First published on SciDev.Net, 25.01.18

[LONDON] Only 2 per cent of hospitals and clinics in lower and middle-income countries (LIMCs) provide patients with good quality services across the four key areas of water, sanitation, hygiene and waste management.

The finding comes from the first study to provide a baseline measure of environmental conditions in healthcare facilities to support progress towards the UN Sustainable Development Goals (SDGs). It looked at more than 130,000 facilities worldwide, and found that half of them lacked regular access to piped water.

The study also warned that around 40 per cent of hospitals and clinics in LIMCs are short of hand-washing soap. The same percentage of facilities cannot provide infectious waste disposal, and three out of four do not have enough sterilisation equipment.

To come up with the estimates, researchers at the Water Institute of the University of North Carolina in the United States compiled data from various sources including UN reports and peer-reviewed literature.

“Nearly 60 per cent of facilities do not have reliable electricity, making it difficult to deliver babies at night, refrigerate vaccines, and provide other critical services,” says Ryan Cronk, one of the authors of the paper.

Without water we cannot do surgeries or flush the toilets, so conditions quickly become terrible

Julius Mollel

The study, published this month (11 January) in the International Journal of Hygiene and Environmental Health, looked at six countries in detail: Bangladesh, Haiti, Malawi, Nepal, Senegal and Tanzania.

Among them, Bangladesh had the highest proportion of facilities with sewer access; but even then, only 17 per cent of hospitals and clinics pipe their wastewater into a sewage system. Access to clean water and wastewater treatment is one of the biggest problems healthcare facilities face in LIMCs.

Julius Mollel, a general surgeon at Nkoaranga Hospital in the Meru district in Tanzania, says getting water is a daily struggle for the hospital, as local groundwater resources are depleted. “Without water we cannot do surgeries or flush the toilets, so conditions quickly become terrible,” he tells SciDev.Net. “We always keep back 50 litres for [each toilet facility in] emergencies.”

According to the study, only 32 per cent of healthcare facilities in Tanzania have access to basic water services. Mollel says Nkoaranga Hospital is looking to international donors to install a 100,000-litre tank to ensure it has a steady water supply. “We get no money from the local government for this,” he says.

Faith-based healthcare facilities appear to be faring better than state-funded ones, and Cronk says this may be linked to more access to international funding making up for a lack of government support.

Where basic water and sanitation facilities are present, there are often secondary problems: more than 70 per cent of Nepalese healthcare facilities, for example, provided toilets for patients, but only 26 per cent had separate toilets for women, leaving female patients vulnerable and exposed.

The authors say that lack of these services threatens the achievement of the water and health-related SDGs. UNICEF, which works with the World Health Organization on implementing the SDGs, says this affects the most vulnerable patients most, especially mothers and newborns.

According to Lizette Burgers, senior adviser on water, sanitation and hygiene at UNICEF, sepsis and pneumonia are the most common infections picked up in hospital settings. “We need to return to the pre-antibiotic era, when infection prevention was recognised as a priority,” she told SciDev.Net. “Governments and other relevant partners have a crucial role to play in making this a reality.”

The WHO is planning to publish a global update on hygiene in healthcare facilities later this year, as part of its monitoring of SDG 6 on clean water and sanitation.

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