Abstract：
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.
摘要：
实现和维持用水的障碍，卫生，卫生,清洁,医疗设施中的废物管理（WASH）包括缺乏支持性的政策环境和充足的资金。虽然存在评估需求和进行初始基础设施改进的指导方针，关于如何制定预算和政策以维持WASH服务的指导很少。我们在塔库尔巴巴市开展了成本核算和宣传活动，尼泊尔,与市政府合作，为卫生保健设施中的WASH制定预算以及运营和维护政策。我们这项研究的目标是(1)描述用于成本计算和宣传的过程和方法，（2）报告在塔库尔巴巴市的8个医疗机构中实现和维持基本WASH服务的成本，(3)报告宣传活动和政策制定的成果。我们应用自下而上的成本计算来列举实现和维护基本WASH服务所需的资源及其成本。实现的年度成本，操作,并维持对WASH服务的基本访问，每个设施从4881美元到9695美元不等。成本调查结果用于编制建议实现的年度预算，操作,维持基本服务，已提交给市政府，并纳入运营和维护政策。迄今为止,市政府采用了该政策，并设立了3831美元的恢复基金，用于基础设施的维修和保养，以及每个设施额外的153美元，用于可自由支配的WASH支出，这些钱在花完的时候要补充。市政当局目前正在全国范围内倡导保健设施中的讲卫生运动，该项目的结果为制定一项国家费用普遍获得服务的计划提供了信息。这项研究旨在为如何收集和应用成本数据以制定政策提供路线图。
