STRONG HEALTH SYSTEMS DON’T EXIST WITHOUT WATER, SANITATION AND HYGIENE: LESSONS FROM COVID-19

This post is part of a series authored by the BASICS (Bold Action to Stop Infections in Clinical Settings) team. BASICS is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%. Tanzania is one of the four countries where BASICS’ rollout is planned

This post originally appeared on WaterAid’s website on April 1, and is reposted with permission.

As of March 31, the World Health Organization (WHO) had reported some 719,000 confirmed cases of coronavirus (COVID19) and 33,000 deaths in 203 countries. Declared a pandemic by the WHO on March 11, infections have spread at a rapid pace, creating an unprecedented global crisis. Many countries continue with full lockdown measures to help slow transmission. Healthcare systems are overwhelmed.

The pandemic has hit Europe and North America hard, and there are fears that African countries could see a similar outbreak, which could have devastating impacts on people’s health, education and livelihoods.

The ability to protect ourselves literally falls into our own hands, as COVID-19 can spread between people through contact with droplets of an infected person. Good hygiene practices are among the key measures for preventing the spread of COVID-19 – and hand hygiene is at the forefront. Effective hand hygiene entails washing hands with soap for at least 20 seconds – this is one of the main ways to protect yourself from contracting the infection.

Handwashing with soap is simple but effective. This is because it inactivates and removes virus particles that may be on our hands. When used properly, soap effectively dissolves the fatty membrane that surrounds the virus particles, causing them to fall apart and be inactivated.

Research shows that handwashing with soap is linked to a 16-23% reduction in acute respiratory infection, substantial reductions in neonatal infections, and a 50% reduction in pneumonia (source: The Lancet).

While the WHO has called on people and governments to emphasize hand hygiene and environmental cleanliness as the most effective way to prevent the infection and spread of COVID-19, this advice is difficult in countries lacking access to clean water, decent toilets and good hygiene. Statistics from the WHO/Joint Monitoring Programme (JMP) show that one in 10 people worldwide have no access to clean water close to home, and around 1.4 billion people have no handwashing facility at all.

Water, soap, and supplies to prevent and control the spread of infections are quintessential for frontline health workers to be able to perform their jobs effectively – yet one in six healthcare facilities globally has no soap and water available for patients, doctors and nurses to wash their hands. Research has shown that over 30% of healthcare facilities in Tanzania lack access to clean water, making hand hygiene a challenge (source: Tanzania Service Provision Assessment).

Additionally, while European countries are implementing lockdown measures and social distancing, many people in low-income countries rely on day-to-day incomes and simply don’t have the option of remaining home. In these places, investing in water, sanitation and hygiene (WASH) is an effective strategy for helping people to practice good hygiene and reduce their risk of COVID-19 and other diseases.

The pandemic and other contagions underscore the practical need for Tanzania to invest in WASH in our communities, schools, public utilities (markets, bus stations) and healthcare facilities. Ensuring that communities can practice good hygiene will dramatically reduce the risk of people contracting infections and reduce the strain on the already stretched healthcare system.

In 2017, the Ministry of Health, Community Development, Gender, Elderly and Children launched the National Guidelines for Water, Sanitation and Hygiene in Healthcare Facilities. The Ministry of Education, Science and Technology also launched guidelines for WASH in schools. We must support the government to ensure these guidelines are resourced and rolled out. This will create resilience within the health and education systems and put us in a better position to deal with future disease outbreaks.

WaterAid Tanzania and our partners will continue to support the government to invest in national hygiene promotion to help equip citizens with the hand-hygiene knowledge and tools they need to protect themselves and their communities. WaterAid will also increase our investment to scale up the provision of WASH services, improve access to handwashing facilities at key locations, use mass media to share important handwashing and hygiene messages, and support healthcare and frontline workers on Infection Prevention and Control training.

In the long term, more investments in WASH are needed to accelerate access and achieve the goals of Tanzania’s Development Vision 2025 and Sustainable Development Goal 6 – universal access to water and sanitation. This means embedding WASH interventions into key national development sectors – putting it firmly at the center of national development. We must take the lessons from COVID-19 to create stronger and more effective health systems.

This is a time where we can all take action. Individuals can  practice good hygiene behaviours to protect themselves and others from the coronavirus; donors can invest in WASH as a core priority of global health security; NGOs and development partners can support the government in its efforts to strengthen hygiene behaviour change programmes and WASH interventions; and media can support getting correct information to the public.

Lastly, we are all indebted to our healthcare workers across Tanzania and across the globe, who are putting themselves at risk to save the lives of others. The best way we can support them is to ensure that they are working in a safe environment, and for that let us push to ensure all healthcare facilities have clean water, decent toilets and good hygiene.