A conceptual evaluation framework for the water and sanitation for health facility improvement tool (WASH FIT)

Abstract

Healthcare facilities (HCFs) in low- and middle-income countries frequently lack water, sanitation and hygiene (WASH) services that are adequate to implement infection prevention and control (IPC) practices, decrease healthcare-associated infections and antimicrobial resistance, and provide quality healthcare. The Water and Sanitation for Health Facility Improvement Tool (WASH FIT), initially published in 2017 and updated in 2018, is a risk-based, continuous improvement framework. The tool aims to improve WASH and related facility management and may contribute to quality of care (QoC) efforts. To date, there is no guidance available on how to monitor and evaluate the use of this tool nor is there rigorous evidence on its effectiveness. We developed a conceptual WASH FIT evaluation framework by drawing from the broader WASH, health systems strengthening, and QoC evidence base. This framework provides a common basis to plan, implement, monitor, and evaluate potential inputs, outputs, outcomes, and impacts from applying WASH FIT. Routine use of the tool, coupled with WASH infrastructure improvements as guided by the tool, can lead to better IPC practices, and may support improvements in occupational safety, QoC, global health security, and ultimately progress towards achieving Sustainable Development Goals 3 (good health and well-being) and 6 (clean water and sanitation).

Evaluating the foundations that help avert antimicrobial resistance: Performance of essential water sanitation and hygiene functions in hospitals and requirements for action in Kenya

“…A focus on improving WASH would, therefore, have a positive effect on multiple aspects of health care. Some of the main inputs needed to improve WASH in health facilities are political resources, financial/material resources and human resources [2]. The leading players to provide these inputs are the national and regional governments, policymakers and at hospital level the senior hospital managers who may also delegate to specific committees.…”

“…The role played by the government, in this case, would be to ensure all hospital achieve a minimum standard for WASH. For example, a directive from the national government on standards for building hospitals would provide minimum standards for WASH infrastructure are present in every facility especially for newer hospitals and in older hospitals that may be undergoing renovation. These governments are also crucial in positioning WASH on the national health agenda linked to the sustainable development goals, universal health coverage [2] and the prevention of AMR to help make WASH a priority for all.…”

“…Training on WASH can be formal preservice or in-service training and mentoring. To achieve these levels of training and competence in these hospitals, there is a need for some trained WASH focal persons to provide technical expertise in hospitals [2]. These focal persons might be recognised through certification, as in the case in some African countries [6].…”

“…Water Sanitation and Hygiene (WASH) services in healthcare facilities are integral in the provision of safe, high-quality healthcare and an essential foundation for averting the spread of antimicrobial resistance (AMR). Facilities with inadequate WASH are associated with a higher risk of hospital-associated infections and increased environmental contamination from clinical waste [1, 2] [3]. A recent global report was published by the World Health Organization’s Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) highlighting the current challenges with WASH.…”

When It Is Not Measured, How Then Will It Be Planned for? WaSH a Critical Indicator for Universal Health Coverage in Kenya

“…The frame was guided by the logic framework (input, activities, output and impact), heuristic framework (agenda setting, formulation, implementation and evaluation) [ 37 ] and policy triangle (grounded in a political economy perspective and considers actors, context, process and content shape policymaking) [ 38 ]. The authors adapted the WaSHFIT conceptual framework [ 39 , 40 ]. It is a framework designed to help implementers identify risks in healthcare facilities and it provides practical tools and templates for managing WaSH and facilities.…”