Counting the cost of healthcare-acquired infections in sub-Saharan Africa

The lack of basic water and hygiene services in healthcare facilities increases the risk of infections, leads to poor quality care and, as our new research shows, has severe economic consequences for low and middle-income countries.

Around the world, one in five healthcare facilities don't have a basic water service and 3.85 billion people use a facility without basic hygiene. Healthcare facilities without adequate water, sanitation and hygiene (WASH) leave patients and staff vulnerable to healthcare-acquired infections (HAIs) such as sepsis and pneumonia. Our new research explores the rates of these infections in seven sub-Saharan African countries: Ethiopia, Ghana, Malawi, Mali, Nigeria, Uganda and Zambia.

In 2022, more than 2.6 billion cases of HAIs were reported in the seven countries studied. In the same year, more than 275,000 people died as a result of an infection they picked up in hospital.

Calculated using an estimate of lost wages and productivity due to infections, lives lost, and the medical costs of treating HAIs, the data shows that these infections cost the seven countries between 0.4% and 2.9% of their annual gross domestic product (GDP). This places a significant toll on their economies, and holds back development and people's health and wellbeing.

The research also looks at the costs to national healthcare systems and reveals that between 2.5% and 10.9% of the countries' healthcare budgets are spent on treating these infections.

HAIs are transmitted due to a lack of cleanliness and hygiene measures during medical care and patient recovery. The most common HAIs are surgical site infections, bloodstream infections, and respiratory tract infections including pneumonia. The highest rates are found in intensive care units, and neonatal or paediatric medical wards. These infections affect people when they are at their most vulnerable – during surgery; during pregnancy, labour and delivery; and, for newborns, in the first moments of their lives. HAIs cause illness, prolonged hospital stays, excess medical costs and can result in disability or death.

A growing proportion of these infections are resistant to anti-microbial drugs, which means they are are costlier to treat and take longer to recover from, leading to worse health outcomes for patients. Antimicrobial resistance (AMR) rates vary across drugs and settings in sub-Saharan Africa, but current estimates suggest that the majority of HAIs are resistant to first-line drugs. This means that the high rate of HAIs in these countries is a pressing issue for the world.

Basic WASH services, waste management and environmental cleaning can prevent at least half of healthcare-acquired infections and is an affordable solution to support economies, make health systems more resilient, and free up healthcare budgets to address other important health issues.

The cost of providing these services is estimated at $1 per capita, so it is highly likely that this spending will be more than covered by savings in medical costs alone.

WASH in healthcare facilities is the first line of defence against infections, and an affordable way for countries to cut down their healthcare expenditure and prevent avoidable deaths. It is also a non-negotiable in protecting people from another pandemic – antibiotic resistance.

We call on:

• Governments and institutions to increase targeted financing for WASH in healthcare facilities, and to champion the case for these life-saving investments.
• Low- and middle-income country governments to prioritise WASH in healthcare facilities when partnering with overseas development finance providers, and by allocating dedicated budgets and mobilising funding.
• Health ministers and their governments to put WASH in healthcare facilities at the centre of global policy and financing commitments on AMR and pandemic prevention.

Top image: Joyce Loti, 45, a hospital attendant, mops the corridors of Ntchisi District Hospital, Malawi. June 2023.