Half of the world’s healthcare facilities do not have basic hygiene services with soap and water or alcohol-based cleaners where patients receive care and in the toilets of these facilities, according to the latest report by the WHO-UNICEF Joint Monitoring Program (JMP). About 3.85 billion people use these facilities, putting them at greater risk of infection, including 688 million people who receive care in facilities without any hygiene services.
“Hygiene facilities and practices in health facilities are not up for discussion. Their improvement is essential for pandemic recovery, prevention and preparedness. Hygiene in healthcare facilities cannot be ensured without increased investment in essential measures that include safe water, clean toilets and safely managed healthcare waste,” said Dr Maria Neira, WHO Director, Department of Environment, Climate Change and health. “I encourage Member States to increase their efforts to implement their 2019 World Health Assembly commitment to improve water, sanitation and hygiene (WASH) services in health facilities and to monitor these efforts.”
The latest report Progress on WASH in Health Care Facilities 2000–2021: Special Focus on WASH and Infection Prevention and Control established for the first time this global baseline of hygiene services – which assesses access at points of care, as well as toilets – as more countries than ever report critical elements of WASH services in their hospitals and other health centres. For hygiene, data is now available for 40 countries representing 35% of the world’s population, up from 21 countries in 2020 and 14 in 2019.
The newly created global assessment reveals a clearer and more alarming picture of the state of hygiene in healthcare facilities. Although 68% of health facilities had hygiene facilities at points of care and 65% had handwashing facilities with soap and water in toilets, only 51% had both and therefore met the criteria for basic hygiene services. Furthermore, 1 in 11 (9%) of healthcare facilities worldwide have neither.
“If health providers don’t have access to hygiene services, patients don’t have a health facility,” said Kelly Ann Naylor, UNICEF Director of WASH and Climate, Environment, Energy and Disaster Risk Reduction (CEED). “Hospitals and clinics without safe water and basic hygiene and sanitation services are a potential death trap for pregnant mothers, newborns and children. Every year, about 670,000 newborns die from sepsis. It’s a travesty – especially since their deaths are preventable.”
The report notes that contaminated hands and the environment play a significant role in the transmission of pathogens in healthcare settings and the spread of antimicrobial resistance. Interventions to increase access to handwashing with soap and water and environmental cleaning form the cornerstone of infection prevention and control programs and are critical to the delivery of quality care, particularly for safe delivery.
Coverage of WASH facilities is still uneven across regions and income groups:
- Facilities in sub-Saharan Africa are lagging behind hygiene services. While three-quarters (73%) of healthcare facilities in the region as a whole have alcohol-based hand rubs or water and soap at points of care, only one-third (37%) have soap-and-water handwashing facilities in toilets . The majority (87%) of hospitals have hand hygiene facilities at point of care, compared to 68% of other healthcare facilities.
- In the least developed countries, only 53% of health facilities have on-site access to secure water source. By comparison, the global figure is 78%, with hospitals (88%) doing better than smaller healthcare facilities (77%) and the figure for East and Southeast Asia is 90%. Globally, about 3% of health facilities in urban areas and 11% in rural areas have no water supply.
- Of the countries with available data, 1 in 10 health facilities worldwide lack sanitation services. The share of health facilities with no sanitary services ranging from 3% in Latin America and the Caribbean and in East and Southeast Asia to 22% in sub-Saharan Africa. In the least developed countries, only 1 in 5 (21%) have basic sanitation services in health facilities.
- The data also reveals that many healthcare facilities lack basic environmental cleaning and safe segregation and disposal of healthcare waste.
The report is being presented at World Water Week, which is being held in Stockholm, Sweden. The annual conference, which runs from 23 August to 1 September, explores new ways to tackle humanity’s greatest challenges: from food security and health to agriculture, technology, biodiversity and climate.
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