ArticleGlobal health, science and practice2024
Budgeting and Advocacy to Improve Water, Sanitation, and Hygiene in Health Care Facilities: A Case Study in Nepal.
Article in Global health, science and practice, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Global capacity for implementing the eight practical steps to achieve universal access to water, sanitation, and hygiene in healthcare facilities: A qualitative study using implementation science.SSM - health systems · 2026Article
- Determinants of access to waste management services in healthcare facilities in 14 low- and middle-income countries.Waste management & research : the journal of the International Solid Wastes and Public Cleansing Association, ISWA · 2026Article
- Mapping the evidence on environmental health services in healthcare facilities in low- and middle-income countries: A systematic literature inventory of over 4,000 studies.medRxiv : the preprint server for health sciences · 2025Article
- Factors enhancing operation and maintenance of sanitation facilities for improved service levels in Kampala Schools.BMC public health · 2025Article
- Resource allocation for environmental health services in healthcare facilities: A qualitative case study from Niger.PLOS water · 2025Article
- Environmental Infrastructure Maintenance Bottlenecks in Healthcare Facilities and Coping Strategies Among Healthcare Workers in Niger.Environmental health insights · 2024Article
Corrections and comments
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Authors and funding
12 authors.
Funding
Abstract
Barriers to achieving and sustaining access to water, sanitation, hygiene, cleaning, and waste management (WASH) in health care facilities include a lack of supportive policy environment and adequate funding. While guidelines exist for assessing needs and making initial infrastructure improvements, there is little guidance on how to develop budgets and policies to sustain WASH services. We conducted costing and advocacy activities in Thakurbaba municipality, Nepal, to develop a budget and operations and maintenance policy for WASH in health care facilities in partnership with the municipal government. Our objectives for this study were to (1) describe the process and methods used for costing and advocacy, (2) report the costs to achieve and maintain basic WASH services in the 8 health care facilities of Thakurbaba municipality, and (3) report the outcomes of advocacy activities and policy development. We applied bottom-up costing to enumerate the resources necessary to achieve and maintain basic WASH services and their costs. The annual costs to achieve, operate, and maintain basic access to WASH services ranged from US$4881-US$9695 per facility. Cost findings were used to prepare annual budgets recommended to achieve, operate, and maintain basic services, which were presented to the municipal government and incorporated into an operations and maintenance policy. To date, the municipality has adopted the policy and established a recovery fund of US$3831 for repair and maintenance of infrastructure and an additional US$153 per facility for discretionary WASH spending, which were to be replenished as they were spent. Advocacy at the national level for WASH in health care facilities is currently being championed by the municipality, and findings from this project have informed the development of a nationally costed plan for universal access. This study is intended to provide a roadmap for how cost data can be collected and applied to inform policy.
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