Nearly one billion globally without water at their health facilities, report finds

1 April 2019
Image: WaterAid/Eliza Powell

Antibiotic resistance stands to worsen as long as nearly half of healthcare facilities in the developing world are without a basic level of water service, WaterAid said today, in response to a new report revealing 45% of healthcare facilities in least-developed countries, and one in four globally, do not have a clean source of water on site.

New data released today by the Unicef-WHO Joint Monitoring Programme, looking at water, sanitation, hygiene, waste disposal and cleaning at the world’s health centres, also reveals:

  • 896 million people globally have no water service at all at their health care facility. 
  • One in five health care facilities globally (21%) had no sanitation service at all. In sub-Saharan Africa, only one in four health care facilities (23%) had decent toilets.
  • More than 1.5 billion people globally have no toilets at all at their local health care facility.
  • In regions where data was available, it shows that hygiene services – including the ability to wash hands with soap -- in health care facilities are often lacking. For example, in Eastern and South-Eastern Asia just one in three health care facilities (36%) had facilities to allow for handwashing with soap.
  • Globally, one in six health care facilities have no handwashing facilities at all.
  • Also of concern are the number of health facilities without good waste management and general cleaning, which can contribute to the spread of infection. Only one in four (27%) health care facilities in least developed countries had the ability to safely dispose of medical waste, and only four countries had data on how health facilities are cleaned.

While the report is a step forward in monitoring progress, few countries have data on the most basic facets of healthcare, making it hard for governments to effectively address this crisis. For instance, just 18 countries had sufficient data to estimate coverage of decent toilets in healthcare facilities. 

Among countries with available data, Comoros, Liberia, the Democratic Republic of Congo, Chad and Niger had the highest percentage of health facilities without any access to water. 

Infections spread quickly in facilities without access to water, decent sanitation, hygiene and proper waste management procedures, with devastating results: Globally, 225,000 babies die of sepsis in their first four weeks of life, most of those in sub-Saharan Africa and South Asia. Many of these deaths might have been prevented had they been born into a clean environment, where birthing attendants were able to wash hands properly with soap and water.

Rising rates of so-called superbugs have also been directly attributed to poor sanitary conditions in healthcare facilities, leading to the overuse and misuse of antibiotics to prevent and treat infections that might have been avoided with proper hygiene practice. A recent British Medical Journal article found almost 16 babies in every 1,000 born in South Asia develop sepsis, and one-third of these babies will die.

Helen Hamilton, WaterAid senior policy analyst on health and hygiene, said: 

“This data reveals the often-deplorable conditions in which health professionals around the world are trying to deliver good care, and which patients must endure when they seek medical help. The battle to save lives, and to slow the rise of deadly superbugs which threaten us all, cannot be won as long as these dedicated frontline staff are denied what we consider the fundamentals of health care: a reliable source of clean water on site, decent toilets, rigorous hygiene procedures, proper disposal of waste and careful cleaning. 

“WaterAid is working in sub-Saharan Africa and South Asia to ensure all healthcare facilities have access to clean water, decent sanitation and good hygiene. As the World Health Assembly prepares to discuss this issue next month, we call upon leaders to make this a global priority and to dedicate the political prioritisation and financing to ensure every healthcare facility everywhere has access to these essentials to good care.”

WaterAid West Africa Regional Director Mariame Dem said:

“This data reveals that some of the lowest rates of access to water and sanitation in healthcare facilities are in West Africa: for instance, 50% of health facilities in Liberia, 39% in Niger, 36% in Nigeria and 26% in Sierra Leone do not have a clean source of water on site. This is all the more shocking given Nigeria’s status as the largest economy on the continent, and the rebuilding of health systems in Liberia and Sierra Leone following the Ebola crisis, which spread fast in the absence of clean water, good sanitation and good hygiene.

“In our interconnected world, a health crisis that threatens one community now may threaten us all. We call upon leaders to address this situation and make water, sanitation and hygiene a top priority in ensuring health care for all.”


For photos from West Africa see:

For photos from East Africa see:

For photos from Southern Africa see:

For photos from South Asia see:

For more information or interviews, please contact: 

Carolynne Wheeler, news manager, [email protected] or +44 (0)207 793 4485, or Fiona Callister, global head of media, [email protected] or +44 (0)207 793 5022. 

Or call our after-hours press line on +44 (0)7887 521 552 or email [email protected]

Notes to Editors:


WaterAid’s vision is of a world where everyone has access to clean water and sanitation. 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 26.4 million people with clean water and 26.3 million people with decent toilets. For more information, visit, follow @WaterAidUK or @WaterAidPress on Twitter, or visit us on Facebook at

  • 844 million people in the world – one in nine – do not have clean water close to home.[1]

  • 2.3 billion people in the world – almost one in three – do not have a decent toilet of their own.[2]

  • Around 289,000 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]

  • To find out if countries are keeping their promises on water and sanitation, see the online database


[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


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