A systematic tool to assess sustainability of safe water provision in healthcare facilities in low-resource settings
To achieve safe water for all (Sustainable Development Goal (SDG) 6), many healthcare facilities (HCF) will require onsite water treatment. We describe a systematic tool to assess the sustainability of safe water provision in HCFs. Data from surveys, water quality testing, and observations are summarized into scores across four domains: technical feasibility; onsite capacity; financial and operational accountability; and institutional engagement. Lessons learned over five years and multiple assessments across twenty hospitals in three countries are presented. Despite onsite treatment, persistent challenges were identified, including inconsistent water supplies and insufficient funding for maintenance. Across the assessments, 82 per cent of tap water samples met WHO guidelines for E. coli. Over time, sustainability improved in most studied hospitals through targeted improvements based on the tool’s results. Given the vulnerability of populations in HCFs and greater investment in HCF water infrastructure as part of SDG 6, systematic sustainability assessment and an evidence-based response is critical.