WASH in Health Care Facilities Assessment Consultant via ReliefWeb

Save the Children

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Total Duration: 51 days (max)

Time Period: May 1, 2016 – July 31, 2017

Location of Assignment: Remote with travel to Haiti and Liberia

Reporting to: WASH Advisor


Water, sanitation, hygiene (WASH), and environmental conditions in health care facilities (HCF) are neglected areas despite a high associated risk for morbidity and mortality. In 2015, the World Health Organization presented data representing 66,101 health care facilities in 54 countries, showing that 38% of HCFs do not have an improved water source, 19% do not have improved sanitation, and 35% do not have water and soap for hand-washing.[1]

Health care-associated infections (HAIs), i.e. infections acquired during the process of care, affect hundreds of millions of patients every year – 15.5% expected to develop one or more infections during a hospital stay in the developing world.[2] Newborns in developing countries are at 3–20 times higher risk of acquiring an HAI than those in high-income countries. Poor WASH is the primary cause of most HAIs, which are estimated at over 1.4 million cases at any given time.[3]

HCFs with insufficient WASH suffer three primary consequences:

  1. The HCF becomes unable to provide safe services (e.g., hygienic births, clean surgeries), especially to mothers, neo­nates, and children,

  2. Populations served by these HCFs lose confidence in the institutions as safe places to seek care,

  3. Emergency responses (e.g., Ebola, Zika) are weakened and threaten a population’s security.

USAID’s Maternal and Child Survival Program (MCSP) has addressed WASH in HCF through several mechanisms and funding streams: Concentrated infection, prevention, and control (IPC) efforts in Liberia, Guinea, and Ghana have sought to reinforce the Ebola response. Development and roll out of MCSP’s Clean Clinic Approach (CCA) in Haiti, DRC, and Mozambique is employing a systematic approach to strengthening a health system’s decentralized ability to make WASH improvements in its facilities.

MCSP is seeking a consultant to review and analyze activities undertaken by MCSP under the WASH in HCF umbrella and make recommendations for improvements. Data collection will include a literature review, in-depth interviews with key players in the WASH in HCF space, targeted discussions with partners implementing similar WASH in HCF and IPC activities, and field visits to Haiti (CCA) and Liberia (IPC) to assess implementation. Integration across sectors, specifically health systems strengthening (HSS) and quality improvement (QI), will be a part of the scope.


Objectives of the assessment include:

  1. Assess the effectiveness of the CCA in bringing about incremental WASH improvements in health facilities with minimal external investment.

  2. Evaluate how effective MCSP was in supporting WASH in HCFs during emergencies – EBOLA and Hurricane Matthew.

  3. Investigate the advantages and disadvantages of WASH in HCF as a platform which includes supporting health systems in emergencies and incorporates various elements such as IPC, WASH infrastructure improvement, and hygiene promotion.

  4. Determine whether improved WASH in HCF is a determinant of a community’s perceptions of and use of the facility.

  5. Assess the effectiveness and value of MCSP’s WASH in HCF work to integrate with other sectors, Health Systems Strengthening and Quality Improvement in particular.

Scope of Work:

The Consultant will lead the design and implementation of a global literature review of existing research on WASH in Health Care Facilities. The literature review should summarize the background, history/evolution, approaches, evidence on effectiveness, and challenges in addressing WASH in HCF. Although review of peer-reviewed literature is the priority, grey literature should not be completely ignored, particularly where little peer-reviewed research is available. The Consultant will ensure that where less reliable evidence is presented, the extent of data reliability is clearly communicated.

The Consultant will identify and interview key global experts in WASH in HCF, health systems strengthening, and quality improvement to identify global challenges, successes, opportunities and policy implications. The list of interviewees will include organizations currently implementing WASH in HCF programming.

Following the literature review and informant interviews, the consultant will submit a summary report of key findings, no longer than 5 pages.

Following submission of the summary report, the consultant will develop a data gathering assessment tool to be approved by MCSP. This tool will form the basis for data gathering activities in Haiti and Liberia.

For the assessment, the Consultant will travel to Haiti and Liberia for a period of approximately 12 days each in order to visit health facilities where IPC and CCA work was undertaken and conduct key informant interviews with staff at these health facilities and with national and local government counterparts.

Level of Effort: 51 days

· Conduct literature review – 8 days

· Global key informant interviews – 7 days

· Analysis and summary report writing – 3 days

· Develop data gathering tool for field visit – 3 days

· Liberia field visit – 12 days

· Haiti field visit – 11 days

· Data analysis and report writing – 5 days

· Report revisions – 1 day

· Presentation of findings – 1 day

Expected deliverables and due dates

  1. Summary report of literature review and global key informant interviews (May 24, 2017)

  2. Data gathering tool for field visits (May 29, 2017)

  3. Draft report (July 7, 2017)

  4. Final report (July 18, 2017)

  5. Presentation to MCSP and USAID ( July 31, 2017)


· Advanced degree in public health, international relations, WASH or other related field

· Experience in designing, implementing and analyzing research protocols and activities, including both quantitative and qualitative research methods

· Strong communication, analytical and writing skills

· Ability to travel to and within Liberia and Haiti

· Fluency in written and spoken English and French

· Experience in the WASH sector at the health facility level.

[1] WHO (2015). Water, Sanitation and Hygiene in Health Care Facilities: status in low-and middle-income countries and way forward: 10 Key Findings.
WHO & UNICEF. Available at: http://www.who.int/water_sanitation_health/publications/wash-hcf-10thing….

[2] WHO (2017). Evidence for Hand Hygiene Guidelines. Internet page. Available at: http://www.who.int/gpsc/tools/faqs/evidence_hand_hygiene/en/

[3] WHO. Healthcare Associated Infections Factsheet. WHO. Brief. Available at: http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf.

How to apply:

How to apply:

Interested candidates are requested to send their CV, biodataform and a cover letter to Ayne Worku at [email protected] with subject line: WASH in Health Care Facilities Assessment Consultant by March 31, 2017 11:59pm EST.