In Zambia, work has been conducted to implement a low-cost intervention to provide simple handwashing facilities to government health care facilities. The handwashing facilities which consist of a simple covered bucket with a tap and bar of soap, cost USD 20 and provide the means to wash hands in priority areas such as labour wards and post-natal care areas.

The program has assesed the use of drinking-water treatment and handwashing stations and evaluate their impact on patient knowledge and practices. The programme has four elements, 1) provision of water stations, 2) watertreatment, 3) handwashing and 4) health worker training. A structured assessment form at baseline and four months was used to monitor progress. To date, the programme has shown improvements in water storage and treatment practices in facilities, and patient ability to demonstrate proper hand washing. However, there have been challenges in providing stations to remote areas, maintaining donor support and communication between different central, provincial and regional levels. While the intervention has enabled a rapid response to the problem and is relatively inexpensive, it does not provide a long-term solution. Multi-sectoral capacity strengthening and an implementation plan between Ministries of Health and local government are required to improve WASH infrastructure. Maintenance and sustainability of such services has been challenging and it is recognised that these must be incorporated into future health strategies.

In addition, work has been conducted on the standardization of a ‘WASH in Health’ package which contains simplified assessment guidelines for WASH and IPC and minimum standards and secondly a programme to provide WASH to vulnerable facilities. The first phase of the programme, to implement a WASH package in 4 facilities and conduct a simplified assessment in an additional 18 facilities, is due to be completed in September 2015. The second phase, to roll out the package in a further 55 facilities will be completed in December 2017.