One In Four Health Facilities Worldwide Lack Basic Water Access, WHO Report Finds
In the world’s 47 least-developed countries, 50% of healthcare facilities lack basic water services and 60% lack sanitation services. The former is the first line of defence against any infectious disease.

One out of every four health facilities worldwide lacks even the most basic access to water supplies. And in the world’s 47 least developed countries, one in every two facilities lacks such access, according to a new WHO report, co-authored with UNICEF, on access to water, sanitation and hygiene (WASH) in health care facilities.

The report also found that one out of every 10 health facilities, including hospitals, lack sanitation services, and one out of three lack facilities basic waste management services to dispose of health care waste – waste that has exploded during the pandemic with the expanded use of personal protective equipment, SARS-CoV2 testing materials alongside the large amounts of disposable waste that is routinely generated.

The dearth of safe water and sanitation facilities is most dire in the world’s 47 least-developed countries (LDCs), where three in five health facilities lack basic sanitation services, and seven out of 10 facilities fail to segregate and manage infectious healthcare waste management adequately.

The net result is that nearly 2 billion people who rely on those health services, as well as the healthcare workers employed in them, are at heightened risk of infections, including from COVID-19, in the midst of the current pandemic.

The new report Fundamentals first: Universal water, sanitation, and hygiene services in health care facilities for safe, quality care, published on Monday, comes only days after Universal Health Coverage Day was observed.

WHO Director-General Dr Tedros Adhanom Ghebreyesus.

“Working in a healthcare facility without water, sanitation and hygiene is akin to sending nurses and doctors to work without personal protective equipment” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General on Monday.

“Water supply, sanitation and hygiene in health care facilities are fundamental to stopping COVID-19. But there are still major gaps to overcome, particularly in least developed countries.”

The report follows an initial baseline analysis last year of WASH in healthcare. The new report is far more comprehensive than last year’s analysis, providing a more robust profile of the situation around the world, Tom Slaymaker, Senior Statistics & Monitoring Specialist at UNICEF, told Health Policy Watch.

Specifically, this year’s report includes data from 165 countries and 794,000 facilities, compared to last year’s data from 125 countries and 560,000 healthcare facilities.

But large gaps in data remain, he stressed, in global estimates for sanitation, hygiene and environmental services coverage.

Countries Are Off Track When it Comes to Universal Access

Despite some pockets of progress, the report warns that countries are “significantly” off track to achieve universal access to basic WASH services within a decade.

While 85% of the 47 least developed countries surveyed undertook situational analyses on access to WASH services, less than a third have costed out new national strategies to improve the situation. And only 10% have integrated WASH indicators into monitoring of national health systems. This includes just 5 countries: Benin, Serbia, Lebanon, Thailand and Nigeria.

Every dollar invested in hand hygiene alone in health care facilities can generate a return of US$15, OECD found in 2018.

“During these unprecedented times, it’s even more clear how fundamental WASH is for prevention of infections and improving health outcomes,” said the World Bank’s Global Director of Health, Nutrition and Population, Muhammad Pate. “We must work even closer together to ensure that WASH is included in all interventions and at scale.”

Funding WASH in healthcare facilities is among the most cost-effective investments that governments can make, emphasized Jennifer Sara, Global Director for Water at the World Bank Group. Every dollar invested in hand hygiene alone in health care facilities can generate a return of US$15, the Organisation for Economic Co-operation and Development (OECD) found in 2018.

“For millions of healthcare workers across the world, water is PPE,” she said. “It is essential that financing keeps flowing to bring water and sanitation services to those battling the COVID crisis on the front lines.”

WASH is Fundamental to Sustainable Development Goals & COVID-19 Response

As populations around the world anticipate a COVID-19 jab, access to WASH services in healthcare facilities has become more critical than ever before. For healthcare workers – who have borne about 15% of the global COVID-19 case toll, even though they account for only 3% of the world’s population – this is especially pressing

“Many [healthcare workers] have fainted after wearing PPE for a long time,” one nursing officer in India was quoted as saying in the report. “We are dehydrated and not drinking enough water. Nurses are being diagnosed with urinary tract infections – it starts leaking and you want to talk about dignity!”

healthcare workers constitute about 3% of the world’s population but have borne about 15% of the global COVID-19 case toll.

Inadequate WASH services can also fuel neglected tropical diseases, which affect 1 in 5 people worldwide, mostly in low- and middle-income countries (LMICs). They also account for 11 million sepsis deaths a year, a preventable life-threatening condition, predominantly affecting newborn children, pregnant or recently pregnant women, as well as those living in LMICs.

In Malawi, where maternal mortality is 30 times higher than in high-income countries, a midwife said in the report: “I remember vividly [when] we had to take women who had just given birth to a nearby river to wash. It would take 45 minutes. Some would collapse along the way. I felt sad for them. But there was no running water at the health facility.”

Apart from infection control and prevention, access to WASH services can also curb antimicrobial resistance, improve quality care, and bolster health system resilience.

Image Credits: UN Water, UNECE, Government ZA.

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