2.8.

4 A crisis in water and sanitation in

educational institutions and health
facilities
Infection prevention and control (IPC) is a core
midwifery and nursing responsibility, essential to
the prevention of maternal and newborn sepsis,
especially in the current time of antimicrobial
resistance. Yet one in four health care facilities
globally lack basic water services, and one in five
have no sanitation service (15).
There are twice as many maternal deaths from
infection (sepsis) in LMICs as in higher-income
countries (HICs), and twice as many health care
facilities in LMICs have no water service than in
HICs. More than one million deaths each year are
associated with unclean births, and infections
account for 26% of neonatal deaths and 11% of
maternal mortality (15).
Without a reliable supply of water and access to
sanitation for education and training, IPC is
unlikely to become the everyday habit it needs to
be. Early findings from the WHO Midwifery
educator survey highlight the poor state of many
educational institutions that lack basic
infrastructure, including water and toilets for
staff, students and women being cared for in the
teaching facility (Box 9).

Box 9. Lack of water and sanitation in

educational institutions affects quality
of care
Access to clean water, soap and hand rub
A significant number of respondents to the
WHO Midwifery educator survey experienced a
lack of access to clean water for teaching. Except
for respondents from the WHO Region of the
Americas, all other educators had trouble
accessing clean water and functioning toilets in
their educational institutions.
This includes lack of clean water for teaching
IPC, cleaning the environment and sterilizing
equipment, as well as lack of soap or hand rub
for basic hand hygiene. In Africa, over 50% of
respondents in English-speaking countries and
75% in French-speaking countries sometimes
lacked access to clean water.
Toilet facilities
Respondents from both the WHO African and
South-East Asia Regions reported lack of
regular access to a functioning toilet. This was
most significant in African English-speaking and
French-speaking regions where 50% of
educators surveyed reported they do not
always have a functioning toilet in the
institution where they teach. This badly affected
the care they were able to offer women during
labour or postnatally, with two thirds of
respondents from French-speaking African
countries raising concerns.
Maintaining personal hygiene
A significant number of respondents reported
they were unable to help women maintain their
personal hygiene. Those who reported always
being able to provide this care were: 25% of
respondents from French-speaking African
countries, less than 40% of those from Englishspeaking
African countries, and just over half
from the WHO South-East Asia Region.