"A healthcare facility without WASH is not a healthcare facility."
- Dr. Maria Neira, director of Public Health and Environment, World Health Organization
"If you can't do the basics forget the rest. Prevention, prevention, prevention."
- Dr. Tedros Adhanom Ghebreyesus, Director-General, World Health Organization
“No one needs lofty theological concepts to justify proper WASH. Without it, healthcare cannot be healthy.”
- Cardinal Michael F. Czerny, Vatican Dicastery for Promoting Integral Human Development
Until 10 years ago, no one thought to measure how many healthcare facilities worldwide had water, sanitation and hygiene (WASH)…because of course they did! Global studies would reveal appalling conditions, and today we know that in the 60 fragile context countries 37% of healthcare facilities do not have basic water services, 81% do not have basic sanitation services.
- Dr. Maria Neira, director of Public Health and Environment, World Health Organization
"If you can't do the basics forget the rest. Prevention, prevention, prevention."
- Dr. Tedros Adhanom Ghebreyesus, Director-General, World Health Organization
“No one needs lofty theological concepts to justify proper WASH. Without it, healthcare cannot be healthy.”
- Cardinal Michael F. Czerny, Vatican Dicastery for Promoting Integral Human Development
Until 10 years ago, no one thought to measure how many healthcare facilities worldwide had water, sanitation and hygiene (WASH)…because of course they did! Global studies would reveal appalling conditions, and today we know that in the 60 fragile context countries 37% of healthcare facilities do not have basic water services, 81% do not have basic sanitation services.
Women wait to give birth in facilities without adequate water and sanitation. PHOTOS: unless otherwise noted are courtesy of Haik Kocharian for Village Health Partnership (VHP)
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Upwards of 50% of healthcare facilities in low-resource settings are run by faith-based organizations (FBOs).
The lack of WASH in Healthcare Facilities (HCFs) is among the most serious and solvable global health issues we face. We know the extent of the problem, how to sustainably fix it, and new initiatives are underway. The path is clear. It’s time to accelerate this critical work. Faiths have a critical role to play. 
Faiths Take a Lead on WASH
The Catholic Church, the largest unified healthcare provider in the world, is piloting a Vatican initiative to get WASH into 150 HCFs in 23 countries, covering care for 28 million people. New pilot initiatives are being launched by Anglican and Methodist denominations and Muslim funders. These new initiatives join thousands of Catholic sisters and scores of FBOs trying to tackle WASH where they serve, underscoring that water is indeed the single symbol shared by every world religion. |
 Photo: Oxfam International
Well into the 21st century, hospitals and healthcare facilities look like something from the 1800s. As medicine travels across bionics and gene therapy into string theory and nanotechnology, the most important discovery that can save millions of lives is left behind. Assuring access to sustainable clean water, toilets, soap, basic sanitation and hygiene practices inside hospitals and health clinics is the foundation for safe and dignified healthcare everywhere. Maternal, newborn and child health, pandemic prevention, antibiotic resistance, Infection Prevention and Control (IPC), and the call for Universal Health Coverage (UHC) all require WASH in healthcare. Multiple Sustainable Development Goals (SDGs) cannot be achieved without it. And yet the health of millions of people is stuck in the Middle Ages. Life-expectancy was shorter because much of the world lived with poor hygiene, practically no sanitation, and unsafe water. In the 19th century the Industrial Revolution, germ theory, and a nurse named Florence Nightingale became the driving force for hospital reform. She convinced the world that improving hygiene and sanitation, as well as having trained professional nurses tend to the sick, were necessities. Ebola and COVID-19 re-enforced the lesson that all healthcare staff and patients need to be able to wash their hands. |
Newborns in intensive care share incubators that cannot be properly cleaned.
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Midwives do the best they can.
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CASE STUDY:
"I recently found myself in a packed labor and delivery ward. When an unexpected twin was born not breathing, we had no choice. With almost no protective gear, two nurses I’d brought with me jumped in and saved the baby. Covered with blood, we just had to hope no mother or child we came in contact with that day was infected with HIV, hepatitis... We had no way to clean up because this massive, overcrowded hospital that serves 2.5 million people, had had no water in six weeks.”
- Margaret “Migs” Muldrow, MD Internal Medicine and Dermatology, Founder, Village Health Partnership
"I recently found myself in a packed labor and delivery ward. When an unexpected twin was born not breathing, we had no choice. With almost no protective gear, two nurses I’d brought with me jumped in and saved the baby. Covered with blood, we just had to hope no mother or child we came in contact with that day was infected with HIV, hepatitis... We had no way to clean up because this massive, overcrowded hospital that serves 2.5 million people, had had no water in six weeks.”
- Margaret “Migs” Muldrow, MD Internal Medicine and Dermatology, Founder, Village Health Partnership
At this main referral facility mothers give birth, side-by-side, sometimes three at a time. With no working water tap, when very busy, the mothers clean up their blood and bodily fluids with their own clothes and rags to make way for the next women about to give birth. Mothers are afraid to deliver here but they are also afraid to die in labor at home. |
At one health center serving some 53,000 people, there is just one latrine, no shower and two donkeys make 20 trips a day to transport water from a nearby, dirty river. It’s clear the donkeys cannot meet the facility’s needs, but the staff does much with little. The place is clean and organized. |
This labor and delivery ward has no working sink, a common problem in healthcare centers around the world.
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"A darling, petite young woman with a beautiful smile on the outside, Mecca’s reality is a daily onslaught of pain and shame due to a completely preventable injury of pregnancy, afflicting a million women and resulting in untold stillbirths. I was in Ethiopia with a project focused on the appalling absence of WASH in healthcare facilities. But I hadn’t anticipated Meeting Mecca..." [read more] |
VHP founder, Dr. Migs Muldrow (far left) and Susan Barnett (far right), founder, Faiths for Safe Water, interview Mecca outside her home. Read her story.
ANTIBIOTIC RESISTENCE
If we don’t take global action to prevent infections, and keep relying on antibiotics to cure infections, we will return to the days before we had any antibiotics.
"Our modern medical system is built on effective antibiotics. If our antibiotics stop working, if bacteria become resistant to most of them, medicine will be in trouble.”
- Eili Klein, Center for Disease Dynamics, Economics and Policy
Anti-microbial resistance, AMR, means many of the common antibiotics we’ve all come to rely on are no longer effective. Drug resistance is a rapidly growing global threat. Drug-resistant diseases can cause longer and more complicated illnesses, more doctor visits, the need for stronger and more expensive drugs, and more deaths. The CDC uncovered new "nightmare bacteria" — resistant to almost every drug, and particularly deadly to the elderly and people with chronic illnesses. Up to half of these infections are fatal.
Yet, 2000 to 2015 saw a 65% rise in worldwide consumption of the drugs; on average, especially among wealthier nations. "Unrestrained antibiotics use is the key reason drug-resistant infections now kill more than half a million people a year worldwide," according to a recent study co-authored by Eli Klein of the Center for Disease Dynamics, Economics and Policy in Washington. About 2 million Americans are sickened by antibiotic-resistant bacteria each year and 23,000 die, according to the CDC.
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But what about the antibiotics of tomorrow? Pharmaceutical companies have continually withdrawn from developing new antibiotics. In 1990, there were at least 18 large pharmaceutical companies actively developing antibiotics. Today, there are four. Concern has led England’s chief medical officer to recently add antimicrobial resistance to the UK’s national risk register of civil emergencies. Five years ago, Dame Sally Davies warned of an “apocalyptic scenario” where people die of common infections and simple operations because antibiotics no longer work. Davies recently told The Guardian, “The importance of clean water, sanitation and vaccination must not be forgotten to avoid infections occurring in the first place.” More in The Guardian. Resistance can also spread between microorganisms. Using antimicrobials in any one sector (human health, aquaculture, agriculture or on crops) can result in unintended exposure in other sectors. AMR can undermine not only human health, but also animal health, crop health and ecosystem health. |
Every infection prevented is one that needs no treatment. 
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PHOTO: Courtesy Unsplash
PANDEMICS
When people on our frontline defense against pandemics cannot adequately wash their hands,
no one is safe.
The lack of access to water, soap and basic sanitation was a key reason why Ebola not only killed some 11,00 people, it was 103-fold higher in healthcare workers in Sierra Leone than in the general population, 42-fold higher in Guinea health workers, and the reason why Liberia lost eight percent of its health workforce.
AND THEN CAME COVID-19 AND HEALTHCARE WORKERS STILL COULD NOT WASH THEIR HANDS.
AND THEN CAME COVID-19 AND HEALTHCARE WORKERS STILL COULD NOT WASH THEIR HANDS.
PHOTE: Courtesy Unsplash
FAITH COMMUNITY CALL-TO-ACTION:
No community is better positioned to lead because faith-based communities run up to 50% of healthcare facilities in some countries. If we are truly committed to preventing suffering, illness and disease, and improving health outcomes, then we must direct greater focus to sustainable WASH in healthcare facilities.
Sustainable WASH in healthcare facilities will require systemic change, and integrating WASH into existing health initiatives like infection prevention and control (IPC) and antimicrobial resistance (AMR), maternal and child health (MCH), quality of care, and universal health coverage (UHC). It will require expertise and support from clinicians, public health professionals, engineers, plumbers, government officials, researchers, donors and more to achieve the goal of universal coverage.
Key stakeholders are working with the senior leadership of the UN, especially WHO and UNICEF, to respond by developing action plans and furthering the global campaign to address this urgent issue. Our faith-based organizations are key stakeholders and our leadership can help prioritize and coordinate vital multi-sector cooperation.
Know an organization that could benefit from more field and technical information about WASH in Healthcare Facilities?
Visit the NEW WASHinHCF.org for a growing list of shared resources.
No community is better positioned to lead because faith-based communities run up to 50% of healthcare facilities in some countries. If we are truly committed to preventing suffering, illness and disease, and improving health outcomes, then we must direct greater focus to sustainable WASH in healthcare facilities.
Sustainable WASH in healthcare facilities will require systemic change, and integrating WASH into existing health initiatives like infection prevention and control (IPC) and antimicrobial resistance (AMR), maternal and child health (MCH), quality of care, and universal health coverage (UHC). It will require expertise and support from clinicians, public health professionals, engineers, plumbers, government officials, researchers, donors and more to achieve the goal of universal coverage.
Key stakeholders are working with the senior leadership of the UN, especially WHO and UNICEF, to respond by developing action plans and furthering the global campaign to address this urgent issue. Our faith-based organizations are key stakeholders and our leadership can help prioritize and coordinate vital multi-sector cooperation.
Know an organization that could benefit from more field and technical information about WASH in Healthcare Facilities?
Visit the NEW WASHinHCF.org for a growing list of shared resources.
WATER IS LIFE:
Photo: Save the Children
BUT TOO OFTEN IT IS NOT:
Maternity Waiting Area
PREVENTION IS
AS CLEAR AS CLEAN WATER.
