Every health care facility has the necessary and functional WASH services and practices in order to provide essential, quality health services for everyone, everywhere. A health care facility without such WASH services is not a health care facility.
At least 50% of all health care facilities globally and in each SDG region have basic WASH services by 2022, and 80% by 2025, with the ultimate aim of 100% by 2030. Improvements seek to address inequities across geographic (rural and urban) areas and among primary, secondary and tertiary facilities.
In many countries, achieving basic services is aspirational and therefore an incremental improvement approach is needed. Where there are no services, the objective is to provide at least some services, even if these do not meet “basic” requirements. Once this has been achieved, obtaining basic services for WASH water should be implemented throughout the facility. Such services, as defined by JMP and supported more broadly by the SDG agenda, should be inclusive, equitable and safely managed in order to provide fully functional services over time. Once basic services have been achieved, countries are encouraged to focus on more “advanced” service levels, including for example, continuous safe piped water, use of more advanced technologies and practices, more rigorous environmental cleaning methods. No matter what stage facilities and countries are at, selection of technologies and practices ought to consider environmental sustainability and use of “green” technologies and practices such as solar power and recycling of non-infectious waste. To track progress on coverage, from 2018 onwards, biannual global coverage reports will be completed by the WHO/UNICEF Joint Monitoring Programme.
Guiding Principles and Approaches
The following outlines the guiding principles and tactics that all countries and stakeholders working towards the global vision will commit to and uphold:
1. Use a human rights-based approach, with a focus on equity and inclusion within the larger umbrella of UHC and quality care for all as well as the drive for universal WASH coverage, which includes institutions. Frame actions within the health systems building blocks and harmonize with priority health programmes including through facility quality improvement teams, IPC and/or AMR teams.
2. Adopt a country-centric approach and create enabling environments for scalable and sustainable programming based on a sound understanding of the national and sub-national context, needs and priorities (e.g. coverage, policies, service delivery models, political economy, climate considerations).
3. Establish cross-sector coordination and defined roles and responsibilities for all concerned ministries ensuring both WASH and health sectors, and relevant government departments share ownership and responsibility for improving WASH in HCF. Partner activities ought to be harmonized with global, regional and national plans.
4. Establish and use nationally and locally relevant metrics to track progress using WHO/UNICEF Joint Monitoring Programme indicators as a point of departure. Aim to prevent duplication and promote synergy in measurement with existing health facility, disease specific and/or programme specific assessments. Develop accountability mechanisms to track progress against these indicators.
5. Implement WASH interventions and best practices according to international and nationally established standards relevant to the level of care provided at each facility, while supporting incremental, sustainable and equitable improvements to eventually achieve higher levels of service.
6. Empower local authorities, their WASH staff and the health workforce, (includes clinician and non-clinical staff such as cleaners, engineers and senior managers), to deliver sustainable WASH services with special attention to hygiene behaviour, linking with existing initiatives to achieve full WASH coverage in their respective area . In addition, advocate for additional staff to support fully functional services.
7. Engage communities, local and facility leaders, civil society, care givers and care seekers in demand creation and accountability mechanisms to hold duty bearers to account. Develop leadership skills to strengthen management and accountability of facility-level leaders.
8. Distil, document and share learnings at every level (facility, sub-national, national, regional and global) to spark ongoing improvements, innovation and scaling-up of proven approaches.
Pathways to progress: implementing the “national WASH in HCF package”
While the focus and activities in specific countries will vary depending on context and needs, a general “national WASH in HCF package” driven by strong leadership and governance at every level is recommended (Figure 1). Initial actions at the national level include conducting health systems analyses and coverage assessments to determine priorities, gaps and bottlenecks and establishing a multi-sectoral entity to coordinate efforts. Evidence should inform national target setting, standard development and strengthening, costing and budgeting and health workforce skills development. National level activities create the enabling environment to allow implementation of better WASH services at the facility level. Facility-level improvements, through tools such as WASH FIT, should be accompanied by community level engagement, staff training and empowerment and regular monitoring and review. Documentation of processes and results is important for reflecting on progress and improving and adapting actions and policies to achieve the overall goal of improved quality of care.
 For global definitions of basic WASH services refer to: https://washdata.org/monitoring/health-care-facilities.
 WHO and UNICEF, through the WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene, are the custodians of global data on water, sanitation and hygiene. https://washdata.org/.