A toolkit for costing environmental health services in healthcare facilities.

Environmental health services (EHS) are critical for safe and functional healthcare facilities (HCFs). Understanding costs is important for improving and sustaining access to EHS in HCFs, yet the understanding of costs is poor and no tools exist to specifically support costing EHS in HCFs in low- and middle-income countries. We developed a toolkit to guide the following steps of costing EHS in HCFs: defining costing goals, developing and executing a data collection plan, calculating costs, and disseminating findings. The costing toolkit is divided into eight step-by-step modules with instructions, fillable worksheets, and guidance for effective data collection. It is designed for use by diverse stakeholders involved in funding, implementation, and management of EHS in HCFs and can be used by stakeholders with no prior costing experience. This paper describes the development, structure, and functionality of the toolkit; provides guidance for its application; and identifies good practices for costing, including pilot testing data collection tools and iterating the data collection process, involving diverse stakeholders, considering long-term costs, and disaggregating environmental costs in records to facilitate future costing. The toolkit itself is provided in the Supplementary Material.

Budgeting for Environmental Health Services in Healthcare Facilities: A Ten-Step Model for Planning and Costing.

Environmental health services (EHS) in healthcare facilities (HCFs) are critical for safe care provision, yet their availability in low- and middle-income countries is low. A poor understanding of costs hinders progress towards adequate provision. Methods are inconsistent and poorly documented in costing literature, suggesting opportunities to improve evidence. The goal of this research was to develop a model to guide budgeting for EHS in HCFs. Based on 47 studies selected through a systematic review, we identified discrete budgeting steps, developed codes to define each step, and ordered steps into a model. We identified good practices based on a review of additional selected guidelines for costing EHS and HCFs. Our model comprises ten steps in three phases: planning, data collection, and synthesis. Costing-stakeholders define the costing purpose, relevant EHS, and cost scope; assess the EHS delivery context; develop a costing plan; and identify data sources (planning). Stakeholders then execute their costing plan and evaluate the data quality (data collection). Finally, stakeholders calculate costs and disseminate findings (synthesis). We present three hypothetical costing examples and discuss good practices, including using costing frameworks, selecting appropriate indicators to measure the quantity and quality of EHS, and iterating planning and data collection to select appropriate costing approaches and identify data gaps.

Evaluation of Hand⁻Dug Wells in Rural Haiti.

Water resources, especially safe, potable water, are limited for many Haitians. In areas where shallow groundwater is available, many household water needs such as laundry, bathing, and cooking are supplied by hand⁻dug wells. In order to better understand the water quality and prevalence of these household wells, 35 hand⁻dug wells were surveyed and sampled near the Hôpital Albert Schweitzer in Deschapelles, Haiti. Water samples were collected and tested for fecal coliform and Escherichia coli using the IDEXX Colilert⁻18 method. Of the samples collected, 89 percent were determined unsafe to use as a drinking water source based on the World Health Organization standard of 1.0 colony⁻forming unit (cfu) E. coli per 100 mL. Sixty⁻six percent of the wells exceeded recreational/body contact standards for the state of Michigan (130 cfu/100 mL). Some of these wells were deemed suitable for conversion to a new well type called in situ filtration (ISF) wells. In situ filtration wells are installed with an internal sand filter pack, PVC casing, pump, and cap which seals the well from surface contamination and provides additional water treatment as water is pumped. Previous ISF installations have reduced E. coli to safe drinking water levels within 90 days.