Does WASH FIT Improve Water, Sanitation, and Hygiene and Related Health Impacts in Healthcare Facilities? A Systematic Review

Environmental health services in healthcare facilities are important, but coverage gaps remain. The World Health Organization and UNICEF developed the Water and Sanitation for Health Facility Improvement Tool (WASH FIT) to assess and improve environmental health services in healthcare facilities. Over 70 countries have adopted it. However, there is little evidence of its effectiveness. This systematic review evaluates whether WASH FIT improves environmental health services and associated health outcomes and impacts. We extracted data from 31 studies on inputs, activities, outputs, outcomes, and impacts associated with WASH FIT and summarized findings using a logic model framework. Twenty-three studies reported quantitative outputs for environmental health services. Of these, only nine reported longitudinal changes in these outputs throughout WASH FIT implementation. Six studies reported quantitative outcomes; the remainder described outcomes qualitatively or not at all. No studies directly measured impacts or evaluated WASH FIT against a rigorous control group. We found that available evidence was insufficient to evaluate WASH FIT’s effectiveness. Further effort is needed to identify the inputs and activities required to implement WASH FIT and to draw specific links between changes in outputs, outcomes, and impacts. Opportunities exist to improve evidence by more comprehensively reporting WASH FIT assessments and exploiting data on health impacts within health management information systems.