Hygiene for health: our campaign to protect people’s health through water, sanitation and hygiene
From advocating for water, sanitation and hygiene in health centres to developing national hand hygiene roadmaps, here we share the highlights of our global health campaign.
Almost 2 billion people in the world – one in four – don't have soap or water to wash their hands at home. 1.7 billion people – more than one in five – don’t have clean water inside their health centre. Yet families, students, patients and healthcare workers need adequate water, sanitation and hygiene (WASH) and soap for so many reasons: to keep girls in school, to prevent and control infections, to keep mothers and babies safe during childbirth, to curb the rise of antimicrobial resistance, and to protect against future pandemics.
Since 2021, WaterAid teams have advocated for sustainable and inclusive WASH in health settings and universal access to hand hygiene through our Hygiene for Health campaign. As the campaign comes to an end, here we share just some of its impact.
How is practising healthcare without WASH? My response is simple: this is not healthcare.” – Dr Rosa Marlene, Director of Zambezia Hospital in Mozambique
Influencing regional change
Pan-Africa
At the Global Healthcare Summit in Rwanda in November 2021, an international WaterAid delegation hosted a side event to launch the Hygiene for Health campaign and build momentum for the development of hand hygiene roadmaps, a key influencing activity of the campaign.
WaterAid teams across the region have been campaigning for the increased prioritisation of hygiene on the AfricaSan agenda for several. In 2021, the AfricaSan Conference declaration document included specific resolutions towards high-level political leadership, and re-thinking how hygiene data is captured and used for decision making. At the 2023 conference, we were the lead agency for the sub-theme on inclusion, hygiene and behaviour change, and the declaration document called for revitalised efforts towards achieving the Ngor Declaration on Sanitation and Hygiene. It specifically called for functional institutional arrangements across sectors for integrated and gender-responsive hygiene services and behaviour change.
West Africa
In West Africa, the team published a first-of-its-kind regional state of hygiene report, with action-focused webinars with representatives from key partners and governments, including UNICEF and the Federal Government of Nigeria. The team is now engaging with youth and community changemakers on the importance of sanitation through the African Sanitation Policy Guidelines programme, following our involvement in developing the guidelines in 2021 as a key partner of the African Ministers Council on Water.
WaterAid West Africa also ran Change the Score, a successful regional sanitation campaign to build on the excitement generated by the World Cup. Launched in November 2022, the campaign reached 19 million people online and millions more through radio, television ads and live events, and saw 3,000 people join a new community of changemakers.
Southern Africa
WaterAid South Africa and WaterAid Malawi campaigned at the 2021 Southern Africa Development Community (SADC) Summit for increased investment in hygiene. They hosted a successful side event that brought together policy makers in the health and WASH sectors from Eswatini, Malawi, Mozambique and Zambia.
At the 2021 SADC Peoples Summit, the teams also influenced the inclusion of two key areas in the resulting communiqué: adequate hospital care as a key concern of the region, and adequate human and financial resources for WASH. This communiqué was presented to Dr. Lazarus McCarthy Chakwera, the President of Malawi and the then SADC Chair.
Highlights by country
Bangladesh
WaterAid Bangladesh collaborated with UNICEF and the Policy Support Branch of the Ministry of Local Government to develop a national costed Hand Hygiene for All Roadmap. This was launched in October 2022 and is guiding the country's efforts towards universal access to hand hygiene by 2030.
The team also helped build the next generation of hand hygiene champions by supporting the UNICEF-WHO Hand Hygiene for All Global Initiative. Through the Youth for SDG6 programme and the Jaago Foundation, young people from three divisions (regions) of Bangladesh received training on the importance of hand hygiene and WASH-related issues.
Nepal
In Nepal, the team facilitated four policy dialogues that were aired on national news, featuring senior government officials, mayors and WaterAid Nepal’s Country Director. The team was also influential in the development of the Department of Health Services' national costed roadmap to improve WASH in health centres, which is on track to be approved. WaterAid Nepal also developed a policy brief on the funding gap for WASH in healthcare facilities, using a project implemented in Bardiya District and data from the Ministry of Water Supply, to promote the use of evidence-based decision making when allocating resources for WASH in local health facilities.
Pakistan
With the Ministry of Climate Change and UNICEF, WaterAid Pakistan published the national Hand Hygiene at Scale Roadmap in 2021. This was integrated into the government's Clean Green Pakistan campaign. Following this, WaterAid Pakistan and UNICEF also supported the development of a hygiene behaviour change strategy which became the overarching framework for the roadmap from August 2022.
Ethiopia
With the leadership of the Ministry of Health, WaterAid Ethiopia, alongside UNICEF, provided support to develop a costed Hand Hygiene for All National Roadmap. This document addresses gaps in access to hand hygiene and practice, and guides efforts towards global and national commitments. It was also incorporated into Ethiopia's One WASH National Programme.
Liberia
In April 2024, the Director-General of the National Public Health Institute of Liberia (NPHIL), Jane A. Macauley, launched the National WASH in Healthcare Facilities Roadmap together with WaterAid Liberia Country Director, Chuchu Selma, and a representative from WHO. WaterAid Liberia was part of the technical working groups during the roadmap's development, along with representatives from the Ministry of Health, NPHIL, WHO, UNICEF, Centers for Disease Control and Prevention, and others.
Since the launch, the team has influenced a meeting between 10 legislators, key government ministries and agencies to increase funding for the WASH sector. As a result, the Ministry of Health, NPHIL and other government entities were instructed by lawmakers to submit a budget with a clear line for WASH, which the team hope will increase financing for WASH in healthcare facilities and the newly launched roadmap.
Malawi
In Malawi, the team influenced the Ministry of Health to develop a costed WASH in Healthcare Facilities Roadmap. They also secured a statement from the Government of Malawi which committed to ensuring there was adequate financing to implement it. Most recently, the government increased its WASH budget from K49bn (US$28 million) to K202bn (US$116 million) and, at a learning event organised by WaterAid in March 2024, the Ministry of Health announced a new pilot grant for WASH in healthcare facilities.
Mali
WaterAid Mali ran a strong media campaign throughout 2021 and 2022 to encourage decision makers to increase investment in hygiene and meet the commitments made at the 2019 World Health Assembly (PDF). The campaign reached more than 145,000 people online; 67,000 on social media and 78,100 through online press.
The team contributed to the update of Mali’s national action plan on WASH in health centres and, in April 2022, supported the Director General of Health and Public Hygiene, Dr Cheick Amadou Tidiane Traoré, to set up a taskforce on WASH and infection prevention and control. The team also contributed to the development of a roadmap and new national strategic plan for WASH in healthcare facilities that are due to be ratified this month.
Nigeria
In Nigeria, the team influenced the development of the National Guidelines for WASH in Healthcare Facilities and the Hand Hygiene for All Roadmap. They also introduced a comprehensive tool to be used to assess WASH facilities in primary health centres across three states of Nigeria and the Federal Capital Territory.
Working with the Federal Ministry of Health, WaterAid Nigeria ensured prioritisation in the budget process for safe and inclusive WASH facilities in the construction and rehabilitation of healthcare facilities. They also secured a commitment from the government to start prioritising inclusive WASH services in health centres.
And in April 2023, influenced by the team's advocacy for the different government ministries to collaborate on sector policy development, the Minister for Environment, Mohammed Hassan Abdullahi, established a committee to develop Nigeria’s first ever comprehensive national WASH policy.
Rwanda
In Rwanda, the team focused on strengthening an inclusive and gender-responsive policy environment. They gathered evidence to advocate for the certification of reusable sanitary pads to increase their accessibility and affordability. They also held a research and results-sharing national dialogue that brought together decision makers, academia and civil society organisations. WaterAid Rwanda also supported the Ministry of Health to develop a Hygiene and Environmental Health Policy and its strategic plan, aimed at minimising health risks and promoting hygiene and health for all.
Zambia
WaterAid Zambia supported the development of two national technical tools: WASH in Health Facilities Standards and the National Technical Assessment Tools for WASH in Health Facilities. These were launched by the Ministry of Health in 2021 and were an important milestone to demonstrate the Zambian government’s commitment to the 2019 World Health Assembly resolution on WASH in healthcare facilities.
The team’s advocacy also elevated WASH on the political agenda. Following his election in August 2021, WaterAid Zambia engaged with President Hichilema and his vice-president to influence key priorities for WASH, developing a position paper that covered key sectors of WASH, health, education and agriculture.
The impact of our federation members
Germany
In Germany, we led a successful multi-stakeholder discussion on WASH and health at the Future of Sanitation and Hygiene Conference. Building on this engagement, WaterAid Germany influenced two central strategies of the Federal Ministry of Economic Cooperation and Development (BMZ) – the Health, Social Protection and Population Policy and Shaping the Future with Africa Strategy. These strategies now recognise the importance of WASH for health interventions.
WaterAid Germany also collaborated with the German government and Malteser International to incorporate WASH for infection prevention and control in the "Pandemics. No Time to Neglect" high-level conference, hosted by the Federal Ministry of Health (BMG) and BMZ in September 2023.
Japan
In 2023, WaterAid Japan secured a mention of WASH in the context of universal health coverage (UHC) in the G7 Leaders’ Communiqué (PDF), the G7 Health Ministers’ Communiqué (PDF) and in the G7 Global Plan for UHC Action Agenda (PDF). The team’s sustained effort resulted in WASH featuring in other prominent G7 discussions and outputs such as the G7 senior development officials’ health discussions and the G7 Climate, Energy and Environment Ministers’ Communiqué (PDF).
Sweden
In May 2023, WaterAid Sweden held a seminar with the All-Party Parliamentary Group on AMR and met with Sweden’s Minister for Social Affairs and Public Health, Jakob Forssmed, in June to discuss WASH, health systems and AMR. In December 2023, the government released its reform agenda which mentions WASH three times in the context of education (schools), health (AMR) and climate (food security).
And in February 2024, the government released a discussion paper ahead of the high-level meeting on AMR, which states that preventative measures such as clean water and sanitation are essential to counteract AMR. The discussion paper also encourages UN organisations to cooperate more closely with the Quadripartite Secretariat for One Health on relevant aspects of their core missions such as WASH.
UK
In the UK, the team supported an inquiry by the All-Party Parliamentary Group that considered the link between antimicrobial resistance (AMR) and the lack of access to WASH in healthcare facilities in the least developed countries (LDCs). This resulted in a report on the importance of WASH to combat AMR, which was launched during an event in parliament in February 2023.
In January 2024, the International Development Select Committee integrated written evidence from the UK team in its report on approach to sexual and reproductive health, in which the committee called for an increase in WASH funding. Most recently, on World Water Day 2024, the UK team launched its 'Manifesto for Water', which outlines key measures the next UK government should take on WASH.
US
With the support of WaterAid America, the Global WASH in Healthcare Facilities Act of 2023 was introduced in the US Congress in September 2023. This legislation, if successful, will require the US Agency for International Development to lead in the development of an action plan and provide annual reporting for its existing work to address the lack of access to safe WASH in healthcare facilities. The introduction of the legislation is the first step in the US process to become law, and is the first WASH-specific legislation to be considered in 10 years.
Where to next?
We are proud of the progress made through the Hygiene for Health campaign, from developing national guidelines for WASH in health facilities and hand hygiene roadmaps, to influencing governments to prioritise funding for these essentials. But we won't stop here.
Current rates of progress need to triple for everyone, everywhere, to have a place to wash their hands at home with soap and water by 2030. In the least developed countries (LDCs), progress needs to increase 12 times. But in LDCs, spending just US$0.60 per person, per year, on WASH in healthcare facilities will save millions of lives every year. This is an achievable and affordable action.
The choice to act – or not – lies with health ministers and their governments. We won’t stop campaigning until they have taken action.
Top image: Halima Khatun visits the Raghunathpur community clinic for a monthly check up during pregnancy. Patients of the community clinic can now access hygienic toilets and drinking water from the clinic facilities. Kaliganj, Satkhira, Bangladesh. December 2022
