Towards a new EU global health strategy

7 min read
Midwife, Juliana Cyril Msoffee, 32, with one-day-old Fatuma Paul, Kiomboi District Hospital, Iramba District, Tanzania, November 2016
Image: WaterAid/ James Kiyimba

As we release our joint civil society shadow proposal for the European Union, Carolina Diaz explains why now is a valuable opportunity for the EU to efficiently and effectively leverage its political and policy influence, through a holistic global health strategy.

The COVID-19 pandemic has been a reminder of the importance of global health to the social, political and economic future of humanity. Investing in public health and supporting strong, resilient health systems has always been important; now, the dangers of not investing have been thrown into sharp relief. But effective, sustainable improvement requires a coordinated, focused approach.

Together with Aidsfonds, Deutsche Stiftung Weltbevölkerung, Global Health Advocates, International Planned Parenthood Federation – European Network and Save the Children, we have produced Towards a new EU global health strategy, a civil society shadow proposal providing recommendations to inspire the European Union (EU) towards a more comprehensive vision and role in global health.

Now is an opportunity for the EU to renew its vision on global health

In 2010, the Council of the EU urged EU institutions and member states to act on global health, a call that resulted in the European Framework on Global Health – Council Conclusions and Commission Communication. Given the tectonic changes in development cooperation and global health since then, the EU needs to renew its vision on global health, so it can address new and neglected global health challenges and adapt to an altered political environment. An integrated framework would optimise use of limited resources, streamline a coherent approach to health and better steer EU efforts to support partner countries, amplifying impact.

The EU has played a vital leadership role in convening donors and mobilising new financial commitments to address COVID-19, demonstrating the ambition and action that are possible when a clear global health imperative drives its agenda. The pandemic – in addition to the election of a new EU Parliament, the appointment of a new Commission, the upcoming start of a new multiannual financial framework and the programming of relevant EU funding instruments – represent a strategic opportunity to define a new EU global health strategy. Read more in our background paper accompanying our strategy.

In our shadow strategy we propose three priorities:

  1. Strengthening resilient health systems to deliver universal health coverage.
  2. Tackling health inequity and addressing health determinants.
  3. Addressing neglected issues within the health sphere.

Water, sanitation and hygiene are an excellent health investment

WASH (water, sanitation and hygiene) is a key health determinant, as outbreaks of infectious diseases such as COVID-19 clearly show. Without functioning health systems with strong WASH systems and services, contagious diseases spread rapidly and disrupt provision of essential health services, causing further death and devastating impacts on economies and societies.

There are huge gaps in provision of WASH services, which disproportionately affect the most marginalised and vulnerable people. Three billion people lack clean water and soap for handwashing at home, and 40% of healthcare facilities lack adequate hand hygiene facilities at points of care where patients are being treated. Women and girls are disproportionately affected, both because of their specific needs – such as for menstrual hygiene management – and as those most frequently burdened with household tasks such as carrying water long distances in the absence of household services.

Financing for WASH services was already in crisis before COVID-19 hit, with the UN highlighting that only 4% of countries (PDF) report having sufficient financial resources to achieve national hygiene targets. Yet the World Health Organization (WHO) estimates that for every dollar invested in water and sanitation globally there is a $4.3 return in reduced healthcare costs, making these vital services an excellent investment.

COVID-19 has magnified this, highlighting the crucial importance of handwashing as a first line of defence. Handwashing is one of the most effective disease prevention methods available; it has been shown to reduce cases of pneumonia by 50%, reduce acute respiratory infection by 16–23% and result in up to 48% reduction in risk of endemic diarrhoea.

Two men using a foot-operated handwashing station in Hyderabad, Pakistan.
Two men using a foot-operated handwashing station installed by WaterAid in Hyderabad, Pakistan, as part of our COVID-19 response.

Recommendations for strengthening resilient health systems to deliver universal health coverage

Among other factors, this requires long-term, sustainable investments in the six building blocks of health systems, with a renewed focus on public health including WASH systems and services; reproductive, maternal, newborn, child and adolescent health; nutrition; mitigation against the impact of climate change; and the ability to prevent and respond to epidemics.

To strengthen resilient health systems, the EU should invest in sustainable WASH service provision, in communities and healthcare facilities, as a critical first line of defence against the spread of many infectious diseases including COVID-19. It should support nationwide scale up of hygiene promotion campaigns, and training of frontline workers in infection prevention and control measures and practices. And it should champion effective cross-sectoral approaches at global and national levels, seek to convene partners across traditional sector silos and showcase innovative integrated approaches, such as those between health and WASH.

Recommendations for integrating WASH with health interventions

It is increasingly clear that combining or integrating WASH and health interventions helps maximise the impact and cost-effectiveness of both. For example, WaterAid analysis estimates that scaling up an integrated package of WASH, rotavirus vaccination and nutritional interventions to 100% coverage could reduce morbidity by nearly two thirds (63%) and almost halve mortality (49%) from diarrhoea and pneumonia – the equivalent of preventing more than 697,000 child deaths a year. In the shadow strategy we therefore recommend that the EU increase focus on four critical areas where WASH and health intersect:

  1. WASH in healthcare facilities – unhygienic conditions undermine efforts to prevent and control outbreaks such as COVID-19, and result in overuse of antibiotics, contributing to antimicrobial resistance (AMR).
  2. Nutrition – access to safe water and sanitation, and good hygiene practices, are essential.
  3. Neglected tropical diseases (NTDs) – WASH is key for prevention and treatment.
  4. Hygiene services for households and communities, and hygiene promotion and behaviour change campaigns – crucial priorities for prevention and control of COVID-19 and future infectious disease outbreaks.

As the EU is embarking in a programming process to define the priorities of the new cooperation cycle for 2021–27, it should also ensure that programming responds to the intersection between health, nutrition and WASH for especially vulnerable populations such as pregnant and lactating women, women of reproductive age and adolescent girls, and infants and young children.

The short film below explains the vital role of WASH in health systems.

Recommendations for WASH and neglected health issues

Regarding the role of WASH in addressing neglected health issues, in our shadow strategy we recommend that the EU champion a cross-sectoral approach by committing to:

  • Fund integration of WASH within NTD programmes.
  • Provide funding to support coordination of WASH and NTD efforts.
  • Support integrated NTD/WASH behaviour change programmes.
  • Encourage partner countries to invest in WASH infrastructure, targeted using NTD data to prioritise the highest risk areas.

The EU’s investments in WASH services in healthcare facilities should also be seen as a key contribution to tackling AMR, because antibiotics are frequently used in unhygienic healthcare settings as a quick fix for poor hygiene.

Sexual and reproductive health and rights (SRHR) is another neglected area of public health in which WASH is essential. Millions of women face challenges in managing menstruation effectively and hygienically because they lack access to essential products and WASH. The EU should commit to a rights-based approach to SRHR and promote integrated and comprehensive services.

Our role in a holistic approach to global health

Finally, our shadow strategy highlights the crucial role of civil society to support the EU in implementing the proposed strategy, and the need to strengthen the EU’s coordination and engagement with civil society organisations.

In EU partner countries, new strategies could contribute to the diverse and inclusive engagement of civil society and communities in all relevant health decision-making processes.

To efficiently and effectively leverage its political and policy influence, the EU needs a strategy that acts like a compass, provides operational guidance and coordinates a holistic approach to global health. Such a strategy should apply to all involved in EU global health action, as well as to EU policies that have a direct impact on health, including in the areas of water, climate, human rights, migration and trade.

We stand ready to continue supporting the development of a new global health strategy and support its implementation in the countries where we work.

Carolina Diaz is EU Advocacy Coordinator at WaterAid. Follow @EUWaterAid for the latest on our advocacy in Europe.