Diary blog: WaterAid at the 72nd World Health Assembly 2019

14 min read
WaterAid delegates at the World Health Assembly 2019
Image: WaterAid/World Health Assembly Delegate

WaterAid is at the 72nd World Health Assembly (WHA) from 20–28 May 2019, advocating the importance of water, sanitation and hygiene (WASH) to universal health coverage. We’re updating this blog daily with the latest news from Geneva.

29 May: Reflecting on WHA 

And that’s a wrap! Most of our team are now back in their respective offices, and are diligently already starting to plan what comes next… 

...and reflecting on a hectic week! We collectively co-organised three side events covering WASH, AMR, cholera, nutrition and UHC. We had countless side meetings with delegations, WHO teams and others. We gave eight formal statements. WaterAid UK’s Chief Executive, Tim Wainwright, managed to hold six senior-level meetings in about six hours. And yes, we got a bit carried away on Twitter… especially during the unforgettable exchange between Prof Wendy Graham and Dr Tedros, which will henceforth be known as ‘the mop-ment’

Megan and Danielle are straight off to Women Deliver, where they will continue to talk about how WASH connects with health and gender equality, and deepen our relationships with the health community. 

And for the rest of us, it’s moving on with the next, crucial step of the resolution – ensuring this international commitment is followed up at a national level is key.  We’ll be there, along with our partners, to support implementation plans, and hold governments accountable for fulfilling this promise.

28 May: A resolution to improve WASH in healthcare facilities!

It’s passed! On Saturday morning, health ministers from every UN member state formally and publicly committed to take action to ensure that every healthcare facility, everywhere, has water, sanitation and hygiene (WASH). Here’s how it all unfolded.

First, representatives of a whole host of member states took to the floor to voice their support for the adoption of the resolution, including a strong display of hygiene promotion from Thailand, and authoritative pledges from our ‘First do no harm’ co-sponsors Tanzania and Zambia. Another co-sponsor, Japan, even gave the event a shout-out during their statement, much to our delight. 

And then, cometh the hour, cometh the woman: as the last team member standing in Geneva, it was down to our head of delegation, Alison Macintyre, to ensure WaterAid gave a powerful statement on why the issue of WASH in healthcare facilities is so fundamentally important. And boy, did she deliver! 

Alison reiterated the urgency the resolution outlined by highlighting the millions of people who currently seek care at health facilities with no water, the billions who seek care where no toilets are available, and the fact that almost half of facilities do not even have hand hygiene stations at points of care. She finished by opening an invitation to all, offering WaterAid’s support in turning these commitments into reality. We already work in more than 12 countries to improve WASH as part of health system-strengthening, and Alison made it clear that we are ready to build on this existing work as part of efforts to achieve safe healthcare for all. 

Following a few further statements, many by our partners, the hammer was hit: resolution adopted! Applause rang out around the assembly, but Alison wasn’t finished yet… she managed to chat with Dr Tedros himself, who told her again how much he thoroughly enjoyed our event earlier in the week. A truly fantastic culmination to what has been years of hard work in the making.  

Alison Macintyre, Technical Lead – Health, WaterAid Australia, with Dr Tedros Adhanom Ghebreyesus, WHO Director-General at the World Health Assembly
Alison Macintyre, Technical Lead – Health, WaterAid Australia (centre), with Dr Tedros Adhanom Ghebreyesus, WHO Director-General

And while Alison might have been alone in the room for this momentous occasion, she definitely wasn’t alone in spirit. The quick-fire activity on the team WhatsApp group revealed that Dedo and Danielle were live streaming from the airport departure lounge, Dan and Helen were each following online from their kitchens back in the UK, and poor Aly turned on wifi during his layover in Paris to be confronted with hundreds of unread messages! The ‘one team, one dream’ mantra certainly lives on…  

24 May: Climate resilience, antimicrobial resistance and comparing notes

Another busy day for our team, as we made statements, met with the World Health Organization (WHO) team and welcomed announcements on cholera commitments.

We made two official statements: Dedo Mate Kodjo, Regional Advocacy Manager for West Africa, in the health, environment and climate change session; and Aly Sow, Programme Manager from WaterAid Mali, contributed to the session on antimicrobial resistance (AMR).

Aly Sow, Programme Manager at WaterAid Mali, reading a statement on antimicrobial resistance
Aly Sow, Programme Manager at WaterAid Mali, reading a statement on antimicrobial resistance

Dedo emphasised how member states must take a long-term approach to water and sanitation planning and financing, and ensure these plans consider climate resilient infrastructure and adaptation measures. In his statement, Aly raised the concern that WASH is still given insufficient attention in AMR discussions, and urged member states to focus prevention efforts in national AMR action plans on supporting WASH services and practices in healthcare facilities. 

Helen Hamilton spent much of the day in meetings, including with the WHO team to discuss our work together. We collaborate across lots of different areas in the countries and regions where we work and at global level. We also support them on monitoring and improving global access to water, sanitation and hygiene, and collaborate to promote better working between WASH and health experts, especially on cholera, neglected tropical diseases and AMR.

We welcome Ethiopia’s announcement that they will start reporting cholera, indicating new political will and momentum to tackle this devastating disease and seek support from partners to bring an end to it.

Many of our delegates will be leaving Geneva in the next day or two, so we also took the opportunity to have a team dinner and take the time to catch up properly. As we are based in seven different countries, we spend most of our time communicating over Skype calls, so it’s great to be together for this short time. The cherry on top of another successful day was getting this great team photo: with all of us in it this time!  

WaterAid delegates outside at the World Health Assembly 2019
WaterAid delegates outside at the World Health Assembly 2019

We’re conscious that there is still plenty more on the agenda, including discussions on the WASH in healthcare facilities resolution that we have been advocating. Alison McIntyre, head of our delegation, will also be looking to make a statement on maternal and child health, and meet with delegations from Japan and Australia before the end of WHA. Stay tuned for more updates… 

23 May: A packed side event, a star guest and regrouping on cholera

There’s only one place to start: with a few reflections on what Tim Wainwright, WaterAid UK’s Chief Executive, called “one of the best meetings I’ve ever attended.”

Even after our meticulous preparation (we have spent weeks carefully preparing along with member state delegates from eSwatini, Germany, Japan, Sweden, Tanzania and Zambia), we never dared to dream that our co-sponsored First do no harm side event would have quite the impact it did.

Passionate speeches were the order of the night: from the opening by the Ministers of Health from eSwatini and Indonesia, to the personal accounts of Lucy Singh, a medical student from the University of Aberdeen, and Kaveri Mayra, a nursing, midwifery and public health researcher from India. One clear message resonated throughout: WASH in healthcare facilities is a life or death matter.

We were also thrilled to hear practical demonstrations of how to implement the necessary policy and practice changes to ensure all healthcare centres have WASH facilities, including from the Deputy Minister of Health for Tanzania. As our recent blog highlights, WaterAid Tanzania have been instrumental in supporting the Government to create these, so we were particularly pleased to see these experiences being so well received in the room.

And, of course, it was an absolute honour to be joined by the World Health Organization’s Director-General, Dr Tedros Adhanom Ghebreyesus, who added his support to ensuring that every healthcare facility has fully functional water, sanitation and hygiene facilities:

We live in a world of extreme paradoxes. We can map and now edit the human genome. We can cure hepatitis C, we’re on the verge of eradicating polio and we’re working to eliminate cervical cancer. New cancer drugs are harnessing the immune system to give hope to patients who previously had none.

And yet hundreds of millions of people around the world still risk infection by seeking care in health facilities that lack basic necessities, including water, sanitation, hygiene, health care waste and cleaning services.

This is a fundamental failing of our duty as health professionals to “first do no harm”. Health facilities must be places of healing, not harm.

However, in one of the most unexpected twists in World Health Assembly history, Dr Tedros’ involvement in this event will be remembered for one clear moment – being handed a mop! Professor Wendy Graham, Chief Scientific Advisor for Soapbox Collaborative and professor at the London School of Hygiene and Tropical Medicine, handed him the prop following her animated speech urging everyone to recognise the vital importance of health facility cleaners and their need for WASH.

It’s hard to believe that this was just one of the three events that we actively engaged in yesterday. We worked with a whole host of partners – Results, Nutrition International, Scaling Up Nutrition and Action Contre La Faim, World Obesity, Global Nutrition Report and AMREF – to host the 'Putting prevention at the centre of Universal Health Care (UHC)' event in the morning. This included perspectives from Ghana, Madagascar, Bangladesh and Kenya, and small group discussions to agree on practical actions we can take.

Dedo Mate Kodjo, Lucy Murage, Megan Wilson-Jones and Callum Northcote at the nutrition side event.
(L-R) Dedo Mate Kodjo, Lucy Murage, Megan Wilson-Jones and Callum Northcote at the putting prevention at the centre of Universal Health Coverage side event.

And, one year on from the WaterAid-backed #EndCholera resolution at last year’s WHA, we were pleased to join our partners from the Global Task Force on Cholera Control (GTFCC) to hear updates on country progress and the importance of prioritising WASH. As Seth Berkley, CEO of GAVI, the vaccine alliance, put it: “At the end of the day, the long-term solution is WASH. Vaccines will be very helpful in emergencies, but let's get to the stage where that is not needed.”

And finally, Leah Richardson gave our second statement of the week, arguing that quality of care cannot be delivered without ensuring that basic WASH services are availability in health facilities.

After a thoroughly exhausting, yet energising day, our delegates are more determined than ever to ensure the resolution on WASH in healthcare facilities gets adopted! Keep following our journey on Twitter.

22 May: WaterAid’s first statement, honouring our citizens and prioritising a human rights-based approach

Day two saw an important step: the approval of the 2020-21 World Health Organization (WHO) programme to finally align with its triple billion goals. Meanwhile, here’s what the WaterAid team got up to...

Our highlight was undoubtedly Danielle Zielinski, our Health and WASH Officer at WaterAid America, making an official statement under Item 11.4 on the Sustainable Development Goals (SDGs).

Danielle Zielinski, Health and WASH Officer at WaterAid America, making a statement at the World Health Assembly
Danielle Zielinski, Health and WASH Officer at WaterAid America, making a statement at the World Health Assembly

Our first statement of the week took a long time to be heard… it’s been both disappointing and frustrating that the time for non-state actors’ (NSA) statements has been squeezed, and the ever-changing agenda has been difficult to engage with effectively. However, despite it being Danielle’s first time at the WHA, she showed herself to be an absolute pro when called on to deliver a rousing speech under pressure at short notice!

Among the plethora of meetings our team attended, many of which included fantastic recognitions of the importance of WASH for Universal Health Coverage (UHC), Helen Hamilton, Senior Policy Analyst from WaterAid UK, found that sometimes, the less said, the better.

The speech that stood out for Helen - echoing Dr Tedros’ plea on day one for delegates to remember that health is about people - came from Dr. Pisut Chunchongkolkul from the Thailand delegation who powerfully stated: “For us, UHC is about honouring our citizens.”

Leah Richardson, WASH and Health Advisor from WaterAid Sweden, was also encouraged to see strong resonance between our existing work and the action plan set out by Peter Salama, WHO Executive Director of UHC during the UHC Technical Briefing meeting.

Leah was thrilled to hear his clear prioritisation of a human rights-based approach, including a strong focus on citizens’ engagement and empowerment; a commitment to investing in measuring results; and a real desire to capture and share lessons. We will actively follow up to see how we can further support these plans as they unfold.

Our team also spent a lot of time preparing for the busy day ahead today: in fact, by the time this is published, we will already have co-hosted the event,  Putting prevention at the centre of UHC, where we focused on the importance of multisectoral collaboration, particularly with WASH and nutrition.

Finally, we are also looking forward to the arrival of the WaterAid UK Chief Executive, Tim Wainwright, who will be speaking at our First do no harm event on quality healthcare, patient safety and antimicrobial resistance this evening. We’re honoured to be working with a whole host of member states, including Sweden, Zambia and Tanzania, and the entire WaterAid team is looking forward to hearing this array of voices coming together from different constituencies to champion WASH in HCF.

21 May: Rooting our decisions in our countries and communities

And we’re off! Our delegates hit the ground running on day one - here’s the lowdown on all the key moments:

Dr Tedros, the Director-General of the World Health Organization (WHO), set the tone at the opening ceremony with a powerful reminder of why thousands of delegates have gathered in Geneva this week: “Health is about people… And we all have a duty to ensure the decisions we make this week take root in our countries and communities.”

As those words began to resonate around the room, the powerful follow-ups of Natasha Mwanza, a UN youth ambassador from Zambia, and Richard Horton, editor of the Lancet, struck our delegation even more strongly.

Natasha’s passionate call to action highlighted that "issues including lack of water and sanitation are causing $30 billion in economic losses for Africa every year due to sickness and loss of productivity.”

And while Richard didn’t explicitly mention water, sanitation and hygiene (WASH), he laid out the “top five” issues he wants member states to tackle: climate crisis, sexual and reproductive health and women’s rights, guaranteeing safe surgery, making health a multisectoral issue, and ensuring WHO is fully funded and resourced – and WASH is fundamental to all.

Danielle Zielinkski, Aly Sow and Dedo Mate Kodjo from WaterAid's WHA delegation, sitting down at a meeting area.
Danielle Zielinkski, Aly Sow and Dedo Mate Kodjo from the WaterAid WHA delegation.

Aly Sow from WaterAid Mali attended a midwifery event, making a well-received intervention highlighting the work Mali has done to support midwives through WASH in healthcare facilities (HCFs).

Aly said: “For the past five years we have been working to integrate WASH in the health field.  For the improvement of health services, we have adopted a programmatic approach by integrating our field work into the Healthy Start campaign.  We have focused our work on health workers, especially midwives, by changing their work environment and enabling ideal conditions for the adoption of handwashing practices during and after childbirth.”

In the evening, we were thrilled to join our partners Scaling Up Nutrition (SUN) at their reception event, which counted the new Assistant Director General, Naoko Yamamoto and WHO Director of Nutrition, Francesco Branca, amongst its guests. We were encouraged by their commitment to collaboration and hope this marks the start of improved cross-team integration.

Two future gatherings on nutrition were also highlighted: SUN Global Gathering in Nepal in November and the Nutrition for Growth at the Tokyo Olympics. We hope both will provide opportunities for commitments to WASH as a nutrition-sensitive investment.

And finally, Dan Jones was pleased to speak to some Ministry of Health representatives from Nepal who knew all about WaterAid Nepal's hygiene promotion integrated with vaccination project!


20 May: final preparations and expectations

In a final flurry of preparation, our WaterAid delegation have been gathering their bags, accreditation passes, and expectations for the 72nd World Health Assembly this week. The team has descended on Geneva from all over the globe: Bhutan, Mali, Canada, Sweden, Senegal, USA and UK.

While some get over their jet lag, we checked in with Dan Jones, Advocacy Coordinator from WaterAid UK and Megan Wilson-Jones, Senior Policy Analyst from WaterAid Canada, to get their lowdown on the week ahead.

Megan told us: “I’m thrilled to be back at WHA following the successful adoption of the WaterAid-backed cholera resolution last year and will be paying particular attention to whether this has really helped drive its political prioritisation. Ultimately, cholera is still a huge issue – look at the recent outbreaks in Mozambique for example. 

"So I’ll be keeping an eye on how WASH has been integrated into long-term prevention plans in high risk countries, and catching up with colleagues from around the world to discuss how successful national cholera control plans have been implemented in a number of countries.”

On his hopes for the week, Dan said: “WHA is the largest gathering of Health Ministers each year. That means we’ve got all the key decision makers in one room at the same time. So my hope is that they finally pay attention to WASH and realise that they can’t achieve their other goals – on Universal Health Coverage, or Antimicrobial Resistance, for example – if they don’t invest in the fundamental building blocks of clean water, decent toilets and good hygiene. 

"I’m hoping in particular that governments of countries with low access to WASH in healthcare facilities start acting on the responsibility they have to their citizens to improve the situation… and that the governments of wealthy countries are held accountable for their responsibility to help them. Health – the good, the bad and the ugly sides of it – won’t respect national borders, so this really is a situation where a global effort is crucial for everyone.” 

And on top of these individual hopes, the whole team is united behind one key goal: ensuring that member states back the proposed resolution on water, sanitation and hygiene in healthcare facilities. We’ll be keeping you up to date all week. In the meantime, follow our live updates on Twitter