Steering clear of dangerous waters

By - World Healthcare Journal
Steering clear of dangerous waters

Water, sanitation and hygiene need to be core components of all health programming, says Tim Wainwright, Chief Executive of WaterAid.


Working as a nurse in a small healthcare facility in low and middle-income countries around the world is a daily feat of multi-tasking. A healthcare professional in rural Tanzania or Malawi, for example, might see around 200 patients a day, working in a one-stop shop where giving immunisations, delivering babies, treating malaria, tuberculosis, waterborne disease and HIV/AIDs amongst other conditions are all part of the everyday workload.

For far too many health professionals though, top of the list is working out whether there is enough water and soap available to be able to deliver a clean safe environment. When these basics are in short supply, the risks of patients becoming sicker than they arrived rise as the fight to prevent hospital acquired infections becomes hopeless.

While these clinics may feel far away from modern healthcare systems in the developed world, the impacts are felt globally. This is why WaterAid will be demanding action by the world’s health ministers in Geneva at the World Health Assembly in June to make sure that every healthcare professional is able to work in a hygienic environment where water is available all the time.

Unreliable water supply isn’t limited to small health posts, but a problem that affects even large hospitals in many countries where the water supply is intermittent, not on site or completely non-existent.

One in five deaths of newborn babies in low and middle-income countries are caused by infections with a strong link to dirty water, poor sanitation and unhygienic conditions.

A recent report by the Unicef-WHO Joint Monitoring Programme revealed that one in four healthcare facilities lack basic water services, impacting over 2bn people globally.


The very real threat of antimicrobial resistance


In too many cases, an absence of clean water, decent sanitation and good hygiene leads to an over-prescription of prophylactic antibiotics as those caring for patients attempt to combat the increased risk of infection created by unhygienic conditions.

The global rise in antibiotic resistant superbugs, in part attributed directly to poor sanitary conditions in healthcare facilities, is not a challenge that will respect national borders.

Recently, the UK’s health secretary called drug-resistant infections a ‘global health emergency’ as he unveiled a plan to cut antibiotic-resistant infections in UK patients by 10 per cent by 2025. Family doctors around the world are now being warned against overprescribing antibiotics.

Through the Sustainable Development Goals - a total of 17 goals agreed by the world’s governments in 2015 to build a better world - leaders have promised to ensure everyone everywhere has access to safe water and sanitation, as well as universal healthcare for all, by 2030. To keep those promises, provision of water, sanitation and hygiene in healthcare facilities must be prioritised.

At every level of the health service, from individual health workers through to government ministries of health and international health organisations, there must be individual and collective responsibility to ensure hygienic conditions in health centres.

This is possible. In Mali, WaterAid worked alongside the Malian Ministry of Health and the WHO to upgrade water facilities at a healthcare facility, where once medical staff had to walk hundreds of metres to wash their hands. I saw first-hand the difference this made to staff and patients.


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. We are also involved at the highest level of governments ensuring water and sanitation are political priorities. In countries such as Cambodia, India, Mali and Tanzania we have worked with governments to put in place national policies and standards for the cleanliness of hospitals and clinics, and now we are supporting communities to hold authorities to account for improvements. But it is clear that a huge challenge remains that is undermining the very fundamentals of healthcare systems.


To truly change this situation, we need leadership from the top and financing to match. Water, sanitation and hygiene need to be core components of all health programming. No new hospital or healthcare facility should be considered finished without a functioning system for water, toilets and the means to maintain good hygiene. All frontline health workers need adequate training to practice proper infection prevention and control procedures.

We will be demanding action from health ministers when they meet in Geneva later this month. For the first time in many years, water, sanitation and hygiene is high on the world health assembly’s agenda, with a proposal for a global resolution on this issue led by Tanzania, Zambia and other affected countries. WaterAid urge the world’s health ministers to adopt this resolution, and act swiftly to put in place a step-change in domestic and international financing for water, sanitation and hygiene in health care facilities.


Universal healthcare can’t be universal or indeed considered healthcare without these.


·        896m 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 1.5bn 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.

Feature image: Tim Wainwright, UK Chief Executive of WaterAid assisting workers at a local facility. Picture: WaterAid

#whjafrica #whjinfrastructure #whjasia #whjpublichealth #whjclinicalservices