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 assist-
ance to developing countries to increase access to sus-
tainable safe water, sanitation, and hygiene in healthcare 
facilities, promote stronger health systems and sustain-
able health infrastructure, build capacity of health work-
ers, and promote the safety of health workers and pa-
tients, especially women and girls, and for other pur-
poses. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Global WASH in 
Healthcare Facilities Act of 2023’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Water, sanitation, and hygiene (WASH) is 
critical to health security, preparedness and response 
efforts, including for the prevention of COVID–19 
and future pandemics. 
(2) WASH in healthcare facilities is necessary 
to ensure health security, including reducing pre-
ventable maternal, newborn, and child deaths and 
reducing the spread of infectious diseases such as 
cholera, diarrhea, and sepsis. 
(3) Globally, 1 out of every 5 healthcare facili-
ties have no basic water services, and 1 in 2 do not 
have adequate facilities to wash hands, leaving 
3,850,000,000 people, including health care workers 
and patients, at greater risk of infections. 
(4) In least-developed countries, about half of 
healthcare facilities lack basic water services, 79 per-
cent have no sanitation services, and 68 percent lack 
basic hygiene services. 
(5) Healthcare acquired infections arise from 
poor hygiene, contribute to patient morbidity and 
mortality, increase the risk of antimicrobial resist-
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ance, and contribute to increased costs for patients, 
their families and healthcare systems. 
(6) An estimated 15 percent of patients in low- 
and middle-income countries acquire one or more in-
fections during a typical hospital stay. Infections as-
sociated with unclean births account for 26 percent 
of neonatal deaths and 11 percent of maternal 
deaths; together they account for more than 
1,000,000 deaths each year. 
SEC. 3. STATEMENT OF POLICY; SENSE OF CONGRESS. 
(a) STATEMENT OF POLICY OBJECTIVES.—It is in 
the national security interest of the United States to in-
crease access to sustainable and safe water, sanitation, 
and hygiene in healthcare facilities, through global health, 
maternal, newborn and child health, and global water pro-
grams, activities, and initiatives that— 
(1) increase access to safe water in healthcare 
facilities; 
(2) enable handwashing at all points of care; 
(3) increase access to toilets in healthcare facili-
ties, including non-sewered sanitation solutions and 
a variety of technologies for sanitation and 
healthcare waste treatment; 
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(4) provide for the safe segregation, treatment, 
and disposal of healthcare waste and increased infec-
tion and prevention control measures; 
(5) promote WASH social and behavior change 
to ensure the safety of health workers and patients 
to improve infection prevention and control meas-
ures; 
(6) improve the ability of patients and 
healthcare workers, including persons with disabil-
ities to access water, sanitation, and hygiene, includ-
ing for their menstrual health and hygiene needs in 
primary, secondary, and tertiary healthcare facilities; 
(7) promote health facility administration man-
agement and monitoring of water, sanitation, and 
hygiene services in healthcare facilities for infection 
prevention and control and quality of care outcomes, 
including— 
(A) ensuring operations and maintenance 
of water and sanitation infrastructure; and 
(B) providing support to patients to adopt 
consistent sanitation, hygiene, and menstrual 
health behaviors; 
(8) integrate water, sanitation, and hygiene 
services into pandemic preparedness and response 
and global health security initiatives, including pre-
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ventive measures that help to contain infectious dis-
ease outbreaks at their source and support resilient 
health facilities to ensure continuous primary care 
during an outbreak; and 
(9) provide technical support to partner govern-
ments, particularly Ministries of Health, to improve 
wash systems and to incorporate safe water, sanita-
tion, and hygiene into national plans, strategies, and 
budgets for new and existing healthcare facilities. 
(b) SENSE OF CONGRESS.—It is the sense of Con-
gress that the Administrator of the United States Agency 
for International Development, in implementing the Glob-
al WASH in Healthcare Facilities Action Plan described 
in section 5, should— 
(1) coordinate in consultation with the USAID 
Assistant Administrator for Global Health, the Sen-
ior Coordinator for Gender Equality and Women’s 
Empowerment, and the Global Water Coordinator, 
to expand safe water, sanitation, and hygiene in 
healthcare facilities; 
(2) promote assistance to and build the capacity 
of national governments to include water, sanitation, 
and hygiene indicators in national health systems 
monitoring and budgets; 
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(3) coordinate 
implementation 
of 
existing 
United States Government strategies related to 
WASH in healthcare facilities, including the United 
States Global Water Strategy and United States 
International Activities to Advance Global Health 
Security and Diplomacy Strategy and Report to 
achieve the objectives of section 3(a); 
(4) include policies that promote the privacy, 
safety, and dignity of women and girls, and dis-
ability access in design, implementation, and evalua-
tion, in accordance with existing USAID policies for 
people with disabilities; 
(5) promote the development of resilient water, 
sanitation, and hygiene systems in healthcare facili-
ties; and 
(6) prioritize high priority countries where the 
needs are greatest. 
SEC. 4. DEFINITIONS. 
In this Act: 
(1) APPROPRIATE
CONGRESSIONAL
COMMIT-
TEES.—The term ‘‘appropriate congressional com-
mittees’’ means— 
(A) the Committee on Foreign Affairs and 
the Committee on Appropriations of the House 
of Representatives; and 
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(B) the Committee on Foreign Relations 
and the Committee on Appropriations of the 
Senate. 
(2) SUSTAINABLE.—The term ‘‘sustainable’’ 
means the ability of a target country, community, 
implementing partner, or intended beneficiary to 
maintain, over time, the programs authorized and 
outcomes achieved pursuant to this Act. 
(3) 
HEALTHCARE
FACILITY.—The 
term 
‘‘healthcare facility’’ means a hospital, clinic, health 
center, or other location established for the purpose 
of providing health care. 
(4) 
HEALTHCARE
WORKER.—The 
term 
‘‘healthcare worker’’ includes doctors, nurses, lab 
technicians, pharmacists, janitors, healthcare admin-
istrators, and other individuals working at or in 
partnership with healthcare facilities. 
(5) HIGH PRIORITY COUNTRY.—The term ‘‘high 
priority country’’ means a country designated pursu-
ant to section 136(h) of the Foreign Assistance Act 
of 1961 (22 U.S.C. 2151h(h)) and any country iden-
tified by USAID as a high priority country for the 
purposes of this Act. 
(6) KEY
STAKEHOLDERS.—The term ‘‘key 
stakeholders’’ means— 
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(A) communities directly affected by the 
lack of access to safe water, sanitation or hy-
giene; 
(B) other appropriate nongovernmental or-
ganizations; and 
(C) agencies or departments of countries 
affected by the lack of access to safe water, 
sanitation, or hygiene. 
(7) USAID.—The term ‘‘USAID’’ means the 
United States Agency for International Develop-
ment. 
(8) WASH.—The term ‘‘WASH’’ means water, 
sanitation, and hygiene. 
SEC. 5. GLOBAL WASH IN HEALTHCARE FACILITIES ACTION 
PLAN. 
(a) ACTION PLAN REQUIRED.—The Administrator of 
the United States Agency for International Development, 
in coordination with the Director of the Centers for Dis-
ease Control and Prevention and the Secretary of State, 
shall develop and implement an action plan, to be known 
as the ‘‘Global WASH in Healthcare Facilities Action 
Plan’’, to accomplish the policy objectives listed in section 
3(a). Such action plan shall— 
(1) set specific, timebound, and measurable 
goals, and identify relevant performance metrics 
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drawing from existing and complementary strategies 
and plans; 
(2) describe monitoring and evaluation plans 
that reflect best practices relating to transparency, 
accountability, localized sustainability, country ca-
pacity, budgetary support and ownership, water, 
sanitation, and hygiene, including appropriate use of 
gender disaggregated data; 
(3) establish clear and transparent criteria for 
WASH in healthcare facilities in target countries, 
drawn from existing water, sanitation and hygiene, 
need for strong health systems, infection prevention 
and control, pandemic preparedness and response, 
maternal, newborn and child health, and nutrition 
programs high priority countries and assessments, 
and for selecting regions and intended beneficiaries 
of assistance; 
(4) describe linkages and coordination with 
other relevant policies, strategies, plans and initia-
tives including those related to gender, resilience, 
global health, and pandemic preparedness and re-
sponse; 
(5) describe measures and approaches to ad-
dress the issues of infection prevention and control, 
menstrual health and hygiene, safe and equitable ac-
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