Ongoing Health Crisis: Safe Water, Sanitation, and Hygiene

According to a recent World Health Organization (WHO) study, an estimated 1.4 million lives could be saved annually by enhancing access to safe water, sanitation, and hygiene services. Although we’ve made modest strides toward achieving Sustainable Development Goal 6 (SDG 6), which strives to ensure universal access to sustainable water and sanitation by 2030, our progress remains insufficient. In 2022, a staggering 2.2 billion people lacked safe drinking water at home, 3.5 billion lacked proper sanitation, and 2 billion couldn’t access soap and water for handwashing. Furthermore, since mid-2021, several low- and middle-income countries have witnessed a resurgence of cholera outbreaks, even in regions unaffected for decades.

In March 2023, the United Nations (UN) organized its first all-UN conference on water in fifty years, emphasizing the need for governments to accelerate their efforts to meet SDG 6. Unfortunately, this call to action faces financial roadblocks, as revealed in a 2022 WHO survey where 95 out of 113 governments reported insufficient funding for their water, sanitation, and hygiene plans. Nevertheless, WHO and the United Nations Children’s Fund (UNICEF) report a global increase in estimated coverage since 2015 for basic water (from 88% to 91%), basic sanitation (from 73% to 81%), and basic hygiene (from 67% to 75%) services.

Yet, this progress still falls short of the SDG 6 threshold for safely managed services, which necessitates safe water on demand and comprehensive sanitation systems. Health analyses of water, sanitation, and hygiene reaffirm that transitioning to safely managed services can yield significant health benefits.

There’s a growing consensus that achieving safely managed water and sanitation demands strengthened government systems, professional service delivery, and substantial investments. While the scale of reform may appear daunting, some countries have rapidly improved these services through public investment, responsible management, transparent data, and accountable governance. India’s Jal Jeevan Mission stands as an inspiring example, demonstrating that remarkable gains can align with the SDGs with high-level political support.

To optimize existing government budgets and limited external support, we must prioritize water, sanitation, and hygiene programs in national health strategies. Recognizing their cost-effectiveness in preventing diseases, reducing healthcare costs, and enhancing productivity is essential. For instance, less than 1 United States dollar per person per year invested in hand hygiene could provide universal handwashing facilities by 2030 in the world’s 46 least-developed countries.

Secondly, employing health surveillance data to inform service delivery in disease hotspots is crucial for identifying high-priority areas and fostering collaborative actions. WHO and partners have developed maps overlaying water, sanitation, and hygiene coverage with endemicity data for neglected tropical diseases in 47 African countries through the Expanded Special Project for Elimination of Neglected Tropical Diseases.

Thirdly, we must progressively apply health-based norms, standards, and regulations to water, sanitation, and hygiene services, as outlined in the WHO Water, Sanitation, and Hygiene Strategy 2018–2025. These norms, consistent with WHO’s guidelines for drinking water quality, sanitation, and health, support national-level standardization and regulations.

However, two challenging realities persist concerning water, sanitation, and hygiene-related diseases.

First, without immediate escalations in investment and system strengthening, the disease burden will remain largely unchanged in the years ahead.

Second, we urgently need to provide basic services to those still lacking them, especially vulnerable populations in rural areas. Otherwise, cholera outbreaks and chronic neglected tropical diseases will persist.

With climate change, urbanization, and the need to prepare for pandemics in mind, WHO and UNICEF have jointly called on governments to prioritize water, sanitation, and hygiene to save lives, enhance health outcomes, and prevent disasters. This call to action echoes the voluntary commitments made by governments, businesses, and civil society entities during the UN 2023 Water Conference and the subsequent High-Level Political Forum in July 2023, all geared toward expediting SDG 6 progress.


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