Building the foundations for digital WASH monitoring in the Marshall Islands
Tracking water, sanitation, and hygiene conditions in health facilities is difficult enough when records sit in different forms and spreadsheets. In the Republic of the Marshall Islands, distance adds another layer: many facilities are on outer islands, travel is expensive, and checking a record in person can take time.
Akvo is working with UNICEF North Pacific and the Ministry of Health and Human Services on an 18-month technical assistance project to improve how this information is managed. The work is focused on the Ministry’s outer-island health services. Rather than starting with a new national platform, the team is first working through the data and the reporting process already in use.
Above: "The Marshall Islands - Majuro - Window" by mrlins
Location
Republic of the Marshall Islands
Sector
Services
Data system assessment Stakeholder mapping
Data strategy
Capacity building
Data management
Impact strategy
Data analysis & insights
MIS design & deployment
Challenge: Paper-based delays and fragmented workflows
Health-facility WASH information in the Marshall Islands already exists. The problem is that it is not always easy to compare, update, or trace it.
A facility assessment may start on paper and later be entered into a spreadsheet. The same facility can appear under slightly different names. Question formats can change. Evidence may sit in a separate file from the score it supports. If a value looks unusual, someone may need to check an older spreadsheet, call the facility, or wait until the next visit.
None of these issues is unusual on its own. Together, they make routine monitoring harder. They also make it difficult for Ministry teams to answer fairly basic questions: Which facilities need attention? Has a problem already been reported before? Is a low score based on a real change or a data-entry issue? Can the same dataset be used for national planning and international reporting?
Currently, monitoring WASH conditions in health facilities across the RMI’s outer islands relies heavily on paper-based data collection and manual compilation. This creates several critical bottlenecks:
- Reporting delays: Significant time lags in producing consolidated results for national decision-makers.
- Data quality risks: Manual transcription from paper to Excel increases the risk of inconsistencies and errors.
- Alignment gaps: Challenges in reporting against WHO/UNICEF Joint Monitoring Programme (JMP) standards for WASH in Health Care Facilities.
- Siloed information: Limited ability to reuse monitoring data for disaster preparedness or performance tracking across other sectors like education
What the team found in the existing data
During the 2026 fieldwork, Akvo and Ministry counterparts reviewed the health-facility assessment process and the spreadsheets already being used. Akvo also configured a digital assessment workflow for demonstration, with scoring and simple analytical views so the team could see how facility-level results might be compared.
The review quickly showed that some of the work needed to happen before any dashboard could be useful.
For example, the Ministry shared its existing Joint Monitoring Program dataset for WASH in health care facilities. When Akvo mapped the data, the team found a formatting inconsistency in the healthcare-waste section. One question used a different response structure from the questions around it. Akvo raised this with the Ministry, agreed on how to standardize the responses, and adjusted the mapping accordingly.
There was another issue. Once the service levels were calculated, almost all facilities appeared at the same level. That may be correct, but the pattern was unusual enough to warrant a check before bringing the data into the Management Information System. The Ministry confirmed that Akvo should proceed with the dataset as provided.
This is the kind of detail that matters in practice. A dashboard can only show what is in the underlying data. If definitions or response options are inconsistent, a polished visual will not fix the problem.
Building a more usable monitoring workflow
The next step is to bring the existing Joint Monitoring Program data into a structured Management Information System environment. This gives the Ministry a cleaner starting point before adding further assessment information.
The Ministry has also shared the Water and Sanitation for Health Facility Improvement Tool, or WASH FIT. It contains many questions covering different parts of health-facility WASH. The team decided not to copy the entire tool directly into the system.
Instead, Akvo and Ministry counterparts will go through it together and select the questions that are actually useful for outer-island health facilities. The first set is expected to focus on information that staff can realistically collect and use: key assessment questions, results by facility and WASH area, issues that need attention, and follow-up actions where those are part of the Ministry’s workflow.
This keeps the design close to the way the Ministry works. It also avoids creating a digital form that is technically complete but too long or difficult to maintain in practice.
Why this matters for outer-island facilities
Better-structured data will not remove the need for field visits. It can, however, make those visits more useful.
If the same facility keeps the same identifier over time, if missing evidence can be flagged, and if staff can see when a record was last updated, some checks can happen before anyone travels. A Ministry officer can decide whether an issue needs a phone call, a technical follow-up, or an in-person visit.
That matters in a country where distance affects the cost and frequency of routine monitoring. The aim is not remote monitoring for its own sake. It is to give Ministry teams enough information to decide how best to use limited time and travel budgets.
A separate discussion with Majuro Water and Sewer Company
The July mission also led to a separate technical discussion with Majuro Water and Sewer Company about its operational data. This is still exploratory work, not a completed deployment, but it raised many of the same practical questions.
The utility described a process in which plant operators record daily measurements on paper and a water monitor later enters the figures into Excel. It is also looking at water-loss tracking, customer-management data and future automated-meter information.
Following these discussions, Akvo and Majuro Water and Sewer Company are exploring where digital improvements could make existing operational information easier to use. The focus is on understanding how current workflows and systems can work together more effectively without creating unnecessary duplication or a long-term maintenance burden. The work is still at an exploratory stage.
Avoiding another system that creates more work
The same concern came up in conversations on disaster and emergency WASH. Government counterparts already receive information through several channels, and an International Organization for Migration-supported management information system is under development.
In that situation, adding a separate dashboard without first understanding the existing flow could make reporting harder. Before proposing another tool, the team needs to know which dataset is authoritative, who checks updates, what information needs to move between institutions, and what is already being handled elsewhere.
That does not mean existing systems should always be kept. If a tool is no longer effective or requires too much custom work to keep extending, replacing part of it may be the better option. The important point is to avoid adding technical complexity without a clear operational benefit.
Progress to date
The project has now moved beyond the initial scoping stage. Akvo and Ministry counterparts have reviewed existing health-facility forms and datasets, tested a digital assessment workflow and scoring approach, checked the Joint Monitoring Program indicator mapping, and agreed the next data-migration step. The Ministry has also shared WASH FIT material for the next round of design work.
Outside the core health-facility work, discussions with Majuro Water and Sewer Company are continuing around operational data and system needs. Conversations on school sanitation and emergency WASH have also helped the team understand where new digital work could add value and where it would be better to strengthen or connect what already exists.
Stay tuned for updates!
What happens next
The immediate work is practical: complete the Joint Monitoring Program upload, document indicator definitions and data-quality issues, and agree on a first set of WASH FIT questions with Ministry counterparts.
After that, Akvo and UNICEF will continue working with government partners on the less visible parts of the system that often determine whether it lasts: who owns the data, who is allowed to change it, how records are validated, what information needs to move between institutions, and what local teams can realistically maintain.
The project is still in progress. A useful measure of success at this stage is whether Ministry teams can access reliable information more easily, see which facilities need attention, and spend less time reconciling files before they can act.
Is your country ready to strengthen its WASH data system?
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