WASH at the Frontline – What do Health Workers Want?


A copy of an article published on the Global Handwashing Partnership’s website, written by Kelly Bridges, Global Water 2020 (October 10, 2019). Watch the SIWI sofa session here.

1. “Hygiene in health facilities will determine if we reach health for all or not.” – H.E. Toyin Saraki, Founder-President, Wellbeing Foundation Africa

In April 2019, the WHO and UNICEF released their first-ever baseline report on the global state of WASH in HCF. The situation is alarming: 2 billion people must seek care in an HCF without basic water services, 1.5 billion in an HCF without sanitation, and 43% of clinics and hospitals do not have handwashing stations at points of care. Perhaps even more concerning is that 17 million mothers annually give birth under these dangerous and inhumane conditions, jeopardizing their health and that of their newborn babies.

What do health workers want? They want soap and water to wash their hands!

They are often the first hands to touch a newborn, but without access to safe, reliable and sustainable WASH, healthcare workers can unintentionally spread disease. In Tanzania, for example, WaterAid reports that for every 100 babies born, two die within the first month. Of these deaths, one in five results from preventable infections and sepsis caused by unsanitary conditions. Mothers are, of course, also at risk of contracting a lethal infection during childbirth. As a result, women worldwide are demanding that every HCF be equipped with adequate WASH services. The What Women Want campaign—led by the White Ribbon Alliance—surveyed 1.2 million women across 114 countries about their demands for quality reproductive and maternal healthcare. They found that, following respectful and dignified care, more than anything else, women want WASH.

Healthcare workers, too, demand WASH so that they can carry out their life-saving work effectively and safely. During the 2014 Ebola outbreak in Sierra Leone, the incidence of Ebola in healthcare workers was 103 times higher than that of the general public. In Liberia, 8% of the health workforce died from Ebola. Midwives, nurses and doctors need water and soap for handwashing for their own protection when treating and caring for patients with infectious diseases.

The bottom line is that clean hands save lives, and it goes without saying that hygiene is imperative to achieving health for all—patients and healthcare workers included.

2. “We all need to be hand hygiene heroes.” – Ron Clemmer, Interim WASH Director, FHI 360

Power lies in the hands of healthcare workers, literally and figuratively. Healthcare workers are critical WASH agents of change, ensuring that proper handwashing practices and other infection prevention and control (IPC) procedures are learned and adopted within the HCF and beyond. Nkwan Jacob Gobte, a Cameroonian nurse, is one such leader in the WASH in HCF movement. Having observed the high rate of neonatal sepsis due to poor IPC behaviors, Nkwan sought to improve hand hygiene and disinfection practices at the hospital he worked in. Under his leadership, this hand hygiene hero oversaw trainings and the development of locally-produced alcohol hand rub. When he first undertook this mission to improve newborn survivability in 2002, the number of cases of newborn sepsis was 86 per 1,000 live births. In 2018, sixteen years later, the number of cases dropped to zero. His remarkable story can be read in full here. USAID’s Clean Clinic Approach provides a model to empower healthcare leaders, like Nkwan, to improve WASH in HCF.

Healthcare workers also have a tremendous role to play in the communities they serve. For Global Handwashing Day in 2018, midwives from the Wellbeing Foundation Africa led handwashing demonstrations for over 2,600 children in Nigeria, training the next generation of hand hygiene heroes. As part of the Foundation’s WASH campaign, midwives are leading the charge to instill good handwashing practices in schools and HCFs, reaching children, mothers and healthcare workers across Nigeria.

3. “It’s a big problem, but it is solvable.” – John Oldfield, Principal, Global Water 2020

Since the UN Secretary-General issued his Call to Action for universal WASH in HCF on World Water Day, March 22, 2018, significant progress has been made. The WHO and UNICEF released the first-ever global WASH in HCF assessment, a resolution was passed unanimously by all 194 Member States at the 72nd World Health Assembly, 80+ stakeholders made commitments to address this issue (including $120 million!), and—last month—Ministries of Health convened in Zambia to announce government commitments. Even the Vatican and the First Lady of Colombia issued their own calls for getting WASH into all HCF! To support governments and organizations wanting to solve this global health crisis, the WHO and UNICEF have made it easy with their practical steps document and www.WASHinHCF.org.

While the problem seems great—and it is— it is also readily solvable.

All the tools are available now to solve the WASH in HCF problem, but greater political will and funding is necessary to ensure the job gets done. The global community must continue to work toward getting WASH into all HCF for the health and wellbeing of mothers, newborns and healthcare workers everywhere. Until every healthcare worker can wash her hands, safe healthcare remains an illusion.