Changing the way we change the world

Why focus on WASH in Healthcare facilities?

Globally, many healthcare facilities lack WASH access. It is widely acknowledged that the Sustainable Development Goals, in particular access to quality essential health-care services, cannot be achieved without access to water, sanitation, and hygiene services. Yet many health care facilities lack basic necessities such as soap, water, and clean toilets.

A 2018 global assessment of environmental conditions at health care facilities in 78 low- and middle-income countries estimated that 50% lacked piped water, 33% lacked improved sanitation, 39% lacked handwashing soap, and 39% lacked adequate infectious waste disposal  Using nationally representative data from six countries, the study found only 2% of healthcare facilities provide all water, sanitation, hygiene, and waste management services.  

Our recent case study of rural health facilities in Ethiopia and Kenya found similar results.  Read the key findings and recommendations here.

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Who is involved in the US?

The World Health Organization (WHO) and UNICEF are leaders of the global response. Several organizations are involved in loose collaboration in the United States.

DC Collaboration

An ad hoc group in DC has a goal to alert US development agencies and lawmakers about ways to support international efforts. Current participants include CCAP Malawi, Dentons, K&L Gates, Global Health Council, Improve International, Millennium Water Alliance, Water 2017, WaterAid, and Waterlines. Contact David Douglas (douglasd at rt66 dot com) for more information.

Conrad N Hilton Foundation & World Vision

The foundation has granted $3 million to World Vision for the purpose of demonstrating sustainable WASH services in all health care facilities in two districts in Mali. PATH was awarded $1.5 million to advance the development of a commercially viable on-site chlorine generator (SE-Flow) for drinking water treatment and infection prevention and control (IPC) in low-resource health facilities, schools and communities. Read more.


The Centers for Disease Control and Prevention (CDC) are working with WHO on an impact assessment of WASHFIT. WASH FIT has been finalised and can be downloaded here.. To date, the tool has been used in Chad, Mali and Liberia with a further five countries beginning the process (DRC, Ghana, Guinea, Senegal and Sierra Leone). 

Johns Hopkins Bloomberg School of Public Health

Researchers at the Johns Hopkins Bloomberg School of Public Health looked at studies on 430 hospitals in 19 low- and middle-income countries. In an article published online in the Journal of Surgical Research, they reported that a third of the hospitals surveyed — a total of 147 — did not have continuous running water.

BabyWASH Coalition

The BabyWASH Coalition is a group of organizations in the US and beyond focused on increasing integration between WASH, early childhood development, nutrition, and maternal newborn and child health  programming, policy-making and funding to improve child well-being in the first 1000 days.  For more information e-mail

Emory University Center for Global Safe WASH

Emory’s CGSW is involved in the high level discussions with WHO & UNICEF, but also has created a monitoring tool to assess the conditions of WASH in Healthcare Facilities. In five years of working with various partners, they have a sense of the special nature of WASH in healthcare facilities versus households. For more information contact Dr. Christine Moe (clmoe at emory dot edu).

UNC Assessment in Malawi

The assessment of 45 health facilities in the northern, central and southern regions of Malawi is being funded by a generous donation from P&G. Data will be collected by researchers from the UNC Institute for Global Health & Infectious Diseases and its UNC Project in Malawi and the Water Institute at UNC. Read more.

Recent research shows...

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