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Tracking country progress on WASH in health care facilities
2024 updates

This document describes the process for collecting information on country progress on WASH in health care facilities and includes a copy of the questionnaire.

Countries are invited to submit a summary of their progress on WASH in health care facilities to populate a “country tracker”. The purpose of the tracker is two-fold: firstly, to help countries to assess their current status and progress to date, and secondly to outline their commitment(s) and planned actions to achieve the 2023 UNGA Resolution on WASH, waste and electricity in health care facilities.

How is the information used?
The country tracker was first published in the December 2020 in Global progress report on WASH in health care facilities: Fundamentals First. A second round of data collection took place in 2022 with an update published in 2023. The latest version of the tracker is available at www.washinhcf.org/country-progress-tracker/. The country tracker now serves as the basis for the biennial update on progress against the 2023 UN Resolution, the first of which will be presented to UNGA in September 2025.

What is being tracked and how is progress measured?
Progress on six of the eight practical steps for WASH in HCF is being tracked.1 Progress is rated using a four-point scale (green, yellow, orange, red). In general, to achieve ‘green’ status activities must be government-led, systematically implemented and sufficiently funded, ‘yellow’ refers to sub-national efforts that are only partially implemented or are partner-driven, ‘orange’ means a need has been identified but activities have not yet begun and ‘red’ means no need identified and no action taken. 'Green’ scores demonstrate strong progress, and the aim is for countries to achieve ‘green’ across all six steps. The distinction between government-led versus partner-driven is not always clear and some assumptions will be made when assigning a score.

Are there any new questions for the latest round of data collection? New questions have been added on integration, equity and electricity to reflect the new targets in the 2024 Global Framework.

How many countries are included in the tracker?
As of September 2024, the tracker includes 73 countries. WHO and UNICEF are seeking additional countries to share a progress update. Countries already included in the tracker are requested to review their status and provide updates of progress made since the last update was published, to feedback to the UNGA on efforts to-date.

How is information being collected?
WHO and UNICEF regional and country offices are asked to work with the relevant government focal point(s) and implementing partners working on WASH in HCF, to complete a short online form. WHO and UNICEF Headquarters will review the information and use it to populate the tracker. Only one submission is requested per country. The completed tracker will then be shared with countries for approval before publication.


NOTE: information should be submitted online at this link.
The following document is for information purposes only.


Name of country:

Completed by:
Name & Organisation
Date:



The criteria used for rating each of the practical steps is copied in the table for ease of reference (coloured boxes).

Please provide copies of, or links to, any relevant documents (policies, strategies, guidelines etc.) which you mention. This will help assign a rating and documents can be added to www.washinhcf.org/resources if you agree. Please indicate if you would prefer documents not to be made public. For all the questions, please provide as much detail as possible.

1.1 CONDUCT SITUATIONAL ANALYSIS
Comprehensive national situational analysis conducted, published and disseminated by the government or with government endorsement. Analysis covers policies, existing data and stakeholder analyses. 

(Note: Must be later than 2014)
An analysis is underway, or has been conducted but not yet validated, published or disseminated or the analysis is out of date.
The need identified to conduct an analysis and planned within the next 12 months. 
No analysis and currently no plans to conduct analysis. 
a. Has a national situational analysis on WASH in HCF been conducted? (Yes/No)


b. If yes, provide more details: has the analysis been published and disseminated? Has it been endorsed by the Ministry of Health? How are the results being used for decision making?



c. If no, are any plans underway to conduct one? Please provide details.





1.2 ESTABLISH BASELINE
National level, government led survey; data harmonized with SDGs; Assessment data informs priority setting & resource mobilisation.
(Note: Must be later than 2014)
Data exists but from small, localised assessments (e.g. from projects and programmes) or is out of date. Limited evidence data is used to inform priorities/resource mobilisation 
The need identified to undertake a survey and planned within the next 12 months. 
No data available and currently no plans to collect data. 
c. Does your country have a national baseline for WASH in HCF? (Yes/No)



d. If yes, is this baseline included in the global database maintained by the JMP? (Yes/No)


e. If no, are there any sub-national data available (e.g. data from smaller surveys that are not nationally representative)?


f. If no baseline exists, what are the plans for establishing a baseline?



Please provide the name of any report(s) and share the online link if available and/or note if report(s) will be submitted via email.


2.1 ESTABLISH NATIONAL COORDINATION MECHANISM (2024 update: STEP 2 SPLIT INTO 2.1 and 2.2)
Intersectoral national team (technical working group, taskforce or similar) led by the Ministry of Health meets regularly with an agreed mandate and terms of reference (TORs) to review progress and drive intersectoral action.

Intersectoral national team (technical working group, taskforce or similar) led by the Ministry of Health has been created but does not meet regularly or is not multisectoral
The need to develop a national coordination mechanism has been identified and planned within the next 12 months.
No national coordination mechanism exists and no plans yet to develop one
a. Does your country have an intersectoral national technical working group (TWG), taskforce or similar working on WASH in HCF? If not, what plans are there to establish one? (If NO, skip to 2.c)
Yes
No, but there are plans to develop one
No
b. If yes, how often does it meet? Does it have an agreed mandate and terms of reference (including areas of intervention, responsibilities, budgets? What has been accomplished to date by the group? How can the TWG be strengthened or improved?



2.2. SET TARGETS & DEFINE ROADMAP
Costed roadmap with targets is published and is funded.
Roadmap with targets is published but is not funded.
The need to develop a roadmap with targets is identified or it is in draft format.
No roadmap or targets exists and no plans yet to develop one
a. Does your country have a national roadmap for WASH in HCF? If yes, what are the key elements included? To what degree has it been finalized and implemented? (Yes/No)


b. Please provide details of the roadmap (title, year published)


c. If there is no roadmap or strategy, are there plans to develop one? (Please provide details)


Is the roadmap sufficiently funded?
Yes 100%
Only partly (see next Q)
Not funded

If partly funded, what % is funded?


d. Are there national targets for WASH in HCF? (Yes/No)


e. If yes, what is the process for assessing progress towards achieving these targets? How is progress supported?


f. If there are no targets, are there plans in place to develop some? (Please provide details)





Please share a link for the costed roadmap and targets if available and/or note if these will be submitted via email.




3. NATIONAL STANDARDS
Comprehensive national standards that are up to date have been published. (Note: should be newer than 2015)
National standards exist but are not comprehensive or are out of date 
The process to develop national standards is planned within the next 12 months or has been started but standards not yet published.
No national standards exist and no plans yet to develop them
a. Does your country have national standards for WASH in health care facilities? What are the key elements in the standards and when were they last updated?



b. Does your country have national standards for management of health care waste? [NB, please indicate if these are a standalone resource or integrated with WASH in HCF standards mentioned above]



c. Are there any gaps in these standards and if so, what are these gaps and how will they be addressed?



d. Do the standards include aspects of climate resilient and sustainable WASH and waste services? If yes for what WASH and waste aspects are climate considerations included?



e. How are these standards regulated, if at all? What accountability mechanisms (e.g. accreditation) exist to ensure implementation of standards? Please provide supporting documents if available.



Please share the online link for any WASH in HCFs or waste management standards if available and/or note if these will be submitted via email.


4. IMPROVE & MAINTAIN INFRASTRUCTURE
Government-led national programme to improve infrastructure to meet national standards and evidence of programme being used to increase resourcing and investments.

(Note: WASH FIT adapted to national context, implemented on a national scale, with consistent follow up.)
Improvement programme piloted or implemented in a small number of facilities (Note: programme not yet scaled up, not government-led or not in line with national standards) 
Plans exist to implement improvement programme within the next 12 months
No improvement programme has been implemented and there are no plans to do so. 
a. Are there any national programmes or mechanisms are in place for improving and maintaining infrastructure? Please provide details.



b. Has WASH FIT ever been used in your country? If so, when did you start and have efforts continued? If not, are there plans and is so when and in which facilities, to implement WASH FIT?



c. Please describe any other initiatives or processes in place for improving and maintaining infrastructure.



5. MONITOR AND REVIEW DATA

WASH indicators aligned with SDG indicators are integrated into routine national health monitoring and data collection systems, systematically analysed and data shared across all levels (facility, district, national) 
WASH indicators are integrated into national health monitoring systems but are either not systematically assessed and/or analysed at national level, or indicators not comprehensive and/or do not align with SDG monitoring 
Plans exist to integrate WASH indicators into national health monitoring systems within the next 12 months
No plans in place to integrate indicators into any routine health monitoring systems
a. Are indicators for WASH in HCF integrated into routine monitoring systems (e.g., HMIS)? If so, when were they added?



b. If yes, is data collection using these indicators up and running? If so, how are data collected, reported and analysed? How are data been used for decision making?



c. If no data on WASH in HCF are yet being collected, what plans, if any, are in place to address this?



d. If no monitoring, what plans are in place for integrating WASH indicators into monitoring systems?



6. DEVELOP HEALTH WORKFORCE
Capacity building* activities for health workforce are available, utilized and mandated nationally to increase knowledge and skills related to WASH and waste.



Capacity building activities for health workforce have been piloted or implemented in some districts or facilities, but not yet scaled up or mandated nationally.

Plans exist to develop and deliver capacity building activities for health workforce within the next 12 months.
No capacity building activities exist and there are no plans to develop any within the 12 months.

* Capacity building activities should meet the needs of both clinical and non-clinical staff, including cleaners and health care waste operators. Programme should be accompanied by policies, resources and strategies
a. Are WASH and waste subjects included in national pre-service training for the health workforce? (Y/N)


b. If yes, provide details of pre-service training programmes and/or initiatives, including which cadres of the health workforce are trained (e.g., nurses, doctors, etc.) and topics covered.



c. Do in-service mentoring or professional development opportunities that exist to further skills of the health workforce on WASH and waste? (Y/N)


d. Are cleaners included in either pre-service or in-service capacity building activities? (Y/N)


e. If no WASH capacity building programme exists for the health workforce, are there plans to develop a programme or initiative?


ELECTRICITY
No scores assigned
No scores assigned
No scores assigned
No scores assigned
a. Has a situational analysis of electricity in health care facilities been undertaken? If yes, provide details (year, title, link to document)


b. Does your country have a national baseline for electricity in health care facilities? If yes, provide details (year, scope, link to data)


c. If no, are there any sub-national data available?


d. Is there a national roadmap for electrification of health care facilities, either standalone or part of another roadmap (such as WASH in HCFs)?


e. If yes, to what degree has it been implemented?


f. Are indicators for monitoring electricity access integrated into routine monitoring systems? If yes, provide details (when integrated, what measured, link to report(s) available)


INTEGRATION
WASH is integrated within health system* planning, programming, financing, implementation, monitoring and reports/tools exist which demonstrate process and efforts.
Efforts are underway to integrate WASH into the health system, but not yet implemented.
The need to integrate WASH within the health system has been identified.
No plans in place to integrate WASH into the health system.
* This may be focused on specific areas of the health sector, such as IPC, MNCH, climate, and/or health emergencies
a. Have WASH and waste been integrated into the health system’s planning, programming, financing, implementation and/or monitoring? (Y/N)


b. If yes, please describe how WASH has been integrated and if this integration is with a specific health programme or priority (i.e. infection prevention and control, maternal and child health, antimicrobial resistance etc.)


c. If no integration has occurred, are plans in place to integrate WASH and waste into health system activities? (Please provide details).


Please share the online link for any documents which demonstrate WASH integration and/or note if these will be submitted via email.


EQUITY
National WASH in HCF policies and plans address inclusivity of services and mainstream gender-transformative WASH and rights (equity, disability) in planning, designing and implementation. Plans are implemented and monitored.
National WASH in HCF policies and plans address inclusivity, but are not resourced, implemented and monitored.

Plans exist to address inclusivity in national WASH in HCF policies and plans within the next 12 months.
No plans in place to address inclusivity.
a. Do WASH in HCF policies/plans address inclusivity of WASH services (including gender and disability)? (Y/N)


b. If yes, how are these plans resourced, implemented and monitored?


c. If no, are there plans in place to address inclusivity of WASH services?


CLIMATE RESILIENCE
No scores assigned
No scores assigned
No scores assigned
No scores assigned
a. Do WASH in HCF policies/plans address climate resilience of WASH services? (Y/N)


b. If yes, how are these plans resourced, implemented and monitored?


c. If no, are there plans in place to address climate resilience of WASH services?


Please share the online link for any documents which demonstrate plans for inclusivity of WASH services and/or note if these will be submitted via email.







Annex: Consolidated scoring criteria


GREEN
YELLOW
ORANGE
RED
1.1 Situational analysis
Comprehensive national situational analysis conducted, published and disseminated by the government or with government endorsement. Analysis covers, existing data and stakeholder analyses. 
(Note: Must be later than 2014)
An analysis is underway, or has been conducted but not yet validated, published or disseminated or the analysis is out of date. 
The need identified to conduct an analysis and planned within the next 12 months. 
No analysis and currently no plans to conduct analysis. 
1.2 Baseline assessment or data
National level, government led survey; data harmonized with SDGs; Assessment data informs priority setting & resource mobilisation.
(Note: Must be later than 2014)
Data exists but from small, localised assessments (e.g. from projects and programmes) or is out of date. Limited evidence data is used to inform priorities/resource mobilisation 
The need identified to undertake a survey and planned within the next 12 months. 
No data available and currently no plans to collect data. 
2.1 National targets and roadmap

Costed roadmap with targets is published and is funded.
Roadmap with targets is published but is not funded.
The need to develop a roadmap with targets is identified or it is in draft format.
No roadmap or targets exists and no plans yet to develop one.
2.2 National coordination
Intersectoral national team (technical working group, taskforce or similar) led by the Ministry of Health meets regularly with an agreed mandate and terms of reference (TORs) to review progress and drive intersectoral action.
Intersectoral national team (technical working group, taskforce or similar) led by the Ministry of Health has been created but does not meet regularly or is not multisectoral.
The need to develop a national coordination mechanism has been identified and planned within the next 12 months.
No national coordination mechanism exists and no plans yet to develop one
3 National Standards2  
a) WASH in HCF
b) Health care waste
Comprehensive national standards that are up to date have been published.
(Note: should be newer than 2015)
National standards exist but are not comprehensive or are out of date. 
The process to develop national standards is planned within the next 12 months or has been started but standards not yet published.
No national standards exist and no plans yet to develop them.
4 Infrastructure improvements


Government-led national programme to improve infrastructure to meet national standards and evidence of programme/WASH FIT being used to increase resourcing and investments.
(Note: WASH FIT adapted to national context, implemented on a national scale, with consistent follow up.)
Improvement programme piloted or implemented in a small number of facilities.
(Note: programme not yet scaled up, not government-led or not in line with national standards) 
Plans exist to implement WASH FIT or other improvement methodology within the next 12 months
WASH FIT or other improvement methodology has not been implemented and no plans to do so. 
5 WASH indicators in national monitoring 
WASH indicators aligned with SDG indicators are integrated into routine national health monitoring and data collection systems, systematically analysed and data shared across all levels (facility, district, national) 
WASH indicators are integrated into national health monitoring systems but are either not systematically assessed and/or analysed at national level, or indicators not comprehensive and/or do not align with SDG monitoring. 
Plans exist to integrate WASH indicators into national health monitoring systems within the next 12 months. 
No plans in place to integrate indicators into any routine health monitoring systems
6 Workforce development
National capacity building programme for health workforce is implemented to increase knowledge and skills related to WASH and waste(Note: Programme should cover both clinical and non-clinical staff, including cleaners and
health care waste operators. Programme should be accompanied by policies, resources and strategies)
Capacity-building or training programme for health facility staff has been piloted or implemented in a small number of facilities,
but not yet scaled up or is not comprehensive in scope or audience.

Plans exist to implement
capacity-building or training programme for health care facility staff within the next 12 months.

No capacity-building or training programme has been implemented and there are no plans to do so within the 12 months.
Electricity
No scores assigned
No scores assigned
No scores assigned
No scores assigned
+Integration
WASH is integrated within health system planning, programming, financing, implementation, monitoring and reports/tools exist which demonstrate process and efforts.
(Note: this may be focused on specific areas of the health sector, such as IPC, MNCH, climate, and/or health emergencies)
Efforts are underway to integrate WASH into the health system, but not yet implemented.
The need to integrate WASH within the health system has been identified.
No plans in place to integrate WASH into the health system.
+Equity
National WASH in HCF policies and plans address inclusivity of services and mainstream gender-transformative WASH and rights (equity, disability) in planning, designing and implementation. Plans are resourced, implemented and monitored.
National WASH in HCF policies and plans address inclusivity, but are not resourced, implemented and monitored.

Plans exist to address inclusivity in national WASH in HCF policies and plans within the next 12 months.
No plans in place to address inclusivity.
+Climate Resilience
No scores assigned
No scores assigned
No scores assigned
No scores assigned