar

ters

full;

only

two

bins (

inste

ad of

thre

e);

or at

som

e but

not a

ll wa

ste ge

nera

tion

point

s

No bi

ns or

sepa

rate

sh

arps

disp

osal

2.13

Was

te co

rrect

ly se

greg

ated

at

all w

aste

gen

erat

ion

poin

tsYe

s So

me s

ortin

g but

not

all co

rrectl

y or n

ot

prac

tised

thro

ugho

ut

the f

acilit

y

No so

rting

2.14

Func

tiona

l bur

ial p

it/fe

nced

w

aste

dum

p or

mun

icipa

l pi

ck-u

p av

aila

ble f

or d

ispos

al

of n

on-in

fect

ious

(non

-ha

zard

ous/

gene

ral w

aste

)

Yes

Pit in

facil

ity bu

t ins

u�cie

nt di

men

sions

; ov

er�ll

ed or

not f

ence

d an

d loc

ked;

irreg

ular

mun

icipa

l was

te pic

k up

, etc.

No pi

t or o

ther

dis

posa

l met

hod

used

2.15

*In

ciner

ator

or al

tern

ative

tre

atm

ent t

echn

olog

y for

the

treat

men

t of i

nfec

tious

and

shar

p w

aste

is fu

nctio

nal a

nd

of a

su�

cient

capa

city

Yes

Pres

ent b

ut no

t fu

nctio

nal a

nd/o

r of a

su

�cie

nt ca

pacit

y

None

pres

ent

Tool

2A

: Ind

icat

ors

asse

ssm

ent


To

ol 2

A

222Sa

nita

tion

and

heal

th ca

re

* See

asso

ciate

d no

te* S

ee as

socia

ted

note

42

2Sa

nita

tion

and

heal

th ca

re

was

te* S

ee as

socia

ted

note

Mee

ts ta

rget

Part

ially

mee

ts

targ

et

Does

not

mee

t ta

rget

Does

indi

cato

r mee

t the

targ

et?

Mar

k /

/ No

tes

(use

addi

tiona

l pag

es if

nec

essa

ry)

Asse

ssm

ent n

umbe

r: __

__

2.16

Su�

cient

ener

gy av

aila

ble

for i

ncin

erat

ion

or al

tern

ative

tre

atm

ent t

echn

olog

ies (

mar

k if

not a

pplic

able

)

Yes,

alway

sYe

s, so

met

imes

Neve

r

AD

VAN

CED

IND

ICAT

ORS

2.17

Haza

rdou

s and

non-

haza

rdou

s wa

ste ar

e sto

red s

epar

ately

befo

re

being

trea

ted/

dispo

sed o

f or m

oved

o�

site

Yes,

sepa

rate

d sto

rage

ar

eas a

vaila

bleSe

para

ted s

tora

ge

area

s are

avail

able

but w

ith in

su�

cient

ca

pacit

y or o

ver�

lled

No se

para

ted s

tora

ge

area

s ava

ilable

2.18*

All in

fectio

us w

aste

is st

ored

in a

prot

ecte

d are

a befo

re tr

eatm

ent,

for n

o lon

ger t

han t

he de

fault

and

safe

time

Yes

Treat

ed be

twee

n 24

–48 h

ours

Treat

ed af

ter 4

8 hou

rs or

not t

reat

ed at

all

2.19*

Anat

omica

l/pat

holog

ical w

aste

is

put i

n a de

dicat

ed pa

tholo

gical

waste

/plac

enta

pit,

burn

t in a

cre

mat

ory o

r bur

ied in

a ce

met

ery

(mar

k if n

ot ap

plica

ble)

Yes

Pit is

pres

ent b

ut no

t us

ed or

func

tiona

l or

over

�lled

or no

t fen

ced

and l

ocke

d

None

pres

ent

2.20*

Dedic

ated

ash p

its av

ailab

le fo

r dis

posa

l of in

ciner

ation

ash (

mar

k if

not a

pplic

able)

Yes

Pres

ent b

ut no

t fu

nctio

nal o

r ove

r�lle

d or

not f

ence

d and

loc

ked

None

pres

ent

2.21

Prot

ocol

or st

anda

rd op

erat

ing

proc

edur

e (SO

P) fo

r safe

m

anag

emen

t of h

ealth

care

was

te

clear

ly vis

ible a

nd le

gible

Yes,

visibl

e and

im

plem

ente

dW

ritte

n but

not v

isible

or

imple

men

ted

No pr

otoc

ol/SO

P in

place

Tool

2A

: Ind

icat

ors

asse

ssm

ent



To

ol 2

A

222Sa

nita

tion

and

heal

th ca

re

* See

asso

ciate

d no

te* S

ee as

socia

ted

note

43

2Sa

nita

tion

and

heal

th ca

re

was

te* S

ee as

socia

ted

note

Mee

ts ta

rget

Part

ially

mee

ts

targ

et

Does

not

mee

t ta

rget

Does

indi

cato

r mee

t the

targ

et?

Mar

k /

/ No

tes

(use

addi

tiona

l pag

es if

nec

essa

ry)

Asse

ssm

ent n

umbe

r: __

__

2.22*

Appr

opria

te pr

otec

tive e

quipm

ent

for a

ll sta

� in

char

ge of

was

te

treat

men

t and

disp

osal

Yes

Som

e equ

ipmen

t av

ailab

le, bu

t no

t for

all s

ta�,

or

avail

able

but

dam

aged

None

avail

able

Perc

enta

ge of

indi

cato

rs m

eetin

g ta

rget

s for

SA

NITA

TION

AND

HEA

LTH

CARE

WAS

TE

Perc

enta

ge of

indi

cato

rs p

artia

lly m

eetin

g ta

rget

s for

SA

NITA

TION

AND

HEA

LTH

CARE

WAS

TE

Perc

enta

ge of

indi

cato

rs n

ot m

eetin

g ta

rget

s for

SA

NITA

TION

AND

HEA

LTH

CARE

WAS

TE

Tool

2A

: Ind

icat

ors

asse

ssm

ent


To

ol 2

A

222Sa

nita

tion

and

heal

th ca

re

* See

asso

ciate

d no

te* S

ee as

socia

ted

note

44



* Not

es: S

anita

tion

and

heal

th ca

re w

aste

The i

ndica

tors

in b

old

are “

esse

ntia

l” an

d sho

uld be

com

plete

d by a

ll fac

ilities

using

WAS

H FIT

. Oth

er in

dicat

ors a

re co

nside

red o

ption

al an

d can

be in

clude

d if t

he fa

cility

has t

he ca

pacit

y to a

ssess

them

.

2.1

At le

ast f

our t

oile

ts p

er ou

tpat

ient

sett

ing

(one

for s

ta�;

one f

or fe

mal

e pat

ient

s; on

e for

mal

e pat

ient

s; on

e for

disa

bled

use

rs).

Mor

e lat

rines

may

be n

eede

d de

pend

ing

on th

e size

of th

e fac

ility

. Im

prov

ed sa

nita

tion

facil

ities

inclu

de �

ush

toile

ts in

to m

anag

ed se

wer o

r sep

tic ta

nk an

d so

akaw

ay p

it, VI

P la

trin

es, p

it la

trin

es w

ith sl

ab an

d co

mpo

stin

g to

ilets

.To

be c

onsid

ered

usa

ble,

a to

ilet/l

atrin

e sho

uld

have

a do

or w

hich

is u

nloc

ked

whe

n no

t in

use (

or fo

r whi

ch a

key i

s ava

ilabl

e at a

ny ti

me)

and

can

be lo

cked

from

the i

nsid

e dur

ing

use,

ther

e sho

uld

be n

o maj

or h

oles

in th

e str

uctu

re, t

he h

ole o

r pit

shou

ld n

ot b

e blo

cked

, wat

er sh

ould

be a

vaila

ble f

or �

ush/

pour

�us

h to

ilets

and

ther

e sho

uld

be n

o cra

cks,

or le

aks i

n th

e toi

let s

truc

ture

. It s

houl

d be

with

in th

e gro

unds

of th

e fac

ility

and

it sh

ould

be c

lean

as n

oted

by ab

senc

e of w

aste

, visi

ble d

irt an

d ex

cret

a and

inse

cts.

2.4

Toile

ts sh

ould

hav

e a b

in fo

r disp

osal

of w

aste

or an

area

for w

ashi

ng, w

ith w

ater

avai

labl

e.2.

5A

toile

t can

be c

onsid

ered

to m

eet t

he n

eeds

of p

eopl

e with

redu

ced

mob

ility

if it

mee

ts th

e fol

low

ing

cond

ition

s: ca

n be

acce

ssed

with

out s

tairs

or st

eps,

hand

rails

for s

uppo

rt ar

e att

ache

d ei

ther

to

the �

oor o

r sid

ewal

ls, th

e doo

r is a

t lea

st 80

cm w

ide,

the t

oile

t has

a ra

ised

seat

(bet

ween

40–4

8 cm

from

the �

oor),

a ba

ckre

st an

d th

e cub

icle h

as sp

ace f

or ci

rcul

atio

n/m

anoe

uvrin

g (1

50 x

150

cm).

The s

ink,

tap

and

wat

er ou

tsid

e sho

uld

also

be a

cces

sible

and

the t

op of

the s

ink 7

5 cm

from

the �

oor (

with

knee

clea

ranc

e). S

witc

hes f

or li

ghts

, whe

re re

leva

nt, s

houl

d al

so b

e at a

n ac

cess

ible

he

ight

(max

. 120

cm).

All s

peci�

catio

ns ar

e bas

ed on

ISO

2154

2:20

11 (B

uild

ing

cons

truc

tion

– Ac

cess

ibili

ty an

d us

abili

ty of

the b

uilt

envi

ronm

ent)

avai

labl

e at:

http

://w

ww.

iso.o

rg/is

o/ho

me/

stor

e/ca

talo

gue_

tc/c

atal

ogue

_det

ail.h

tm?c

snum

ber=

5049

8 2.

6A

func

tiona

l han

d hy

gien

e sta

tion

may

cons

ist of

soap

and

wat

er w

ith a

basin

/pan

for w

ashi

ng h

ands

. Wat

er sh

ould

not

be c

hlor

inat

ed. A

lcoho

l-bas

ed h

andr

ub is

not

suita

ble f

or u

se at

latr

ines

. 2.7

For l

ow lit

erac

y or il

liter

ate c

leane

rs, th

is sh

ould

be ad

apte

d and

sim

pli�e

d acco

rding

ly wi

th re

cogn

izable

pictu

res a

nd ill

ustra

tions

.2.8

, 2.9

No le

akag

e fro

m pi

pes n

or so

akaw

ay pi

t and

soak

away

mor

e tha

n 30 m

from

wat

er so

urce

, with

grea

se tr

ap an

d no v

isible

pool

of st

agna

nt w

ater.

2.10

Light

ing fo

r lat

rines

is ne

cessa

ry in

all fa

ciliti

es w

here

nigh

t-tim

e ser

vices

are p

rovid

ed an

d whe

re th

ere i

s not

su�

cient

natu

ral li

ght t

o safe

ly us

e the

latri

ne du

ring t

he da

y.2.

12Fu

nctio

nal m

eans

cont

aine

rs sh

ould

not

be m

ore t

han

thre

e-qu

arte

rs fu

ll, b

e lea

k-pr

oof w

ith a

lid an

d cle

arly

labe

lled

(i.e.

easil

y dist

ingu

ishab

le ac

cord

ing

to a

colo

ur, l

abel

or sy

mbo

l).

2.15

Incin

erat

or (i

f des

igne

d fo

r inf

ectio

us w

aste

and

not j

ust g

ener

al w

aste

) mus

t fol

low

spec

i�c d

esig

n re

quire

men

ts (e

.g. u

se of

�re

bric

ks/re

fract

ory b

ricks

and

mor

tar (

vs. c

omm

on b

uild

ing

brick

s) th

at ca

n w

ithst

and

the t

empe

ratu

res n

eede

d fo

r the

se in

ciner

ator

s (gr

eate

r tha

n 80

0°C)

. For

com

plet

e bur

ning

, a d

ual c

ham

ber i

ncin

erat

or is

nee

ded

that

reac

hes t

empe

ratu

res a

bove

800°

C and

11

00°C

, res

pect

ivel

y. In

case

dua

l inc

iner

ator

s are

not

avai

labl

e and

ther

e is a

n im

med

iate

nee

d fo

r pub

lic h

ealth

pro

tect

ion,

smal

l-sca

le in

ciner

ator

s mig

ht b

e use

d. Th

is in

volv

es a

com

prom

ise

betw

een

the e

nviro

nmen

tal i

mpa

cts f

rom

cont

rolle

d co

mbu

stio

n w

ith an

over

ridin

g ne

ed to

pro

tect

pub

lic h

ealth

if th

e onl

y alte

rnat

ive is

indi

scrim

inat

e dum

ping

. The

se ci

rcum

stan

ces e

xist

in

man

y dev

elop

ing

situa

tions

and

smal

l-sca

le in

ciner

atio

n ca

n be

a re

alist

ic re

spon

se to

an im

med

iate

requ

irem

ent.

For g

uide

lines

, see

Safe

man

agem

ent o

f was

tes f

rom

hea

lth-c

are a

ctiv

ities

(WHO

, 20

14).

Was

te m

ay b

e tre

ated

o� si

te. I

f so,

ther

e sho

uld

be a

mea

ns to

con�

rm it

is tr

eate

d sa

fely

once

rem

oved

from

the f

acili

ty p

rem

ises.

2.18

Unles

s a re

frige

rate

d sto

rage

room

is av

ailab

le, st

orag

e tim

es fo

r infec

tious

was

te (e

.g. th

e tim

e bet

ween

gene

ratio

n and

trea

tmen

t) sh

ould

not e

xcee

d the

follo

wing

perio

ds:

• Te

mpe

rate

clim

ate:

72 ho

urs i

n wint

er /

48 ho

urs i

n sum

mer.

• W

arm

clim

ate:

48 ho

urs d

uring

the c

ool s

easo

n / 24

hour

s dur

ing th

e hot

seas

on.

Fenc

ed ar

ea pr

otec

ted f

rom

�ood

ing pl

us lin

ed an

d cov

ered

pit >

30 m

from

wat

er so

urce

plus

no un

prot

ecte

d hea

lth ca

re w

aste

is ob

serv

ed. If

was

te re

mov

ed o�

site

, bot

h the

site

and t

he ho

lding

area

(minu

s the

pit)

shou

ld co

mply

with

the a

bove

requ

irem

ents.

2.19

Place

nta p

its: li

ned o

r unl

ined d

epen

ding o

n the

geolo

gy, w

ith sl

ab, w

ith ve

ntila

tion p

ipe.

2.20

Ash p

its: li

ned o

r unl

ined d

epen

ding o

n the

geolo

gy bu

t mus

t pre

vent

leac

hing t

o the

envir

onm

ent,

with

slab

, bot

tom

of pi

t at l

east

1.5 m

away

from

grou

ndwa

ter t

able.

If wa

ter g

ets i

nto t

he as

h pit,

it ca

n lea

ch po

lluta

nts

into t

he so

il.2.2

2Pr

otec

tive e

quipm

ent f

or pe

ople

hand

ling w

aste

man

agem

ent i

nclud

es: g

loves

, apr

on, t

ough

rubb

er bo

ots.

To

ol 2

A

http://www.iso.org/iso/home/store/catalogue_tc/catalogue_detail.htm?csnumber=50498

http://www.iso.org/iso/home/store/catalogue_tc/catalogue_detail.htm?csnumber=50498

45


3Hy

gien

e* S

ee as

socia

ted

note

Mee

ts ta

rget

Part

ially

mee

ts

targ

et

Does

not

mee

t ta

rget

Does

indi

cato

r mee

t the

targ

et?

Mar

k /

/ No

tes

(use

addi

tiona

l pag

es if

nec

essa

ry)

Asse

ssm

ent n

umbe

r: __

__

Part

A: H

and

hygi

ene

ESSE

NTI

AL

IND

ICAT

ORS

3.1*

Func

tioni

ng h

and

hygi

ene

stat

ions

are a

vaila

ble a

t all

poin

ts of

care

Yes

Stat

ions p

rese

nt,

but n

o wat

er an

d/or

soap

or al

coho

l ha

ndru

b solu

tion

Not p

rese

nt

3.2*

Ha

nd h

ygie

ne p

rom

otio

n m

ater

ials

clear

ly vi

sible

and

unde

rsta

ndab

le at

key p

lace

s

Yes

Som

e plac

es bu

t no

t all

None

AD

VAN

CED

IND

ICAT

ORS

3.3*

Func

tionin

g han

d hyg

iene s

tatio

ns

are a

vaila

ble in

serv

ice ar

eas

Yes

Stat

ions p

rese

nt,

but n

o wat

er an

d/or

soap

or al

coho

l ha

ndru

b solu

tion

Not p

rese

nt

3.4*

Func

tionin

g han

d hyg

iene s

tatio

ns

avail

able

in wa

ste di

spos

al ar

eaYe

sSt

ation

s pre

sent

, bu

t no w

ater

and/

or so

ap

Not p

rese

nt

3.5Ha

nd hy

giene

com

plian

ce ac

tiviti

es

are u

nder

take

n reg

ularly

Yes

Com

plian

ce

activ

ities

in po

licy,

but n

ot ca

rried

out

with

any r

egula

rity

No co

mpli

ance

ac

tiviti

es

Tool

2A

: Ind

icat

ors

asse

ssm

ent

Date

of as

sess

men

t: . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

Mem

bers

of te

am co

nduc

ting

asse

ssm

ent:

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .. .

. . . .

. . . .

. . . .

. . . .

. . . .

. .

Note

s: . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

.. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . ..

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

. . . .

. . . .

. . . .

. . . .

. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .. .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. .. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .. .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. .. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

To

ol 2

A

* See

asso

ciate

d no

te3

46



3Hy

gien

e* S

ee as

socia

ted

note

Mee

ts ta

rget

Part

ially

mee

ts

targ

et

Does

not

mee

t ta

rget

Does

indi

cato

r mee

t the

targ

et?

Mar

k /

/ No

tes

(use

addi

tiona

l pag

es if

nec

essa

ry)

Asse

ssm

ent n

umbe

r: __

__

Part

B: F

acili

ty e

nvir

onm

ent,

clea

nlin

ess

and

disi

nfec

tion

ESSE

NTI

AL

IND

ICAT

ORS

3.6

The e

xter

ior o

f the

facil

ity is

we

ll-fe

nced

, kep

t gen

eral

ly

clean

(fre

e fro

m so

lid w

aste

, st

agna

nt w

ater

, no a

nim

al an

d hu

man

faec

es in

or ar

ound

the

facil

ity p

rem

ises,

etc.)

Yes

Partl

y but

im

prov

emen

ts co

uld be

mad

e/ye

s, so

met

imes

Not k

ept c

lean a

t all

3.7

Gene

ral l

ight

ing

su�

cient

ly

powe

red

and

adeq

uate

to

ensu

re sa

fe p

rovi

sion

of h

ealth

ca

re in

cludi

ng at

nig

ht (m

ark i

f no

t app

licab

le)

Yes,

alway

sYe

s, so

met

imes

Neve

r

3.8*

Fl

oors

and

horiz

onta

l wor

k su

rfac

es ap

pear

clea

nYe

sSo

me �

oors

and

work

surfa

ces

appe

ar cl

ean b

ut

othe

rs do

not

Mos

t and

/or a

ll �oo

rs an

d sur

faces

are

visibl

y dirt

y

3.9

Appr

opria

te an

d we

ll m

aint

aine

d m

ater

ials

for

clean

ing

(i.e.

det

erge

nt, m

ops,

buck

ets,

etc.)

are a

vaila

ble

Yes

Yes,

avail

able

but

not w

ell m

ainta

ined

No m

ater

ials

avail

able

3.10

*At

leas

t two

pai

rs of

hou

seho

ld

clean

ing

glov

es an

d on

e pai

r of

over

alls

or ap

ron

and

boot

s in

a goo

d st

ate,

for e

ach

clean

ing

and

was

te d

ispos

al st

a�

mem

ber

Yes

Avail

able

but i

n po

or co

nditi

onNo

t ava

ilable

Tool

2A

: Ind

icat

ors

asse

ssm

ent

To

ol 2

A

* See

asso

ciate

d no

te3

47


3Hy

gien

e* S

ee as

socia

ted

note

Mee

ts ta

rget

Part

ially

mee

ts

targ

et

Does

not

mee

t ta

rget

Does

indi

cato

r mee

t the

targ

et?

Mar

k /

/ No

tes

(use

addi

tiona

l pag

es if

nec

essa

ry)

Asse

ssm

ent n

umbe

r: __

__

3.11

At le

ast o

ne m

embe

r of s

ta�

can

dem

onst

rate

the c

orre

ct

proc

edur

es fo

r cle

anin

g an

d di

sinfe

ctio

n an

d ap

ply t

hem

as

requ

ired

to m

aint

ain

clean

and

safe

room

s

Yes

Proc

edur

e is k

nown

bu

t not

appli

edPr

oced

ure n

ot kn

own o

r ap

plied

3.12

Beds

hav

e ins

ectic

ide t

reat

ed

nets

to p

rote

ct p

atie

nts f

rom

m

osqu

ito-b

orne

dise

ases

Yes,

on al

l bed

sAv

ailab

le on

som

e bu

t not

all b

eds,

or

avail

able

but w

ith rip

s an

d or h

oles

No be

d net

s ava

ilable

AD

VAN

CED

IND

ICAT

ORS

3.13

A mec

hanis

m ex

ists t

o tra

ck su

pply

of IP

C-re

lated

mat

erial

s (su

ch as

glo

ves a

nd pr

otec

tive e

quipm

ent)

to id

entif

y sto

ck-o

uts

Yes

Mec

hanis

m ex

ists b

ut

is no

t enf

orce

dNo

mec

hanis

m ex

ists

3.14

Reco

rd of

clea

ning v

isible

and

signe

d by t

he cl

eane

rs ea

ch da

yYe

sRe

cord

exist

s, bu

t is

not c

omple

ted d

aily o

r is

outd

ated

No re

cord

of �o

ors a

nd

surfa

ces b

eing c

leane

d

3.15

Laun

dry f

acilit

ies ar

e ava

ilable

to

was

h line

n fro

m pa

tient

beds

be

twee

n eac

h pat

ient

Yes

Facil

ities

exist

, but

are

not w

orkin

g or n

ot

being

used

No fa

ciliti

es an

d/or

no

linen

3.16

The f

acilit

y has

su�

cient

natu

ral

vent

ilatio

n and

whe

re th

e clim

ate

allow

s, lar

ge op

ening

wind

ows,

skyli

ghts

and o

ther

vent

s to

optim

ize na

tura

l ven

tilat

ion

Yes

Som

e ven

tilat

ion bu

t no

t well

main

taine

d or

insu�

cient

to pr

oduc

e na

tura

l ven

tilat

ion

No

3.17

Kitch

en st

ores

and p

repa

red f

ood i

s pr

otec

ted f

rom

�ies

, oth

er in

sects

or

rats

Yes

No

Tool

2A

: Ind

icat

ors

asse

ssm

ent

To

ol 2

A

* See

asso

ciate

d no

te3

48



3Hy

gien

e* S

ee as

socia

ted

note

Mee

ts ta

rget

Part

ially

mee

ts

targ

et

Does

not

mee

t ta

rget

Does

indi

cato

r mee

t the

targ

et?

Mar

k /

/ No

tes

(use

addi

tiona

l pag

es if

nec

essa

ry)

Asse

ssm

ent n

umbe

r: __

__

3.18

Beds

for p

atien

ts sh

ould

be

sepa

rate

d by 2

.5 m

from

the c

entre

of

one b

ed to

the n

ext a

nd ea

ch

bed h

as on

ly on

e pat

ient

Yes,

all be

ds m

eet

this

guida

nce

Som

e but

not

all be

ds �t

this

crite

rion

No be

ds m

eet t

his

crite

rion

Perc

enta

ge of

indi

cato

rs m

eetin

g ta

rget

s for

HYG

IENE

Perc

enta

ge of

indi

cato

rs p

artia

lly m

eetin

g ta

rget

s for

HYG

IENE

Perc

enta

ge of

indi

cato

rs n

ot m

eetin

g ta

rget

s for

HYG

IENE

* Not

es: H

ygie

neTh

e ind

icato

rs in

bol

d ar

e “es

sent

ial”

and s

hould

be co

mple

ted b

y all f

acilit

ies us

ing W

ASH

FIT. O

ther

indic

ator

s are

cons

idere

d opt

ional

and c

an be

inclu

ded i

f the

facil

ity ha

s the

capa

city t

o asse

ss th

em.

3.1

Poin

t of c

are i

s whe

re th

ree e

lem

ents

com

e tog

ethe

r: th

e pat

ient

; the

hea

lth ca

re w

orke

rs; a

nd ca

re or

trea

tmen

t inv

olvi

ng co

ntac

t with

the p

atie

nt or

thei

r sur

roun

ding

s. Th

is m

ay in

clude

co

nsul

tatio

n ro

oms,

oper

atin

g ro

oms,

deliv

ery r

oom

s and

labo

rato

ries.

Hand

hyg

iene

stat

ions

shou

ld h

ave a

sink

or b

ucke

t with

tap

and

wat

er w

ith so

ap or

alco

hol-b

ased

han

drub

. The

re sh

ould

be a

t le

ast t

wo h

and

hygi

ene s

tatio

ns in

a w

ard

with

mor

e tha

n 20

bed

s.Ve

rify t

hat w

ater

is av

aila

ble f

rom

the t

ap.

3.2

Key p

lace

s inc

lude

at p

oint

s of c

are,

the w

aitin

g ro

om, a

t the

facil

ity’s e

ntra

nce a

nd w

ithin

5 m

of la

trin

es.

3.3Sin

k or b

ucke

t with

tap a

nd w

ater

with

soap

or al

coho

l-bas

ed ha

ndru

b.Se

rvice

area

s inc

lude s

teril

izatio

n, la

bora

tory,

kitch

en, la

undr

y, sh

ower

s, wa

ste zo

ne an

d mor

tuar

y. (To

ilets

are i

nclud

ed un

der 2

.7.)

3.4

Tap a

nd w

ater

with

soap

.3.

8Cl

ean

as n

oted

by ab

senc

e of w

aste

, visi

ble d

irt an

d ex

cret

a and

inse

cts.

Envi

ronm

enta

l sur

face

s or o

bjec

ts co

ntam

inat

ed w

ith b

lood

, oth

er b

ody �

uids

, sec

retio

ns or

excr

etio

ns ar

e cle

aned

and

disin

fect

ed as

soon

as p

ossib

le u

sing

stan

dard

hos

pita

l det

erge

nts/d

isinf

ecta

nts.

3.10

Was

te d

ispos

al st

a� w

ho op

erat

e the

incin

erat

or sh

ould

hav

e an

apro

n, g

love

s, go

ggle

s, fa

ce m

ask a

nd b

oots

.

Tool

2A

: Ind

icat

ors

asse

ssm

ent

To

ol 2

A

* See

asso

ciate

d no

te3

49


4M

anag

emen

t* S

ee as

socia

ted

note

Mee

ts ta

rget

Part

ially

mee

ts

targ

et

Does

not

mee

t ta

rget

Does

indi

cato

r mee

t the

targ

et?

Mar

k /

/ No

tes

(use

addi

tiona

l pag

es if

nec

essa

ry)

Asse

ssm

ent n

umbe

r: __

__

ESSE

NTI

AL

IND

ICAT

ORS

4.1

WAS

H FI

T or o

ther

qua

lity

impr

ovem

ent/m

anag

emen

t pl

an fo

r the

facil

ity is

in p

lace

, im

plem

ente

d an

d re

gula

rly

mon

itore

d

Yes

Com

plete

but

has n

ot be

en

imple

men

ted a

nd/o

r is

not m

onito

red,

or

incom

plete

No pl

an

4.2*

An an

nual

pla

nned

bud

get f

or th

e fa

cility

is av

aila

ble a

nd in

clude

s fu

ndin

g fo

r WAS

H in

frast

ruct

ure,

se

rvice

s, pe

rson

nel a

nd th

e co

ntin

uous

pro

cure

men

t of W

ASH

item

s (ha

nd h

ygie

ne p

rodu

cts,

min

or su

pplie

s to r

epai

r pip

es,

toile

ts, e

tc.)

whi

ch is

su�

cient

to

mee

t the

nee

ds of

the f

acili

ty

Yes

Yes,

but b

udge

t is

insu�

cient

No bu

dget

4.3

An u

p-to

-dat

e dia

gram

of th

e fa

cility

man

agem

ent s

truc

ture

is

clear

ly vi

sible

and

legi

ble

Yes

Yes,

but n

ot up

to da

teNo

t ava

ilable

4.4

Adeq

uate

clea

ners

and W

ASH

mai

nten

ance

sta�

are a

vaila

ble

Yes

Som

e ava

ilable

, but

no

t ade

quat

e or n

ot

skille

d/m

otiva

ted

None

avail

able

Tool

2A

: Ind

icat

ors

asse

ssm

ent

Date

of as

sess

men

t: . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

Mem

bers

of te

am co

nduc

ting

asse

ssm

ent:

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .. .

. . . .

. . . .

. . . .

. . . .

. . . .

. .

Note

s: . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

.. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . ..

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

. . . .

. . . .

. . . .

. . . .

. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .. .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. .. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .. .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. .. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

To

ol 2

A

Man

agem

ent

44444444

50



4M

anag

emen

t* S

ee as

socia

ted

note

Mee

ts ta

rget

Part

ially

mee

ts

targ

et

Does

not

mee

t ta

rget

Does

indi

cato

r mee

t the

targ

et?

Mar

k /

/ No

tes

(use

addi

tiona

l pag

es if

nec

essa

ry)

Asse

ssm

ent n

umbe

r: __

__

AD

VAN

CED

IND

ICAT

ORS

4.5A p

roto

col fo

r ope

ratio

n and

m

ainte

nanc

e, inc

luding

proc

urem

ent

of W

ASH

supp

lies i

s visi

ble, le

gible

and i

mple

men

ted

Yes

Prot

ocol

exist

s but

not

imple

men

ted

No pr

otoc

ol

4.6Re

gular

war

d-ba

sed a

udits

are

unde

rtake

n to a

ssess

the a

vaila

bility

of

hand

rub,

soap

, sing

le us

e tow

els

and o

ther

hand

hygie

ne re

sour

ces

Yes

Unde

rtake

n les

s th

an on

ce a

week

or

asse

ssmen

t is

incom

plete

Not u

nder

take

n

4.7Ne

w he

alth c

are p

erso

nnel

rece

ive IP

C tra

ining

as pa

rt of

their

orien

tatio

n pr

ogra

mm

e

Yes

Som

e but

not a

ll sta

�No

train

ing

4.8He

alth c

are s

ta�

are t

raine

d on W

ASH/

IPC e

ach y

ear

Yes

Sta�

are t

raine

d but

no

t eve

ry ye

ar or

only

som

e sta

� ar

e tra

ined

No tr

aining

4.9Fa

cility

has a

dedic

ated

WAS

H or

IPC

foca

l per

son

Yes

Yes,

but f

ocal

point

do

es no

t hav

e su�

cient

tim

e, re

sour

ces o

r m

otiva

tion t

o car

ry ou

t du

ties

No

4.10

All s

ta�

have

a job

descr

iption

wr

itten

clea

rly an

d leg

ibly,

includ

ing

WAS

H-re

lated

resp

onsib

ilities

and

are r

egula

rly ap

prais

ed on

their

pe

rform

ance

Yes

Som

e, bu

t not

all, s

ta�

have

a job

descr

iption

or

their

perfo

rman

ce is

no

t app

raise

d

No jo

b des

cript

ion

writt

en

Tool

2A

: Ind

icat

ors

asse

ssm

ent

To

ol 2

A

Man

agem

ent

44444444

51


4M

anag

emen

t* S

ee as

socia

ted

note

Mee

ts ta

rget

Part

ially

mee

ts

targ

et

Does

not

mee

t ta

rget

Does

indi

cato

r mee

t the

targ

et?

Mar

k /

/ No

tes

(use

addi

tiona

l pag

es if

nec

essa

ry)

Asse

ssm

ent n

umbe

r: __

__

4.11

High

perfo

rming

sta�

are r

ecog

nized

an

d rew

arde

d and

thos

e tha

t do n

ot

perfo

rm ar

e dea

lt wi

th ac

cord

ingly

Yes

Eithe

r high

or lo

w pe

rform

ers a

ddre

ssed

but n

ot bo

th

No ac

tion o

r re

cogn

ition

of st

a�

base

d on p

erfo

rman

ce

Perc

enta

ge of

indi

cato

rs m

eetin

g ta

rget

s for

M

ANAG

EMEN

T

Perc

enta

ge of

indi

cato

rs p

artia

lly m

eetin

g ta

rget

s for

M

ANAG

EMEN

T

Perc

enta

ge of

indi

cato

rs n

ot m

eetin

g ta

rget

s for

M

ANAG

EMEN

T

* Not

es: M

anag

emen

tTh

e ind

icato

rs in

bol

d ar

e “es

sent

ial”

and s

hould

be co

mple

ted b

y all f

acilit

ies us

ing W

ASH

FIT. O

ther

indic

ator

s are

cons

idere

d opt

ional

and c

an be

inclu

ded i

f the

facil

ity ha

s the

capa

city t

o asse

ss th

em.

4.2

The b

udge

t ref

ers t

o tha

t use

d fo

r cap

ital a

nd op

erat

iona

l cos

ts. I

t cou

ld b

e fro

m th

e com

mun

ity m

anag

emen

t gro

up an

d/or

the g

over

nmen

t, ac

cord

ing

to th

e pol

icies

and

prac

tices

in th

e cou

ntry

.

Tool

2A

: Ind

icat

ors

asse

ssm

ent

To

ol 2

A

Man

agem

ent

44444444

52



Tool

2A

: Ind

icat

ors

asse

ssm

ent e

xam

ple

Date

of as

sess

men

t: 15

Mar

ch 2

018

M

embe

rs of

team

cond

uctin

g as

sess

men

t: Em

ily M

utamb

o, Ja

cob S

afa, G

ithu M

eru

Note

s: Wa

teren

gineerhelp

edco

nducttheas

sessme

ntasitwa

sthefirstas

sessme

ntandtheteam

neededextra

assis

tance.Theas

sessme

nttoo

kafulldaybe

causeit

wasthefi

rsttim

eofdoin

gsucha

nas

sess

ment.

The

next

asse

ssme

nt is

likely

to ta

ke le

ss tim

e. Idr

iss an

d Joh

n were

not a

vaila

ble on

the d

ay of

the a

sses

smen

t. The

y will l

ook a

t a co

py of

the r

esult

s at t

he ne

xt te

am m

eetin

g to m

ake s

ure th

ey ag

ree w

ith th

e res

t of t

he te

am’s d

ecisio

ns.

1W

ater

* See

asso

ciate

d no

te

Mee

ts ta

rget

Part

ially

mee

ts

targ

et

Does

not

mee

t ta

rget

Does

indi

cato

r mee

t the

targ

et?

Mar

k /

/ No

tes

(cont

inue

in yo

ur W

ASH

FIT n

oteb

ook

if ne

cess

ary)

As

sess

men

t num

ber:

____

ESSE

NTI

AL

IND

ICAT

ORS

1.1*

Impr

oved

wat

er su

pply

pip

ed in

to

the f

acili

ty or

on p

rem

ises a

nd

avai

labl

e

Yes,

impr

oved

wat

er

supp

ly wi

thin

facilit

y an

d ava

ilable

Impr

oved

wat

er su

pply

on pr

emise

s, (o

utsid

e of

facil

ity bu

ilding

) an

d ava

ilable

No im

prov

ed w

ater

so

urce

with

in fac

ility

grou

nds,

or im

prov

ed

supp

ly in

place

but n

ot

avail

able

Pipe

d wate

r sys

tem in

plac

e but

water

supp

ly no

t alw

ays

avail

able.

1.2*

Wat

er se

rvice

s ava

ilabl

e at a

ll tim

es an

d of

su�

cient

qua

ntity

fo

r all

uses

Yes,

ever

y day

and o

f su

�cie

nt qu

antit

yM

ore t

han �

ve da

ys

per w

eek o

r eve

ry

day b

ut no

t su�

cient

qu

antit

y

Fewe

r tha

n �ve

days

pe

r wee

kAs

sess

ment

2: N

ow th

at pi

pes a

re wo

rking

, it is

poss

ible

to ge

t a gr

eater

quan

tity o

f wate

r for

the f

acilit

y.

1.3*

A re

liabl

e drin

king

-wat

er st

atio

n is

pres

ent a

nd ac

cess

ible

for s

ta�,

pa

tient

s and

care

rs at

all t

imes

an

d in

all l

ocat

ions

/war

ds

Yes,

at al

l tim

es/w

ards

an

d acce

ssible

to al

lSo

met

imes

, or o

nly

in so

me p

laces

or no

t av

ailab

le fo

r all u

sers

Not a

vaila

bleAs

sess

ment

1: No d

rinkin

g-wa

ter st

ation

s are

avail

able.

Asse

ssme

nt 2:

Drin

king-

water

stat

ions p

rocu

red fr

om

fundsfrom

districtofficean

dinstalled

inso

meplaces

but s

till ne

eded

in m

atern

ity ar

ea.

1.4*

Drin

king

-wat

er is

safe

ly st

ored

in

a cle

an b

ucke

t/tan

k with

cove

r an

d ta

p

Yes

All a

vaila

ble dr

inking

-wa

ter p

oints

are s

afely

store

d

Not s

afely

store

d in

any w

ater

point

s or

no dr

inking

-wat

er

avail

able

Asse

ssme

nt 1: N

ot ap

plica

ble as

no dr

inking

-wate

r cu

rrentl

y ava

ilable

.As

sess

ment

2: Sa

fe sto

rage

guide

lines

are n

ow be

ing

follo

wed.

AD

VAN

CED

IND

ICAT

ORS

1.5Sa

nitar

y ins

pecti

on ris

k sco

re (u

sing

sanit

ary i

nspe

ction

form

3)Lo

w ris

kM

edium

risk

High

or ve

ry hi

gh ris

kSI

form

3 us

ed (p

iped d

istrib

ution

). Ass

essm

ent 1

: Sc

ored

9/1

0.

Wat

er1

To

ol 2

A

53


Tool

2B:

Rec

ord

of a

sses

smen

t

Dom

ain

Asse

ssm

ent 1

Asse

ssm

ent 2

Asse

ssm

ent 3

Asse

ssm

ent 4

%No

tes

%No

tes

%No

tes

%No

tes

Wat

erTo

tal n

umbe

r of in

dicat

ors

asse

ssed:

___

___

Date

of as

sess

men

t:

Sani

tatio

n an

d he

alth

care

w

aste

Tota

l num

ber o

f indic

ator

s as

sesse

d: _

____

_

Date

of as

sess

men

t:

Hygi

ene

Tota

l num

ber o

f indic

ator

s as

sesse

d: _

____

_

Date

of as

sess

men

t:

Man

agem

ent

Tota

l num

ber o

f indic

ator

s as

sesse

d: _

____

_

Date

of as

sess

men

t:

Over

all f

acili

ty

scor

eDa

te of

asse

ssm

ent:

Give

perce

ntag

e of in

dicat

ors a

chiev

ed fo

r eac

h asse

ssmen

t.

To

ol 2

B

Tota

l num

ber o

f indic

ator

s

54



Tool

2B:

Rec

ord

of a

sses

smen

t exa

mpl

e

Dom

ain

Asse

ssm

ent 1

Asse

ssm

ent 2

Asse

ssm

ent 3

Asse

ssm

ent 4

%No

tes

%No

tes

%No

tes

%No

tes

Wat

erTo

tal n

umbe

r of in

dicat

ors

asse

ssed:

___

___

Date

of as

sess

men

t: 24

Septe

mber

Year

125

Mar

ch Ye

ar 2

5Ov

erall, i

mprov

emen

ts ne

eded

as fe

wer t

han h

alf of

the

indic

ators

met s

tanda

rds.

10Sig

nificantimpro

veme

nt(nu

mber

of in

dicato

rs me

eting

sta

ndar

ds do

ubled

) and

no

area

s whe

re sta

ndar

ds no

t me

t. Som

e add

itiona

l pro

gres

s co

uld be

mad

e.

43

4

0

13

Give

perce

ntag

e of in

dicat

ors a

chiev

ed fo

r eac

h asse

ssmen

t.

To

ol 2

B

55


Sani

tary

insp

ecti

on fo

rm �

: Dug

wel

l wit

h ha

nd p

ump

I. G

ener

al in

form

atio

n

Nam

e of f

acilit

y: . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

Loc

ation

and/

or na

me o

f dug

well

: . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

Dat

e of in

spec

tion:

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. .

Wea

ther

cond

ition

s dur

ing in

spec

tion:

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. .

Note

: If th

ere i

s mor

e tha

n one

dug w

ell ac

cesse

d by t

he fa

cility

, or if

the f

acilit

y use

s oth

er w

ater

sour

ces (

such

as sp

rings

or bo

reho

les),

carry

out s

anita

ry in

spec

tions

for t

hese

sour

ces t

oo

II. S

peci

�c q

uest

ions

for a

sses

smen

t1.

Is th

e sou

rce lo

cate

d at a

n uns

afe di

stanc

e fro

m an

unse

aled l

atrin

e (i.e

. a la

trine

in cl

ose p

roxim

ity is

uphil

l or a

t a lo

catio

n whe

re th

e gro

undw

ater

grad

ient w

ould

�ow

from

the l

atrin

e to t

he w

ater

sour

ce)?

..

..

Yes

N

o2.

Is th

e fen

ce ab

sent

, inad

equa

te or

fault

y? .

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

. Y

es

No

3. Ca

n anim

als ha

ve ac

cess

with

in 30

m of

the w

ell? .

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

. Y

es

No

4. Is

ther

e any

othe

r sou

rce of

pollu

tion w

ithin

30 m

of th

e well

(suc

h as a

nimal

bree

ding,

farm

ing, ro

ads,

healt

h car

e was

te, h

ouse

hold

waste

)?

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

Yes

N

o5.

Is th

ere s

tagn

ant w

ater

with

in 3 m

of th

e well

? .

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

Yes

N

o6.

Is th

e dra

inage

chan

nel a

bsen

t or c

rack

ed, b

roke

n or in

need

of cl

eanin

g?

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

Yes

N

o7.

Is th

e cem

ent �

oor o

r slab

less

than

2 m

in di

amet

er ar

ound

the t

op of

the w

ell? .

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

Yes

N

o8.

Are t

here

crac

ks in

the c

emen

t �oo

r or s

lab? .

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

Yes

N

o9.

Is th

e han

d pum

p loo

se at

the p

oint o

f atta

chm

ent o

r, for

rope

-was

her p

umps

, is th

e pum

p cov

er m

issing

or da

mag

ed?

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

. Y

es

No

10. I

s the

well

cove

r abs

ent,

crack

ed or

insa

nitar

y? .

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

Yes

N

oTo

tal s

core

of ri

sk fa

ctor

s as t

otal

num

ber o

f “YE

S” an

swer

s: __

__

III. R

esul

ts a

nd c

omm

ents

Sani

tary

insp

ectio

n ris

k sco

re (t

ick ap

prop

riate

box

):

Impo

rtan

t poi

nts o

f risk

not

ed:

List

acco

rding

to qu

estio

n num

bers

1–10

:. .

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Add

ition

al co

mm

ents:

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. . . .

. . . .

. . . .

. .

IV. N

ames

and

sig

natu

res

of a

sses

sors

:

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

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. . . .

. . . .

. . . .

. . . .

. . .

Very

hig

h ris

k (ris

k sco

re: 9

–10)

Hi

gh ri

sk (r

isk sc

ore:

6–8)

M

ediu

m ri

sk (r

isk sc

ore:

3–5)

Lo

w ri

sk (r

isk sc

ore:

0–2)

Tool

2C:

San

itar

y in

spec

tion

form

s

To

ol 2

C

56



Not

es fo

r SI f

orm

�: D

ug w

ell w

ith

hand

pum

p1.

Is

the

sour

ce a

t an

unsa

fe d

ista

nce

from

a la

trin

e?La

trine

s clos

e to g

roun

dwat

er su

pplie

s may

a�ec

t wat

er qu

ality

(for

exam

ple, b

y in�

ltrat

ion of

faec

al m

ater

ial).

Pollu

tion o

f unc

on�n

ed sh

allow

aquif

ers p

oses

a ris

k, es

pecia

lly in

the w

et se

ason

, as f

aeca

l mat

erial

(and

othe

r poll

utan

ts)

may

�ow

into t

he w

ater

sour

ce. T

he ris

k of c

onta

mina

tion w

ill de

pend

on se

vera

l facto

rs inc

luding

whe

ther

the l

atrin

e is s

ealed

, the

type

of so

il and

the d

irecti

on of

grou

ndwa

ter �

ow. Y

ou m

ay ne

ed to

chec

k stru

cture

s visu

ally a

nd/o

r disc

uss

with

loca

l tec

hnici

ans t

o det

erm

ine th

e risk

. Whil

e the

re is

no un

iversa

l safe

dista

nce,

a lat

rine b

eing u

phill

of gr

ound

wate

r �ow

and/

or w

ithin

30 m

, wou

ld, ge

nera

lly, p

ose a

risk (

thus

an an

swer

of “y

es”).

2.

Is th

e fe

nce

abse

nt o

r fau

lty?

If the

re is

no fe

nce o

r if th

e fen

ce is

inap

prop

riate

(for

exam

ple, t

oo lo

w or

not e

quipp

ed w

ith a

func

tionin

g gat

e) or

dam

aged

, anim

als (i

nclud

ing th

ose u

sed f

or co

llecti

ng th

e wat

er) c

an ac

cess

the w

ell si

te. T

hey m

ay da

mag

e the

stru

cture

an

d poll

ute t

he ar

ea w

ith ex

creta

. You

will

need

to ch

eck b

oth t

he pr

otec

tion o

f the

site

and w

heth

er an

imals

are r

outin

ely in

the a

rea.

If you

obse

rve e

ither

of th

ese p

roble

ms,

answ

er “Y

es”.

3.

Can

anim

als

have

acc

ess

wit

hin

30 m

of t

he w

ell?

If anim

als ca

n acce

ss th

e well

site

or it

s im

med

iate v

icinit

y, th

ey m

ay da

mag

e the

stru

cture

and p

ollut

e the

area

with

excre

ta. Y

ou w

ill ne

ed to

chec

k bot

h the

prot

ectio

n of t

he si

te an

d whe

ther

anim

als ar

e rou

tinely

in th

e are

a. If y

ou

obse

rve e

ither

of th

ese p

roble

ms,

answ

er “Y

es”.

4.

Is th

ere

any

othe

r sou

rce

of p

ollu

tion

wit

hin

30 m

of t

he w

ell (

such

as

anim

al b

reed

ing,

cul

tiva

tion

, roa

ds, g

arag

es, c

raft

ent

erpr

ises

or w

aste

)?An

imal

or hu

man

faec

es on

the g

roun

d clos

e to t

he w

ell co

nstit

ute a

risk t

o wat

er qu

ality,

espe

cially

whe

n wat

er di

versi

on di

tches

are n

ot pr

esen

t. Di

spos

al of

othe

r was

te (f

or ex

ample

, hou

seho

ld, ag

ricult

ural

or co

mm

ercia

l) ind

icate

s tha

t en

viron

men

tal s

anita

tion p

racti

ces a

re po

or, w

hich c

onsti

tute

s a ris

k to w

ater

quali

ty. Th

is ca

n be c

on�r

med

by ob

serv

ation

of th

e gen

eral

surro

undin

gs in

the c

omm

unity

. If yo

u �nd

any o

f the

se pr

actic

es w

ithin

30 m

of th

e well

, ans

wer

“Yes

”.

5.

Is th

ere

stag

nant

wat

er w

ithi

n 3

m o

f the

wel

l?If p

ools

of w

ater

accu

mula

te ar

ound

the w

ell th

ey m

ay pr

ovide

a ro

ute f

or co

ntam

inant

s to e

nter

the s

ource

. If yo

u obs

erve

spilt

wat

er or

pools

of w

ater

clos

e to t

he w

ell, a

nswe

r “Ye

s”.

6.

Is th

e dr

aina

ge c

hann

el a

bsen

t or c

rack

ed, b

roke

n or

in n

eed

of c

lean

ing?

Poor

cons

tructi

on or

main

tena

nce o

f the

drain

age c

hann

el lea

ds to

crac

ks an

d bre

aks.

Espe

cially

whe

n com

bined

with

spilla

ge of

wat

er an

d poo

r san

itary

cond

ition

s, th

is po

ses a

risk t

o wat

er qu

ality.

If yo

u obs

erve

any o

f the

se pr

oblem

s, an

swer

“Yes

”.

7.

Is th

e ce

men

t �oo

r or s

lab

abse

nt o

r les

s th

an 2

m in

dia

met

er a

roun

d th

e to

p of

the

wel

l?Th

e slab

is bu

ilt to

prev

ent b

ack�

ow of

wat

er in

to th

e well

. To d

o this

adeq

uate

ly it

need

s to b

e at l

east

2 m in

diam

eter.

If it

is ab

sent

or to

o sm

all, a

nswe

r “Ye

s”.

8.

Are

ther

e cr

acks

in th

e ce

men

t �oo

r or s

lab?

Crac

ks, e

spec

ially

deep

ones

, in th

e cem

ent m

ay al

low ba

ck�o

w int

o the

wat

er so

urce

. If yo

u see

deep

crac

ks, a

nswe

r “Ye

s”.

9.

Is th

e ha

nd p

ump

loos

e at

the

poin

t of a

ttac

hmen

t or,

for r

ope-

was

her p

umps

, is

the

pum

p co

ver m

issi

ng o

r dam

aged

?A l

oose

hand

pum

p or a

miss

ing pu

mp c

over

may

allow

back

�ow

of co

ntam

inate

d wat

er in

to th

e wat

er so

urce

. If th

e pum

p is n

ot se

cure

ly at

tach

ed to

the p

ump b

ase i

n the

apro

n (or

the p

ump c

over

is m

issing

), an

swer

“Yes

”.

10.

Is th

e w

ell c

over

abs

ent,

crac

ked

or in

sani

tary

?Ab

senc

e of a

cove

r, a cr

acke

d cov

er or

an in

sanit

ary c

over

incre

ases

the l

ikelih

ood o

f con

tam

inatio

n ent

ering

the w

ell. If

you o

bser

ve an

y of t

hese

prob

lems,

answ

er “Y

es”.

Tool

2C:

San

itar

y in

spec

tion

form

s

To

ol 2

C

57


Sani

tary

insp

ecti

on fo

rm �

: Dee

p bo

reho

le w

ith

mot

oriz

ed p

ump

I. G

ener

al in

form

atio

n

Nam

e of f

acilit

y: . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

Loc

ation

and/

or na

me o

f bor

ehole

: . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

Dat

e of in

spec

tion:

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. .

Wea

ther

cond

ition

s dur

ing in

spec

tion:

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

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. . . .

. . . .

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. . . .

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. . . .

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. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. .

Note

: If th

ere i

s mor

e tha

n one

bore

hole

acce

ssed b

y the

facil

ity, o

r if th

e fac

ility u

ses o

ther

wat

er so

urce

s (su

ch as

sprin

gs or

dug w

ells),

carry

out s

anita

ry in

spec

tions

for t

hese

sour

ces t

oo.

II. S

peci

�c q

uest

ions

for a

sses

smen

t1.

Is th

ere a

latri

ne or

sewe

r with

in 15

–20 m

of th

e ext

racti

on si

te/w

ell-h

ead?

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

. Y

es

No

2. Is

the n

eare

st lat

rine a

pit l

atrin

e tha

t per

colat

es to

soil,

i.e. n

ot co

nnec

ted t

o a se

ptic

tank

or se

wer?

.

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

Yes

N

o3.

Is th

ere a

ny ot

her s

ource

of po

llutio

n (e.g

. anim

al ex

creta

, rub

bish,

surfa

ce w

ater

) with

in 10

m of

the b

oreh

ole?

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

. Y

es

No

4. Is

ther

e an u

ncap

ped w

ell w

ithin

15–2

0 m of

the b

oreh

ole?

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

Yes

N

o5.

Is th

e dra

inage

area

arou

nd th

e pum

p hou

se fa

ulty?

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

Yes

N

o6.

Is th

e fen

cing a

roun

d the

insta

llatio

n dam

aged

in an

y way

whic

h wou

ld pe

rmit

any u

naut

horiz

ed en

try or

allow

anim

als ac

cess?

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

Yes

N

o7.

Is th

e �oo

r of t

he pu

mp h

ouse

perm

eable

to w

ater

? .

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

. Y

es

No

8. Is

the w

ell se

al un

sanit

ary?

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

Yes

N

o9.

Is th

e chl

orina

tion f

uncti

oning

prop

erly?

.

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

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..

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..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

. Y

es

No

10. I

s chl

orine

pres

ent a

t the

sam

pling

tap?

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

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..

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..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

. Y

es

No

Tota

l sco

re of

risk

fact

ors a

s tot

al n

umbe

r of “

YES”

answ

ers:

____

III. R

esul

ts a

nd c

omm

ents

Sani

tary

insp

ectio

n ris

k sco

re (t

ick ap

prop

riate

box

):

Impo

rtan

t poi

nts o

f risk

not

ed:

List

acco

rding

to qu

estio

n num

bers

1–10

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Add

ition

al co

mm

ents:

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. .

IV. N

ames

and

sig

natu

res

of a

sses

sors

:

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Very

hig

h ris

k (ris

k sco

re: 9

–10)

Hi

gh ri

sk (r

isk sc

ore:

6–8)

M

ediu

m ri

sk (r

isk sc

ore:

3–5)

Lo

w ri

sk (r

isk sc

ore:

0–2)

Tool

2C:

San

itar

y in

spec

tion

form

s

To

ol 2

C

58



Tool

2C:

San

itar

y in

spec

tion

form

s

Sani

tary

insp

ecti

on fo

rm �

: Pub

lic/y

ard

taps

and

pip

ed d

istr

ibut

ion

I. G

ener

al in

form

atio

nNa

me o

f fac

ility:

. . . .

. . . .

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. . D

ate o

f insp

ectio

n: . .

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Wea

ther

cond

ition

s dur

ing in

spec

tion:

. . . .

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. . . .

Loca

tion a

nd/o

r nam

e of w

ater

sour

ce(s)

feed

ing th

e dist

ribut

ion sy

stem

:. . . .

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. Lo

catio

n and

/or n

ame o

f sto

rage

rese

rvoir

feed

ing th

e dist

ribut

ion sy

stem

(if a

ny):

. . . .

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Note

: If th

e dist

ribut

ion sy

stem

is se

rved

by a

stora

ge re

serv

oir, a

lso ca

rry ou

t a sa

nitar

y ins

pecti

on us

ing SI

form

5: St

orag

e res

ervo

irs.

II. S

peci

�c q

uest

ions

for a

sses

smen

tNo

te: F

ill in

one f

orm

per p

ublic

or ya

rd ta

p und

er in

spec

tion.

In fa

ciliti

es w

ith w

ater

pipe

d dire

ctly i

nto t

he bu

ilding

only

ques

tions

7–10

apply

. Not

all t

aps w

ithin

the f

acilit

y nee

d to b

e ins

pecte

d in e

very

insp

ectio

n rou

nd –

a se

lecte

d sa

mple

is su

�cie

nt.

Publ

ic or

yard

tap

1. Do

es th

e tap

leak

? .

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

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..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

Yes

N

o2.

Is th

e tap

or ar

e atta

chm

ents

(such

as ho

ses)

insan

itary

? ..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

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..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

Yes

N

o3.

Does

spilt

wat

er ac

cum

ulate

arou

nd th

e tap

stan

d? .

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

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..

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..

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..

..

..

..

..

..

..

..

..

..

..

..

..

..

Yes

N

o4.

Is th

e are

a aro

und t

he ta

p sta

nd po

llute

d by w

aste

, faec

es or

othe

r mat

erial

s? .

..

..

..

..

..

..

..

..

..

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..

..

..

..

..

..

..

..

..

..

. Y

es

No

5. Is

the a

rea a

roun

d the

tap s

tand

unfen

ced,

allow

ing an

imals

to ac

cess

the a

rea?

..

..

..

..

..

..

..

..

..

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..

..

..

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..

..

..

. Y

es

No

6. Is

ther

e a se

wer o

r a la

trine

at an

unsa

fe dis

tanc

e fro

m th

e tap

stan

d (ge

nera

lly 30

m bu

t may

be m

ore o

r les

s dep

endin

g on t

he gr

adien

t, ge

ology

and s

ize of

wat

er or

sewe

r infra

struc

ture

)? .

..

..

..

..

..

..

. Y

es

No

Pipe

d di

strib

utio

n7.

Are t

here

any s

igns o

f leak

s in t

he in

spec

tion a

rea (

for e

xam

ple, a

ccum

ulatin

g wat

er)?

..

..

..

..

..

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..

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..

..

..

..

..

..

..

. Y

es

No

8. Ar

e any

of th

e pipe

s exp

osed

abov

e gro

und i

n the

insp

ectio

n are

a? .

..

..

..

..

..

..

..

..

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..

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..

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..

..

..

..

..

. Y

es

No

9. Ha

ve us

ers r

epor

t any

pipe

brea

ks w

ithin

the l

ast w

eek?

..

..

..

..

..

..

..

..

..

..

..

..

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..

..

..

..

..

..

Yes

N

o10

. Has

ther

e bee

n disc

ontin

uity i

n the

last

10 da

ys?

..

..

..

..

..

..

..

..

..

..

..

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..

..

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..

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..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

Yes

N

oTo

tal s

core

of ri

sk fa

ctor

s as t

otal

num

ber o

f “YE

S” an

swer

s: __

__

III. R

esul

ts a

nd c

omm

ents

Sani

tary

insp

ectio

n ris

k sco

re (t

ick ap

prop

riate

box

):

Note

: In si

tuat

ions w

here

only

ques

tions

7–10

apply

, the

scor

e belo

w ca

n be a

dapt

ed as

follo

ws: “

Very

high

” = 4;

“High

” = 3;

“Med

ium” =

2; “L

ow” =

0–1.

Impo

rtan

t poi

nts o

f risk

not

ed:

List

acco

rding

to qu

estio

n num

bers

1–10

:. .

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. . . .

. . . .

. .

Add

ition

al co

mm

ents:

. . . .

. . . .

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. . . .

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. . . .

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. . . .

. .

IV. N

ames

and

sig

natu

res

of a

sses

sors

:

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

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. . . .

. . . .

. . . .

. . . .

. . .

Very

hig

h ris

k (ris

k sco

re: 9

–10)

Hi

gh ri

sk (r

isk sc

ore:

6–8)

M

ediu

m ri

sk (r

isk sc

ore:

3–5)

Lo

w ri

sk (r

isk sc

ore:

0–2)

To

ol 2

C

59


Not

es fo

r SI f

orm

�: P

ublic

/yar

d ta

ps a

nd p

iped

dis

trib

utio

n1.

D

oes

the

tap

leak

?If t

aps a

re le

aking

or da

mag

ed th

en cr

acks

may

prov

ide a

rout

e for

cont

amina

nts t

o ent

er th

e pipe

s, pa

rticu

larly

if the

distr

ibutio

n sys

tem

is op

erat

ing in

term

itten

tly. L

eakin

g tap

s also

cont

ribut

e to w

ater

was

tage

. Dur

ing th

e ins

pecti

on, y

ou

will n

eed t

o di�

eren

tiate

betw

een w

ater

from

leak

ing ta

ps an

d spil

t wat

er. If

you o

bser

ve le

aks o

r dam

age a

t tap

s, an

swer

“Yes

”.

2.

Is th

e ta

p or

are

att

achm

ents

(suc

h as

hos

es) i

nsan

itar

y?If t

he ta

p is c

onta

mina

ted,

or if

any a

ttach

men

ts to

the t

ap (s

uch a

s hos

es) a

re in

sanit

ary,

colle

cted w

ater

may

be co

ntam

inate

d and

cont

amina

tion c

an be

intro

duce

d to t

he di

stribu

tion s

yste

m. If

the t

ap is

insa

nitar

y, an

swer

“Yes

”.

3.

Doe

s sp

ilt w

ater

acc

umul

ate

arou

nd th

e ta

p st

and?

Any s

pilt w

ater

may

be co

ntam

inate

d by r

uno�

, esp

ecial

ly if a

nimals

have

acce

ss to

the c

ollec

tion a

rea.

Cont

ainer

s may

be co

ntam

inate

d by t

he sp

ilt w

ater

durin

g coll

ectio

n. Al

so, if

crac

ks ar

e pre

sent

in th

e coll

ectio

n are

a, th

ey m

ay pr

ovide

a r

oute

for c

onta

mina

nts t

o ent

er th

e dist

ribut

ion pi

pes,

parti

cular

ly if t

he di

stribu

tion s

yste

m op

erat

es in

term

itten

tly. If

you o

bser

ve ac

cum

ulatio

n of s

pilt w

ater,

answ

er “Y

es”.

4.

Is th

e ar

ea a

roun

d th

e ta

p st

and

insa

nita

ry?

Faec

es, u

nwan

ted p

lant g

rowt

h/we

eds,

rubb

ish an

d oth

er w

aste

incre

ases

the r

isk of

wat

er be

com

ing co

ntam

inate

d dur

ing co

llecti

on –

for e

xam

ple, b

y con

tam

inatin

g coll

ectio

n con

taine

rs. If

you o

bser

ve an

y of t

hese

prob

lems c

lose t

o the

ta

p, an

swer

“Yes

”.

5.

Is th

e ar

ea a

roun

d th

e ta

p st

and

unfe

nced

, allo

win

g an

imal

s to

acc

ess

the

area

?If t

here

is no

fenc

e or if

the f

ence

is in

appr

opria

te (f

or ex

ample

, too

low

or no

t equ

ipped

with

a fu

nctio

ning g

ate)

or da

mag

ed, a

nimals

(inc

luding

thos

e use

d for

colle

cting

the w

ater

) can

acce

ss th

e tap

stan

d are

a. Th

ey m

ay ca

use d

amag

e to

the t

aps a

nd po

llute

the a

rea o

r coll

ectio

n con

taine

rs wi

th ex

creta

. You

will

need

to ch

eck w

heth

er an

imals

are r

outin

ely in

the a

rea b

y ask

ing re

siden

ts an

d by p

erso

nal o

bser

vatio

n in t

he ar

ea (i

nclud

ing se

eing a

ny an

imal

excre

ta at

the

site)

. If yo

u obs

erve

any o

f the

se pr

oblem

s or if

the a

rea i

s unf

ence

d, an

swer

“Yes

”.

6.

Is th

ere

a se

wer

or a

latr

ine

at a

n un

safe

dis

tanc

e fr

om a

tap

stan

d?An

y lea

ks fr

om a

sewe

r or in

�ltra

tion f

rom

a lat

rine c

ould

cont

amina

te th

e pipe

d wat

er, es

pecia

lly if

ther

e are

any c

rack

s in t

he di

stribu

tion s

yste

m an

d if t

he di

stribu

tion s

yste

m op

erat

es in

term

itten

tly. G

roun

dwat

er m

ay �o

w to

ward

s the

dis

tribu

tion p

ipes f

rom

the d

irecti

on of

the s

ewer

or la

trine

. You

can o

bser

ve la

trine

s and

cros

s-che

ck w

ith re

siden

ts bu

t you

may

need

to as

k rele

vant

prof

essio

nals

abou

t the

loca

tion o

f sew

ers.

If eith

er a

sewe

r or l

atrin

e is p

rese

nt, a

nswe

r “Y

es”.

7.

Are

ther

e an

y si

gns

of le

aks

in th

e in

spec

tion

are

a (f

or e

xam

ple,

acc

umul

atin

g w

ater

)?If p

ipes a

re da

mag

ed or

leak

ing th

en cr

acks

may

prov

ide a

rout

e for

cont

amina

nts t

o ent

er th

e pipe

s, pa

rticu

larly

if the

distr

ibutio

n sys

tem

oper

ates

inte

rmitt

ently

. Wat

ch ou

t for

stag

nant

wat

er or

unex

pecte

d �ow

s of w

ater

abov

e gro

und

but y

ou w

ill ne

ed to

di�e

rent

iate b

etwe

en w

ater

from

leak

age a

nd sp

ilt w

ater.

If yo

u obs

erve

leak

s in t

he in

spec

tion a

rea,

answ

er “Y

es”.

8.

Are

any

of t

he p

ipes

exp

osed

abo

ve g

roun

d in

the

insp

ecti

on a

rea?

Expo

sure

of th

e pipe

mea

ns th

at it

is m

ore p

rone

to bo

th da

mag

e (es

pecia

lly if

by/o

n a ro

ad) a

nd co

ntam

inatio

n fro

m ru

no�

than

pipe

s belo

w gr

ound

. You

will

need

to id

entif

y the

rout

es of

the m

ain pi

pelin

es in

the i

nspe

ction

area

. If th

e pip

eline

s are

expo

sed,

answ

er “Y

es”.

9.

Hav

e us

ers

repo

rted

any

pip

e br

eaks

wit

hin

the

last

wee

k?Pip

e bre

aks p

ose a

risk t

o wat

er qu

ality

as co

ntam

inant

s can

ente

r the

syste

m th

roug

h the

brea

k, pa

rticu

larly

if the

distr

ibutio

n sys

tem

oper

ates

inte

rmitt

ently

. You

will

need

to as

k res

ident

s abo

ut an

y pipe

brea

ks. If

brea

ks ar

e rep

orte

d, an

swer

“Yes

”.

10.

Has

ther

e be

en d

isco

ntin

uity

in th

e la

st 1

0 da

ys?

Durin

g disc

ontin

uities

, the

distr

ibutio

n pipe

s bec

ome e

mpt

y and

pres

sure

di�e

renc

es m

ay le

ad to

ingr

ess o

f wat

er an

d silt

from

the s

oil ar

ound

the p

ipes.

As w

ater

and s

oil m

ay be

cont

amina

ted t

his po

ses a

risk t

o wat

er qu

ality.

You w

ill ne

ed to

ask r

eside

nts a

bout

disco

ntinu

ities

. Also

reco

rd th

e fre

quen

cy an

d dur

ation

, if po

ssible

. If th

ere h

as be

en a

disco

ntinu

ity, a

nswe

r “Ye

s”.

Tool

2C:

San

itar

y in

spec

tion

form

s

To

ol 2

C

60



Tool

2C:

San

itar

y in

spec

tion

form

s

Sani

tary

insp

ecti

on fo

rm �

: Rai

nwat

er h

arve

stin

gI.

Gen

eral

info

rmat

ion

Nam

e of f

acilit

y: . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

Loc

ation

and/

or na

me o

f rain

wate

r sto

rage

: . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . .

Dat

e of in

spec

tion:

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. .

Wea

ther

cond

ition

s dur

ing in

spec

tion:

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

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. . . .

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. . . .

. . . .

. . . .

. . . .

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. . . .

. . . .

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. . . .

. . . .

. . . .

. . . .

.

Note

: If th

e fac

ility u

ses o

ther

wat

er so

urce

s (su

ch as

sprin

gs or

bore

holes

), ca

rry ou

t san

itary

insp

ectio

ns fo

r the

se so

urce

s too

.

II. S

peci

�c q

uest

ions

for a

sses

smen

t1.

Is th

ere a

ny vi

sible

cont

amina

tion o

f the

roof

catch

men

t are

a (pla

nts,

dirt,

or ex

creta

)? .

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

Yes

N

o2.

Are t

he gu

tterin

g cha

nnels

that

colle

ct wa

ter d

irty?

.

..

..

..

..

..

..

..

..

..

..

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..

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..

..

. Y

es

No

3. Is

ther

e any

de�c

iency

in th

e �lte

r box

at th

e tan

k inl

et (e

.g. la

cks �

ne gr

avel)

? .

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

Yes

N

o4.

Is th

ere a

ny ot

her p

oint o

f ent

ry to

the t

ank t

hat i

s not

prop

erly

cove

red?

..

..

..

..

..

..

..

..

..

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..

..

..

..

..

. Y

es

No

5. Is

ther

e any

defec

t in t

he w

alls o

r top

of th

e tan

k (e.g

. cra

cks)

that

could

let w

ater

in?

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

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..

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..

..

..

..

..

..

..

..

..

..

..

..

Yes

N

o6.

Is th

e tap

leak

ing or

othe

rwise

defec

tive?

..

..

..

..

..

..

..

..

..

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..

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..

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..

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..

..

..

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..

..

..

..

..

..

..

..

..

..

Yes

N

o7.

Is th

e con

crete

�oor

unde

r the

tap d

efecti

ve or

dirty

? ..

..

..

..

..

..

..

..

..

..

..

..

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..

..

..

..

Yes

N

o8.

Is th

e wat

er co

llecti

on ar

ea in

adeq

uate

ly dr

ained

? .

..

..

..

..

..

..

..

..

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..

..

..

..

Yes

N

o9.

Is th

ere a

ny so

urce

of po

llutio

n aro

und t

he ta

nk or

wat

er co

llecti

on ar

ea (e

.g. ex

creta

)? .

..

..

..

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..

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..

..

Yes

N

o10

. Is a

buck

et in

use a

nd le

ft in

a plac

e whe

re it

may

beco

me c

onta

mina

ted?

..

..

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..

..

Yes

N

oTo

tal s

core

of ri

sk fa

ctor

s as t

otal

num

ber o

f “YE

S” an

swer

s: __

__

III. R

esul

ts a

nd c

omm

ents

Sani

tary

insp

ectio

n ris

k sco

re (t

ick ap

prop

riate

box

):

Impo

rtan

t poi

nts o

f risk

not

ed:

List

acco

rding

to qu

estio

n num

bers

1–10

:. .

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Add

ition

al co

mm

ents:

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. .

IV. N

ames

and

sig

natu

res

of a

sses

sors

:

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. . . .

. . . .

. . . .

. . .

Very

hig

h ris

k (ris

k sco

re: 9

–10)

Hi

gh ri

sk (r

isk sc

ore:

6–8)

M

ediu

m ri

sk (r

isk sc

ore:

3–5)

Lo

w ri

sk (r

isk sc

ore:

0–2)

To

ol 2

C

61


Tool

2C:

San

itar

y in

spec

tion

form

s

Sani

tary

insp

ecti

on fo

rm �

: Sto

rage

rese

rvoi

rsI.

Gen

eral

info

rmat

ion

Nam

e of f

acilit

y: . .

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Dat

e of in

spec

tion:

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. . .

Wea

ther

cond

ition

s dur

ing in

spec

tion:

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. . .

Loca

tion a

nd/o

r nam

e of s

tora

ge re

serv

oir: .

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. . .

Loca

tion a

nd/o

r nam

e of w

ater

sour

ce(s)

feed

ing th

e res

ervo

ir: .

. . . .

. . . .

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Note

: If th

ere i

s mor

e tha

n one

stor

age r

eser

voir u

sed i

n you

r fac

ility,

use o

ne fo

rm fo

r eac

h res

ervo

ir. If t

he st

orag

e res

ervo

ir fee

ds a

piped

distr

ibutio

n sys

tem

, also

carry

out a

SI us

ing SI

form

3: Pu

blic/y

ard t

aps a

nd pi

ped d

istrib

ution

. If t

he st

orag

e res

ervo

ir is e

quipp

ed w

ith a

tap f

or co

llecti

ng w

ater,

also

carry

out a

SI us

ing qu

estio

ns 1–

6 of S

I form

3: Pu

blic/y

ard t

aps a

nd pi

ped d

istrib

ution

.

II. S

peci

�c q

uest

ions

for a

sses

smen

t1.

Is th

ere a

ny po

int of

leak

age o

f the

pipe

betw

een s

ource

and s

tora

ge re

serv

oir?

..

..

..

..

..

..

..

..

..

..

..

..

..

..

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..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

. Y

es

No

2. Is

the p

hysic

al inf

rastr

uctu

re of

the s

tora

ge re

serv

oir cr

acke

d or l

eakin

g? .

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

Yes

N

o3.

Is th

e ins

pecti

on co

ver o

f the

stor

age r

eser

voir a

bsen

t or o

pen?

.

..

..

..

..

..

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..

..

..

. Y

es

No

4. Is

the i

nspe

ction

cove

r fau

lty, c

orro

ded o

r is th

e con

crete

arou

nd th

e cov

er da

mag

ed? .

..

..

..

..

..

..

..

..

..

..

..

..

..

..

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..

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..

..

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..

..

..

..

..

..

..

..

..

..

..

..

..

. Y

es

No

5. Is

the i

nspe

ction

cove

r visi

bly di

rty?

..

..

..

..

..

..

..

..

..

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..

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..

. Y

es

No

6. Ar

e scre

ens p

rote

cting

the a

ir ven

ts on

the s

tora

ge re

serv

oir m

issing

or da

mag

ed? .

..

..

..

..

..

..

..

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..

..

. Y

es

No

7. If t

here

is an

over

�ow

pipe,

is th

e scre

en pr

otec

ting i

t miss

ing or

dam

aged

? .

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

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..

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..

..

Yes

N

o8.

Is th

ere a

ny sc

um or

fore

ign ob

ject i

n the

stor

age r

eser

voir?

.

..

..

..

..

..

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..

. Y

es

No

9. Is

the d

iversi

on di

tch ab

ove t

he st

orag

e res

ervo

ir abs

ent o

r non

-func

tiona

l? .

..

..

..

..

..

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..

..

Yes

N

o10

. Is t

he ar

ea ar

ound

the s

tora

ge re

serv

oir un

fence

d or is

the f

ence

dam

aged

, allo

wing

anim

als to

acce

ss th

e are

a? .

..

..

..

..

..

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..

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..

..

Yes

N

o11

. Is t

he st

orag

e res

ervo

ir not

regu

larly

clean

ed an

d disi

nfec

ted?

..

..

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. Y

es

No

Tota

l sco

re of

risk

fact

ors a

s tot

al n

umbe

r of “

YES”

answ

ers:

____

III. R

esul

ts a

nd c

omm

ents

Sani

tary

insp

ectio

n ris

k sco

re (t

ick ap

prop

riate

box

):

Impo

rtan

t poi

nts o

f risk

not

ed:

List

acco

rding

to qu

estio

n num

bers

1–11

:. .

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Add

ition

al co

mm

ents:

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. .

IV. N

ames

and

sig

natu

res

of a

sses

sors

:

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. . .

Very

hig

h ris

k (ris

k sco

re: 9

–11)

Hi

gh ri

sk (r

isk sc

ore:

6–8)

M

ediu

m ri

sk (r

isk sc

ore:

3–5)

Lo

w ri

sk (r

isk sc

ore:

0–2)

To

ol 2

C

62



Not

es fo

r SI f

orm

�: S

tora

ge re

serv

oirs

1.

Is th

ere

any

poin

t of l

eaka

ge o

f the

pip

e be

twee

n so

urce

and

sto

rage

rese

rvoi

r?If p

ipes a

re da

mag

ed or

leak

ing th

en cr

acks

may

prov

ide a

rout

e for

cont

amina

nts t

o ent

er th

e pipe

s. Wat

ch ou

t for

stag

nant

wat

er or

unex

pecte

d �ow

s of w

ater

abov

e gro

und.

If you

obse

rve l

eaks

, ans

wer “

Yes”.

2.

Is th

e ph

ysic

al in

fras

truc

ture

of t

he s

tora

ge re

serv

oir c

rack

ed o

r lea

king

?Cr

acks

allow

cont

amina

nts t

o rea

ch th

e wat

er st

ored

in th

e tan

k; lea

kage

also

lead

s to l

oss o

f wat

er. If

you �

nd de

ep cr

acks

that

pene

trate

the t

ank,

answ

er “Y

es”.

3.

Is th

e in

spec

tion

cov

er o

f the

sto

rage

rese

rvoi

r abs

ent o

r ope

n?If t

here

is no

insp

ectio

n cov

er, or

the c

over

is no

t clos

ed at

the t

ime o

f insp

ectio

n, it

allow

s con

tam

inant

s (su

ch as

bird

drop

pings

or ot

her f

aece

s fro

m ro

dent

s or c

ats)

to re

ach t

he w

ater

stor

ed in

the t

ank r

apidl

y, es

pecia

lly in

wet

wea

ther.

If yo

u obs

erve

eith

er of

thes

e pro

blem

s, an

swer

“Yes

”.

4.

Is th

e in

spec

tion

cov

er fa

ulty

, cor

rode

d or

is th

e co

ncre

te a

roun

d th

e co

ver d

amag

ed?

Corro

ded o

r dam

aged

cove

rs an

d cra

cked

conc

rete

surro

unds

allow

cont

amina

nts (

such

as bi

rd dr

oppin

gs or

othe

r fae

ces f

rom

rode

nts o

r cat

s) to

reac

h the

wat

er st

ored

in th

e tan

k rap

idly,

espe

cially

in w

et w

eath

er. If

you o

bser

ve an

y of

thes

e pro

blem

s, an

swer

“Yes

”.

5.

Is th

e in

spec

tion

cov

er v

isib

ly d

irty

?If t

he in

spec

tion c

over

is co

ntam

inate

d by f

aece

s (fo

r exa

mple

, from

bird

s or r

oden

ts), s

pider

web

s, ins

ects,

soil o

r slim

e, th

is po

ses a

risk t

o wat

er qu

ality.

If yo

u obs

erve

any o

f the

se pr

oblem

s, an

swer

“Yes

”.

6.

Are

scr

eens

pro

tect

ing

the

air v

ents

on

the

stor

age

rese

rvoi

r mis

sing

or d

amag

ed?

If the

re ar

e no s

creen

s pro

tecti

ng th

e air v

ents,

or if

they

are d

amag

ed, t

his al

lows i

nsec

ts an

d oth

er an

imals

(suc

h as b

irds a

nd ro

dent

s) to

acce

ss th

e res

ervo

ir. Th

is po

ses a

risk t

o wat

er qu

ality.

If yo

u obs

erve

eith

er of

thes

e pro

blem

s, an

swer

“Y

es”.

7.

If th

ere

is a

n ov

er�o

w p

ipe,

is th

e sc

reen

pro

tect

ing

it m

issi

ng o

r dam

aged

?If t

here

are n

o scre

ens p

rote

cting

the o

ver�

ow pi

pe, o

r if th

ey ar

e dam

aged

, this

allow

s ins

ects

and o

ther

anim

als (s

uch a

s bird

s and

rode

nts)

to ac

cess

the r

eser

voir.

This

pose

s a ris

k to w

ater

quali

ty. If

you o

bser

ve ei

ther

of th

ese p

roble

ms,

answ

er “Y

es”.

8.

Is th

ere

any

scum

or f

orei

gn o

bjec

t in

the

stor

age

rese

rvoi

r?If t

here

is an

y scu

m �o

ating

on th

e sur

face o

f the

wat

er ta

ble (f

or ex

ample

, inse

cts, fo

am or

alga

e), o

r if th

ere a

re an

y oth

er ob

jects

on th

e gro

und o

f the

rese

rvoir

(for

exam

ple, d

ead a

nimals

or ru

bbish

), th

is po

ses a

risk t

o wat

er qu

ality.

If yo

u obs

erve

any o

f the

se co

nditi

ons,

answ

er “Y

es”.

9.

Is th

e di

vers

ion

ditc

h ab

ove

the

stor

age

rese

rvoi

r abs

ent o

r non

-fun

ctio

nal?

The r

ole of

the d

itch i

s to p

rote

ct th

e res

ervo

ir fro

m su

rface

runo

� by

dire

cting

it do

wnhil

l and

away

from

the r

eser

voir.

If the

ditch

is �l

led w

ith w

aste

or po

orly

cont

oure

d the

n run

o� ca

n coll

ect a

nd in

�ltra

te ne

ar th

e res

ervo

ir, po

ssibly

ca

using

dam

age t

o the

infra

struc

ture

or po

sing a

risk t

o wat

er qu

ality

due t

o ing

ress

into t

he re

serv

oir. Y

ou sh

ould

look f

or w

ater

or w

aste

colle

cted i

n the

ditch

. If th

e ditc

h is a

bsen

t or n

ot fu

nctio

ning c

orre

ctly,

answ

er “Y

es”.

10.

Is th

e ar

ea a

roun

d th

e st

orag

e re

serv

oir u

nfen

ced

or is

the

fenc

e da

mag

ed, a

llow

ing

anim

als

to a

cces

s th

e ar

ea?

If the

re is

no fe

nce –

or if

the f

ence

is in

appr

opria

te (f

or ex

ample

, too

low

or no

t equ

ipped

with

a fu

nctio

ning g

ate)

or da

mag

ed –

anim

als (i

nclud

ing th

ose u

sed f

or co

llecti

ng th

e wat

er),

can a

ccess

the r

eser

voir a

rea.

They

may

caus

e da

mag

e to i

t and

pollu

te th

e are

a with

excre

ta. Y

ou w

ill ne

ed to

chec

k whe

ther

anim

als ar

e rou

tinely

in th

e are

a by a

sking

resid

ents

and b

y per

sona

l obs

erva

tion i

n the

area

(inc

luding

seein

g any

anim

al ex

creta

at th

e site

). If y

ou ob

serv

e any

of

thes

e pro

blem

s or if

the a

rea i

s unf

ence

d, an

swer

“Yes

”.

11.

Is th

e st

orag

e ta

nk n

ot re

gula

rly

clea

ned

and

disi

nfec

ted?

The s

tora

ge ta

nk sh

ould

be w

ashe

d with

soap

and w

ater,

then

the w

hole

of th

e ins

ide w

iped u

sing 0

.5% ch

lorine

solut

ion. T

his sh

ould

occu

r thr

ee or

four

tim

es pe

r yea

r. If t

his is

not d

one,

answ

er “N

o”.

Tool

2C:

San

itar

y in

spec

tion

form

s

To

ol 2

C

63


Haz

ards

(pro

blem

s)

List t

he m

ain ha

zard

s (pr

oblem

s) th

at yo

u fac

e. Th

ese w

ill be

ind

icato

rs th

at w

ere s

core

d or

Risk

s

List t

he po

ssible

risks

asso

ciate

d with

each

haza

rd (p

roble

m)

Leve

l of r

isk

vs.

feas

ibili

ty o

f ad

dres

sing

pro

blem

Place

indic

ator n

umbe

r on g

rid

for ea

ch ris

k (se

e Figu

re 3.3

)

Act

ions

Agre

ed ac

tions

to be

unde

rtake

n eith

er lo

cally

or at

the d

istric

t/re

giona

l leve

ls.

Facil

ity/co

mm

unity

Dist

rict/r

egio

nal

Wat

er

Sani

tatio

n an

d he

alth

care

was

te

Tool

3: H

azar

d an

d ri

sk a

sses

smen

t Da

te of

asse

ssm

ent:

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

.

Note

: Thr

ee ro

ws ar

e pro

vided

for e

ach d

omain

. If m

ore t

han t

hree

haza

rds a

re id

enti�

ed, c

ontin

ue on

an ad

dition

al sh

eet.

To

ol 3

64



Haz

ards

(pro

blem

s)

List t

he m

ain ha

zard

s (pr

oblem

s) th

at yo

u fac

e. Th

ese w

ill be

ind

icato

rs th

at w

ere s

core

d or

Risk

s

List t

he po

ssible

risks

asso

ciate

d with

each

haza

rd (p

roble

m)

Leve

l of r

isk

vs.

feas

ibili

ty o

f ad

dres

sing

pro

blem

Place

indic

ator n

umbe

r on g

rid

for ea

ch ris

k (se

e Figu

re 3.3

)

Act

ions

Agre

ed ac

tions

to be

unde

rtake

n eith

er lo

cally

or at

the d

istric

t/re

giona

l leve

ls.

Facil

ity/co

mm

unity

Dist

rict/r

egio

nal

Hygi

ene

Man

agem

ent

Tool

3: H

azar

d an

d ri

sk a

sses

smen

t

To

ol 3

65


To

ol 3

Haz

ards

(pro

blem

s)

List t

he m

ain ha

zard

s (pr

oblem

s) th

at yo

u fac

e. Th

ese w

ill be

ind

icato

rs th

at w

ere s

core

d or

Risk

s

List t

he po

ssible

risks

asso

ciate

d with

each

haza

rd (p

roble

m)

Leve

l of r

isk

vs.

feas

ibili

ty o

f ad

dres

sing

pro

blem

Place

indic

ator n

umbe

r on g

rid

for ea

ch ris

k (se

e Figu

re 3.3

)

Act

ions

Agre

ed ac

tions

to be

unde

rtake

n eith

er lo

cally

or at

the d

istric

t/re

giona

l leve

ls.

Facil

ity/co

mm

unity

Dist

rict/r

egio

nal

Wat

er1.3

No d

rinkin

g-wa

ter st

ation

s are

avail

able

in the

fac

ility,

theref

ore s

taff a

nd pa

tients

are u

nable

to

drink

wate

r at f

acilit

y and

no w

ater is

avail

able

for

swall

owing

med

icine

s.

Risk

of w

aterb

orne

illnes

s whe

n pat

ients

drink

un

safe

water

. Fa

cility

to in

stall

cove

red cl

ean c

ontai

ner

andregula

rlyfilland

chlor

inate.

Autho

rities

to ex

tend

piping

into

facilit

y and

ins

talllongertermfilter

sto

treat

wate

r at p

oint o

f co

llecti

on.

1.6 So

me en

dpoin

ts in

the w

ater s

upply

are n

ot wo

rking

, taps

are b

locke

d or b

roke

n. Wa

ter is

not

avail

able

from

the ta

ps in

the m

atern

ity w

ard.

Clea

ning c

anno

t be c

arrie

d out

as ea

sily a

fter

delive

ring,

leadin

g to r

isk of

infec

tion f

or st

aff an

d pa

tients

. Wate

r not

avail

able

for ha

nd hy

giene

, or f

or

wome

n to w

ash t

hems

elves

after

delive

ring.

Risk

of

infec

tion,

less d

ignity

for w

omen

.

Clea

ners

to rem

ove d

ebris

; plu

mbers

to re

pair b

roke

n pip

es on

ce pa

rts re

ceive

d.Au

thorit

ies pr

ovide

new

pipes

/valv

es to

mak

e rep

airs.

1.9 T

he fa

cility

does

not c

urren

tly tr

eat w

ater, a

nd

beca

use o

f poo

r stor

age a

nd ha

ndlin

g as w

ell as

un

safe

munic

ipal s

uppli

es, w

ater q

uality

does

not

meet

drink

ing-w

ater s

tanda

rds or

stan

dards

for

munic

ipal us

es.

Staff

and p

atien

ts at

risk o

f infec

tion f

rom

unsa

fe wa

ter.

Facil

ity to

safel

y stor

e wa

ter an

d, if p

ossib

le,

use c

hlorin

e trea

tmen

t wh

ile lo

nger

term

, mor

e su

staina

ble op

tions

are

soug

ht.

Distri

ct au

thorit

ies to

wor

k wit

h par

tners

to se

cure

treat

ment

(i.e. e

lectro

-chlorina

tororfilter

).Re

giona

l auth

oritie

s to

prior

itize t

reatm

ent o

f wa

ter su

pplie

d to h

ealth

ca

re fac

ilities

.

1.6

1.3 1.9

Tool

3: H

azar

d an

d ri

sk a

sses

smen

t exa

mpl

eDa

te of

asse

ssm

ent:

26 M

arch

201

7 (Ye

ar 1)

Note

: Thr

ee ro

ws ar

e pro

vided

for e

ach d

omain

. If m

ore t

han t

hree

haza

rds a

re id

enti�

ed, c

ontin

ue on

an ad

dition

al sh

eet.

1.6 So

me en

dpoin

ts in

the w

ater s

upply

are n

ot wo

rking

, taps

are b

locke

d or b

roke

n. Wa

ter is

not

1.6 So

me en

dpoin

ts in

the w

ater s

upply

are n

ot wo

rking

, taps

are b

locke

d or b

roke

n. Wa

ter is

not

1.6 So

me en

dpoin

ts in

the w

ater s

upply

are n

ot av

ailab

le fro

m the

taps

in th

e mate

rnity

war

d.wo

rking

, taps

are b

locke

d or b

roke

n. Wa

ter is

not

avail

able

from

the ta

ps in

the m

atern

ity w

ard.

work

ing, ta

ps ar

e bloc

ked o

r bro

ken.

Water

is no

t

1.9 T

he fa

cility

does

not c

urren

tly tr

eat w

ater, a

nd

beca

use o

f poo

r stor

age a

nd ha

ndlin

g as w

ell as

1.9

The

facil

ity do

es no

t cur

rently

trea

t wate

r, and

be

caus

e of p

oor s

torag

e and

hand

ling a

s well

as

1.9 T

he fa

cility

does

not c

urren

tly tr

eat w

ater, a

nd

unsa

fe mu

nicipa

l sup

plies

, wate

r qua

lity do

es no

t be

caus

e of p

oor s

torag

e and

hand

ling a

s well

as

unsa

fe mu

nicipa

l sup

plies

, wate

r qua

lity do

es no

t be

caus

e of p

oor s

torag

e and

hand

ling a

s well

as

meet

drink

ing-w

ater s

tanda

rds or

stan

dards

for

unsa

fe mu

nicipa

l sup

plies

, wate

r qua

lity do

es no

t me

et dr

inking

-wate

r stan

dards

or st

anda

rds fo

r un

safe

munic

ipal s

uppli

es, w

ater q

uality

does

not

1.9 T

he fa

cility

does

not c

urren

tly tr

eat w

ater, a

nd

beca

use o

f poo

r stor

age a

nd ha

ndlin

g as w

ell as

1.9

The

facil

ity do

es no

t cur

rently

trea

t wate

r, and

be

caus

e of p

oor s

torag

e and

hand

ling a

s well

as

1.9 T

he fa

cility

does

not c

urren

tly tr

eat w

ater, a

nd

unsa

fe mu

nicipa

l sup

plies

, wate

r qua

lity do

es no

t be

caus

e of p

oor s

torag

e and

hand

ling a

s well

as

unsa

fe mu

nicipa

l sup

plies

, wate

r qua

lity do

es no

t be

caus

e of p

oor s

torag

e and

hand

ling a

s well

as

meet

drink

ing-w

ater s

tanda

rds or

stan

dards

for

unsa

fe mu

nicipa

l sup

plies

, wate

r qua

lity do

es no

t me

et dr

inking

-wate

r stan

dards

or st

anda

rds fo

r un

safe

munic

ipal s

uppli

es, w

ater q

uality

does

not

munic

ipal us

es.

meet

drink

ing-w

ater s

tanda

rds or

stan

dards

for

munic

ipal us

es.

meet

drink

ing-w

ater s

tanda

rds or

stan

dards

for

66



Cate

gori

zing

pro

blem

s an

d ri

sks

by th

e le

vel o

f di�

cult

y to

add

ress

the

prob

lem

or r

isk

This

is a

sec

ond

optio

n fo

r ran

king

the

haza

rds.

Plot

ting

all t

he le

vels

of r

isk

vs. t

he fe

asib

ility

of a

ddre

ssin

g th

e pr

oble

m, f

or e

ach

haza

rd id

enti�

ed, o

n th

e fo

llow

ing

mas

ter

grid

can

ass

ist i

n de

velo

ping

the

impr

ovem

ent p

lan

and

prio

ritiz

ing

actio

ns (T

ask

4).

Hig

her r

isk

Mor

e di

�cu

lt to

add

ress

Hig

her r

isk

Easi

er to

add

ress

Low

er ri

skM

ore

di�

cult

to a

ddre

ss

Low

er ri

skEa

sier

to a

ddre

ss

Di�culty of addressing problem

Seri

ousn

ess

of ri

sk

Seri

ousn

ess

of ri

sk

Di�culty of addressing problem

Prob

lem

s/ha

zard

s

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. . . .

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To

ol 3

67


Wha

t spe

ci�c

impr

ovem

ent

acti

on w

ill b

e ta

ken

to re

solv

e th

e ha

zard

s id

enti

�ed?

The a

ction

s to b

e tak

en lin

k to t

he

haza

rds r

ecor

ded i

n Too

l 3

Who

will

car

ry o

ut th

e ta

sk

and

is th

ere

anyo

ne w

ho w

ill

supe

rvis

e it

?

List p

eople

resp

onsib

le fo

r im

plem

enta

tion

Wha

t res

ourc

es

are

need

ed to

do

it?

Reso

urce

s cou

ld be

sta�

, te

chnic

al or

�nan

cial

Whe

n do

you

ex

pect

to

com

plet

e th

is

acti

on?

Indic

ate t

arge

t dat

e

Com

plet

ion

date

Once

the a

ctivit

y has

be

en co

mple

ted,

reco

rd

the d

ate o

f com

pletio

n

Task

5: M

onit

orin

g

Whe

n yo

u re

view

the p

lan,

how

doe

s it n

eed

to b

e ch

ange

d?

Wha

t, if a

ny, a

dditi

onal

e�or

ts ar

e nee

ded?

Re

view

1Re

view

2

Wat

er

Sani

tatio

n an

d he

ath

care

was

te

Hygi

ene

Man

agem

ent

Tool

4: I

mpr

ovem

ent p

lan

Date

impr

ovem

ent p

lan

writ

ten:

. . .

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. . . .

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e Rev

iew

1: .

. . . .

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. . . .

. . D

ate R

evie

w 2:

. . .

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. . . .

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. . . .

. . . .

. . . .

To

ol 4

68



Wha

t spe

ci�c

impr

ovem

ent

acti

on w

ill b

e ta

ken

to re

solv

e th

e ha

zard

s id

enti

�ed?

The a

ction

s to b

e tak

en lin

k to t

he

haza

rds r

ecor

ded i

n Too

l 3

Who

will

car

ry o

ut th

e ta

sk

and

is th

ere

anyo

ne w

ho w

ill

supe

rvis

e it

?

List p

eople

resp

onsib

le fo

r im

plem

enta

tion

Wha

t res

ourc

es

are

need

ed to

do

it?

Reso

urce

s cou

ld be

sta�

, te

chnic

al or

�nan

cial

Whe

n do

you

ex

pect

to

com

plet

e th

is

acti

on?

Indic

ate t

arge

t dat

e

Com

plet

ion

date

Once

the a

ctivit

y has

be

en co

mple

ted,

reco

rd

the d

ate o

f com

pletio

n

Task

5: M

onit

orin

g

Whe

n yo

u re

view

the p

lan,

how

doe

s it n

eed

to b

e ch

ange

d?

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t, if a

ny, a

dditi

onal

e�or

ts ar

e nee

ded?

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view

1Re

view

2

Wat

er1.3

Drin

king-

water

stat

ions t

o be

boug

ht an

d ins

talled

in w

aiting

ar

eas.

Jaco

b to a

ssign

budg

et for

pu

rcha

sing a

nd so

urce d

rinkin

g-

water

stat

ions.

Idriss

to en

sure

statio

ns ar

e ins

talled

in co

rrect

place

s.

US$1

0 pe

r stat

ion,

plusc

eramicfi

ltersat

US$4

0 ea

ch.

Total

US$5

0 x 4

ne

eded

= US

$200

.

15 A

pril.

15 A

pril.

No dr

inking

-wate

r av

ailab

le in

mater

nity

ward

so ad

dition

al sta

tions

need

to be

bo

ught

when

fund

s are

avail

able.

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aksinp

ipingwillb

efixedto

ensu

re tha

t tap

s are

work

ing.

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l eng

ineer

to be

contr

acted

to

carry

out r

epair

s to p

iping

.Tw

o day

s of w

ork a

t a

cost

of US

$10/

day.

1 Jun

e.5

June

.Ac

tion c

omple

ted. P

ipes

will b

e mon

itored

in ca

se

of an

y furt

her le

akag

es.

1.9 W

ater f

or dr

inking

-wate

r sta

tions

will b

e trea

ted us

ing

ceramicfi

ltration

.Ja

cob t

o ass

ign bu

dget

for

purc

hasin

g and

sourc

e drin

king-

wa

ter st

ation

s. Fa

toum

ata

respo

nsibl

e for

trea

ting w

ater.

Fato

umata

's tim

e.On

going

activ

ity.

Treat

ment

to sta

rt in

April

once

mate

rials

are a

vaila

ble.

Treat

ment

starte

d on

21 A

pril 2

016.

Drink

ing st

ation

s are

not

filledregularlyenough

when

wate

r sup

ply is

ab

sent.

Tool

4: I

mpr

ovem

ent p

lan

exam

ple

Date

impr

ovem

ent p

lan

writ

ten:

Mar

ch (Y

ear 1

)

Date

Rev

iew

1: S

eptem

ber (

Year

1)

Date

Rev

iew

2: D

ue M

arch

(Yea

r 2)

To

ol 4

1.3 D

rinkin

g-wa

ter st

ation

s to

be bo

ught

and i

nstal

led in

wait

ing

1.3 D

rinkin

g-wa

ter st

ation

s to

be bo

ught

and i

nstal

led in

wait

ing

1.3 D

rinkin

g-wa

ter st

ation

s to

befixed

ensu

re tha

t tap

s are

work

ing.

1.9 W

ater f

or dr

inking

-wate

r sta

tions

will b

e trea

ted us

ing

1.9 W

ater f

or dr

inking

-wate

r sta

tions

will b

e trea

ted us

ing

1.9 W

ater f

or dr

inking

-wate

r

ensu

re tha

t tap

s are

work

ing.

1.9 W

ater f

or dr

inking

-wate

r sta

tions

will b

e trea

ted us

ing

1.9 W

ater f

or dr

inking

-wate

r sta

tions

will b

e trea

ted us

ing

1.9 W

ater f

or dr

inking

-wate

r ceramicfi

ltration

.sta

tions

will b

e trea

ted us

ing

filtrat

ion.

statio

ns w

ill be t

reated

using

filtrat

ion.

6969

Annex 1Guidance for national or district level implementers and policymakers

The following section is designed for national or district level implementers who may be considering using WASH FIT. It provides a summary of best practices on how to design a training package and presents two di�erent scenarios for implementing WASH FIT. It also includes a questionnaire to help track progress of WASH FIT implementation and a timeline template for planning WASH FIT activities.

Seek input and ownership from key WASH and health stakeholders before implementationConducting a training programme without the necessary planning and stakeholder engagement will not be very fruitful. Meeting with key WASH and health stakeholders to discuss training needs, other existing training packages and appropriate timelines in line with other policy and funding mechanisms is important at the outset. This includes linking with broader quality of care initiatives, health sector policy review and planning mechanisms, as well as more targeted e�orts such as those to improve maternal and child health or infection prevention and control.

Engage health colleagues to ensure alignment with national quality initiatives, guidelines and standards and planning processesWhen adapting WASH FIT for implementation, involve health colleagues and discuss which elements of WASH FIT can be used to implement wider quality improvements. For example, the WHO Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level (WHO, 2016a) and the WHO Standards for improving quality of maternal and newborn care in health facilities (WHO, 2016c) both include speci�c standards and measures for WASH. The implementation of each of these will require WASH interventions and maintenance of WASH services and therefore speci�c WASH FIT tools (i.e. the assessment or risk assessment forms) can be adapted and incorporated into these e�orts to realize health aims.

Determine how the training will be rolled out before commencingConsider how to roll-out training at the start. Develop a timeline, roles, responsibilities and funding requirements for rolling out training, ongoing skills development and technical support and, crucially, monitoring and evaluation.

Identify target traineesIt is important to develop clear criteria for those who will undergo training. The primary trainees will be those working in health care facilities (including cleaners and maintenance individuals) – they should be individuals who demonstrate an interest and motivation to further improve their skills and competencies. Other potential trainees include national/regional/district health and water government sta� working on environmental health and/or IPC, NGO partners, facility sta�, including cleaners, and community water and health committee members. It is important that supervisors of those trained are also fully supportive of facilitating the wider system changes that need to happen in order to realize many of the goals of WASH FIT.

Adapt the training materials to suit context and needsTraining should build on existing training programmes and materials. Try not to duplicate existing e�orts. For example, if there is already a national training curriculum on IPC, sta� may already have some existing technical


70

knowledge which will help them with WASH FIT. Conversely, revision and refreshers courses can also be useful. A set of modules are available to accompany this guide on the WASH in Health Care Facilities website (http://www.washinhcf.org/resources/training/).

Include a visit to a health care facility in the trainingIf possible, hold the training at or near a health care facility and include a visit to the facility in the training. This will enable participants to gain �rst-hand experience of conducting an assessment. They should use the results of the assessment to develop an example improvement plan.

Prepare a budget that re�ects aims and available resources, with potential to scale-upThe training budget should realistically consider all the costs, which include the actual training, but also the follow-up support that is required to assist facilities in ongoing challenges and improvements. In addition, it is useful to consider the funds for physical supplies as even providing some minor, immediate improvements (such as hand hygiene stations, low-cost water �ltration or on-site chlorine generation) can help realize major improvements in reducing health risks and set the foundation for longer term improvements such as piped water.

Options for trainingThere are several options or scenarios for conducting training. Two of these – running training directly in a few facilities or districts as well as a national training of trainers – are brie�y summarized below.

Scenario A – Targeted facility trainingsIn this scenario, the training is implemented in a few facilities or pilot districts. This involves direct training of sta� (ideally in their own facility) and allows for modi�cations and re�ections on the indicators and other tools that are required for the speci�c context. Such training is also an option when resources are limited and may be an opportunity to initiate WASH FIT, demonstrate success and then, based on these positive outcomes, seek additional support from government, donors and/or other partners. Finally, it helps develop a set of “model” facilities that can be used to disseminate learning and serve as reference centres for future waves of facilities that undertake WASH FIT.

Scenario B – Regional or national trainingA second scenario is to conduct a training of trainers for a particular region or the entire country. In such cases, those trained will go on to train others, so it is particularly important that the trainers have both technical and training skills and experience. In order to roll-out such a programme e�ectively, su�cient resources are needed to ensure the material and training is eventually cascaded to all targeted health care facilities. It also means that any adaptation of the material needs to happen rapidly. The advantage is that it provides a large cohort from which to build knowledge and share lessons learned and reach many more facilities.

Continual learning and exchangeFor both scenarios, it is important to provide ongoing technical assistance and provide refresher courses. It is better to do a series of shorter trainings rather than a longer, one-o� training. Long trainings take people away from their facilities for a long time, which can have negative impacts, especially on small facilities where such individuals are critical to providing WASH and health care services to communities, often with many needs.

One possible option would to be establish peer-to-peer learning with another facility which is implementing WASH FIT. For example, conducting exchange visits between facilities, having sta� from larger facilities provide technical support to smaller facilities or establishing an email exchange for facilities to ask each other questions. Consider having one or more “model” facilities that meet an accreditation scheme or national quality standards that can serve as examples for others to follow. This will incentivize facilities to make improvements.



http://www.washinhcf.org/resources/training/

http://www.washinhcf.org/resources/training/

71

Tracking progress and improving WASH FITOnce a facility has begun to implement WASH FIT, it is essential that it is supported and guided through the process. Monitoring and evaluation require investment but are important to ensure that resources used for training are put to good use and the enabling environment for quality of care improvements is achieved. Ideally, monitoring and evaluation will be built into the health system, with district health o�cials tracking improvements and, during their regular facility supervisory visits, addressing aspects of WASH along with a host of other health issues. Exploring the use of digital tracking of improvements through phone applications may be a worthwhile investment to provide real-time inputs and immediate changes.


72

Has the WASH FIT process been started? ❑ Yes ❑ NoIf not, why not? (tick all that apply)

❑ Limited understanding of methodology

❑ Lack of �nancial resources

❑ Limited motivation for or appreciation of WASH FIT

❑ Too complicated/too many forms

❑ Other (please describe):

WASH FIT external follow-up visit questionnaire For the �rst visit, answer all questions. You may be able to skip some questions on subsequent visits.

General information

Name of the facility: District:

Date of visit:

Number of visit (e.g.1st, 2nd):

Name(s) and organization of person conducting the visit:

Name of the WASH FIT team member contributing to evaluation:

Name of the WASH FIT team lead (if di�erent):



73

Is there a WASH FIT folder/notebook available? ❑ Yes (ask to see it) ❑ No

In talking to the facility manager, do you think that leadership is engaged? (tick which applies)

❑ Yes, fully engaged and supportive of the initiative (e.g. a member of the WASH FIT team)

❑ Somewhat engaged but does not seem to be driving change

❑ Not at all engaged

Please provide additional details:

What have patient reactions been to WASH FIT? What is their attitude to it? (tick which applies)

❑ Patients are aware of WASH FIT and are engaged and supportive

❑ Patients are aware of WASH FIT but not engaged

❑ Patients are not aware of WASH FIT

Please provide additional details:

Do members of the WASH FIT team adequately understand the WASH FIT process? Ask the team to explain the WASH FIT methodology

❑ Yes, they completely understand the process and can explain it well

❑ Yes, but have only partial understanding

❑ No, limited understanding

Please provide additional details (e.g. speci�c areas of confusion/lack of understanding):


74

Task 1: Team meetingsIs there a record of the WASH FIT team? ❑ Yes ❑ No How many members are on the team?

How many times has the team met?

How often do they meet?

What date was the last team meeting?

Are there records of the team meetings?

Make a note of the feedback you gave to the WASH FIT team (if any):

Task 2: Indicators assessmentDate of baseline assessment: (indicate if no assessment completed)

Date of most recent assessment:

What number assessment is this? ❑ 1st ❑ 2nd ❑ 3rd ❑ 4th ❑ Other

If the baseline assessment has not been completed, why not? (For example, insu�cient understanding, understa�ed, etc.)

Note any changes observed since the previous evaluation:

Sanitary inspection forms completed? ❑ Yes ❑ No Which form(s) was completed? (tick all that apply)❑ SI 1: Dug well with hand pump

❑ SI 2: Borehole with motorized pump

❑ SI 3: Public/yard taps and piped distribution

❑ SI 4: Rainwater harvesting

❑ SI 5: Storage reservoirs (which can be used in combination with any abstraction methods)

How could the team improve their assessments? Provide the team with suggestions and feedback and make a note here:



75

Task 3: Hazard and risk assessment Tool 3 �lled in: ❑ Yes ❑ No List the main problems identi�ed

Area Hazards/problems identi�edWater

Sanitation

Hygiene

Management

Are the levels of risk assigned to the problems appropriate? ❑ Yes ❑ No

If not, provide details:

Task 4: Developing an improvement plan Tool 4 �lled in: ❑ Yes ❑ No What actions have been taken since the last visit?

Action taken By whom When Commentse.g. Hand washing posters printed and posted outside latrines

Idriss, caretaker 5 January Posters drawn by community members, translated into local language


76

Next steps

What speci�c actions will be taken by the WASH FIT team?Record all items identi�ed, e.g. hold a WASH FIT team meeting on dd/mm/yy, engage facility management to lend greater support to WASH in health care facility, conduct a training for cleaners, redo the assessment etc.

1.

2.

3.

4.

5.

What actions (if any) will be taken at the district level/national level?

What kind of additional support does the facility need and what actions are necessary to obtain this support? (e.g. �nancial, technical training, WASH-related supplies)

Date of next visit:

General observationsMake a note of any observations about the state of the facility and progress made on the WASH FIT process:



77

Activity planning exampleThis template is intended as an example to help plan WASH FIT activities within a facility. It can be used at the national, district or facility level. It will also help those monitoring WASH FIT to keep track of activities and ensure that the process is sustained. A few example activities are provided. These can be adapted or replaced with other activities as required.

MonthActivity Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Share the materials and lessons learned from the WASH FIT training with the rest of the facility

✘

All facility members to read the training materials and WASH FIT guide ✘

Meeting to identify external partners to join the WASH FIT team ✘

First weekly meeting of the core WASH FIT team ✘

Present the WASH FIT methodology to the rest of the team ✘

Complete baseline facility assessment with the whole team ✘

First meeting with external partners ✘

Make initial immediate improvements (e.g. install hand hygiene stations and start daily record of cleaning)

✘

Conduct review of progress and discuss longer term improvements with the district o�cials

✘

Implement improved water supply, including storage and piped water in examination rooms

✘


78

Gratitude is extended to the following experts, policymakers and practitioners who reviewed WASH FIT with the aim of making it practical and user friendly: Benedetta Allegranzi, WHO, Geneva, Switzerland; Arshad Altaf, WHO, Geneva, Switzerland; Irene Amongin, WHO, New York, United States of America; David Baguma, African Rural University, Kampala, Uganda; Isaac Yaw Barnes, Global Alliance for Sustainable Development, Accra, Ghana; Sophie Boisson, WHO, Geneva, Switzerland; John Brogan, Terre des hommes, Lausanne, Switzerland; Romain Broseus, WaterAid, New York, United States of America; Lizette Burgers, UNICEF, New York, United States of America; John Collett, World Vision, United States of America; Suzanne Cross, Soapbox, Aberdeen, United Kingdom; Lindsay Denny, Emory University, Atlanta, United States of America; Mamadou Diallo, WaterAid, Bamako, Mali; Anil Dutt Vyas, Manipal University, Jaipur, India; Erin Flynn, WaterAid, London, United Kingdom; Rick Gelting, CDC, Atlanta, United States of America; Georgia Gon, Soapbox, Aberdeen, United Kingdom; Sufang Guo, UNICEF, Kathmandu, Nepal; Moussa Ag Hamma, Direction Nationale de la Santé, Bamako, Mali; Danielle Heiberg, WASH Advocates, Washington D.C., United States of America; Alex von Hildebrand WHO, Manila, Philippines; Chelsea Huggett, WaterAid, Melbourne, Australia; Peter Hynes, World Vision, Washington D.C., United States of America; Rick Johnston, WHO, Geneva, Switzerland; Hamit Kessaly, CSSI, N’Djamena, Chad; Claire Kilpatrick, WHO, Geneva, Switzerland; Ashley Labat, World Vision, Washington D.C., United States of America; Alison Macintyre, WaterAid, Melbourne, Australia; Fatoumata Maiga Sokona, WHO, Bamako, Mali; Bijan Manavizadeh, WASH Advocates, Washington D.C., United States of America; Joanne McGri�, Emory University, Atlanta, United States of America; Estifanos Mengistu, International Medical Corps, London, United Kingdom; Arundhati Muralidharan, WaterAid, New Delhi, India; Kannan Nadar, UNICEF, Lagos, Nigeria; Françoise Naissem, Ministry of Health, N’Djamena, Chad; Jonas Naissem, WHO, N’Djamena, Chad; Francis Ndivo, WHO, Monrovia, Liberia; Stephen Ndjorge, WHO consultant, Monrovia, Liberia; Molly Patrick, CDC, Atlanta, United States of America; Margaret Person, CDC, Atlanta, United States of America; Michaela Pfei�er, WHO, Geneva, Switzerland; Sophary Phan, WHO, Phnom Penh, Cambodia; Alain Prual, UNICEF, Dakar, Senegal; Rob Quick, CDC, Atlanta, United States of America; Emilia Raila, UNICEF, Monrovia, Liberia; Katharine Anne Robb, Emory University, United States of America; Channa Sam Ol, WaterAid, Phnom Penh, Cambodia; Deepak Saxena, Indian Institute of Public Health, Gujarat, India; Dai Simazaki, National Institute of Public Health, Saitama, Japan; Kyla Smith, WaterAid, Ontario, Canada; Daniel Spaltho�, UNICEF, Ouagadougou, Burkina Faso; Julie Storr, WHO, Geneva, Switzerland; Masaki Tagehashi, National Institute of Public Health, Saitama, Japan; Niki Weber, CDC, Atlanta, United States of America; Megan Wilson, WaterAid, London, United Kingdom; Hanna Woodburn, WASH Advocates, United States of America; Yael Velleman, WaterAid, London, United Kingdom; Nabila Zaka, UNICEF, New York, United States of America; Raki Zghondi, WHO, Amman, Jordan.

Share feedbackThose who have used this guide are encouraged to send feedback to [email protected] to allow for future improvements and knowledge exchange. Please visit www.washinhcf.org to learn about the latest country e�orts in adapting and implementing WASH FIT.

Annex 2Contributors



[email protected]

www.washinhcf.org

Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Photo creditsPage iv: © WHO/Arabella HayterPage viii: © WHO/Isadore BrownPage 2: © WHO/Sergey VolkovPage 8: © WHO/Arabella HayterPage 17: © WHO/Arabella HayterPage 23: © WHO/Arabella HayterPage 30: © WHO/Arabella Hayter





Documents

Water and Sanitation for Health Facility Improvement Tool ...€¦ · Water and Sanitation for Health Facility Improvement Tool (WASH FIT˜ A practical guide for improving quality