Indicators are the ‘signals’ that enable measurement of the progress or targets and therefore of change, e.g. changes in the frequency of safe disposal of babies’ excreta or washing hands before eating. There are different levels of programme intervention (with corresponding indicators) that together deliver the overall goal of the response. A goal is a complex overall aim that in WASH is usually about protecting public health. The activities, such as constructing toilets or handwashing facilities, contribute to the outputs, e.g. people using these facilities, which in turn contribute to outcomes, e.g. reducing disease risks. Each level is measured with its own indicators. 

The five essential ‘output’ indicators for monitoring HP (as part of a WASH response) relate to: 1) safe excreta disposal, 2) handwashing with soap at key times, 3) the use of safe drinking water, 4) the practice of these target hygiene behaviours amongst all sectors of the community (including vulnerable groups) and 5) enabling women to manage menstruation with privacy and dignity. However, the selection of indicators will be dependent on the context and whether the programme is responding to WASH health risks or the outbreak of a specific disease. 

The initial assessment and analysis (chapter  A ) identifies the needs as well as what and how change can be achieved. Assessment findings inform the design of the objectives and indicators for the WASH intervention. This initial information can help to establish a baseline for each indicator so that monitoring can track any changes by the end (‘endline’) of an intervention. Additional specific information may be needed to fill in gaps in the baseline or to better understand the determinants of specific behaviours. In an emergency, there may be constant changes in the context and monitoring is essential to measure progress and to adapt the programme.

Monitoring is about identifying the things that are going well and the things that need changing. It should also track the effective and efficient use of funds and whether the programme is having the intended impact. However, it is difficult to attribute an impact on health to WASH interventions alone, as public health is influenced by the response as a whole rather than by a single sector intervention. Proxy indicators (measuring change indirectly, using a substitute indicator) are often used to support monitoring, e.g. handwashing with soap is known to reduce diarrhoeal diseases and it can therefore be assumed that if people are washing their hands at key times there will be an impact on their health - so handwashing with soap is a proxy indicator for the impact on health. 

Different methods and tools can be used to collect monitoring data; they are similar to those used for assessments. Examples are: Transect Walks T.52, Pocket Chart Voting T.31, (Community) Mapping T.7, community meetings, team meetings, Observation T.28, Focus Group Discussions T.14 and post-distribution monitoring. In some circumstances remote programming E.10 and data collection may be necessary.

Using different methods helps to capture different perspectives and to triangulate and cross-check information, e.g. Observation T.28 addresses how drinking water is stored at household level and Pocket-Chart Voting T.31 addresses the sources of drinking water. Monitoring data should not simply be about numbers (such as how many latrines have been built) but about whether the community is satisfied with them and whether the latrines are in good condition and being used. Both quantitative and qualitative data is usually required. 

It is also important to monitor community engagement and participation (chapter  E ) - ensuring that all sectors of the community, including vulnerable groups, are consulted and represented in all aspects of the programme. Data should be disaggregated by age, gender and disability as a minimum.

The WASH cluster plays a key role in the coordination of monitoring systems. The Global WASH Cluster Coordination Toolkit provides guidance on how to establish a WASH response monitoring plan, with information compiled from different sources across the sector.