Background Information:

The WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP), have produced regular updates on water, sanitation and hygiene (WASH) since 1990.

Together, they are responsible for monitoring the 2030 Sustainable Development Goal (SDG) targets related to WASH. Targets 6.1 and 6.2 refer to universal and equitable access to drinking water, sanitation and hygiene for all. The term ‘universal’ implies all settings, including households, schools, health care facilities, workplaces and public spaces, and since 2019 the JMP has maintained a global database on WASH services in health care facilities. WASH in health care facilities is also essential for achievement of target 3.8 which aims to provide access to quality essential health care services for all.

The JMP uses service ladders to benchmark and track progress on WASH services. For the purpose of global monitoring, the definition of WASH in health care facilities includes not only water supply, sanitation and hand hygiene, but also health care waste management and environmental cleaning, which in health care settings are closely related to sanitation and hygiene.

Basic Service

Hand Hygiene: Functional hand hygiene facilities (with water and soap and/or alcohol-based hand rub) are available at points of care, and within five metres of toilets.

Environmental Cleaning: Protocols for cleaning are available, and staff with cleaning responsibilities have all received training.

Waste Management: Waste is safely segregated into at least three bins, and sharps
and infectious waste are treated and disposed of safely.

Water: Water is available from an improved source on the premises.

*Improved water sources are those that by nature of their design and construction have the potential to deliver safe water. These include piped water, boreholes or tubewells, protected dug wells, protected springs, rainwater, and packaged or delivered water.

Sanitation: Improved sanitation facilities are usable, with at least one toilet dedicated for staff, at least one sex-separated toilet with menstrual hygiene facilities, and at least one toilet accessible for people with limited mobility.

*Improved sanitation facilities are those designed to hygienically separate human excreta from human contact. These include wet sanitation technologies – such as flush and pour-flush toilets connecting to sewers, septic tanks or pit latrines – and dry sanitation technologies – such as dry pit latrines with slabs, and composting toilets.

Key Messages:

The JMP has recently released estimates on WASH in health care facilities for 2021.

Hand hygiene

In 2021

• Half (51%) of health care facilities globally had a basic hand hygiene service, meaning that functional hand hygiene facilities were available at points of care, and within five metres of toilets.
• Only one third (32%) of health care facilities in least developed countries (LDCs) had a basic hygiene service.
• National data on basic hygiene services were available for 35% of the global population, and for 37% of the population of LDCs.
• 1 out of 11 health care facilities (9%) globally had no service (lacking hand hygiene facilities at points of care, as well as soap and water at toilets).
• 3.85 billion people lacked a basic hygiene service at their health care facility, including 688 million people with no service.
• 68% of health care facilities globally had hand hygiene facilities at points of care, while 65% had handwashing facilities with soap and water at toilets.

Environmental Cleaning

In 2021:

• 21 countries (representing 7% of the global population) had sufficient data to estimate national coverage of basic environmental cleaning services in health care facilities.
• There were not enough countries with national data on environmental cleaning to calculate regional or global estimates for basic environmental cleaning services.
• 72% of hospitals in Central and Southern Asia had a basic environmental cleaning service, meaning that cleaning protocols were available, and that staff with cleaning responsibilities had all received training.
• In sub-Saharan Africa, 26% of rural health care facilities had a basic environmental cleaning service. 45% had cleaning protocols, and 32% had staff trained on environment cleaning.

Waste Management

In 2021:

• 65 countries had sufficient data to estimate national coverage of basic waste management services in health care facilities, meaning that waste was segregated at points of generation, and sharps and infectious waste were treated and disposed of safely.
• There were not enough countries with basic estimates to calculate global coverage of waste management services. National data on basic waste management services were available for 24% of the global population.
• 39% of health care facilities in sub-Saharan Africa had a basic health care waste management service.
• One out of three health care facilities in fragile contexts (32%) and in LDCs (34%) had a basic health care waste management service.
• Three out of five (61%) hospitals globally had a basic health care waste management service.
• 73% of health care facilities globally had systems for segregating waste.
• 681 million people in sub-Saharan Africa lacked a basic waste management service at their health care facility, including 66 million people with no service (neither segregation at points of generation nor safe treatment and disposal).

Water

In 2021:

• 78% of health care facilities globally had a basic water service, meaning water was available from an improved source on the premises.
• 59 countries and three of the eight SDG regions had sufficient data to estimate national coverage of basic water services in health care facilities.
• Regional coverage of basic water services ranged from 52% in sub-Saharan Africa to 90% in Eastern and South-Eastern Asia.
• National data on basic water services were available for 37% of the global population, and for 53% of the population of LDCs.
• 11% of health care facilities globally had a limited water service, meaning they had access to an improved source that was either located off the premises or did not have water available at the time of the survey.
• 11% of health care facilities globally had no service, meaning they either used water from an improved source more than 500 metres from the premises or an unimproved source, or had no water source at all.
• Globally, 3% of health care facilities in urban areas and 11% in rural areas had no service.
• 88% of hospitals but only 77% of smaller health care facilities had a basic water service.
• Globally, 1.7 billion people lacked a basic water service at their health care facility, including 857 million people who had no service at their health care facility.

Sanitation

In 2021:

• There were not enough countries with estimates to calculate global coverage of basic sanitation services in health care facilities. National data on basic sanitation services were available for 19% of the global population.
• 41 countries and three SDG regions had sufficient data to estimate national coverage of basic sanitation services in health care facilities.
• 10% of health care facilities globally had no service, meaning they had unimproved toilets or no toilets at all.
• The proportion of health care facilities with no sanitation service ranged from 3% in Latin America and the Caribbean as well as Eastern and South-Eastern Asia to 22% in sub-Saharan Africa.
• 780 million people globally had no service at their health care facility.

Useful Links:

Link to the related WHO news release:

https://www.who.int/news/item/30-08-2022-half-of-health-care-facilities-globally-lack-basic-hygiene-services—who–unicef

Link to the JMP Report:

https://www.who.int/publications/i/item/progress-on-wash-in-health-care-facilities-2000-2021–special-focus-on-wash-and-infection-prevention-and-control-(ipc)