The 68th World Health Assembly

Strengthening health systems to achieve universal access to water, sanitation and hygiene and ensuring quality, safe health care - a blog by Alison Macintyre, Health Advisor, WaterAid Australia.


15 Jun 2015 | AU

“It is estimated that 1,400 children die each day from diarrhoea caused by unsafe water and poor sanitation.”

“Parasitic infections, such as soil-transmitted helminths (worms), caused by a lack of sanitation and hygiene, infect around 2 billion people globally.”

“Among hospital-born babies in developing countries, health care-associated infections are responsible for up to 56% of all causes of death in the neonatal period.”

These are the statistics that the public health and water, sanitation and hygiene (WASH) communities use every day to motivate our work and inform our advocacy to improve access to health care and WASH. But what are we really asking for when we think about WASH and health? Why is it essential that the health sector embeds water, sanitation and hygiene in all relevant health priorities, programs and policies to achieve our mutual goals of universal access to WASH and universal health coverage?

To answer these questions, let’s focus on the alarming statistic above regarding preventable newborn deaths. Over the past 15 years, great progress has been made to reduce maternal mortality globally by encouraging women to deliver their babies in a health care facility with a trained birth attendant. However, what hasn’t been prioritised in this progress is ensuring quality care at the facilities. If we are encouraging women to access health care, we should also be responsible for ensuring the basic principle of quality care: first, do no harm. It is almost 200 years ago that Ignaz Semmelweis showed that handwashing dramatically reduces the chance of women dying after childbirth from infection. We should not still be advocating for this to be common practice.

Unfortunately, this is not the case, particularly when we assess WASH access in health care facilities (HCF). Despite the critical need of WASH for quality health service delivery, coverage in healthcare facilities in low and middle income settings is alarmingly poor; almost 40% do not have access to a water supply, 19% to safe sanitation and 35% do not have water and soap for handwashing. Without this basic infrastructure and hygiene practices, providing safe care is compromised and universal health coverage of quality care will not be met.

The 68th World Health Assembly (WHA) that concluded in recently in Geneva discussed several health priorities including antimicrobial resistance, maternal and newborn care, climate change, and universal health coverage. If member states are to be accountable to achieving improvements in these areas, they will require strong, resilient health systems with robust basic public health infrastructure, including WASH. However, WASH in HCF is all too often overlooked in WHA discussions and resolutions.

WaterAid is working with the World Health Organization to ensure that WASH in HCF is no longer ignored. Through hosting the first WASH and health care focused side event with the Ministers of Health from Zanzibar and Bhutan at the WHA, we stressed the need for the health sector to lead action, management and investment to improve access to WASH in HCF. This is a health, not a WASH issue. We called for WASH in health care facilities to be prioritised as a necessary input to achieving all global and national health goals, especially those linked to Universal Health Coverage (UHC). UHC aims for everyone to have access to affordable, available, accessible, acceptable and quality health care services for prevention, treatment and wellbeing. WASH in HCF is central to achieving each of these elements of UHC.  We are aiming for all countries to have national standards and policies on WASH in health care facilities and dedicated budgets to improving and maintaining these WASH services. Without this, we will not be able to achieve universal access to WASH by 2030 nor will the health sector achieve quality universal health coverage.

This blog was first published on the Sanitation and Water for All website.

Healthcare facility