Infections acquired in healthcare facilities – such as sepsis and pneumonia – are costing Sub-Saharan Africa $8.4 billion each year and leading to thousands of preventable deaths. At least half of these infections could be prevented by improving water, sanitation and hygiene (WASH) in these facilities, finds new research published today (7 April 2024) by WaterAid and the World Bank.
Conducted across seven African countries; Nigeria, Malawi, Ethiopia, Zambia, Uganda, Mali and Ghana, the new data unveiled for World Health Day highlights that if healthcare-acquired infections were to half, then at least 138,000 lives could be saved every year and a staggering $4.2 billion could be saved as a cost to the economy.
The research uncovers that lack of cleanliness and hygiene measures during medical care and recovery time are major causes of transmissions of infection. According to WaterAid, the most common healthcare-acquired infections are surgical site infections, bloodstream infections, and respiratory tract infections, including pneumonia, and the highest rates are found in intensive care units, neonatal wards or ICUs, and pediatric medical wards.
These findings paint a bleak picture, not only of the needless loss of life from entirely preventable causes but of the fact these infections, on average, consume 1.1% of these countries’ GDP and 4.5% of their total health budgets every year. This equates to an $8.4 billion a year cost to the 7 countries in Sub Saharan Africa – equivalent to the total amount needed to provide universal, basic clean water and waste services in healthcare facilities in the 46 least developed countries (LDCs)[i].
In Malawi, the financial toll of these infections on GDP is as high as 2.92%, and a staggering 10.9% of its annual healthcare budget is being absorbed by treating them. This is a cost that will only increase as a greater share of these infections become resistant to antibiotics, warns WaterAid. Antibiotic resistance is a growing global health emergency, contributing to nearly five million deaths every year.
Sol Oyuela, WaterAid’s Executive Director of Global Policy and Campaigns, said:
“Our new research highlights a bleak reality for those living without access to clean water, sanitation and hygiene, from mothers to health care workers. The economic burden of this crisis is falling hard on the shoulders of countries across Sub Saharan Africa.
“Without these basic human rights, millions are left suffering from infections that are increasingly resistant to first-line antibiotics, leading to countless – and needless – deaths from preventable causes.
“And as we learnt during Covid19, superbugs pay little to no respect to country borders. As more infections become resistant to antibiotics, the costs for these countries and the threat to global public health will continue to rise putting us all at risk. This is a global fight and we are not safe until everyone is safe.”
The new data comes ahead of the UN High Level Meeting on antimicrobial resistance (AMR) this September, which will see global leaders gather later this year to discuss the global threat. WaterAid is urging governments to stop preventable deaths in low- and middle-income countries through tackling diseases threatening future pandemics globally.
Clean water, decent sanitation and good hygiene are the first line of defence against infection in healthcare settings[ii], yet WaterAid says that half of the world’s healthcare facilities do not have basic hand hygiene services – rising to two thirds across the 46 least developed countries. When hospitals and clinics do not have these essential services, infections can rapidly spread – putting all patients, including new mothers and babies, at risk and leaving doctors with little choice but to prescribe antibiotics.
Increased investment from donors and international financial institutions for health care facilities is essential to break the chain of infection, decrease the demand for antibiotics, and reduce the opportunity for a resistant infection to become dominant – an investment that would pay for itself. WaterAid is calling for:
- Country governments, UN Member States, international financial institutions and the G7 and G20 Presidencies must work together to make sure every healthcare facility, everywhere has clean water, sanitation and hygiene services (WASH).
- Donor countries, multilateral development banks, and other financing sources must support local governments with financing as a matter of priority to tackle the AMR crisis and to deliver improved water, sanitation and hygiene, as identified in country national action plans.
Sol Oyuela, WaterAid’s Executive Director of Global Policy and Campaigns, said:
“Every healthcare facility must be able to operate with clean water, decent toilets and good hygiene – these are basic human rights – but this won’t be achieved without international collaboration.
“We need to see high income countries and development banks prioritise finance and delivery of water, sanitation, and hygiene in clinics and hospitals in all major global health decision-making, as well as low-and middle-income countries earmarking finance for this in all domestic health budgets.
“If action is not taken imminently, the most vulnerable communities will continue to pick up the tab with their lives now – with the rest of the world soon to follow”.
This reality is playing out in healthcare facilities across Sub-Saharan Africa and beyond. For Joseph, a Clinical Officer at Busolwa Dispensary in Tanzania, working in a facility that had no clean water or hand washing facilities present meant that doctors couldn’t wash their hands after delivering babies.
In one case Joseph recalled a baby being born and wrapped in dirty clothes that were used during the delivery which led to the baby developing life-threatening sepsis. Often, women would give birth and then pick up new infections.
“Before the water, sanitation and hygiene infrastructures were improved, antibiotics were used a lot. You might find that a woman has delivered a baby, and at that time, because the toilets were not safe, a patient leaves with infections, like UTIs, which forces her to come back to the healthcare facility and for us to prescribe her with antibiotics,” he explained.
For Msanide, a Nurse Midwife Technician, at a labour ward in the Mkhuzi Health centre, Malawi, she witnessed first-hand what happens when mothers are left exposed to infection and the devastating consequences that comes with this.
She also explained the strong link between water, sanitation and hygiene and the protection of mothers and newborns alike.
“What pains me most is the pain of that woman who carried that child for nine months and ends up going back home without a baby. It is a painful thing to witness and go through.
“If a nurse midwife is not feeling well due to infections… a woman might develop fever or … some [babies] are born whilst chocking, others are born dead. So, indeed availability of water and good sanitation facilities affects the way babies are born,” she explained.
Claire Chase, Senior Water Economist at the World Bank, said:
“We are very pleased that this new methodology developed by the World Bank can be used by countries around the world to assess economic costs and to help advocate for greater investment in water, sanitation and hygiene.
“This data evidence comes at a pivotal time ahead of the 2024 Spring Meetings in Washington DC, where we’ll be meeting with country voices and global leaders to discuss how we can best respond to these pressing issues.”
Guy Hutton, Senior Economist and Financing Specialist Working in Water, Sanitation and Hygiene who conducted the research, said:
“It should be the number one priority of health systems around the world to combat healthcare associated infections. In the African countries covered in this study, at least one in every 10 patients admitted to hospital is unnecessarily burdened by an additional infection circulating within the hospital.
“These preventable infections impact patients, their families and healthcare providers by causing additional illness, prolonged hospital stay, potential disability, and sometimes death, and they lead to significant excess expenditures and absorb valuable time of healthcare professionals that could have been used to treat other patients.”
