Transforming Health Systems: The Vital Role of Water, Sanitation and Hygiene
By Dan Jones, Advocacy Coordinator, WaterAid and Alison Macintyre, Health Advisor, WaterAid
As decision-makers come together at the Global Conference on Primary Health Care, we urge them to address the disturbing lack of water, sanitation and hygiene services in many healthcare facilities, which is fatally undermining progress towards UHC.
Encouraging women to give birth in a hospital or clinic offering basic healthcare has been a global health priority for decades. Great achievements have been made, with three quarters of women now delivering with a skilled birth attendant, resulting in a 44% reduction in maternal mortality since 1990.
It seems then anachronistic that, in March of this year, the UN Secretary General called for urgent action to improve water, sanitation and hygiene (WASH) in healthcare facilities. Surely a healthcare centre without adequate WASH facilities is not one that can provide care to women, or, in fact, anyone? One would assume that from the outset of the Alma-Ata Declaration decades ago, the first steps taken to improve maternal health would have been underpinned by the provision of WASH where women give birth and in homes where newborns spend the first precious days of their life. WASH was strongly recognised in the Alma-Ata declaration yet seems to have been one of the most neglected elements of primary health care (PHC) efforts since.
The Harm is Clear
As few as 2% of healthcare facilities in low- and middle- income countries provide all four basic water, sanitation, hygiene and waste management services as defined by the WHO/UNICEF Joint Monitoring Program for SDG 6. A landscape report by WHO and UNICEF in 2015 estimated that over one in three healthcare facilities did not have a water supply or soap for handwashing, and nearly one in five did not have safe sanitation.
Although there is little research into the health impacts of inadequate WASH in healthcare facilities, it is likely that it increases the risk of healthcare-associated infections, the spread of antimicrobial resistance, and the risk of mothers and newborns dying from sepsis. As seen during the recent Ebola and cholera outbreaks, poor WASH can reduce the effectiveness of preventing and responding to health emergencies. Beyond these specific aspects, WASH in healthcare facilities is fundamental to ensuring quality of care and dignity for patients and health workers alike.
Since 2015, significant progress has been made. There are now globally agreed indicators to track WASH in healthcare facilities under the SDGs. Several major health strategies — such as the Global Action Plan for Antimicrobial Resistance and WHO’s Standards for Improving Quality of Maternal and Newborn Care — all recognise WASH as core to achieving their goals.
Less Talk, More Action
However, guidelines are not sufficient. Governments and international institutions must adopt, implement and reinforce them. This requires strong health systems, leadership and accountability. Renewed attention to PHC offers an ideal platform to strengthen WASH both in facilities and homes.
Underlying the alarming WASH conditions in many healthcare facilities is a systematic neglect of WASH within PHC, health systems as a whole, and global financing. The WASH problem must be tackled across all elements of the health system, to support strong governance, robust accountability and monitoring, quality service provision, a well-trained and adequate workforce, and the provision of the right technologies and commodities. The strong engagement of communities in decision-making about health and WASH services must underpin all this, and sufficient domestic and international financing is crucial.
Transforming Health Systems
WaterAid has worked in partnership with ministries of health to drive country-level action. Our report ‘Transforming health systems: the vital role of water, sanitation and hygiene’ shows how a systems strengthening approach has driven WASH improvements and thereby the quality of care in countries as diverse as Cambodia, India, Malawi and Nicaragua. Our findings are feeding into a WHO and UNICEF-led process to respond to the UN Secretary General’s Call to Action.
If we are to ensure every woman receives good-quality and safe care during childbirth, every health facility must have basic WASH services. The renewal of commitment in Astana this week must lead to investment in these foundational elements if quality PHC and UHC are to be more than just a dream.
