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 latest JMP estimates for WASH in health care facilities find that in 2019:

• 76 per cent of health care facilities had a basic water service, meaning water was available from an improved source on the premises. Over 700 million people globally had no water service at their health care facility.
• 10 per cent 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 800 million people globally had no sanitation service at their health care facility.
• 68 per cent of health care facilities globally had hand hygiene facilities at points of care but there were insufficient data to generate a global estimate on the availability at soap and water at toilets, or for basic hygiene services.
• In Least Developed Countries, only 30 per cent of health care facilities had basic waste management services. There were not enough countries with estimates to calculate global coverage of basic waste management services.
• Only 12 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, 24 per cent of health care facilities lacked a basic water service in 2019 and among these, 9 per cent had no water service. This means 712 million people had no water service at their health care facility. In Least Developed Countries (LDCs) half (50 per cent) of health care facilities lacked a basic water service. Fewer hospitals (12 per cent) lacked a basic water service compared to other health care facilities (25 per cent), and 2 per cent of health care facilities in urban areas had no water service compared to 9 per cent 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 per cent of health care facilities in Landlocked Developing Countries had basic sanitation services. In 2019, more than 800 million people worldwide (10 per cent) had no sanitation service at their health care facility. In Latin America and the Caribbean, 38 per cent of healthcare facilities had a basic service. In sub-Saharan Africa, rural healthcare facilities (11 per cent) were twice as likely to have no sanitation facility than urban healthcare facilities (37 per cent).

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. 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 68 per cent of health care facilities globally had hand hygiene facilities at points of care. In Eastern and South-Eastern Asia, 38 per cent of healthcare facilities had a basic service. In sub-Saharan Africa, 84 per cent of hospitals had hand hygiene facilities at points of care compared to 69 per cent of other health care facilities.

Basic waste management services in health care facilities

Approximately 15 per cent 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. There were not enough countries with basic estimates to calculate global coverage of basic waste management services for all health care facilities, but 71 per cent of hospitals had a basic waste management service. In Least Developed Countries, only 30 per cent of health care facilities has basic waste management services, while in sub-Saharan Africa, 54 per cent of hospitals and 31 per cent of other health care facilities had basic waste management services. Two out of three (69 per cent) of health care facilities had systems for segregation of waste.

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 2019, only 12 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.

[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.