Clinic A clinic Was investigated in Chief Albert Luthuli Local municipality in south Africa WASH evaluation To evaluate access to WASH, a Water and Sanitation for Health Facility Improvement Tool (WASH FIT) dealing with WASH conditions, availability, supply, sanitation, hygiene, and waste management was used to obtain WASH aspects of the health care clinics (WHO, 2017). The WASHFIT used is divided into essential and advanced indicators for the four domains which include water, sanitation and healthcare waste, and hygiene. Three domains of the WASHFIT including water, sanitation and hygiene were investigated in this study. The indicators for each domain were ranked from meets target, partially meets target, and does not meet target; this ranking was explained by the tool for each indicator. For instance, a water indicator on improved water supply piped into the premises of the facility (clinic). According to the tool this indicator is met when there is improved supply within the facility and available, partially met when water supply is outside of facility building and available, and the target is not met when there is no improved water source within facility grounds (WHO, 2017). Sample collection Samples were collected in 290 mL Sodium Thiosulphate sampling bottles and transported on ice. Four tap water samples were collected from each site which included kitchen, bathroom, consultation room and an outside tap. Physicochemical parameters such as pH, temperature, electrical conductivity, and total dissolved solids were measured onsite using the pH/EC meter (HANNA Instruments, USA). Total and Free chlorine was measured using the YSI 900 chlorine meter .Turbidity was measured using the TN-100 EUTECH. The microbiological analysis of the samples was carried out within 6 hours of collection. For this analysis,100 mL of the sample was used in the detection of E. coli and coliforms using the IDEXX Colilert Quanti-Tray/2000 assay according to manufacturers instructions. The following tables answered interview question show the results which were found in the clinic Questions AND answers for semi-structured Interviews To find out the challenges faced by the clinics in terms of WASH 1. What is the main source of water in the facility? Municipal 2. Any backup or alternative source of water? -JoJo Tanks 3. Does it happen that the facility stays without water supply from the main source? Yes 3.1. How long does it usually take? -1 TO 2 WEEKS 4. Who do you report to when experiencing water shortages? - Municipality 4.1. What is being done when you report water shortages? -Tanks get filled with water by municipal trucks 5. How often do hygienic products (Sanitizers, soaps, cleaning material) get supplied in a year?- irregular 6. Do you have to apply for hygienic products to be supplied? -ordered 6.1. Who do you apply to? -Caroline hospital 6.2. How long does delivery take after application?- 2 weeks 7. Are there any challenges you face in terms of the supply .

1. Clinic A clinic Was investigated in Chief Albert Luthuli Local municipality in south Africa
WASH evaluation To evaluate access to WASH, a Water and Sanitation for Health Facility
Improvement Tool (WASH FIT) dealing with WASH conditions, availability, supply, sanitation,
hygiene, and waste management was used to obtain WASH aspects of the health care clinics
(WHO, 2017). The WASHFIT used is divided into essential and advanced indicators for the four
domains which include water, sanitation and healthcare waste, and hygiene. Three domains of
the WASHFIT including water, sanitation and hygiene were investigated in this study. The
indicators for each domain were ranked from meets target, partially meets target, and does not
meet target; this ranking was explained by the tool for each indicator. For instance, a water
indicator on improved water supply piped into the premises of the facility (clinic). According to
the tool this indicator is met when there is improved supply within the facility and available,
partially met when water supply is outside of facility building and available, and the target is not
met when there is no improved water source within facility grounds (WHO, 2017). Sample
collection Samples were collected in 290 mL Sodium Thiosulphate sampling bottles and
transported on ice. Four tap water samples were collected from each site which included
kitchen, bathroom, consultation room and an outside tap. Physicochemical parameters such as
pH, temperature, electrical conductivity, and total dissolved solids were measured onsite using
the pH/EC meter (HANNA Instruments, USA). Total and Free chlorine was measured using the
YSI 900 chlorine meter .Turbidity was measured using the TN-100 EUTECH. The
microbiological analysis of the samples was carried out within 6 hours of collection. For this
analysis,100 mL of the sample was used in the detection of E. coli and coliforms using the
IDEXX Colilert Quanti-Tray/2000 assay according to manufacturers instructions. The following
tables answered interview question show the results which were found in the clinic Questions
AND answers for semi-structured Interviews To find out the challenges faced by the clinics in
terms of WASH 1. What is the main source of water in the facility? Municipal 2. Any backup or
alternative source of water? -JoJo Tanks 3. Does it happen that the facility stays without water
supply from the main source? Yes 3.1. How long does it usually take? -1 TO 2 WEEKS 4. Who
do you report to when experiencing water shortages? - Municipality 4.1. What is being done
when you report water shortages? -Tanks get filled with water by municipal trucks 5. How often
do hygienic products (Sanitizers, soaps, cleaning material) get supplied in a year?- irregular 6.
Do you have to apply for hygienic products to be supplied? -ordered 6.1. Who do you apply to?
-Caroline hospital 6.2. How long does delivery take after application?- 2 weeks 7. Are there any
challenges you face in terms of the supply of hygienic products e.g. incompetent suppliers? -
None 8. Any other challenges you face with meeting proper health standards within the facility
e.g. lack of education from people within communities where the clinics are located? - water
shortages and inconsistent supply of hygienic products The following table show interview

2. answered question Answers 3= meets target 2= partially meets target 1= does not meet target 0=
not applicable SYMBOL ANSWER PROBLEM STATEMENT OR QUESTION 3 1.1 =
improved water supply piped into the facility or on premises and available 2 1.2 = water
services available at all times and sufficient quantity for all uses 2 1.3= a reliable drinking
water station is present and of sufficient quantity for all uses 3 1.4= drinking water is safely
stored in clean bucket/tank with cover and tap 0 1.5= sanitary inspection risk score (using
sanitary inspection form 3) 3 1.6= all endpoints i.e. taps are connected to an available and
functioning water supply 2 1.7= water services available throughout the year 3 1.8=
water storage is sufficient to meet the needs of the facility for two days 3 1.9= water is
treated and collected for drinking with a proven technology that meets WHO performance
standards 2 1.10= drnking water has appropriate chlorine residual (0.2 mg/L/0.5mg/L in
emergencies) or E.coli/100 mland is not turbid 2 1.11= the facility water supply is regukated
according to national water quality standards (mark if no standards exist) 0 1.12= energy is
available for heating water (mark if not applicable) 0 1.13= energy is availabkle for pumping
water (mark if not applicable) 2 1.14= atleast one shower or bathing area is available per 40
patients in inpatient settings and is fuctioning and accessible 2 1.15= showers are adequately
lit, including at night 2 2.1= number of available and usable toilets or improved latrines for
patients 3 2.2= toilets or improved latrines clearly separated for staff and patients 3 2.3=
toilets clearly separated for male and female 3 2.4= atleast one toilet provides means for
menstrual needs 3 2.5= atleast one toilet meets the needs of people with limited mobility
3 2.6= functioning hand hygiene stations within 5m of latrines 2 2.7= record of cleaning
toilets visible and signed by the cleaners each day 3 2.8= wastewater is safely managed
through the use of onsite treatment i.e. septic or sent to sewer system 3 2.9= greywater (i.e.
rainwater or wastewater) drainage system is in place that diverts water away from the facility 2
2.10= latrines are adequately lit, including at night 1 2.11= a trianed person is responsible
for the management of health care waste 3 2.12= functional waste generation points for: non-
infectious, infectious and sharp waste 3 2.13= waste correctly segragated at all waste
generation points 3 2.14= functional burial pit/fenced waste dump or municipal pick-up
available for general/non-infectious waste 0 2.15= incinerator or alternative treatment
technology for the treatment of infectious and sharp waste is functional and of a sufficient
capacity 0 2.16= sufficient energy available for incenaration or altenative treatment technologies
(mark if N/A) 3 2.17= hazardous and non-hazardous waste are stored separatley before being
treated/disposed of or moved off-site 1 2.18= all infectious waste is stored in protected area
before treatment, for no longer than the default and safe time 0 2.19= anatomical/pathological
waste is put in a dedicated pathological waste/placenta pit, burnt I a crematory or buried in a
cemetry (mark if N/A) 0 2.20= dedicated ash pit available for disposal of incineration ash (mark

3. if N/A) 1 2.21= protocol or standard operating procedure (SOP) for management of health
care waste clearly visible and legible 3 2.22= appropriate protective equipment for all staff in
charge of waste treatment and disposal 3 3.1= functioning hand hygiene satations are
available at all points of care 3 3.2= hand hygiene promotion materials clearly visible and
understandable at key places 3 3.3= functioning hand hygiene stations are available in service
areas 3 3.4= functioning hand hygiene stations available in waste disposal area 2 3.5=
hand hygiene compliance activities are undertaken regularly 3 3.6= the exterior of the
facility is well-fenced and kept clean 2 3.7= general lighting sufficiently powered and
adequate to ensure safe provision of health care including at night (mark if N/A) 3 3.8= floors
and horizontal work surfaces appear clean 3 3.9= appropriate and well maintained cleaning
materials 3 3.10= atleast two pairs of household gloves and one pair of overalls or apron
and boots ina good state, for each cleaning and waste disposal staff member 2 3.11= atleast one
member of staff can demostrate the correct procedures for cleaning and disinfection and apply
them as required to maintain clean and safe rooms 0 3.12= beds have insecticide treated nets to
protect patients from mosquito-borne diseases 3 3.13= a mechanism to track IPC-related
materials such as gloves and protective equipment to identify stock outs 3 3.14= record of
cleaning visible and signed by the cleaners each day 1 3.15= laundry facility are available to
wash linen from patient beds between patient 3 3.16= the facility has sufficient natural
ventilation and where the climate allows, large open windows, skylights and other vents to
optimize ventilation 3 3.17= kitchen stores and prepared foos is protected from flies, other
insects or rats 0 3.18= beds for patients should be seperated by 2.5m from the centre of one
bed to the enxt and each bed has only one patient SAMPLE WERE TAKEN IN DIFFERENT
AREAS OF THE CLINIC THE TABLE BELOW SHOW THE RESULTS FOUND Sampling
_Area Clinic_Clusters 1= Outside_ Tap 1= Clinics_1_4 2= Toilet_Tap 2= Clinics_5_7 3=
Kitchen_Tap 3= Clinics_8_9 4=Consultation_Room_Tap 4= Clinics_10_14 5= Clinics_15_17
Clinics Clinic_Clusters Sampling _Area pH Free_Cl_(mg/l) Total_Cl_ (mg/l) Temperature_
C Conductvity_(EC)_ ms TDS_ppm Turbidity_NTU Total_coliforms_ MPN/ 100ml E.coli_
MPN/ 100ml CLINIC 4 1 8.88 0 0 21.0 75 37 2.90 93.3 10.9 CLINIC 4 2 9.14 0 0.03 19.0 73
37 2.95 117.8 9.8 CLINIC 4 3 8.69 0 0 36.3 91 45 2.35 0 0 CLINIC 4 4 8.85 0 0 20.8 74 37 2.88
135.4 9.8 WRITE A REPORT THEAT FULLY INTERPREATS ALL THE RESULTS
FOUND THE CLINIC, NAME THE EFFECTS THAT CAN RESULT FROM THE RSULT
AND RECOMMEND ON WHAT SHOULD BE DONE.CLEARLY ELABORATE EACH
RESULT FOUND .