UN sustainable development goals: improve health through clean water

WaterAid Mali’s Country Representative, Mamadou Diarafa Diallo, calls on UN negotiators to include clean water in health-care facilities within the Sustainable Development Goals.


26 Mar 2015

This week, on the heels of World Water Day, the UN’s permanent representatives are negotiating the shape of the new Sustainable Development Goals (SDGs), replacing the Millennium Development Goals (MDGs). These will provide a blueprint for development which will guide the world’s efforts to eradicate extreme poverty for the next 15 years and beyond. The outcomes of these important negotiations will ultimately affect millions of people here in my home country of Mali, and across the globe.

All countries have committed to new goals that go beyond simple aid.

Water and sanitation feature in the proposed goals – as both a dedicated goal and as indicators of progress in goals on gender and education.

But, halfway through these negotiations, a vital piece of the puzzle is still missing. Water, sanitation and hygiene are nowhere to be seen in the goal on health and wellbeing, despite targets on ending preventable child deaths and ensuring everyone has access to health-care.

Without measuring and giving incentives for progress on water, sanitation and hygiene, there can never be good health. This week the World Health Organization revealed that at least 38% of hospitals, clinics and community health centres in the developing world do not have access to safe water.

This does not mean no tap to turn on in the building. This means no clean waterpoint within 500 metres – several minutes’ walk away with full jerrycans.

For a country like Mali, which has just had a brush with Ebola, it is clear to us that basic things like washing your hands are not to be taken for granted. Many people in rural areas believe in the tradition that washing your hands washes away your protection. In the face of strongly held beliefs, difficult access to water, little money and few resources, epidemics can take hold quickly.

Aminata Dicko collecting water from the yogododji, an unsafe water source, Ourare Alaye Tem, in the commune of Mondoro, Douentza.
Unsafe water source, Mali. Photo: WaterAid/Layton Thompson

In the rural village of Diatoula, just 15km from the outer edge of Bamako, Mali's capital, a single nurse is responsible for the health of the 1,000 inhabitants. She has delivered 33 babies this year and counselled 20 women on their pregnancies; she also treats malaria and other common illnesses and refers others to a bigger centre. This year, she has seen five babies die: three stillborn after their mothers delivered at home, and two within two weeks of birth.

“To me it’s very important to have clean hands, and clean equipment. Just imagine, people come to you as a patient, and you are dirty and the place is dirty. They will not even want to come to you. We do not have enough materials here but we are trying to do our best here to provide a clean environment,” the nurse, Vinima Baya, said. “It’s a lot of challenge to be in. You want to help the community, you want to give the best of yourself, but you don’t have the means.”

There is a safe waterpoint at the other side of the village, outside the school, but the clinic itself is served only by a traditional well of murky water, prone to low levels in dry season and open to toads and other small animals that inevitably fall in. Women are expected to bring clean water for their deliveries – five trips to the school waterpoint on the other side of the village.

For Fatoumata Diarra, aged 16, this was not enough to save her tiny baby boy from what was likely a deadly infection, after he came home to her family’s dusty courtyard, home to a large extended family as well as a few cows and chickens.

“When I realised my baby was not feeling well, I tried to give him some traditional medicines. I just noticed some black spots on his legs, his body and his penis. The black spots started from the belly and went down to the legs,” she told WaterAid researchers, describing likely symptoms of sepsis. “He wouldn’t drink anything. After I noticed he wasn’t well, it took only one day before he died.”

Baby Allaman died on his 15th day, one of 500,000 newborn babies who die each year because of a lack of safe water, good sanitation and good hygiene practice.

It doesn’t have to be this way. The World Health Organization report is an effort to create a complete picture of water, sanitation and hygiene, and an important first step towards tackling this embarrassment.

But if we do not include these services in new development goals on health, we risk never being able to address this crisis in a meaningful way.

Nearly 1,400 children die each day from diarrhoeal illnesses preventable with safe water, safe toilets and handwashing with soap. The same number of newborns die each day of deadly infections which could have been prevented by being delivered into a clean environment, by hands washed with soap and safe water.

Yet there is no measure of whether heath-care facilities have these basic services included in proposals on new development goals.

Water and sanitation are included elsewherein the goal on gender (measuring how much time women must spend collecting water) and in education (measuring whether schools have drinking water and gender-separate toilets). WaterAid and its partners are calling on the wider health sector to ensure a target on universal health coverage includes measuring water, sanitation and hygiene access in health-care facilities.

We encourage women to deliver in health-care centres to protect them and their fragile newborns. We must ensure these centres are first doing no harm by providing these basic building blocks of effective health care.

Here in Mali, where the average life expectancy is just 54, one in ten children will not survive past their fifth year, in part because of high rates of diarrhoea and infection.

We owe it to them to make these negotiations count.

Mamadou Diarafa Diallo is the Country Representative for WaterAid Mali. For global policy, practice and advocacy updates and discussion, follow @wateraid on Twitter.

This blog originally appeared on The Lancet Global Health Blog.