Published in 2019 by WHO and UNICEF, the eight steps are a set of practical actions that countries should take in order to sustain WASH services and practices in a range of health care settings, from primary to tertiary facilities.
They are a distillation of “what works” in over 50 countries. The eight steps are presented in a linear fashion, however, the actions can occur in various orders and/or simultaneously. Some actions are undertaken at the national level and some at the subnational or facility level. Some may apply to all levels.
Conduct situational analysis of enabling environment for WASH in health care facilities (specifically health and WASH policies, governance structures, institutional arrangements, funding streams and stakeholders). Assess WASH coverage and compliance.
Related resources: Guidance – how to conduct a situational analysis, Cambodia Situation Analysis, WASH Assessment in the Gaza Strip
Set detailed targets (with a national costed roadmap) to address gaps, and estimate costs (capital investments, rehabilitation and recurrent costs). A joint WASH and health taskforce or technical working group is an effective mechanism to help set these targets and develop a roadmap.
Related resources: Ghana National Strategy for WASH-IPC in HCF
Develop standards (a set of requirements that dictate the infrastructure and resources necessary to provide sustainable WASH services) and implement using accountability mechanisms (regulation, accreditation, licensing, community scorecards, feedback mechanisms).
Related resources: Guidelines for Climate-Resilient and Environmentally Sustainable Health Care Facilities in Fiji, other national examples
Select, install, operate, maintain and improve WASH infrastructure, (including through use of WASH FIT) to ensure sufficient, functioning WASH services are available.
Related resources: Case studies of WASH FIT implementation, WASH FIT portal
Track the status or progress of WASH interventions by monitoring and reviewing indicators on a regular basis, including through national health monitoring information systems.
Related resources: Uganda HMIS Review Report
Invest in a well-trained and well-supported health workforce to enable health systems to perform well and to respond appropriately to challenges.
Related resources: Zambia IPC-WASH Training Manual
Give community members and organizations agency in decision-making and management of services to ensure that health care facilities provide the level of care that citizens deserve and expect.
Related resources: Focus Group Discussions in Indonesia
Generate evidence to understand the problem, what to do about it and scale-up proven improvement approaches.
Related resources: Implementing the Clean Clinic Approach improves WASH quality in health facilities in the Western Highlands of Guatemala