WASH in health care facilities

Achieving and maintaining WASH services in health care facilities is critical for universal quality health coverage, infection prevention and control (IPC), patient safety, and child and maternal health, in particular the time around child delivery. WASH also extends beyond health impacts to issues of dignity and respect, staff morale, and performance and safety. Accordingly, WASH in health care facilities is part of the 2030 Sustainable Development Goal (SDG) targets related to WASH. The SDG targets 6.1 and 6.2 refer to universal and equitable access to drinking water, sanitation and hygiene for all. The term ‘universal’ implies all settings, including households, schools, health care facilities, workplaces and public spaces. Target 3.8 aims to provide access to quality essential health-care services for all. Moreover, WASH in health care facilities is directly related to a number of other health goals, namely reducing maternal mortality, and under-five and neonatal mortality (SDG targets 3.1 and 3.2).

The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), through the WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP), have been producing regular updates on water, sanitation and hygiene (WASH) since 1990. Together, they are responsible for monitoring the SDG targets related to WASH in households, schools and healthcare facilities. The JMP published a global baseline report WASH in health care facilities in 2019 and releases progress updates every two years. The most update was published in 2024 (with estimates up to the year 2023)

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The JMP uses service ladders to benchmark and track progress across countries. WASH services in healthcare facilities include water supply, sanitation and hygiene, but also health care waste management and environmental cleaning, which in health care settings are closely related to sanitation and hygiene.

JMP service ladders for WASH in health care facilities

a) Improved water sources are those that by nature of their design and construction have the potential to deliver safe water. These include piped water, boreholes or tubewells, protected dug wells, protected springs, rainwater and packaged or delivered water.
b) Improved sanitation facilities are those designed to hygienically separate human excreta from human contact. These include wet sanitation technologies such as flush and pour-flush toilets connecting to sewers, septic tanks or pit latrines, and dry sanitation technologies such as dry pit latrines with slabs, and composting toilets.

The JMP produces regional or global estimates when data are available from countries representing at least 30 per cent of the relevant regional or global population. For the reference year of the most recent update, 2023, there were insufficient data to produce global estimates for any of the five basic service levels. There were recent data from enough countries to produce estimates of the population with no water, no sanitation, and no hygiene service: in 2023, 743 million people (9 per cent of the global population) had no water service at their health care facility, meaning that the facility had no water source, used an unimproved water source like an unprotected well or spring, or had to collect water from an improved source more than 500 metres away. Likewise, 661 million people (8 per cent) had no sanitation service at their health care facility (the facility had no toilets or only unimproved sanitation facilities), and 722 million people (9 per cent) had no hygiene service (no functional hand hygiene facilities at points of care or at toilets).

In 2023, there were insufficient country level data to make global estimates for any of the basic WASH services in health care facilities

Global coverage of water, sanitation, hygiene, environmental cleaning, and waste management services in 2023 (per cent)

Source: WHO/UNICEF JMP, Data update on WASH in health care facilities for 2023: special focus on primary health care, 2024.

The recent data update in 2024 highlights the status of WASH in health care facilities in fragile contexts, as they represent particularly vulnerable populations, who often lack primary health care and are in most urgent need of quality health care services.

In the 60 countries, areas and territories classified as ‘fragile contexts’, more than a third of health care facilities (37 per cent) lacked a basic water service in 2023. Less than half (46 per cent) had basic hygiene, only a third (34 per cent) had basic environmental cleaning, a quarter (25 per cent) had basic waste management and less than a fifth (19 per cent) had basic sanitation services. Globally, 2 billion people lived in these fragile contexts in 2023. Of these, 1.6 billion lacked basic sanitation at their health care facilities, 1.5 billion lacked basic waste management, and 1.3 billion lacked basic cleaning. 1.1 billion lacked basic hygiene and 717 million lacked basic water.

In 2023, coverage of WASH in health care facilities was very low in fragile contexts

Coverage of water, sanitation, hygiene, environmental cleaning, and waste management services in fragile contexts, 2023 (per cent)

Source: WHO/UNICEF JMP, Data update on WASH in health care facilities for 2023: special focus on primary health care, 2024.

Basic water services in health care facilities

Water is needed at health care facilities for drinking, hand hygiene, bathing, cleaning, cooking and a variety of medical uses. Water is critical to maintain health and for recovery. Women, in particular, may need large quantities of drinking water during childbirth and while breastfeeding.

In 2023:

• 72 countries and 2 SDG regions had estimates for basic water services in health care facilities, meaning water was available from an improved source on the premises.
• There were not enough countries with data to calculate global estimates for basic water services.
• Regional coverage of basic water services ranged from 60 per cent in sub-Saharan Africa to 76 per cent in Northern Africa and Western Asia.
• In fragile contexts, 37 per cent of health care facilities lacked a basic water service.
• 80 per cent of non-hospitals had a basic water service.
• 74 per cent of rural health care facilities had a basic water service.
• 9 per cent of health care facilities (covering 743 million people) had no water service.
• In 38 countries, at least 1 in 20 health care facilities had no water service. .

In 2022:

• Globally, 78 per cent of health care facilities had a basic water service, 11 per cent had a limited service and 11 per cent had no service.
• 1.7 billion people still lacked a basic water service, including 861 million with a limited service and 874 million with no service.

42 out of 72 countries with estimates had >75 per cent coverage of basic water services in 2023

Proportion of health care facilities with a basic water service in 2023 (per cent)

Note: Statistics in this report refer to countries, areas and territories.
Source: WHO/UNICEF JMP, Data update on WASH in health care facilities for 2023: special focus on primary health care, 2024.

Basic sanitation services in health care facilities

Sanitation services in health care facilities are essential to the provision of quality care and directly impact the health, welfare and dignity of patients and staff. Healthcare facilities with basic sanitation services have improved and usable sanitation facilities with at least one toilet dedicated for staff, at least one sex-separated toilet with menstrual hygiene facilities, and at least one toilet accessible for people with limited mobility.

In 2023:

• 51 countries and 2 SDG regions had estimates for basic sanitation services in health care facilities, meaning improved sanitation facilities that were usable, with at least one toilet dedicated for staff, at least one sex-separated toilet with menstrual hygiene facilities and at least one toilet accessible for people with limited mobility.
• There were not enough countries with data to calculate global estimates for basic sanitation services.
• Regional coverage of basic sanitation services ranged from 22 per cent in sub-Saharan Africa to 36 per cent in Northern Africa and Western Asia.
• In fragile contexts, less than one in five health care facilities (19 per cent) had basic sanitation services.
• 8 per cent of health care facilities globally (covering 661 million people) had no sanitation service.
• In 36 countries, at least 1 in 20 health care facilities had no sanitation service.

11 out of 51 countries with estimates had >75 per cent coverage of basic sanitation services in 2023

Proportion of health care facilities with a basic sanitation service in 2023 (per cent)

Note: Statistics in this report refer to countries, areas and territories.
Source: WHO/UNICEF JMP, Data update on WASH in health care facilities for 2023: special focus on primary health care, 2024.

Basic hygiene services in health care facilities

Hand hygiene is one of the most effective ways to prevent disease transmission. Handwashing facilities at the toilets in health care facilities can help reduce the spread of disease between patients and health care workers.

In 2023:

• 47 countries and 2 SDG regions had estimates for basic hygiene services in health care facilities, meaning functional hand hygiene facilities were available at points of care and within five metres of toilets.
• There were not enough countries with data to calculate global estimates for basic hygiene services.
• Regional coverage of basic hygiene services ranged from 34 per cent in sub-Saharan Africa to 58 per cent in Northern Africa and Western Asia.
• In fragile contexts, less than half (46 per cent) of health care facilities had a basic hygiene service.
• 4 out of 5 health care facilities (80 per cent) had functional hand hygiene facilities at points of care.
• Globally, 9 per cent of health care facilities (covering 722 million people) had no hygiene service.
• In 20 countries, at least 1 in 20 health care facilities had no hygiene service.

In 2022:

• Globally, 61 per cent of health care facilities had a basic hygiene service.
• 3.4 billion people lacked a basic hygiene service at their health care facility.

21 out of 47 countries with estimates had >75 per cent coverage of basic hygiene services in health care facilities in 2023

Proportion of health care facilities with a basic hygiene service in 2023 (per cent)

Note: Statistics in this report refer to countries, areas and territories.
Source: WHO/UNICEF JMP, Data update on WASH in health care facilities for 2023: special focus on primary health care, 2024.

Basic waste management services in health care facilities

Health care waste should be segregated into at least three categories (general non-hazardous waste, infectious waste, and sharp waste), then safely treated and disposed to prevent the spread of infection.

In 2023:

• 66 countries and 2 SDG regions had estimates for basic health care waste management services in health care facilities, meaning health care waste was safely segregated into at least three bins, and sharps and infectious waste were treated and disposed of safely.
• There were not enough countries with data to calculate global estimates for basic health care waste management services.
• 40 per cent of health care facilities in Northern Africa and Western Asia, and 26 per cent of health care facilities in sub-Saharan Africa had basic health care waste management services.
• In fragile contexts, 1 in 4 health care facilities (25 per cent) had basic health care waste management services.
• Globally, 71 per cent of health care facilities had materials for safe segregation of health care waste at the point of generation.
• In 18 countries, at least 1 in 20 health care facilities had no health care waste management service.

22 out of 66 countries with estimates had >75 per cent coverage of basic waste management services in health care facilities in 2023

Proportion of health care facilities with a basic waste management service in 2023 (per cent)

Note: Statistics in this report refer to countries, areas and territories.
Source: WHO/UNICEF JMP, Data update on WASH in health care facilities for 2023: special focus on primary health care, 2024.

Basic environmental cleaning services in health care facilities

Effective environmental cleaning at health care facilities is a fundamental intervention for infection prevention and control and significantly reduces the transmission of health care associated infections. Health care facilities should establish written protocols for cleaning and regularly train health care workers on effective implementation of those protocols. Healthcare facilities have basic environmental cleaning services when protocols for cleaning are available, and staff with cleaning responsibilities have all received training.

In 2023:

• 39 countries and 1 SDG region had estimates for basic environmental cleaning services in health care facilities, meaning protocols for cleaning were available and staff with cleaning responsibilities had all received training.
• There were not enough countries with data to calculate global estimates for basic environmental cleaning services.
• In Northern Africa and Western Asia, only 26 per cent of health care facilities had a basic environmental cleaning service.
• In fragile contexts, only one third (34 per cent) of health care facilities had basic environmental cleaning services.
• In 25 countries, at least 1 in 20 health care facilities had no environmental cleaning service.

9 out of 39 countries with estimates had >75 per cent coverage of basic environmental cleaning services in health care facilities in 2023

Proportion of health care facilities with a basic environmental cleaning service in 2023 (per cent)

Note: Statistics in this report refer to countries, areas and territories.
Source: WHO/UNICEF JMP, Data update on WASH in health care facilities for 2023: special focus on primary health care, 2024.

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