* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
New WHO report says only 38 percent of healthcare facilities have having access to clean water
A few years ago, I spent the night at a maternity home in rural Nicaragua.
This happened by chance; at the time, I was travelling with a network of Nicaraguan women working to prevent gender-based violence in remote communities of the Atlantic Coast. We had arrived earlier that day and checked into the only ‘hotel’ in town, only to leave almost immediately due to the number of drunk men on the premises and the unlockable door. The maternity home was the only other available option.
This was a new facility, built through the contribution of a large aid agency. It had many beds, a kitchen, a delivery room, even a young and enthusiastic female doctor.
And it was absolutely filthy.
There was dust everywhere, the beds were dirty with no mattresses or sheets, and cockroaches were rushing around the dirty floor. There was no running water, and so the flush toilet didn’t work either. We paid to have water carried over from a nearby well so that we could at least have a wash. But of course what we could see was just the visible dirt; we tried not to think of the invisible dirt – the multitude of bacteria probably spread around every surface of this ‘flagship’ facility.
I didn’t sleep that night – it could have been the hard floor, the cockroaches, or the drunk man who burst through the door in the middle of the night in search of accommodation. But the overall feeling of filth remained etched in my memory – as is the knowledge that this facility is the only option for thousands of women in surrounding communities, who often make their dangerous way by canoe or horseback in hope of a safe delivery for them and their children.
The few hours I spent there weren’t enough to understand what has led to this situation in such a new facility. Perhaps a broken pipe? A dry water tank due to a lack of rain? Or perhaps more likely, these are the symptoms of a deeper planning and management failure.
Regardless of the cause, the consequence was clear – this facility was failing to provide the most basic of requirements for a safe birth – a clean environment, and clean hands of the doctor and midwives who attended births under these circumstances, in order to avoid life-threatening infections such as puerperal sepsis.
At the time of my visit, Nicaragua had already become a middle-income country; this had done nothing to change the circumstances in poor rural communities. The same situation exists still in most of the countries in which WaterAid works.
A new report published by the World Health Organization this week makes for grim reading, with only 38% of healthcare facilities described as having access to water. Sadly, the healthcare facility I describe here would have counted as ‘having access’, since the well from which water was fetched was within 500m of the facility, and because it had a toilet, functional or not.
Such ‘access’ is a far cry from the standards set by WHO for all healthcare facilities, and leaves so many important questions unanswered. Is water and soap available to healthcare providers in the delivery room, where life-saving handwashing needs to be practiced? Is the water itself safe to drink or to wash with? Who washes the sheets? Who does the cleaning and how well? What happens to medical waste? And as sepsis may take several days to develop, do we even know how many infections occurred as a result of the poor hygiene conditions in this facility?
Preventable infections such as sepsis at birth are not a new threat; they are not an unfamiliar pathogen awaiting further investigation or the development of a vaccine. Nor do they require prohibitively expensive interventions. They have been known to medical practice for generations, and the infection control measures implemented in high-income countries have saved countless lives.
The widespread existence of these conditions is an affront to healthcare professionals, and a terrible and easily preventable injustice. Of course, the solution cannot be to discourage births from taking place in healthcare facilities; home environments may be just as dirty, and lack skilled personnel and the ability to provide emergency obstetric care.
The solution must be to ensure that any existing or new healthcare facilities have the most basic requirement of all – keeping their patients and staff safe. And putting water and sanitation into every healthcare facility must form the bedrock of safe, hygienic healthcare.
Yael Velleman is the Senior policy analyst, sanitation and health at WaterAid
