Kate Holt/Jhpiego

Water, Sanitation and Hygiene (WASH)

Handwashing is the single most cost-effective intervention to prevent pneumonia and diarrhea in children, and reduces infections in mothers and children during pregnancy and childbirth. Both A Promise Renewed and the Integrated Global Action Plan for the Prevention and Control for Pneumonia and Diarrhoea (GAPPD) list handwashing and other hygiene behaviors as core interventions for protecting children from these leading causes of death.

Adequate WASH conditions and practices are a cornerstone to providing high-quality health care services. In low- and middle-income countries, 50% of health care facilities (HCFs) lack piped water, 33% lack improved sanitation, 39% lack handwashing soap, 39% lack adequate infectious waste disposal, and 73% lack sterilization equipment. In nationally representative data from six countries, only 2% of HCFs provide all water, sanitation, hygiene and waste management services. As a result, an estimated 16% of patients acquire a health care associated infection during their stay at a health facility. Sepsis and other infections account for a growing proportion of maternal (11%) and neonatal deaths (22%). With the growing number of deliveries taking place in HCFs, WASH conditions and practices within facilities must be improved in order to achieve national and global Sustainable Development Goal targets.

MCSP’s WASH activities work across the continuum of care and at all levels of the health system through nontraditional messaging models that reflect country-specific behaviors and social norms. The Program also employs counseling, demonstration and practice at all stages of the maternal, newborn and child health continuum of care. Examples include: instructions on the construction of handwashing stations, such as tippy taps; development of handwashing corners; and household-level demonstrations of water treatment, safe water storage, and treatment methods.

Through the Clean Clinic Approach, MCSP is working to strengthen management systems to improve WASH conditions and practices in HCFs and provide high-quality care to patients.

To download MCSP’s WASH fact sheet, click here.

Key Results


  • To improve the quality of infection prevention and control, MCSP has implemented the Standards-Based Management and Recognition approach in more than 100 HCFs in Program countries.
  • MCSP with Save the Children co-developed and tested its comprehensive Clean Clinic Approach to ensure effective national coverage and empower local levels to improve existing WASH in HCF.
  • In Haiti, MCSP designed and piloted the Clean Clinic Approach, beginning as a 19-facility pilot in 2015 and expanding to 69 facilities in 2017. Working through the Ministry of Public Health and Population (MSPP), the approach ensures that facilities meet MSPP WASH in HCF standards. In 2016, Hurricane Matthew tested the Haitian health system’s capacity for response and recovery: in areas where the Clean Clinic Approach had trained personnel on WASH in HCFs, health services rebounded more quickly and efficiently.
  • In DR Congo, MCSP worked with the Ministry of Health’s Office of Hygiene and Public Safety to develop their own version of the Clean Clinic Approach (Centre de Sante Assaini). Within the first month, two supported HCFs increased their cleanliness scores to 75% and 66% (from baselines of 31% and 33%, respectively).
  • In Mozambique, the Program is building the capacity and participation of co-management committees (CMCs) – groups composed of both HCF staff and community representatives. Through the CMCs, MCSP works to prioritize facility improvements, and to develop and implement annual action plans. The Program is also working with two provincial governments to finalize a rapid assessment form, which will assess the WASH and cleanliness status of HCFs and inform annual action plans.

More results from the WASH program can be found on MCSP’s WASH for Healthcare webpage.

Maternal Child Survival Program
Maternal and Child Survival Program