water and sanitation for health facility improvement tool
TRANSCRIPT
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)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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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
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Nurse at primary health care centre, Ségou, Mali.
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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
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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
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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
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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
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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
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
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
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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
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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.
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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.
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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.
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
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
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N, V
ISIO
N A
ND
ACC
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BIL
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OTIVATIO
N, V
ISION
AN
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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
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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
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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.
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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.
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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
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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).
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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”.
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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.
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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.
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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.
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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.
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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
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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.
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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
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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?
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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.
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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.
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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.
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Task
4
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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.
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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).
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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.
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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
HEALTH CARE FACILITIESWASH IN
FOR BETTER HEALTH CARE SERVICES
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
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
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
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
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)
HEALTH CARE FACILITIESWASH IN
FOR BETTER HEALTH CARE SERVICES
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
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
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
.
HEALTH CARE FACILITIESWASH IN
FOR BETTER HEALTH CARE SERVICES
To
ol 1
B
35
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
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
HEALTH CARE FACILITIESWASH IN
FOR BETTER HEALTH CARE SERVICES
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
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
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
HEALTH CARE FACILITIESWASH IN
FOR BETTER HEALTH CARE SERVICES
* 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
39
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
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:
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
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. . . .
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Note
s: . .
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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
HEALTH CARE FACILITIESWASH IN
FOR BETTER HEALTH CARE SERVICES
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
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
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
HEALTH CARE FACILITIESWASH IN
FOR BETTER HEALTH CARE SERVICES
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
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
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
HEALTH CARE FACILITIESWASH IN
FOR BETTER HEALTH CARE SERVICES
* 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
45
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
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:
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
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. . . .
. . . .
. . . .
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Note
s: . .
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To
ol 2
A
* See
asso
ciate
d no
te3
46
HEALTH CARE FACILITIESWASH IN
FOR BETTER HEALTH CARE SERVICES
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
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
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
HEALTH CARE FACILITIESWASH IN
FOR BETTER HEALTH CARE SERVICES
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
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
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: . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
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. . . .
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.. . . .
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. . . .
. . . .
To
ol 2
A
Man
agem
ent
44444444
50
HEALTH CARE FACILITIESWASH IN
FOR BETTER HEALTH CARE SERVICES
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
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
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
HEALTH CARE FACILITIESWASH IN
FOR BETTER HEALTH CARE SERVICES
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
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
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
HEALTH CARE FACILITIESWASH IN
FOR BETTER HEALTH CARE SERVICES
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
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
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
HEALTH CARE FACILITIESWASH IN
FOR BETTER HEALTH CARE SERVICES
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
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
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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. . . .
. . . .
. . . .
. .
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?
.
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
. Y
es
No
10. I
s chl
orine
pres
ent a
t the
sam
pling
tap?
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
. 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
HEALTH CARE FACILITIESWASH IN
FOR BETTER HEALTH CARE SERVICES
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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..
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..
..
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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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..
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..
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..
..
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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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..
..
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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..
..
. 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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..
..
. 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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..
..
. 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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..
..
..
..
..
..
..
..
..
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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. . . .
. . . .
. .
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
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
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
HEALTH CARE FACILITIESWASH IN
FOR BETTER HEALTH CARE SERVICES
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:
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
.
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?
.
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
. 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?
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
. 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?
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
Yes
N
o6.
Is th
e tap
leak
ing or
othe
rwise
defec
tive?
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
Yes
N
o7.
Is th
e con
crete
�oor
unde
r the
tap d
efecti
ve or
dirty
? ..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
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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..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
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?
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
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
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
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? .
..
..
..
..
..
..
..
..
..
..
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..
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..
..
..
..
..
..
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..
..
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..
..
..
..
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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..
..
..
..
..
..
..
..
..
. Y
es
No
5. Is
the i
nspe
ction
cove
r visi
bly di
rty?
..
..
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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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..
..
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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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..
..
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
HEALTH CARE FACILITIESWASH IN
FOR BETTER HEALTH CARE SERVICES
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
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
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
HEALTH CARE FACILITIESWASH IN
FOR BETTER HEALTH CARE SERVICES
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
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
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
HEALTH CARE FACILITIESWASH IN
FOR BETTER HEALTH CARE SERVICES
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
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
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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. . . .
. . . .
Dat
e Rev
iew
1: .
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. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . D
ate R
evie
w 2:
. . .
. . . .
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. . . .
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. . . .
. . . .
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To
ol 4
68
HEALTH CARE FACILITIESWASH IN
FOR BETTER HEALTH CARE SERVICES
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
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.
1.6Le
aksinp
ipingwillb
efixedto
ensu
re tha
t tap
s are
work
ing.
Loca
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
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
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.
HEALTH CARE FACILITIESWASH IN
FOR BETTER HEALTH CARE SERVICES
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.
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
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):
HEALTH CARE FACILITIESWASH IN
FOR BETTER HEALTH CARE SERVICES
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):
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
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:
HEALTH CARE FACILITIESWASH IN
FOR BETTER HEALTH CARE SERVICES
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
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
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:
HEALTH CARE FACILITIESWASH IN
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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
✘
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
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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.
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Annex 2Contributors
HEALTH CARE FACILITIESWASH IN
FOR BETTER HEALTH CARE SERVICES
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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
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
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