The majority of patients attending inpatient services in southern Africa are required to be accompanied by guardians to support their care.

As such, Guardian Waiting Shelters (GWSs) are an essential component of Malawi’s health care system as they serve as a temporary home for patient guardians while taking care of their relatives admitted to the hospital and expectant mothers. Despite GWSs playing a crucial role in Malawi’s healthcare system, past studies have primarily concentrated on maternity waiting homes, GWS have been largely neglected both in terms of infrastructure and management. Further, previous studies in Malawi focused on a few selected healthcare facility GWSs in Southern Malawi that revealed a lack of ownership and hygiene infrastructure which affects the implementation of effective infection prevention and control in this setting. This is particularly important given the overcrowding of these facilities and the regular interactions between guardians and their sick relatives. Initial Stakeholder engagement with government and other key stakeholders suggested the need to conduct a wider assessment of GWS to encompass the whole country as there are social, cultural and norm variations which may potentially influence GWS their available infrastructure and management, including WASH hygiene interventions. Further, stakeholder mapping of all actors involved in GWS management at all levels (i.e. national, district and community) is essential to inform the effective co-designing of guidelines and standards interventions to improve GWS management.

Gathering this information is essential, taking advantage of the Malawi National WASH standards for the healthcare facilities currently under development.