Institutional WASH in the SDGs : data gaps and opportunities for national monitoring

The inclusion of water, sanitation and hygiene (WASH) in non-household settings in the Sustainable Development Goals (SDGs) elicits the need for data to track progress over time. This review focuses on schools and health care facilities, and seeks to: (1) assess the availability of SDG baseline data for ten case study countries; (2) evaluate the extent to which existing national data allowmonitoring against the SDG criteria; and (3) identify opportunities to improve the availability and quality of data for SDG monitoring. While none of the ten countries could provide all of the data needed to establish comprehensive SDG baselines, every country had information on at least some of the indicators. Education Management Information Systems (EMIS) currently provide the majority of national data on WASH in schools and, in many cases, could be aligned with the SDG criteria with only minor changes. Far fewer data are available for health care facilities. Health Management Information Systems (HMIS) provide a potential entry point for national monitoring. However, where HMIS are administered monthly, annual data collection instruments, such as facility inventory surveys, may be more appropriate. These findings have implications for monitoring WASH in other settings, such as workplaces and prisons. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licence (CC BY 4.0), which permits copying, adaptation and redistribution, provided the original work is properly cited (http://creativecommons.org/licenses/by/4.0/). doi: 10.2166/washdev.2018.031 s://iwaponline.com/washdev/article-pdf/8/4/595/512398/washdev0080595.pdf Christie Chatterley (corresponding author) Fort Lewis College, 1000 Rim Dr., Durango, CO 81301, USA E-mail: cachatterley@fortlewis.edu Tom Slaymaker Robert Bain UNICEF HQ, 3 United Nations Plaza, New York, NY 10017, USA Chander Badloe UNICEF EAPRO, P.O. Box 2-154, Bangkok 10200, Thailand Alban Nouvellon UNICEF LACRO, Apartado postal 0843-03045, Panama, República de Panama Rick Johnston World Health Organization, Avenue Appia 20, Geneva 1202, Switzerland


INTRODUCTION
. WASH benefits also extend beyond health impacts to include dignity and respect, staff morale, and performance and safety (Pearson & McPhedran ).
While global monitoring of WASH in institutions is still a nascent effort, reviews of available data have been conducted in recent years. In the 2015 publication Advancing WASH in Schools Monitoring, national coverage data for water and sanitation in primary schools were reported for 149 countries (UNICEF ). National data on handwashing facilities in schools were only readily accessible for 11. While a number of countries could provide water and sanitation data, often through the national Education Management Information System (EMIS), indicator definitions were either not specified or varied widely between countries and data sources. This limits the potential for generating accurate cross-country comparisons and for regional and global aggregation. For example, coverage estimates for water in schools in Kiribati (3%) were based on a minimum quantity of water per student from an improved source, while in Bolivia, coverage (87%) included schools where any water source existed, regardless of type or functionality.
Harmonized data on WASH in health care facilities are even less widely available. A 2015 global study provides estimates for WASH in health care settings for 54 countries (WHO ). However, estimates from only 20 of these are nationally representative and nine are from the year 2010 or later. Additionally, as with WASH in schools monitoring, indicators were unclear or varied between sources.  National EMIS questionnaires were collected from national government websites, the UNESCO Asia and Pacific regional office, and global and regional UNICEF offices.
Questionnaires from a total of 71 countries were collected, providing an expanded picture beyond the ten case study countries. WASH-related questions were extracted from each questionnaire and assessed for the inclusion of each of the seven new SDG criteria for WASH in schools (Table 1). National Health Management Information System (HMIS) questionnaires were also solicited, but proved difficult to access and reported to not include WASH data in most countries.
The ability to establish SDG baselines was assessed based on all available national data in the public domain.
In the process of data collection, stakeholders were consulted in each case study country to understand their perceived challenges and opportunities in establishing national baselines for the SDG criteria for WASH in schools and health care facilities. Stakeholders comprised UNICEF country office representatives in all ten countries, as well as partners and national stakeholders, including officers from the Ministry of Education, Ministry of Health, and National Statistics Office.

Currently available SDG baseline data
In the ten countries, baseline data were already available for some of the SDG indicators for WASH in schools and health care facilities ( Figure 1). Half of the countries were able to provide data on the SDG criteria for 'basic' drinking

Schools
Drinking water Water from an improved* drinking water source (piped water, protected well/spring, rainwater, packaged or delivered water) available at school the day of the survey Sanitation Improved* sanitation facilities (flush/pour-flush toilet, pit latrine with slab, composting toilet), which are single-sex and usable (available, functional, private) Hygiene Handwashing facilities which have soap and water available the day of the survey Health care facilities Water Water is available from an improved*source located on premises sanitation Improved* sanitation facilities are usable, with at least one toilet dedicated for staff use, at least one sex-separated toilet with menstrual hygiene facilities, and at least one adapted for people with limited mobility Hand hygiene Functional hand hygiene facilities (with water and soap, and/or alcohol-based hand rub) are present at points of care and within 5 metres of toilets Among the ten case study countries, only Peru had all of the information necessary to make a baseline estimate for 'basic' sanitation in schools. Other countries had inadequate information on whether facilities are of an 'improved' type or if they are single-sex. Papua New Guinea was able to report a rough estimate based on the availability of functional toilets for boys and for girls, but it is unclear if these facilities are actually single-sex or shared since the EMIS did not include a question on mixed use toilets. Honduras should be able to produce a baseline estimate for 'basic' sanitation in schools, based on the questions in the national EMIS, but the microdata were unavailable and national reports did not provide information on single-sex sanitation.
Indonesia and Cambodia collect data on usability and single-sex sanitation, but do not solicit information on facility type to understand if toilets are of an 'improved' type. Six of the ten countries could provide coverage data for 'improved' sanitation, but lacked information on the criteria for 'basic' sanitation service.
Two countries could establish SDG baselines for 'basic' hygiene services in schools. An additional five countries had data on the proportion of schools with handwashing facilities, but lacked data on the availability of soap and/or water. Cambodia collects information on the presence of handwashing facilities with soap, but lacks information on water availability.
Data on 'basic' drinking water and health care waste disposal were available in Guyana and Haiti, in addition to 'basic' hand hygiene in Haiti (Figure 1). None of the ten countries were able to provide comprehensive data on  (Table 1) and should be able to establish comprehensive SDG baselines, while 63% capture two or more of the seven criteria A review of available data and associated questionnaires from these ten countries found that the SPA survey included seven of the 13 SDG criteria, the EmONC included three, and national surveys included one or two. Half of the data sources captured data on the proportion of health care facilities with an improved water source, while 43% collected data on water availability and 36% on usable sanitation facilities ( Figure 4). None of the data sources included information on sex-separated toilets or menstrual hygiene facilities, suggesting that the needs of women are not being considered in monitoring of WASH in health care facilities.

Challenges and opportunities
In many countries, the EMIS provides a viable mechanism to monitor the SDGs for WASH in schools through existing national systems. There are seven core questions globally recommended for monitoring WASH in schools in the SDGs (    (2) align existing national monitoring and accreditation systems with the SDG criteria based on global guidance (WHO & UNICEF a, b) and national priorities; (3) analyze, report and disseminate results from all WASH questions included in national monitoring questionnaires; and (4) track progress toward reducing inequities between subnational locations and facility types (including ECD centers, where appropriate). In all cases, data must be analyzed and results disseminated at all levels to inform national and local decision-making and action. Buy-in and leadership of senior Ministry of Education and Ministry of Health officials will be critical to incorporating the SDG criteria for WASH in schools and health care facilities in national monitoring systems, reports, and follow-up actions.
In the longer-term, global monitoring of WASH in institutions could be expanded to include other high use or highrisk settings, such as work places and prisons. The recent increased interest in WASH beyond the household can support the development and improvement of monitoring structures for these additional settings (Kendall & Snel ). Improving WASH at both the household and nonhousehold level increases the potential to realize the health, education and quality of life benefits anticipated from WASH investments. Global monitoring of WASH in these settings can ensure that progress is made toward SDG achievement for WASH in institutions.