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 30 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.
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.
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).
Select, install, operate, maintain and improve WASH infrastructure, (including through use of WASH FIT) to ensure sufficient, functioning WASH services are available.
Track the status or progress of WASH interventions by monitoring and reviewing indicators on a regular basis, including through national health monitoring information systems.
Invest in a well-trained and well-supported health workforce to enable health systems to perform well and to respond appropriately to challenges.
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.
Generate evidence to understand the problem and what to do about it and scale-up proven improvement approaches.