Project Details.

The Strengthening Wholistic & Inclusive Systems for Health (SWISH) project is a multi-country initiative implemented by WaterAid with financial support from Global Affairs Canada (GAC), aiming to strengthen the integration of Water, Sanitation, and Hygiene (WASH) within public health systems. In Pakistan, the project focused on improving infection prevention and control (IPC), hygiene behaviours, and equitable access to safe, inclusive, and climate-resilient WASH services at the primary healthcare level, particularly for maternal, newborn, and child health (MNCH) services. 

As part of the SWISH programme, a Baseline Assessment was conducted in Lodhran District, Punjab, covering ten selected public healthcare facilities and their catchment communities. The baseline was designed to generate statistically robust benchmark data aligned with WaterAid’s global Monitoring, Evaluation, and Learning (MEL) framework, allowing for comparability across Pakistan, Liberia, and Zambia. The assessment employed a mixed-methods approach, combining facility-level audits, structured behavioural observations, household hygiene observations, client and staff surveys, and participatory accessibility and safety audits. A key innovation of the project was the integration of Gender Equality, Disability, and Social Inclusion (GEDSI) principles and the use of the Empowerment in WASH Index (IN-GEM) to capture power dynamics influencing service delivery and hygiene behaviours. 

Under the SWISH Baseline Assessment assignment, HIMAT Consulting Private Limited (HCPL) is responsible for the end-to-end design, implementation, quality assurance, and reporting of the baseline study in Pakistan. HCPL’s services include: Methodological design and inception planning, including development of a detailed inception report aligned with WaterAid’s global protocols, national standards, and the SWISH Performance Measurement Framework (PMF).

 Adaptation and operationalization of standardized data collection tools, including customized WASH FIT-based facility assessment tools, IPC behavioural observation instruments, household hygiene observation checklists, HBC and IN-GEM questionnaires, and participatory accessibility and safety audit tools. Sampling design and field implementation, covering a census of ten healthcare facilities, universal coverage of facility staff, and proportionate random sampling of households using immunization lists within HCF catchment areas. Enumerator recruitment, training, and supervision, including preparation of detailed training plans, delivery of training-of-trainers (ToT) and enumerator trainings, pilot testing of tools, and continuous field mentoring. 

HIMAT Consulting conducted field data collection management, encompassing healthcare facility assessments, staff observations and surveys, household observations and interviews, focus group discussions, and participatory accessibility and safety audits. Quality assurance and data management, including spot checks, structured back-checks, daily supervision, paper-to-digital data entry into the mWater platform, and rigorous data cleaning and validation protocols.