WASH & Safe Water

WASH: Addressing Water Safety and Sustainability in Low- and Middle-Income Countries

With the creation of the2015 Sustainable Development Goals, nations around the globe aim to “provide universal access to safe drinking water in healthcare facilities by 2030.” Healthcare facilities are hubs that should promote disease control and general health, but a healthcare facility with unsafe water sources and poor sanitation poses great risks for patients, staff, and visitors alike. Although the aim is to provide universal access to these resources, reliable data on the status of water, sanitation and hygiene (WASH) in healthcare facilities are scarce. Drawing from available data in low- and middle-income countries, a recent WHO report estimates that about 38% of healthcare facilities do not have a basic water supply, 19% do not have basic sanitation, and 35% do not have water and soap for hand washing.

Water Tap

In order to promote advocacy and action in this area, we need knowledge of baseline WASH conditions and sustainability and a standardized measure to monitor improvement. Katharine Robb, the Associate Director of Research Projects for Emory University’s Center for Global Safe Water, Sanitation, and Hygiene, saw this unmet need in her research and fieldwork and began creating a solution. Robb and her team, with funding from the General Electric Foundation, developed two tools to address the gap: one assesses WASH conditions in healthcare facilities and the other measures the sustainability of safe water provision in healthcare facilities.

The WASH Condition Scorecard looks at WASH conditions in healthcare facilities and evaluates them through a score system. This system assesses the extent to which basic WASH standards are met using a simple traffic light (red, yellow, green) system. The scoring system provides an easy, standardized method to communicate the current WASH conditions of a given facility. As Robb describes, “it is a quick snapshot using a scale that most people are familiar with to communicate how healthcare facilities are performing in a given region.” The scale allows for both comparison across healthcare facilities and tracking of progress over time. Importantly, the tool identifies which healthcare facilities and which components of WASH (water, sanitation, hygiene, waste management, etc.) require the most attention so that scarce development resources can be allocated toward the areas that need them most.


The second tool focuses on the sustainability of safe water in healthcare facilities. This tool looks at sustainability in four domains: technical feasibility, on-site capacity, accountability, and institutional engagement. The tool produces a radar plot graphic output, providing a quick way to show how a healthcare facility performing in different areas of sustainability. The tool is used to identify where risks to sustainability lie (i.e. issues with water supply, budgeting, training, etc.). The tool is designed for healthcare facilities with onsite treatment, which is not as widely used yet. However, in order to achieve universal safe water in healthcare facilities, the majority of facilities will need to adopt some kind of onsite water treatment and the sustainability of such will be critical.

Many governments, non-profits, and healthcare workers share the same goal of improving access to sustained safe WASH in healthcare facilities, yet without a means of measurement it is impossible to track advancement. Robb’s two technologies provide a platform to assess baseline status of WASH in healthcare facilities and illuminate where certain facilities may be lacking. In early May, through a partnership with World Vision, data collection began in Zambia assessing fifty-five healthcare facilities in several regions. Emory and World Vision will use the data to inform and prioritize programmatic activities to improve WASH in healthcare facilities. Planned scale-up of the application of these tools has the potential to enhance WASH conditions in healthcare facilities globally.

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