Ainslie Street Advisory: Facilities Readiness Assessment

Blog written by William Haggerty, Founder + Principal at Ainslie Street Advisory

At a rural district hospital in West Africa, a medical oxygen production plant went down for scheduled maintenance and a two-day job took almost a week – because the hospital didn’t have a consistent water supply. Replacing a pressure swing adsorption (PSA) oxygen plant’s zeolite molecular sieve requires clean water to flush the pressure vessels, and submersible pumps require electricity, and the grid is intermittent, and fuel is expensive, and so the maintenance team waited for power, to get water, to clean the pressure vessels, to put the PSA oxygen plant back into service. Meanwhile, the clinical team burned through days of backup cylinder inventory until the oxygen plant finally came back online. This kind of downtime chain reaction happens all the time in limited-resource healthcare facilities [1], and it almost never gets spotted in advance.

All WASH practitioners working in healthcare delivery understand that reliable potable water supply is non-negotiable for safe clinical procedures, patient hydration and nutrition, and effective infection prevention and control, but according to WHO/UNICEF Joint Monitoring Program data from 2023, only 60% of healthcare facilities in sub-Saharan Africa had access to basic water services (defined as an improved water source on the healthcare facility premises)[2]. What’s not often considered is that a reliable water supply is also critical to facilities’ operations and maintenance, and when it’s interrupted, the ripple effects show up in places a WASH assessment would never look – like PSA oxygen plant downtime.

Ainslie Street Advisory developed the Facilities Readiness Assessment (FRA) to catch healthcare infrastructure failures before they happen. The FRA covers water and sanitation alongside electrical infrastructure, medical oxygen supply, waste management, and operations and maintenance, and includes references such as Médecins Sans Frontières’ Public Health Engineering in Precarious Situations and the WHO/UNICEF WASH in Health Care Facilities Global Baseline Report. In the example above, the FRA would have flagged the gaps in power, water, and medical O₂ supply before the maintenance team took the plant out of service, enabling the facilities team to prepare by stockpiling a bit of fuel, filling the water tanks, and compressing a few extra oxygen cylinders before getting started. The FRA also distinguishes what matters most across a facility by specifying Critical Life Safety factors, e.g. consistent free residual chlorine monitoring is not weighted equally with sufficient handwashing points.

Ainslie Street Advisory is a fee-for-service infrastructure advisory firm grounded in over a decade of humanitarian and global health implementation experience. ASA deploys the Facilities Readiness Assessment at limited-resource healthcare facilities and provides additional infrastructure advisory services like pre-procurement technical assessment, capital project development support, and O+M program design. We operate globally with a focus on sub-Saharan Africa and are available for new client engagements now. Contact us at hello@ainsliestreet.com.

Ainslie Street Advisory’s Facilities Readiness Assessment is available free of charge at: https://ainsliestreet.com/FRA-tool-download.

[1] Water, sanitation, hygiene, waste and electricity services in health care facilities: progress on the fundamentals. 2023 global report, pp. 9-11. Geneva: World Health Organization and the United Nations Children’s Fund (UNICEF), 2023, link. Accessed 13 April 2026.

[2] WASH in health care facilities 2023 data update: special focus on primary health care, Geneva: World Health Organization and the United Nations Children’s Fund (UNICEF), 2024, link. Accessed 13 April 2026.