The COVID-19 pandemic is a global emergency that demands urgent collective action – not only to withstand this crisis but to build resilience against the threat of future health crises.
Together with physical distancing, practicing good hygiene is a vital first line of defense against COVID-19 and at the core of public health advice from the World Health Organization (WHO).
It is especially crucial in the absence of a vaccine for COVID-19. Handwashing is one of the most effective disease prevention methods available. Evidence suggests it can reduce cases of pneumonia by 50% and acute respiratory infection by 16–23%, while reducing risk of endemic diarrhea by 48%.1 Public health is impossible without access to clean water, soap and hygiene services for frontline health workers, their patients, and communities. Yet globally, 3 billion people lack soap and water at home. The situation is similarly stark in health centers globally.
2 in 5 people lack hand hygiene facilities at the point of care. 1 in 4 people has no clean water on site. 1 in 5 have no decent toilets to use. In least-developed countries, nearly half have no clean water on-site and only 1 in 4 can safely dispose of medical waste.
This presents a critical weakness in health systems – a fundamental flaw in our collective armor for global health security. Governments and donors have neglected to invest adequately in the basics of clean water, soap and decent toilets for decades and, even now, hygiene investment to bolster weak health systems is largely absent from COVID-19 national responses and donor support.
Water Aid already urges Heads of Government and Health Ministers to take the following critical actions, in line with WHO guidance, ensuring that urgent investment in hygiene and public health is central to a COVID-19 response and rebuild strategy.
The Government of Tanzania and WaterAid will focus on three high-risk regions including Dar es Salaam, Arusha, and Zanzibar, and build on existing programs in the Geita region. Interventions will support the Ministry to scale up WASH services including handwashing facilities at key locations, mass media campaigns for handwashing and hygiene messages, and provide critical training for healthcare and frontline workers on Infection Prevention and Control (IPC). In line with National Guidelines for WASH in healthcare facilities, IPC and WASH interventions will respond to COVID-19 while strengthening resilience to future health crises.
The Ministry of Health in Cambodia has focused on improving the quality of care across its health system by improving basic water and sanitation services at healthcare facilities. Challenges persist in hygiene and cleaning infrastructure, training, and practices. A Provincial Health Department is working with WaterAid to rapidly assess hand hygiene infrastructure and management at primary health facilities, to help identify and address gaps and challenges in implementing COVID-19 response requirements. Additionally, a review of cleaning guidance and knowledge of cleaners on the frontline is underway to support improved training.
COVID-19 knows no borders, yet it has exacerbated multiple dimensions of inequality – economic, gender, rural, urban, age, ability, and access to basic WASH and health services. Frontline health workers, community health volunteers and carers are predominantly women. They face an increased risk of infection in conditions with limited WASH; as well as increased pressure to manage lack of WASH; increased exposure to the virus; and increased risk of violence and retaliation in times of crisis.
Lockdown measures present further risks to health and safety, especially for women and children, while those living in crowded urban slums have no way to physically distance themselves and no sanitation services. Ensuring that COVID-19 responses promote equitable access to WASH is essential to realizing human rights and can be a critical step in tackling these persistent inequalities. Furthermore, it mitigates the impact on livelihoods and maintains the gains made against existing global health priorities such as nutrition, cholera, sexual and reproductive health rights (SRHR), and neglected tropical diseases (NTDs). Investing in WASH now is a ‘no regrets’ action that Member States must take to confront COVID-19, sustain existing public health interventions, and build resilience to future crises.
Immunisation programs are currently at risk due to impacts of COVID-19.5 Comprehensive disease control and prevention requires inclusive and sustainable WASH services and hygiene behaviors, alongside established immunisation programs. There is a strong rationale for the joint delivery of these essential services as immunisation programs reach more people than any other health intervention and serve as an entry point to integrate WASH – with particular emphasis on hygiene behavior change.
As the world waits for a COVID-19 vaccine, Water Aid urges the Member States to prioritize joint delivery of hygiene and immunisation, and utilize the flexibility that Gavi has provided to reallocate up to 10% of existing health system strengthening investments to fill critical gaps in hygiene services. Prioritizing joint delivery of integrated programs now will ready national plans, help sustain critical immunisation platforms, and stand ready with hygiene-integrated approaches for the eventual launch of a COVID-19 vaccine.
