Estimating the Cost of Achieving Universal Basic Wash Standards in Health Care Facilities in the 46 Least Developed Countries

Background: An alarming number of health care facilities in low- and middle-income countries lack basic water, sanitation, hygiene, and waste management (WASH services). This study estimates the costs of achieving universal coverage of basic WASH services in health facilities in the 46 least developed countries (LDCs). Methods: In-need facilities were quantified by combining published facility counts with estimated WASH service coverage. Country-specific per-facility capital and recurrent costs to deliver basic service standards were collected via survey. Baseline estimates were modelled alongside lower and upper estimates for which key assumptions were adjusted. Findings: An estimated US$6·5–9·6 billion over 10 years is needed to achieve universal coverage of basic WASH services in LDCs’ health facilities. Capital and recurrent costs are 44–50% and 50–56% of the total, respectively. On average, US$0·24–40 per capita in capital investment is needed each year, while annual maintenance and operation costs are expected to increase from US$0·10 in 2021 to US$0·39–0·60 in 2030. Waste management accounts for the greatest share of costs (43–49%), followed by sanitation (21–28%), water (20%), and hygiene (10–11%). Needs are greatest for non-hospital facilities (94%) and in rural areas (68%). Interpretation: Investment will need to be scaled up to reach universal coverage of basic WASH services in health facilities. Financial needs are modest compared to overall health and WASH spending and will yield numerous health benefits. To sustain services, countries will need to routinely budget for operations and maintenance. Funding Information: World Health Organization (including underlying grants from the governments of Japan, Netherlands, and UK), World Bank, and UNICEF. Declaration of Interests: MC reports personal fees from the World Health Organization during the conduct of the study and from Results for Development, ThinkWell, and the World Bank outside the submitted work. SM reports personal fees from the World Health Organization during the conduct of the study and from Vysnova Partners outside the submitted work. RJ reports grants from Agence francaise de developpement, Bill and Melinda Gates Foundation, Government of the Netherlands Ministry of Foreign Affairs, UN-Water Inter-Agency Trust Fund, United Kingdom Foreign, Commonwealth & Development Office, and Swiss Agency for Development and Cooperation, both during the conduct of the study and outside the submitted work. IA, JA-ST, SG, OH, TS, CC, GH, and MM have nothing to disclose.