Transforming health systems: the vital role of water, sanitation and hygiene

Health centers without water, sanitation and soap for handwashing in low and middle-income countries are contributing to thousands of patient deaths and risking the global rise of antimicrobial resistance, warns a new report from WaterAid, which calls for urgent action.

Released at the opening of the World Health Assembly (21 May), following UN Secretary General António Guterres’s call for the international community to prioritize action on water, sanitation and hygiene in healthcare facilities, the report is a manifesto for change for governments and donors, to ensure all health centers around the world have access to these vital facilities by 2030, as part of the drive to achieve universal health coverage.

According to the World Health Organization and UNICEF 38% of healthcare facilities across low and middle-income countries lack access to a water source, one in five (19%) are without access to adequate toilets, and over a third (35%) are without adequate facilities for washing hands with soap. Babies born in health centers in these countries are up to 20 times more likely to develop neonatal sepsis, and 15% of all patients in these settings acquire at least one infection during a hospital stay. Many of these deaths would be preventable if conditions in these health centers had access to clean water and adequate toilets and if hands were routinely washed.

Another major study, released earlier this year, showed the situation could be far worse with half (50%) of healthcare facilities surveyed lacking access to piped water while a third (33%) are without access to improved toilets, and even more (39%) do not have facilities for washing hands with soap.

Treating patients in dirty and unhygienic conditions makes the jobs of midwives, nurses and doctors impossible, and has tragic consequences. According to the World Health Organization, every minute a newborn dies from infection caused by a lack of access to clean water, decent toilets and hygiene, a number which could be reduced if the health centers in which babies are delivered had access to these basic facilities.

WaterAid’s report Transforming Health Systems: the vital role of water, sanitation and hygiene, argues that governments must act now to better coordinate between ministries and organizations focused on health and those leading on water, sanitation and hygiene, and ensure water, sanitation and hygiene are properly integrated into national healthcare policies, programs and strategies. Effective, long-term financing by governments and donors must also be prioritized to ensure these essential building blocks of quality healthcare are sustainable and governments must ensure that progress is properly monitored within the health system.

Report author and health researcher for WaterAid Australia, Alison Macintyre, says:

In Transforming Health Systems, WaterAid offers a manifesto for change; showcasing a set of solutions based on our experience working with governments across the world which, if properly implemented, we believe will help ensure that Universal Health Coverage is transformed from a promise to a reality for all.

Drawing on examples of WaterAid’s work in healthcare facilities from Cambodia to Nicaragua, Myanmar to Malawi Transforming Health Systems makes a series of recommendations to health ministries in order to address the crisis faced by healthcare facilities globally, including:

• Embed the need for water, sanitation and hygiene in healthcare facilities as a core priority for investment across all relevant health efforts, including maternal and newborn health, tackling antimicrobial resistance, health emergency preparedness, infection prevention and control, sexual and reproductive health and rights, quality of care and plans for achieving Universal Health Coverage.

• Strengthen coordination between ministries of health, water, sanitation and hygiene, and finance, with researchers, UN agencies, NGOs and healthcare professional groups.

• Actively engage with local communities, healthcare users, frontline health workers and vulnerable groups to ensure that progress towards better health systems is socially inclusive and responsive to the needs of everyone, leaving no one behind.

• Put in place national minimum standards for water, sanitation and hygiene in all government and private healthcare settings, and ensure these are adhered to, with improvement plans and the necessary investment put in place where needed.