New data from the Joint Monitoring Program show global progress on WASH in health care facilities

Background

The World Health Organisation/United Nations Children’s Fund (WHO/UNICEF) Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) has published their 2024 data update , with a special focus on WASH and Primary Health Care (PHC). Ensuring an adequate supply of safe water and basic sanitation, the report states, has long been seen as integral to PHC. The report describes PHC as a whole-of-society approach to health that aims to maximize the level and distribution of health and well-being by putting primary care and essential public health functions at the heart of integrated health services.

In the 2024 update, the authors explore the interrelationships between PHC and Water, Sanitation and Hygiene (WASH) services, underlining the central importance of WASH to the advancement of PHC, arguing that adopting a PHC approach is critical to improving (WASH) services, and vice versa.  

The JMP has collected and reported on, national, regional and global estimates of progress on drinking water, sanitation and hygiene (WASH) services since 1990. In support of its vision of the “progressive realization of universal access to drinking water, sanitation and hygiene (WASH) and the reduction of inequalities in service levels by 2030”, the JMP strives to produce reliable estimates of national, regional and global progress on WASH to inform decision making. To this end, the JMP maintains an extensive global database and has become the leading source of comparable estimates of progress at national, regional and global levels.

The JMP has been reporting specifically on health care facilities since 2019, when it published a global baseline report. The report contained harmonised estimates for water, sanitation, hand hygiene, health care waste management, and environmental cleaning (WASH) services in health care facilities. The report was followed by three subsequent reports on fundamentals in health care facilities in 2020, infection prevention and control (IPC) in 2022 and this year’s report on primary health care (PHC).

The WHO and UNICEF are active in over 190 countries worldwide and obtain their data from regular national surveys and in consultation with national data sources and authorities. The JMP strives to support countries to adapt and apply the new SDG targets and indicators in national development plans and to provide guidance on how information from household surveys, administrative systems and other sources can be integrated in order to monitor progress.

WHO and UNICEF, through the JMP, are custodian agencies for the SDG targets 6.1 and 6.2 on drinking water, sanitation and hygiene. WASH in health care facilities is also essential for achieving SDG target 3.8 which aims to provide access to quality essential health care services for all.

WHO and UNICEF, as co-facilitators of the global efforts on WASH and waste in health care facilities, have recently – through a publication - launched a Global Framework for Action (2024-2030) to increase political commitment and leadership, and rapidly scale up investments through joint advocacy with major health, WASH, waste management and energy initiatives. The Global Framework follows from United Nations General Assembly resolution on sustainable, safe and universal water, sanitation, hygiene waste and electricity services in health care facilities. All 193 United Nations Member States unanimously approved the resolution in December 2023.

 

The 2024 update

The JMP publishes updated estimates on WASH in health care facilities in even years, and the current 2024 update presents updated country, regional and global estimates for WASH in health care facilities up to the year 2023, replacing previous progress updates.

The JMP uses service ladders to benchmark and track progress on WASH services. For the purposes of global monitoring, the definition of WASH in health care facilities not only includes 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.

The JMP produces regional or global estimates when data are available from countries representing at least 30% of the relevant regional or global population. For 2023, the reference year of the 2024 update, insufficient data were available to produce such global estimates for any of the five basic service levels. This lack of data is caused in part by the timing of household surveys, which take place once every four to six years, so that in some reporting years, there is as yet no renewal of data, and one has to rely on earlier statistics.

Nevertheless, there were recent data from enough countries to produce estimates of the population without access to water, sanitation or hygiene services: in 2023, 742 million people (9% of the global population) had no water service at their health care facility, 660 million people (8%) had no sanitation service at their health care facility, and 722 million people (9%) had no functional hand hygiene facilities at points of care or at toilets.

A year earlier, in 2022, it was possible to report that globally, 78% of health care facilities (serving 6.2 billion people) had basic water services and a further 11% (serving 861 million people) had limited water services. Also, 57% of health care facilities (serving 4.6 billion people) had basic hand hygiene services, while 34% (serving 2.7 billion people) had limited hygiene services.

The report also shows that data availability on the topic of WASH in health care facilities is rapidly improving over time. Based on the available data, the 2024 update concludes that the total number of countries with estimates for basic WASH services has grown steadily from 2019 to 2024. For instance, while in 2019 data was only available from 38 countries on basic water services in health care facilities, this had risen to 73 countries by 2024. In the area of sanitation services, data was only available from 18 countries in 2019, rising to 52 countries in 2024. In 2019, data was available from 14 countries on basic hygiene services in health care facilities, rising to 48 in 2024. Furthermore, data coverage is higher in some regions, typically where health facility assessments are regularly supported by development partners, such as least developed countries (LDCs), and low- or lower-middle-income countries.

Data coverage is also relatively high for the set of 60 countries, areas and territories classified by the Organisation for Economic Co-operation and Development (OECD) as ‘fragile contexts’, based on a framework that encompasses six dimensions of fragility (economic, environmental, human, political, security and social). The 2024 update highlights the status of WASH in health care facilities in fragile contexts because they represent particularly vulnerable populations who often lack primary health care and are in most urgent need of quality health care services.

In the 60 countries, areas and territories classified as ‘fragile contexts’, more than a third (37%) of health care facilities lacked a basic water service in 2023. Less than half (46%) had basic hygiene, only a third (34%) had basic environmental cleaning, a quarter (25%) had basic waste management and less than a fifth (19%) had basic sanitation services. Globally, 2 billion people lived in these fragile contexts in 2023. Of these, 1.6 billion people lacked basic sanitation at their health care facilities, 1.5 billion lacked basic waste management, and 1.3 billion lacked basic cleaning. In addition, 1.1 billion people lacked basic hygiene and 717 million lacked basic water services.

Furthermore, the 2024 update mentions the great variability in coverage of basic WASH services within SDG regions, most notably in Northern Africa and Western Asia where it ranges from less than 20% access to universal coverage (more than 99% access). While some countries have already achieved universal coverage for all five basic WASH services, there is at least one country in each region with coverage below 25% for one of the basic services.

The 2024 update also states that it is common for service levels to be lower in fragile contexts - which account for the majority of countries in the world which have less than 20% coverage of basic WASH services. The JMP only produces regional estimates when data are available that represent at least 30% of the regional population. Regional estimates are currently available for all WASH services in Northern Africa and Western Asia, and for all but environmental cleaning services in sub-Saharan Africa.