Every healthcare centre in the world’s poorest countries could have taps and toilets for just half-an-hour’s worth of COVID-19 spending

Posted by
Maya Verber
6 April 2021
WaterAid/ Dennis Lupenga

As G20 finance ministers meet this week in Rome to discuss how they will build back from the pandemic, WaterAid is urging global leaders to commit to new funding of at least $1.2 billion, to ensure all hospitals and clinics, particularly within the world’s poorest countries, have clean water, decent toilets and proper handwashing facilities.

Since the onset of Covid-19, rich countries have spent significant sums, an average of nearly 10% of their GDP [1], and a total of $20.6 trillion, on stimulus packages to help bolster their economies and to recover from the pandemic [2]. The sum needed, $1.2 billion, equates to just thirty minutes-worth of the past year’s spending. This  investment would bring these vital frontline defenses against future pandemics to all healthcare facilities in the poorest nations.

Globally,1.8 billion people are at higher risk of COVID-19 and other infectious diseases because they use or work in a healthcare facility which lacks basic water services. Providing doctors, nurses and patients with somewhere to clean their hands is one of the most effective ways to halt the spread of disease. And yet, one in four healthcare facilities has no clean water on site, one in three has no handwashing facilities at the point of care and one in ten has no decent toilets. In the world’s poorest countries, the situation is even worse – half of all hospitals and clinics there have no clean water.

An essential injection of finance by the G20 would prevent millions of avoidable deaths through infections and diseases. Not only has research shown that washing hands with soap helps reduce the spread of coronaviruses by one third [3] but it would also help curb the growth of antimicrobial resistance as antibiotics are too often used in unclean health facilities as a 'quick fix' in place of proper hygiene – Which is contributing to an increasingly alarming situation as antibiotics lose their power to fight infections.

According to the World Health Organization, investment of this nature would take just one year to pay for itself and produce savings for every dollar invested thereafter.[4]

But an ever-growing debt crisis is preventing poorer countries from being able to invest into basic water services, with some countries paying billions of dollars in international debt service each year. Zambia, for example, paid over $2 billion in 2019, a staggering 11% of its Gross National Income and have since defaulted on their payments. Pakistan paid a huge $11 billion in debt service in the same year – an amount which could pay for access to taps, toilets and handwashing facilities in hospitals across all of the least developed countries three times over. A huge 83% of people surveyed in Italy agreed that the richest countries and other private lenders should suspend debt repayments due from poorer governments.

A new global poll of over 18,000 adults across 15 countries including the UK, Brazil, Nigeria, India, Australia and the USA, [5] commissioned by WaterAid and conducted by YouGov, reveals that three quarters (75%) of those surveyed believe that debt payments of the poorest countries (including to private sector creditors) should be suspended so that countries can invest more of their scarce resources into essentials like water and soap to help fight Covid-19 and other diseases.

While debt service to governments are currently suspended, this suspension will end in June of this year as the pandemic continues.  Even the extension of this suspension which the International Monetary Fund is currently calling for, which moves to include private sector lenders, will do little more than delay payments for countries struggling with unpayable debt. True debt relief and restructuring, which the G20 can enact [6], would radically change the economic prospects of poorer nations. With the means to invest, countries can then make smart economic decisions that tackle the immediate crisis whilst also protecting against any future pandemics.

Tim Wainwright, WaterAid's Chief Executive, said:

“Spending at least £1.2 billion on water, sanitation and hygiene for healthcare centres is a no-brainer investment, both saving lives now and also protecting against future pandemics and the devastation they cause. This sum equates to just thirty minutes-worth of what has been spent over the last year on Covid response packages. Yet it could change everything for the millions who have no option but to seek care from the 50 per cent of health care facilities in the poorest countries which don’t have clean water. 

“We must find the money needed as a matter of urgency, to make sure all healthcare facilities in the poorest countries have clean water and soap before another pandemic hits. If frontline health workers can’t wash their hands; keep patients clean; or have somewhere decent to go to the toilet, a hospital is not a hospital at all - it’s a breeding ground for disease.”


[1] 9.7% according to a UNCTAD study and Statista has Japan as largest at 20.9% of its GDP.

[2] Devex counts $20.6 trillion in pandemic-related funding announced by December 2020, the vast majority is from Governments - $12.2 trillion - and Multilaterals second largest at $7.7 trillion.

[3] Beale S, Johnson A, Zambon M, null n, Hayward A, Fragaszy E. Hand: Hygiene Practices and the Risk of Human Coronavirus Infections.

[4] p3 of our UHC Day Action Plan - Taken from WHO 2020 Combatting Antimicrobial Resistance through water, sanitation and hygiene and infection prevention and control in health care

[5] Based on polling conducted by YouGov for WaterAid: 18,635 adults surveyed across 15 countries: Australia, Brazil, Canada, France, Germany, India, Italy, Japan, South Korea, Nigeria, Saudi Arabia, Sweden, South Africa, UK, USA. See our agenda for the G7 and G20 summits in 2021: Investing in water, sanitation and hygiene for global recovery and resilience.

    For more information, please contact:

    In London: Anna France-Williams, Senior Media Officer, [email protected]  or Maya Verber, Senior Media Officer, [email protected]. Or call our after-hours press line on +44 (0)7887 521 552 or email [email protected].

    In the US: Emily Haile, Senior Communications and Media Manager, [email protected]

    In Delhi: Juhi Mohan, Media and Communications Coordinator, [email protected]

    In Melbourne: Tegan Dunne, Communications Manager, [email protected] or +61 3 9001 8248

    In Ottawa: Aneesha Hampton, Communications Manager, [email protected] or +1 (613) 230-5182.

    In Stockholm: Magdalena Olsson, Communications Manager, [email protected] or +46 (0)8 677 30 33 or +46 (0)73 661 93 31, or Petter Gustafsson, Communications Officer, on [email protected] or +46 (0)8 677 30 21 or +46 (0)72 858 58 51

    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 www.wateraid.org, follow @WaterAidUK or @WaterAidPress on Twitter, or find WaterAid UK on Facebook at www.facebook.com/wateraid.

    • 785 million people in the world – one in ten – do not have clean water close to home.[1]
    • 2 billion people in the world – almost one in four – do not have a decent toilet of their own.[2]
    • 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.[3]
    • Every £1 invested in water and toilets returns an average of £4 in increased productivity.[4]
    • Just £15 can provide one person with clean water.[5]

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

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