Appropriate Excreta Disposal and Sanitation Facilities and Protocols

Photo by Steve Sara / MCSP

Appropriate Resources:

In their 2017 progress update report, the Joint Monitoring Programme released the first international standard monitoring service ladders for WASH services in HCFs. Appropriate Excreta Disposal and Sanitation service levels are defined as:

  • Basic: Improved facilities are usable, separated for patients and staff, separated for women, provide menstrual hygiene facilities, and meet the needs of people with limited mobility.
  • Limited: Limited: Improved sanitation facilities are present but are not usable or do not meet the needs of specific groups (staff, women, people with limited mobility).
  • No service: Pit latrines without a slab or platform, hanging latrines, or no toilets or latrines at the facility.

In addition to these international infrastructure standards, international SPHERE sanitation standards provide guidelines for sanitation facilities in public spaces (e.g., ratio of persons per toilet, gender and privacy considerations, etc). Handwashing stations and soap should be conveniently placed near every sanitation facility. For handwashing standards, click here.

Note: National policies and standards should be consulted when designing, monitoring or evaluating excreta disposal and sanitation facility standards.

Appropriate Staff, Process and Management Considerations:

Maintaining clean and functioning sanitation facilities is an essential part of HCF cleanliness and can impact patient satisfaction. HCF management should establish routine and frequent (multiple times/day) cleaning and re-stocking schedules for patient, visitor and staff toilet facilities. Waste management roles and responsibilities should be clearly established among HCF staff.

A continuous stock of cleaning supplies and anal cleansing materials should be maintained. While sanitation infrastructure repair may not be within the capacity of HCF staff, the HCF management should be equipped to seek and maintain partnerships with private or government sanitation service providers to maintain and repair sanitation infrastructure.

Patients and visitors should be instructed to use HCF toilet facilities, and these rules should be enforced by HCF staff.

MCSP Rapid Assessment Questions:

To improve sanitation conditions, each HCF can consider the following questions from MCSP’s health care facility rapid assessment tool. The tool was adapted from WHO’s Essential Environmental Standards in Health Care.

Excreta disposal: Adequate, accessible and appropriate toilets are provided for patients, staff and care givers.

Design and construction Operation and maintenance
  • Are there sufficient toilets in the health-care setting?
  • Are there sufficient toilets actually in use?
  • Are the toilets hygienic to use and easy to clean?
  • Are the toilets clean and without smell?
  • Are the toilets easily accessible for all users?
  • Are access routes to toilets kept in good condition and well lit?
  • Are the toilets deemed acceptable by users?
  • Do patients, staff and caregivers find the toilets appropriate?
  • Is there a cleaning and maintenance plan to clean toilets?
  • Is there an effective cleaning and maintenance routine in operation?
  • Is there a dedicated staff person responsible for sanitation management?
  • Is there a staff person with sanitation management in their job description?

Additional Tools and Resources for Appropriate Excreta Disposal and Sanitation Facilities and Protocols in HCF settings:

  • In 2017, WHO & UNICEF published the WASHFit Tool, which includes essential indicator and advanced indicator assessment tools for sanitation (Tool 2), risk assessment templates (Tool 3), and improvement plan templates (Tool 4).
  • Soap Box Collaborative’s WASH and Clean toolkit, which includes various WASH HCF assessment tools. Tool 1: Facility needs assessment Tool, and Tool 3: Walkthrough Checklist have sanitation questions.