This document describes an approach for conducting a national situational analysis of water, sanitation and hygiene (WASH) as a basis for improving quality of care (herein referred to as quality, as defined in Box 1). A situational analysis is the first of the eight practical steps recommended by WHO and UNICEF as a means to trigger action to improve and sustain WASH in health care facilities, a prerequisite for providing quality care (1).

The availability of water, sanitation and hygiene (WASH) services in health care facilities, especially in maternity and primary-care settings where they are often absent, supports core aspects of quality, equity and dignity for all people. Recent data from WHO and UNICEF show that globally, one in four health care facilities lack basic water services, one in ten have no sanitation services and one in three have neither hand hygiene facilities at the point of care nor systems to segregate waste1. In Least Developed Countries, the gaps are even greater, where twice as many facilities lack basic water and sanitation services…more