In the United States, a hospital without running water would cause quite a shock, but in some parts of the world, it’s downright common. Thirty-eight percent of medical facilities in low- and middle-income countries lack an improved water source, and 35 percent lack sufficient soap for hand washing, according to a report commissioned by the World Health Organization and the United Nations Children’s Fund.
The review, co-authored by professor Jamie Bartram and graduate student Ryan Cronk of The Water Institute at the University of North Carolina, looked at data from 90 studies of medical facilities published between 1998 and 2014 covering, in total, 66,101 hospitals and other medical facilities. The list spanned 54 countries (mostly in Africa and the Americas) and included places like Sierra Leone and Zimbabwe in Africa; Haiti, Barbados, and Mexico in the Americas; and some countries in Asia.
The focus was on three particular measures: water, sanitation, and hygiene, collectively known as WASH. For the purposes of their research, Bartram and Cronk’s standards were not particularly high; they defined a medical facility as having water if there was an improved water source—one capable of keeping contaminants out of the water—within 500 meters of the facility. Similarly, the sanitation element required, essentially, that visitors to a clinic or hospital have at least a latrine within the facility, and the basic hygiene element required little more than soap-and-water or alcohol hand-washing stations inside the facility.
In total, just 62 percent of hospitals and other care centers had access to an improved water source within 500 meters.
Needless to say, those requirements fall far below traditional WHO standards. Yet, in total, just 62 percent of hospitals and other care centers had access to an improved water source within 500 meters, 81 percent had access to improved sanitation facilities—again, the standard for “improved” is quite low, implying anything from a latrine to well-maintained, indoor toilets—and just 65 percent had access to soap or an alcohol-based cleanser for hand washing.
The review also found an “alarming” lack of data on WASH standards in health care facilities. Though the review covered several dozen countries and tens of thousands of facilities, data was scant in Asia and the Middle East, and whatever data was at hand was often incomplete. While data on water availability was present for all the facilities surveyed, data on sanitation was only available in 62,524 facilities representing 36 countries. When it came to hygiene, there was data on just 40,536 facilities, covering 35 countries.
“Urgent action at the global, national and facility is needed to improve WASH conditions,” Bartram and Cronk write in their report.
Despite the bleak outlook, there are examples that provide some hope. Laos, for example, has created its own WASH standards which have so far been implemented in 25 health care centers, and in 2013, Mongolia produced standards that highlighted infrastructure, maintenance practices, and infection control.
“Through coordinated, global action, with leadership from the health sector, ensuring that all health care facilities have WASH services is an aim that can be realized,” Bartram and Cronk write.
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