Application of the Water and Sanitation for Health Facility Improvement Tool to Identify Water, Sanitation, and Hygiene Gaps in Healthcare Facilities in Bangladesh

ABSTRACT. Inadequate water, sanitation, and hygiene services remain a major challenge in healthcare facilities (HCFs), particularly in low- and middle-income countries. In the present study, the WHO’s Water and Sanitation for Health Facility Improvement Tool (WASH FIT) was used to identify system-level WASH gaps and inform quality improvement in selected HCFs in Bangladesh. This cross-sectional study was conducted purposively in 16 HCFs across six divisions of Bangladesh between October and December 2023. Water, sanitation, and hygiene conditions were assessed using WASH FIT, which evaluates 96 indicators across seven domains. Indicators were scored on a three-point scale, and domain and overall performance were categorized using WASH FIT cutoff points and WHO/United Nations Children’s Fund Joint Monitoring Program service ladders. No facility achieved an overall WASH FIT score greater than 67%. Although all facilities had basic water supplies, 93.8% had less than 1 day of water storage capacity, and 62.5% lacked reliable drinking water stations. Sanitation services were poor, with no facility scoring greater than 46%; none had disability-accessible toilets, and 81.3% lacked menstrual hygiene management facilities. Hand hygiene was the weakest domain, with soap available at only 56.6% of handwashing stations. Only 37.5% of facilities practiced proper healthcare waste segregation, and none provided adequate personal protective equipment to waste handlers. Environmental cleaning scores were also low because of inadequate protocols and limited trained staff. These findings reveal the value of WASH FIT for identifying infrastructure, operational, governance, and management gaps to support evidence-informed planning and strengthen infection prevention and control in healthcare facilities.