Water, sanitation and hygiene: a foundation of strong resilient health systems

Water, sanitation and hygiene services in healthcare facilities are essential for providing quality care and preventing avoidable deaths, yet one in five healthcare facilities worldwide have no water services. A new learning report from WaterAid highlights the urgent need to address this crisis to improve the quality of health services and behaviours, strengthen pandemic preparedness and create resilient health systems.

As the world faces climate change, epidemics and the ongoing COVID-19 pandemic, inclusive, sustainable and climate-resilient water, sanitation and hygiene (WASH) services are more important than ever. The need is all the more urgent in healthcare facilities (HCF), where a lack of access to these services has long undermined the quality and safety of healthcare, and set back progress on achieving universal health coverage.

Half of healthcare facilities in the world’s 47 least-developed countries, for example, don’t have basic water services.

COVID-19 has brought renewed focus on health systems and healthcare facilities, highlighting gaps and inequalities. The pandemic has also underlined the simple fact that WASH services and behaviours in healthcare facilities are a prerequisite for infection prevention and control, for the safety of patients and health workers, and for building strong and resilient health systems that can deliver quality healthcare in times of crisis.

This learning report is based on lessons from our work with ministries of health and partners to improve WASH in healthcare facilities in more than 20 countries – in some cases for more than a decade. We share practical experiences of system strengthening and explore examples of where progress has been made at district and national levels. We have also gathered case studies to demonstrate how we have strengthened the technical, political and financial aspects of WASH in healthcare facilities, in partnership with governments and national and global partners.

Explore the map below to read the case studies accompanying this report - or download them below. 

This report is targeted at WASH in HCF practitioners, governments, donors and WASH and health decision makers. While the report is not an evaluation or an exhaustive analysis of all of our WASH in HCF programmes, it does make the following recommendations for governments, in partnership with civil society and development partners:

• Integrate WASH in HCF as a core component in policies on health and infection prevention and control; for maternal, child and newborn health; antimicrobial resistance; health security; pandemic preparedness and response programmes; and in strategies to achieve universal health coverage.
• Encourage cross-sectoral working and strengthen national and sub-national coordination between ministries responsible for health, finance and WASH, to ensure there is adequate finance to support the sustainable and inclusive delivery of all aspects of WASH across the health system.
• Track progress against national standards on WASH in HCF within routine health monitoring systems and responsive citizen-led accountability mechanisms.
• Develop, finance and implement costed national strategies for WASH in HCF, and invest in WASH in HCF as part of broader health systems and pandemic preparedness investments, with sustainable long-term domestic and donor financing.
• Support communities to hold health and WASH duty bearers to account for progress on WASH in HCF. This includes a commitment of time and resources (both human and financial) to scale up access to WASH in HCF and improve WASH service levels, so communities and frontline workers’ demands for safe, dignified and quality care are met – and enable them to deal with shocks effectively, especially during crises such as the COVID-19 pandemic.

We hope that, by capturing lessons learned and sharing approaches that have supported success, we will show where investment and action are needed to achieve inclusive and sustainable access to WASH in all healthcare facilities.

Download the case studies (PDF)

Bangladesh

Cambodia

Ghana

India

Malawi

Mali

Myanmar

Nepal

Tanzania

Uganda

Zambia