Building better links between WASH and the health sector – the role of universal health coverage?

Liam_SollisToday marks World Water Day, an opportunity to remind ourselves of the severe dearth of services and facilities that provide adequate water, sanitation and hygiene (WASH) conditions across the world. The figures remain stark. Two and a half billion people do not have access to basic sanitation worldwide, over one billion rely on open defecation, and 768 million people are without access to improved sources of drinking water. Clearly, despite broad awareness that WASH is fundamental to health outcomes, efforts to redress poor conditions have largely been too slow and ineffective.

So what does this mean for the health sector? Firstly of course, it means a huge strain on resources with some estimates suggesting as many as half of all hospital beds in developing countries are filled with people affected by WASH-related illnesses. But we should also see inadequate WASH conditions as not only a burden on the health sector, but as a challenge that the health sector must be first in line to tackle.

In our recent conference in Dakar, AfGH hosted a discussion on the role of Universal Health Coverage (UHC) in attaining the right to health for all. UHC is first and foremost about strengthening health systems to ensure greater equity in the delivery of health care, but time and time again we heard delegates stress that UHC is a component part of wider efforts to realise the right to health for all, and it cannot be seen in isolation. The right to health is intrinsically linked to rights to social security, adequate food, freedom from discrimination and in particular, the right to clean water and adequate sanitation.

To achieve improved health outcomes for all, we need to better appreciate these interlinkages, something current discussions around the post-2015 development framework are encouraging us to do. The Open Working Group (OWG) report recently published its second draft of its focus area document identifying the many interlinkages between health and other sectors, but is some way off pinpointing what that might mean in practice, and how the future framework will reflect these links. This is a challenge for all of us involved in post 2015 and health; we must do more to highlight the important role integrated approaches to health can play in improving health outcomes, and identifying how these links can best be utilised.

In our recently published paper written in collaboration with WaterAid, we emphasise how any comprehensive definition of UHC must incorporate WASH. It suggests that health systems should lead the cross-sectoral action on WASH as a central component of efforts to improve public health; and that UHC efforts are used as an opportunity to redress the neglect of WASH, through embedding it into key functions of the health sector.

WASH is critical to the quality of care provided and levels of infections contracted in healthcare settings. A clean health facility is a safer health facility, but nonetheless healthcare-associated infection rates remain far too high, which can have deadly consequences (eight per cent of maternal mortality is still caused by sepsis globally).

Ensuring facilities remain hygienic, providing clean water, safely disposing of waste; these are simple steps that can be taken within the health sector that will have a positive impact on health outcomes. In recent decades the lack of joint action on health and WASH has resulted in poor progress in key areas, including maternal, new-born and child health. Momentum towards UHC gives us an opportunity to address these failings and take a big step towards realising the right to health for all.

Read our paper to find out more:

Realising the right to health for all: Universal Health Coverage (UHC) and Water, Sanitation and Hygiene (WASH)


Liam Sollis
Policy and Advocacy Advisor
Plan UK



  1. Mandy says

    I understand the global momentum towards UHC btu I firmly believe that UHC cannot be achieved without other determinants including water and sanitation.
    Many countries fail to acknowledge that.


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