Water, sanitation and hygiene in health care facilities

SEVENTY-SECOND WORLD HEALTH ASSEMBLY WHA72.7 Agenda item 12.5 28 May 2019 Water, sanitation and hygiene in health care facilities The Seventy-second World Health Assembly, Having considered the report on patient safety: water, sanitation and hygiene in health care facilities;1 Recalling the Declaration of Astana from the Global Conference on Primary Health Care (Astana, 25 and 26 October 2018) which envisages strengthening primary health care as the most inclusive, effective and efficient approach to enhance people’s physical and mental health, as well as social well-being, and that primary health care is a cornerstone of a sustainable health system for effective universal health coverage and health-related Sustainable Development Goals; Recalling also resolution WHA64.24 (2011) on drinking water, sanitation and health, which emphasizes the tenets of primary health care as set out in the Declaration of Alma-Ata on Primary Health Care and other resolutions recalled therein (WHA35.17 (1982), WHA39.20 (1986), WHA42.25 (1989), WHA44.28 (1991), WHA45.31 (1992), WHA51.28 (1998) and WHA63.23 (2010)) and resolution WHA70.7 (2017) which stressed the role of improving safe drinking water, sanitation facilities, health care waste management and hygiene practices in primary health care; Recalling further United Nations General Assembly resolution 64/292 (2010) on the human right to water and sanitation and resolution 72/178 (2017) and the United Nations Human Rights Council resolution 39/8 (2018), both on the human rights to safe drinking water and sanitation; Noting that without sufficient and safe water, sanitation and hygiene services in health care facilities, countries will not achieve the targets set out in Sustainable Development Goal 3 (Ensure healthy lives and promote health and well-being for all at all ages) and Goal 6 (Ensure availability and sustainable management of water and sanitation for all), including reducing maternal and newborn mortality and achieving effective universal health coverage, and those in Sustainable Development Goals 1 (End poverty in all its forms everywhere), 7 (Ensure access to affordable, reliable, sustainable and modern energy for all,), 11 (Make cities and human settlements inclusive, safe, resilient and sustainable) and 13 (Take urgent action to combat climate change and its impacts); Noting also that the provision of safe water, sanitation and hygiene services is fundamental for patient safety and has been shown to reduce the risk of infection for patients, carers, health workers and surrounding communities, and noting that progress towards the provision of those services in health care facilities would also allow for effective and timely prevention of cholera, and care for patients with the 1 Document A72/27. WHA72.7 2 disease, in addition to diarrhoeal and other diseases, as recognized in resolution WHA71.4 (2018) on cholera prevention and control; Recalling WHA68.7 (2015) on the global action plan on antimicrobial resistance, which underscores the critical importance of safe water, sanitation and hygiene services in community and health care settings for better hygiene and infection prevention measures to limit the development and spread of antimicrobial-resistant infections and to limit the inappropriate use of antimicrobial medicines, ensuring good stewardship; Noting the findings of the joint WHO and UNICEF report, WASH in health care facilities: global baseline report 2019,1 which revealed that one in four health care facilities lack basic water services, one in five have no sanitation service and 42% have no hygiene facilities at point of care; underscoring the implications of not having these basics in these places, including the spread of infections in places that are supposed to promote health and basic hygiene for disease prevention; and stressing the implications for the dignity of patients and other users who seek health care services, particularly women in labour and their newborn babies; Recalling the statement of the United Nations Secretary-General, making a global call for action for water, sanitation and hygiene in all health care facilities; Noting that the Director-General’s report to the Seventy-first World Health Assembly on health, environment and climate change2 identified global driving forces, including population growth, urbanization and climate change, which are expected to significantly affect the availability and quality of, and access to, water and sanitation services and freshwater resources, and the urgent need for addressing the links between climate, energy, safe water, sanitation and hygiene and health, 1. URGES Member States:3 (1) to conduct comprehensive assessments according to the national context and, where appropriate, to quantify: the availability and quality of, and needs for, safe water, sanitation and hygiene in health care facilities; and infection prevention and control status, using existing regional and global protocols or tools4,5 and in collaboration with the global effort to improve provision of safe water, sanitation and hygiene in health care facilities;6 1WASH in health care facilities: global baseline report 2019. Geneva: World Health Organization and the United Nations Children’s Fund; 2019. 2 Document A71/11. 3 And, where applicable, regional economic integration organizations. 4 WHO and UNICEF. Water and sanitation for health facility improvement tool (WASH-FIT): a practical guide for improving quality of care through water, sanitation and hygiene in health care facilities. Geneva: World Health Organization/UNICEF; 2018 (https://www.who.int/water_sanitation_health/publications/water-and-sanitation-for-health- facility-improvement-tool/en/, accessed 7 February 2019). 5 WHO. National infection prevention and control assessment tool (IPCAT2) and Infection Prevention and Control Assessment Framework at the Facility Level (IPCAF), see https://www.who.int/infection-prevention/tools/core- components/en/ and links therein (accessed 7 February 2019). 6 WHO and UNICEF are jointly coordinating the global efforts to improve safe water, sanitation and hygiene (WASH) in health care facilities. Action is focused on a number of key areas, including national assessments. More information can be found on the knowledge portal on WASH in health care facilities – global action to provide universal access by 2030: www.washinhcf.org (accessed 7 February 2019). WHA72.7 3 (2) to develop and implement a road map according to national context so that every health care facility in every setting has, commensurate with its needs: safely managed and reliable water supplies; sufficient, safely managed and accessible toilets or latrines for patients, caregivers and staff of all sexes, ages and abilities; appropriate core components of infection prevention and control programmes, including good hand hygiene infrastructure and practices; routine, effective cleaning; safe waste management systems, including those for excreta and medical waste disposal; and, whenever possible, sustainable and clean energy; (3) to establish and implement, according to national context, minimum standards for safe water, sanitation and hygiene and infection prevention and control in all health care settings and build standards for safe water, sanitation and hygiene and infection prevention and control into accreditation and regulation systems; and establish accountability mechanisms to reinforce standards and practice; (4) to set targets within health policies and integrate indicators for safe water, sanitation and hygiene and infection prevention and control1 into national monitoring mechanisms to establish baselines, track progress, and track health system performance on a regular basis; (5) to integrate safe water, sanitation and hygiene into health programming, including into nutrition and maternal, child and newborn health within the context of safe, quality and integrated people-centred health services, effective universal health coverage, infection prevention and control, and containment of antimicrobial resistance; (6) to identify and address inequities and interruptions in the availability of adequate safe water, sanitation and hygiene services in health facilities, especially in facilities that provide maternity services and in primary health care facilities; (7) to align their strategies and approaches with the global effort for safe water, sanitation and hygiene in health care facilities2 and contribute to the realization of Sustainable Development Goal 3 (Ensure healthy lives and promote health and well-being for all at all ages) and Goal 6 (Ensure availability and sustainable management of water and sanitation for all); (8) to have procedures and funding in place to operate and maintain services for safe water, sanitation and hygiene and for infection prevention and control in health facilities, and to make continuous upgrades and improvements based on needs so that infrastructure continues to operate and resources are made available to help facilities to access other sources of safe water in the event of failures in the normal water supply, so that environmental and other impacts are minimized and in order to maintain hygiene practices; (9) to educate and raise awareness, in line with regional agreements, on water, sanitation and hygiene, with a particular focus on maternity, hospital facilities and settings used by mothers and children; and to conduct ongoing education campaigns on the risks of poor sanitation, including 1 WHO and UNICEF. Core questions and indicators for monitoring WASH in health care facilities in the Sustainable Development Goals. 2018 (https://www.who.int/water_sanitation_health/publications/core-questions-and-indicators-for- monitoring-wash/en/, accessed 7 February 2019). 2 WHO/UNICEF global activities on WASH in health care facilities. (https://www.who.int/water_sanitation_health/facilities/en/, accessed 7 February 2019). WHA72.7 4 open defecation, to discourage this practice and encourage community support for use of toilets and safe management of faecal waste by health workers; (10) to establish strong multisectoral coordination mechanisms with the active involvement of all relevant ministries, particularly those responsible for health, finance, water and energy; to align and strengthen collaborative efforts and ensure adequate financing to support the delivery of all aspects of safe water, sanitation and hygiene and infection prevention and control across the health system; and to invest in a sufficient and well-trained health workforce, including health care workers, cleaners and engineers to manage safe water, sanitation and hygiene services, provide ongoing maintenance and operations and perform appropriate safe water, sanitation and hygiene and infection prevention and control practices, including strong pre-service and ongoing in-service education and training programmes for all levels of staff; (11) to promote a safe and secure working environment for every health worker, including working aids and tools, safe water, sanitation and hygiene services and cleaning and hygiene supplies, for efficient and safe service delivery; 2. INVITES international, regional and local partners: (1) to raise the profile of safe water, sanitation and hygiene and infection prevention and control in health care facilities, in health strategies and in flexible funding mechanisms, and thereby direct efforts towards strengthening health systems as a whole, rather than focusing on vertical or siloed programming approaches; (2) to support government efforts to empower communities to participate in the decision-making concerning the provision of better and more equitable safe water, sanitation and hygiene services in health facilities, including their reporting to authorities about insufficient or inadequate safe water, sanitation and hygiene services; 3. REQUESTS the Director-General: (1) to continue to provide global leadership and pursue the development of technical guidance to achieve the targets set out in this resolution; (2) to report on the global status of access to safe water, sanitation and hygiene in health care facilities as part of efforts to achieve Sustainable Development Goal 6 (Ensure availability and sustainable management of water and sanitation for all), including through the Joint Monitoring Programme, and to include safe water, sanitation and hygiene and infection prevention and control in health care facilities within effective universal health coverage, primary health care and efforts to monitor the quality of care; (3) to catalyse the mobilization of domestic and external resources from the public and private sectors, and to support the development of national business cases for investment in safe water, sanitation and hygiene and infection prevention and control in health care facilities; (4) to continue to raise the profile of safe water, sanitation and hygiene and infection prevention and control in health care facilities within WHO and at high-level political forums, and to work with other United Nations agencies in order to respond to the United Nations Secretary-General’s call to action in a coordinated manner; WHA72.7 5 (5) to work with Member States and partners to review, update and implement the global action plan and support Member States in the development of national road maps and targets for safe water, sanitation and hygiene in health care facilities; (6) to work with partners to adapt existing reporting mechanisms and, if necessary, develop new such mechanisms in order to capture and monitor progress on the coordination, implementation, financing, access, quality and governance of safe water, sanitation and hygiene and infection prevention and control in health care facilities, according to established indicator reporting methodology for Sustainable Development Goal 6 (Ensure availability and sustainable management of water and sanitation for all);1 (7) to support coordination and implementation of safe water, sanitation and hygiene and basic infection prevention and control measures in health care facilities and triage centres in times of crisis and humanitarian emergencies through the Health and WASH clusters, leveraging partnerships to prevent disease outbreaks in these contexts; (8) to report on progress in the implementation of the present resolution to the Health Assembly in 2021 and 2023. Seventh plenary meeting, 28 May 2019 A72/VR/7 = = = 1 Includes protocols, methods and reporting conducted by the WHO/UNICEF Joint Monitoring Programme and the WHO-led UN-Water Global Analysis and Assessment of Sanitation and Water.