WASH in health care facilities: an essential element to achieving universal health coverage and a critical step on the road to ending cholera

December 18, 2020


Strong health care systems are critical to support the world’s poorest and most vulnerable communities. Confronting a global pandemic or combatting an ancient disease such as cholera, which continues to affect at least 47 countries across the globe, requires safe and dignified health care.

Jackeline Gideon Mwiguta, a nurse/midwife at the Nyarugusu Dispensary in the Geita Region of Tanzania
Jackeline Gideon Mwiguta, a nurse/midwife at the Nyarugusu Dispensary in the Geita Region of Tanzania – © WaterAid/Sam Vox

Combined with socioeconomic factors, weak health systems impede progress toward universal health coverage (UHC).  Inadequate basic infrastructure such as water, sanitation, and hygiene (WASH) facilities, and human resource gaps (such as training and equipping the health workforce) lead to poor quality services and lack of trust in seeking health care (WHO, 2019).

For the prevention of cholera, long-term WASH provisions – alongside the use of oral cholera vaccines – are essential to strengthening the enabling environment. The role of WASH is a “best buy” in public health, alleviating a preventable health and economic burden. Additionally, improving and maintaining WASH conditions at health care facilities can also help to establish trust in health services and related health care seeking behaviours.

WASH in health care facilities (HCFs) underpins dignified and inclusive care for all. However, significant inequalities exist in the least developed countries, where 50% of HCFs lack basic water services and 67% lack basic sanitation services. Such conditions impact women, most often in positions of care, and people with disabilities even more.  Improved public health relies on us getting the basics right – this begins with WASH in HCFs for ‘fundamentals first’ – and long-term WASH for prevention of cholera.

As Chair of the GTFCC WASH Working Group, WaterAid -under the direction of Dr. Nurullah Awal of WaterAid Bangladesh – will use its unique position to advocate for the urgent investment in water, sanitation and hygiene required to achieve the goals of the Global Roadmap to Ending Cholera by 2030 and to secure progress toward universal health coverage. WaterAid calls for the following urgent actions for WASH:

  • Invest in WASH services, infrastructure, supplies and training for all frontline health workers – 70% of whom are women – including cleaners and auxiliary staff in accordance with the previously agreed WHA72.7 resolution
  • Initiate nationwide mass public health information campaigns that include good hygiene practices tailored to meet the needs of all.
  • Ensure indicators for access to WASH in health care facilities, communities, and the most at-risk groups are embedded in national government monitoring and standards for universal health coverage – particularly for quality of care and pandemic preparedness – and the data is used to drive action towards universal health coverage.

Improvements to national system strengthening for public health, including WASH, are urgently needed in the fight to end cholera. The longstanding burden of cholera will continue to be exacerbated by conflict, climate change, urbanization and population growth. Sensitizing decision-makers and continued advocacy for adequate resource allocations to achieve targets in national cholera plans is essential. Now is the time to accelerate multi-sectoral action at country, regional and global levels to end cholera.