The Basics Are Still Missing: Hospitals Face a Global Sanitation Emergency

Global access to water, hygiene and waste-management services in health-care facilities has improved since 2015, but major weaknesses remain in sanitation and environmental cleaning. WHO and UNICEF estimate that only 40% of facilities met the basic sanitation standard in 2025 and 59% met the basic environmental-cleaning standard, highlighting how the quality and inclusiveness of essential services increasingly matter alongside their physical presence.

The global push to improve water, sanitation and hygiene (WASH) in health-care facilities has delivered measurable gains, but the latest WHO–UNICEF figures expose a more complicated reality.

According to the WHO–UNICEF Joint Monitoring Programme report, Progress on water, sanitation, hygiene, environmental cleaning and waste management in health-care facilities 2015–2025, in 2025, 85% of health-care facilities had basic water services, 72% had basic hygiene services and 71% had basic health-care waste-management services, yet only 40% met the basic sanitation standard and 59% qualified for basic environmental cleaning. The gap shows that improving health infrastructure is increasingly about whether essential services are safe, usable and inclusive, not merely whether they exist.

Globally, 89% had some form of sanitation and 85% had usable toilets, but the basic standard also requires facilities to be improved, accessible and capable of serving patients, staff, women and girls, and people with limited mobility. Only around half of facilities had sex-separated toilets, accessible toilets or menstrual-hygiene facilities.

The Global Health Gap Is Shifting From Access to Quality

For years, health infrastructure debates have focused heavily on whether hospitals and clinics have water points, toilets and handwashing facilities. The new global picture suggests that the next challenge is harder: ensuring those services actually function to a standard that protects patients and staff. A toilet that is unusable, inaccessible or unsuitable for women and girls may count as infrastructure, but it does not deliver the same public-health value as a genuinely inclusive sanitation service.

WHO and UNICEF are calling for routine monitoring that examines whether services are clean, accessible and functional, rather than simply recording whether infrastructure has been installed. The policy shift is subtle but significant because it changes the benchmark from construction to performance.

It also exposes inequalities that broad coverage figures can hide. Facilities may technically report sanitation services while still excluding patients with disabilities, women requiring menstrual-hygiene facilities or others who need safe and private access. That means national averages can improve while important weaknesses remain embedded inside individual hospitals and clinics.

Cleaning Has Become a Front-Line Patient Safety Issue

Environmental cleaning is another major weakness. Only 59% of health-care facilities globally met the basic standard in 2025, which requires both cleaning protocols and trained cleaning staff. Eighteen percent met neither requirement, corresponding to facilities serving a population of roughly 1.5 billion people, while only 24% of facilities in least developed countries met the basic environmental-cleaning standard.

This is not a matter of appearance or routine housekeeping. Environmental cleaning is part of infection prevention and control because contaminated care environments can contribute to health-care-associated infections and the spread of antimicrobial resistance. A facility can therefore have doctors, medicines and equipment while still exposing patients to avoidable risks if cleaning systems are weak.

The inclusion of trained cleaning staff in the basic standard is also important because it highlights a persistent blind spot in health investment. Buildings and equipment attract funding more easily than maintenance systems, protocols and support workers, yet those operational functions determine whether infrastructure remains safe once it is in use. Reliable cleaning is therefore part of clinical safety, even though it often sits outside the most visible parts of health-care delivery.

Progress Is Real, but the Weakest Services Still Matter Most

The global picture is not uniformly negative. Between 2015 and 2025, coverage improved for basic water, hygiene and health-care waste management, with hygiene recording the largest increase. Even so, around one in ten health-care facilities still had no water service and a similar proportion had no sanitation service, showing that basic access remains unfinished alongside the emerging challenge of service quality.

The data also reveal how uneven global monitoring remains. The number of countries with estimates across all five service areas increased from 29 in the previous Joint Monitoring Programme update to 39 in 2025, but important gaps persist. Global trends for sanitation and environmental cleaning still cannot be calculated, making it difficult to determine whether those areas are improving, stagnating or falling behind other WASH services.

Policy tends to follow what governments can measure consistently. Water and hygiene have clearer long-term trends, while sanitation and environmental cleaning are only now gaining comparable international visibility. As measurement improves, countries may face growing pressure to address weaknesses that previously remained obscured by broader infrastructure statistics.

Political Commitments Now Face an Implementation Test

The new data arrive at a moment of rising international attention to water, sanitation and hygiene in health-care facilities. In May 2026, the United Nations General Assembly adopted a resolution calling for stronger national standards, regular monitoring and reporting, and costed and financed plans for sustainable and resilient WASH, waste and electricity services. The resolution also recognized WHO and UNICEF as co-coordinators of global efforts and called for expanded data coverage through the Joint Monitoring Programme.

The next challenge is whether those commitments translate into changes at facility level. Installing infrastructure remains essential, but meeting basic standards also requires recurring budgets, trained personnel, maintenance systems and monitoring that identifies whether services remain safe and accessible over time. Without those elements, new facilities can deteriorate or fail to meet the needs of the patients they were designed to serve.

The stakes are particularly high for women during childbirth, newborns, young children and people with disabilities, groups identified as especially vulnerable when sanitation and hygiene services fall short. Safe health care depends not only on medical expertise but on the environment in which treatment takes place, from the availability of water to the cleanliness of wards and the accessibility of toilets.