‘Prevention first’ to avert global superbug crisis: WaterAid prescribes water, sanitation and hygiene in healthcare

on
23 May 2019
P. Kaveri, mother of a jaundiced newborn. Area Hospital Banswada, Nizamabad
WaterAid/Ronny Sen

Antimicrobial resistance (AMR), or ‘superbugs’, is a global health emergency. Sepsis, diarrhoea, pneumonia and cholera can spread rapidly in hospitals and clinics which are unclean, and yet this is preventable. Clean water, decent sanitation and good hygiene facilities are urgently needed in health care centers globally. Many health workers who cannot rely on the availability of soap and clean water are over-prescribing antibiotics as a prophylactic measure, contributing to the rising threat of resistance. The frontline defence – good hygiene, clean water, decent toilets – is key.

The race to prevent what the UK Government terms the ‘catastrophic threat’ of antimicrobial resistance, expected to kill up to 10 million people a year globally by 2050, is being hampered by the lack of access to clean water, hygiene and good sanitation in developing nations. WaterAid is urging the world’s health ministers to back the proposed resolution for water, sanitation and hygiene in healthcare facilities as they meet in Geneva for the annual World Health Assembly, 20-28 May.

Currently 844 million people globally lack access to clean water and 2.3 billion are without safe, private toilets. In the poorest countries almost half (45%) of health care facilities do not have clean water on site, globally one in five healthcare facilities (21%) do not provide decent toilets and one in six health care facilities have no handwashing facilities at all. The World Health Organisation (WHO) and UNICEF estimate that more than 1.5 billion people globally have no decent toilets at their local healthcare facility.

Progress on access to clean water, sanitation and hygiene in low- and middle-income countries is perilously slow, despite an international target to reach everyone, everywhere with access to clean drinking water and toilets by 2030.

Global successes in improving maternal and newborn health are among those most threatened by the growing threat of antimicrobial resistance. More and more women in these countries are giving birth in health facilities, but a large proportion of them still lack water, sanitation and hygiene facilities - basic necessities for safe care.

WaterAid has an international team of nine policy and programme staff attending the conference, headed by Alison Macintyre, WaterAid Australia's Technical Lead in Health.

Helen Hamilton, WaterAid’s Senior Policy Analyst on Health & Hygiene said:

“Where clinics and hospitals have filthy toilets, little or no clean water, and low levels of hygiene, it creates an ominous environment where drug-resistant diseases can thrive. As more and more women are giving birth in a healthcare centre, generally assumed to be safer than home-births, this is leading up to a far from perfect storm. Without good hygiene and infection-prevention control measures, the growing threat of antimicrobial resistance means that mums and their newborns are particularly vulnerable to infection, needlessly dying of diseases such as sepsis acquired at birth. This can be tackled if the political will is there.

“‘First do no harm’ is a founding principle of health care. We all know that prevention is better than cure, and yet the level of political will to improve water, sanitation and hygiene in healthcare centres does not measure up to the urgency of the need. Health ministers around the world need to take action to escalate the critical role that water, sanitation and hygiene play in preventing infection and curbing AMR. This life-saving trio are fundamental to good quality safe healthcare - they are not an add-on to health; they are the heroes.

“Countries such as Zambia and Tanzania are championing this World Health Assembly resolution, driven by national crises such as the cholera epidemic, but this is a worldwide threat to life. We’re globally inter-connected and health threats such as the antimicrobial resistance emergency do not respect national borders, but threaten us all. World health leaders must prioritise universal access to water, sanitation and hygiene services in the decisions they make in Geneva to embed and crucially to sustain progress.”

WaterAid’s top priority will be to persuade health ministers to agree a proposed World Health Assembly resolution on water, sanitation and hygiene in healthcare facilities. It is estimated by WHO and UNICEF that 45% of healthcare facilities in least developed countries do not have a basic water service, and 1.5 billion people had no sanitation service at their local healthcare facility. Without these essentials, good health care is impossible and the aspiration of achieving Universal Health Coverage or ‘health for all’ will remain a distant dream. A resolution on this issue would be a public, specific commitment by government health ministers globally to take action to address this, laying the foundations for a step-change in investment and action.

The scale of the AMR crisis:

  • According to the World Bank drug-resistant infections could cause global economic damage on par with the 2008 financial crisis
  • By 2050, the death toll could be one person every three seconds if AMR is not tackled now.
  • The World Health Organization estimates 490,000 people develop multi-drug resistant TB globally each year, and drug resistance is starting to complicate the fight against HIV and malaria.
  • Diarrhoea, pneumonia and cholera are often preventable through basic improvements in water, sanitation and hygiene (WASH); these infections are commonly treated with antibiotics and are increasingly resistant to available drugs.
  • Around 289,000 children die each year from diarrhoeal diseases caused by dirty water and poor sanitation. That’s almost 800 children each day, or one child every two minutes.
  • An estimated 494 million cases of diarrhoea are treated annually with antibiotics in India, Nigeria, Indonesia and Brazil
  • Antibiotic use to prevent diarrhoea could be cut by 60% in India, Nigeria, Indonesia and Brazil by improving people’s access to water and sanitation
  • According to a recent Lancet paper, hospital-acquired infections are the third-biggest contributor to AMR globally