Evaluating Water, Sanitation and Hygiene (WASH) Services in Healthcare Facilities: A Comparative Cross-Sectional Study Using the WHO Water and Sanitation for Health Facility Improvement Tool (WASH FIT).

Background Water, sanitation and hygiene (WASH) services are foundational to safe health care delivery and infection prevention, yet facility-level evidence from Pakistan remains limited. This study assessed and compared WASH services at two hospitals using the World Health Organization's Water and Sanitation for Health Facility Improvement Tool (WASH FIT). Methods A comparative cross-sectional assessment was conducted in December 2025 at two hospitals in Rawalpindi (Hospital A) and Islamabad (Hospital B). Two teams of assessors independently evaluated both facilities through structured observation and record review. Indicators were scored on the standard WASH FIT scale across seven domains, and service levels assigned using JMP core-indicator criteria. To ensure comparison against an identical indicator set, five indicators that did not apply equally to both facilities owing to service configuration or cross-referencing within another domain were excluded, yielding an analytical set of 97 indicators scored in both facilities. Results Hospital A scored 147 of 194 points (75.8%) and Hospital B 127 of 194 (65.5%). Hospital A met basic service criteria in four of five domains with defined JMP ladders, compared with two of five in Hospital B. Among these five domains, hand hygiene was strongest, 10/10 (100%) and 9/10 (90%), and sanitation weakest, 15/26 (57.7%) and 12/26 (46.2%). The largest difference between facilities was in management and workforce, 16/24 (66.7%) versus 7/24 (29.2%). Both scored higher on essential than advanced indicators: 76/82 (92.7%) versus 50/82 (61.0%); 67/82 (81.7%) versus 41/82 (50.0%). Sixteen indicators were unmet in both facilities, concentrated in wastewater management, laundry infrastructure, and institutional planning. Conclusion Both hospitals demonstrated moderate WASH performance, with the largest difference observed in management and workforce rather than infrastructure. Strengthening governance and workforce capacity alongside infrastructure may improve WASH performance in resource-limited healthcare facilities.