As uninspiring as it could be as a topic of a blog post, the healthcare infrastructure plays a critical role in our lives. During a crisis, and beyond, public infrastructure is an excellent litmus test for the Government and Non-government organisations – can we finally pull the resources to reform and modernize?

First years of crisis, we saw an increased interest, from the NGO partners in the first place, to the critical infrastructure. There was a somewhat chaotic but non-theless well intented effort of half-a-dozen international organisations and local agencies in identifying the critical needs of healthcare facilities.

Somehow, almost all of them at some point in their implementation strategy focused on the washrooms and restrooms – from the provision of sanitary fixtures to the full renovation of the facilities.

WASH FIT Assessment of Sanitation of 38 Health Facilities

Our project has trained and assessed 38 health facilities in conflict-affected regions of Ukraine using the WASH FIT methodology.

WASH FIT is a risk-based quality improvement tool covering the aspects of WASH and Infection Prevention and Control (IPC) in the Health Facility:

1. Water Supply
2. Sanitation
3. Hand Hygiene
4. Waste Management
5. Environmental cleaning
6. Energy and Environment
7. Human Resource and Facility Management

This article will outline the key findings of the Sanitation Domain and summarize the 3-year effort of the WASH partners trying to cover almost 40-50 years of neglect.

Sanitation Domain Analysis – Methods

We assessed the sanitation of health facilities across 13 standard WASH FIT indicators, each of which is scored 0, 1, or 2 depending on the criticality of the issue:

• 0: Gap (Non-functional)
• 1: Partially addressed
• 2: Fully functioning

To get the relative final score, we devided absolute score by max value of 26 (13*2) and multiplied by 100% (as a percentage of the maximum).

For example, if the facility scored 13 points, the relative score is 50% (13/26*100%).

Analysis: Criticality and Context

We break down that percentage into three criticality categories:

• Severe (<50%),
• Moderate (50–70%),
• Mild (>70%).

Looking at our first graph, the situation is largely manageable: less than 25% of assessed facilities fall into the “Critical” category (Relative score < 50%) with major gaps in their water domain.

The Sanitation as Worst and Best perfoming Domain

Finally, we contextualize against the other six domains in the WASH FIT assessment (such as water supply or sanitation). We analyze whether Sanitation lands in a facility’s “Top 3” or “Bottom 3” performing areas.

The Analysis leaves very little room for doubt:

The Sanitation domain still remains riddled with problems and continuous effort is needed to adress them in a more ssystematic way

It ranks in the Top 3 best-performing and Bottom 3 worst-performing domains, with pretty much average frequency, so it is difficult to see it as outliier like Waste Management or Energy and Environment domains.

The bottom line:

It is equally likely that you will encounter sanitation infrastructure in a critical state as it is to find a system where most pressing issues are sorted

Sanitation, Water Supply, and Waste Management Domains