Water Quantity and Access

Photo by Steve Sara / MCSP

Appropriate Resources:

In its 2017 progress update report, the Joint Monitoring Programme released the first international standard monitoring service ladders for WASH services in HCFs. Water service levels are defined as:

  • Basic: water from an improved source is available on premises.
  • Limited: Water from an improved source is available off premises; or an improved source is on-site, but no water is available.
  • No service: Unprotected dug well or spring, surface water, or no water source.

Note: National policies and standards should also be consulted when implementing, monitoring or evaluating water quantity and access standards.

Appropriate Staff, Process and Management Considerations:

Water infrastructure at HCFs cannot be sustained without functioning maintenance and repair systems. HCFs should establish systems for reporting water supply issues to HCF management. While water supply 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 water service providers to maintain and repair water infrastructure. HCF management should also establish a sustainable mechanism for securing water supply maintenance and repair funding. In HCFs without piped water systems, HCF management should establish staff responsibilities for water treatment and collection frequency and should ensure water is conveniently available in each required ward within the facility.

MCSP Rapid Assessment Questions:

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

Sufficient water is available at all times and in the correct places for medical activities, personal hygiene, cleaning and laundry, drinking, and food preparation.

Design and construction Operation and maintenance
  • Does the water supply have the capacity required for the size of the HCF?
  • Is the quantity of water supply monitored by staff?
  • In HCFs without piped water systems, are designated staff responsible for water collection? What is the required frequency for re-filling water storage stations throughout the facility? Is there a treatment regimen in place and is it followed?
  • Is there a suitable alternative supply in case of need?
  • What are alternative water supplies and are they sufficient?
3 Are there sufficient, clearly identified water points or water storage containers for each of the following:

  • Handwashing and personal hygiene (esp. near patient treatment areas, toilets, and areas of food preparation)
  • Drinking- water
  • Laundry and cleaning needs  (medical areas, bed pans, sheets, etc)
  • Showers (for inpatients)
  • Cooking
  • Medical procedures, treatments and operations
  • Are drinking-water points properly used and adequately maintained?
  • Is clean water available in surgery and maternity (especially labor and delivery) wards?
  • Is there a dedicated staff person responsible for water quantity and access?
  • Is there a staff person with water quantity and access in their job description?

Additional Tools and Resources for Water Quantity and Access in HCF settings:

  • In 2017, WHO & UNICEF published the WASHFit Tool, which includes essential indicator and advanced indicator assessment tools for water quantity and access (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 water quantity and access questions.