Last weekend I spoke at a conference at the Water Institute at UNC-Chapel Hill about health workers’ essential role in promoting good hygiene in their communities and practicing it themselves at home and in the workplace, especially in caring for young children and expectant women.

Although in many developed countries running water that is safe for drinking and bathing and working toilets are ubiquitous, a third of the world’s population goes without these luxuries.

• Today, 2.5 billion people do not use improved sanitation, and 70% of these people live in rural areas.
• Nearly a billion people worldwide do not have access to a safe water supply.

Understanding how these shortages affect our work in global health was one of the focuses of the recent conference, “Water and Health: Where Science Meets Policy,” sponsored by the UNC Institute of the Environment and the Water Institute. My remarks focused on the fact that health workers and health facilities are not immune to the scarcities of basic necessities that plague many developing countries. Working without potable water and a toilet makes it all the more challenging for a health worker to offer high-quality care. When I think about my own area of focus—maternal, newborn, child health/family planning—I realize safe water and sanitation in health facilities and in communities are critical components to caring for children and pregnant women. For example, we know that:

• There is an inverse relationship between maternal and newborn survival and access to improved water sources. Women need safe water during pregnancy, of course, but it is also essential for safe delivery and postpartum and newborn care. One study shows that when birth attendants and mothers wash their hands with soap, newborns are 44% more likely to survive.
• Safe water and careful hygiene practices can also prevent neonatal sepsis, a blood infection that occurs in the first weeks of life, which is one of the top three killers of newborns. This infection  can be prevented through good hygiene during and immediately following delivery.

As our guest blogger, Jennifer Platt from the Water Institute, wrote a couple of weeks ago, a simple action like hand washing can save lives. This is all the more critical for health workers since unwashed hands of health workers are the most common carrier of micro-organisms from one patient or body part to the next, and from one work surface to the next. Clean hands are absolutely essential.

IntraHealth International’s work in improving health worker performance often focuses on infection prevention and promotion of good hygiene practices. The importance of these practices cannot be underestimated, especially for health workers, who are providing maternal, newborn, and child health and family planning services. During labor and delivery, clean birthing kits and delivery room are critical, and the insertion and removal of intrauterine devices and implants requires sterile supplies and clean hands. Protecting babies and young children from vaccine preventable infections needs to involve safe disposal of the needles used for immunizations. The scales used to weigh babies also need regular cleaning between each child.

IntraHealth conducts health facility needs assessments, which often reveal an absence of a reliable source of clean water or a designated location and practice for hand washing, that sterilization of equipment is done incorrectly, or that the general exam area is not clean. In some cases, this requires renovations of the facility to connect it with a safe water supply, build a washing area, or improve latrines. IntraHealth facilitates in-service trainings on infection prevention and supports production of new or revised job aids on hand washing or sterilization. We also support ministries of health and local health centers to develop and implement evidence-based policies to guide sanitary practices and define infrastructure expectations. Monitoring progress is important, and there are simple checklists to support health workers to adopt better behaviors. IntraHealth also recognizes the important role community health workers play in teaching their communities about the importance of good hygiene and sanitation practices and reinforcing such practices themselves.

Increasingly, global health programs are building in these critical links with water and sanitation work.  For example, under the President’s Emergency Plan for AIDS Relief, some projects aimed at preventing and treating HIV/AIDS incorporate safe water interventions. In the area of maternal, child, and newborn health, we need to continue to emphasize the importance of hygiene—educating skilled birth attendants on the importance of washing their hands between every antenatal care client and ensuring that maternity centers have access to safe water supplies, for example.

I am very encouraged to see these links being drawn at the Water Institute conference, and I hope to see many more partnerships between maternal, newborn, and child health experts and those in the fields of water and sanitation because after all, access to these basic necessities of safe water and a clean latrine are essential in all global health work.