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On 8 August 2014 the World Health Organisation declared the West Africa Ebola outbreak a public health emergency of international concern. . The virus went on to kill more than 11,000 people, spreading rapidly in healthcare facilities and communities without regular access to water, good sanitation or rigorous hygiene practices, and claimed the lives of many dedicated health workers.
While there has been progress, two years on, serious deficiencies remain in access to water, sanitation and hygiene in communities, hospitals and clinics, raising the risk of another epidemic.
Joe Lambongang, Acting Country Director of WaterAid Liberia and Sierra Leone said:
“The terrible suffering of the people of Sierra Leone and Liberia during the Ebola crisis is at high risk of being repeated in another disease epidemic if we do not see action to improve water, sanitation and hygiene practices in our communities, schools and healthcare facilities. “These basic provisions are the first line of defence against infectious diseases including Ebola. To ask healthcare professionals to battle an epidemic without clean water, safe toilets and somewhere to wash their hands is unrealistic and needlessly puts lives at risk. We have the tools to help stop outbreaks before they begin – but we need to put them into action.
“The governments of Sierra Leona and Liberia have pledged alongside all members of the United Nations to deliver water and sanitation to everyone, everywhere by 2030 as part of the UN Global Goals on sustainable development. It is essential that we see political priority and funding for these basic building blocks of good health and development.”
Some 37.4% of people in Sierra Leone and 24.5% in Liberia do not have access to clean water, while 86.7% of people in Sierra Leone and 83.1% in Liberia do not have access to basic sanitation.
Recent analysis has shown that healthcare facilities are still lacking in water, sanitation and hygiene services.
In Sierra Leone, a situational analysis conducted by the WHO in the Western Area district of Freetown Municipality, released in March 2016, found much more work is required to improve access to water, sanitation and hygiene in hospitals and clinics:
- Out of 171 latrines in healthcare facilities in the region, some 71 were not functional;
- Some 53% of existing latrines are open-pit latrines, which contribute to the spread of infection;
- Some 40% of urban clinics in the region have boreholes but more than one-quarter of these run dry in the dry season;
- Some one-quarter of healthcare facilities have no water storage tanks to help conserve water for times of intermittent supply;
- While each healthcare facility now has an average of three handwashing facilities, compared to very low numbers before the outbreak, only 23% were reported to have soap and water all of the time and only 9% had functioning handwashing stations near toilets.
In Liberia, a baseline report on water, sanitation and hygiene in health facilities in 2015 found:
- Some 95% of health facilities do not meet the Ministry of Health and Social Welfare (now Ministry of Health) standards in terms of water quantity for all purposes.
- More than 50% of surveyed health facilities do not have a protected year-round source of water, and 20% do not have any protected source on site
- Average daily water use at primary health facilities is 97 gallons, compared to the stated standard of 425 gallons. Only 4% (23 out of 528) of primary care facilities reported using 425 gallons or more on average, while only 7% (9 out of 127)of secondary care facilities reported using the minimum of 1600 gallons.
- While 89% of health facilities reported handwashing facilities in strategic locations, this dropped to 61% which reported handwashing facilities at the toilets; during observation only 42% of latrines were observed to have handwashing stations nearby.