Three reasons governments and donors must invest in water, sanitation and hygiene in healthcare facilities

5 min read
Image: WaterAid/ Frehiwot Gebrewold

Improving water, sanitation and hygiene (WASH) in healthcare facilities is a powerful investment — not just for improved health outcomes and stronger health system resilience, but also for care that is compassionate, dignified and inclusive. In short, it’s one of the best buys in public health. Helen Hamilton, WaterAid’s Senior Policy Analyst for Health and Hygiene, shares three reasons why.

1. WASH protects health workers

WASH is vital for health workers' safety. Health crises such as Ebola and COVID-19 have further emphasised what we have long known — there can be no safe working environment for health workers without WASH. As Dr Tedros Adhanom Ghebreyesus, Director General of the World Health Organization has said, “Working in a healthcare facility without water, sanitation and hygiene is akin to sending nurses and doctors to work without personal protective equipment.”

Lack of adequate WASH services in facilities places healthcare providers at increased risk of healthcare-associated infections, undermining their safety, motivation and ability to do their job well in a clean and safe environment. This can contribute to the challenge of retaining staff, particularly in rural areas.

Women comprise 70% of the world's healthcare workers, making the lack of WASH in healthcare facilities an issue of women’s right to health and safety. Women also have distinct WASH needs, including to manage their periods hygienically and with dignity. Promoting health worker safety through access to WASH directly contributes to eliminating discriminatory work practices, the empowerment of women, and safer care. The safety of health workers therefore directly impacts the safety of patients.

Ma Nyein Myint Oo cleaning a hospital floor wearing protective equipment, in Lemyethna Hospital, Ayeyarwady Region, Myanmar, March 12 2020.
Ma Nyein Myint Oo cleaning a hospital floor wearing protective equipment, in Lemyethna Hospital, Ayeyarwady Region, Myanmar, March 12 2020.
Image: WaterAid/ Ko Ko Htay

2. WASH is what women want

When the White Ribbon Alliance asked women from 114 countries about their top demands for maternal healthcare, they received 1.2 million responses with a clear message: after respectful and dignified care, women’s second highest priority was WASH. Women want safe, dignified care — and that includes having health facilities with running water, private toilets, and clean beds and sheets.

Clean care in healthcare facilities is both lifesaving and essential to improving women’s empowerment and experience of healthcare, especially during pregnancy and childbirth. Every year up to one million mothers and newborns die because of preventable infections linked to unclean births. Having WASH facilities readily available in healthcare settings dramatically improves reproductive, maternal, adolescent and child health. Practising straightforward hygiene during antenatal care, labour and birth reduces the risk of healthcare-acquired infections, sepsis and death for infants and mothers.

Lack of WASH in healthcare facilities contributes to significant patient dissatisfaction and stops women from seeking maternity care, which contributes to poor health outcomes for mothers and babies. Improving WASH in healthcare facilities should be prioritised as a means of tackling healthcare-acquired infections, but also to improve patient satisfaction and encourage timely seeking of care.

Elisa and her newborn baby, Olivia, 45 days old, standing outside the Manjakandriana commune health centre's newly built sanitation block, Manjakandriana commune, Madagascar.
Elisa and her newborn baby, Olivia, 45 days old, standing outside the Manjakandriana commune health centre's newly built sanitation block, Manjakandriana commune, Madagascar.
Image: WaterAid/Ernest Randriarimalala

3. WASH combats antimicrobial resistance

Healthcare-associated infections are on the rise globally, as is antimicrobial resistance (AMR). The first major global analysis of the impact of AMR estimates that resistance itself caused at least 1.27 million deaths in 2019. This confirms that AMR is a global health threat, with the highest burden and worst impacts seen in low- and middle-income countries where access to clean water, sanitation and hygiene services is lowest.

A core element of safe and quality care is hygienic practices and environment. Healthcare-associated infections are a clear marker of inadequate infection prevention and control. Childbirth is risky, and babies do not have fully developed immune systems, especially if they are premature, so are more susceptible to illnesses, either from infections their mother may already have or from infections contracted in hospital.

Prophylactic use of antibiotics to counter the high risk of infection due to inadequate WASH is a serious issue. For example, in India and Bangladesh, a study found that 13 of 15 maternity units, public and non-public, routinely administered antibiotics to all labouring women, irrespective of whether they had a normal or complicated delivery. Relying on antibiotics to do the job of effective infection prevention and control and WASH is costing us dearly — overuse and misuse of antibiotics undermines measures to control drug resistance worldwide. Improving infection prevention and control and WASH is a proven cost-effective solution to reduce healthcare-associated infections and decrease the need for antibiotics.

Jalia Nabukeera, enrolled midwife, holding a baby just two hours old, as the baby’s mother Mariam looks on, at Katabi Health Centre III, Wakiso District, Uganda.
Jalia Nabukeera, enrolled midwife, holding a baby just two hours old, as the baby’s mother Mariam looks on, at Katabi Health Centre III, Wakiso District, Uganda.
Image: WaterAid/ James Kiyimba

WASH is a no regrets investment

With decisive action, this story of lack of access to WASH in healthcare facilities can change within a generation. We know the estimated cost of achieving universal access to WASH in existing healthcare facilities in the world’s 46 least-developed countries is around US$9.6 billion. It would only take an annual commitment of around $600 million in external financing and a domestic commitment of around $355 million to make WASH available in every healthcare facility in these 46 least developed countries. These investments would not only yield benefits of up to 16 times their value and start paying for themselves within just one year, but would also reduce the burden of unpaid work on women and girls, strengthen health system resilience and boost economic growth (PDF). In our new report, WASH: a foundation of strong resilient health systems, we highlight practical examples and actions to strengthen systems for WASH in healthcare facilities.

Water, sanitation and hygiene are pillars of public health and dignity — we can prevent pandemics with them, and they can save a mother’s or a child's life. Investing in WASH in healthcare facilities contributes to tackling AMR and reducing infections, and enables health workers to focus on patient care rather than collecting water. Clean hands save lives; WASH in healthcare facilities is imperative to achieving health for all.

Helen Hamilton is WaterAid's Senior Policy Advisor for Health and Hygiene. Connect with her on Twitter, and keep up to date with our World Health Assembly conversations via our global Twitter @wateraid.

Top image: Bedriya Jemal, a health extension professional at Buriya Health Post, washes her hands with the water installed in her office after providing services to the people who visit the health post. Buriya Kebele, Oromia, Ethiopia.