No more excuses: governments can solve the hygiene crisis in global healthcare by 2030

5 min read
Image: WaterAid/ Dennis Lupenga

Ahead of this year's World Health Assembly, Annie Msosa and Julie Henri highlight the commitments governments must make to solve the global crisis of poor hygiene in healthcare facilities.

"You have reached a clean zone" – the message welcomes visitors at the Nkhuzi health centre in Ntchisi, Malawi. 

As one walks around, it becomes clear that good hygiene is taken seriously at every corner in this facility.  

The grounds are well kept and areas are designated for medical and other types of waste. Handwashing facilities with soap and water are available at key points: where care is provided, outside toilets and in the clinic grounds. Those seeking care are made aware of the hygiene facilities available and consistently reminded to use them properly.   

There is also a guardians’ shelter, where pregnant women who live far away from the healthcare facility can stay from at least a month before their due date. The shelter at the Nkhuzi centre has an adequate number of bathrooms, toilets and handwashing facilities. One can easily tell the women like waiting here because they take responsibility for keeping everything as clean as they found it.

New WASH facilities constructed at Nkhuzi Health Centre, funded by the Wimbledon Foundation. Ntchisi, Malawi, May 2022. Image: WaterAid/Francis Chipanda

Without water, sanitation and hygiene women felt unsafe 

However, this is all a stark difference from just a few years ago. Back then, the shelter lacked water, sanitation and hygiene (WASH) facilities and pregnant women felt safer staying at home (where these essentials were available) than coming to the shelter to wait until delivery. 

This was a difficult and dangerous choice for the women: while seeking to protect their unborn children and themselves from infections they could get in the unclean guardian shelter and maternity ward, by staying at home they chanced not being able get to the healthcare facility in time to give birth, which still posed risks to their and their children’s lives. "Even for us, it was not making sense to encourage women to come and stay at the guardian shelter where their stay would be miserable. So, the impact of not having clean water had far worse consequences," said Zelifa Mzoma, Nurse Midwife.

Zelifa Mzoma, 39, Nurse Midwife, holding a baby, Nkhuzi Health Centre, Ntchisi, December 2022. Image: WaterAid/ Dennis Lupenga

Water, sanitation and hygiene services have boosted safety and morale 

Now the facility has WASH services, the sense of pride and motivation among healthcare workers is evident; they feel proud to provide quality and safe healthcare to those who come to the facility.   

"With clean hands, I can ably handle my job and keep babies and other clients safe from infection. We have seen a huge drop in sepsis cases in the past four months [since facilities were installed]. This has boosted our professional morale. We have all we need to do our job right," said Zelifa.  

It is not just the clinical staff – the cleaners also feel proud of the impact the centre’s hygienic environment has on users and the community.  

"The community members have borrowed a leaf from our book on how to properly get rid of waste, which they are emulating in their respective homes. This is exciting for us as WASH champions," said Phillimon Kampango, Cleaner and Ground Labourer.  

The safety, protection and dignity that the Nkhuzi clinic now affords its users and workers are foundational to quality health service. And the sense of community and trust that is being built in the process is inspiring. 

This is just a glimpse of what is possible if the basics are invested in. On a global scale, the effects would be huge. 

 If health ministers decide that every healthcare facility in the world must have WASH services: 

  • 1.4 million lives of newborns and mothers will be saved 
  • 7 out of 10 hospital-acquired infections will be prevented and hospital stays will be reduced  
  • Healthcare-associated sepsis cases will be halved  
  • Healthcare workers will be protected and supported to do their jobs well 
  • Communities’ trust in their health systems will grow 
  • The overall cost of healthcare will reduce
Phillimon Kampango, 34, ground labourer, Nkhuzi Health Centre, Ntchisi, Malawi, December 2022. Image: WaterAid/ Dennis Lupenga

What will it take to achieve the basics of healthcare?

A targeted investment of US$9.6 billion will make WASH available in every healthcare facility in the world’s 46 least developed countries (LDCs). This is less than a dollar (US$0.60) per person in these countries per year until 2030 and represents just 3% of current health spending across LDCs. This is less than the cost of two bars of soap in Malawi!

Yet, globally one in two people use or work in a healthcare facility that does not have access to basic hygiene services. This problem is most critical in least developed countries, where only a third of healthcare facilities have access to basic hygiene. 

Solving this crisis will not break the bank and will reduce overall healthcare costs – every dollar spent on hygiene saves $16 on healthcare. An annual commitment of $600 million in external financing and a domestic commitment of $355 million from LDCs is all we need in this decade to get there. 

We cannot accept anything less from our health leaders. They have the power and the means to end this crisis for good.

An infographic illustrating a healthcare centre and featuring the text: '$600m annual external funding' and '$335m annual domestic revenue from least developed countries'.
The annual commitments required to make WASH available in every healthcare facility in the world’s 46 least developed countries. Image: WaterAid

At the World Health Assembly global health leaders must commit to end this crisis

The World Health Assembly’s latest progress report notes that countries are not moving fast enough to finance and implement roadmaps for universal access to WASH in healthcare facilities.

Ensuring people can survive the health services experience without being harmed is not something to be debated, negotiated or postponed; it must be demanded. To that end, we want commitments from global health leaders to: 

  1.  Take concrete steps to collectively meet the $9.6 billion financing gap for WASH in healthcare facilities in LDCs
  2. Ringfence financing for WASH in healthcare facilities in key health sector programmes 
  3. Establish strong monitoring and accountability systems to make sure governments and donors deliver on their commitments 

We know health leaders have the resources to save millions of lives; the world is awaiting action. No more excuses.

Read our policy brief Water, sanitation and hygiene in healthcare facilities: an investment that will save lives

Top image: A broken and disused sink at Ntaja health centre, Machinga, Malawi, September 2020.