Integrating Water, Sanitation and Hygiene

in Green and Safe Health Facilities in the Philippines

June Philip Ruiz1, Bonifacio Magtibay2,

Maria Sonabel Anarna3
1
Health Facility Development Bureau, Department of
Health 2World Health Organization 3 Health
Promotion Bureau, Department of Health

Philippines
Global Challenge
Philippines has the
highest disaster risk ● Climate Change
worldwide (WRR, 2022)
● Natural Disasters
● Covid -19 Pandemic

Healthcare Service
Delivery

2
 Updated Philippine Development Plan

Ultimate Goal: Build the adaptive capacities of

women and men in their communities, increase the
resilience of vulnerable sectors and ecosystems to
climate change, and optimize mitigation
opportunities towards gender-responsive and
rights-based sustainable development

https://pdp.neda.gov.ph/updated-pdp-2017-2022/

3
 GOALS:

(1) improve climate resilience

(2) environmental sustainability
A Modern,
Resilient, and
Sustainable
Healthcare
System

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Investing for Resiliency and Sustainability

Special Provision Section 17.

Green Health Facilities

The DOH through its Green and Safe

Health Facilities Program, shall, as
much as possible, promote the
greening of hospitals and health
facilities

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Health Leads
Climate Resilient
Health System
The DOH Takes The Leadership And Management Roles In The
Implementation Of The Green And Safe Health Facilities
Standards And Guidelines.

6
Health Sector Strategy 2023-2028

PROTECT from Health Risks

Strategic Objective: Strategic Intervention:

Health facilities and ✓ Resilient and Green Health

services are safe Facilities

2028
2024 2026 50% Targets:
16% 33% (220/440)
Govt hospitals are climate
resilient and environmentally
2023 2025 2027 sustainable
8% 25% 41% 7
Technical
Standard and
Guidelines
...minimizing the carbon footprint of
the health sector while continuing to
provide quality health and safety to the
people

download:
https://bit.ly/DOHGreenManual

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GUIDELINES AND STANDARDS FOR GSHFs
General Provision of Green Health Facilities

Provisions of PD
No. 1096, its IRR,
and the Green
Building Code as
the referral code
of the National
Building Code
shall be
supplementary
to this Green
Manual

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Applicability of Green and Safe HF
Guidelines
The technical Guidelines and
Standards of the Green and Safe
(Climate Smart ) Health Facilities
of the DOH applies to all
Hospitals and other Health
1% Facilities
2% 3% 4%
•

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GOVERNANC
E Leadership and management roles in the
implementation of the Green and Safe Health
Facility (HF)

Enjoins chiefs of all hospitals and medical centers and

heads of other HFs to implement green and safe
standards

Influence, motivate, convince, and make members of the health

community and the public on the goals and tasks of green HF

Ensuring that the minimum requirements of this Green Manual are

applied in their respective facilities

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ENERGY
EFFICIENCY Hospitals consume a large amount of electricity that
require reliable electricity. Conduct of Energy Audit as
requirement by Energy Efficiency and Conservation
Act.

Energy Conserving Design of Building promotion of the

energy conserving design of buildings

Renewable Energy Act of 2008, shall use every available energy

resource efficiently, and utilization alternative energy efficient
systems

Energy Efficiency and Conservation Act of 2019, aims to reduce

monthly consumption of electricity and transport petroleum products
by at least ten (10%)

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WATER EFFICIENCY,
SANITATION AND Water is a core element of life. A lot of Filipinos are
still exposed to unsafe water

HYGIENE
Implementation of Water Safety Plan (WSP) in Health
Facilities to ensure drinking water safety

Sanitation Safety Plan (SSP) will guide to facilitate the

implementation of health risk assessment and management
plans

Without adequate attention to water, sanitation, and hygiene (WASH),

universal health coverage will be difficult to attain

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Introduction

Planners, developers and designers should address

the problem of dwindling water supply and
control water contamination in HFs and come up
with the most effective means of dealing with risks
that threaten the safe quality of drinking-water and
public health

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Important aspects of
water services:

1. 2. 3.
The quantity and quality of The location and accessibility Reliability of the water
water available of water points within the supply over time
health facility

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Uses of
water in HFs
A reliable supply of safe water is needed for
preparing meals, hygiene, housekeeping, and a
variety of general and specialized medical uses,
therefore it is central to a patient’s experience of
health care. It also helps in reducing the risk of
spread of infectious diseases within the HF.

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Safe Water Supply

An improved water supply should be

available daily within the HF through:

● Piped water into health care facility or yard/

plot
● Public tap or standpipe
● Tubewell or borehole or protected well
● Improved spring
● Rainwater from a cistern or tank
● Packaged water – bottled water
● Water from water refilling stations

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Safe Water
Supply
● The quality of water intended for drinking should also meet
the Philippine National Standards for Drinking Water of 2017
PNSDW
● Water to be used for medical purposes, such as dialysis, shall
comply with the AO No. 2013-0003 Implementing Guidelines
in the Analysis, Monitoring, and Maintenance of Water Used
in Dialysis Facilities
● Water used for laundry and for cleaning floors and other
surfaces need not be of drinking-water quality, as long as it is
relatively clean. The water is disinfected or with a detergent.

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Safe Water
Supply
● DOH AO 2014-0027: National Policy on Water
Safety Plan (WSP) for all Drinking Water Service
Providers
● The WSP concept is a cost effective and
preventive strategy that ensures safety and
quality of drinking-water.

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Sufficient
Water Supply
● Water tank shall be installed to meet the needs of
the facility for 3 days
● In areas where water supply is not sufficient,
water dispensers and other water containers,
such as jerry cans, shall be made available and
must be regularly cleaned and subject to random
microbiological testing.
● Safe drinking water must be guaranteed for at
least 72 hours in case of emergencies

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Sufficient Water Supply

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 Water Audit:
● This should include monitoring and recording the volume of
water consumed and noting the various uses of water at
the HF.
● Consider Formal Water Audit, in particular to the hospital
and other HF where water is being used. Sub-metering
each HF building can assist in identifying leaks within the
various supply pipes

Elements of water audit must record the following

but not limited to:

● Amount of water produced

● Amount of water delivered to metered users
● Amount of water delivered to unmetered users
● Amount of water loss (balance of water, including
leaks)
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General Steps of Water
Audit

1. Set an 2. Modify the 3. Compile the

evaluation attached following:
period worksheet
usually the previous provided in the ● water production
calendar year Green Manual, if (if relevant)
needed, to meet the ● water purchased
system’s needs (if any)
● sales (metered)
data

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General Steps of Water
Audit -10%

4. Make 5. Complete the 6. Determine

adjustments to the summary sheet whether water loss
metered amounts, provided in exceeds 10% of the
as necessary Appendix B of the total amount
Green Manual for produced.
submission
● If so, follow up by
developing a
water loss
reduction plan.

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 WASH in Health
Facilities
Water and Sanitation for
Water Safety Plan for Sanitation Safety Plan for
Health Facility
Improvement Tool Health Facilities Health Facilities
Download: https://bit.ly/PLANwater Download: https://bit.ly/SSPplanHF
Download: https://bit.ly/WASHFITguide

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DOH Guidelines for
WASH FIT
● Implementing Water and Sanitation for Health Facility
Improvement Tool (WASH FIT) is a first step for HFs and can guide
them to become climate resilient by having competent risk
assessment and sustainable improvement plans in all domains of
WASH.

● Aligning with the DOH’s Green and Safe Health Facilities Manual,
1st Edition or Green Manual which sets water efficiency, sanitation,
and hygiene as one of its performance standard, the Guidelines of
WASH FIT has been simplified to allow the straightforward
application of the tool and the prompt development of water,
sanitation, and hygiene (WASH) improvement plans.

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Six WASH FIT Domains
1 2 3

Water Sanitation Waste Management

Supply, storage, Toilets, treatment, wastewater From generation
quality, conservation to final disposal

4 5 6

Management
Hand Hygiene Environmental Cleaning
Lighting, pumping, heating, ventilation,
Infrastructure, compliance, training Staff, protocols training,
occupational health

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Benefits of Improved
WASH in HFs

Strengthen the capacity Implement quick and Significantly reduce

effective responses emerging and growing
of HFs to prevent
during emergencies, such threats from
disease outbreak and
as natural disasters, antimicrobial-resistant
carry out basic infection infections, disease
outbreaks, and pandemics
prevention outbreaks, and pandemics

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Hazard and risk 1. Assemble and
train the WASH FIT
assessment team and hold
regular meetings

5. Continuously 2. Conduct an
evaluate and assessment of the
improve the plan facility

3. Undertake
4. Develop and hazard and risk
implement an assessment and
improvement plan note according to
seriousness
For every indicator with score of 1 (yellow) or 0 (red), list all the
potential hazards / problems and associated risks.
 Level of Risk versus Feasibility of
Addressing Problems

Seriousness How will you assess seriousness

of risk of the risk in the example
LOW RISK HIGH RISK
DIFFICULT Low risk High risk
TO ADDRESS Difficult to address Difficult to address

Feasibility of
addressing
problems
Is the hazard or problem difficult
to address in the example?
EASY TO Low risk High risk
Easy to address Easy to address
ADDRESS
 Level of Risk versus Feasibility of
Addressing Problems

• Level of risk for each problem is

context-specific; no right or wrong
answer
D B • Should be undertaken by several
individuals within the team to increase
C A the validity of the risk assessment
• The team should consider each
individual’s conclusion to arrive at a
single overall risk level.
Hazards and Risk
Assessment
• The risks will be classified
based on the degree of its
effect to the exposed
public.
• The team must also weigh
the level or seriousness of
the problems/risks in
relation to how easy or
difficult it will be to resolve
the problem or hazard.
Risk Definition Action
The hazard/problem very likely Urgent action
results in injuries, acute and/or needed to address
High Risk chronic illness, infection or an the problem
inability to provide essential services.
The hazard/problem likely results in Must be addressed
Medium moderate health effects, minor after high risk issues
Risk injuries, discomfort or unsatisfactory have been resolved
services.
No major health affects anticipated. Can be addressed
once resources are
Low Risk
available
Unknown Further information is needed to
Risk categorize the risk.
W1.3 HH3.3
W – Water

D M2.1
B HM2.22 S - Sanitation
HM – Health Care Waste
W1.2 Management
EC3.9
HH – Hand Hygiene
S2.6 EC – Environmental Cleaning

C A M - Management

HH3.2 HH3.1 M1.1

 Improvement Plan

LIST THE SPECIFIC IDENTIFY PERSON/S OR DETERMINE THE ESTIMATED BUDGET SET TARGET DATE OF RECORD THE ACTUAL
IMPROVEMENT GROUP/S RESPONSIBLE RESOURCES REQUIRED AND IDENTIFY SOURCE COMPLETING THE DATE OF COMPLETION
ACTIONS FOR IMPLEMENTING TO ACCOMPLISH THE OF FUNDS ACTION OF THE ACTION
THE ACTIONS PLAN
WASH in HCF in WHO Project Areas
Impact of Emergencies
and Disasters to WASH
Service in HF
● WASH conditions worsen in emergencies and disasters,
and may contribute to the disruption, damage, or loss of
facilities and services
● Lack of safe drinking water supply and proper sanitation
management, compounded by increased vulnerabilities,
may cause potential outbreak of vector and
water-borne diseases such as cholera and typhoid fever

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HEALTH CARE
Conduct of health care waste audit to aid HFs in
WASTE understanding waste generation and translate to
waste reduction

MANAGEMENT
Establishment of Green Public Procurement (GPP)
System in the Health Facility promotes sustainable
consumption and production

DOH Health Care Waste Manual 4th Edition contains

decisions on production, handling and treatment of wastes

Through Safe and Sustainable Management of HF wastes, steps

are taken towards Green and Safe HF

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ENVIRONMENTALL
Y RESILIENT HF and health workers are among the major
casualties of disasters

HEALTH FACILITY
Build HFs based on WHO Guidance for Climate
Resilient and Environmentally Sustainable Health
Facilities

Universal Health Care geared toward reducing

vulnerability to climate change and disaster impacts

In accordance to Policies and Guidelines on Hospitals Safe

from Disasters, hospital buildings are expected to remain
standing and functional during and after disasters

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MATERIAL
Locally sourced materials to be used that are
SUSTAINABILITY avail within a certain distance of the project
sites

Embracing green building materials is a good

alternative the HFs material sustainability.

Use of sustainable materials, procurement of

sustainable and recyclable products

About 2.5% of the material cost must be rapidly

renewable to be considered green

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SITE
SUSTAINABILITY Sustainable HFs project must serve more than
its immediate function.

Healing gardens within, fresh air, herbal plants,

accessibility, existence of alternative routes

Sustainable Site Plan help reduce GHGs and adapt to

effects of climate change

Proposed green site guidelines must fall within the

provisions of site, building and development laws.

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ENVIRONMENTAL
Establishment of Smoke-Free Environments in Public
QUALITY and Enclosed Places

IEQ encompasses the condition of the building- air quality,

lighting, thermal condition, ergonomics- and their effects on
occupants

Well-designed HVAC systems affect IEQ and asepsis integrity

through specifically HVAC related factors

Philippine Green Building Code declares IEQ requires efficient

design and operation practices that take into consideration the
building environment to improve occupant health, productivity and
safety.

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Green Viability
Assessment System Recognition of Green, Safe HFs

Green Rating Score (%) Assessment

Collect
Collect For Monitoring

1 Green Star 55-65 Minimum practice

Recognize
Recognize Review
Review
2 Green Stars 66-75 Average Practice

For Recognition

3 Green Stars 76-85 Above Average Practice

Validate
Validate Assess
Assess
4 Green Stars 86-95 Good Practice

5 Green Stars 96-100 Best Practice

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Recognition of Green Health Facilities
under Green Viability Assessment System

● 5 Green Stars – 5 DOH Hospitals

● 4 Green Stars – 13 DOH Hospitals

● 3 Green Stars – 15 DOH Hospitals

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 Future Activities
WASH and Green,
Safe, and ● DOH Licensing
Climate-resilient
Standards ● PhilHealth
Accreditation

Training Modules
Nationwide capacity
● Greening of HF
building
● WASH in HF

● HCWM Audit
● Greening and WASH Monitoring
● Assessment and Recognition of Green Hospitals
Greener,
Healthier, and
Safe Built Environment for
Health Care