Dissecting WASH Assessment Tools and Recommending a Comprehensive Tool for Indian Healthcare Facilities

Poonam Trivedi,1 Priya Bhavsar,2 Pachillu Kalpana,2,3 Krupali Patel,4 Tanmoy Das,5 Sandul Yasobant,1,2,6 Deepak Saxena1,2,6 1Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, Gujarat, India; 2Centre for One Health Education, Research & Development (COHERD), Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, Gujarat, India; 3Centre for Development Research (ZEF), University of Bonn, Bonn, Germany; 4Parul Institute of Public Health, Parul University, Waghodia, Gujarat, India; 5Terre des hommes Foundation, Kolkata, West Bengal, India; 6School of Epidemiology & Public Health, Datta Meghe Institute of Medical Sciences (DMIMS), Wardha, Maharashtra, IndiaCorrespondence: Deepak Saxena, Indian Institute of Public Health Gandhinagar, Opp. Air Force Head Quarters, Nr. Lekawada, Gandhinagar, Gujarat, 382042, India, Email ddeepak72@iiphg.orgAbstract: Providing adequate Water Sanitation and Hygiene (WASH) in Health Care Facilities (HCFs) has many benefits, including achieving Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC). However, there is a significant shortage of statistics on the status of WASH in Healthcare Facilities (WinHCF), resulting in roadblocks in developing improvement strategies. Further, there is a lack of detailed comparison of WASH components covered in available tools against the standards. The present study aims to dissect the national and international tools for WASH assessment in HCFs to suggest comprehensive WASH indicators. The databases like PubMed, Scopus, ScopeMed, Cochrane and Google Scholar were used to extract the available tools. The assessment process, methodology, and components of national and various international tools were compared and synthesized. A total of seven tools, namely WASH FIT 2, Facet, SARA, SPA, TOOL BOX-II, CDC and Kayakalp, were compared on eight components: water, sanitation, hand hygiene, healthcare waste, environmental cleaning and hygiene, infrastructure, workforce management, policy and protocols. Although most tools have covered the same indicators, the methodology and definitions differ. Few of the tools fail to capture the basic indicators defined by Joint Monitoring Programme (JMP). The critical indicators of policy and protocols are only covered in WASH FIT 2, Kayakalp, and TOOL BOX-II. Likewise, most tools fail to capture the indicator of cleaning, IPC practices and climate resilience. The present review also highlighted the limitations of selected tools regarding definitions, methodology and implementation. Hence, based on the review findings, a comprehensive short tool has been developed to monitor WASH in HCF of India. It comprises all the essential fundamental indicators identified from various tools, and recommended by the JMP service ladder with proper definitions. This tool can be helpful for hospital staff and managers for the routine monitoring of WASH in HCFs and improve the quality of care and IPC practices in HCFs.Keywords: WASH, IPC, SDGs, universal health coverage, assesment