Frequently asked questions

The HCF-WISE Scales are survey tools that measure patients' and health care facility staff members' experiences with water, sanitation, and hygiene at the facility, across accessibility, acceptability, and adequacy. They are being developed and validated for use across diverse countries, languages, and facility types, so that results from one setting can be compared with results from another.

Most WASH measures record whether facilities exist and what technical condition they are in. The HCF-WISE Scales record what people encounter when they try to use those facilities. The two are complementary. Knowing that a facility has an improved water source on the premises tells you what was installed; knowing that staff routinely ration water between patients tells you whether it is working.

Experiences across six domains: water, sanitation, hygiene, environmental cleaning, waste management, and menstrual health. Questions ask how often something happened over a defined recall period, and people report the frequency on a three-point scale.

The project was previously called INWISE, for Institutional WASH Insecurity Experiences, and covered health care facilities and schools together. As the two instruments matured they became distinct enough to warrant separate names and separate homes: HCF-WISE for health care facilities and School-WISE for schools. You will still see INWISE in earlier materials, presentations, and publications. It is the same project and consortium.

They are among the newest members of the WISE Scales family, which already includes validated measures of household water insecurity (HWISE) and individual water insecurity (IWISE). HCF-WISE extends the same approach to settings outside the household and includes other dimensions alongside water.

Not yet. The instruments now being implemented are longer than the final scales will be. The current phase determines which items perform consistently across sites so that the final scale is as short as possible without losing valuable information.

Yes, within limits. Core items stay standardized, because comparability across sites is the entire point of the exercise. Partners work with the study team to ensure wording and translation fit the local context, including locally relevant examples where those help people answer, and site-specific questions can be added alongside the core items to answer questions that matter locally.

No specialist WASH knowledge is required. The study team provides training and materials. Prior experience with survey data collection is helpful, but it is not a prerequisite.

Implementing the HCF-WISE surveys within work you are already doing in health care facilities, typically by adding the questionnaires to existing monitoring or evaluation activities; obtaining local ethical approval; and contributing de-identified data to the shared database.

Early access to the tools, training and technical support from the study team, results returned for your own sites, opportunities for co-authorship on project publications, membership in a global network of WASH measurement practitioners, and a direct hand in shaping how institutional WASH is measured.

There are limited funds to support implementation. We do work with partners to identify complementary funding and to develop joint proposals where there is a good fit.

A typical site spans about ten facilities. The main determinants of the timeline are local ethical approval and facility scheduling rather than the survey itself, which is a single session per respondent.

It should not. Patients are approached only after they have been discharged, interviews take place away from clinical areas, and staff interviews are scheduled around facility workflow. Site teams plan this with facility management before beginning.

The data you collect remain yours. Contributing sites hold sole ownership of the data they contribute, unless a different agreement is reached, and share them with the consortium for the purposes of scale development and equivalence testing. You retain the right to publish your own analyses, including summary statistics and predictive analyses, without seeking permission. The one restriction is that sites do not publish site-specific WASH insecurity scales, since doing so would undercut the development of a comparable one.

Contact us and describe where you work and what you have planned.

Patients aged 18 and older who have been discharged from the facility, and facility staff who have worked there for at least three months. Staff include those providing clinical care or administrative support and those responsible for environmental cleaning, hygiene, and maintenance. Anyone who cannot communicate independently or with assistance is not enrolled.

Either a cognitive interview, which is a conversation about how you understand the survey questions themselves, or the survey, which asks about your experiences with water, sanitation, and hygiene at the facility. Survey responses are collected privately by trained study staff on a tablet.

No. Patients are invited only after they have been discharged, and neither taking part nor declining has any bearing on the treatment you receive. Your answers are not shared with the staff who treated you.

A single session, held in a private space. The exact length is stated in the consent form you receive before you agree to take part.

No. Participation is voluntary, you may skip any question you prefer not to answer, and you may stop at any point without giving a reason and without consequence.

This is a low-risk study. The main risks are loss of confidentiality, discomfort from discussing WASH experiences, and concern about how answers might reflect on you or your facility. Responses are kept confidential, no answer is shared with your facility in a way that identifies you, and you may skip any question.

No. Individual answers are not shared with facility management, supervisors, or colleagues. Facilities receive summary results only, with no identifying information. This matters particularly for cleaning and maintenance staff, whose candid answers are among the most useful the study collects.

They are stored without your name on encrypted, password-protected servers, and only trained study personnel can access them. Answers are combined with those of other respondents before any result is reported.

Yes. Participating facilities receive a short summary report of the key findings, with identifying information removed. Summary reports are also shared with local development partners and government officials so that findings can inform decisions.

Yes. The study is approved by the Institutional Review Board of Northwestern University, approval number STU00219169, and local ethical approval is obtained at every site before data collection begins.

Names are not stored with survey responses. Data are held on encrypted, password-protected servers with access restricted to trained study personnel. Results are never reported at a level that could identify an individual, and results based on very small numbers of respondents are not published as headline findings.

Sites contribute de-identified data to a harmonized database managed by the Executive Committee. Contributing sites hold sole ownership of the data they contribute, unless a different agreement is reached, and all sharing follows the consortium's written data sharing and attribution guidelines.

Requests for access to consortium data are considered case by case. Get in touch and describe what you want to do.