Essential Elements in Response to Global Health Care Inequalities

By Anthony Rock

As global leaders of governments, industry, finance, and development converged on New York City for the 74th Session of the United Nations General Assembly, the crisis of global inequality was in sharp focus.  Commitments to the UN Sustainable Development Goals, established in 2015, remain woefully unfulfilled, even as societal disparities increase between those with access to more opportunities and those whose most essential needs remain unmet. Borrowing from the immortal words of 19th Century author Charles Dickens, “It was the best of times, it was the worst of times…”

The Gates Foundation, and Bill and Melinda Gates in particular, deserves high praise for giving voice to these inequalities in the Foundation’s third annual Goalkeepers report, entitled “Examining Inequality 2019”.  Moreover, the Foundation rightfully identifies primary health care inequalities among the highest priorities for action at all levels, global to local. Today, more than ever, national leaders cannot ignore the demands of their populations for adequate, essential health services in their communities.

Admittedly, the sheer breadth of needs in primary health care is vast and daunting.  And yet, equality is readily achievable in at least one fundamental area that ties together so many of these health challenges. 

Far too little attention is given to the immense, yet solvable, crisis of inadequate water, sanitation, and hygiene (WASH) in primary health care facilities (HCFs). It is unimaginable today that more than 2 billion people must visit health care facilities that do not provide the most basic requirements of water, toilets and soap.

Most at risk

Mothers and newborns are among the most vulnerable to these problems. More than 17 million mothers give birth each year in hospitals and clinics that lack these fundamental services, risking their own welfare and that of their newborn children. More than one million deaths each year are associated with unclean births, while infections account for 26% of neonatal deaths and 11% of maternal mortality.

Infections are easily transmitted by unwashed hands, contaminated beds, unsafe water, and dirty instruments. The result often includes: increases in healthcare-associated infections; the increased burden of expensive, hard-to-treat and life-threatening resistant infections; and dramatic decreases in patient confidence in health care. These threats are not limited to patients. Lack of WASH places the welfare of many dedicated health care providers equally at risk.

Even the most tenacious and threatening diseases can be mitigated by effective WASH services. To confront the scourge of Ebola, for example, every measure of response is required. And yet, in the Democratic Republic of the Congo (DRC), a country that is ravaged by the Ebola virus, 50% of health care facilities have no water and nearly 60% have no sanitation facilities. Basic hand hygiene supplies are desperately needed, as well.

The foundation for safe care is especially absent in HCFs in developing countries around the world. The first global baseline report analyzed data from over 560,000 HCFs in 125 countries and showed that 45% of HCFs in the least-developed countries lacked basic water services, including 49% of HCFs in sub-Saharan Africa (JMP, 2019).

These unacceptable conditions and their implications in many countries today have not been lost on UN Secretary-General Antonio Guterres. In the past year, he has issued a Global Call-to-Action for WASH in Health Care Facilities, and his spotlight on this crisis has, in turn, inspired a comprehensive UN-led global implementation strategy with ambitious targets for action, as well as a Resolution on WASH in Health Care Facilities, adopted unanimously by member states of the World Health Assembly.

What’s needed?

The Secretary-General’s message is clear and compelling. WASH is a fundamental necessity of primary health services that benefits society uniformly. Experience has demonstrated repeatedly that health systems weakened by inadequate WASH will fail, in turn, to provide for the safety and wellbeing of entire populations, from the most vulnerable to the most productive. Its importance does not distinguish between the rich and poor, the urban and rural, or the young and old. Tragedy comes in the most personal sense; and it puts at risk everything from pandemic prevention and containing anti-biotic resistance, to social and economic growth. Inadequate WASH in health is a crisis of the masses and addressing this key element in global inequality serves critical needs of entire populations. Importantly, solutions do not require new discoveries or technological innovations. This challenge is solvable today, with the tools readily at our disposal.

Leaders at national, regional, and local levels must therefore acknowledge both the moral and the economic imperative to make needed investments in adequate WASH in health facilities for healthy and vibrant societies. Those who are entrusted with delivering health care, as well as water and sanitation services, must, in turn, recognize the imperative to work together for progress. Progress requires training, monitoring, and evaluation to ensure sustainability.

It is heartening that some countries are beginning to recognize this source of inequality and accelerate their responses in response to the UN Call to Action. More efforts are underway to assess national needs and set concrete targets and roadmaps for action with national standards that are consistent with World Health Organization guidelines.

We should be encouraged that the Gates Foundation is shining a bright light on the persistent inequalities in primary health care within and among societies today. More development and finance organizations — global and local, large and small – must identify ways in which their missions and capabilities can support this challenge, and the clearest target of opportunity is unquestionably the foundational health challenge of inadequate water, sanitation, and hygiene in health care facilities.

These inequalities simply cannot be permitted to stand. If it is in our hands to strengthen societies, economically and otherwise, then let those hands be clean and busy securing these most basic services for the wellbeing and dignity of people in health care facilities everywhere.

About the author:

Anthony “Bud” Rock is a Principal at Global Water 2020. Following a distinguished 3-decade diplomatic career in U.S. government service, which included serving in U.S. embassies in Paris, Brussels and Tel Aviv, Mr. Rock was VP for Global Engagement at Arizona State University and the former President/CEO of the Association of Science-Technology Centers, Incorporated (ASTC) and Executive Publisher of Dimensions, the leading professional publication of the science center field.