Strong health systems don’t exist without water, sanitation and hygiene: lessons from COVID19

1 April 2020
handwashing with soap

As of 31st March, the World Health Organisation (WHO) have said there are around 719,000 reported confirmed cases of corona virus (COVID19) and 33,000 deaths in 203 countries. Declared a pandemic by the WHO on 11th March, the infections have spread at a rapid pace, and created an unprecedented situation around the world – with many countries implementing full lockdown measures as a way to slow down the spread of the virus, which is currently overwhelming healthcare services. While the pandemic has hit Europe the hardest, there are fears that African countries could see a similar outbreak, which could have devastating impacts on people’s health, education and livelihoods.

The ability to protect ourselves from the virus falls into our own hands – literally, this is because COVID-19 can spread between people through contact with droplets of an infected person.

Among the key measures for preventing the spread of COVID-19 is through good hygiene behaviours. At the forefront of this is hand-hygiene, which entails hand washing with soap for at least 20 seconds – this is one of the main ways to protect yourself from contracting the infection. Handwashing with soap is simple but effective. This is because it inactivates and removes virus particles that may be on our hands. When used properly, soap effectively dissolve the fatty membrane that surrounds the virus particles, causing them to fall apart and be inactivated. Research shows that handwashing with soap has been linked to: 16-23% reduction in acute respiratory infection, substantial reductions in neonatal infections, and a 50% reduction in pneumonia (source: The Lancet).

Jenipher Lewis Gotora, 25, midwife at Kashishi Health Centre, after demonstrating to Eunice Bundala, 24, how to use the new handwashing facility nearby the maternity ward, Kashishi Health Centre, Geita District, Tanzania, June 2018.
WaterAid/ James Kiyimba
Jenipher Lewis Gotora, 25, midwife at Kashishi Health Centre, after demonstrating to Eunice Bundala, 24, how to use the new handwashing facility nearby the maternity ward, Kashishi Health Centre, Geit

While WHO has called on people and governments worldwide to emphasize hand-hygiene and environmental cleanliness as the most effective way to prevent the infection and spread of COVID-19, this advice is difficult for those countries which lack access to clean water, decent toilets and good hygiene. Statistics from the WHO/Joint Monitoring Programme (JMP) show that globally one in 10 people do not have access to clean water close to home, and around 1.4 billion people have no handwashing facility at all.

Water, soap, and supplies to prevent and control the spread of infection are quintessential for frontline health workers to be able to perform their jobs effectively –one in six healthcare facilites globally do not have soap and water available for patients, doctors and nurses to wash their hands. Research has shown that over 30% of healthcare facilities in Tanzania do not have access to clean water, making hand-hygiene a challenge, particularly for healthcare workers (source: Tanzania Service Provision Assessment).

Additionally, while European countries are implementing lockdown measures and ‘social distancing’, which require people to stay home, many communites in low-income countries are reliant on day-to-day income and therefore do not have the option of remaining home. In this instance, investing in water, sanitation and hygiene will be the effective strategy of supporting communities to practice good hygiene behaviours and hence prevent them getting the COVID-19.

The outbreak of the coronavirus and other contagions underscore the practical need for Tanzania to invest in water, sanitation and hygiene in our communites, schools, public utilities (markets, bus stations)  and healthcare facilities. By ensuring that communities are facilitated  to practice good hygiene behaviours, it will dramatically reduce the risk of people contracting infections, and reduce the strain on the already stretched healthcare system. In 2017, the Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) launched the National Guidelines for Water, Sanitation and Hygiene in Healthcare Facilities, and the Ministry of Education, Science and Technology launched the Water, Sanitation and Hygiene in Schools guidelines. We must support Government to ensure these guidelines are resourced and rolled out, which will allow us to create more resilience to the health and education systems in the country, and put us in a better position to deal with future disease outbreaks.

WaterAid Tanzania and our partners will continue to support the Government to invest in nationwide hygiene promotion to help equip citizens with the hand-hygiene knowledge and tools to protect themselves and their communties. WaterAid will also increase our investment to scale-up the provision of water, sanitation and hygiene services, improving access to handwashing facilities at key locations, using mass media to share important handwashing and hygiene messages, and supporting healthcare and frontline workers on Infection Prevention and Control training.

Access to water, sanitation and hygiene ensures a safe and clean environment at the healthcare facility.

In the long-term, we must invest more into accelerating  access to water, sanitation and hygiene, in order to reach the goals of Tanzania's Development Vision 2025 and Sustainable Development Goal 6 – universal access to water and sanitation. This means embedding water, sanitation and hygiene interventions into key national development sectors - putting it firmly at the centre of national development. We must take the lessons from COVID-19 to create a stronger and more effective health systems.

This is a time where we can all take action – individuals to practice good hygiene behaviours to protect themselves and others from getting the corona virus, donors who can invest in water, sanitation and hygiene, as a core priority of global health security, NGOs and development partners who can support the Government in their efforts to strengthen hygiene behaviour change programmes and water, sanitation and hygiene interventions, and media to support getting the correct information to the public.

Lastly, we are all indebted to our healthcare workers across Tanzania and across the globe, who are putting themselves at risk to save the lives of others. The best way in which we can support them is to ensure that they are working in a safe environment, and for that let us push to ensure all healthcare facilities have clean water, decent toilets and good hygiene.