Nurse in Uttar Pradesh - Photo credit Prashanth Vishwanathan


Question & Answers on the 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, second edition.

For someone who is not familiar with WASH FIT, can you remind me briefly what it is?

WASH FIT (the Water and Sanitation for Health Facility Improvement Tool) is a risk-based management tool for health care facilities, covering key aspects of water, sanitation, hand hygiene, environmental cleaning, health care waste management and selected aspects of energy, building and facility management. The purpose of the tool is to support health care facility staff to incrementally improve and sustain their WASH and waste management services.

WASH FIT 2.0 provides you with an easy-to-use framework to develop, monitor and continuously implement an infrastructure improvement plan and to prioritize specific WASH actions. It provides a comprehensive and modular package of resources, including interactive adult-based learning training slides, from which you can select and adapt key materials. It supports your efforts to meet local, national and/or global standards, and facilitates multi-sectoral solutions by bringing together all those who share responsibility for providing WASH services, including legislators/policymakers, district health officers, hospital administrators, water engineers and users.

What’s new in WASH FIT 2.0?

There are six exciting new features of WASH FIT 2.0:

  1. ADDITIONAL TARGET SETTINGS: It includes guidance to adapt the tool for use in additional settings including rudimentary or temporary emergency health care facilities, larger facilities (e.g. regional or district hospitals), and those in middle-income settings where higher levels of services are sought.
  2. EMPHASIS ON CLIMATE: WASH FIT 2.0 has a greater focus on climate resilience and change mitigation strategies such as water conservation, waste reduction and low-carbon energy.
  3. CONSIDERATION OF GENDER EQUALITY AND INCLUSION: Through each of the five steps of WASH FIT, specific guidance and examples are provided on how to ensure planning and decision making, assessments, infrastructure improvements and hygiene behaviours consider and include the needs of women, children, minorities, those with disabilities and other important but often overlooked stakeholders.
  4. EMPHASIS ON PREVENTION: The tool includes guidance to ensure WASH services prevent the spread of pathogens and antimicrobial resistance.
  5. UPDATED ASSESSMENT INDICATORS: The updated assessment forms now include climate, gender and equity considerations, as well as indicators for facilities with more advanced WASH services and tertiary settings.
  6. LINKAGES TO RELATED ISSUES AND AVAILABLE RESOURCES: Finally, it addresses additional WASH-related aspects of health care facilities, namely energy, vector control and occupational health.
I have been using the previous version of WASH FIT 1.0 – how and why should I use version 2.0?

If you are already familiar with WASH FIT then incorporating concepts, indicators and tools from the new guide should be simple. Building on the best features of WASH FIT 1.0, the new guide provides a practical step-by-step approach to adapt and use WASH FIT in a range of contexts. Version 2.0 has a particular focus on building, upgrading and sustaining WASH and energy services that are climate resilient as well as being equitable and inclusive. Additionally, it contains updated information on the connections with quality and infection prevention and control.

WASH FIT 2.0 responds to specific feedback on expanding indicators, providing easy to use and sound risk frameworks for prioritizing improvements, targeted factsheets on topics such as climate, safe plumbing and gender and equity, checklists and examples of national adaptation and implementation of WASH FIT.

Is there an ideal time to switch from 1.0 to 2.0? For example, I’ve just finished a WASH FIT 1.0 assessment.

Be guided by the findings from your assessment for your action plan. You many find additional helpful prompts in 2.0. When you plan to start your next round of assessments, WASH FIT 2.0 will help you gain deeper insights into issues like gender and climate resilience. The fact sheets and check lists can also help to focus on specific elements of WASH and waste for which you would like to address in further detail.

Who is the target audience of WASH FIT 2.0?

The primary users of WASH FIT have expanded to now include environment and climate specialists, planners and advocates. Therefore, WASH FIT 2.0 is for quality improvement (QI) teams, WASH and IPC focal points, community WASH and health committees and technical staff (engineers, inspectors, plumbers) and WASH FIT team leaders. It is also for health care facility managers and other senior managers, local/district government officials and health offices, national health policy-makers (e.g. ministries of health) and health regulators. In addition, it is of interest to infrastructure and WASH financing officials, WASH and health non-governmental organizations, civil society and other partners supporting or leading implementation, evaluation and programme planning.

How is WASH FIT 2.0 structured?

The guide has five key sections:

  • Section 2 describes how WASH FIT can be integrated with quality of care, infection prevention and control and maternal child health efforts, and how the sustainability and climate resilience of WASH services can be improved.
  • Section 3 describes the WASH FIT process, from training and initial implementation to scale-up, and the financing and investments needed to improve and maintain WASH services.
  • Section 4 describes some of the factors for success needed at the local and facility levels, including staff and community involvement, and the role of senior leadership.
  • Section 5 details the five-step WASH FIT improvement cycle for facilities to assess, maintain and improve services over time.
  • Section 6 provides a set of tools and templates to support the five-step cycle.
  • The annexes include guidance on using and adapting the assessment tool, a set of sanitary inspection forms to assess a facility’s water supply and technical fact sheets.
Tell me more about the new Manual for Trainers that complements the guide.

The manual for trainers that includes details on preparation, delivery and evaluation of training, which can be adapted to the local context, and a set of modifiable PowerPoint modules with trainer notes and participatory exercises. We hope this will build capacity in a wider range of people, to deliver important information on achieving WASH FIT improvements as one part of their efforts.

Is there any training offered to countries and organizations to help them use the WASH FIT guide and associated resources?

WHO and UNICEF along with partners, including national governments are working to develop WASH FIT skills through regional and national trainings. Short videos on specific aspects of WASH FIT are available on the WASH in HCF YouTube channel ( Current WASH FIT related material on OpenWHO is being updated.

How can I access WASH FIT 2.0?

WASH FIT 2.0 and the associated documents and resources (manual for trainers, assessment tool, fact sheets, checklists, training slides etc.) can be downloaded from the WASH FIT Portal: This includes the technical factsheets, manual for trainers, all of the updated training modules and the new updated assessment form.

What languages is WASH FIT 2.0 available in?

The WASH FIT portal and guide is available in English, French and Spanish and in Arabic and Russian later in 2023.

The training modules and manuals is currently only available in English.

How is WASH FIT 2.0 linked to Water Safety and Sanitation Safety Planning?

WASH FIT 2.0 utilizes the same incremental, step-wise approach and draws upon the guidelines used in Water Safety Plans (WSPs) and Sanitation Safety Planning (SSPs). WASH FIT 2.0 covers many areas of WASH and waste and therefore does not go into as much detail on water or sanitation as WSPs and SSPs. However, WASH FIT 2.0 includes new Sanitation Inspection Forms for different types of water supplies allowing more detailed monitoring. Where existing WSPs and SSPs are ongoing in the same communities as WASH FIT, it may be beneficial to link these efforts and share expertise.

My role involves advocating for action on WASH in health care – how can I convince senior people to use WASH FIT 2.0?

Providing examples from WASH FIT 2.0 on how diverse countries such as Ghana, Indonesia, Mali and the Philippines have used the tool to meet national health objectives around universal health coverage or quality of care for mothers and children can help convince leaders of the value of investing in WASH in health care facilities and use of WASH FIT. In addition, WASH FIT 2.0 now includes more information on budgeting and resources, based on a global costing analysis which indicates that the resource needs for WASH services in health care facilities are modest and “doable” with current government and donor spending on WASH and health.

I don’t work directly on WASH in health – should I be interested in this new package?

If you work in an area related to the quality or safety of health care, including the prevention and control of infection, yes – you should be most interested in this package. There are still major gaps in WASH and waste services, even in middle income countries. Improving WASH and waste services is not only a necessary pre-requisite for achieving any major health objective from reducing spread of antimicrobial resistance to improving quality of care, but also such investments provide a high value of return.

I am a partner in an NGO and we have our own improvement resources – is WASH FIT 2.0 relevant to me?

In many countries WASH FIT is being adopted as the national tool by the Ministry of Health and provides a common approach for all partners to use. Using the same approach saves resources through common designs and harmonized monitoring. Sharing experiences from a common approach shows how to sustain improvements and address key gaps around climate resilience, gender and safely managed services.

How does WASH FIT link to the WHO/UNICEF 8 Practical Steps?

Step 4 of the 8 Practical Steps for improving and sustaining WASH services and practices in health care facilities is concerned with improving and maintaining infrastructure. It is this practical step that includes use of WASH FIT and other risk-based improvement tools. More and more countries are undertaking infrastructure improvements, through WASH FIT or other approaches.

I want to use WASH FIT 2.0, where do I start?

Start by reading the guide which includes all you need to use the tool. Reaching out to colleagues in your own organization and country/region to understand what current efforts may be underway and understanding how and where you can contribute is also useful. The online country tracker gives an overview of which countries are implementing WASH FIT and conducting infrastructure improvements. While all elements of WASH FIT are important, it may make sense to start improvements in one area (e.g. safe and sustainable waste management or hand hygiene) and build upon small successes to develop more comprehensive improvements at the facility, district and national level. No change is too small and by working collaboratively and engaging leaders at every level, a long-term, sustainable improvement programme can be implemented.