One in three health centres STILL operating without soap or water two years after global promise

20 May 2021
Image: WaterAid/Wimbledon Foundation/Dennis Lupenga

Water Aid is calling for global leaders to prioritise basic hygiene for health care facilities as part of COVID-19 pandemic recovery plans. The demand comes as heads of state, international organisations and health ministers from around the world prepare to attend the Global Health Summit, followed by the World Health Assembly. These events are taking place against a backdrop of international struggles to bring the virus under control.

Two years ago, the World Health Assembly’s 194 members unanimously agreed to ensure universal access to water, sanitation, and hygiene in all hospitals and other health facilities – since then the pandemic has highlighted just how vital these basic services are in controlling infection. Dr Tedros Adhanom Ghebreyesus, WHO Director-General, has described soap and water as akin to personal protective equipment and absolutely fundamental for stopping the spread of COVID-19.

But figures[1] which will be presented to the World Health Assembly this week, show that one in four healthcare facilities globally is still without clean water on site, one in three still has nowhere for staff to wash their hands where patients are treated and one in ten still lacks decent toilets. In the world’s poorest countries, half of all hospitals and clinics have no clean water on site. This data shows that across the world almost 2 billion people depend on healthcare facilities without basic water services, putting them at greater risk of catching COVID-19 and other deadly diseases.

Last December the WHO estimated that to bring clean water, handwashing facilities and decent toilets to the health care centres in the poorest countries would cost just $3.6billion – which equates to around an hour and a half’s worth of what the whole world’s spent in a year on the Covid-19 response.

Ahead of the World Health Assembly, WaterAid have been speaking to health workers, patients and families in about the challenges of keeping themselves and patients safe without soap and water to wash your hands or somewhere decent to go to the toilet.

Dr. Chandrashekhar Prasad, Deputy Superintendent of Jai Prakash Narayan Hospital in Gaya, Bihar, in India, which is being hit hard by a surge in COVID-19 cases said:

“There is an overall lack of sanitisation across the hospital with no cleaning of wards and inadequate measures to dispose of bio-medical waste. As a result, a few sanitation workers tested positive for Covid-19 recently.

“Basic handwashing stations are missing at the vaccination and testing facilities and patients are not displaying essential Covid-19 appropriate behaviours.”

Nurse, Lalmani Devi, who also works at the hospital, added:

“There are very few functional toilets in the hospital premises. The rest are either broken or lying in a state of disrepair. The handwashing stations do not have any provision for liquid soap or sanitisers either.”

WaterAid have also been speaking to health workers across four maternity wards in Ntchisi District, Malawi – where the charity plans to work later this year. More than half of healthcare facilities in Malawi are without handwashing facilities, almost two thirds have no decent toilets and almost one fifth do not have clean water on site. For midwives and those involved in maternity care, this absence is frightening. Without water, toilets and soap, health centres, the very places which are supposed to keep mums and babies well, become breeding grounds for the rapid spread of infectious diseases. Globally, one million mothers and newborn babies die from infections soon after birth each year.

Aviss Chioko, 29, is a nursing officer working in the postnatal ward at Ntchisi District Hospital she explains the worrying challenges she has faced daily through the pandemic:

“The different instruments we use every day in our line of work are supposed to be cleaned using water through decontamination processes such as sterilisation. Having no water means we can’t do such tasks effectively. This puts our patients at risk.”

Community midwife technician Eunice Kalimbira from the same hospital says:

“We need thorough handwashing in our line of duty. With no water, we can’t wash our hands. At the moment, we use the hand sanitisers but at some point, you still need water, especially where you have to get rid of blood.’

WaterAid and the Wimbledon Foundation are working together to provide clean water, decent sanitation and good hygiene in four healthcare facilities in the Ntchisi District, bringing a clean, safe and hygienic environment to over 300,000 people – but there are millions more people being put at risk every day, who go to work or seek care without these fundamental services.

Research[2] has shown that money spent on water, sanitation and hygiene within healthcare is a ‘best buy’ for any country, producing a fifty per cent return on investment. It helps to:

  • slow the spread of antimicrobial resistance - so-called Superbugs;
  • prevent the spread of hospital infections;
  • and reduce maternal and newborn deaths.

Helen Hamilton, senior policy analyst, WaterAid, said:

“Globally, a staggering 1.8 billion people are at greater risk of contracting COVID-19 and other diseases, simply because they use or work in a healthcare facility which lacks basic water services. In the twenty first century this simply shouldn’t be and needn’t be the case.

“Two years ago, at the World Health Assembly, global leaders resolved to prioritise water, sanitation and hygiene in all healthcare facilities. Now is the time for them to make good on those promises.

“It would take just 30 US cents a year to make sure every health centre and hospital in the poorest countries had a reliable water supply, working toilets and good hygiene – a measure which could save the lives of one million new mothers and babies from dying of infection every year.”



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Notes to Editors:

WaterAid is working to make clean water, decent toilets and good hygiene normal for everyone, everywhere within a generation. The international not-for-profit organisation works in 28 countries to change the lives of the poorest and most marginalised people. Since 1981, WaterAid has reached 27 million people with clean water and 27 million people with decent toilets. For more information, visit, follow @WaterAidUK or @WaterAidPress on Twitter, or find WaterAid UK on Facebook at

  • 785 million people in the world – one in ten – do not have clean water close to home.[3]
  • 2 billion people in the world – almost one in four – do not have a decent toilet of their own.[4]
  • Around 310,000 children under five die every year from diarrhoeal diseases caused by poor water and sanitation. That's around 800 children a day, or one child every two minutes.[5]
  • Every £1 invested in water and toilets returns an average of £4 in increased productivity.[6]
  • Just £15 can provide one person with clean water.[7]

[1] From WHO and UNICEF

[5] Prüss-Ustün et al. (2014) and The Institute for Health Metrics and Evaluation (2018)

[6] World Health Organization (2012) Global costs and benefits of drinking-water supply and sanitation interventions to reach the MDG target and universal coverage