In Cambodia, there are now more babies being delivered by health professionals and more women choosing to deliver at a health facility than ever before[1]. A significant decline in the maternal mortality ratio has been reported, from 472 deaths per 100,000 live births in 2005, to 170 deaths per 100,000 live births in 2014[2]. However demographic and health data show a much slower decrease in the rate of neonatal mortality, which now accounts for half of all deaths in children under-five[3]. As a result, there has been a renewed focus on improving the quality of care provided at health care facilities in Cambodia.

Currently, a comprehensive understanding of the status of water, sanitation and hygiene facilities and practices is not known. The National Institute of Public Health undertook a study to assess (1) policies and planning, including standards and coverage targets related to WASH in HCFs; (2) related monitoring and evaluation mechanisms, tools and data, in particular the routine facility data collected through Health Management Information System and health facility assessments data and tools; and (3) key actors involved in or working on WASH in HCFs, and their related role and responsibilities. The study revealed there is no reliable national monitoring and evaluation mechanism for WASH in HCFs and no single policy document which comprehensively describes national policies and planning, including standards and coverage targets, on WASH in HCFs.

Additionally, WaterAid and the Center for Global Safe WASH (CGSW) at Emory University have developed two similar but separate tools to assess WASH infrastructure and resources in a subset of health care facilities (HCFs). Preliminary results from these show that though most facilities assessed had a water supply present, reliability and quality of water was poor, particularly at health centres. Sanitation facilities are present but are not accessible for patients and staff who are pregnant or have mobility restrictions.


Key Actions

  • Review assessment tools and conduct larger, provincial wide assessments to gain a thorough understanding of the status of WASH in HCF
  • Explore how WASH in HCF will be a core component of the Ministry of Health’s Health Strategic Plan 3 currently under development
  • Undertake risk-based WASH assessments in facilities and identify key priorities for improvement and upgrades
  • Support infection, prevention and control and hygiene training among health care staff including nurses, midwives, doctors and cleaners.
  • Map all partners undertaking work related to WASH in HCF and establish a working group with these stakeholders


[1] Royal Government of Cambodia. (2013). Annual progress report: achieving the Millennium Development Goals. Phnom Penh: Ministry of Planning.

[2] MoH, MoP and ICF International. (2015). Cambodia Demographic and Health Survey 2014. Phnom Penh, Cambodia: National Institute of Statistics, Directorate General for Health and ICF international.

[3] Countdown to 2015. (2014). Fulfilling the health agenda for women and children: the 2014 report. Countdown to 2015.