Specialist on WASH in Health Care and Educational Settings

The World Bank



In the 2030 agenda for sustainable development, access to WASH services extends beyond the home, to cover schools, workplaces and health care facilities. In institutional settings, WASH services are used by many people and the lack of safe and adequate facilities can have a negative impact on educational achievement in schools and quality of health care services.

The access to WASH services in schools can impact completed years of schooling in several ways. When children are healthier, well-fed, and have access to safe water and quality facilities, they are more likely to attend school. Improved access to sanitation facilities in schools has been linked to increased enrollment in primary schools in India[1] and a higher rate of school completion in Brazil.[2] While in school, girls require an environment that is supportive of menstrual hygiene management (MHM) in order to ensure regular school attendance and participation. The presence of gender segregated bathrooms, hygiene and handwashing facilities can hence present a friendly and a supportive environment for girls.

Similarly, the availability and access to sustainable water, sanitation and hygiene (WASH) services is highly essential to providing safe and quality care and preventing infection in health care facilities (HCFs). Evidence has shown that provision of clean water and sanitation facilities such as handwashing stations has a direct impact on reduction in disease transmission (UNICEF, 2019).[3] The lack of WASH services in health care facilities has significant impact on maternal, newborn and child health in terms of increased morbidity and mortality. Globally, 1300 young children die every day due to diarrheal disease caused by unsafe water, sanitation and hygiene (UNICEF, 2019). Studies have shown that with access to WASH in HCFs, the risks of site-related or preventable infections among HCF staff, patients, and the wider community decreases. Hence, access to WASH services in institutional settings are crucial to the achievement of Sustainable Development Goals (SDGs) on education and health. 

The WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) has highlighted the state of WASH in Schools and HCFs (JMP, 2019):

  • Although 69% of schools globally had a basic drinking water service, nearly 570 million children lacked a basic service at school. Nearly half of schools in sub-Saharan Africa (SSA) had no service;
  • 66% of schools globally had a basic sanitation service but over 620 million children lacked a basic service at school. A third of schools in SSA and South Eastern Asia had no service;
  • 53% of schools globally had a basic hygiene service but nearly 900 million children lacked a basic service at school. Over one in three primary schools and a quarter of secondary schools had no hygiene service
  • 1 in 4 HCFs lacks basic water service
  • 1 in 5 HCFs has no sanitation service, which has an impact on more than 900 million and 1.5 billion people, respectively.
  • 1 in 6 HCFs has no hygiene service.

The Sustainable Development Goals (SDGs) provide guidelines to address WASH in institutions through SDG Goal 6, which ensures availability and sustainable management of water and sanitation for all. Besides this, WASH in schools is also covered by Goal 4, which ensures inclusive & equitable quality education & promote lifelong learning opportunities for all; and HCFs through Goal 3, which focuses on health for all, particularly Universal Health Coverage.

Operational Toolkit for WASH in health care and educational settings

Hence, to fully contribute to the SDG agenda and to ensure a multi-sectoral response to the infectious disease outbreaks, the Water Global Practice (GP) at the World Bank recently developed an Operational Toolkit for World Bank task teams and clients to deliver on WASH infrastructure and services. The content of the Toolkit was developed according to gaps identified through a desk review of existing literature and resources for WASH in both health care and educational settings.  It consists of two sets of modular packages covering all aspects of WASH in health care and educational settings. Each set contains 9 modules covering the full cycle of project design, implementation and supervision (Figure 1).

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Figure 1: Packages considered under the Operational Toolkit

The Toolkit modules include generic Terms of References, guidance notes and checklists for each of these activities. These modules need to be adapted to the country and project context in close collaboration with client and World Bank task teams.

Access to WASH in Madagascar [4]

In terms of access to basic water services, Madagascar presents one of the widest gaps between the rich and poor (measured by quintiles); coverage is at 20 percent in the poorest quintile against 82 percent in the highest quintile.[5] According to the latest data from JMP (2017), 54.4 percent of the global population has access to basic water services[6] but only 36.3 percent of the rural population has access to basic water services, compared to 85.8 percent in urban areas. Additionally, only 10.5 percent of the population has access to basic sanitation services (6.3 percent in rural areas compared to 17.8 percent in urban areas), with coverage at 0 percent for the poorest quintile of the population and 18 percent of the richest quintile (JMP 2017).

The water supply, sanitation and hygiene (WASH) sector performs poorly, with low quality of services. According to the Multiple Indicator Cluster Survey (MISC) carried out in 2018 by INSTAT: (i) more than half of the Malagasy population (57 percent) does not have access to an improved water source; (ii) 4 in 5 people drink water contaminated with E. Coli, i.e. fecal matter; (iii) out of 5 individuals, 4 do not have access to an adequate basic sanitation service and 2 practice open defecation; (iv) only 1 in 4 people have a device for washing their hands with soap and water; and (v) 9 out of 10 women have access to appropriate products, and a private place to wash and change during menstruation, but 1 in 10 women reported that they are not able to participate in a social, school or economic activity during her menstruation.

Madagascar National Water Project (P174477)

The Madagascar National Project will contribute to the Government’s long-term vision for the development of the water sector. The project is an Investment Project Financing (IPF) with the proposed amount of US$ 150 million and is expected to last 5 years. This project will help support the GoM to tackle the main challenges to the development of the water sector, and to plan key long-term interventions. The project development objective of this project is to increase access to improved water sources in the Greater Antananarivo area and select secondary towns.[7] The secondary towns (districts) to benefit from the Project intervention will be selected during preparation. The project will be implemented by Ministère Eau, Assainissement et Hygiene (MEAH), which will conduct the key strategic studies, and will pilot the institutional development of the sector and the national water and electricity utility – Jiro Sy Rano Malagasy (JIRAMA) will manage the investments side.


In collaboration with project task teams, the Toolkit is now being implemented in a number of countries in East and Southern Africa. In addition, the World Bank Team is preparing a training workshop on the Toolkit. These ToRs specify the scope of services aiming at providing Country Technical Support as well as central project support.  The key objectives of the assignment are:

  1. Support the design and facilitation of a workshop on Institutional WASH in Madagascar.
  2. Support the World Bank Task team in the design of Institutional WASH activities within a new World Bank Water Supply and Sanitation operation for Madagascar.
  3. Support the World Bank Task team in the design of Institutional WASH activities in other countries in Francophone Africa

Scope of Work

  1. Design and facilitation of Institutional WASH workshop

The consultant will support the World Bank team to design and facilitate a workshop on WASH in Institutional settings in Madagascar. The objective of this workshop is to increase awareness and knowledge of the Operational Toolkit for WASH in Healthcare Facilities and Schools and present examples of how the Toolkit has been implemented in select countries. The Workshop will be structured to provide insights into the details of the Operational Toolkit for WASH in Healthcare Facilities and Schools that has been developed. These will cover the different modules developed shown in Figure 1.

The Water GP’s WASH in Health and Education team will lead the workshop and will work very closely with the Water GPs Communications team, in its organization and delivery. The event is expected to mobilize participants, comprising World Bank TTLs/staff and government counterparts from the Water, Health and Education Sectors. The profile of the government counterparts present at the Workshop is to be confirmed but will ideally include: line ministry directors/heads/representatives of national departments responsible for WASH in Healthcare Facilities and Schools; service providers with responsibility for WASH in Healthcare Facilities and Schools; and sub-national government representatives with responsibility for WASH in Healthcare Facilities and Schools.

Successful case studies of implementation of the Toolkit from around the world will also be provided along with the presentation and discussion of practical material and tools developed for better designing such interventions.

The workshop should be designed to be highly participative to encourage discussion and to ensure participants have the opportunity to delve into some of the case studies and the tools presented, drawing on the experience of the specialists and case studies.

  • During some sessions, round tables will be created to give participants the opportunity to have a number of breakout discussions and exercises on strategic topics.
  • The participants will be guided in the preparation of action plans that will be intended to help them move towards use of the operation Toolkit in country.
  • Each team (government counterparts and World Bank project team member) will be asked to develop an action plan for their WASH in HCF/Education setting based on the material presented. These action plans will lay out what lessons they will take from the event, what they will do differently on returning home, and what support they would like to receive from development partners for achieving the goals of their action plans.

The Workshop will be required to be designed to be delivered and facilitated virtually due to the current COVID-19 environment.

The expected outcomes from the Workshop are:

  • Increased knowledge on the WASH in Health Care Facilities and Schools approach and the toolkit at the disposal of task teams and their government counterparts
  • Demystification of relevant successful case studies and approaches/strategies to achieving sustainable WASH access in WASH in Healthcare Facilities and Schools
  • Improved knowledge exchange between teams and government counterparts working on similar issues
  • Follow up activities, as needed, with the WASH in Healthcare Facilities and Schools team.

The consultant is expected to finalize the design, facilitated and write up a training methodology for the workshop. The consultant is also expected to write up a short workshop report, outlining the key outcomes of the workshop and detailing participants. It is expected the workshop will be delivered before December 2021.

  1. Design of Institutional WASH activities in World Bank Projects:

The tasks below will apply at different stages of project preparation and implementation: 

  1. Review background and project documents to familiarize with project and country context.
  2. Develop a brief WASH bottleneck analysis, identifying possible WASH actions in project components, procurement plans and existing institutional arrangements.
  3. Support client and project team to identify an appropriate set and sequencing of Toolkit materials for the project and prepare an implementation timeline, including resource requirements for each activity as inputs into a procurement plan.
  4. Based on the set of Toolkit materials that will be used in the country, adapt these as needed to the project and country context. This includes liaising with subject experts in inclusion, fragility, climate to incorporate these considerations in Toolkit materials.
  5. Provide support to task team and client to hire and supervise the consultants, as needed
  6. Serve as the Bank’s point person for matters related to implementation of the Toolkit, liaising regularly with counterparts and keeping the team informed with regular updates regarding any issues that arise.
  7. Contribute to knowledge, learning and communication activities (e.g. PPTs for BBLs, blogs, policy note, etc.) to highlight the country experience on integrating WASH in HCF Toolkit, as needed. Contribute to conceptualization of a workshop training on the Toolkit and preparation of material, as needed.
  8. Refine the Toolkit materials as needed based on country experience
  9. Submit periodic reports on the consultant activities and other relevant reports as requested by Task Teams/ PMU (e.g. inputs to AMs, ISRs, etc).

Deliverables & proposed timelines

The following deliverables are expected:

Design and facilitation of Institutional WASH workshop

  • Finalized PPT and training materials for the workshop
  • Workshop training methodology document
  • Workshop report
  • Other written outputs as requested by the TTL.

Design of Institutional WASH activities in World Bank Projects:

  • WASH situational analysis/ diagnostic (per country)
  • Inception report which sets the country and project context, recommended set of Toolkit materials and sequencing, implementation timeline and resource requirements (per country)
  • Final Toolkit materials adapted to country/project context.
  • Progress summary during implementation of Toolkit (e.g. inputs to AMs, ISRs, etc.).
  • Inputs to knowledge, learning and communications materials, and revisions to Toolkit materials, as needed.

These are tasks are those currently envisioned.  The consultant may be asked to perform other duties as required.


The contract will cover 50 days between November 2021 to June 2022. The 50 days will not be used consecutively but will be spread out over the course of the contract period. The number of contracted days and the contract period can be extended based on progress and World Bank needs.


Due the current COVID-19 situation the consultant is expected to support the assignment home-based.

Consultant Qualifications

The consultant shall have the following qualifications:

  • Advanced university degree in Public Health, Social Science, Economics, Engineering or a field relevant to international WASH related development assistance.
  • Minimum 5 years relevant professional experience on issues related to sustainable development, human development, and sustainable urban/ rural sanitation.
  • Knowledge of Water supply, sanitation and hygiene (WASH) interventions and its intersections with health, nutrition and education desired
  • Proven track record of designing and delivering trainings and workshops.
  • Demonstrated understanding of cross cutting issues such as gender and social inclusion.
  • Proven ability to interact with other teams and technical specialists, within and outside their own task team.
  • A track record of delivering analytical work to a high standard and in a timely fashion.
  • The consultant should have the ability to work well in teams but be proactive in taking responsibility for his/her work products.
  • Strong writing skills in English and French are required, knowledge of Malagasy would be an asset.
  • Past experience in WBG lending operations/investment projects in Sub-Saharan Africa would be asset.


The remuneration rate applicable will be determined taking into account the candidate experience and following the World Bank Remuneration Matrix for Consultant (STC).

Counterpart and Reporting

The short-term consultant will report to Claire Chase (Senior Economist, Water GP) and Ruth Kennedy-Walker (Senior Water Supply and Sanitation Specialist, Water GP) and other members of the team. The consultant is expected to work closely with the client and WB project task team. 

Payments will be output based for days worked, with dates agreed upon prior to the beginning of the contract.

Applications can be sent to Shrutha Sivakumar ([email protected]) by October 31. Applications will be reviewed on a rolling basis.

[1] Adukia, A. (2017). Sanitation and education. American Economic Journal: Applied Economics, 9(2), 23-59.

[2] Ortiz-Correa, J. S., Resende Filho, M., & Dinar, A. (2016). Impact of access to water and sanitation services on educational attainment. Water Resources and Economics, 14, 31-43.

[3] WASH in Health Care Facilities UNICEF Scoping Study in Eastern and Southern Africa. (2019). Retrieved from UNICEF website: https://www.unicef.org/esa/media/4826/file/UNICEF-WASH-in-Health-Care-Facilities-2019.pdf

[4] Project Concept Note – Madagascar National Water Project (P174477)

[5] JMP. 2019. Progress on household drinking water, sanitation and hygiene I 2000-2017. Focus on Inequalities. World Health Organization.

[6] Drinking water from an improved source, provided collection time is not more than 30 minutes for a roundtrip including queuing.

[7] Initial number of towns is 10, this number as well as the final designation will be agreed during project preparation.






IHE Delft Institute for Water Education - MSc in Water and Sustainable Development