Opinion: From resolution to revolution in health care

A health worker attends to patients at the Chikuni Mission Hospital in Monze, Zambia. Photo by: Bread for the World / CC BY-ND

When the World Health Assembly’s 194 members unanimously adopted a resolution earlier this year calling for universal access to water, sanitation, and hygiene in hospitals and other health facilities, it was a critical step forward for patients and staff; and tackling antimicrobial resistance and disease prevention.

Now it’s time for the WASH revolution — and if recent events are indicative of commitments, we have good news. National governments recognize that the health and well-being of our people is a prerequisite to socio-economic development. Getting there will require a paradigm shift — from raising awareness to tangible and sustainable action so that WASH services are available in all types of health care facilities and in diverse environments.

I’m heartened, having recently come from the inaugural country-level meeting, hosted by the World Health Organization and UNICEF in my country, to see that the revolution has begun. Eighteen countries made substantive commitments and began to develop action plans, with timelines, for each of the eight actions outlined in the WHA resolution.

It is not just this continent that faces this WASH challenge. A recent WHO/UNICEF report reminds us that 1.5 billion people in low- and middle- income countries use health care facilities that lack water services. Two billion people use health care facilities without sanitation services. The provision of water was reported to be lowest in the African region, with 42% of all health care facilities lacking an improved source of water on-site or nearby.

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Health care-associated infections affect hundreds of millions of patients every year around the world, with at least 15% of patients estimated to develop one or more infections during a hospital stay. The burden of infections is especially high in newborns. Sepsis and other severe infections are major killers, estimated to cause 430,000 deaths globally, every year.

It is clear that we cannot accelerate progress toward the reduction of maternal, newborn, child, and adolescent morbidity and mortality without smart investment in WASH services in health care facilities.

Zambia is taking proactive steps to move our nation from challenges to solutions. Our national development plan has prioritized access to adequate and safe WASH as a high impact service to accelerate human capital development. Without it, we recognize that there can never be “health for all.”

As a country, we first needed a better understanding of the problem. With support from WHO, in August 2019, we conducted an assessment of WASH services in our health care facilities in six provinces. We found that improved water supply stands at 69%; improved sanitation at 53%; health care waste management at 64%; hand hygiene at 62%; cleanliness and disinfection at 49%.

The Zambian government is resolved to use an integrated and multisectoral approach to engage various stakeholders within the country and beyond to improve the status quo. We are focused on strengthening key health systems to sustainably improve service delivery that includes WASH services.

Guided by our national health strategic plan 2017-2021, Zambia has recruited 22,000 health workers since 2017, working at various levels of the health care system, to improve health service delivery as well as patient safety. The ministry has prioritized human resources as a key pillar in improving service delivery and we remain committed to achieving our legacy goal of recruiting 30, 000 health care workers by 2021 having recruited 22,000 health care workers since 2017.

We are modernizing our hospitals, constructing 650 health posts, and 108 mini-hospitals in which WASH services have been prioritized.

Of course, we cannot do this without funding. Our government is also in the process of implementing a national health insurance scheme, which is expected to bring extra revenue to support health programs including WASH services. The scheme entitles, to contributing members, a predetermined set of health care benefits. In other words, the introduction of compulsory national health insurance will ensure that no Zambian will have to suffer financial hardships when accessing health care services.

Getting WASH into health care facilities catalyzes important health and social benefits beyond health care facilities themselves. To further spur improvement in the health status of our people, we have developed an antimicrobial resistance action plan; we developed and are implementing a national adaptation strategy in response to climate change; and we expect our national action plan for public health security to leverage resources for WASH services.

We believe it has become an imperative for all WHO member states, partners, NGOs, civil society, leaders — at all levels, academia, research institutions, the media, and other stakeholders to prioritize investment in WASH services in health care facilities if we are to significantly improve the health and well-being of our people and accelerate progress toward the attainment of the multiple health-related SDGs.

It’s also time that we partner and build strong cross-region coalitions to improve WASH services. Our nations are strategic allies that together, can explore and galvanize support for policies and resource mobilization that improve health, and with better health, economic progress across Africa.

I am convinced that these approaches and coordination will accelerate our attainment of the global targets set by WHO, of ensuring that 60% of all health care facilities globally have at least basic WASH services by 2022; 80% by 2025; and 100% by 2030.  

We are answering the U.N. Secretary General’s António Guterres global call to action, calling for prioritization and amplification of the significance of WASH services in all health care facilities, and the WHO 2019 resolution to implement those WASH services.

Collectively, we can be that generation that changed the landscape and triggered health care improvements for the benefit of all our citizens, but especially those among us who are the most vulnerable of all.

About the author

  • Zambia%2520moh%2520headshot

    Chitalu Chilufya

    Dr. Chitalu Chilufya, a physician, is Zambia's minister of health since August 2016. He is also a member of the National Assembly of Zambia, representing Mansa Central.