New data on WASH in health care facilities must act as a rallying cry for urgent action

4 April 2019
1 in 6 hygiene HCF

WHO and UNICEF recently published new data on the status of water, sanitation and hygiene (WASH) in health care facilities around the world. WaterAid’s Dan Jones, Alison Macintyre and Helen Hamilton explain why the numbers must act as a rallying cry for urgent action.

These deeply concerning statistics (pictured above), among many others, were published earlier this week by the WHO and UNICEF 'Joint Monitoring Programme for Water Supply, Sanitation and Hygiene' (JMP), who are responsible for monitoring progress towards Sustainable Development Goal 6 (SDG 6). This first global baseline data for WASH in health care facilities shows that many countries are nowhere near on track to achieve universal WASH services and universal health coverage (UHC) for everyone, everywhere by 2030, and many others simply have no idea about their status or progress.

It is time to stop accepting the unacceptable

At last year’s World Health Assembly, we vividly remember senior WHO director Dr Maria Neira exclaiming in frustration: "We are accepting the unacceptable – we simply shouldn’t call it a health care facility if there is no water, sanitation and a piece of soap. It is time to stop accepting it." By that definition, the new data reveals a major crisis in basic healthcare provision – it estimates that 896 million people globally had no water service at their health care facility in 2016 (latest data available) and more than 1.5 billion people globally had no sanitation service at their health care facility. And one in six health care facilities globally had no place to wash your hands with soap and water, meaning they lacked hand hygiene facilities at points of care, as well as soap and water at toilets.

This is the first time that globally-representative data on WASH in health care facilities has been collected, and as such is a major step forward for monitoring progress towards the SDGs. However, the report also reveals huge data gaps that should be worrying to many governments. Just 38 countries out of nearly 200, and just three of the eight SDG regions of the world, had sufficient data to estimate coverage of basic water services in health care facilities. For basic sanitation services, that fell to 18 countries and only one SDG region with sufficient data. Too few countries had sufficient data for the JMP to make credible global estimates for the provision of basic sanitation, hygiene, waste management or cleaning services in health care facilities.

Map of data from JMP reportWHO/UNICEF
Map of data from JMP report

Think about that. That means the vast majority of countries are unable to monitor their progress on the most basic facets of health care services, nearly four years after the SDGs were agreed and with eleven years remaining until 2030. Most health care facilities cannot be called health care facilities under Dr Neira’s definition.

A winnable battle…

Dr Neira is right. This is utterly unacceptable. It is also a solvable problem. Published alongside the JMP data is WHO and UNICEF’s report on 'Practical steps to achieve universal access' (pdf), which WaterAid has contributed to. This report, intended to outline the response to the UN Secretary General’s 'call to action' to address WASH in health care facilities, is a neat encapsulation of years of country experience from around the world that shows that this issue can be tackled. It lays out eight actions that health ministers, in collaboration with others, can take, ranging from establishing national standards for WASH in health care facilities, to investing in training for the health workforce, to engaging communities and strengthening accountability. These actions closely mirror those taken by WaterAid teams around the world over recent years, documented in our report 'Transforming Health Systems: the vital role of WASH'.

Antonio Guterres WASH in HCFs


…that goes to the heart of healthcare

It is imperative that health ministers, supported by development partners, move quickly to take these practical actions. Without doing so, the very foundations of universal health coverage are fatally weakened. Think of how a health system can be strengthened to prevent and control outbreaks of diseases like cholera and Ebola – and how those diseases spread without good hygiene and infection prevention and control. Think about global efforts to improve 'quality of care' and 'patient safety' – and how those efforts are undermined if health workers know that they themselves are spreading infections because they simply cannot wash their hands properly after treating a patient. Think about the growing fears of a 'post-antibiotic world' where so-called 'super-bugs' cannot be treated with the antibiotics we are so reliant on – and think about how medical staff in low-income settings are forced to over-use and misuse antibiotics because they simply cannot rely on basic hygiene.

Let this be the moment that we act

This new data should be a rallying cry for a step-change in commitment and action on WASH in health care facilities. At WaterAid, we have been supporting a number of Member State delegations in Geneva to put forward a proposed resolution on this issue at the World Health Assembly in May. With the delegations of Zambia and Tanzania in the lead, the resolution garnered support from across regions at the preparatory Executive Board meeting in January, including from Australia, Brazil, eSwatini, Ethiopia, India, Indonesia, Kenya, Nigeria, the USA and all Member States of the EU (yes, including the UK!).

This resolution – if it is adopted – would be a written, public commitment from all of the world’s health ministers to act. It would be a clear promise that communities could hold their governments to account for fulfilling. It could set the stage for new SMART financial and policy commitments to rapidly accelerate progress – and to quickly improve the data. WaterAid stands ready to work with governments and partners to make this a reality, so that everyone everywhere has quality healthcare by 2030.


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