WASH in health care facilities

JMP monitoring of WASH in health care facilities includes tracking ‘basic’ water, sanitation, hygiene, waste management and environmental cleaning. Definitions of ‘basic’ services have been developed by a global task team convened by the JMP and incorporated into new JMP service ‘ladders’ for WASH in health care facilities. The JMP estimates for WASH in health care facilities are based on mapping national data to these standardised core indicators.

The 2019 JMP report on WASH in health care facilities provides the first global estimates for the new SDG indicators and finds that in 2016:

• 74% of health care facilities had a basic water service, meaning water was available from an improved source on the premises. Nearly 900 million people globally had no water service at their health care facility.
• 21% of health care facilities globally had no sanitation service, meaning they had unimproved toilets, such as pit latrines without a slab, hanging latrines and bucket latrines, or no toilets at all. More than 1.5 billion people globally had no sanitation service at their health care facility.
• One out of six health care facilities (16%) globally had no hygiene service, meaning they lacked hand hygiene facilities at points of care, as well as soap and water at toilets. 58% of health care facilities globally had hand hygiene facilities at points of care.
• In Least Developed Countries, only 27% of health care facilities has basic waste management services. There were not enough countries with estimates to calculate global coverage of basic waste management services.
• Only four countries had sufficient data to estimate the proportion of health care facilities with basic environmental cleaning services.

Basic water services in health care facilities

Water is needed at health care facilities for drinking, cooking, hand hygiene, bathing, cleaning, 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. Globally, 26% of health care facilities lacked a basic water service in 2016 and among these, 12% had no water service. This means 894 million people had no water service at their health care facility. Fewer hospitals (4%) had no water service compared to other health care facilities (11%), and 5% of health care facilities in urban areas had no water service compared to 15% in rural areas.

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. There were insufficient data to produce a global estimate of basic sanitation services, but 42% of health care facilities in Landlocked Developing Countries had basic sanitation services.  In 2016, more than 1.5 billion people worldwide (21%) had no sanitation service at their health care facility. While 9% of hospitals had no sanitation service, other health care facilities were over twice as likely (20%) to have no sanitation service. Globally, 16% of government health care facilities and 36% of non-government facilities had no sanitation service.

Basic hygiene services in health care facilities

Health care worker hand hygiene is one of the most effective ways to prevent disease transmission between patients. Handwashing facilities at the toilets can also help reduce the spread of disease between patients. In 2016, one out of six health care facilities (16%) globally had no hygiene service.  There were insufficient data to calculate a global estimate for basic hygiene services due to a lack of data on the availability of handwashing facilities at toilets, but 58% of health care facilities globally had hand hygiene facilities at points of care. In sub-Saharan Africa, 84% of hospitals had hand hygiene facilities at points of care compared to 64% of other health care facilities.

Basic waste management services in health care facilities

Approximately 15% of waste produced at health care facilities is infectious or hazardous.1 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 Least Developed Countries, only 27% of health care facilities has basic waste management services. There were not enough countries with basic estimates to calculate global coverage of basic waste management services, but 60% of health care facilities globally had systems for segregating waste at the point of generation. In sub-Saharan Africa, 60% of hospitals and 38% of other health care facilities had basic waste management services.

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.2 Health care facilities should establish written protocols for cleaning and regularly train health care workers on effective implementation of those protocols. In 2016, only four countries had data on both the availability of cleaning protocols and the training of health care workers to estimate the proportion of health care facilities with basic environmental cleaning services. An additional three countries had data on either the availability of cleaning protocols or health care worker training, but not both.

References

1 World Health Organization, Safe Management of Wastes from Health-care Activities, WHO, Geneva, 2014, <www.who.int/water_sanitation_health/publications/wastemanag/en>.

2 World Health Organization, Guidelines on Core Components of Infection Prevention and Control Programmes at the National and Acute Health Care Facility Level, WHO, Geneva, 2016, <www.who.int/gpsc/ipc-components/en>.