One in 50: When It Comes To Water, Sanitation and Hygiene, Too Many Health Care Facilities Are Being Left Behind

This blog was written by Danielle Zielinski, Sanitation Policy Project Officer at WaterAid as part of Global Health Council’s Member Spotlight Series. WaterAid is an international not-for-profit determined to reach everyone, everywhere with clean water, decent toilets and good hygiene, within a generation. WaterAid is a 2018 Global Health Council member.

When you’re sick, you’re likely to visit a health center. Many of us take for granted that our local health center will have a toilet, a place to wash hands with soap and water and a system to safely dispose of medical waste.

These seem like basic requirements. But if you live in the developing world, new estimates put your chances of reaching a facility with adequate water, sanitation, hygiene and waste management at only 1 in 50—about the same chance as the average person making a half-court shot in basketball.

Hope you’re feeling lucky.

A recent study from the Water Institute at the University of North Carolina, looks at the environmental conditions in nearly 130,000 healthcare facilities across 78 low- and middle-income countries. The study—published in January in the International Journal of Hygiene and Environmental Health—offers the most comprehensive analysis to date of inequalities in healthcare.

The news is grim. Half of healthcare facilities surveyed lack access to piped water, a third are without access to improved toilets, and even more—39%—do not have facilities for washing hands with soap. A sampling of six countries showed that only 2% of facilities provide a combination of piped water, improved toilets, decent handwashing facilities and adequate waste management.

Without water and sanitation services, health care facilities can harm the patients they are supposed to help. A lack of water, sanitation, and hygiene (WASH) puts both patients and health workers at a greater risk of infection, disease and even death. The World Health Organization estimates several hundred million patients annually acquire infections in health care settings due to poor handwashing practices—due in part to the lack of available soap and water. And as we saw with the 2014-2016 Ebola epidemic in West Africa and the recent cholera outbreak in Yemen, inadequate WASH infrastructure allows deadly diseases to spread unchecked.

New mothers and newborns are especially vulnerable. Every minute, a newborn dies from infections caused by a lack of safe water and an unclean environment. Sepsis and other infections due to unhygienic conditions are also a leading cause of preventable maternal deaths.

People shouldn’t have to roll the dice when they enter a health facility. They shouldn’t have to worry that the place they come to for care might make them sicker. Healthcare workers should have a safe and quality environment in which to do their jobs, to the benefit of us all. It’s time to start closing these gaps. And it starts with treating WASH as a fundamental part of health systems.

The US Global Water Strategy includes a key outcome around decreased mortality/morbidity from causes linked to lack of WASH and plans from USAID and the CDC which call out improving WASH in health care facilities. This is a good start. But it requires support from Congress through funding and policy, and must not be undermined by current efforts to reorganize USAID or other political tug-of-war. After all, epidemics like Zika and Ebola don’t respect national borders. More advocacy is needed to ensure the strategy lives up to its potential, and truly informs practice and program implementation.

Citizens around the world are also speaking up and taking action. In Burkina Faso, citizens and journalists recently questioned their health minister about sanitation in health care facilities during a live broadcast, leading to promises of improvement. In Cambodia, advocacy has led to cross-sectoral commitments to improve WASH in health centers. The Ministry of Rural Development has set targets for 70% access to improved WASH in health centers and schools by 2025, and the Ministry of Health has set targets for 95% of health facilities to have basic water supply and 90% of health facilities to have basic sanitation by 2020.

And in Malawi, WaterAid is leading efforts to address infection prevention and control in 16 health centers across Kasungu, Nkhotakota and Machinga districts. Work includes training health care workers and modeling improvements like solar-powered water systems, inclusive toilets and bathrooms and repairing septic tanks and incinerators for waste management.

It is up to all of us to work toward better data, plans, funding, and action to ensure health facilities meet WASH standards. The UNC study is a sobering reminder of the sheer volume of work left to be done. But the good news is we don’t need to wait for new technology or medical advances to get started. We have the tools we need right now to save lives.

Safe water. Decent toilets. Soap for handwashing. In every health facility.

Let’s not leave anything to chance.

Esther Elias and her new born baby at Nyarugusu Dispensary, Nyarugusu, Geita District, Tanzania, September 2017. (WaterAid/ Sam Vox)