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Philippine Roadmap for Sustainable, Safe, and Universal Access to Water, Sanitation, Hygiene and Waste in Health Facilities

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Category
wash
Status
current
Hospital Levels
L1L2L3
Issuing Body
Department of Health
Extracted
2026-04-23

PHILIPPINE ROAD MAP

FOR SUSTAINABLE, SAFE, AND UNIVERSAL ACCESS TO WATER, SANITATION, HYGIENE AND WASTE IN HEALTH FACILITIES 2030

Published by

Department of Health San Lazaro Compound Rizal Avenue, Sta. Cruz, Manila 1003 PHILIPPINES

PRODUCTION CREDITS

Project Leader/s: Dr. Ma. Bituin S. Reyes Engr. June Philip O. Ruiz

Copy Editor: Mr. Glenn A. Cruz

Ms. Georgina Mae R. Zulueta

Acknowledgement: World Health Organization UNICEF

Development of the Guidelines was initiated, completed, and subsequently published through the HFDB.

For inquiries, contact the Health Facility Development Bureau: Phone: +63 2 8651 7800 locals 1401, 1403, 1406

Email Address: hfdb@doh.gov.ph or gshfp@doh.gov.ph

PHILIPPINE ROADMAP FOR SUSTAINABLE, SAFE, AND UNIVERSAL ACCESS TO WATER, SANITATION, HYGIENE AND WASTE IN HEALTH FACILITIES

(2025 – 2030)

1.INTRODUCTION
1.1.Rationale
for
the
Formulation
of
a
Philippine
roadmap
for
WASH
in
HFs
1
1.2.Scope
of
the
Roadmap
1.3.Intended
Users
of
the
Roadmap
2.
IN
HFS		CONSIDERATIONS
IN
THE
DEVELOPMENT
OF
THE
PHILIPPINE
ROADMAP		OF
WASH
2.1.Global
Framework
and
Guidelines		3
2.2.Relevant
National
Policies
and
Issuances		7
2.3.Existing
National
Plans
and
Programs		12
3.SITUATIONAL
ANALYSIS
AND
ASSESSMENT
ON
WASH
IN
HF
3.1.Health
Impacts
of
Inadequate
WASH
in
Health
Facilities		16
3.2.Stakeholders
of
the
WASH
in
HF
in
the
Philippines		17
3.3.WASH
in
HF
Standards		18
3.4.WASH
in
HF
Baseline		19
3.5.Monitoring
of
HFs		24
3.6.Existing
DOH
Programs
on
WASH
in
HFs		25
3.7.Capacity
Building
Activities
on
WASH		26
3.8.Community
Engagement
Activities		26
3.9.Summary
of
Identified
Issues
and
Challenges
in
WASH
in
HFs		26
4.STRATEGIC
FRAMEWORK
4.1.Vision28
4.2.Mission28
4.3.National
Target		28
4.4.Strategies
and
Actions		29
4.5.Potential
Funding
Sources		36

1. INTRODUCTION

The provision of safe, sustainable, functional and climate-resilient water, sanitation, health care waste management, hygiene and environmental cleaning infrastructure and services (referred as WASH) across all parts of a health care facility is crucial in preventing deaths as its plays a vital role in infection prevention, preventing spread of antimicrobial resistance (AMR), patient and health worker safety and overall health outcomes. In addition, several global health initiatives and efforts also highlighted that having a reliable electricity supply is important in improving the quality, reliability and availability of the WASH facilities and services. These services are also an essential component in preparing for and responding to disease outbreaks, pandemic and emergency scenarios.

This Philippine Roadmap for WASH in HFs aims to strengthen the WASH services resilience of health care systems in preventing disease outbreaks, allow effective responses to emergencies including disasters and outbreaks and bring emergencies under control when they occur. This roadmap was developed in alignment with the global and national health priorities and targets. Improvement of water efficiency and hygiene in HF, provide quality of care and reduce infections, HFs must have the appropriate infrastructure and staff capacities to provide safe, effective, equitable and people-centered services.

1.1. RATIONALE FOR THE FORMULATION OF A PHILIPPINE ROADMAP FOR WASH IN HFS

As committed by the Philippine Department of Health during the 2019 World Health Assembly (WHA), a national roadmap should be developed and implemented so that the country will be guided on how all health facilities (HFs) will have access to safely managed and reliable water supplies, sufficient, safely managed, and accessible toilets or latrines for patients, caregivers, and staff of all sexes, ages, and abilities, appropriate core components of infection prevention and control programmes, including good hand hygiene infrastructure and practices, routine, effective cleaning, safe waste management systems, including those for excreta and medical waste disposal, and sustainable and clean energy.

1.2. SCOPE OF THE ROADMAP

The roadmap covers all DOH-licensed government and private health facilities in the country. As of December 31, 2024, there are a total of 10,770 DOH-licensed health facilities in the Philippines of which 69% are privately-owned and 31% are government-owned.

Table 1-1: DOH-licensed Health Facilities in the Philippines (as of December 31, 2024)

Type
of
HF		GovernmentPrivateTotal
Ambulance
Service
Provider		513889
Ambulatory
Surgical
Clinics		3259262
Birthing
Home
Facilities		117817912969
Blood
Service
Facility		13101114
Cancer
Treatment
Facility		54954
Clinical
Laboratory		27933503626
Type
of
HF		GovernmentPrivateTotal
Clinical
Laboratory
for
Molecular		202343
Pathology
Covid-19
Testing
Laboratory		107108215
Free
Standing
Dialysis
Clinics		25558583
Hospital
(Level
I)		336459795
Hospital
(Level
II)		59336395
Hospital
(Level
III)		6061121
Infirmary358266624
Primary
Care
Facility		78835832
Psychiatric
Care
Facility		34649
Total3,2857,48010,770
Source:
Health
Facilities
and		ServicesRegulatoryBureau
(https://hfsrb.doh.gov.ph/list-of-licensed-health-facilities/)

1.3. INTENDED USERS OF THE ROADMAP

This national roadmap is intended for the Department of Health (DOH), as the main implementer of this roadmap, the local government units (LGUs), HF administrators and workers, Development Partners and International Organization, Non-Government Organizations (NGOs), private sector partners and other stakeholders that are involved in WASH in HFs.

2. CONSIDERATIONS IN THE DEVELOPMENT OF THE PHILIPPINE ROADMAP OF WASH IN HFS

2.1. GLOBAL FRAMEWORK AND GUIDELINES

(i) Sustainable Development Goals and WASH in HFs

Provision of sufficient and safe WASH services in HFs is important in achieving the 2030 Agenda for Sustainable Development. Safe water, functioning sanitation facilities, implementation of proper hygiene and cleaning practices (SDG 6) are important in improving health outcomes linked to maternal, newborn, and child health (SDG 3).

Table 2-1: SDG Targets related to WASH in HF
SDGSDG
Targets		Relevance
of
WASH
in
HFs
6:
Ensure
availability
and
sustainable
management
of
water
and
sanitation
for
all.		6.1:
By
2030,
achieve
universal
and
equitable
access
to
safe
and
affordable
drinking
water
for
all
6.2:
By
2030,
achieve
access
to
adequate
and
equitable
sanitation
and
hygiene
for
all
and
end
open
defecation,
paying
special
attention
to
the
needs
of
women
and
girls
and
those
in
vulnerable
situations.		The
terms
"universal"
and
"for
all"
in
the
SDG
targets
6.1
and
6.2
suggest
that
the
monitoring
of
the
WASH
must
go
beyond
the
household
and
must
be
expanded
to
non-household
settings
such
as
the
health
facilities.
Provision
of
WASH
in
HFs
supports
these
targets
by
ensuring
that
both
patients
and
healthcare
workers
have
access
to
safe
water,
sanitation,
and
hygiene,
which
are
critical
for
infection
prevention,
patient
care,
and
overall
public
health
3:
Ensure
healthy
lives
and
promote
well-being
for
all
at
all
ages.		3.1:
By
2030,
reduce
the
global
maternal
mortality
ratio
to
less
than
70
per
100,000
live
births.
3.2:
By
2030,
end
preventable
deaths
of
newborns
and
children
under
5
years
of
age,
with
all
countries
aiming
to
reduce
neonatal
mortality		Safe
and
sufficient
WASH
services
in
HFs
is
critical
in
preventing
infections
and
ensuring
safe
childbirth,
reducing
the
risk
of
maternal
and
neonatal
deaths,
combating
SDGSDG
Targets		Relevance
of
WASH
in
HFs
to
at
least
as
low
as
12
per
1,000
live
births
and
under-5
mortality
to
at
least
as
low
as
25
per
1,000
live
births.
3.8:
Achieve
universal
health
coverage,
including
financial
risk
protection,
access
to
quality
essential
health-care
services
and,
access
to
safe,
effective,
quality,
and
affordable
essential
medicines
and
vaccines
for
all.
3.9:
By
2030,
substantially
reduce
the
number
of
deaths
and
illnesses
from
hazardous
chemicals
and
air,
water,
and
soil
pollution
and
contamination.		disease
outbreaks
and
providing
quality
care

(ii) The Eight Practical Steps: A Framework for National Action

As response to the Global Call to Action, to elevate the importance of and prioritize action on WASH in all health facilities, of the Secretary-General of the United Nations (UN) in 2018, WHO recommended eight practicals steps that Member States can adapt and implement to improve and sustain WASH services in HCFs as presented in Figure 2-1 To achieve universal coverage of WASH in health care facilities, WHO and UNICEF developed the 8 Practical Steps to help guide national action. This document outlines the existing resources for each of these steps, as well as providing examples from countries who have already achieved the step..

Figure 2-1: Eight Practical Steps to Improve and Sustain WASH in HCFs (WHO, 2019)1

The progress of the Philippines on these practical steps is summarized in Table 2-2. This is based on the 2023 Global Progress Report of World Health Organization (WHO) and United Nations Children's Fund (UNICEF).

Table 2-2: Progress of the Philippine on practical steps as of April 20232

Practical
Step		Score/
Progress
11a.
Conduct
situation
analysis		4
Practical
step
is
completed
or
achieved
on
a
national
level
and/or
large-scale
implementation
is
ongoing
1b.
Conduct
(baseline)
assessment		2
A
need
has
been
identified
and/or
plans
are
in
place
to
star
2Set
targets
and
establish
coordination
mechanism		3
Practical
step
is
underway
or
partially
completed
33a.
Establish
national
WASH
standards		4
Practical
step
is
completed
or
achieved
on
a
national
level
and/or
large-scale
implementation
is
ongoing
3b.
Establish
national
health
care
waste
standards		4
Practical
step
is
completed
or
achieved
on
a
national
level
and/or
large-scale
implementation
is
ongoing
4Improve
and
maintain
infrastructure		4
Practical
step
is
completed
or
achieved
on
a
national
level
and/or
large-scale
implementation
is
ongoing
5Monitor
and
review
data		2
A
need
has
been
identified
and/or
plans
are
in
place
to
start
6Develop
health
workforce		2
A
need
has
been
identified
and/or
plans
are
in
place
to
start
7Engage
communities		ND
No
data
8Conduct
research
and
share
learning		ND
No
data

(iii) 72 nd World Health Assembly (WHA) Resolutions on WASH in HFs

During the seventy-second WHA on WASH in HFs held on 28 May 2019, all UN Member States were urged to implement the following strategies to answer the global call for action for WASH in all HCFs.

  • conduct comprehensive assessments on the availability and quality of, and needs for, safe water, sanitation and hygiene in health care facilities;
  • develop and implement a roadmap according to national context;

1 Water, sanitation and hygiene in health care facilities: practical steps to achieve universal access. Geneva: World

Health Organization; 2019. License: CC BY-NC-SA 3.0 IGO

2 Water, sanitation, hygiene, waste and electricity services in health care facilities: progress on the fundamentals. 2023 global report. Geneva: World Health Organization and the United Nations Children's Fund (UNICEF), 2023. License: CC BY-NC-SA 3.0 IGO

  • establish and implement national minimum standards for WASH, integrate in thee accreditation and regulation systems and establish accountability mechanisms;
  • set targets and indicators and integrate into the national monitoring mechanisms
  • integrate WASH into health programming
  • identify and address inequities and interruptions in the availability of WASH services
  • align strategies and approaches with the global effort
  • establish procedures and funding to operate, maintain and implement continuous upgrades and improvements
  • educate and raise awareness
  • establish strong multisectoral coordination mechanisms
  • promote safe and secure working environmental for every health workers
  • (iv) Global Framework for Action (2024-2030)

Based on the WHO-UNICEF 2023 Global Report, large gaps still exist in WASH and electricity services in HFs. About 22% of HFs lack basic water services, 10% do not have toilets and 25% do not practice waste segregation. Hygiene services remain limited with 50% do not have basic hygiene facilities with water and soap or alcohol-based hand-rub. It was also estimated that about 1 billion people in low- and lower-middle-income countries are served by HFs that do not have reliable electricity or have no electricity at all3.

In 2024, WHO-UNICEF published the Global Framework for Action (2024-2030) for water, sanitation, hygiene, waste and electricity services in all health care facilities to achieve essential, climate-resilient, quality health services. The framework emphasized that achieving universal access to WASH and electricity services in HCFs requires coordinated efforts across multiple sectors, sustainable financing, and strong partnerships to ensure that all HCFs have access to the resources needed to protect patients, healthcare workers, and communities, and ultimately achieve better health outcomes worldwide

WHO-UNICEF identified three key areas where greater action is needed to accelerate the progress in meeting SDG 3 and SDG6 targets:

  • Integrate WASH, waste and electricity services into health planning, programming, financing and monitoring at all levels.
  • Regular monitor and review progress, and strengthen accountability

Develop and empower the health workforce to deliver and maintain WASH, waste and electricity services, and practice good hygiene

<sup>3Water, sanitation, hygiene, waste and electricity services in health care facilities: progress on the fundamentals. 2023 global report. Geneva: World Health Organization and the United Nations Children's Fund (UNICEF), 2023. License: CC BY-NC-SA 3.0 IGO.

2.2. RELEVANT NATIONAL POLICIES AND ISSUANCES

The following are the national policies and issuances that are particularly relevant to the provision of WASH in HFs.

(v) Presidential Decree (PD) No. 856: Code on Sanitation of the Philippines

The Code on Sanitation was promulgated on 23 December 1975 with the ultimate objective of improving and directing public health services towards the protection and promotion of peoples' health.

IRR of PD 856 Chapter 2: Water Supply (1998). This chapter in the Code on Sanitation prescribes that before water is used, distributed or sold for drinking, it should pass the criteria on standard parameters and values for bacteriological, physical, chemical, biological, and radiological quality set by the Philippine National Standards for Drinking Water (PNSDW).

IRR of PD 856 Chapter 18: Refuse Disposal (1998). Section 4 of this chapter sets the minimum standards and requirements for the segregation and storage of refuse/solid waste. It indicates the standard color coding of the waste containers per type of waste. Section 9 of Chapter 18 sets the specific requirements for the management of biomedical wastes from health care facilities and other similar establishments.

IRR of PD 856 Chapter 20: Pollution of the Environment (1998). Section 5 of this chapter lists the sanitary requirements that must be provided by the establishments, including health care facilities:

  • Adequate and potable water supply in accordance to Chapter 2 of PD 856 and PNSDW 2017
  • Sewage collection and disposal complaint to Chapter 17 of PD 856
  • Solid waste management in compliance to Chapter 18 of PD 856
  • Hand washing facilities with adequate water supply and soap
  • Adequate and clean toilet facilities for male and female and disabled workers and clients
  • Proper lightning and ventilation.

Revised Implementing Rules and Regulations (RIRR) of PD 856 Chapter 17: Sewage Collection and Disposal, Excreta Disposal and Drainage (2021). This Chapter of PD 856 sets the guidelines for the provision of individual excreta disposal systems and proper disposal of wastewater, including hospital wastewater. It also sets the proper design for the construction of septic tanks.

(vi) Republic Act (RA) No. 7160: Local Government Code of 1991

Section 17. Basic Services and Facilities, provides for LGUs to endeavor to be self-reliant and continue exercising powers and discharging duties and functions currently vested upon them. Among the basic services and facilities enumerated that shall be provided by the LGUs, funded out by their respective funds, are:

For a Barangay:

● health and social welfare services which include maintenance of barangay health centers and day care centers;

  • services and facilities related to general hygiene and sanitation, beautification and solid waste collection, and;
  • maintenance of water supply systems

For a Municipality or City:

  • health services including implementation of programs and projects on primary health care, maternal and childcare, and communicable and non-communicable disease control services, access to secondary and tertiary health services, purchase of medicines, medical supplies, and equipment needed to carry out the services;
  • solid waste disposal system or environmental management system and services or facilities related to general hygiene and sanitation, and;
  • infrastructure facilities intended primarily to service the needs of residents including clinics, health centers and other health facilities necessary to carry out health services

For a Province:

  • health services which include hospitals and other tertiary health services;
  • infrastructure facilities intended to service the needs of the province including inter-municipal waterworks, drainage and sewerage, flood control, and irrigation systems.
  • (vii) Republic Act No. 4226: Hospital Licensure Act

This act requires all hospitals and other health service establishments to acquire a licensure permit prior to operations and this permit must be renewed regularly. Requirements for licensing of a hospital and other health service establishments include (a) the provision of potable drinking water and records of water analysis that is updated every 6 months, (b) proper management of health care waste management in accordance to the management manual of DOH and environmental laws of EMB, (c) and provision of proper sanitation facilities including hand washing.

DOH Administrative Order (AO) No. 2012-012: Rules and Regulation Governing the New Classification of Hospitals and Other Health Facilities in the Philippines. This DOH AO provides guidelines on the classification of the healthcare facilities. It also includes the requirements of the health care facilities to provide safe, effective and efficient services to its patients. Regarding information management, the health facility must maintain technical records/ logbooks on the results of the water analysis.

  • For environmental management, each health care facility must observe the following:
  • Well ventilated, lighted, clean, safe and functional areas;
  • Adequate, safe and potable water supply;
  • Proper disposal of hazardous, toxic and infectious wastes in accordance with RA 6969;
  • Solid waste management based on the Health Care Waste Management Manual of DOH ad RA 9003;
  • Liquid waste management in accordance with the Health Care Waste Management Manual of DOH and DENR-EMB policy;
  • Implementation of no smoking policy.

DOH Circular No. 2016-042: Guidelines in the Application for Department of Health Permit to Construct. This DOH circular order sets the guidelines on the requirements and

process of application for the permit to construct required to all health care facilities prior to its construction. The issuance of the permit to construct is done by the regional offices of the DOH. Annex B to G of this DOH circular order provides the planning and design guidelines for hospitals and other health facilities. The checklist for the floor plans of the health care facilities is shown in annex H. The said checklist indicates the service areas in the health facility where toilet and handwashing facilities are required.

DOH Circular No. 2018-0103: Revised Licensing Assessment Tools for Hospitals. In support to RA 4226, the revised assessment tool for the hospital licensure was developed. This sets the criteria and indicators that the hospital must comply. Among others, the following are required to be provided by the hospital for them to be licensed:

  • Provision of safe and potable water;
  • Water analysis every 6 months;
  • Health care waste management compliant to the DENR-EMB standards and DOH's HCWM manual, and;
  • Provision of toilet facilities including hand washing.
  • (viii) Republic Act No. 6969: Toxic Substances and Hazardous and Nuclear Wastes Control Act of 1990

DENR Administrative Order (DAO) No. 2013-22: Revised Procedures and Standards for the Management of Hazardous Wastes. DAO 2013-22 serves as the procedural manual for RA 6969, also known as the "Toxic Substances and Hazardous and Nuclear Waste Control Act of 1990". This acts as a guide for the proper management of hazardous wastes including pathological or infectious wastes (M501) and pharmaceuticals and drugs (M503). Procedures and standards for the proper storage, transport, treatment and disposal of hazardous wastes are included in the DAO.

Joint DENR-DOH Administrative Order No. 2005-02: Policies and Guidelines on Effective and Proper Handling, Collection, Transport, Treatment, Storage and Disposal of Health Care Wastes. This Joint Administrative Order (JAO) harmonizes the efforts of DOH and DENR on the management of the health care wastes. It clarifies the jurisdiction, authority and responsibilities of the DENR and DOH in terms of the management of the health care wastes. The JAO also specifies the standards and guidelines for the proper management of the health care wastes from the point of generation up to the treatment and disposal. This applies to all the health care waste generators, transporters and owners of the TSD.

(ix) Republic Act No. 9275: The Philippine Clean Water Act of 2004

Republic Act No. 9275 emphasizes the importance of proper wastewater treatment and disposal to protect the Philippines' water resources. The Act holds industries, commercial establishments, and local governments accountable for their wastewater management practices, ensuring compliance with national standards and promoting cleaner, sustainable practices in water use and discharge.

As highlighted in Sections 7 and 14, the Act mandates the development and enforcement of discharge permits for facilities that generate wastewater, which are regulated by the Department of Environment and Natural Resources (DENR). All industries, commercial establishments, and local government units (LGUs) that discharge wastewater must comply with the effluent standards set by the DENR. The discharge of untreated or

inadequately treated wastewater into bodies of water, such as rivers, lakes, and seas, is strictly prohibited.

DENR Administrative Order No. 2016-08: Water Quality Guidelines and General Effluent Standards and DENR AO No. 2021-19: Updated Water Quality Guidelines and General Effluent Standards . DAO 2016-08 and 2021-19, among others, sets the standards of the effluent that must be complied by all point sources of water pollution when discharging to receiving water body or land. This DAO applies to all types of industries regardless of the quantity of wastewater discharged.

(x) Republic Act No. 11223: Universal Health Care Act

Passed by the Senate and House of Representatives of the Philippines on 10 December 2018 and Approved by the President on 20 February 2019, RA 11223 or the Universal Health Care Act prescribes reforms in the health care system and appropriated funds therefor. This Act effectively declares that it is the policy of the State to protect and promote the right to health of all Filipinos and aims to realize better performance in health systems that include proactive and effective health promotion programs or campaigns, which includes WASH. To regulate safety and quality, RA 11223 also promotes the establishment of an incentive scheme to acknowledge and reward health facilities that provide better quality, efficiency, and equity. For governance and accountability measures, the UHCA counts on the DOH to strengthen national efforts in providing a comprehensive and coordinated approach to health development.

The Act emphasizes that healthcare facilities must comply with national standards for licensing and accreditation set by the Department of Health (DOH) and the Philippine Health Insurance Corporation (PhilHealth). This includes meeting essential requirements for safe water, sanitation, and hygiene services. Facilities that do not meet these standards cannot be accredited or licensed to operate.

(xi) Philippine Green Building Code

To complement Presidential Decree No. 1096 National Building Code, the Philippine Green Building Code sets the minimum standards to improve the building's efficiency and sustainability and minimize its negative impacts to human health and the environment. This code includes efficient practices, designs, methods and technologies that will enhance the building's performance without significant increase in cost. The Code has six (6) performance standards: (1) energy efficiency, (2) water efficiency, (3) material sustainability, (4) solid waste management, (5) site sustainability and (6) indoor environmental quality.

DOH Department Circular No. 2019-0059: Green Certification of Government Health Care Facility Projects. This DOH circular order requires all healthcare facilities with a total building area of 10,000 square meters to integrate in their design and operation the greening initiatives in accordance with the Philippine Green Building Code. A green certification must be secured to the DOH by the concerned health care facilities.

(xii) Other Relevant DOH Issuances

DOH AO No. 2014-027: National Policy of Water Safety Plan (WSP) for All Drinking-Water Service Providers. The policy requires all drinking-water service providers to develop Water Safety Plans (WSP) and implement it in managing or operating their water supply system.

DOH AO No. 2016-002: National Policy on Infection Prevention and Control in Healthcare Facilities. The general objective of this policy issuance is to provide guidance for the establishment and effective implementation of the core components of Infection Prevention and Control in healthcare facilities. Issued on 08 January 2016, this AO applies to all healthcare facilities providing preventive, curative, restorative, and rehabilitative care in the Philippines. It recognizes that infection prevention and control is a vital component of quality healthcare and patient safety, and thus all HCF in the country should implement IPC effectively. The eight (8) components of the IPC Program and the priority areas that shall be established in HCFs are specifically identified and described under AO 2016-0002.

DOH AO No. 2017-007: Guidelines in the Provision of the Essential Health Service Packages in Emergencies and Disasters. The AO stipulates that requirements of the general population shall be met primarily through hygiene promotion, water supply, excreta disposal, vector control, solid waste management, and drainage in accordance with national and international standards.

DOH AO No. 2017-0010: Philippine National Standards for Drinking Water (PNSDW) of 2017. Administrative Order No. 2017-0010 of the Department of Health, also known as the Philippine National Standards of Drinking Water of 2017, sets the norms for drinking water quality and for water sampling and examination. This AO applies to all drinking-water service providers. Under this AO, all drinking water service providers are required to regularly monitor the quality of the drinking water in terms of microbiological, physical, chemical and radiological constituents. The parameters of drinking water quality were further classified as (1) mandatory, (2) primary, and (3) secondary parameters. The minimum frequency of sampling for the different parameters depends on the level and mode of water supply. Analysis of the water samples must only be done by DOH-accredited laboratories.

DOH AO 2020-0003: Strategic Framework on the Adoption of Integrated People-Centered Health Services in All Health Facilities. Provides the framework to provide guidance for the institutionalization of integrated people-centered health services in all HFs to ensure that all HFs are responsive to the needs of the patients. The IPCHS framework highlights the importance of having a unified client experience survey tool to evaluate and monitor the responsiveness of the HFs with the needs of the patients. An integral component of the IPCHS is the provision of appropriate infrastructure in the HFs to promote a healing environment by providing and maintaining a clean, safe and sanitary facility and environment for HF personnel, patients and clients.

DOH Department Circular No. 2020-0191: Circulation of the Health Care Waste Management Manual (4th edition). DOH updated the 3rd edition of the Health Care Waste Management Manual. The Manual provides a comprehensive set of guidelines on the safe management of health care wastes from the point of generation until disposal.

DOH Circular No. 2021-0437: Dissemination of Green and Safe Health Facilities Manual 1st Edition. In 2021, DOH published the Green and Safe Health Facilities Manual (1st edition) to provide guidelines for health facilities to to minimize the carbon footprint of the health sector while continuing to provide quality health and safety to the people.

DOH Memorandum 2023-0252: Adherence to the Guidelines on the Green and Safe Health Facilities Requirements Integration of Climate and Disaster Resilient Measures in the Construction of Health Facilities. This requires all newly constructed health facilities to conform with the building design stipulated in the Green and Safe Health Facilities Manual.

DOH Circular No. 2023-0185: Guidelines on Water and Sanitation for Health Facility Improvement Tool (WASH FIT). A localized version of WASH FIT has been developed with the objective of better aiding the Philippine health sector by taking into account relevant local context. It has been simplified to allow the straightforward application of the tool and the prompt development of WASH improvement plans by WASH FIT multisectoral teams and other users, such as policymakers and health program implementors. The suggested forms (or task-specific tools) were formulated in consideration of current and increasing concerns such as the greening of HFs, pandemics (e.g., COVID-19), impacts of climate change, and emergency situations.

2.3. EXISTING NATIONAL PLANS AND PROGRAMS

(i) National Objectives for Health (NOH) (2023-2028) and 8-Point Action Agenda

The National Objectives for Health Philippines (2023-2028), in alignment with the Philippine Development Plan 2023-2028 and Ambisyon Nation 2040, was formulated to outline the strategic priorities and actionable targets for the health sector in achieving the goals of the UHC. It is designed to ensure that the health system in the Philippines becomes more inclusive, resilient, and responsive to the needs of the population. The goals include universal access to health services, financial protection, and quality care, with a strong emphasis on prevention, system strengthening, and emergency readiness.

The NOH (2023-2028) was articulated through the 8-Point Action Agenda of DOH. Action Agenda 4 prioritizes the establishment of a responsive and resilient health system to effectively prevent, prepare for and respond to and recover from public health emergencies and crises. To meet this, one of the strategic interventions identified is to strengthen the climate resilience and environmental sustainability of health care facilities. It was also highlighted that the provision of sustainable and safe management of WASH is important during public health emergencies to maintain public health and prevent the spread of diseases, and should therefore be prioritized.

(ii) Philippines Health Facility Development Plan (PHFDP) 2020-2040

The PHFDP is a strategic roadmap that outlines the country's investment plan for improving health infrastructure and services to become responsive, equitable and resilient, consistent with the UHC Act. The plan requires all LGUs to align their local investment plans for health with the targets and priorities set in the PHFDP. The plan also encourages the private sectors to help address the gaps identified in the PHFDP. Moreover, the Office of the President released the Memorandum Circular No. 26 entitled "Adopting the Philippine Health Facility Development Plan 2020-2040, Directing All National Government Agencies and Instrumentalities, and Encouraging Local Government Units, to Undertake Efforts in Support Thereof.

The PHFDP acknowledges that the availability of sustainable water, sanitation and environmental, chemical and health care waste management services are essential to quality of care and infection prevention and control in health care facilities. To safeguard public health and maintain essential services, the plan mandates that all health facilities must be designed to be climate-resilient and environmentally sustainable. This ensures that these vital services remain operational, even during emergencies and disasters, thereby

protecting both patient and healthcare worker safety and contributing to the continuity of care during crises.

(iii) National Environmental Health Action Plan (NEHAP) 2030

The NEHAP 2030 which was disseminated through Department Circular No. 2023-0452 dated September 26, 2023, provides the country's strategic framework aimed to address environmental health issues and to promote sustainable practices for the protection of public health. It was developed in alignment with the country's overall health and development goals and international commitments, such as the Sustainable Development Goals (SDGs).

The NEHAP also covered WASH-related environmental health issues and climate-resiliency of health facilities. One of the strategic directions of NEHAP 2030 includes the construction, retrofitting and maintenance of health facilities to be green, safe and climate resilient. Table 2-4 presents the key actions identified in the NEHAP that is related to WASH in HFs

Table 2-3: NEHAP 2030 Action Plans for WASH and Waste Management in Health Facilities

ActionTimelineImplementingKPI
Agencies
Safe
Water
Supply,
Sanitation,
Hygiene
and
Health
Plan
B.4.5.
Require
all
government
buildings
(including
public
learning
institutions
and
Rural
Health
Units),
publicly
owned
and
used
facilities
to
have
climate-resilient,
WASHFIT,
and
water-efficient
fixtures,
and
rainwater
harvesters
and
storage
facilities.		2023-2030LWUA,
DPWH,
DILG,
DepEd,
LGUs		%
of
government
and
public
spaces
that
have
WASH-fit,
water-efficient
fixtures,
and
RWH
and
storage
facilities
B.5.2.
Develop
for
the
public
IEC
advocacy
materials
on
WASH,
safe,
efficient
and
sustainable
water
use,
safe
sanitation
and
disposal
of
waste,
open
defecation,
as
well
as
targeted
messaging
on
WASH
in
learning
institutions,
workplaces,
and
wastewater
management.		2024-2030DOH,
PIA,
DILG,
DOLE.
DepEd		Presence
of
social
marketing
and
public
information
plan
Presence
of
IEC
materials
#
of
people
reached
with
IEC
materials
yearly
B.5.4.
Provide
continuous
capacity
building
and
professional
development
of
environmental
health
workers
at
the
regional,
provincial
and
local
level
to
effectively
implement
WASH
related
initiatives
from
enforcing
legislation,
monitoring
and
surveillance,
WASH
planning
and
management,
risk
assessment
and
management,
contingency		2023-2030DOH,
DENR		#
of
provincial
implementers
trained
yearly
#
of
local
implementers
trained
yearly
ActionTimelineImplementing
Agencies		KPI
planning
for
WASH
in
emergencies,
health
education,
and
social
and
behavioral
change
communications
(SBCC).
B.6.2.
Ensure
regular
monitoring
of
WASH
facilities
(and
WASH
improvement
plans)
in
public
and
private
health
facilities,
in
workplaces,
and
in
learning
institutions
to
guarantee
that
they
are
compliant
with
WASH-FIT
technical
guidelines
and
standards
and
are
toxic-free		2023-2030DOH,
DILH,
DOLE,
DepEd,
CHED,
TESDA		%
of
WASH
facilities
regularly
monitored
B.6.3.
Incentivize
and
recognize
green,
safe,
and
resilient
health
facilities
through
the
Green
and
Safe
Health
Facilities
Manual
accompanying
the
Green
Viability
Assessment
tool
that
includes
the
Water
and
Sanitation
for
Health
Facility
Improvement
Tool
(WASH
FIT)		2023-2030DOH,
DILG		#
of
health
facilities
recognized
yearly
Health
Care
Waste
Management
D.2.8.
Formulate,
finance,
and
support
a
multi-sectoral,
interagency
research
and
development
agenda
that
looks
into:
o
Challenges,
opportunities
and
best-practices
on
health
care
waste
management
in
the
community
and
health
facilities,
especially
in
the
context
of
public
health
emergencies
o
Viability
of
technologies
and
innovations
for
sustainable
and
resilience
management
of
solid
wastes
and
healthcare
wastes		2023-2024DOST,
DOH		%
increase
in
research
publications
on
SWM
and
Health
D.6.2.
Provide
a
comprehensive,		2024-2025DOHUpdated
health
care
waste
management
ActionTimelineImplementing
Agencies		KPI
climate-resilient
health
care
waste
management
that
can
accommodate
communities
and
health
facilities
during
health
crises
like
the
COVID-19
pandemic.		plan
for
health
facilities

(iv) Green and Safe Health Facilities Strategic Plan 2030

In alignment with the 8-Point Action Agenda particularly Action Agenda 4 (Handa sa krisis), DOH formulated the Green and Safe Health Facilities Strategic Plan 2030, which was disseminated through Department Memorandum No. 2024-0241 dated June 21, 2024. This plan provides a detailed sustainable program and overall direction in the planning, financing, implementation, monitoring and evaluation of Green and Safe Health Facilities.

The strategic plan targets that by 2028, at least 50% of hospitals and other health facilities owned and operated by the national and local governments are implementing green, safe and climate-resilient health facility development.

3. SITUATIONAL ANALYSIS AND ASSESSMENT ON WASH IN HF

3.1. HEALTH IMPACTS OF INADEQUATE WASH IN HEALTH FACILITIES

Inadequate WASH in HFs can lead to significant health impacts, including increased infection rates, higher maternal and neonatal mortality, affecting patients and health workers.

a) Increased Risk of Healthcare-Associated Infections (HAIs)

Poor hygiene, lack of clean water, and inadequate sanitation facilities contribute to the spread of infections in HFs. Pathogens can easily spread between patients, health workers, and surfaces, leading to HAIs such as sepsis, surgical site infections, and respiratory infections, further complicating treatment and increasing morbidity and mortality..

b) Higher Maternal and Neonatal Mortality

Women and newborns are particularly vulnerable to the effects of inadequate WASH in HFs, especially during childbirth. Contaminated water, unclean delivery rooms, and lack of sanitation can result in maternal sepsis, infections in newborns, and complications during childbirth.

c) Impact on Infection Prevention and Control (IPC) Programs

Without adequate WASH services, IPC programs become less effective. HF may struggle to maintain proper cleaning and disinfection of surfaces, equipment, and laundry, leading to poor infection control and increasing the likelihood of cross-contamination between patients and staff.

Inadequate WASH also challenges efforts to prevent the spread of antimicrobial-resistant (AMR) infections, which thrive in unsanitary environments.

d) Increased Risk of Outbreaks During Health Emergencies

In times of health emergencies, such as outbreaks of infectious diseases (e.g., COVID-19, Ebola), or during natural disasters, health facilities without robust WASH services become ill-equipped to handle the influx of patients. This can lead to the rapid spread of infections and make it difficult to control outbreaks within and beyond the HF.

e) Environmental Contamination

Improper disposal of healthcare waste, especially in facilities without adequate waste management systems, can lead to environmental contamination, including water pollution. Contaminated water sources can cause diseases to spread to the community, leading to outbreaks of waterborne illnesses.

f) Decreased Quality of Care

HFs with inadequate WASH services are often perceived as providing poor quality care. This can reduce trust in the healthcare system, deter people from seeking care when needed, and lead to negative patient outcomes due to delayed or avoided medical treatment.

3.2. STAKEHOLDERS OF THE WASH IN HEALTH FACILITY IN THE PHILIPPINES

The development and implementation of the roadmap for WASH in HFs requires collaboration among various stakeholders, including government agencies, healthcare providers, development partners, and civil society organizations. Recognizing each stakeholder's interests and level of influence is crucial for forming partnerships, securing resources, and ensuring long-term improvements in WASH services across the health sector. Table 3-1 presents the identified different stakeholders who will be involved in, or affected by, and their roles in the implementation of this roadmap.

Table 3-1: Stakeholders for the Roadmap on WASH in HFs

Table 3-1: Stakeholders for the Roadmap on WASH in HFs
Stakeholder
Group		Role
in
the
Roadmap
DOH
HFDB		●
Lead
agency
responsible
to
ensure
the
implementation
of
this
roadmap,
monitor
and
evaluate
the
outcomes
●
Responsible
for
policy
development,
regulation,
and
oversight
of
health
facilities,
including
WASH
services
●
Advocate
the
importance
of
sustainable
and
safe
WASH
in
HFs
DOH
Health
Facilities
and
Services
Regulatory
Bureau
(HFSRB)		●
Ensure
compliance
of
HFs
with
WASH
standards
as
part
of
the
licensing
process
DOH
CHD
Health
Facility
Development
Unit
(HFDU)		●
Responsible
for
implementing
national
health
policies
and
programs
at
the
regional
level.
●
Provide
technical
assistance
within
their
regions
to
achieve
WASH
compliance
and
improve
service
delivery
DOH
Health
Promotion
Bureau
(HPB)		●
Provide
technical
assistance
in
the
development
of
health
promotion
materials
DOH
Knowledge
Management
and
Information
Technology
Services
(KMITS)		●
Coordinate
with
HFDB
for
the
development
and
integration
of
health
information
systems
for
health
facilities
●
Provide
technical
assistance
to
HFDB
for
the
development
of
database
on
WASH
in
HF
DOH
Health
Policy
Development
and
Planning
Bureau
(HPDPB)		●
Explore
research
opportunities
on
WASH
in
HF
Local
Government
Unit		●
Manage
local
health
facilities
and
allocate
resources
for
local
healthcare
programs
●
Ensures
that
local
health
facilities
meet
WASH
standards
to
improve
community
health
and
service
quality
Development
partners
(WHO,
UNICEF)		●
Provide
technical
assistance
to
capacitate
HFs
on
WASH
standards
and
management
plans
●
Provides
technical
guidance
and
support
for
implementing
WASH
programs
in
HFs.
Donors
and
Funding
Agencies
(ADB,
World
Bank)		●
Provide
funding
and
technical
assistance
for
health
infrastructure
development,
including
WASH
improvements.
HF
Administrators		●
Oversee
the
day-to-day
operations
of
health
facilities,
including
WASH
services.
●
Ensure
that
the
HFs
meet
WASH
standards
to
improve
patient
care
and
reduce
infection
risks.
●
Directly
responsible
for
the
implementation
of
WASH
programs
within
HFs
and
advocate
for
the
necessary
resources
and
support
Stakeholder
Group		Role
in
the
Roadmap
HF
workers		●
Implement
WASH
protocols
and
practices,
including
hygiene
practices,
infection
control,
and
waste
management.
●
Compliance
with
WASH
standards
in
the
daily
operation
is
critical
to
the
success
of
meeting
the
goals
for
WASH
improvement
●
Operate
and
maintains
WASH
services
Private
HFs		●
Support
the
national
roadmap,
programs
and
plans
on
WASH
in
HF
●
Comply
with
the
national
WASH
standards
Civil
Society
Organizations
and
Non-government
Organizations
(NGOs)		●
Advocate
for
WASH
services
in
HFs
●
Provide
technical
assistance
and
funding
for
capacity
building
Academe●
Conduct
operational
research
and
studies,
and
share
learning,
analyze
WASH
data
for
evidence-based
decision
making
and
evaluation
of
WASH
interventions
Patients
and
Community
Groups		●
Adhere
to
WASH
practices
and
proper
use
of
WASH
infrastructures
when
in
HF
●
Provide
valuable
insights
into
the
quality
of
WASH
services
●
Advocate
for
better
WASH
services
in
health
facilities

3.3. WASH IN HEALTH FACILITY STANDARDS

Licensing of Health Facilities

The licensing requirements of health facilities requires the provision of WASH services. Each type of health facility has an assessment tool that is being used by the HFSRB which includes the following indicators.

  • Provision of safe water supply and conduct of bacterial water analysis every 6 months
  • Provision of separate, gender-segregated toilets for patient, staff and visitors and accessible to persons with disabilities
  • Implementation of health care waste management procedures
  • Implementation of cleaning procedures
  • Implementation of IPC program

The planning and design guidelines of each health facility details the specific technical requirements and standards for the WASH services.

Localized WASHFIT

The localized WASH FIT was developed considering the national standards on water supply, sanitation, hand hygiene, health care waste management, environmental cleaning and management that must be complied by all health facilities based on the existing national regulations, policies and standards for health facilities.

Health Care Waste Management

The DOH Health Care Waste Management Manual (4 th edition) also provides the standards and guidelines on the proper management of health care wastes from point of generation up to the final disposal.

Green and Safe Health Facilities

The Green and Safe Health Facilities Manual (1st edition) contains comprehensive guidelines and standards to support the implementation of sustainable and environmentally safe practices in healthcare facilities.

The Green and Safe Health Facilities Manual accompanied by the Green Viability Assessment (GVA) tool contains eight performance standards namely, (1) Governance, (2) Energy Efficiency, (3) Water Efficiency, Sanitation and Hygiene, (4) Health Care Waste Management, (5) Environmentally Resilient Health Facility, (6) Site Sustainability, (7) Materials Sustainability, and (8) Indoor Environmental Quality.

National Standards in Infection Prevention and Control in Health Facilities

The National Standards in IPC Manual (3rd edition) provides guidelines and standards to prevent and control infections within health facilities. The manual aims to ensure patient safety, protect healthcare workers, and minimize healthcare-associated infections (HAIs) through standardized protocols and practices. It includes technical standards, guidelines and procedures on IPC education and training, hand washing, environmental cleaning and health care waste management, among others.

3.4. WASH IN HEALTH FACILITY BASELINE

The accomplished WASHFIT assessment forms submitted by the 538 HFs (300 hospitals, 238 PCFs) to DOH in 2023 were used to establish the baseline of WASH in HFs in the Philippines4. It should be noted that these data were based on the self-assessment done by the health facilities and were not validated by DOH.

With the assistance of the WHO-UNICEF Joint Monitoring Programme (JMP) team, the results of the WASH assessment were processed and analyzed to identify the WASH service level of the HFs in the country. The service level were categorized using the JMP WASH Service Ladders as shown in Table 3-3.

Table 3-2: JMP WASH Service Level Definitions

Basic ServiceLimitedNo Service
WaterWater is available from an improved source on the premises.An improved water source is within 500 metres of the premises, but not all requirements for basic service are met.Water is taken from unprotected dug wells or springs, or surface water sources; or an improved source that is more than 500 metres from the facility; or the facility has no water source.
SanitationImproved sanitation facilities are usable with at least one toilet dedicated for staff, at least one sex-separated toilet with menstrualAt least one improved sanitation facility, but not all requirements for basic service are met.Toilet facilities are
unimproved (pit
latrines without a slab
or platform, hanging
latrines and bucket
latrines), or there are

<sup>4 Considering the total number of licensed HFs (10,322 HFs), the number of samples needed to achieve 95% confidence level is at least 371 HFs.

Basic
Service		LimitedNo
Service
hygiene
facilities,
and
at
least
one
toilet
accessible
for
people
with
limited
mobility.		no
toilets
or
latrines
at
the
facility.
Hand
hygiene		Functional
hand
hygiene
facilities
(with
water
and
soap
and/or
alcohol-based
hand
rub)
are
available
at
points
of
care,
and
within
5
metres
of
toilets.		Functional
hand
hygiene
facilities
are
available
at
either
point
of
care
or
toilets,
but
not
both.		No
functional
hand
hygiene
facilities
are
available
at
either
point
of
care
or
toilets.
Health
care
waste
management		Waste
is
safely
segregated
into
at
least
three
bins,
and
sharps
and
infectious
waste
are
treated
and
disposed
of
safely.		There
is
limited
separation
and/or
treatment
and
disposal
of
sharps
and
infectious
waste,
but
not
all
requirements
for
basic
service
are
met.		There
are
no
separate
bins
for
sharps
or
infectious
waste,
and
sharps
and/or
infectious
waste
are
not
treated/disposed
of
safely.
Environmental
cleaning		Protocols
for
cleaning
are
available,
and
staff
with
cleaning
responsibilities
have
all
received
training.		There
are
cleaning
protocols
and/or
at
least
some
staff
have
received
training
on
cleaning.		No
cleaning
protocols
are
available,
and
no
staff
have
received
training
on
cleaning.

Table 3-4 presents the WASH service levels in hospitals and PCFs. As shown, a high percentage of the hospitals (ranging from 85-93%) have basic services on water, sanitation, hygiene, HCWM and environmental cleaning. However, 2% of the hospitals had no service on hygiene and 3% had no service on HCWM.

For PCFs, 89% had basic service on water, 59% had basic service on hygiene, 56% had basic service on environmental cleaning but less than half had basic service on sanitation (44%) and HCWM (34%). There were 13% that had no service on HCWM and 10% had no service on environmental cleaning.

Table 3-3: Status of WASH services in Health Facilities (2023)

Proportion of health facilities (%)
Service
Ladder		WaterSanitationHygieneHCWMEnvironmental
Cleaning
HospPCFHospPCFHospPCFHospPCFHospPCF
2023202320232023202320232023202320232023
Basic Service93898644855975349356
Limited Service7---14402253734
No Service----21313-10
Insufficient
Data		-111456------

Figure 3-1: Water Service Level in Hospitals and PCF (2023)

Figure 3-2: Sanitation Service Level in Hospitals and PCF (2023)

Figure 3-3: Hygiene Service Level in Hospitals and PCF (2023)

Figure 3-4: Health Care Waste Management Service Level in Hospitals and PCF (2023)

Figure 3-5: Environmental Cleaning Service Level in Hospitals and PCF (2023)

3.5. MONITORING OF HEALTH FACILITIES

Health Facility Profiling System

DOH launched the Health Facility Profiling System on October 15, 2021 to collect, organize, and manage data on health facilities across the country. It serves as a comprehensive database that contains key information about the bed capacity, services, infrastructure, and staffing of healthcare facilities.

The Health Facility Profiling Tool allows the monitoring of the latest supply of health facilities and equipment and the quality of health services provided to evaluate the progress of the system-wide strengthening of the health facility networks to augment the identified gaps in the Philippine Health Facilities Development Plan 2020-2040. One of the components reported is the utilities used by the HFs which includes questions on energy/power sources, water source for drinking water for patients and water in toilets and health care waste management. Data collection is done annually by DOH HFDB.

HF Self-Assessment Tools on WASH

DOH has not yet established a formalized monitoring and evaluation program specifically tailored for the WASH services of the HFs. However, DOH has developed various self-assessment tools designed to guide the HFs in evaluating their own WASH facilities and services and identify strengths and areas for improvement to ensure compliance with the national standards. Since 2022, DOH has required all government health facilities to complete and submit these tools. These self-assessment tools are as follows:

  • Green Viability Assessment (GVA) Tool This tool is applicable only to hospitals and is part of the Green and Safe Health Facilities (GSHF) Manual. The GVA tool determines the Green Rating of hospitals. The DOH, through the CHDs, with assistance from the HFDB, conducts validation of the self-assessed scores provided by the hospitals. This validation process involves site inspections and review of documents as supporting evidence.
  • WASHFIT As part of Task 2, the assessment of WASH infrastructure and practices is done using the indicators set in the WASHFIT. Currently, the DOH does not validate the results of the assessments conducted by health facilities due to a lack of trained personnel.
  • Health Care Waste Management (HCWM) Self-Assessment Tool This tool evaluates the health facility's compliance with the DOH Health Care Waste Management Manual (4th edition).
  • Integrated Hospital Operations and Management Program (IHOMP)

In addition, as required by the PNSDW 2017, the health facilities conduct microbial testing of its water supply, at least once a month (if population is more than 600) or once every other month (if population is less than or equal to 600). The results are submitted to the respective DOH CHDs.

The information gathered from these tools are currently not being processed or analyzed due to the lack of designated personnel responsible for managing the data. Additionally, there is no centralized database in place to store and systematically record the collected data. The absence of both manpower and infrastructure hinders the DOH to analyze the overall status of WASH in HFs, monitor progress, or make actionable improvement measures.

Another challenge of DOH is the low submission rate of health facilities , with most submissions are from government hospitals. There are health facilities, specially the primary care facilities, that do not submit because they lack the technical capacity to effectively use the tools. Private HFs are not required but are encouraged to participate.

3.6. EXISTING DOH PROGRAMS ON WASH IN HFS

Health Facilities Enhancement Program (HFEP)

The Health Facilities Enhancement Program (HFEP) of DOH aims to improve public health facilities by constructing new and upgrading and rehabilitating existing public health facilities across the country such as barangay health stations (BHS), rural health units/urban health centers (RHU/UHC) and LGU hospitals. The HFEP aims to upgrade priority BHSs and RHUs to provide Basic Emergency Obstetric and Newborn Care (BEmONC) services for the reduction of maternal mortality; to upgrade government hospitals and health facilities in provinces to make them more responsive to the health needs of the catchment population; to upgrade lower level facilities to be able to accommodate nursing students and to establish gate-keeping functions to avoid congestion in higher level hospitals, and; to expand the services of existing tertiary hospitals to provide higher tertiary care and as teaching, training hospitals.

On July 18, 2023, DOH released the Department Memorandum 2023-0252, entitled " Adherence to the Guidelines on the Green and Safe Health Facilities Requirements Integration of Climate and Disaster Resilient Measures in the Construction of Health Facilities". This mandates all new construction and for renovation/upgrading projects that are funded by DOH and foreign assisted projects through HFEP to incorporate the standards of GSHF Manual 2021 and Hospital Safe from Disasters (HSFD) in the building design.

3.7. CAPACITY BUILDING ACTIVITIES ON WASH

A training needs assessment (TNA) was conducted on 9 September 2024 for selected government hospitals and DOH CHDs to identify the training required to enhance their capacity to provide safe and sustainable WASH services. The results revealed that most hospitals and DOH CHDs have significant training needs in the following areas: Water Safety Plan (WSP), Sanitation Safety Plan (SSP), and the operation and maintenance of water supply, sanitation systems, hospital plumbing systems, as well as environmental cleaning for DOH CHDs.

DOH HFDB, with assistance from various development partners (i.e., WHO, UNICEF, ADB, Worldbank), has been providing several trainings and capacity building activities to DOH CHDs and selected health facilities on health care waste management, Green and Safe Health Facility Standards, WASHFIT and IPC. In addition, the DOH CHDs also conduct their own training activities to capacitate the health facilities within their region.

DOH, with support from WHO, is currently developing standardized training modules to ensure the consistency of training quality provided by the different DOH CHDs.

DOH E-Learning Platform

The DOH Academy E-Learning Platform provides an online learning system to support the Learning and Development Interventions (LDI) needs of all Human Resources for Health (HRH). This is accessible to all public and private sectors. The e-learning platform allows HRH to access training materials anytime, anywhere, and can be accessed with the use of Information and Communications Technology devices such as computers or smartphones. This provides flexibility to those in remote areas or with busy schedules. It supports continuous learning without the need to attend physical workshops or seminars. The platform includes a variety of courses to enhance the skills, knowledge, and competencies of the HRH. With the developed modules for WASH FIT, the HFDB shall be transforming these modules into an e-Learning module to be uploaded in DOH Platform.

3.8. COMMUNITY ENGAGEMENT ACTIVITIES

Community in this roadmap refers to the patients, clients and visitors of the health facilities.

The Integrated People-Centered Health Services Framework of DOH aims to ensure that all health facilities are responsive to the needs of the patients. One of the strategies identified is to promote engagement and effective partnership with the patients by establishing a feedback mechanism to determine the patient's experience by using a standardized client experience survey form. The Standardized Client Experience Survey Tool of DOH allows patients to provide feedback on critical aspects of health facility services, including the cleanliness and availability of water in toilets and bathrooms. All DOH-retained hospitals, medical centers, sanitaria and hospitals with established Malasakit Centers are required to run the survey to its patients every quarter and the results are submitted to DOH HFDB.

3.9. SUMMARY OF IDENTIFIED GAPS AND CHALLENGES IN WASH IN HFS

The identified gaps and challenges that hinder the successful implementation and improvement of WASH services in health facilities are summarized in Table 3-5. These barriers encompass various aspects, including infrastructure limitations, inadequate funding, insufficient staff training, lack of proper monitoring, and fragmented data collection systems.

Table 3-4: Identified Gaps and Challenges

ComponentGaps
and
Challenges
Situational
analysis
and
baseline
assessment		●
Accomplished
WASHFIT
assessment
forms
submitted
by
HFs
were
not
validated
by
DOH
●
DOH
has
no
assigned
personnel
to
manage
and
process
the
data
submitted
by
the
hospitals
●
DOH
has
no
procedure
in
place
for
the
processing
and
analysis
of
data
submitted
●
DOH
has
no
digitalized
central
database
for
the
baseline
of
WASH
in
HFs.
Compliance
of
HFs
to
WASH
national
standards		●
Limited
budget
allocation
of
the
HFs
for
the
upgrading
and
maintenance
of
WASH
facilities
●
Lack
of
green
standards
for
PCF
to
ensure
climate-resiliency
and
sustainability
ComponentGaps
and
Challenges
●
GVA
is
not
part
of
the
regulatory
and
licensing
measures
of
DOH
thus,
hospitals
are
not
mandated
to
comply
WASH
Service
Level		●
There
are
HFs
that
do
not
have
functional
hand
hygiene
facilities,
lack
adequate
systems
for
health
care
waste
management
and
are
not
implementing
environmental
cleaning
protocols.
●
PCFs
also
have
low
access
to
basic
sanitation
facilities
Programs
for
the
improvement
of
WASH
in
HFs
to
meet		●
HFs
are
hesitant
to
adapt
the
WASHFIT
due
to
lack
of
trained
personnel
and
limited
financial
resources.
●
Improvement
plan
is
not
being
prepared
by
the
HFs
as
part
of
WASHFIT
●
The
existing
WASH
management
tools
have
overlapping
or
slightly
differing
indicators
which
cause
confusion
to
HFs,
consumes
more
time
and
resources
Monitoring
of
WASH
in
HFs		●
DOH
has
not
yet
established
a
formalized
monitoring
and
evaluation
program
specifically
tailored
for
the
WASH
services
of
the
HFs.
●
Lack
of
trained
personnel
and
budget
at
both
national
and
local
levels
to
monitor
and
evaluate
the
compliance
of
HFs
with
the
WASH
standards
●
DOH
has
no
digitalized
central
database
for
the
monitoring
of
status
of
WASH
in
HFs.
Capacity
building
for
Health
Facility
Staff		●
HFs
and
DOH
CHDs
have
high
needs
for
training
on
WSP,
SSP,
O&M
of
WASH
systems
●
The
DOH
eLearning
platform
does
not
have
courses
on
WASH
O&M
and
improvement
●
There
is
no
standardized
training
program
and
modules
for
WASH
O&M
and
improvement
plans
training
Community
engagement
activities		●
DOH's
existing
Standardized
Client
Experience
Survey
Tool
currently
focuses
on
gathering
feedback
solely
related
to
the
cleanliness
and
availability
of
water
in
toilets
and
bathrooms,
but
does
not
cover
other
critical
WASH
services
within
health
facilities.
●
Lack
of
awareness
of
patients,
and
visitors
on
the
importance
of
WASH
services
in
health
facilities,
leading
to
improper
use
or
damage
to
facilities.
●
No
existing
programs
to
engage
or
educate
patients
and
visitors
on
the
importance
of
proper
use
and
maintenance
of
WASH
in
HFs
Operational
research
and
learning		●
There
are
no
existing
health
system
studies
on
WASH
in
HFs
using
national
data
●
DOH
has
no
program
for
operational
research
and
learning
on
WASH
in
HF
●
Weak
multi-sectoral
collaboration
on
research
and
learning
for
WASH
in
HF

4. STRATEGIC FRAMEWORK

4.1. VISION

By 2030, all health facilities have basic services on water, sanitation, hygiene, waste and environmental cleaning.

4.2. MISSION

To provide sustainable, safe, and universal access to WASH services in all healthcare facilities, ensuring quality healthcare, infection prevention, the safety of patient and health worker, while enhancing healthy system resilience. This will be achieved through effective policy implementation, resource management, the promotion of best practices and stronger partnership and collaboration with stakeholders.

4.3. NATIONAL TARGET

By 2030, 100% all health facilities have basic WASH services.

4.4. STRATEGIES AND ACTIONS

Strategy 1: Refining the baseline data of DOH on WASH in HFs and establish monitoring and reporting system for WASH in HFs

This strategy aims to have a more comprehensive overview of the WASH status across HFs and ensure that the data reported by the HFs accurately reflects the existing conditions of the WASH infrastructure and practices in the HFs. To achieve this, the following actions shall be implemented:

  • Develop and implement policy requiring all HFs to accomplish and submit WASHFIT assessment to increase the submission rate
  • The DOH CHDs should conduct continuous capacity building activities to health facilities within their region on how to use WASHFIT
  • Advocate WASHFIT to private health facilities
  • Develop and implement procedures/guidelines to validate the WASHFIT assessment of the health facilities. This activity can be integrated into the GVA validation process of DOH.
  • Assign focal person in CHD to collate and monitor the data submitted and validated

In addition, to facilitate the collection and analysis of data and track or monitor the WASH status of HFs, the following should be done.

  • Rollout digital form of WASHFIT for easier submission and consolidation of data
  • Develop and implement monitoring and evaluation program to track the status of WASH in HFs
  • Develop guidelines for the data analysis, interpretation and generation of national report
  • In alignment with the Green and Safe Health Facilities Strategic Plan, develop functional health systems data infrastructure capable of generating national reports on WASH in HFs. Integrate geospatial mapping tools to document the locations of health facilities with inadequate or no WASH services.
  • Include WASH indicators in the Health Profiling System
  • Assign focal person for the centralized data processing and generation of national report

Strategy 2: Strengthening the compliance of HFs on WASH standards

The following are the actions to ensure that all HFs are continuously complying the the WASH standards:

  • Integrate WASHFIT assessment validation process as part of the HF's license approval or renewal procedure.
  • Develop incentive and recognition programs for HFs that consistently comply with WASH standards. These could include awards, recognitions, certifications, or additional government funding (i.e., HFEP).

Strategy 3: Promoting robust maintenance and continuous improvement of WASH services and infrastructure

The objective of this strategy is to ensure that the WASH systems in the HFs are properly maintained and continuous improvement is being implemented for sustainable operation. Actions under this strategy include:

  • Develop and integrate the indicators of GVA, WASHFIT, WSP, SSP, and HCWM audit into a unified, comprehensive assessment tool. This integration aims to lessen the administrative burden on HFs and streamline the monitoring and validation processes conducted by DOH
  • Develop operating and maintenance (O&M )technical guidelines for WASH in HFs
  • Provide capacity building to HFs on proper maintenance and repair of WASH infrastructures
  • Advocate to HFs the development of improvement plan for WASHFIT. Provide financial support or grants to health facilities that develop WASH improvement plans, helping them to implement the identified improvements

Strategy 4: Provision of continuous learning development for health workers on WASH

This strategy aims to ensure the continuous development of skills and enhancement of knowledge of health workers at all levels regarding WASH practices and standards.

  • Develop national training program and workplan and standard training modules for the following key WASH topics to ensure consistent, high-quality training across all HFs. The existing training modules developed by WHO and UNICEF for the Philippines can be adopted.
    • o Green and Safe Health Facilities
    • o WASHFIT
    • o Health Care Waste Management
    • o Water Safety Plan
    • o Sanitation Safety Plan
    • o O&M of water supply system, sanitation facilities and plumbing system
    • o IPC
    • o Environmental Cleaning Protocols
  • Conduct training-of-trainors to DOH CHD and selected health workers who will serve as trainers in their respective HF
  • Develop e-learning modules for the key WASH topics and upload to DOH ELearning Academy
  • Collaborate with NGOs, international organizations, and private sector stakeholders to leverage additional funding for the capacity building of HFs

Strategy 5: Increasing HF community (patient and visitors) engagement activities for the operation and maintenance of WASH services in the HF

Engaging patients and visitors can lead to improved WASH practices, increased accountability, and enhanced health outcomes. Below are activities to increase community engagement activities focused on WASH services in HFs.

● Develop and promote feedback mechanism programs in HFs for WASH services by:

  • o Install suggestion boxes or QR codes in WASH areas for feedback of patients and clients
  • o Add questions in the Standardized Client Experience Survey Tool of DOH about the availability, cleanliness and accessibility of WASH facilities in the HFs
  • Enhance the implementation of facility-level IEC activities by:
    • o Providing/installing signages in strategic areas within hospital on proper hygiene, waste disposal
    • o Providing simple and clear instructions on how to use and maintain WASH facilities properly, such as keeping toilets clean, reporting blockages, and conserving water when appropriate.
    • o Using social media and HF newsletters to promote positive WASH behaviors and highlight those who contribute to maintaining facilities
    • o Including sessions during IPC week highlighting the importance of WASH practices can enhance patient satisfaction, and contribute to better health outcomes.

Strategy 6: Collaborate with Academe, NGOs and HFs to Conduct Operational Research and Share Learning

The objective of this strategy is to foster strong, effective partnerships with academic institutions, NGOs, and HFs to conduct valuable operational research and facilitate knowledge sharing on WASH in health facilities. These collaborations will enhance the understanding of WASH challenges, inform better policies, and promote sustainable improvements in HFs. To achieve this, the following actions will be implemented.

  • Assign point person for to oversee the conduct of research on WASH in HF
  • Develop research program in collaboration with academic partners, NGOs and HFs focusing on operational challenges, best practices, and innovative solutions for WASH in health facilities
  • Facilitate knowledge sharing and presentation of best practices of HFs during GSHF conference
Key
Action		TimelineKPIImplementing
Agencies
Strategy
1:
Refining
the
baseline
data
of
DOH
on
WASH
in
HFs
and
establish
monitoring
and
reporting
system
for
WASH
Develop
and
implement
policy
requiring
all
HFs
to
accomplish
and
submit
WASHFIT
assessment
to
increase
the
submission
rate		2025-2026%
HF
that
submitted
WASHFIT		DOH
HFDB
Continuous
capacity
building
activities
to
health
facilities
within
their
region
on
how
to
use
WASHFIT		2025-2028%
of
HFs
trained
yearly		DOH
CHD
LGU
Advocate
WASHFIT
to
private
health
facilities		2025-2028%
HF
that
submitted
WASHFIT		DOH
HFSRB
Develop
and
implement
procedures/guidelines
to
validate
the
WASHFIT
assessment
of
the
health
facilities.
This
activity
can
be
integrated
into
the
GVA
validation
process
of
DOH.		2025-2030%
HFs
validated
yearly		DOH
HFDB
Assign
focal
person
in
CHD
to
collate,
process
and
monitor
the
data
submitted
and
validated
and
generate
regional
report		2025%
of
CHDs
with
a
regional
report		DOH
HFDB
DOH
CHD
Rollout
digital
form
of
WASHFIT
for
easier
submission
and
consolidation
of
data		2025%
HF
that
submitted
WASHFIT		DOH
HFDB
Develop
and
implement
monitoring
and
evaluation
plan
and
tools
to
track
the
status
of
WASH
in
HFs
Include
WASH
indicators
in
the
Health
Profiling
System		2025-2030%
of
target
WASH
reports
generated		DOH
HFDB
DOH
KMITS
Develop
guidelines
for
the
data
analysis,
interpretation
and
generation
of
national
report		2025-2030Published
national
report
on
WASH
in
HF		DOH
HFDB
In
alignment
with
the
Green
and
Safe
Health
Facilities
Strategic
Plan,
develop
functional
health
systems
data
infrastructure
capable
of
generating
national
reports
on
WASH
in
HFs.
Integrate
geospatial
mapping
tools
to
document
the
locations
of
health
facilities
with
inadequate
or
no
WASH
services.		2025-2028Operational
national
database
on
WASH
in
HF		DOH
HFDB
DOH
KMITS
Key
Action		TimelineKPIImplementing
Agencies
Strategy
2:
Strengthening
the
compliance
of
HFs
on
WASH		standards
Integrate
WASHFIT
assessment
validation
process
as
part
of		2025-2027%
of
facilities
assessed		DOH
HFSRB
the
HF's
license
approval
or
renewal
procedure.		using
the
revised
tool		DOH
HFDB
Develop
incentive
and
recognition
programs
for
HFs
that
consistently
comply
with
WASH
standards.
These
could
include
awards,
certifications,
or
additional
government
funding
(i.e.,
HFEP).		2025-2030%
HFs
recognized
yearly		DOH
HFDB
Strategy
3:
Promoting
robust
maintenance
and
continuous		improvement
of		WASH
services
and
infrastructure
Develop
and
integrate
the
indicators
of
GVA,
WASHFIT,
WSP,
SSP,
and
HCWM
audit
into
a
unified,
comprehensive
assessment
tool.
This
integration
aims
to
lessen
the
administrative
burden
on
HFs
and
streamline
the
monitoring
and
validation
processes
conducted
by
DOH		2025%
of
target
users
utilizing
the
simplified
WASH
tool		DOH
HFDB
Develop
O&M
technical
guidelines
for
WASH
in
HFs		2025-2027%
of
HFs
oriented
on
O&M
manual		DOH
HFDB
Provide
capacity
building
to
HFs
on
proper
maintenance
and
repair
of
WASH
infrastructures		2027-2030%
HFs
trained
yearly		DOH
HFDB
DOH
CHD
Advocate
to
HFs
the
development
of
improvement
plan
for
WASHFIT
Provide
financial
support
or
grants
to
health
facilities
that
develop
WASH
improvement
plans,
helping
them
to		2025-2028%
HF
that
developed
improvement
plan		DOH
HFDB
DOH
CHD
Development
Partners
implement
the
identified
improvements
Strategy
4:
Provision
of
continuous
learning
development		for
health
workers		on
WASH
Develop
national
training
program
and
workplan
and
standard
training
modules
for
the
following
key
WASH
topics
to
ensure
consistent,
high-quality
training
across
all
HFs.
The
existing
training
modules
developed
by
WHO
and
UNICEF
for
the
Philippines
can
be
adopted.		2025-2028%
of
training
program
conducted
%
of
target
modules
developed
and		DOH
HFDB
Green
and
Safe
Health
Facilities
o
WASHFIT
o		cascaded
%
of
target
trainers
trained
Key
Action		TimelineKPIImplementing
Agencies
Health
Care
Waste
Management
o
Water
Safety
Plan
o
Sanitation
Safety
Plan
o
O&M
of
water
supply
system,
sanitation
facilities
o
and
plumbing
system
IPC
o
Environmental
Cleaning
Protocols
o
Conduct
training-of-trainors
to
DOH
CHD
and
selected
health
workers
who
will
serve
as
trainers
in
their
respective
HF		2026-2030Number
of
trainers
trained		DOH
HFDB
Develop
e-learning
modules
for
the
key
WASH
topics
and
upload
to
DOH
ELearning
Academy		2025-2028#
of
HCWs
who
utilized
or
accessed
the
modules		DOH
HFDB
Collaborate
with
NGOs,
international
organizations,
and
private
sector
stakeholders
to
leverage
additional
funding
for
the
capacity
building
of
HFs
Strategy
5:
Increasing
HF
community
(patient
and
visitors)
services
in
the
HF		2025-2030
engagement		Decrease
in
unfunded
activities
activities
for
the
operation
and		DOH
HFDB
NGO,
Development
Partners
maintenance
of
WASH
Add
questions
in
the
Standardized
Client
Experience
Survey
Tool
of
DOH
about
the
availability,
cleanliness
and
accessibility
of
WASH
facilities
in
the
HFs
and
install
suggestion
boxes
or
QR
codes
in
WASH
areas
for
feedback
of
patients
and
clients.		2025-2028Increase
in
number
of
respondents
/
Increase
in
response
rate		DOH
HFDB
Advocate
to
HFs
to
enhance
the
implementation
of
facility-level
IEC
activities
by:		2025-2030%
HF
that
implement
IEC
programs
on
WASH		DOH
HFDB
DOH
HPB
Providing/installing
signages
in
strategic
areas
within
hospital
on
proper
hygiene,
waste
disposal
Providing
simple
and
clear
instructions
on
how
to
use
and
maintain
WASH
facilities
properly,
such
as
keeping
toilets
clean,
reporting
blockages,
and
conserving
water
when
appropriate.		HFs
%
of
target
number
of
people
who
were
reached
by
the
IEC
materials
Key
Action		TimelineKPIImplementing
Agencies
Using
social
media
and
HF
newsletters
to
promote
positive
WASH
behaviors
and
highlight
those
who
contribute
to
maintaining
facilities
Include
sessions
during
IPC
week
highlighting
the
importance
of
WASH
practices
can
enhance
patient
satisfaction,
and
contribute
to
better
health
outcomes
Strategy
6:
Collaborate
with
Academe,
NGOs
and
HFs
to
Conduct
Operational
Research
and
Share
Learning
Assign
point
person
for
to
oversee
the
conduct
of
research
on
WASH
in
HF		2025-2026Research
agenda
developed
with
a
plan
and
budget		DOH
HFDB
DOH
HPDPB
Develop
research
program
in
collaboration
with
academic
partners,
NGOs
and
HFs		2025-2030Number
of
published
studies
conducted
->
%
of
studies
utilized
for
policy
or
planning		DOH
HFDB
DOH
HPDPB
Academe,
NGO
Facilitate
knowledge
sharing
and
presentation
of
best
practices
of
HFs
during
GSHF
conference		2025-2030%
of
target
attendees
participated		DOH
HFDB

4.5. POTENTIAL FUNDING SOURCES

Table 4-2: Potential Sources of Funding for WASH in HFs

SourcePotential
Sources
National●
DOH
budget
allocations,
as
provided
by
the
UHC
law
IRR
Sec
17.6
●
Budget
for
HFEP
●
Budgetary
commitments
by
assigned
lead
and/
or
support
implementing
agencies,
as
provided
by
IACEH
Resolution
No.
2020-001
Local●
Provincial,
City,
and
Municipal
Government
General
Fund
(GF)
●
Provincial,
City,
and
Municipal
Local
Disaster
Risk
Reduction
and
Management
Fund
(LDRRMF),
as
provided
by
RA
10121
ExternalFunding
support
from:
●
Development
partners
●
Donors
and
Funding
Agencies
●
NGOs
●
Private
sector
through
CSR
programs,
foundations
●
Public-Private
Partnerships
Source: NEHAP 2030

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