Improved water, sanitation, hygiene and waste services in health-care facilities, Ukraine.

Problem: Water, sanitation and waste infrastructure and services in Ukrainian health-care facilities often fail to meet global and national standards, hindering the provision of safe, quality care. The war has worsened existing problems.

Approach: To incrementally improve water, sanitation, hand hygiene, environmental cleaning and health-care waste practices, the World Health Organization (WHO) is working with the health ministry, the Ukrainian Public Health Centre and regional United States Centers for Disease Prevention and Control (CDC) to implement the Water and Sanitation for Health Facility Improvement Tool (WASH FIT). In December 2022, WHO trained staff from the regional CDC, Ukrainian Public Health Centre and nine priority health-care facilities. Facility teams assessed services, and developed and implemented improvement plans in January 2023. Follow-up assessments were conducted after six months.

Local setting: About 4300 health-care facilities operate in Ukraine. Funding for new water and sanitation infrastructure, as well as operating and maintaining existing services, is likely inadequate.

Relevant changes: After implementation, the average WASH FIT score increased from 66 out of a maximum of 100 (range: 57-73) to 83 (range: 69-93). Facilities more effectively managed water-related risks, replaced broken taps, improved waste management practices and installed backup water supply and storage sources.

Lessons learnt: WASH FIT can be used to identify gaps in water, sanitation, hygiene and waste services and track progress towards addressing these gaps. Engaged local leaders, health-based national water, sanitation, hygiene standards, regular on-site training and mentoring drive these improvements. Strengthening public health entities is critical to institutionalize the process.