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Investing $600 million in water and toilets in health facilities could help stave off the next pandemic

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Providing clean water and toilets in every health facility in the poorest countries in the world would cost the equivalent of just under 1.5 hours of this weekend's Easter spending in the US and UK[1], according to new analysis by WaterAid released today.

Ahead of finance ministers for the world's richest economies meeting on Tuesday in Washington, WaterAid is calling on donor governments to invest US$600 million a year – which would contribute to saving millions of lives and be an important defence against the next pandemic, the charity said.

WaterAid’s analysis builds on research recently published in the Lancet[2], by focussing on the lack of water, sanitation and hygiene access in health facilities in the 46 least developed countries where the need for safe water and sanitation is highest and the financing gap largest.

The charity said that investment in clinics and hospitals in these countries is more urgent than ever, with pandemics and anti-microbial resistance becoming an increasing health threat[3]. Currently only half of healthcare facilities in the least developed countries have water on site. Additionally, the poorest countries are struggling to respond to due to rising living costs, the economic impacts of COVID-19 and a debt crisis engulfing the global south which limits fiscal space to invest in essential services.

Claire Seaward, Global campaigns director, WaterAid, said: “A perfect storm of COVID-19, rising living costs and the spiralling debt crisis mean that already stretched health services across the globe are being pushed to breaking point.

“As a result, patients may not get the care they need – or worse find the clinics and hospitals they go to for treatment or to give birth in are breeding grounds for disease. In low-income and middle-income countries, more deaths occur due to poor quality care than from lack of access to care[4].

“Investing in water, toilets and hand hygiene save lives, eases pressure on health services and protects patients and staff.

For just 2.6% of the consumer money the UK and US will spend over this Easter weekend, donor governments could save millions of lives and break the devastating cycle of debt, so that poorer countries are able to provide for their own people.”

Dr Maria Neira, Director of Department of Environment, Climate Change and Health of WHO in Geneva, said. “Our pricetag analysis shows it would take just 0.60 USD/per capita/per year to provide universal basic WASH and waste services in health care facilities in the 46 least developed countries. This is a modest cost compared to current government spending and donor investments in health and WASH, and it’s very do-able. The economic and social benefits of such fundamental investments are enormous, from mother and newborn lives saved, antibiotic use averted to health worker retention.”

WaterAid’s analysis reveals that 75% of global funding for water and sanitation is now in the form of loans when the “gold standard” (set by the Development Assistance Committee (DAC) is that loans should comprise no more than 10% of development financing.

With external debt in low and lower-middle income countries almost doubling from $1.4 Trillion in 2011 to $2.6 Trillion in 2020, countries face a deepening cycle of debt and reliance on external financing. Many countries are now paying more in debt than on health annually with 60%[5] of low-income countries now officially in debt distress or at high risk of it.

WaterAid is calling on the world’s richest countries, including the G7, who will meet in Germany in June, to deliver on the US$600 million annual funding gap in order to provide lifesaving water sanitation and hygiene facilities to healthcare centres in some of the poorest countries by 2030.

In order to achieve this – the leading economies must meet their international aid commitments and ensure that responding to the crisis in Ukraine doesn't come at the expense of millions of lives elsewhere


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Notes to Editors:


Research published on the 7th April 2022 in The Lancet found that around between US$6·5 billion to US$9·6 billion is needed from 2021 to 2030 to achieve water and sanitation provision in every public health facility in the world’s poorest countries. WaterAid's analysis assesses how much of these costs can realistically be met from LDC domestic resources. The financing gap identified once this is taken into account is around US$600 million a year.

The World Health Assembly resolution 72.7, unanimously agreed in 2019, international, regional and local partners committed "to help fill the gap in resource-limited countries by implementing efforts to provide WASH in health facilities."