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Published on: 07/03/2019

Water, sanitation, and hygiene (WASH) are key ingredients to basic healthcare, yet studies show that they are often absent in healthcare facilities around the world. This absence of soap, water and toilets poses a massive health risk and greatly reduces the effectiveness of healthcare for health professionals, patients, and communities. Without safe and adequate WASH in healthcare settings, mothers and newborns are likely to contract healthcare-associated infections, and infectious disease outbreaks and antimicrobial resistance are difficult to contain. In a 2018 survey of 129,000 healthcare facilities in 78 low- and middle-income countries, 50% of healthcare facilities lacked piped water, 33% of healthcare facilities lacked toilets and 39% of healthcare facilities lacked soap for handwashing. In six of the countries from the survey – Bangladesh, Haiti, Malawi, Nepal, Senegal, and Tanzania – only 2% of healthcare facilities had WASH and waste management services.

In response to the bleak state of WASH services in healthcare facilities, the United Nations Secretary-General issued a call to action on World Water Day 2018 (March 22) for universal WASH coverage in all healthcare facilities by 2030. In order to realize the United Nations Secretary-General’s ambitious target, advocacy at all levels within developing countries is vital.


Health and patient advocates can and must play a central role in increasing political and social pressure on budget and policy decision makers. Successful advocacy for systemic changes will ensure that WASH in healthcare facilities is planned for and supported by sufficient budget lines, accounting for both the capital cost of infrastructure and its on-going maintenance. Advocates will also urge behavior change and institutional capacity building of local governments across the health and WASH sectors. This work will focus on those most affected by the lack of WASH facilities and services to ensure appropriate budget allocation and disbursement, and, when needed, changes in policy and policy enforcement.  

To strengthen the voice of advocates working on health, patient rights, and WASH, IRC, with support from Global Water 2020, is providing technical and financial support for advocacy for WASH in healthcare facilities. Collaborative advocacy is a new and innovative way to increase the focus on this challenging issue facing the WASH and health sectors. The grantees are: Health Rights Advocacy Forum (Kenya), NGO Forum for Public Health (Bangladesh), Rural Health Advocacy Project (South Africa), and White Ribbon Alliance (Malawi). These four organizations will carry out national and subnational advocacy work to improve access to sustainable WASH services in healthcare facilities in their respective countries.

The grantees will engage diverse stakeholders to improve the state of WASH in healthcare facilities, from national ministries of health and finance to district-level health authorities. By targeting key decision makers and influencers across sectors, the grantees aim to shape policies, standards, and budgets to make sure WASH is included in all healthcare facilities. Experiences from the grantees will be shared on global and national knowledge sharing and media platforms including While the grants will fund one year of advocacy activities, these four forward-thinking grantees are already integrating WASH in healthcare facilities into their existing health and WASH advocacy programming far beyond 2019.

2019 Grantees

Health Rights Advocacy Forum (HERAF), Kenya

Founded in 2006, HERAF advocates nationwide for a human rights-based approach to healthcare delivery in Kenya. As part of this sub-grant, HERAF will work to increase the prioritization, financing, implementation and maintenance of WASH infrastructure in healthcare facilities in Kenya by: 1) raising awareness of WASH in healthcare facilities among key decision makers by framing it as a human rights issue, 2) advocating for the development and implementation of WASH policies and guidelines to improve the state of WASH in healthcare facilities, and 3) increasing funding for this issue by engaging with the Ministries of Health, Planning and Finance at the national and subnational levels.

NGO Forum for Public Health, Bangladesh

Since 1982, the NGO Forum for Public Health (or NGO Forum) has brought together 850 WASH non-governmental organizations (NGO), community-based organizations (CBO), and private sector stakeholders to increase access to safe and sustainable WASH and healthcare services, alleviate poverty, and promote climate change adaptation centered on disaster risk reduction. As a recipient of the WASH in Healthcare Facilities Advocacy Sub-Grant, the NGO Forum will advocate for the integration of WASH in healthcare facilities in Bangladesh’s National Strategy for Water Supply and Sanitation 2014 by: 1) elevating the priority of this issue within relevant Ministries, 2) establishing a national platform to facilitate dialogue between WASH and health stakeholders, and 3) creating model WASH practices in line with the national strategy.

Rural Health Advocacy Project (RHAP), South Africa

Based in Johannesburg, RHAP is a health research and advocacy organization working to increase access to equitable, quality healthcare throughout rural South Africa. RHAP advocates for rural-friendly health policies, rural health financing and human resources for rural health, along with their effective implementation. As part of the advocacy sub-grant, RHAP will work with healthcare facility governing bodies in a sub-district in the Eastern Cape to prioritize WASH in healthcare facility compliance as per the National Core Standards and the Ideal Clinical Realisation and Maintenance Programme. Secondly, RHAP will increase coverage of WASH in healthcare facilities in relevant discourses through technical and accountability advocacy.

White Ribbon Alliance (WRA), Malawi

WRA Malawi was founded in 2002 to address Malawi’s high maternal and newborn mortality rate through advocacy for midwifery services, respectful maternity care, citizen journalism, and citizen-led accountability, as well as empowering midwives to advocate for their needs. With the advocacy sub-grant, WRA Malawi will advocate that the Ministry of Health incorporate WASH in healthcare facilities in national WASH and healthcare strategies and policies, as well as achieve WASH services in at least 30% of healthcare facilities in three districts by influencing policy and budget processes and promoting accountability. 

IRC is an international think-and-do tank that supports governments and organizations in transforming the way they approach WASH challenges. IRC engages with national institutions on finance, water security, sanitation, hygiene, and monitoring practices.

Global Water 2020 is a fully-funded, bipartisan advocacy and facilitation initiative designed to accelerate progress towards global water security and sanitation for all. Global Water 2020’s projects range from WASH in healthcare facilities to transboundary water management.

 To learn more about WASH in healthcare facilities, please visit:

To learn more about this particular program, please contact: Elynn Walter at

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