Investing $600 million in water and toilets in health facilities could help stave off the next pandemic and save millions of lives

19 April 2022

Providing clean water and toilets in every health facility in the poorest countries in the world would cost the equivalent of just under 1.5 hours of this weekend's Easter spending in the US and UK, according to new analysis by WaterAid released today.

Ahead of a meeting of finance ministers from the world's richest economies today in Washington, WaterAid is calling on donor governments to invest US$600 million a year, which would contribute to saving millions of lives and be an important defence against the next pandemic, the charity said.

WaterAid’s analysis builds on research recently published in the Lancet, by focusing on the lack of water, sanitation and hygiene in healthcare facilities in the 46 least developed countries, where the need for safe water and sanitation is highest, and the financing gap is largest.

The charity said that investment in clinics and hospitals in these countries is more urgent than ever, with pandemics and anti-microbial resistance becoming an increasing health threat. Currently only half of healthcare facilities in the least developed countries have water on site. Additionally, the poorest countries are struggling to respond due to rising living costs, the economic impacts of COVID-19 and a debt crisis engulfing the global south which limits fiscal space to invest in essential services.

Claire Seaward, Global Campaigns Director, WaterAid, said:

A perfect storm of COVID-19, rising living costs and the spiralling debt crisis mean that already stretched health services across the globe are being pushed to breaking point."

“As a result, patients may not get the care they need – or worse, find the clinics and hospitals they go to for treatment or to give birth in are breeding grounds for disease. In low-income and middle-income countries, more deaths occur due to poor quality care than from lack of access to care."

“Investing in water, toilets and hand hygiene save lives, eases pressure on health services and protects patients and staff."

“For just 2.6% of the consumer money the UK and US will have spent over this Easter weekend, donor governments could save millions of lives and break the devastating cycle of debt, so that poorer countries are able to provide for their own people.”

Dr Maria Neira, Director of the Department of Environment, Climate Change and Health of WHO in Geneva, said:

“Our price tag analysis shows it would take just 0.60 USD per capita per year to provide universal basic WASH and waste services in healthcare facilities in the 46 least developed countries. This is a modest cost compared to current government spending and donor investments in health and WASH, and it’s very do-able. The economic and social benefits of such fundamental investments are enormous, from mother and newborn lives saved, antibiotic use averted to health worker retention.”

WaterAid’s analysis reveals that 75% of global funding for water and sanitation is now in the form of loans when the “gold standard”, set by the Development Assistance Committee, is that loans should comprise no more than 10% of development financing.

With external debt in low and lower-middle income countries almost doubling from $1.4 trillion in 2011 to $2.6 trillion in 2020, countries face a deepening cycle of debt and reliance on external financing. Many countries are now paying more in debt than on health annually with 60% of low-income countries now officially in debt distress or at high risk of it.

WaterAid is calling on the world’s richest countries, including the G7 who will meet in Germany in June, to deliver on the US$600 million annual funding gap in order to provide lifesaving water, sanitation and hygiene facilities to healthcare centres in some of the poorest countries by 2030.

In order to achieve this, the leading economies must meet their international aid commitments, and ensure that responding to the crisis in Ukraine doesn't come at the expense of millions of lives elsewhere.


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Notes to Editors:

Research published on 7 April 2022 in the Lancet found that between US$6.5 billion to US$9.6 billion is needed from 2021 to 2030 to achieve  water and sanitation provision in every public health facility in the world’s poorest countries. WaterAid's analysis assesses how much of these costs can realistically be met from the least developed countries domestic resources. The financing gap identified once this is taken into account is around US$600 million a year.

The World Health Assembly resolution 72.7, unanimously agreed in 2019 by international, regional and local partners, committed "to help fill the gap in resource-limited countries by implementing efforts to provide WASH in health facilities".

Table 1: Share of health and WASH funded by top 20 donors funding these sectors


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 28 million people with clean water and nearly 29 million people with decent toilets.

For more information, visit our website, follow us on Twitter (@WaterAidUK, @WaterAid or @WaterAidPress), or find us on Facebook, LinkedIn or Instagram.

  • 771 million people in the world – one in ten – do not have clean water close to home.[1]
  • 1.7 billion people in the world – more than one in five – do not have a decent toilet of their own.[2]
  • Around 290,000 children under five die every year from diarrhoeal diseases caused by poor water and sanitation. That's more than 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]

[1] WHO/UNICEF Joint Monitoring Programme (JMP) Progress on drinking water, sanitation and hygiene: 2017 update and SDG Baselines

[2] WHO/UNICEF Joint Monitoring Programme (JMP) Progress on drinking water, sanitation and hygiene: 2017 update and SDG Baselines

[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