When a community gets clean water for the first time, it creates a powerful ripple effect, saving lives and improving people’s health, education and livelihoods. Water is just the beginning.

Nearly half of healthcare facilities in low-income countries have no clean water and a third have no access to handwashing. Without these essentials, sick patients, newborns, new moms and frontline staff are at great risk of infection and disease.

Jacob, a healthcare provider in Tanzania (please scroll down to read his story ), couldn’t wash his hands between patients. He told WaterAid: “The working conditions were so bad, I felt like resigning.”

This issue of The Ripple Effect highlights the importance of water, sanitation and hygiene in healthcare. We know that the entire health sector must function properly to make changes sustainable. That’s why we take a holistic approach, working with governments, frontline health workers and communities to drive progress at every level.

Thanks to your generous support, WaterAid has been working in healthcare centers for 40 years. We bring clean water to frontline staff so they can treat patients safely and ensure communities the most basic tenets of care. We teach the importance of proper hygiene and sanitation and empower health workers to educate their patients. Then, we support regional and national governments to use our work as a blueprint and scale progress nationwide.

WaterAid has launched an ambitious ten-year plan that brings a significant shift in our approach to achieving access to clean water, decent toilets and good hygiene for everyone, everywhere. We will work in concentrated geographic areas to bring change to scale, which will help us to impact wider changes at the national level.

We won’t stop until every physician and midwife can turn on a tap to wash their hands. Until every janitor has water and soap to clean. Until new mothers can bathe with dignity, no matter where they live. Until everyone, everywhere has the same access to water when seeking care.

Together, we can make that happen.

With gratitude,

Kelly Parsons, CEO

WaterAid America

Our new strategy will help us reach 400 million more people over the coming decade.

Clean water:

The heart of healthcare

Mary, nurse and midwife, holding a newborn baby at Mangamba Health Centre in Malawi,
Image: WaterAid/ Dennis Lupenga
Image: WaterAid/ Carielle Doe


Nearly half of all health facilities in low-income countries do not have running water.

A broken, dirty, unused sink, at a health centre in Malawi.
Image: WaterAid/ Dennis Lupenga

60 seconds

Every minute a newborn dies from an infection caused by lack of clean water.

Dirty water is used to wash medical equipment at a health centre in Mozambique
Image: WaterAid/ Sam James


Handwashing with soap can cut the rate of diarrheal illness in half and respiratory illness by 25%

Handwashing with soap can cut the rate of diarrheal illness in half and respiratory illness by 25 percent
Image: WaterAid/ Ernest Randriarimalala

Tanzania: A Story of Life

Nyaganga, a nurse and midwife, showing a mom how to keep her newborn baby comfortable in Tanzania
Image: WaterAid/ James Kiyimba

In the district of Geita, northwestern Tanzania, some healthcare facilities that don’t have water ask pregnant women to bring it with them when they give birth. If the nearest water source to the hospital is unsafe, or patients are unable to bring water with them, they must buy it from commercial vendors at inflated prices. The water is sold in 20 liter buckets and can cost up to 500 Tanzanian shillings (US $0.22) each – a cost which many can’t afford.

Kalunde Rashid gave birth to her second child at Chikobe Health Center in Tanzania. “Mum is here taking care of me. She is old and could not go to collect water down the valley, so we had to buy two buckets,” says Kalunde.During delivery, Kalunde bled so much that all the water was used for cleaning the delivery room. There was no water left for bathing.

In training, nurses and midwives are told that the minimum amount of water they should use during childbirth is 100 liters. At Chikobe Health Center, because of acute water shortages, staff can only use 40 liters.

“Bacterial infections and sepsis are common in babies and mothers,” says Dolgan Joseph, a nurse who has worked at Chikobe for six years. “If we can get water and electricity here, my work will be easy. Once the hospital environment is clean, it minimizes the rates of infection.”

Globally, 1.8 billion people are at risk of infectious diseases because they use or work in a health facility that doesn’t have water.

Such infections can lead to prolonged hospital stays, long-term disability and spiraling healthcare costs. High infection rates and poor water, sanitation and hygiene can damage trust in health systems and make patients less likely to seek care when they are sick.

Thanks to supporters like you, WaterAid brought clean water and infection control measures to hospitals throughout Geita district. Today, the number of women choosing to give birth at health centers has doubled. Zero cases of maternal sepsis were reported after these interventions, compared to 19 cases before the arrival of clean water.

Nyaganga a nurse and midwife in the Geita Ditrict of Tanzania
I’ll never forget the day a pregnant woman came here at night ready to deliver but there was no water. I had to run home to collect water. If I did not have water at home, what would I have done?
Nyaganga, nurse, Geita district Tanzania

Learn more about our work in Tanzania

Image: WaterAid/ James Kiyimba

The clinic had sinks, but no water supply, so the staff had to depend on unprotected sources or buy water from vendors, which then had to be purified with chlorine. Once, the clinic endured three months without a working toilet when their latrine became full, and nobody came to empty it.

People visiting the hospital used to look for latrines in neighboring homes or wait until they got back to their home.

When the staff couldn’t wait any longer, they decided to take matters into their own hands. With the help of community members, and without any money, they built a new pit latrine using an old rainwater harvesting tank.

Since then, WaterAid has worked with local partners to build toilets and medical waste disposal facilities at Kakora and construct a solar-powered water system. The system not only supplies water to the health center but also serves the primary and secondary schools, and the rest of Kakora village – reaching more than 3,000 people. The changes have come as a great relief to Jacob.“I am very happy today,” he says. “My work is more enjoyable.”

To work reliably in any setting, however remote, technology needs to be affordable, adaptable and sustainable.

In Ghana, the local authorities disconnected water systems from some health centers that were unable to afford the monthly tariffs. WaterAid implemented solar-powered and gravity systems for piped water supply in these areas, because of their lower running costs.

Since we began our work on the ground and advocacy at the national level, the Government of Zambia has set new targets to provide 90% of healthcare facilities with basic water and sanitation and 80% with waste management and handwashing facilities by the end of 2022.

The new water tank which has increased water supply capacity at Kawinga health centre, Machinga, Malawi, September 2020.
The new water tank which has increased water supply capacity at Kawinga health centre, Machinga, Malawi, September 2020.
Image: WaterAid/ Dennis Lupenga


Reaching remote communities

In Ghana, over 2 million people are now benefiting from WaterAid’s efforts to provide clean water, toilets and waste management facilities at health centers in some of the hardest to reach communities. These include clinics for mothers, babies and children. Facilities are gender-sensitive and disability inclusive, with delivery rooms and separate toilets for staff and clients and for male and female patients. Infection prevention and control has improved significantly, with the first two districts we worked in reporting zero maternal deaths that year.

Almost every dollar invested in water and sanitation services yields a return of $5 due to reduced healthcare costs for individuals and society, and greater productivity.

A nurse stands in front of a Health Center in Zambia
A nurse stands in front of a Health Center in Zambia
Image: WaterAid/ Chileshe Chanda

Raising Our Voices

Why I give: Q&A with a WaterAid Supporter

My name is Jamie Mathews Heustess. I work as a neonatal intensive care nurse at a large trauma center in Savannah, Georgia. This is a quick snapshot of me during a shift. Here’s why I support WaterAid and why you should, too. Everyone needs clean, accessible water. Everyone. No one is excluded from that. Whether you are two years old or 100, poverty stricken or a multibillionaire, the need for clean water transcends race, sex, socioeconomic status, or religious affiliation. If I can help one family or one village to have fresh water access, I consider that lives saved. It is that simple. Read my Q&A with WaterAid to learn more about how I use clean water at work to protect my patients, myself and my family.

Water is very important! I am always washing my hands to keep my smallest charges healthy and safe. I scrub in before my care begins, then again before and after each patient interaction. For 12 hours a day, handwashing is the first line of defense to keep them safe.

Absolutely not! Besides using clean water for handwashing, if we did not have clean water to bathe newborns, the infection risk would skyrocket.

Any place where you deal with germs increases your risk to bring it home. It may sound funny, but I don’t wear my work shoes into my house. When I get home, my scrubs are taken off in the garage and placed directly into a sanitizing load of laundry immediately. I take a shower and then I can participate in family time. I wear a mask whenever I am out running errands, my son who has autism does the same, even with his sensory issues! I protect my family and my premature infants in every way I can.

"Clean water saves lives. It’s that simple."

healthcare portraits | WaterAid

—Jamie Mathews Heustess

An impossible task

Image: WaterAid/ Genaye Eshetu

Nestled in the hills of Jabi Tehnan in rural Ethiopia, the Yiraber Health Center is home to hard-working staff who want the best for their patients. But they struggle daily to find water.

Tirunesh works for the hospital. She’s paid a modest fee to collect 10 gallons of water every day. Twice a day, she makes the back-breaking journey on foot to a spring. Half of the water Tirunesh collects is used for handwashing. The other half is for cleaning. And still, it’s not enough.

Ideally, every room should be mopped. But Yehasab, the hospital cleaner, has to choose which rooms to mop and which to just sweep, even though sweeping won’t properly clean the surface and minimize the risk of infection.

Without clean water, patients are exposed to infectious diseases like scabies or diarrhea. Trachoma (a contagious infection of the eye, which can lead to blindness) is common, because people can’t use clean water to wash their faces.

Even though Yehasab has had training in infection prevention, she can’t apply it here. Like other staff members, she doesn’t have enough water to wash her hands when she needs to.

Yehasab, a cleaner at Yiraber Health Centre in Ethiopia
I really want to clean the health center well, but I can’t because of the lack of water, and that affects the patients, because people can easily get infections, when the health center is not clean.
Yehasab, health center cleaner, Ethiopia

Yaye, a clinical nurse at Yiraber, has to reuse water for patients daily–even for cleaning equipment. Often, he has to wait until he goes home to wash his hands. Staff at Yiraber try to teach the community about good hygiene and disease prevention, but without water, they’re barely able to practice it themselves. “It is a sorrowful experience working here,” says Yaye. “I feel sad that, instead of healing patients, I might expose them to other diseases.”

Progress, but the journey is not over yet

We’ve made great strides together, but more progress is needed to ensure that reliable clean water, toilets and hygiene facilities are a reality throughout hospitals worldwide.

A health attendant, cleans the corridors at a Health Centre in Malawi
Image: WaterAid/ Dennis Lupenga

We must urgently invest in services, infrastructure, supplies and training – and advocate for the use of tools including assessments, procurement, design and quality standards.

Image: WaterAid/ James Kiyimba

So far we have reached:

28.8 million
people with
decent toilets

26.1 million
people with
hygiene education