Life-threatening illnesses such as cholera and diarrhoea are preventable with adequate water, sanitation and hygiene. It is unacceptable that they still cost lives today.

When clean water, decent toilets and good hygiene are not a normal part of daily life, the impacts on health and wellbeing are devastating. Never was this more clear than during the COVID-19 pandemic and more recently, the unprecedented cholera outbreaks across southern Africa. 

Handwashing is vital to help break the chain of infections, including stopping the spread of coronavirus and cholera. But for people across the world without access to soap and water, following this public health advice has been impossible. And, with half of all healthcare facilities operating without a basic hygiene service, millions of health workers and their patients are left without the tools to keep them safe from infections. To protect people's health and prevent future pandemics, every health centre, everywhere, must have adequate water, sanitation and hygiene (WASH) services, as well as environmental cleaning and healthcare waste management. 

Without access to these essential services, people are at risk of potentially fatal diseases such as cholera and serious conditions such as blinding trachoma. More than 273,000 children under five die every year from diarrhoeal diseases caused by unsafe WASH. That's almost 750 children a day, or one child nearly every two minutes.

And the effects go beyond the illnesses themselves. Frequent bouts of illness and undernutrition keep children from attending school and adults from going to work, limiting students’ potential and reducing adults’ income. All of this contributes to a vicious cycle of poverty, and impacts on a country’s economic growth and development.

And without clean water and soap in healthcare facilities, staff cannot deliver high-quality and safe healthcare, putting the lives of themselves and their patients – especially vulnerable mothers and babies – in danger.

WASH in health centres: an investment that will save lives

The world faces devastating health risks due to major gaps in WASH services in health facilities. We outline the critical actions governments and donors must take to change this and protect the lives of patients and staff.

Halima visits her community clinic for a monthly check up during pregnancy. Patients can now access hygienic toilets and pure drinking water at the facility. Satkhira, Bangladesh. December 2022.
Image: WaterAid/Fabeha Monir

Cholera and WASH

Cholera is a deadly waterborne disease that is entirely preventable when people have access to clean water, decent toilets and good hygiene. It is spread when food and water is contaminated by faeces, including through poor hand hygiene around food preparation. It causes acute watery diarrhoea and can cause death within hours.

The world is experiencing an unprecedented series of cholera epidemics, with larger and more lethal outbreaks occurring in countries where the disease has not been seen for years. The outbreaks are not only occurring in more countries – they are also larger and deadlier. In 2022 and 2023, Malawi and Mozambique experienced their worst outbreaks in decades.

Climate change is greatly increasing the vulnerability of many countries to cholera. This includes countries where cholera is endemic and cases occur seasonally, as well as those in fragile settings where the disease is not endemic. This is on top of longstanding drivers like conflict, poverty, humanitarian crises and population displacement, which have all worsened in recent years.

The provision of water and sanitation services, and good hygiene behaviours, are the only long-term solutions for ending this crisis and, ultimately, eliminating cholera for everyone, everywhere. 

Cholera therefore forms an important focus of our health work. We are working to respond to current cholera outbreaks, while also considering long-term solutions through our work with governments and other key stakeholders, including communities. These solutions include increasing access to WASH and integrating hygiene behaviour change interventions into public health emergency response. 

We are also a key partner of the Global Task Force for Cholera Control (GTFCC) on advocacy and have served as chair of the GTFCC WASH working group. Prior to this, we were official partners at the launch of the Global Roadmap to End Cholera in 2017 and helped push through a resolution on cholera at the 2018 World Health Assembly.

Our approach

We focus on health in our research, programmes, policy and advocacy, boosting our efforts to improve access to clean water, toilets and hygiene as a key health intervention. Through our activities, we influence change from the national level to individual behaviours, to ensure improvements last. For example, in Malawi, we worked with the Ministry of Health to develop an innovative training pacakge for frontline health workers' to enhance their awareness of the importance of WASH for effective infection prevention and control. 

We foster integration between sectors and government ministries, helping those working in WASH, health, education, nutrition and more to work together to make a bigger difference. We also empower communities by amplifying their voice in the design, planning and provision of WASH services.

We participate at global events, such as the World Health Assembly, United Nations General Assembly, World Bank Spring Meetings, WHO Executive Board Meetings and G7 and G20 forums, to influence governments to increase the prioritisation of WASH in international and national health policies and strategies. And we advocate for decision-makers to embed WASH in relevant areas, such as healthcare facilities. 

Only by making clean water, decent toilets and good hygiene normal for everyone, everywhere, can we prevent infectious diseases, tackle undernutrition, deliver high-quality and safe health services that keep people well, and unlock economic potential.

Latest resources and expert opinion

Top image: Jalia Nabukeer, enrolled midwife, washes her hands outside the outpatient department block before attending to patients, Wakiso District, Uganda, February 2022.

Second image: Halima visits her community clinic for a monthly check up during pregnancy. Patients can now access hygienic toilets and pure drinking water from the clinic facilities. Satkhira, Bangladesh. December 2022.

Page last updated: May 2024