{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T07:51:14Z","timestamp":1787903474863,"version":"build-2784847793"},"reference-count":57,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Environ\ufffdHealth\ufffdInsights"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:p>Infrastructure for water, sanitation, hygiene, cleaning, and waste management is essential for supporting safe environmental conditions in healthcare facilities. Routine maintenance is important for preventing infrastructure breakdowns, but few studies have examined healthcare facility maintenance practices. This study documented environmental maintenance tasks in healthcare facilities in Niger, described bottlenecks to maintenance, and assessed strategies for coping with breakdowns. At 34 rural healthcare facilities in Niger, we conducted quantitative surveys to assess frequency of maintenance tasks and held qualitative interviews with healthcare facility staff to understand bottlenecks to maintenance. On at least a monthly basis, 4% of healthcare facilities inspected their water source and pump for the purpose of detecting and replacing worn parts, 15% inspected water taps and basins, and 29% inspected incinerators. Healthcare facility staff described barriers to accessing government funds for maintenance. Instead, they paid out of their own salaries or raised funds through appeals to community members or revenue generation initiatives. Other bottlenecks included ill-defined management responsibilities and difficulty of finding skilled technicians for maintenance. Findings highlight opportunities to support healthcare facilities in budgeting, advocacy, and training skilled technicians. Initiatives to install infrastructure at healthcare facilities will be more sustainable if they are accompanied by postconstruction planning, training, and funding for maintenance.<\/jats:p>","DOI":"10.1177\/11786302241271554","type":"journal-article","created":{"date-parts":[[2024,8,14]],"date-time":"2024-08-14T04:32:30Z","timestamp":1723609950000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":9,"title":["Environmental Infrastructure Maintenance Bottlenecks in Healthcare Facilities and Coping Strategies Among Healthcare Workers in Niger"],"prefix":"10.1177","volume":"18","author":[{"given":"Lucy K","family":"Tantum","sequence":"first","affiliation":[{"name":"The Water Institute at UNC, Gillings School of Global Public Health, the University of North Carolina at Chapel Hill, Chapel Hill, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ezechiel","family":"Mahamane","sequence":"additional","affiliation":[{"name":"World Vision Niger, Niamey, Niger"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie","family":"Bauza","sequence":"additional","affiliation":[{"name":"The Water Institute at UNC, Gillings School of Global Public Health, the University of North Carolina at Chapel Hill, Chapel Hill, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kairou Oudou Bilo","family":"Mahamadou","sequence":"additional","affiliation":[{"name":"World Vision Niger, Niamey, Niger"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisha Y","family":"Sanoussi","sequence":"additional","affiliation":[{"name":"Department of Bioengineering & Therapeutic Sciences, University of California San Francisco\/University of California Berkeley, Berkeley, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Salzberg","sequence":"additional","affiliation":[{"name":"The Water Institute at UNC, Gillings School of Global Public Health, the University of North Carolina at Chapel Hill, Chapel Hill, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darcy M","family":"Anderson","sequence":"additional","affiliation":[{"name":"The Water Institute at UNC, Gillings School of Global Public Health, the University of North Carolina at Chapel Hill, Chapel Hill, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,8,14]]},"reference":[{"key":"bibr1-11786302241271554","unstructured":"Joint Monitoring Programme. Progress on WASH in Health Care Facilities 2000-2021: Special Focus on WASH and Infection Prevention and Control (IPC). WHO\/UNICEF Joint Monitoring Programme; 2022. Accessed September 21, 2022. https:\/\/data.unicef.org\/resources\/jmp-wash-in-health-care-facilities-2022\/"},{"key":"bibr2-11786302241271554","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.17-0208"},{"key":"bibr3-11786302241271554","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2016.06.040"},{"key":"bibr4-11786302241271554","doi-asserted-by":"publisher","DOI":"10.2166\/wh.2020.220"},{"key":"bibr5-11786302241271554","unstructured":"World Health Organization, UN-Water. National Systems to Support Drinking-Water, Sanitation and Hygiene: Global Status Report 2019. UN-Water Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS) 2019 Report. World Health Organization; 2019. Accessed July 31, 2023. https:\/\/apps.who.int\/iris\/handle\/10665\/326444"},{"key":"bibr6-11786302241271554","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18020817"},{"key":"bibr7-11786302241271554","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijheh.2019.05.003"},{"key":"bibr8-11786302241271554","first-page":"6","volume":"3","author":"Oladejo E","year":"2015","journal-title":"Int J Civ Eng Constr Estate Manag"},{"key":"bibr9-11786302241271554","doi-asserted-by":"publisher","DOI":"10.2166\/h2oj.2021.095"},{"key":"bibr10-11786302241271554","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclepro.2019.117836"},{"key":"bibr11-11786302241271554","first-page":"21","volume":"7","author":"Bothma B","year":"2000","journal-title":"Acta Structilia"},{"key":"bibr12-11786302241271554","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2019.01.291"},{"key":"bibr13-11786302241271554","unstructured":"Baumann E, Danert K. Operation and Maintenance of Rural Water Supplies in Malawi - Study Findings. Swiss Resource Centre and Consultancies for Development; 2008. Accessed October 18, 2022. https:\/\/sswm.info\/sites\/default\/files\/reference_attachments\/BAUMANN%20and%20DANERT%202008%20Operation%20and%20Maintenance%20of%20Rural%20Water%20Supplies%20in%20Malawi.pdf"},{"key":"bibr14-11786302241271554","unstructured":"Seventy-second World Health Assembly. Water, sanitation and hygiene in health care facilities. Published online May 28, 2019."},{"key":"bibr15-11786302241271554","volume-title":"Water and Sanitation for Health Facility Improvement Tool (WASH FIT): A Practical Guide for Improving Quality of Care Through Water, Sanitation and Hygiene in Health Care Facilities","author":"World Health Organization","year":"2022","edition":"2"},{"key":"bibr16-11786302241271554","doi-asserted-by":"publisher","DOI":"10.2166\/washdev.2021.254"},{"key":"bibr17-11786302241271554","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18115641"},{"key":"bibr18-11786302241271554","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1322470"},{"key":"bibr19-11786302241271554","volume":"16","author":"Weber N","year":"2018","journal-title":"Health Secur"},{"key":"bibr20-11786302241271554","unstructured":"Project of UNC\u2019s Water Institute. World vision 14 country evaluation. 2023. Accessed November 29, 2023. https:\/\/waterinstitute.unc.edu\/projects\/world-vision-14-country-evaluation"},{"key":"bibr21-11786302241271554","doi-asserted-by":"publisher","DOI":"10.17615\/5BQ1-1H87"},{"key":"bibr22-11786302241271554","volume-title":"Water, Sanitation, and Hygiene in Health Care Facilities: Practical Steps to Achieve Universal Access to Quality Care","author":"World Health Organization","year":"2019"},{"key":"bibr23-11786302241271554","volume-title":"Clean Clinic Approach (CCA)","author":"Maternal and Child Survival Program, Save the Children","year":"2016"},{"key":"bibr24-11786302241271554","doi-asserted-by":"publisher","DOI":"10.2166\/washdev.2013.128"},{"key":"bibr25-11786302241271554","doi-asserted-by":"crossref","first-page":"35","DOI":"10.11604\/pamj.supp.2020.37.1.26512","volume":"37","author":"Baissa AM","year":"2020","journal-title":"Pan Afr Med J"},{"key":"bibr26-11786302241271554","volume-title":"Rapport de L\u2019evaluation de La Disponibilite de La Capacite Operationnelle Des Services de Sante Avec Les Outils SARA Et DQR Niger 2015","author":"Ministry of Public Health","year":"2015"},{"key":"bibr27-11786302241271554","unstructured":"Tilley E, Ulrich L, Luethi C, Reymond P, Zurbruegg C, eds. Compendium of Sanitation Systems and Technologies. 2nd ed. Eawag; 2014. Accessed November 14, 2022. https:\/\/sswm.info\/content\/operation-and-maintenance"},{"key":"bibr28-11786302241271554","volume-title":"Life-Cycle Costs Approach: Costing Sustainable Services (WASHCost Briefing Note 1a)","author":"Fonseca C","year":"2011"},{"key":"bibr29-11786302241271554","author":"Institut National de la Statistique - INS\/Niger, ICF International","year":"2013","journal-title":"Enqu\u00eate D\u00e9mographique et de Sant\u00e9 et \u00e0 Indicateurs Multiples Du Niger 2012"},{"key":"bibr30-11786302241271554","unstructured":"Savadogo A, Tsimpo Nkengne C, Sanoh A. Understanding Poverty and Reversals in Five Charts on Niger. World Bank Blogs. Published February 1, 2022. Accessed March 27, 2024. https:\/\/blogs.worldbank.org\/en\/nasikiliza\/understanding-poverty-and-reversals-five-charts-niger"},{"key":"bibr31-11786302241271554","volume-title":"Essential Environmental Health Standards in Health Care","author":"Adams J","year":"2008"},{"key":"bibr32-11786302241271554","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-017-0552-5"},{"key":"bibr33-11786302241271554","doi-asserted-by":"publisher","DOI":"10.1186\/s13031-020-00294-w"},{"key":"bibr34-11786302241271554","doi-asserted-by":"publisher","DOI":"10.1186\/s40814-022-01053-9"},{"key":"bibr35-11786302241271554","doi-asserted-by":"publisher","DOI":"10.1177\/1525822X10388468"},{"key":"bibr36-11786302241271554","unstructured":"World Health Organization. Safe Management of Wastes From Health-Care Activities. 2nd ed. World Health Organization; 2014. Accessed May 8, 2023. https:\/\/apps.who.int\/iris\/handle\/10665\/85349"},{"key":"bibr37-11786302241271554","volume":"2015","author":"Baker R","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"bibr38-11786302241271554","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-017-2460-4"},{"key":"bibr39-11786302241271554","volume-title":"Water, Sanitation, Hygiene, Waste and Electricity Services in Health Care Facilities: Progress on the Fundamentals","author":"World Health Organization, UNICEF","year":"2023"},{"key":"bibr40-11786302241271554","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pwat.0000021"},{"key":"bibr41-11786302241271554","doi-asserted-by":"publisher","DOI":"10.1080\/07900621003775763"},{"key":"bibr42-11786302241271554","unstructured":"Sustainable WASH Systems Learning Partnership. Maintenance Approaches to Improve the Sustainability of Rural Water Supplies. University of Colorado Boulder; 2020. Accessed July 20, 2023. https:\/\/www.globalwaters.org\/sites\/default\/files\/Maintenance%20Approaches%20to%20Improve%20the%20Sustainability%20of%20Rural%20Water%20Supplies.pdf"},{"key":"bibr43-11786302241271554","unstructured":"Gilbert N, Apambire B. Improving sustainability of WASH in healthcare facilities (HCFs) in Malawi: Evolving the Circuit Rider Approach. Loughborough University; 2021. Accessed July 31, 2023. https:\/\/repository.lboro.ac.uk\/articles\/conference_contribution\/Improving_sustainability_of_WASH_in_healthcare_facilities_HCFs_in_Malawi_evolving_the_Circuit_Rider_Approach\/16974130\/1"},{"key":"bibr44-11786302241271554","volume-title":"Sustaining Rural Water- A Comparative Study of Maintenance Models for Community-Managed Schemes","author":"Lockwood H.","year":"2019"},{"key":"bibr45-11786302241271554","doi-asserted-by":"publisher","DOI":"10.1021\/acs.est.2c00939"},{"key":"bibr46-11786302241271554","volume":"1","author":"Fink EL","year":"2022","journal-title":"PL"},{"key":"bibr47-11786302241271554","doi-asserted-by":"publisher","DOI":"10.2166\/washdev.2014.136"},{"key":"bibr48-11786302241271554","doi-asserted-by":"publisher","DOI":"10.1016\/j.worlddev.2022.106094"},{"key":"bibr49-11786302241271554","volume":"1","author":"Cord C","year":"2022","journal-title":"PL"},{"key":"bibr50-11786302241271554","volume":"12","author":"Chettry LK","year":"2024","journal-title":"P"},{"key":"bibr51-11786302241271554","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph14121584"},{"key":"bibr52-11786302241271554","unstructured":"McNicholl D, Hope R, Money A, et al. Performance-Based Funding for Reliable Rural Water Services in Africa. Uptime Consortium; 2019. Accessed March 20, 2024. https:\/\/www.globalwaters.org\/resources\/assets\/performance-based-funding-reliable-rural-water-services-africa"},{"key":"bibr53-11786302241271554","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(22)00099-7"},{"key":"bibr54-11786302241271554","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijheh.2021.113802"},{"key":"bibr55-11786302241271554","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2017-000648"},{"key":"bibr56-11786302241271554","volume":"4","author":"Watson J","year":"2019","journal-title":"BMJ Glob Health"},{"key":"bibr57-11786302241271554","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czu065"}],"container-title":["Environmental Health Insights"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11786302241271554","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/11786302241271554","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11786302241271554","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T19:23:23Z","timestamp":1777404203000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/11786302241271554"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":57,"alternative-id":["10.1177\/11786302241271554"],"URL":"https:\/\/doi.org\/10.1177\/11786302241271554","relation":{},"ISSN":["1178-6302","1178-6302"],"issn-type":[{"value":"1178-6302","type":"print"},{"value":"1178-6302","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1]]},"article-number":"11786302241271554"}}