Lack of toilets and safe water in health-care facilities

Editorials 210 In March 2015, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) released a report 1 on the status of water and sanitation in health-care facilities from 54 low-and middle-income countries. Data representing 66 000 health facilities show that water was not readily available in about 40%. 1 Over a third of facilities lacked soap for hand washing and a fifth lacked toilets. In many countries, in facilities where water is available, there is no guarantee that it is safe for consumption. 2 This is a major embarrassment for the health sector: health facilities serve as foci for infection and patients seeking treatment fall ill and may die, for the lack of the most basic requirements for good hygiene – safe, reliable water supplies and adequate sanitation. Pregnant mothers rely on a birthing environment that, at a minimum, does not place them or their baby at risk. Infections cause nearly half of late neonatal deaths (430 000) 3 – many of which are attributable to inadequate hygiene. The same conditions contribute to major disease outbreaks, such as cholera, as well as the spread of antimicrobial resistance – another major public health threat. 4 Safe water and adequate sanitation are fundamental to a healthy and dignified life. The benefits of water and sanitation include diarrhoeal diseases averted, other infections prevented, better nutrition , financial and economic savings, and improved education, especially for girls. 5 Proposals for the Sustainable Development Goals include a target to achieve universal access to basic drinking water, sanitation and hygiene for households, schools and health-care facilities, by 2030. Improved hygiene in health-care facilities is an urgent need and a strategic investment for health objectives, including maternal and child health, infection prevention, outbreak response and health systems strengthening. 6 First, policies and standards should be established and progress tracked on delivering appropriate services. Countries with national plans and targets have better water and sanitation in health-care facilities. 1 This suggests that national planning can drive service expansion. Guidelines, such as WHO's Essential environmental health standards in health care, can assist in policy-making, including standards appropriate for different circumstances. 7 Existing monitoring initiatives, such as health management information systems could readily incorporate water, sanitation and hygiene indicators. Service availability and readiness assessments, 1 enable comparison between facilities (for benchmarking); between countries and facility types (for resource allocation and standard setting); and over time (to …