Half of developing world health clinics without piped water

WaterAid has called for urgent action to ensure all health centres around the world have access to clean water, decent sanitation, and good hygiene, in response to a new study that reveals only half of healthcare facilities in low- and middle-income countries have access to piped water.

The study – by Ryan Cronk and Jamie Bartram at the Water Institute of the University of North Carolina, published in the International Journal of Hygiene and Environmental Health - examines the environmental conditions in nearly 130,000 healthcare facilities across 78 low- and middle-income countries, offering the most comprehensive analysis to date of inequalities in the provision of adequate healthcare.

According to the findings, half (50%) of healthcare facilities surveyed lack access to piped water while a third (33%) are without access to improved toilets, and even more (39%) do not have facilities for washing hands with soap. A sampling of six countries showed only 2% of facilities are able to provide a combination of piped water, improved toilets, decent handwashing facilities and adequate waste management services.

WaterAid warns that without these basic facilities - the cornerstones of quality and safe healthcare – patients and health workers are at greater risk of infection, disease and even death, with new mums and their babies at particular risk. Every minute, a newborn dies from infections caused by a lack of safe water and an unclean environment, despite the links between poor hygiene practices, dirty water and infant mortality being in the public consciousness for over 150 years.

In Tanzania, for instance, only 32% of healthcare facilities have access to the most basic level of water access, only seven percent have piped to sewer sanitation services and over a third (34%) lack handwashing facilities.

In Geita, a remote region in northern Tanzania, water and sanitation access is the worst in the country. Working in a clinic here can mean a two-kilometre walk to a dirty riverbed to collect water for cleaning and sterilising equipment, or paying the equivalent of a half-day’s wages to purchase water of poor quality from a street vendor.

For 39-year-old, Salome, giving birth in such dire conditions resulted in tragedy when her baby girl, Margaret, died from a suspected infection. She was just three days old.

WaterAid is working in the community to improve these conditions.

Salome explains:

“The baby started to have a very high fever. So we went to get grippe water and paracetamol syrup, but it didn't work. The fever continued to be very high. The next day we brought the baby back to the health centre. They took a blood and urine sample but could find nothing wrong.

“The midwife that delivered, the doctor and lab technician came to discuss what to do because the fever would not come down. He was given glucose syrup and I was given a prescription. My husband took it to town to get it and I went to the houses nearby to wait. But before my husband got back with the medicine, the baby died. The baby was so hot it took three hours to cool down after it died.”

This research brings into sharp focus the terrible inequalities experienced by healthcare professionals and their patients in hospitals and health centres in some of the world’s poorest communities. There is a very real human cost to these inequalities. The World Health Organization estimates that every minute a newborn in the developing world dies from infections related to a lack of clean water and an unclean environment.

This is simply unacceptable. Through Global Goal 6, the international community promised to ensure everyone, everywhere has access to safe water and sanitation and through Goal 3 promised Universal Health Coverage – both by 2030. The two are intrinsically linked; we cannot deliver health coverage to all with hospitals that do not have water, sanitation and hygiene. With Goal 6 – the commitment to ensure water and sanitation access for all – due for review in just six months, the pressure is on for world leaders to demonstrate how they are going to meet this promise to the world’s poor.