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Insights into Editorial: A WASH for healthcare

Insights into Editorial: A WASH for healthcare


Healthcare facilities are many and varied. Some are primary, others are tertiary.

Many are public, some are private. Some meet specific needs, and some are temporary, providing acute care when disaster strikes.

In 2015, for the first time, WHO and UNICEF assessed the status of WASH in health care facilities in low- and middle-income countries.

With a significant proportion of facilities without any services at all, WHO, UNICEF and partners committed at a global meeting to address the situation, with the aim of achieving universal access in all facilities, in all settings, by 2030.

A global action plan with five change objectives was developed in March 2015. In the first phase of this work, four task teams (comprised of health and WASH specialists) are working to address five change objectives and produce tangible deliverables.


WASH amenities should be strictly made available:

Whatever their differences, and wherever they’re located, adequate water, sanitation and hygiene (WASH) amenities, including waste management and environmental cleaning services, are critical to their safe functioning.

When a healthcare facility lacks adequate WASH services, infection prevention and control are severely compromised. This has the potential to make patients and health workers sick from avoidable infections.

As a result (and in addition), efforts to improve maternal, neonatal and child health are undermined.

Lack of WASH facilities also results in unnecessary use of antibiotics, thereby spreading antimicrobial resistance.

In 2018, the United Nations (UN) issued a Global Call to Action to elevate the importance of and prioritize action on WASH in all health care facilities, including primary, secondary and tertiary facilities in both the public and private sectors.

The call recognises the important role WASH plays in preventing infections, saving lives, and improving quality of care.


Recent report on WASH Services:

The WHO/UNICEF JMP report, WASH in Health Care Facilities, is the first comprehensive global assessment of water, sanitation and hygiene (WASH) in health care facilities.

It outlines that, WASH services in many facilities across the world are missing or substandard.

It finds that 1 in 8 health care facilities has no water service and 1 in 5 has no sanitation service – impacting close to 900 million and more than 1.5 billion people, respectively.

One in every six healthcare facilities was estimated to have no hygiene service (meaning it lacked hand hygiene facilities at points of care, as well as soap and water at toilets), while data on waste management and environmental cleaning was inadequate across the board.


Enhancing primary healthcare will improve WASH services:

In WHO’s South-East Asia region, efforts to tackle the problem and achieve related Sustainable Development Goal (SDG) targets are being vigorously pursued.

As outlined at a WHO-supported meeting in New Delhi in March, improving WASH services in healthcare facilities is crucial to accelerating progress towards each of the region’s ‘flagship priorities’, especially the achievement of universal health coverage.

Notably, improving WASH services was deemed essential to enhancing the quality of primary healthcare services, increasing equity and bridging the rural-urban divide.

A World Health Assembly Resolution passed is hoping to catalyse domestic and external investments to help reach the global targets.

These include:

  • Ensuring at least 60% of all healthcare facilities have basic WASH services by 2022;
  • At least 80% have the same by 2025; and
  • 100% of all facilities provide basic WASH services by 2030.


WHO- and UNICEF-recommended practical steps to be implement:

Across the region, and the world, a lack of quality baseline data limits authorities’ understanding of the problem.

First, health authorities should conduct in-depth assessments and establish national standards and accountability mechanisms.

There is need of national road-maps to improve WASH services are developed, health authorities should create clear and measurable benchmarks that can be used to improve and maintain infrastructure and ensure that facilities are ‘fit to serve’.

All UN agencies, Member States, and partners are now being asked to invest more in this critical component for health and wellbeing.


Educating the health workers:

Second, health authorities should increase engagement and work to instil a culture of cleanliness and safety in all healthcare facilities. There should be a lot of information campaigns to all the working staff.

All workers in the health system from doctors and nurses to midwives and cleaners should be made aware of, and made to practise, current WASH and infection prevention and control procedures (IPC).

Third, authorities should ensure that collection of data on key WASH indicators becomes routine.

It will help accelerate progress by promoting continued action and accountability. It will also help spur innovation by documenting the links between policies and outcomes.


Way Forward:

To help do this, modules on WASH services and IPC should be included in pre-service training and as part of ongoing professional development.

In addition, authorities should work more closely with communities, especially in rural areas, to promote demand for WASH services.

WHO is working with member states as well as key partners to develop a data dashboard that brings together and tracks indicators on health facilities, including WASH services, with a focus on the primary care level.

As member states strive to achieve the ‘flagship priorities’ and work towards the SDG targets, that outcome is crucial.

Indeed, whatever the healthcare facility, whoever the provider, and wherever it is located, securing safe health services is an objective member states must boldly pursue.