Alarming figures on a lack of clean water in health centres have been highlighted in a joint report published on Tuesday by the World Health Organisation (WHO) and the United Nations Children’s Fund (Unicef). “Access to water in health centres and even in delivery rooms has fallen between the gaps in the millennium development goals,” said Bruce Gordon, coordinator of water, sanitation, hygiene and health for the WHO. “It’s an embarrassment for the health sector that this issue is so ignored. It’s a fixable crisis. It’s a crisis because it’s hidden.”
Nurse Vinima Baya carries a tub that is used to bring clean water
to the community health centre for women in labour, in the village
of Diatoula, 15km from Bamako, Mali.
Photograph: Tara Todras-Whitehill/WaterAid
In low- and middle-income countries, 38% of health centres have no access to water, according to the report. It says that adequate sanitation is lacking in 19% of health centres, and 35% do not even provide water and soap for staff and patients to wash their hands and maintain basic hygiene.
Dirty water and the lack of safe toilets are among the top five killers of women worldwide. Without these basic facilities, health centres cannot adequately prevent and control infections, placing mothers and children at risk during delivery. Where latrines are not provided, mothers in labour may have to go outside to relieve themselves, and tend to leave health facilities within hours of giving birth, leaving little time for them to receive advice and support.
Drawing on data from 54 countries, the report covers more than 66,000 centres. But the data is likely to overstate actual access significantly, since most surveys merely note the presence of water within 500 metres of the health centre rather than indicating whether supplies are piped, safe to drink or year-round.
The report is a first step towards a baseline study as NGOs and health organisations encourage governments, donors and stakeholders to make water, sanitation and hygiene (Wash) in health contexts both a higher political priority and measurable as part of the new sustainable development goals. Better data is crucial for Wash access to be included in indicators on heath, education and gender goals.
The findings show that Mali is currently the poorest performer, with just 20% of health facilities providing clean water. There is inequity within many countries – for example in Kenya, where 58% of hospitals had access to water but only 35% of primary health clinics. In Ethiopia, there is access to drinking water in 99% of the capital’s health facilities but only 23% in the Gambela region.
Vietnam is one country that now monitors Wash in health centres. It has encouraged progress by holding a clean toilet contest and offering incentives to improve services.
Globally, one in 50 babies die before they are a month old. According to a report released by WaterAid on Tuesday, one in five newborn deaths could be prevented with safe water, sanitation and clean hands. In 2013, more than 2.7 million newborns did not survive a month, and 99% of these neonatal deaths occur in low- and middle-income countries.
Barbara Frost, WaterAid’s chief executive, said: “The links between dirty hands, dirty water and infant mortality have been known about for over 150 years so this is not a solution waiting for an answer, but an injustice waiting for action.
“The ability to keep a hospital or clinic clean is such a fundamental basic requirement of healthcare that you have to question whether a facility without clean running water or basic sanitation can adequately serve its patients.”
Diatoula in Mali, 15km south-east of Bamako, is a community of 1,000 people. Vinima Baya, 29, the only nurse, runs the centre with the support of a pharmacist, Soungalo Diarra, 30, who had three months’ training in the typical medicines likely to be required at the centre. She did three years’ specialist nursing training after completing her baccalaureate.
Baya, who is originally from Bamako, has two children herself. She came at the request of the community, but can only afford to stay on by growing onions to sell in her spare time. Her husband lives near his work in a nearby town.
It costs 3,500 CFA ($5.60) for an uncomplicated delivery at the centre, plus any necessary drugs. This fee covers salaries and the basic equipment at the centre – there is no state or other external funding.
As there is no water within the facility, patients need to bring in 25-30 litres of water or five buckets’ worth to try to maintain a clean environment during the birth. There is a hand pump on the other side of the village near the school (donated by Japan), but the nearest water point to the centre is a deep well, which can run low at certain points of the year.
Reviewing her register, Baya notes that there have been 33 births at the centre so far this year; three of the babies were born dead and two died within their first month.
Sixteen-year-old Fatoumata Djarra’s son, Allaman Sidiqi Djarra, her first child, died 15 days after he was born.
Fatoumata Djarra, 16, who lost her son 15 days after he was born,
outside her house in the village of Diatoula, 15km from Bamako,
Mali. Photograph: Tara Todras-Whitehill/WaterAid
“When I was pregnant, I came for consultation and advice. I gave birth here in the community health centre. It was at night. I came with my family members,” she said. “They went to collect water at the well in the village. I didn’t have any special circumstances in my delivery.”
When Fatoumata noticed her baby was not well she gave him traditional medicine. “I just noticed some black spots on his legs and his body. He wasn’t feeling good, he didn’t eat anything, he didn’t drink anything. It took only one day before he died.”
Though Fatoumata did not return to the health centre for confirmation, the symptoms suggest sepsis infection.
Ahead of the development finance meeting in Addis in July, ways of raising the necessary capital for water, sanitation and hygiene are under urgent consideration. A live debate is whether Wash would benefit from a global fund mechanism like HIV and aids, vaccines or education, or whether it would be better served by more cross-cutting funding. Currently, it is often down to households and communities to find their own solutions. The WHO-Unicef report found that only 25% of countries have funded plans to address the issue.