I 

118TH CONGRESS 

1ST SESSION H. R. 5545 

To authorize an Action Plan for United States foreign assistance to developing 

countries to increase access to sustainable safe water, sanitation, and 

hygiene in healthcare facilities, promote stronger health systems and 

sustainable health infrastructure, build capacity of health workers, and 

promote the safety of health workers and patients, especially women 

and girls, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 18, 2023 

Ms. MENG (for herself, Mr. BLUMENAUER, and Mr. LAHOOD) introduced the 

following bill; which was referred to the Committee on Foreign Affairs 

A BILL 

To authorize an Action Plan for United States foreign assistance to developing countries to increase access to sustainable safe water, sanitation, and hygiene in healthcare 

facilities, promote stronger health systems and sustainable health infrastructure, build capacity of health workers, and promote the safety of health workers and patients, especially women and girls, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Global WASH in 

3 Healthcare Facilities Act of 2023’’. 

4 SEC. 2. FINDINGS. 

5 Congress finds the following: 

6 (1) Water, sanitation, and hygiene (WASH) is 

7 critical to health security, preparedness and response 

8 efforts, including for the prevention of COVID–19 

9 and future pandemics. 

10 (2) WASH in healthcare facilities is necessary 

11 to ensure health security, including reducing pre12 ventable maternal, newborn, and child deaths and 

13 reducing the spread of infectious diseases such as 

14 cholera, diarrhea, and sepsis. 

15 (3) Globally, 1 out of every 5 healthcare facili16 ties have no basic water services, and 1 in 2 do not 

17 have adequate facilities to wash hands, leaving 

18 3,850,000,000 people, including health care workers 

19 and patients, at greater risk of infections. 

20 (4) In least-developed countries, about half of 

21 healthcare facilities lack basic water services, 79 per22 cent have no sanitation services, and 68 percent lack 

23 basic hygiene services. 

24 (5) Healthcare acquired infections arise from 

25 poor hygiene, contribute to patient morbidity and 

26 mortality, increase the risk of antimicrobial resistVerDate Sep 11 2014 18:16 Sep 22, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5545.IH H5545

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1 ance, and contribute to increased costs for patients, 

2 their families and healthcare systems. 

3 (6) An estimated 15 percent of patients in low4 and middle-income countries acquire one or more in5 fections during a typical hospital stay. Infections as6 sociated with unclean births account for 26 percent 

7 of neonatal deaths and 11 percent of maternal 

8 deaths; together they account for more than 

9 1,000,000 deaths each year. 

10 SEC. 3. STATEMENT OF POLICY; SENSE OF CONGRESS. 

11 (a) STATEMENT OF POLICY OBJECTIVES.—It is in 

12 the national security interest of the United States to in13 crease access to sustainable and safe water, sanitation, 

14 and hygiene in healthcare facilities, through global health, 

15 maternal, newborn and child health, and global water pro16 grams, activities, and initiatives that— 

17 (1) increase access to safe water in healthcare 

18 facilities; 

19 (2) enable handwashing at all points of care; 

20 (3) increase access to toilets in healthcare facili21 ties, including non-sewered sanitation solutions and 

22 a variety of technologies for sanitation and 

23 healthcare waste treatment; 


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1 (4) provide for the safe segregation, treatment, 

2 and disposal of healthcare waste and increased infec3 tion and prevention control measures; 

4 (5) promote WASH social and behavior change 

5 to ensure the safety of health workers and patients 

6 to improve infection prevention and control meas7 ures; 

8 (6) improve the ability of patients and 

9 healthcare workers, including persons with disabil10 ities to access water, sanitation, and hygiene, includ11 ing for their menstrual health and hygiene needs in 

12 primary, secondary, and tertiary healthcare facilities; 

13 (7) promote health facility administration man14 agement and monitoring of water, sanitation, and 

15 hygiene services in healthcare facilities for infection 

16 prevention and control and quality of care outcomes, 

17 including— 

18 (A) ensuring operations and maintenance 

19 of water and sanitation infrastructure; and 

20 (B) providing support to patients to adopt 

21 consistent sanitation, hygiene, and menstrual 

22 health behaviors; 

23 (8) integrate water, sanitation, and hygiene 

24 services into pandemic preparedness and response 

25 and global health security initiatives, including preVerDate Sep 11 2014 05:45 Sep 20, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5545.IH H5545

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1 ventive measures that help to contain infectious dis2 ease outbreaks at their source and support resilient 

3 health facilities to ensure continuous primary care 

4 during an outbreak; and 

5 (9) provide technical support to partner govern6 ments, particularly Ministries of Health, to improve 

7 wash systems and to incorporate safe water, sanita8 tion, and hygiene into national plans, strategies, and 

9 budgets for new and existing healthcare facilities. 

10 (b) SENSE OF CONGRESS.—It is the sense of Con11 gress that the Administrator of the United States Agency 

12 for International Development, in implementing the Glob13 al WASH in Healthcare Facilities Action Plan described 

14 in section 5, should— 

15 (1) coordinate in consultation with the USAID 

16 Assistant Administrator for Global Health, the Sen17 ior Coordinator for Gender Equality and Women’s 

18 Empowerment, and the Global Water Coordinator, 

19 to expand safe water, sanitation, and hygiene in 

20 healthcare facilities; 

21 (2) promote assistance to and build the capacity 

22 of national governments to include water, sanitation, 

23 and hygiene indicators in national health systems 

24 monitoring and budgets; 


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1 (3) coordinate implementation of existing 

2 United States Government strategies related to 

3 WASH in healthcare facilities, including the United 

4 States Global Water Strategy and United States 

5 International Activities to Advance Global Health 

6 Security and Diplomacy Strategy and Report to 

7 achieve the objectives of section 3(a); 

8 (4) include policies that promote the privacy, 

9 safety, and dignity of women and girls, and dis10 ability access in design, implementation, and evalua11 tion, in accordance with existing USAID policies for 

12 people with disabilities; 

13 (5) promote the development of resilient water, 

14 sanitation, and hygiene systems in healthcare facili15 ties; and 

16 (6) prioritize high priority countries where the 

17 needs are greatest. 

18 SEC. 4. DEFINITIONS. 

19 In this Act: 

20 (1) APPROPRIATE CONGRESSIONAL COMMIT21 TEES.—The term ‘‘appropriate congressional com22 mittees’’ means— 

23 (A) the Committee on Foreign Affairs and 

24 the Committee on Appropriations of the House 

25 of Representatives; and 


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1 (B) the Committee on Foreign Relations 

2 and the Committee on Appropriations of the 

3 Senate. 

4 (2) SUSTAINABLE.—The term ‘‘sustainable’’ 

5 means the ability of a target country, community, 

6 implementing partner, or intended beneficiary to 

7 maintain, over time, the programs authorized and 

8 outcomes achieved pursuant to this Act. 

9 (3) HEALTHCARE FACILITY.—The term 

10 ‘‘healthcare facility’’ means a hospital, clinic, health 

11 center, or other location established for the purpose 

12 of providing health care. 

13 (4) HEALTHCARE WORKER.—The term 

14 ‘‘healthcare worker’’ includes doctors, nurses, lab 

15 technicians, pharmacists, janitors, healthcare admin16 istrators, and other individuals working at or in 

17 partnership with healthcare facilities. 

18 (5) HIGH PRIORITY COUNTRY.—The term ‘‘high 

19 priority country’’ means a country designated pursu20 ant to section 136(h) of the Foreign Assistance Act 

21 of 1961 (22 U.S.C. 2151h(h)) and any country iden22 tified by USAID as a high priority country for the 

23 purposes of this Act. 

24 (6) KEY STAKEHOLDERS.—The term ‘‘key 

25 stakeholders’’ means— 


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1 (A) communities directly affected by the 

2 lack of access to safe water, sanitation or hy3 giene; 

4 (B) other appropriate nongovernmental or5 ganizations; and 

6 (C) agencies or departments of countries 

7 affected by the lack of access to safe water, 

8 sanitation, or hygiene. 

9 (7) USAID.—The term ‘‘USAID’’ means the 

10 United States Agency for International Develop11 ment. 

12 (8) WASH.—The term ‘‘WASH’’ means water, 

13 sanitation, and hygiene. 

14 SEC. 5. GLOBAL WASH IN HEALTHCARE FACILITIES ACTION 

15 PLAN. 

16 (a) ACTION PLAN REQUIRED.—The Administrator of 

17 the United States Agency for International Development, 

18 in coordination with the Director of the Centers for Dis19 ease Control and Prevention and the Secretary of State, 

20 shall develop and implement an action plan, to be known 

21 as the ‘‘Global WASH in Healthcare Facilities Action 

22 Plan’’, to accomplish the policy objectives listed in section 

23 3(a). Such action plan shall— 

24 (1) set specific, timebound, and measurable 

25 goals, and identify relevant performance metrics 


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1 drawing from existing and complementary strategies 

2 and plans; 

3 (2) describe monitoring and evaluation plans 

4 that reflect best practices relating to transparency, 

5 accountability, localized sustainability, country ca6 pacity, budgetary support and ownership, water, 

7 sanitation, and hygiene, including appropriate use of 

8 gender disaggregated data; 

9 (3) establish clear and transparent criteria for 

10 WASH in healthcare facilities in target countries, 

11 drawn from existing water, sanitation and hygiene, 

12 need for strong health systems, infection prevention 

13 and control, pandemic preparedness and response, 

14 maternal, newborn and child health, and nutrition 

15 programs high priority countries and assessments, 

16 and for selecting regions and intended beneficiaries 

17 of assistance; 

18 (4) describe linkages and coordination with 

19 other relevant policies, strategies, plans and initia20 tives including those related to gender, resilience, 

21 global health, and pandemic preparedness and re22 sponse; 

23 (5) describe measures and approaches to ad24 dress the issues of infection prevention and control, 

25 menstrual health and hygiene, safe and equitable acVerDate Sep 11 2014 05:45 Sep 20, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H5545.IH H5545

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1 cess to WASH for health workers, gaps in current 

2 data, monitoring and evaluation analysis and capac3 ity, consistent with the policy objectives described in 

4 section 3(a); 

5 (6) support partner governments to strengthen 

6 supply chains and, as appropriate, establish and 

7 maintain strategic stockpiles of critical water, sani8 tation, hygiene and menstrual health products, 

9 clean, operational and maintenance inputs, and re10 lated hardware for resilient healthcare; 

11 (7) address women’s and girls’ specific needs 

12 for water, sanitation, and hygiene access in 

13 healthcare facilities, in particular, personal safety, 

14 privacy, dignity, and menstrual health and hygiene 

15 and maternal health; 

16 (8) support the long-term sustainability of 

17 water, sanitation, and hygiene access in healthcare 

18 facilities especially at points of care, through health 

19 systems resiliency approaches including capacity 

20 building; 

21 (9) leverage new and existing water, sanitation, 

22 and hygiene technologies, including non-sewered 

23 sanitation solutions, and a variety of technologies for 

24 sanitation and healthcare waste treatment; 


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1 (10) in support of sustainably increased WASH 

2 access in healthcare facilities and increased local 

3 ownership, identify criteria, and methodology for 

4 graduating countries from United States assistance 

5 provided for the policy objectives listed in section 

6 3(a); and 

7 (11) anticipate resource needs to implement the 

8 Action Plan, including such amounts to be trans9 ferred by the Secretary of State to the Adminis10 trator of USAID pursuant to section 6(a). 

11 (b) INCLUSION IN OTHER STRATEGIES, POLICIES, 

12 PLANS, AND INITIATIVES.—The Administrator may in13 clude the Action Plan required by subsection (a) as a com14 ponent of the USAID Agency-Specific Plan for the United 

15 States International Activities to Advance Global Health 

16 Security and Diplomacy Strategy required by the Global 

17 Health Security and International Pandemic, Prepared18 ness and Response Act (subtitle D of title LV of the Na19 tional Defense Authorization Act for Fiscal Year 2023), 

20 or as a component of other USAID strategies, policies, 

21 plans or initiatives, as appropriate. 

22 (c) ACTION PLAN SUBMISSION.—Not later than 1 

23 year after the date of the enactment of this Act, the Ad24 ministrator of USAID shall submit to the appropriate con25 gressional committees a report consisting of— 


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1 (1) the Global WASH in Healthcare Facilities 

2 Action Plan required under subsection (a); and 

3 (2) a description of the manner in which the 

4 Administrator intends to advance the policy objec5 tives listed in section 3(a) through such action plan. 

6 SEC. 6. ASSISTANCE TO IMPLEMENT THE GLOBAL WASH IN 

7 HEALTHCARE FACILITIES ACTION PLAN. 

8 (a) AUTHORIZATION OF APPROPRIATIONS.— 

9 Amounts appropriated pursuant to the authorization 

10 under section 5564 of the National Defense Authorization 

11 Act for Fiscal Year 2023 are also authorized to be made 

12 available during fiscal years 2024 through 2027 to carry 

13 out the Global WASH in Health Care Facilities Action 

14 Plan described in section 5 in support of the United States 

15 International Activities to Advance the Global WASH in 

16 Healthcare Facilities Action Plan. 

17 (b) AUTHORIZATION OF TRANSFERS.—Subject to the 

18 availability of funds appropriated pursuant to the author19 ization under section 5564 of the National Defense Au20 thorization Act for Fiscal Year 2023 and in accordance 

21 with subsection (a), the Secretary of State is authorized 

22 to transfer to the Administrator of the USAID such sums 

23 as may be necessary to implement the Global WASH in 

24 Health Care Facilities Action Plan described in section 5 

25 of this Act. 


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1 (c) MONITORING AND EVALUATION.—The Adminis2 trator shall seek to ensure that assistance to implement 

3 the Global WASH in Healthcare Facilities Action Plan is 

4 provided under established parameters for a rigorous ac5 countability system to monitor and evaluate progress and 

6 impact of the action plan, including by reporting to the 

7 appropriate congressional committees and the public on an 

8 annual basis, in accordance with section 7. 

9 SEC. 7. REPORTS. 

10 (a) INITIAL REPORT.—Not later than 1 year after 

11 the date of the submission of the Global WASH in 

12 Healthcare Facilities Action Plan required under section 

13 5, the Administrator shall submit to the appropriate con14 gressional committees a report that describes the status 

15 of the implementation of the Action Plan. 

16 (b) CONTENT.—The report required under subsection 

17 (a) shall— 

18 (1) contain a summary of the Global WASH in 

19 Healthcare Facilities Action Plan as an appendix; 

20 (2) describe the progress made in implementing 

21 the Action Plan; 

22 (3) identify the indicators and measure results 

23 over time, as well as the mechanisms for reporting 

24 such results in an open and transparent manner, in25 cluding disaggregated data on healthcare facilities 


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1 with basic or safe access to water, sanitation and hy2 giene defined by the World Health Organization and 

3 UNICEF; 

4 (4) contain a transparent and detailed account5 ing of USAID spending to implement the Global 

6 WASH in Healthcare Facilities Action Plan and re7 lated activities; 

8 (5) describe how the Global WASH in 

9 Healthcare Facilities Action Plan leverages other 

10 United States global health programs including but 

11 not limited to maternal and child health, health sys12 tems, and global health security; 

13 (6) describe the impact of the Global WASH in 

14 Healthcare Facilities Action Plan on other global 

15 health programs, including progress in the pro16 motion of infection prevention and control, strength17 ening global health security and pandemic prepared18 ness, prevention and response and reducing prevent19 able maternal and child deaths; 

20 (7) assess efforts to coordinate United States 

21 global health programs, activities, and initiatives 

22 with key stakeholders; 

23 (8) assess United States Government-facilitated 

24 private investment in related sectors and the impact 


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1 of private sector investment in target countries and 

2 communities; 

3 (9) assess the increased access to safe sanita4 tion and hand washing stations in healthcare facili5 ties, including to address menstrual health and hy6 giene needs; 

7 (10) incorporate a plan for regularly sharing 

8 lessons learned with a wide range of stakeholders, 

9 including local civil society organizations in an open, 

10 transparent manner and through biennial stake11 holder consultation; and 

12 (11) establish mechanisms for receiving feed13 back from stakeholders and incorporating feedback 

14 into updates of relevant congressionally mandated 

15 strategies and action plans. 

16 (c) SUBSEQUENT REPORTS.—For the five-year pe17 riod beginning on the date of the submission of the initial 

18 report required under subsection (a), the Administrator 

19 shall annually submit to the appropriate congressional 

20 committees a report on the status of the implementation 

21 of the action plan, the progress made in achieving the ele22 ments described in section 5, and any changes to the ac23 tion plan since the date of the submission of the most re24 cent prior report. 


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1 (d) INCLUSION IN OTHER REPORTS.—The Adminis2 trator may include the report required by subsection (a) 

3 as a component of the United States International Activi4 ties to Advance Global Health Security and Diplomacy 

5 Strategy report or as a component of other USAID re6 ports, as appropriate. 

7 (e) PUBLIC AVAILABILITY OF INFORMATION.—The 

8 information referred to in subsections (a) and (b) shall 

9 be timely made available on the public website of USAID 

10 in a consolidated, downloadable, and machine-searchable 

11 format. 

Æ 


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