I’m delighted to celebrate the first ever Universal Health Coverage Day. WaterAid is joining several hundred organisations worldwide to raise awareness of the critical importance that universal health coverage can make to people’s lives. Sadly, the vast majority of countries in which WaterAId works do not have universal health coverage systems. To give just one example, a recent study by the London School of Hygiene and Tropical Medicine investigated access to water and sanitation in healthcare facilities in Tanzania. These basic human rights are incredibly important to the safety and wellbeing of mothers, children and healthcare staff, but the study showed that only 44% of births at healthcare facilities and only 24% of delivery rooms were ‘water-safe’ and ‘sanitation-safe’1. Despite the funding that goes into healthcare each year, we are trying to fight infection and disease with one arm tied behind our backs if quality is not a primary concern. As long as health coverage in so many developing countries is defined narrowly as the delivery of direct medical interventions, we will fail to achieve a transformative change in public health. An emerging consensus A nurse attends to a woman at Kaeweken Health Clinic in Liberia. The clinic has no hand pump so water has to be fetched from the main building nearby. Credit: Aubrey Wade/WaterAid/Panos So, why now for Universal Health Coverage Day? With less than a year until all UN member states are expected to agree the Sustainable Development Goals (SDGs), we are presented with an opportunity to do things differently. In recent years, there has been a clear and emerging consensus that universal health coverage should be a key part of the framework, and importantly this has been recommended by member states in the preliminary draft of the Open Working Group report. As a water, sanitation and hygiene (WASH) advocate, I see universal health coverage as a critical step forward in fighting diarrhoeal diseases. Predominantly attributed to living with inadequate access to basic water, satiation and hygiene, diarrhoea claims the lives of 1,400 children every day in developing countries. Yet, in high income countries, for example the UK, it is usually nothing more than a mild inconvenience. One of the key differences is that the scourge of diarrhoeal illness has been dealt with as a public health intervention which involved cohesive measures ranging from improving hygiene in health centres to delivering piped water. Treating the public’s health as a comprehensive, multi-sector responsibility (with direction by the health ministry) is vital to reducing the disease burden. While we don’t know the final shape of the post-2015 framework, it seems likely that universal health coverage will play a key part in it. For member states signing up to the declaration, this offers a golden opportunity to put comprehensive and quality health services at the core of their country’s development. Starting with health services and moving beyond Universal health coverage has been defined as ensuring that all people have access to health information and services (promotive, preventive, curative and rehabilitative) of sufficient quality to cover the variety of their needs. And at the same time that they do not suffer financial hardship by paying for these services. If countries are to meet this definition, they can start with ensuring that healthcare services are of sufficient quality and affordable, but they must not stop here. Returning to the earlier example of the study in Tanzania, the researchers found that 43% of births in Tanzania take place at home. Of these, only 1.5% of home births take place in water-safe and sanitation-safe conditions. Improving healthcare facilities to ensure they have basic WASH access will have a catalytic impact in demonstrating the importance of water and sanitation as determinants of health. Yet, we must go much further in extending coverage of public health if we’re going to make a difference to the health of those mothers (and their children) who will be giving birth at home. This means working with other sectors, including water and sanitation (as well as education and nutrition to name just two), so that interventions with an impact on public health are joined up and coherent. This can range from ensuring that vaccination programmes are linked with handwashing and hygiene promotion to using WASH access data to prepare for outbreaks of waterborne diseases like Cholera. Working together: reaching everyone The main health problems seen by staff Kaeweken Health Clinic in Liberia are TB, malaria, diarrhoea and pregnancy-related. Credit: Aubrey Wade/WaterAid/Panos We talk a lot about the importance of reaching everyone, everywhere at WaterAid. Our aspiration is that by 2030, we will see a world with universal access to basic water, sanitation and hygiene services. In the post-2015 process, this is often referred to as ensuring no one is left behind. Delivered fully, universal health coverage offers an opportunity to achieve this. The experience and capability of health ministries in changing behaviours will be vital to challenging entrenched habits such as open defecation, which is practised by more than a billion people. But, we need to ensure that universal health coverage is delivered in a truly universal fashion and doesn’t neglect the poorest and most marginalised people. The importance of universal health coverage in improving water and sanitation services cannot be understated. If we are to achieve scale in access to water, sanitation and hygiene, it is imperative that WASH is recognised not just as an issue of public infrastructure but as a key determinant of human health. This is why we are calling for the post-2015 framework to embrace interlinkages between WASH and health. Specifically, we believe that any targets on maternal and child health, universal health coverage, and sexual and reproductive health should include indicators on access to water, sanitation and hygiene. You can read more about this here and here. With fewer than 300 days until the SDGs are expected to be agreed, it is more urgent than ever that WASH advocates make the case for universal health coverage to include environmental determinants such as water, sanitation and hygiene. If this is achieved, I believe that on future Universal Health Coverage Days we’ll have a lot more to celebrate. Apollos Nwafor is WaterAid's Regional Advocacy Manager for West Africa. For global policy, practice and advocacy updates and discussion, follow @wateraid on Twitter. 1Benova L, Cumming O, Gordon BA, Magoma M and Campbell OMR (2014) Where there is no toilet: water and sanitation environments of domestic and facility births in Tanzania PLoS One, published online 5 Sept 2014 DOI: 10.1371/journal.pone.0106738.