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.”
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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.
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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
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“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.
Funding challenge
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.
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