Development and application of tools to cost the delivery of environmental health services in healthcare facilities: a financial analysis in urban Malawi

Anderson, Darcy M.; Cronk, Ryan; Pak, Emily; Malima, Precious; Fuente, David; Tracy, J. Wren; Mofolo, Innocent; Kafanikhale, Holystone; Hoffman, Irving; Bartram, Jamie

doi:10.1186/s12913-021-06325-3

Cited by 5 publications

(11 citation statements)

References 26 publications

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“…While there have been previous studies costing WASH in healthcare facilities (see, e.g. 14,[17][18][19] ), to our knowledge this is the first study to document the application of costs data for improved policy and practice. Even where cost evidence is being generated, its translation into meaningful improvements in policy and practice has been slow.…”

Section: Discussionmentioning

confidence: 97%

“…We pre-populated the spreadsheet with resources essential for achieving basic WASH, based on previous field research. 14 We conducted a pilot visit to one healthcare facility, where we observed conditions and availability of infrastructure, goods, and services related to WASH. We also conducted a meeting to understand how repair tasks were carried out. This information was used to refine the list of resources pre-populated in the spreadsheet.…”

Section: Methodsmentioning

confidence: 99%

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Budgeting and advocacy to improve water, sanitation, and hygiene in healthcare facilities: a case study in Nepal

Chettry,

Bohara,

Bohara

et al. 2024

Preprint

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Barriers to achieving and sustaining access to water, sanitation, hygiene, waste management (collectively, "WASH") in healthcare facilities include a 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 in the long-term. We conducted costing and advocacy activities in Thakurbaba municipality, Nepal, with the aim of developing a budget and operations and maintenance policy for WASH in healthcare facilities in partnership with the municipal government. Our objectives for this study are 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 eight healthcare 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 of WASH services ranged from USD 4,881 to 9,527 (including operations and maintenance and annualized capital investments). Cost findings were used to prepare annual budgets recommended to achieve and maintain basic access, which were presented to municipal government and incorporated into an operations and maintenance policy. To-date, the municipality has adopted the policy and established a recovery fund of USD 3,831 for repair and maintenance of infrastructure, and an additional USD 192 per facility for discretionary WASH spending. Advocacy at the national level for WASH in healthcare facilities is currently being championed by the municipality, and findings from this project are being used to inform 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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Section: Discussionmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 99%

Budgeting and advocacy to improve water, sanitation, and hygiene in healthcare facilities: a case study in Nepal

Chettry,

Bohara,

Bohara

et al. 2024

Preprint

Self Cite

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“…Prior research on costing may help identify inputs and activities. Bottom-up costing studies on environmental health services in healthcare facilities have developed frameworks to identify essential inputs and activities (Anderson, Cronk, et al, 2021; Anderson, Wren Tracy, et al, 2021). However, these frameworks are not tailored to WASH FIT programs and will require verification and likely adaptation.…”

Section: Discussionmentioning

confidence: 99%

Does WASH FIT improve water, sanitation, and hygiene and related health impacts in healthcare facilities? A systematic review

Lineberger,

Cronk,

Kpodzro

et al. 2024

Preprint

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Introduction: Environmental health services (e.g., water, sanitation, hygiene, cleaning, waste management) in healthcare facilities are important to improve health outcomes and strengthen health systems, but coverage gaps remain. The World Health Organization and United Nations Children's Fund developed WASH FIT, a quality improvement tool, to help assess and improve environmental health services. Fifty-three countries have adopted it. However, there is little evidence of its effectiveness. This systematic review evaluates whether WASH FIT improves environmental health services or associated health outcomes and impacts. Methods: We conducted database searches to identify relevant studies and extracted data on study design, healthcare facility characteristics, and inputs, activities, outputs, outcomes, and impacts associated with WASH FIT. We summarized the findings using a logic model framework and narrative synthesis. Results: We included 31 studies in the review. Most inputs and activities were described qualitatively. Twenty-three studies reported quantitative outputs, primary WASH FIT indicator scores, and personnel trained on WASH FIT. Nine studies reported longitudinal data demonstrating changes in these outputs throughout WASH FIT implementation. Six studies reported quantitative outcomes measurements; the remainder described outcomes qualitatively or not at all. Common outcomes included allocated funding for environmental health services, community engagement, and government collaboration, changes in knowledge, attitudes, or practices among healthcare staff, patients, or community members, and policy changes. No studies directly measured impacts or evaluated WASH FIT against a rigorous control group. Conclusions: Available evidence is insufficient to evaluate WASH FIT's effects on outputs, outcomes, and impacts. Further effort is needed to comprehensively identify the inputs and activities required to implement WASH FIT and to draw specific links between changes in outputs, outcomes, and impacts. Short-term opportunities exist to improve evidence by more comprehensive reporting of WASH FIT assessments and exploiting data on health impacts within health management information systems. In the long term, we recommend experimental studies. This evidence is important to ensure that funding invested for WASH FIT implementation is used cost-effectively and that opportunities to adapt and refine WASH FIT are fully realized as it continues to grow in use and influence.

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“…We tested these tools through field data collection in urban Malawi in 2018. The setting and methods are described elsewhere ( Anderson et al 2021b ). In brief, we collected data in three individual facilities (two private clinics and a government central hospital) and a small private network of seven facilities providing care to patients enrolled in clinical research studies.…”

Section: Toolkit For Costing Ehs In Hcfsmentioning

confidence: 99%

“…Empirical data on costs generated during toolkit development are available in Anderson et al (2021b) . The fillable spreadsheet in Supplementary Material, File 2 also contains example data that we collected during toolkit development.…”

Section: Toolkit For Costing Ehs In Hcfsmentioning

confidence: 99%

A toolkit for costing environmental health services in healthcare facilities

Anderson

Tracy

Cronk

et al. 2021

Journal of Water, Sanitation and Hygiene for Development

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Environmental health services (EHS) in healthcare facilities (HCFs) are critical for providing a safe, functional healthcare environment, but little is known about their costs. Poor understanding of costs impedes progress toward universal access of EHS in HCFs. We developed frameworks of essential expenses required to provide EHS and conducted an ex-post financial analysis of EHS in a network of medical research and training facilities in Lilongwe, Malawi, serving an estimated 42,000 patients annually through seven outpatient buildings. We estimated the cost of providing the following EHS: water, sanitation, hygiene, personal protective equipment use at the point of care, waste management, cleaning, laundry, and vector control. We developed frameworks of essential outputs and inputs for each EHS through review of international guidelines and standards, which we used to identify expenses required for EHS delivery and evaluate the completeness of costs data in our case study. For costing, we use a mixed-methods approach, applying qualitative interviews to understand facility context and review of electronic records to determine costs. We calculated initial costs to establish services and annual operations and maintenance. Available records contained little information on the upfront, capital costs associated with establishing EHS. Annual operations and maintenance totaled USD 220,427 for all EHS across all facilities (USD 5.21 per patient encounter), although costs of many essential inputs were missing from records. Annual operations and maintenance costs were highest for cleaning (USD 69,372) and waste management (USD 46,752). Missing expenses suggest that documented costs are substantial underestimates. Costs to establish services were missing predominantly, because purchases pre-dated electronic records. Annual operations and maintenance costs are incomplete primarily, because administrative records did not record sufficient details to disaggregate and attribute expenses. Electronic health information systems have potential to support efficient data collection. However, we found that existing record systems were decentralized and poorly suited to identify EHS costs. Our research suggests a need to better code and disaggregate EHS expenses to properly leverage records for costing. Frameworks developed in this study are a potential tool to develop more accurate estimates of the cost of providing EHS in HCFs.

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Development and application of tools to cost the delivery of environmental health services in healthcare facilities: a financial analysis in urban Malawi

Cited by 5 publications

References 26 publications

Budgeting and advocacy to improve water, sanitation, and hygiene in healthcare facilities: a case study in Nepal

Budgeting and advocacy to improve water, sanitation, and hygiene in healthcare facilities: a case study in Nepal

Does WASH FIT improve water, sanitation, and hygiene and related health impacts in healthcare facilities? A systematic review

A toolkit for costing environmental health services in healthcare facilities

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