Reflections on My Summer Practicum with The UNC Water Institute

It has been a few weeks since my practicum ended with the UNC Water Institute. I am grateful that I was given this opportunity to explore the field of water and sanitation hygiene (WASH) in health care facilities (HCFs) and was able to connect with several organizations and WASH professionals during the practicum.

The key activities that I completed during this practicum included a grey literature sorting, systematic reviews of documents and document extractions, nine interviews (11 participants) of international WASH in healthcare facility professionals, and an analysis of the website. These activities guided my practicum products, which included a mini study and report of the website, and a compilation of WASHFIT modules on sanitation related studies.

One of the most interesting parts of the practicum were the interviews. The interviews conducted were to find out training and capacity development needs in HCFs internationally, and questions asked in the interview were based on the eight practical steps identified by the WHO and UNICEF to reach universal access to WaSH in healthcare facilities, such as conducting situation assessments, establishing national standards, implementing infrastructure, and monitoring. I found that many HCFs, with the support of local and national governments had accomplished situational assessments and established at least a national standard, with some HCFs developing individual standards for HCFs or within a specific community. A large barrier to moving forward with implementation, monitoring, and community engagement were resources available to be allocated to hardware and software needs. As the WASH sector grows and the need for services becomes more apparent, resources will need to be prioritized in such a way that they sustain HCF abilities to carry through the eight practical steps.

These interviews also shaped our practicum team’s perception of what tools and guidelines are necessary for advancing services in several domains of WASH and helped us create the WASHFIT modules. The modules included a summary of an intervention or study, the findings and outcomes, and any other information that was important to note about the intervention. The modules also included a visual of where each intervention was conducted, the details of the area, which included type of healthcare facility, geographic makeup (urban or rural), and included icons to symbolize what WASH components were included in the intervention. Once published and shared, WASH professionals may use these modules to guide interventions in their own HCFs and advance within the eight practical steps.


WASH and Environmental Conditions in Health Care Facilities

Hello! My name is Anushka Banerjee, and I am an MPH candidate in the Global Health concentration at the UNC Chapel Hill Gillings School of Global Public Health. Some of my public health interests include water and sanitation hygiene (WASH), emergency and disaster preparedness and response, and community health access and equity. This summer, I am completing my practicum with the UNC Water Institute, and participating in a project that analyzes WASH and environmental conditions in health care facilities globally. The goal of the project is to use the information to curate and support development of training and capacity building to improve WASH services in these health care facilities (HCF). I am working with a few other MPH students at UNC, and so far it has been a pleasure to meet and work with them!

While our practicum started a few weeks ago, we have been diving headfirst into preliminary tasking. We have been reading through several reports from the Joint Monitoring Program (JMP) and the World Health Organization (WHO), including information about WASH FIT. Many healthcare facilities across the world lack the resources and tools, mechanisms, and personnel to reinforce proper WASH, which compromises the ability of such HCFs to deliver equitable, safe, and quality care to community members. Lack of WASH can also negatively impact infection prevention and control (IPC), which can cause a loss of IPC and lead to detrimental short-and-long term health outcomes. WASH FIT is a management tool and guide for HCFs and is used as a framework to develop, monitor, and implement improvement plans for key aspects of WASH services. These key aspects include water, sanitation, hand hygiene, environmental cleaning, health care waste management, and parts of energy/building/facility management.

Caption: An overview of the WASH FIT cycle, along with anticipated outcomes and impacts. (WHO, 2022)

WASH FIT collaborates with political, financial, human, civil society, and energy/climate/health resources to create a team, assess HCF facilities, identify areas for improvement, develop a plan and act, and monitor, review, adapt, and improve the plan. The goal of these plans guided by WASH FIT are to improve infrastructure, services, and facility management. This includes improved IPC, less environmental pollution, and a more efficient use of resources across the HCF.

As we move forward with the practicum, we will be conducting systematic reviews, interviews with health care facility personnel, and doing an analysis of the findings from both. Using this, we will develop our deliverables for the practicum, and have a more holistic view of the status of WASH in global health care facilities. The first few weeks of this practicum have excited me for what is to come, and I can’t wait to share next time!

– Anushka