WaterAid warns of antibiotic resistance as report finds one billion people go without water at health facilities

Posted by
Emily Haile
2 April 2019
Water, Health, Maternal health, Toilets
Sor Socheat, 35, Hospital Cleaner, in the delivery room at Sampov Loun Hospital, Cambodia.
Image: WaterAid/ Laura Summerton

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April 2, 2019 — 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. WaterAid responded to a new report revealing 45% of healthcare facilities in least-developed countries, and one in four globally, do not have clean 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 centers, 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 the crisis. For instance, only 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 which might have been avoided with proper hygiene practice. Healthcare-associated infections are the third major driver of antibiotic resistance globally, and 15% of patients in developing countries acquire at least one infection during a hospital stay.

In addition to the implications for disease transmission, unsafe and unhygienic conditions in health care facilities negatively impact health worker attendance, morale, retention and safety.

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 more information, please contact:

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

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