Intended for healthcare professionals

Feature The BMJ Appeal Christmas 2019

The BMJ Appeal Christmas 2019: With WaterAid’s help, cleaner clinics offer safer healthcare

BMJ 2019; 367 doi: (Published 19 December 2019) Cite this as: BMJ 2019;367:l6977
  1. Jane Feinmann, freelance journalist
  1. London, UK
  1. jane{at}

WaterAid brings clean water, sanitation, and better hygiene to the most vulnerable people worldwide, which is why we’ve chosen the charity for The BMJ’s Christmas appeal this year, writes Jane Feinmann. Please give generously

Avelina Alfred’s first child died just hours after she gave birth. This 21st century experience of childbirth is a shocking reminder of an easily forgotten truth: that clean water on tap is essential to providing effective healthcare.

Alfred had given birth last year in a village clinic in northwest Tanzania that at the time lacked running water and proper toilets. She doesn’t know the exact cause of death, but what happened is not unusual in such settings. Worldwide a newborn baby dies on average every second from an infection related to a lack of safe water and an unclean environment, it has been estimated.12

“The hospital was always dirty,” Alfred told The BMJ. Like every other patient, she paid for water to be collected from a nearby lake. “1000 shillings [£0.32; €0.39; $0.43] for four buckets—and when the water ran out we would have to buy some more,” she recalls.

Things at Nkome Dispensary clinic are very different now, however, thanks to the international charity WaterAid, which in the past year has helped bring clean water and sanitation to 149 healthcare facilities—and nearly 1.5 million people.

In early 2019 WaterAid funding enabled a piped water connection and water storage tanks to be installed at the clinic.

Earlier this year 23 year old Alfred gave birth to a healthy child. “There is tap water available in the maternity wards, and the whole hospital is clean,” she said.

Yet a vast effort is needed to bring water, sanitation, and hygiene services to every healthcare facility worldwide. Doctors in high and middle income countries, who take it for granted that they can wash their hands before attending to patients and where staff clean the floors and linen, may struggle to appreciate the scale.

Figures from the World Health Organization and Unicef’s Joint Monitoring Programme for WASH (water, sanitation, and hygiene services) show that 896 million people use healthcare facilities that have no water service and 1.5 billion use facilities with no sanitation.3 A fifth of the world’s healthcare facilities, including almost one in 10 hospitals, have no toilet other than rudimentary setups such as pits or bucket latrines.

The Unicef programme estimates that 17 million women in the world’s poorest countries give birth each year in health centres with inadequate water, sanitation, and hygiene—increasing the risk of deadly infections in mother and newborn. One is Katiu Community Health Centre in northern Ghana, where WaterAid is currently hoping to introduce WASH facilities. The midwife Faustina Sedjoa provides care in a unit where she and her clients have to collect dirty water from a borehole outside the compound. “There is one pit latrine, but it is dirty and unsafe, so pregnant women are advised not to use it. They share one chamber pot and have nowhere to bathe after giving birth,” she says.

The problem is dire, says Ibrahim Kabole, WaterAid’s country director in Tanzania. “Lack of clean water and sanitation in healthcare facilities makes it very hard to prevent infections, especially for new mothers,” he says. Without WASH, says Ibrahim, a medical doctor, “communities are at higher risk from deadly diseases and conditions, such as cholera, diarrhoea, sepsis, malnutrition, pneumonia, and trachoma.”

What’s more, dirty hospitals are hardly likely to enhance confidence. “Patients may be unwilling to attend the health centre and prefer to give birth at home, which can lead to complications,” he explains.

Queen Kulwa Machella, also a doctor, began her first job as clinical officer at Nkome’s clinic with the new WASH facilities in place, and states the obvious, at least for high and middle income countries. “Water is so important. We need it to clean everything to stop the transmission of infections. Without it, patients are at risk, and I would also be at risk of acquiring infections,” she says.

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


How to donate

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


  • Provenance and peer review: Commissioned; not externally peer reviewed.

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


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