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Sierra Leone: Enabling good hygiene practices in healthcare facilities

African Development Bank (AfDB) funding support to WASH in HCF intervention 

As part of the Emergency COVID-19 Relief Assistance for Water, Sanitation and Hygiene (WASH) Improvement Program funded by the African Development Bank (AfDB), UNICEF worked with implementing partners, Community Empowerment and Development Agency (CEDA) and Community Organization for Development and Empowerment (CODE-SL) to construct over 55 modern toilets, 33 showers, 11 laundries, and 11 waste management facilities, including incinerators for treating waste in 11 Peripheral Health Units (PHUs) across eight districts in the country. The partnership also enabled the installation of water supply systems in the 11 PHUs and the distribution of Infection Prevention and Control (IPC) materials through the District Health Management Teams (DHMTs) covering the eight districts. More information on this can be accessed at: here 

UNICEF Bolivia: Relevance of strengthening WASH services in healthcare facilities.

In Bolivia, WASH in healthcare facilities intervention in 58 health centers which include construction, rehabilitation, or refurbishment of WASH components per the need of each of the healthcare facilities enabled 97% of the first-line healthcare facilities in El Alto City to have optimized condition of access to water, sanitation, hygiene, and solid waste disposal and improve the quality of health care for more than 1 million inhabitants of 14 neighborhoods. Find more here

UNICEF’s Strategic Framework: Healthy Environments for Healthy Children

Addressing the challenge of environmental sustainability is imperative not only to keeping our Global Goals promise, but also to realizing the right to health and well-being of every child. At UNICEF, we recognize that fulfilling our mandate and protecting the most vulnerable children requires action on climate change and environmental degradation to be integrated across our global health programme. This Strategic Framework aims to support programme teams to do just that.

The State of WASH in Cameroon


In 2019 the World Health Assembly (WHA 72/A72 R7) urged member countries and organizations to conduct comprehensive assessments to quantify the availability, quality and needs for IPC/WASH in health care facilities and develop roadmaps for improvement (WHO, 2019). By 2020, all countries were supposed to have done their baseline WASH assessments, and by 2022, 60 % would have attained basic WASH coverage, 80% by 2025 and 100% by 2030.  A few years away from 2030, many countries are still lagging behind these targets and the attainment of agenda 2030 is still questionable.

Infection Prevention & Control, Water, Sanitation & Hygiene (IPC/WASH) are the foundation of quality/universal health care and the determinant for the attainment of many health interventions like hand hygiene, environmental cleaning and disinfections, antimicrobial stewardship, clean hospitals etc. Every health care facility needs necessary and functional IPC/WASH services to provide essential and quality health services to all at all times. Unfortunately, globally, nearly half the world’s population lives without a safe toilet, at least 2 billion people still use a drinking water source contaminated with feces, and only 50% of the health facilities have hand washing facilities. (WHO, 2020). According to the WHO, 2 billion people still do not have access to basic sanitation and 5% of the world population from 55 countries still practice open defecation (WHO/UNICEF, 2020). Many of them are found in developing countries like Cameroon. The absence of WASH services seriously compromises patient safety and contributes to health care associated infections, antibiotic resistance and maternal and neonatal mortality (WHO, 2019; USAID, 2018).

The Goal of the assessment

This survey is the first to be done in Cameroon and therefore aimed to generate  baseline WASH data  which could be used to advocate   for WASH improvements in Cameroon.

Design and methods

103 health facilities from 35 health districts in six of ten regions in Cameroon were assessed  from November 29 to December 31, 2020. WHO/UNICEF WASH Facility Improvement tool (WASHFIT) and Hand Hygiene Self-Assessment tool was used.  All health facilities were included irrespective of type and ownership. The teams were well received and accepted in all the facilities visited. Access permission was obtained on the day of the assessment. Each facility was assessed by a trained monitor accompanied by a staff of each facility designated by the head of the facility. The trained monitor gave some brief orientation on how to use the tool on the spot and both the staff and the monitor independently graded the facility and compared their observations at the end of the session, to ensure that the staff was comfortable with the monitor observation. Where there was any disparity, the monitor discussed his or her score with the staff to arrive at a consensus  All the components of the WASHFIT tool including water, sanitation, hand hygiene, environmental cleaning and disinfection, health care waste, and management were covered. The indicators that were fully met were then used to calculate WASH coverage for each facility.

Results(see details on power point)

We found that WASH coverage is low in Cameroon, the lowest in health posts, followed by integrated health centers compared to hospitals.


There is a serious need to improve wash in Cameroon with particular attention at health posts and integrated health centers.

Integrating Disaster Risk Reduction and climate change adaptation in WASH in Healthcare assessment and planning


In Vanuatu, health-care facilities are struggling to adequately function during normal operation due to poor WASH services. Worse yet, natural disasters can substantially impose stress on existing WASH services impacting water supply, sanitation and hygiene infrastructure. In April 2020, Tropical Cyclone (TC) Harold hit Vanuatu and caused significant damage to WASH infrastructure in 98 health facilities.  Of the 98 facilities assessed, 18% reported non-functioning toilets and 45% reported damage to the facilities water systems. With WASH infrastructure damaged, health facilities ceased to provide essential medical care to the injured and sick or resorted to alternative, less safe water options, including rivers and streams. Provincial Emergency Operations Centers (PEOC) situation reports recorded numerous casualties, five deaths, and cases of diarrhoea, acute respiratory infections, acute fever amongst children and adults in affected areas as a result of inadequate water, sanitation, and hygiene conditions in health facilities and communities.  

Vanuatu is the most at-risk country for natural hazards in the world, an estimated 64% of the population is impacted by a disaster each year. The direct damage cost to WASH infrastructure in health care facilities during TC Harold was estimated at $ 1, 611, 930 USD. With climate change increasing the risks, an effective method for identifying and mitigating these risks in health facilities preparedness is crucial.  

This case study highlights key actions undertaken by Vanuatu government to integrate Disaster Risk Reduction and Climate Change Adaptation measures in assessment and planning to improve long-term sustainability of WASH services in HealthCare facilities in both peace and emergency. 


A national WASH in Healthcare facilities assessment tool, WASH in Heltkea (WinHK) template was developed by adapting the Vanuatu Department of Water Resources Drinking Water Safety and Security Plan template and WASH FIT template. Additional data and feedback was collected through key informant interviews with key staff from the Ministry of Health (MoH), Department of Water Resources (DoWR), and EWBNZ, and Hexagon WASH Specialist who led the development of the assessment tool. This additional feedback was incorporated into the tool.  


Recognizing the need to create resilient and strong water, sanitation, and hygiene (WASH) systems in healthcare facilities, the government of Vanuatu  created a national WASH in Healthcare facility (WinHK) assessment tool in collaboration with EWBNZ and UNICEF. The WinHK tool is a participatory process for healthcare facility (HCF) committees to review WASH and IPC related risk including climate risks and create an action plan to address those risks as part of continuous improvements and disaster preparedness. When facilitated at the facility level, it triggers disaster risk reduction actions whilst setting infrastructure provision standards that are climate resilient for system upgrades. In water stressed areas, solar pumped groundwater and other alternatives are recommended improvements to complement existing rainwater harvesting systems and to meet the water demand at the healthcare facility. Rainwater harvesting storage tanks have been reinforced with cyclone strapping to withstand strong gale force wind. The disaster risk reduction planning component of the WinHK tool encourages health committees to proactively carry out key early warning preparedness measures to safely manage and secure WASH infrastructure prior to onset of disasters. They are also encouraged to consider the location of WASH infrastructure in relation to natural disasters such as flooding and landslides. The template strongly supports participation of women and girls in healthcare facility planning and overall decision making. This combined approach all works towards achieving resilient and “Safely Managed” service provision as key target of the SDGs. The government of Vanuatu is implementing an innovative approach for WASH resilience focusing on providing health care facilities with the capacity to adapt and manage to climate risk, rather than just providing infrastructure.  


To ensure sustainable and equitable service at HCF, governments, stakeholders, and communities need knowledge and skills to identify and manage WASH risks associated with climate change and natural hazards prominent in Vanuatu. The WinHK tool contextualized and tested in four provinces will be used to develop climate sensitive improvement plans to support upgrade of resilient WASH services in healthcare facilities

Case study on the use of innovative approaches to enable safe water and environmental cleaning practices

A path for scaling-up technology, capacities and solutions

Different type electric chlorinators were installed in targeted health care facilities in response to Covid19. A total of 35 electrolytic chlorinators were installed in 35 Hospitals across the country during 2020/21.

  • The machine allows the production of 4 liters of CL for 1KG of table salt, which is used for disinfection of water and cleaning surfaces.
  • Patients and surrounding communities were engaged to understand their needs for the product
  • Communities provide salt to hospitals, and also exchange salt with other commodities (soap and hand sanitizer)
  • Win-win situation for both communities and HCF


David Simon


Case study in Haiti

This case study highlights the WASH infrastructure and hygiene promotion intervention in health care facilities in response to Covid19 and its impact on addressing the risk of the infection transmission.

Find more here

Lesson on WASH in HCFs intervention in Uganda

This project is a 12-month project with support from the Government of Japan. The project supported the Government of Uganda COVID-19 emergency response through provision of life saving health, nutrition, water, sanitation and Hygiene (WASH) services in the most vulnerable districts, including refugee hosting districts, Karamoja and COVID-19 hotspot areas in Uganda.

The specific WASH interventions were;

  • Upgrading of water systems, solar powered systems
  • provision of latrine facilities for patients (separate for men and women) including bathing facility for women near the maternity ward.
  • Provision of facilities for waste management (incinerator, placenta pit and other solid waste management systems
  • Provision of WASH supplies.
  • Mentoring of health workers on infection prevention and control.

More details are found here