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One in four health facilities lack basic water access, WHO report reveals

Community social mobilisers wash their hands before the polio vaccination campaign in Hamar Jajab district in Mogadishu, Somalia on Wednesday 28 October 2020. Credit: UNICEF.

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 (LDCs), one in every two facilities lacks such access.

The dearth of safe water and sanitation facilities is most dire in the world’s 47 least-developed countries (LDCs), where one in every two facilities lack access to basic water services, according to a new joint WHO and UNICEF report 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 – volumes of which have exploded during the pandemic with the expanded use of personal protective equipment alongside the large amounts of disposable waste that are routinely generated by the healthcare sector.

In LDCs, three out of every five health facilities lack basic sanitation, even a safely-constructed latrine.  And seven out of 10 facilities in LDCs fail to safely segregate and manage their infectious healthcare waste.

Why is this important? 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.

“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 at a press briefing 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 the least developed countries.”

Report is most comprehensive survey of healthcare facilities yet. The new report Fundamentals first: Universal water, sanitation, and hygiene services in health care facilities for safe, quality care , follows an initial baseline analysis last year of WASH facilities in the healthcare sector. With data from 165 countries and 794,000 health facilities of all kinds, the new report provides a more robust profile of the situation around the world, said Tom Slaymaker, Senior Statistics & Monitoring Specialist at UNICEF. That is as compared to last year's report, the first ever, which surveyed 125 countries and 560,000 healthcare facilities.

But “large” gaps in data remain in terms of estimating the gaps in sanitation, hygiene and environmental services coverage in the health sector, he stressed.

Countries are off track. Despite some progress, the report warns that countries are “significantly” off track to achieve universal access to basic WASH services within a decade, a target for the Sustainable Development Goals.

While 85 per cent of the 47 least developed countries surveyed have at least undertaken a situational analyses of the state of access to WASH services in their countries, less than a third have developed and costed national strategies for making improvements. And only a handful of countries, including Benin, Serbia, Lebanon, Thailand and Nigeria, have integrated WASH indicators into their tracking of national health systems.

“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, emphasised 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 $15, the Organization 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.”

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