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Table 3 Annual costs of environmental health service provision within a network of private healthcare facilities in Lilongwe, Malawi. Due to the high proportion of expected but missing expenses, total annual costs are substantial underestimates of true costs. Costs are reported in 2019 United States dollars ($) and have been rounded to the nearest dollar. Total annual cost and breakdown by cost category may not match precisely due to rounding

From: Development and application of tools to cost the delivery of environmental health services in healthcare facilities: a financial analysis in urban Malawi

Service

Total annual cost

Breakdown by cost category

Expenses observed

Expenses missing or substantially incomplete

Water

$32,878

Capital maintenance: $548

Consumables: $31,272

Direct support: $1057

Consumables for water utility bills, bottled water, disposable cups

Direct support from supervisory, logistics, and procurement staff

Maintenance and repair of water main connection, distribution pipes, access points at point of care and for drinking, emergency storagea

Recurrent training for water safety and testing

Consumables for water testing and treatment

Personnel costs for water testing and treatment, monitoring and filling of emergency water storage

Sanitation

$7707

Capital maintenance: $849

Consumables: $5800

Direct support: $1057

Consumables for anal cleansing materials

Direct support from supervisory, logistics, and procurement staff

Maintenance and repair of menstrual hygiene facilities

Maintenance and repair of toilets, septic tanks, sewer/septic tank connection pipesa

Consumables for utility costs for toilet operation and menstrual hygiene management facility; soap, drying materials, and menstrual products (e.g., sanitary pads) for menstrual hygiene management

Hygiene

$23,989

Recurrent training: $1821

Consumables: $21,110

Direct support: $1057

Annual safety trainingb

Consumables for soap and hand drying materials

Direct support from supervisory, logistics, and procurement staff

Maintenance of sinks and hand rub dispensers

Recurrent training for hand hygiene promotion materials at defecation sites

Consumables for alcohol-based hand rub and utility costs for sink operation

Personal protective equipment (PPE)

$26,310

Recurrent training: $1821

Consumables: $23,432

Direct support: $1057

Annual safety trainingb

Consumables for disposable PPE (gloves, masks, aprons, gowns, face shields)

Direct support from supervisory, logistics, and procurement staff

Personnel costs for decontamination, sterilization, and restocking of reusable PPE included under waste management

Waste management

$46,752

Capital maintenance: $6735

Recurrent training: $1821

Consumables: $13,621

Personnel: $22,273

Direct support: $2114

Contracted activities: $189

Annual safety trainingb

Consumables for waste collection, segregation, and transportation (disposable waste containers, waste labeling materials, vehicle fuel) and disposable PPE

Capital maintenance of waste transportation vehicles

Direct support from supervisory, logistics, and procurement staff

Contracted services for waste treatment and final disposal

Capital maintenance for collection, storage, transportation trolleys/carts, and treatment equipmenta

Consumables for utilities for autoclave operation

Consumables for disposable PPE for waste handling

Direct support for immunizations for waste handlers, waste weighing scale

Contracted services for fuel contributions for incineration operation

Cleaning

$69,372

Recurrent training: $1821

Consumables: $17,391

Personnel: $46,968

Direct support: $2114

Contracted services: $1078

Consumables for cleaning chemicals (antiseptics, disinfectants, soaps, and detergents) and supplies (disposable cloths)

Personnel for all cleaning non-contracted activities

Annual safety trainingb

Direct support from supervisory, logistics, and procurement staff

Contracted services for carpet cleaning in office areas

Capital maintenance of sluice room and sterilization equipment

Consumables for disposable PPE (aprons, gloves, face shields, masks, gowns)

Direct support for immunizations for cleaners

Laundry

$8482

Direct support: $1057

Contracted services: $7425

Direct support from supervisory, logistics, and procurement staff

Contracted services for laundry of laboratory coats

None

Vector control

$4937

Consumables: $473

Direct support: $1057

Contracted services: $3407

Consumables for insecticides

Direct support from supervisory, logistics, and procurement staff

Contracted services for fumigation for insects and rodents

None

  1. a Indicates that some expenses for the described item were included but judged to be substantially incomplete
  2. b Total cost of annual safety trainings was $1821 for all safety trainings conducted within the facility network. Full cost of safety trainings are included under each relevant EHS (hygiene, PPE, waste management, cleaning)