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Assessment of water, sanitation and hygiene in HCFs: which tool to follow?

  • Krupali Patel , Pachillu Kalpana , Poonam Trivedi , Sandul Yasobant and Deepak Saxena EMAIL logo


Water, sanitation and hygiene (WASH) is important to improve and maintain the quality of health care services. Improving and managing WASH services require strong and consistent monitoring mechanisms to measure progress and direct efforts where needs are greatest. Although several tools are available to assess WASH in health care facilities (HCFs), there is always a dilemma among the program managers to select an appropriate tool for the assessment of WASH. Thus, it was aimed to perform a descriptive review of all available WASH assessment tools and assist in reaching a consensus for an optimal tool to assess WASH in HCFs. For this descriptive review, PubMed, ScopeMed and Google Scholar were used to search all available tools for the assessment of WASH. All the tools available online since 1991 till July 2018 were included in the review. Globally, nine different WASH assessment tools were retrieved. The majority of them have their self-limitations on the basis of 11 selected indicators and were examined in all the retrieved tools. There are variability and overlapping components within the specific tools. Very few survey instruments including human resource (HR), supply, budget, patient/staff satisfaction and documentation for appropriateness of WASH were found to be neglected. The majority of instruments were based on the subjective assessment of WASH validating with microbiological surveillance and photo documentation. The descriptive review suggests that various tools are available for the assessment of WASH but none of them seem to be complete with all indicators and to have consensus for the elements. Therefore, there is a need to develop a robust and comprehensive tool for the assessment of WASH in HCFs.

Corresponding author: Dr. Deepak Saxena, MD, PhD, Department of Epidemiology, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, Gujarat, India, Phone: +91 9327396717


We would like to acknowledge the Emory University and Soapbox for providing access to the necessary WASH tools. We would also like to thank the Centre for Environmental Health (CEH), India for supporting this review.

  1. Research funding: This project was funded by the Center for Environmental Health, India.

  2. Conflict of interest: Authors state no conflict of interest.

  3. Informed consent: Not applicable.

  4. Ethical approval: The conducted research is not related to either human or animal use.


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Received: 2019-01-09
Accepted: 2019-04-22
Published Online: 2019-07-02
Published in Print: 2019-12-18

© 2019 Walter de Gruyter GmbH, Berlin/Boston

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