are categorized as ranking “high” in WASH. **However, it is important to note that a perfect score of 1 indicates relatively better WASH but not necessarily adequate WASH based on JMP standards. Therefore, it is most useful to read these results to compare across upazilas keeping in mind that bad scores indicate very poor WASH in CCs but good scores do not necessarily reflect adequate WASH.** Similarly, the upazila level poverty probabilities and stunting estimates are also rescaled to range between 0 and 1, and then categorized into “low” or “high” poverty/stunting based on the 0.5 score cut‐ off. Again, “low” and “high” should be read in relative terms only.

Using the WASH, poverty and stunting indices, we identify and map upazilas in Bangladesh that rank high in poverty and in stunting in relation to their WASH status. The base maps for the upazilas are from the Global Administrative Areas database.

The Status of WASH in Community Clinics: A Snapshot

**The community clinics in Bangladesh still have a long way to go to achieve adequate WASH facilities that are critical to providing safe, hygienic environments that help promote proper treatment and well‐ being of patients.** Overall, the rapid assessment data shows that adequate handwashing facilities at CCs are becoming near universal, whereas adequate water and sanitation are far from adequate.

**A large majority of the community clinics had limited WASH facilities only.** Table 3 shows the number of CCs that met individual WASH category criteria. Less than 36 percent of the community clinics had basic water supply, i.e. a functional improved water source. Around 30 percent did not have any functional sanitation facility. Only 16 percent had two functional latrines on premises. According to the 2008 WHO guidelines, HCFs must have at least 4 functional, _Table 3:HCFs with limited/ basic WASH, by category_ improved sanitation facilities on premises.  Less than 2 percent of the community clinics met this WHO _WASH Category_ Freq. % criterion. Eighty‐five percent of the community clinics _Basic Water_ 4,201 35.33 have adequate handwashing facility with soap and _Limited Sanitation ≥ 1 latrines_ 8,352 70.24 water. However, it is unclear to what extent the _Limited Sanitation ≥ latrines_ 1,950 16.4 handwashing facilities were affected by the lack of _Limited Sanitation ≥ 4 latrines_ 181 1.52 functional water supply. _Limited Handwashing_ 10 190 85.7

|_WASH Category_|Freq.|%|
|---|---|---|
|_Basic Water_|4,201|35.33|
|_Limited Sanitation ≥ 1 latrines_|8,352|70.24|
|_Limited Sanitation ≥ latrines_|1,950|16.4|
|_Limited Sanitation ≥ 4 latrines_|181|1.52|
|_Limited Handwashing_|10,190|85.7|

**The CBHC survey revealed that a major challenge is**

**that many community clinics did not have any type of WASH facility within premises;** 2,280 community clinics (19 percent) did not have any functional water, sanitation or hand‐washing facility.<sup>6</sup>

**Of the 11,891 CCs surveyed, 3,660 community clinics reached the ‘limited’ JMP standard detailed in Figure 1.** In other words, only about 31 percent of the community clinics had at least a functional improved water source (handpump or piped), at least one functional latrine (type unknown), and a handwashing station with water and soap. If we set a stricter standard of at least two functioning latrines (one for each gender) as suggested as one of the criterion in the JMP ‘basic’ sanitation tier, the number of community clinics with adequate overall WASH falls to 1,003. These preliminary numbers show that most rural and peri‐urban residents in Bangladesh have less than reliable primary health services in CCs, which are often the first line of care for patients.

> 6 For further details, please refer to Annex‐Table 3 and Annex‐Table 4.

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