PT  - JOURNAL ARTICLE
AU  - Chettry, Laxman Kharal
AU  - Bohara, Prakash
AU  - Bohara, Ramesh C.
AU  - Rijal, Ramhari
AU  - Khadha, Sarad
AU  - Subedi, Hari
AU  - Giri, Debesh
AU  - Sharma, Sarbesh
AU  - Dhungana, Upendra
AU  - van der Valen, Matteus
AU  - Brogan, John
AU  - Anderson, Darcy M.
TI  - Budgeting and Advocacy to Improve Water, Sanitation, and Hygiene in Health Care Facilities: A Case Study in Nepal
AID  - 10.9745/GHSP-D-23-00491
DP  - 2024 Jun 27
TA  - Global Health: Science and Practice
PG  - e2300491
VI  - 12
IP  - 3
4099  - http://www.ghspjournal.org/content/12/3/e2300491.short
4100  - http://www.ghspjournal.org/content/12/3/e2300491.full
SO  - GLOB HEALTH SCI PRACT2024 Jun 27; 12
AB  - Key MessagesDeveloping and allocating funding for operations and maintenance for basic water, sanitation, hygiene, cleaning, and waste management (WASH) services in health care facilities remains a challenge in Nepal.We estimated annualized costs across 8 health care facilities in Thakurbaba municipality and found that additional investment (US$1659–US$4285) per facility per year was needed to achieve basic service.We used dissemination workshops, stakeholder consultations, and data validation and certification processes recommended by the municipality to build credibility and trust in the budget estimates.Based on budget estimates, Thakurbaba municipality successfully drafted, adopted, and funded an evidence-based policy for WASH in health care facilities operations and maintenance and is advocating at the provincial and national levels for funding and costed roadmaps.Key ImplicationWe describe the process of costing, policy development, and advocacy to serve as a roadmap for policymakers and practitioners to progress toward universal access, in line with the Eight Practical Steps recommended by the World Health Organization and UNICEF for WASH in health care facilities.Barriers to achieving and sustaining access to water, sanitation, hygiene, cleaning, and waste management (WASH) in health care facilities include a lack of supportive policy environment and adequate funding. While guidelines exist for assessing needs and making initial infrastructure improvements, there is little guidance on how to develop budgets and policies to sustain WASH services. We conducted costing and advocacy activities in Thakurbaba municipality, Nepal, to develop a budget and operations and maintenance policy for WASH in health care facilities in partnership with the municipal government. Our objectives for this study were to (1) describe the process and methods used for costing and advocacy, (2) report the costs to achieve and maintain basic WASH services in the 8 health care facilities of Thakurbaba municipality, and (3) report the outcomes of advocacy activities and policy development. We applied bottom-up costing to enumerate the resources necessary to achieve and maintain basic WASH services and their costs. The annual costs to achieve, operate, and maintain basic access to WASH services ranged from US$4881–US$9695 per facility. Cost findings were used to prepare annual budgets recommended to achieve, operate, and maintain basic services, which were presented to the municipal government and incorporated into an operations and maintenance policy. To date, the municipality has adopted the policy and established a recovery fund of US$3831 for repair and maintenance of infrastructure and an additional US$153 per facility for discretionary WASH spending, which were to be replenished as they were spent. Advocacy at the national level for WASH in health care facilities is currently being championed by the municipality, and findings from this project have informed the development of a nationally costed plan for universal access. This study is intended to provide a roadmap for how cost data can be collected and applied to inform policy.