Access to safe water, sanitation, and hygiene (WASH) services plays an important role in protecting the health, well-being, and resilience of individuals and communities around the world. WASH efforts have the potential to prevent 6.3% of deaths worldwide and 9.1% of the global disease burden,[1] but 844 million people still don’t have clean water close to home, and 2.3 billion don’t have a decent toilet.[2]

Every year, approximately 289,000 children under age 5 die from diarrheal diseases caused by poor-quality WASH.[3] Approximately half of all undernutrition is not due to lack of food, but caused by infections from inadequate WASH.[4]

Half of healthcare facilities in low- and middle-income countries (LMICs) lack access to piped water, 33% are without improved toilets, and 39% do not have facilities for washing hands with soap.[5] This is a major global health security risk that directly contributes to the spread of diarrhea, pneumonia, and even Ebola — as well as other life-threatening infections. In developing countries, 15% of patients acquire at least one infection during a hospital stay,[6] and sepsis is a leading cause of both maternal and neonatal mortality.[7]

Health and development efforts are more effective and sustainable over the long term if they address WASH, including those related to maternal and child health, HIV/AIDS, neglected tropical diseases (NTDs), food security, nutrition, and other global health security issues.


Ensure that funding for WASH programming is sustained during the current budgetary climate, and integrate WASH financing across multiple development sectors. Congress should provide robust funding for the Global Health Programs and Development Assistance accounts, both of which fund the U.S. Agency for International Development (USAID) WASH programs, in addition to supporting vital Centers for Disease Control and Prevention (CDC) work done to increase the global capacity for preventing and responding to water-related health risks.

Support initiatives and measures that include measurable WASH goals for success. This includes legislation on maternal and child health, outbreak and disaster response, global health security, primary health care, and health systems strengthening.

Improve aid effectiveness by supporting the Water for the World Act, which coordinates WASH goals across government agencies and links indicators to positive health outcomes. Give increased attention to the needs of women and girls, who are disproportionately impacted by lack of WASH.

Girls of Wayuuma’ana School play by the compostable toilets outside Wayuuma’ana, Maicao, La Guajira, Colombia, March 2017. Credit: WaterAid/Jordi Ruiz Cirera


Universal access to clean water and sanitation would save more than $11.6 billion in the health care sector[8] and return $220 billion to the global economy each year in these health care savings and increased productivity. Every $1 spent on safe water and sanitation is estimated to generate a little over $4.30 in increased productivity and decreased health care costs.[9]

The U.S. government and Congress have shown strong leadership in the effort to improve safe water, sanitation, and hygiene access globally. In 2017, USAID and the Department of State released the first whole-of-government Global Water Strategy, as required by the Senator Paul Simon Water for the World Act of 2014. A key outcome of this strategy is decreased mortality and morbidity linked to lack of WASH; another goal is strengthened ties to the health goals of other government initiatives, such as the Global Food Security Act of 2016 and the 2014-2015 Multi-Sectoral Nutrition Strategy. Internal restructuring at USAID, which places WASH within the Bureau for Resilience and Food Security, should further bolster coordination with Global Health Bureau outcomes. The health gains made possible by such coordinated WASH efforts can be tremendous. Increased WASH support contributes to the achievement of other U.S. global health priorities, including improved child nutrition, the end of preventable child and maternal deaths, and the control and elimination of NTDs. In conjunction with sufficient funding from donors and national governments, U.S. investments can mean that women and girls no longer get sick from dirty water or poor sanitation, fewer days of work and school are missed, income and productivity levels increase, and accrued household savings can benefit the health and education of entire families.

Programs implemented by USAID, CDC, and their partners strengthen the capacity of developing country governments to address WASH challenges that greatly impact the health and security of their populations. USAID’s ongoing response to the 2012 Child Survival Call to Action shows the benefits of prioritizing the links between WASH and overall health outcomes, especially those related to diarrheal diseases and maternal health. The Global Health Security Agenda (GHSA) and forthcoming U.S. Global Health Security Strategy also make the critical link between WASH and health on a global scale, recognizing WASH programming as a key intervention for preventing the spread of disease and a primary tool for decreasing antimicrobial resistance. The Child Survival Call to Action, the GHSA, and the Feed the Future initiatives are all important U.S. government tools for promoting global health — but in order to fully realize the benefits of these tools, the integration of WASH services is essential.


  1. U.S. Government Global Water Strategy
  2. CDC Global WASH Facts


Lisa Bos, World Vision,
Mary Kate Costello, The Hunger Project,
Danielle Zielinski, WaterAid America,


[1] “Global WASH Fast Facts,” CDC.

[2] “Progress on Drinking Water, Sanitation and Hygiene: 2017 Update and SDG Baselines,” WHO, 2017.

[3] “289,000 children die every year from diarrhoeal diseases caused by poor WASH,” WASHwatch.

[4] “Safer water, better health: Costs, benefits and sustainability of interventions to protect and promote health,” WHO, 2018.

[5] Cronk, Ryan and Jamie Bartram. “Environmental conditions in health care facilities in low- and middle-income countries: Coverage and inequalities.” International Journal of Hygiene and Environmental Health, April 2018; 221(3):409-422.

[6] Allegranzi, Benedetta and Sepideh Bagheri Nejad, et al. “Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis,” The Lancet, January 2011; 377(9761):228-241.

[7] Say, Lale and Doris Chou, et al. “Global causes of maternal death: a WHO systematic analysis.” The Lancet Global Health, May 2014; 2:e323-333.

[8] “How WASH relates to health, education and development,” UNICEF.

[9] “Global costs and benefits of drinking-water supply and sanitation interventions to reach the MDG target and universal coverage,” WHO, 2012.

©2019 Global Health Council