Integrating water, sanitation and hygiene (WASH) and health for improved universal health outcomes: what governments must do to deliver quality care

4 min read
Image: WaterAid/Basile Ouedraogo

As the world accelerates progress toward quality healthcare, governments must prioritize increased access to inclusive and sustainable water, sanitation and hygiene (WASH) services in healthcare facilities.

Clean water, decent toilets and good hygiene help to control and prevent diseases and their spread. They protect health workers and patients and allow the delivery of quality health care services. Sadly, these normal things are the forgotten foundations for good health. The impact on women and children is alarming – estimates are that one in five births globally takes place in least-developed countries and, each year, 17 million women in these countries give birth in health centers with inadequate water, sanitation and hygiene.

In Nigeria – one of the four countries that BASICS initially targets – half of healthcare facilities lack clean water, 88% are without basic sanitation and 57% lack handwashing facilities with soap. In a corroborative assessment by WaterAid in 2016 in six Nigerian states (Bauchi, Benue, Ekiti, Enugu, Plateau and Jigawa), primary healthcare centers assessed in urban, semi-urban and rural areas generally had low access to piped water within the facility; more than 20% lacked toilets. In addition, our assessment found there were no structured systems for the operation and maintenance of water and sanitation facilities.

For health workers like Gloria Samuel, the lack of water makes it difficult for her to carry out her duties as a cleaner at the Bwari Town Clinic in Abuja.

“We don’t have water so we buy it from the vendor or practice rain harvesting during the rainy season,” Gloria says. “The rain-harvested water is used to clean the toilets and water bought is used for cleaning more sensitive instruments and for patients who need clean water to wash up, but we still do not know how clean the water is.

“With the water situation, I only wash the toilets once a day and that is not good enough, but if we have constant water flow, we will be happy. When we work without water, it is difficult because this is a hospital. A hospital can’t stay without water because the work will not move forward.”

Globally, an estimated 896 million people use healthcare facilities with no water service, and one in five facilities has no sanitation service, impacting 1.5 billion people.2  Diseases like Ebola, Lassa Fever and cholera spread fastest when these services are lacking. This cycle ensures improvements in health are not sustainable. Often times, the dire consequences are manifested in ill health, deaths, economic losses and a lifetime legacy of disease and poverty.

When clean water, decent toilets and good hygiene services are available, the ripple effect is transforming. Risks of infection for patients and their families, staff and surrounding communities are greatly reduced; people are kept safe from deadly diarrhoeal diseases and are better able to break free from poverty. 

In 2017, Nigeria launched a scheme to revitalize 10,000 primary healthcare centers across the country to make quality and affordable healthcare accessible to the poor and vulnerable. This commitment presented a window to integrate inclusive and sustainable WASH services into the program plans and design. However, despite this and other efforts around improving maternal and child health and nutrition, achieving the goal of Universal Health Coverage requires increased political commitment, practical policies, strong coordination and partnerships, financing and preventive interventions.

There’s need for better coordination, collaboration and integration between WASH and health actors based on the recognition that WASH underpins quality health outcomes. Furthermore, improving healthcare requires a multi-sector approach that incorporates investments in WASH alongside other sub-sectors like nutrition, maternal and child health, menstrual hygiene management and gender. WASH is an essential building block for patient safety, quality of care, for tackling undernutrition and threats like antimicrobial resistant infections, and for realising Sustainable Development Goal 3 – ensuring healthy lives and promoting well-being for all.

United Nations Secretary-General António Guterres says “Water, sanitation and hygiene services in health facilities are the most basic requirements of infection prevention and control, and of quality care. They are fundamental to respecting the dignity and human rights of every person who seeks health care and of health workers themselves.”

We couldn’t agree more! Only by making clean water, decent toilets and good hygiene available for everyone, everywhere, can we prevent diseases from spreading, transform lives and livelihoods and deliver quality health services that keep people well and unlock their potential.