Intended for healthcare professionals

Feature The Big Picture

The BMJ Christmas 2019 appeal: a health centre is not a health centre if it doesn’t have clean water

BMJ 2019; 367 doi: (Published 05 December 2019) Cite this as: BMJ 2019;367:l6807
  1. Dan Jones, advocacy coordinator
  1. WaterAid, London SE11 5JD, UK
  1. danjones{at}

In Kharumwa Hospital in northwestern Tanzania doctors such as Casmir Lubango (pictured) have seen clean water and good sanitation transform the healthcare they provide. Lubango’s hospita­­­l used often to run out of clean water or had to use it sparingly, until the international charity WaterAid helped bring a reliable source to the hospital, as well as decent toilets and hygiene training.

“I’m happy we have enough water at the health centre now,” said Lubango. “Personal hygiene among patients has greatly improved. Our wards are congested but very clean.

“Improved access to water and good hygiene practices in a hospital environment means infection prevention and control. There are no longer sepsis cases, due to improved hygiene.

“These things combined have won us the trust and confidence of the patients, leading to more people visiting the health centre for medical attention.”

Clean water, decent sanitation, and good hygiene are essential to quality healthcare, yet a quarter of the world’s healthcare facilities have no clean water on site, a fifth lack basic sanitation, and almost half don’t have handwashing points where treatment is given.1

Without clean water and soap to keep their hands, equipment, and the environment clean, healthcare staff cannot prevent the spread of diseases, a particular threat to mothers and babies. Every minute a newborn baby dies from infection caused by lack of safe water and an unclean environment.23

The spread of infection can increase antimicrobial resistance, resulting in longer hospital stays, more treatment, and a greater risk of death. Deaths from antimicrobial resistance are predicted to outpace those from cancer by 2050,4 and we cannot hope to tackle this global health threat without getting the basics of infection prevention and control right.

Improving access to clean water, decent sanitation, and good hygiene in healthcare facilities is a cost effective way to uphold infection prevention and control, reducing the incidence of infections overall, cutting the need for antibiotics, and helping to curb antimicrobial resistance. The result is long lasting health and economic benefits for populations everywhere.

The charity WaterAid works locally, nationally, and globally to put clean water, decent toilets, and hygiene at the centre of good healthcare. It helps to bring these basic facilities to health centres in some of the world’s poorest countries and collaborates with governments to prioritise clean water and good sanitation in healthcare provision.

In May health ministers at the World Health Assembly unanimously agreed a formal resolution that ensuring provision of safe water, sanitation, and hygiene in healthcare facilities was “fundamental for patient safety and has been shown to reduce the risk of infection for patients, carers, and health workers.”5 This resolution is a start, not an end. A strong healthcare system is our frontline defence against disease, but a health centre is not a health centre if it doesn’t have clean water. The basics have been neglected for too long, and without getting them right we will undermine other efforts to ensure safe care for all.

Donations from BMJ readers would support WaterAid in helping more people to live healthier lives. The charitable Alchemy Foundation will double every donation from BMJ readers up to £25 000 (€30 000; $32 000). For a more significant gift, please email

WaterAid needs your support: please give generously

  • £60 is enough to buy a clean water tank for a school in a country such as Burkina Faso

  • £144 is enough to install handwashing stations

  • in one school in a country such as Malawi

  • £288 is enough to build two toilets in a country such as Ghana

Donate online:

Donate by phone: +44 (0) 300 123 4341


  • Competing interests: I have read and understood the BMJ policy on declaration of interests and have no relevant interests to declare.

  • Provenance and peer review: Not commissioned; not externally peer reviewed.


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