Quality (8) WHO/UNICEF: Understanding barriers to quality of care: An approach for situational analysis of WASH and quality in health care facilities (2)

21 April, 2021

On 25 March I posted a message about a new WHO and Unicef publication: Understanding barriers to quality of care: An approach for conducting a situational analysis of water, sanitation and hygiene (WASH) and quality in health care facilities.

I also posted this on the SuSanA forum (Sustainable Sanitation Alliance) and the lead moderator Elisabeth Muench reminds us of a publication on this topic in 2019.

Water, sanitation, and hygiene in health care facilities practical steps to achieve universal access to quality care


I forward the message below.


Hi Neil,

Your post prompted me to take another look at the 2019 WHO publication in order to understand: what are the barriers to providing WASH in health care facilities? (as it seems like such a no brainer, that clean water and sanitation are paramount for health care facilities to be effective)

I found them listed on page 14 here:

Incomplete standards

Inadequate monitoring

Disease-specific budgeting

Disempowered workforce

Poor WASH infrastructure

Each of those factors are explained in more depth in the document.

Furthermore, the document talks about "Eight Practical Steps to Improve and Sustain WASH in Health Care Facilities" in Section 3:

1. Conduct situation analysis and assessment

2. Set targets and define roadmap

3. Establish national standards and accountability mechanisms

4. Improve and maintain infrastructure

5. Monitor and review data

6. Develop health workforce

7. Engage communities

8. Conduct operational research and share learning.

Point 4 in that list is probably the hardest one and requires the most funds!



P.S. I have also updated the Wikipedia article on WASH with this information, see here:



Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org