Insights from the HCF-WISE project
Data collection is complete at several sites and analysis is underway. Full findings will be published in peer-reviewed papers and in site reports returned to participating facilities. Three patterns are already clear.
Pattern 1Service availability is not the same as service adequacy
Patients and staff at health care facilities classified as having basic WASH services can still go without.
Where facilities were in place, patients and staff still reported difficulty reaching them, or found that the services did not meet their needs reliably. Supply-side indicators alone can make a health care facility look well served when the people in it are not.
Pattern 2WASH disparities exist within and across facilities
Individual-level data show disparities by age, gender, disability, and position at the health care facility.
Patients and staff often differ, though not always in the same direction: sometimes staff have better services, and sometimes they expect more of them and report more problems that affect their wellbeing and their ability to do their work.
Pattern 3Challenges across all domains
Difficulties are not confined to one domain.
The most burdensome domain differs from facility to facility. Handwashing stations are often present; soap at the moment of need often is not. At all three sites with data so far, more patients and more staff reported not having enough soap than not having enough water to wash their hands. Managing menstruation is among the most common challenges, yet it is not captured as a standalone service level in global monitoring.
Explore the data
Below you can explore every HCF-WISE item asked at each site. Pick a site and a domain; the grey bar is the difference between the percentage of patients and the percentage of staff who reported it.
Water
- Felt thirsty but had no safe water to drink Patients: 56%Staff: 58%
- Worried water problems could make them or others sick Patients: 24%Staff: 31%
- Drinking water tasted, looked, or smelled badStaff only Patients: not askedStaff: 40%
- Worried there would not be enough waterStaff only Patients: not askedStaff: 63%
- Water supply at the facility was interruptedStaff only Patients: not askedStaff: 54%
- Could not concentrate on duties because of thirstStaff only Patients: not askedStaff: 46%
- Water problems affected their ability to provide careStaff only Patients: not askedStaff: 42%
- Water problems affected their ability to clean the facilityStaff only Patients: not askedStaff: 37%
- Performed or assisted a procedure without enough waterStaff only Patients: not askedStaff: 42%
- Patients were asked to bring or fetch their own waterStaff only Patients: not askedStaff: 37%
- Flooding or heavy rains disrupted activities (past 12 months)Staff only Patients: not askedStaff: 62%
Sanitation
- Unable to use a toilet when needed Patients: 76%Staff: 49%
- Thought the toilets were dirty or smelled bad Patients: 80%Staff: 73%
- Thought it was unsafe to go to the toilet Patients: 65%Staff: 39%
- Worried they could be seen while using the toilet Patients: 30%Staff: 30%
- Not enough materials to clean themselves afterwards Patients: 81%Staff: 73%
- Ate or drank less to avoid using the toiletsStaff only Patients: not askedStaff: 38%
- Waited until they got home to use a toiletStaff only Patients: not askedStaff: 66%
- Felt ashamed or embarrassed to use the toiletsStaff only Patients: not askedStaff: 41%
- Could not concentrate on duties because they needed a toiletStaff only Patients: not askedStaff: 41%
Hygiene
- Not enough water to wash hands Patients: 58%Staff: 54%
- Not enough soap to wash hands Patients: 82%Staff: 69%
- Unable to get their hands as clean as they wanted Patients: 67%Staff: 65%
- Felt annoyed by the handwashing options availableStaff only Patients: not askedStaff: 49%
Environmental cleaning
- Thought the areas where care was given were dirty Patients: 36%Staff: 50%
- Thought other parts of the facility were dirty Patients: 42%Staff: 49%
- Worried uncleanliness could make them or others sick Patients: 31%Staff: 40%
- Thought surfaces were not properly cleanedStaff only Patients: not askedStaff: 48%
- Thought medical equipment was not properly cleanedStaff only Patients: not askedStaff: 34%
- Not enough soap, detergent, or disinfectant for cleaningStaff only Patients: not askedStaff: 73%
- Used less cleaning product to avoid running outStaff only Patients: not askedStaff: 77%
- Limited in cleaning by problems with the cleaning toolsStaff only Patients: not askedStaff: 77%
- Used their own money to buy cleaning suppliesStaff only Patients: not askedStaff: 28%
- Not enough protective equipment to work safelyStaff only Patients: not askedStaff: 58%
- Reused disposable protective equipment because supply ran shortStaff only Patients: not askedStaff: 42%
Waste management
- Thought waste was not properly disposed of Patients: 36%Staff: 33%
- Worried waste could make them or others sick Patients: 34%Staff: 34%
- Waste containers were overfilledStaff only Patients: not askedStaff: 33%
- Could not manage waste adequately or safelyStaff only Patients: not askedStaff: 50%
Menstrual health
Asked of patients and staff who menstruate
- No clean, safe place to change menstrual materials Patients: 85%Staff: 36%
- Difficult to dispose of menstrual materials privately Patients: 91%Staff: 44%
- Unable to wash after changing menstrual materials Patients: 90%Staff: 54%
- Felt nervous or embarrassed about coming to workStaff only Patients: not askedStaff: 22%
- Missed work because of their periodStaff only Patients: not askedStaff: 6%
- Worried materials would not be available in an emergencyStaff only Patients: not askedStaff: 44%
- Did not have materials to absorb their periodStaff only Patients: not askedStaff: 38%
How to read this. Each dot is the share of respondents who reported the experience at least some of the time (“some of the time” or “most of the time” for patients, “sometimes” or “many times” for staff), out of everyone who answered the item. The grey bar shows the gap between patients and facility staff.
Item wording was adapted for each site and is shortened here; hover over a dot for the percentage and the number of respondents behind it. Menstrual health items were asked only of patients and staff who menstruate. Values based on fewer than 30 respondents are not shown.
Patients answered about their time at the facility and staff about the past four weeks. In Uganda staff were asked about both the current and the opposite season; the current-season answer is the one shown.
These are preliminary descriptive results from the scale-development phase. They describe the participating health care facilities only, are not representative of the country, and have not yet been peer reviewed.
More analyses ahead
The core purpose of this project is to determine which items work well for assessing WASH insecurity within and across settings. Analyses are currently focused on which items are understood consistently across languages and settings, which items distinguish facilities that differ in ways we can verify, and which items can be dropped without losing information. The final scale will be shorter than the instruments now being implemented.
Findings will be published in peer-reviewed papers and returned to participating health care facilities and ministries as short reports. The site explorer above is a first, preliminary version of the interactive site profiles; it will be updated as more findings emerge.
Follow the work
Papers and site reports are forthcoming and will be posted on the Resources page, where a first article and a presentation are already available.