Frontline health facilities faltering without water, sanitation, hygiene and electricity – WHO, UNICEF new report

Worldwide, millions of lives could be saved and billions in economic losses prevented through one simple, affordable intervention: water, sanitation, and hygiene (WASH) services in health care facilities.

Safe WASH services enable life-saving infection prevention and control practices, curb the spread of antimicrobial resistance, and help in delivering quality primary health care services to all. Yet, actions taken in countries are insufficient, according to a new report by the World Health Organization (WHO) and UNICEF (United Nations Children’s Fund) released today.

Water, Sanitation, Hygiene, Waste and Electricity Services in Health Care Facilities: 2023 Global Progress Report highlights that an estimated 8 million people die annually in 137 low- and middle-income countries from poor-quality health care, resulting in US$6 trillion in economic losses from poor health and premature mortality.

WASH, waste and electricity services are major contributors to high quality health care. Interventions such as improving availability of hand hygiene and drinking water stations, regular cleaning, functioning toilets and regular on-site water supply can greatly help in improving health services, staff performance and in respecting the dignity of health care facility users.

“We are often given the excuse that public health problems are too costly to fix, but we now understand that providing basic WASH and energy to health care facilities is both non-negotiable and affordable,” said Dr Maria Neira, WHO Director for Environment, Climate Change and Health. “We have no excuses and time is running out. Basic infrastructure is a prerequisite to quality of care and is essential for life-saving practices.”

On average, basic WASH services cost only 60 US dollar cents per person each year in the least developed countries, or just 6% of current annual least developed government health spending. As the risk of future pandemics, climate change, and geopolitical insecurity and conflict increases, investment is more critical than ever. Yet, currently, just 12% of all countries have more than 75% of funds needed to reach targets for WASH in health care facilities.

WASH, waste and electricity services more generally have critical impacts on the health of mothers and babies during childbirth. Lack of services increases the risk of infection, particularly sepsis, which can be deadly for children and mothers. More than 1 million women and girls indicated that WASH services are their second most important demand for quality reproductive and maternal health, after dignified and respectful care.

“Latest data reveals that 5 million children lost their lives before their fifth birthday from preventable causes, half of which were newborns,” said Cecilia Scharp, UNICEF Director of Water, Sanitation, and Hygiene and Climate, Energy, Environment and DRR. “Many of these deaths are preventable by a solution as simple as safe water and soap. Safely managed water and sanitation services where babies are born will help to save the lives of millions of children and mothers each year.”

Approximately 43% of the newborn deaths occurred in sub-Saharan Africa, where only half of health care facilities have a water source on site. In addition, global progress in reducing maternal mortality stalled between 2016 and 2020. If the world continues on this trend, it will miss the Sustainable Development Goal target to reduce preventable maternal mortality, costing more than 1 million lives by 2030.

An online tracking mechanism is providing valuable insights on where country progress is greatest, with over 70% of 73 reporting countries having established baseline data, updating and implementing health care waste and WASH standards, including with a climate resilience focus. However, less than 1 in 5 countries have undertaken national infrastructure improvements or are tracking and using WASH data within health management information systems.

WHO and UNICEF call on countries and partners to implement the following recommendations in order to rapidly improve WASH, waste, and electricity services in health care facilities:

Addressing financial obstacles;

Integrating WASH, waste and electricity services into health planning;

Developing and empowering the health workforce to deliver and maintain WASH, waste and electricity services, and practising good hygiene; and

Strengthening accountability by regularly monitoring and reviewing progress.

WHO and UNICEF are co-hosting a Global Summit on Water, Sanitation, and Hygiene (WASH), waste and electricity services in health care facilities in Amman, Jordan, today. The event is attended by representatives from over 30 countries, providing a vital platform to discuss the report’s findings with the aim to consolidate country insights and to create an opportunity for health leaders to strategize on implementing key recommendations and scaling up solutions.