Adeguate water, sanitation and hygiene (WASH) are essential components of providing basic health services.
The provision of WASH in health care facilities serves to prevent infections and spread of disease, protect staff and patients, and uphold the dignity of vulnerable populations including pregnant women and the disabled.
Yet, many health care facilities in low resource settings lack basic WASH services, compromising the ability to provide safe care and presenting serious health risks to those seeking treatment.
The consequences of poor WASH services in health care facilities are numerous.
Health care associated infections affect hundreds of millions of patients every year, with 15% of patients estimated to develop one or more infections during a hospital stay (Allegranzi et al., 2011). The burden of infections is especially high in newborns.
Sepsis and other severe infections are major killers estimated to cause 430,000 deaths annually.
The risks associated with sepsis are 34 times greater in low resource settings (Oza et al., 2015).
Lack of access to water and sanitation in health care facilities may discourage women from giving birth in these facilities or cause delays in care-seeking (Velleman et al., 2014).
Conversely, improving WASH conditions can help establish trust in health services and encourage mothers to seek prenatal care and deliver in facilities rather than at home – important elements of the strategy to reduce maternal mortality (Russo et al., 2012).
Improving WASH in health care facilities is now beginning to attract the attention of governments, donors and the international public health community.
A proposed target of universal basic coverage of WASH in health care facilities by 2030 has been recommended for inclusion in post-2015 UN Sustainable Development Goals (WHO/UNICEF, 2014a).
Global health initiatives such as ‘Every Woman Every Child’, the integrated ‘Global Action Plan against Pneumonia and Diarrhoea’, and quality of care during childbirth highlight the mportance of basic, universal WASH services in health care facilities (WHO/UNICEF, 2012; WHO, 2014).
Furthermore, the Director General of the World Health Organization (WHO) has declared that improving WASH in health care facilities is an urgent priority (WHO, 2013).
The large number of actors and funds committed to universal health coverage provides an opportunity to highlight the essential role of WASH in achieving this aim (Action for Global Health and WaterAid, 2014). However, despite these advancements, political will is still low.
According to the 2014 UN-Water Global Analysis and Assessment of Sanitation and Drinking-water (GLAAS) findings, only one quarter of countries have policies on WASH in health care facilities that are implemented with funding and regular review (WHO, 2014).
In order to effectively address deficient WASH services in health care facilities, it is important to first understand the extent of the problem and subsequently prioritize action where needs are greatest.