Only 40% of healthcare facilities worldwide meet basic sanitary standards: WHO and UNICEF warn of systemic risk to patients

Even modern healthcare can't be safe without the most basic things—clean water, a working toilet, access to handwashing, proper cleaning, and safe disposal of medical waste. However, a new global report from the World Health Organization and the United Nations Children's Fund shows that this very basic infrastructure remains unavailable in many healthcare facilities. According to a 2025 assessment, only 40% of healthcare facilities worldwide met the criteria for basic sanitation.

The results were published on August 18, 2026, in a joint World Health Organization and UNICEF report, "Progress on Water, Sanitation, Hygiene, Environmental Cleaning, and Waste Management in Health Care Facilities 2015-2025." The document was prepared as part of the Joint Monitoring Programme for Water Supply, Sanitation, and Hygiene. For the first time, researchers were able to obtain global estimates simultaneously for all five key components of healthcare facility infrastructure: water, sanitation, hygiene, cleaning, and healthcare waste management.

The most alarming figure concerns sanitation. Around 11% of healthcare facilities had no sanitation at all, meaning they lacked improved toilets or used sanitation facilities that did not meet minimum standards. According to WHO and UNICEF estimates, these facilities serve areas home to approximately 936 million people.

Moreover, it's not just about patient comfort. Inadequate water supplies, inability to properly wash hands, unclean sanitary facilities, and improper waste management are directly linked to infection safety in healthcare. Particularly vulnerable are women in labor, newborns, small children, post-operative patients, and people with weakened immune systems.

The state of essential sanitary and hygienic services in healthcare facilities worldwide in 2025

Component	Institutions with a basic level	Institutions without services	Population served by institutions without services
Water supply	85%	11%	907 million people
Sanitation	40%	11%	936 million people
Hand hygiene	72%	8%	652 million people
Cleaning and disinfection of premises	59%	18%	about 1.5 billion people
Handling medical waste	71%	7%	571 million people

Data source: WHO/UNICEF Joint Monitoring 2025. [1]

The presence of a toilet does not mean that a medical facility meets sanitary standards.

It's important to interpret the 40% figure correctly. It doesn't mean that 60% of hospitals and clinics worldwide have no toilets at all. According to WHO and UNICEF, approximately 89% of institutions have some kind of sanitation facility, and approximately 85% have usable toilets. However, the requirements for a "basic sanitation service" are significantly more stringent.

For a healthcare facility to be classified as basic sanitation, toilets must be of an improved type and usable. Furthermore, there must be at least one separate toilet for staff, separate sanitary facilities for men and women with facilities for menstrual hygiene, and at least one toilet accessible to people with limited mobility.

These additional requirements proved to be the main obstacle. According to the World Health Organization, only approximately half of healthcare facilities had toilets that met gender-separated, disability-accessible, or menstrual hygiene requirements. The lack of accessible toilets and menstrual hygiene facilities was particularly common, preventing facilities from moving from the limited to the basic sanitation category.

Thus, the problem goes far beyond simply having a toilet. A post-operative patient, a wheelchair user, a pregnant woman, or a patient with severe weakness may be physically unable to use a toilet that is formally available. UNICEF emphasizes that the sanitary infrastructure of a healthcare facility must simultaneously ensure safety, accessibility, and human dignity.

What is needed for basic sanitation in a healthcare facility?

Requirement	Why is it important?
Improved and functional toilet	Prevents human contact with excrement
Separate toilet for staff	Reduces sanitary risks and improves work safety
Separate toilets for men and women	Provides privacy and security
Possibility of maintaining menstrual hygiene	Especially important for patients and staff
Toilet for people with limited mobility	Makes medical care physically accessible
Serviceability and availability during assistance	The formal presence of a closed or faulty toilet is not considered sufficient

The criteria were developed by the Joint Monitoring Programme of WHO and UNICEF. [2]

Sub-Saharan Africa remains the region with the most severe deficits

The global figure of 40% conceals vast regional disparities. For sanitation, the researchers were able to obtain data from 70 countries and three Sustainable Development Goal regions, representing approximately 48% of the world's population. In sub-Saharan Africa, only 23% of healthcare facilities met basic sanitation standards.

By comparison, in Central and South Asia, the figure was approximately 55%. This more than twofold gap demonstrates how critically the quality of medical infrastructure depends on the state's economic capacity, the sustainability of its healthcare systems, and the ability to regularly finance not only hospital construction but also their day-to-day operations.

The situation is even worse in the most vulnerable groups of countries. In the least developed countries, landlocked developing countries, and countries in fragile or crisis situations, basic sanitation was available in less than one in five health care facilities—approximately 19% of cases.

This creates a vicious cycle. Countries with high infectious disease rates, high maternal and child mortality, and limited medical resources often have the weakest sanitation infrastructure. As a result, medical care itself can be provided in conditions that complicate the prevention of infection. WHO and UNICEF therefore view water supply, sanitation, and hygiene as part of the quality of medical care, rather than as a separate public utility issue.

Geographical differences

Indicator	Sub-Saharan Africa	Central and South Asia
Basic sanitation	23%	55%
Basic water supply	57%	89%
Basic hygiene	34%	82%
Handling medical waste	24%	69%
Ecological cleaning of premises	about 46%*	data is limited

*Regional estimates are not available for all indicators and regions, as the completeness of national data varies. [3]

The water situation is better, but 907 million people are served by institutions without basic water supply

Of the five components assessed, water showed the highest score. In 2025, 85% of healthcare facilities had basic water supply, compared to approximately 76% in 2015. This is one sign of real infrastructure improvements over the past decade.

However, even this relatively high figure represents a huge absolute shortage. Basic water service was unavailable in 11% of healthcare facilities. These facilities serve areas with a population of approximately 907 million people. In some cases, water was not available directly on-site, was supplied from an unprotected source, or had to be transported from over 500 meters away.

Water in a hospital is needed for more than just drinking. It's essential for hand washing, cleaning rooms, sanitizing equipment, preparing food, caring for patients, maintaining sanitary facilities, and numerous medical procedures. A reliable water supply is especially crucial in maternity wards, where water is needed for both the mother, the newborn, and the medical staff.

The report also revealed significant inequalities within countries. Basic water supply was available in approximately 92% of urban health facilities, compared to 75% in rural areas. Furthermore, hospitals were better equipped than smaller health facilities: approximately 89% versus 79%. Thus, the most significant shortages often occur in primary care in rural areas.

Water supply for medical institutions

Indicator	Meaning
Basic water supply in the world in 2015	76%
Basic water supply in 2025	85%
City institutions	92%
Rural institutions	75%
Hospitals	89%
Other medical institutions	79%
Institutions without basic services at all	11%
Population associated with such institutions	907 million people

[4]

Almost a third of institutions do not provide basic hand hygiene conditions.

Another key element of safe healthcare is the ability to regularly sanitize hands directly where patient care is provided. By 2025, 72% of healthcare facilities worldwide met basic hygiene requirements. This is a significant improvement compared to 2015, when the figure was approximately 55%.

However, approximately 8% of facilities lacked basic hygiene services at all, representing a population of approximately 652 million people. To be included in this category, it was sufficient to have functional hand sanitizers both at the point of care and near restrooms.

Interestingly, the availability of hand sanitizers directly at the patient's location was significantly more common than adequate infrastructure near restrooms. According to the report, approximately 89% of healthcare facilities had functioning hand hygiene facilities at points of care, but only about 75% had soap and water near restrooms.

Regional disparities were again enormous. In sub-Saharan Africa, approximately 34% of healthcare facilities had basic hand hygiene, while in Central and South Asia, the figure was approximately 82%. This gap is fundamental for infection control, as hand hygiene is one of the easiest ways to break the chain of transmission of microorganisms between patients and healthcare workers.

How well is hand hygiene ensured?

Indicator	2015	2025
Medical facilities with basic hygiene	55%	72%
Hygiene products directly at the point of care	-	89%
Water and soap near the toilets	-	75%
Institutions without hygiene services	-	8%
The population served by such institutions	-	652 million

[5]

Hospital cleaning is more than just a clean floor.

One of the report's most important innovations was the first global assessment of healthcare facility environmental cleaning. Only 59% of facilities met the basic standard, while approximately 18% failed to meet either of the two core requirements. The areas served by these facilities serve approximately 1.5 billion people.

By "basic cleaning," WHO and UNICEF don't mean merely the visual cleanliness of premises. Facilities must have established cleaning protocols, and staff responsible for cleaning and disinfecting premises must be appropriately trained. Therefore, a hospital where a cleaner regularly wipes surfaces, but the staff isn't trained in infection control methods and there's no standard protocol, may not meet the basic level.

Patient rooms, operating rooms, procedure rooms, patient examination areas, and restrooms are particularly critical. Contaminated surfaces and improper cleaning can contribute to the transmission of microorganisms within a healthcare facility. Therefore, the WHO explicitly considers environmentally friendly cleaning a fundamental element of infection prevention and control.

The lowest indicators were again recorded among the poorest countries. In the least developed countries, only about 24% of healthcare facilities met the basic standard of cleanliness. Moreover, there is less data for this indicator than for water or sanitation: the global assessment is based on information from 54 countries, so it is not yet possible to calculate a complete trend over the decade.

What does basic eco cleaning mean?

Element	Requirement
Written protocols	Must determine the order of cleaning of different areas
Trained staff	All employees with cleaning duties must be trained.
Patients' rooms	Regular safe cleaning is required
Operating	Require particularly strict infection control
Procedural and examination	Must be processed according to established rules
Sanitary facilities	Require separate pollution control
Basic level in the world	59% of institutions
Complete absence of both requirements	18% of institutions

[6]

Medical waste remains another weak link

Used needles, contaminated dressings, biological waste, and regular household waste cannot be collected and disposed of in the same way. WHO and UNICEF consider a basic system in which healthcare waste is separated into at least three categories: general non-hazardous waste, potentially infectious materials, and sharps. Hazardous waste must then be safely processed and disposed of.

In 2025, 71% of healthcare facilities met these criteria, an increase from 59% in 2015. Approximately 80% of surveyed facilities had the means to safely separate waste, and a similar percentage used adequate waste treatment methods.

However, approximately 7% of healthcare facilities lacked a basic waste management system at all. They serve areas with a population of approximately 571 million people. In 16 countries, at least one in ten healthcare facilities simultaneously failed to ensure safe waste separation, treatment, and disposal.

Regional differences are significant: basic waste management systems were present in approximately 24% of healthcare facilities in sub-Saharan Africa and 69% of facilities in Central and South Asia. In countries experiencing fragile and crisis conditions, the figure was only around 25%.

Medical waste in numbers

Indicator	Meaning
The basic system in 2015	59%
Basic system in 2025	71%
Availability of materials for waste separation	80%
Adequate waste treatment	80%
Complete lack of basic service	7%
The population served by such institutions	571 million people
Sub-Saharan Africa	24% of the base level
Central and South Asia	69%

[7]

Why the sanitary crisis is becoming an infectious safety issue

Sanitary conditions in a hospital are fundamentally different from those in everyday life. Medical facilities simultaneously receive large numbers of people with infections, open wounds, catheters, post-surgical injuries, or weakened immune systems. Even relatively minor violations of sanitary procedures can therefore create conditions for the transmission of pathogens between patients, visitors, and staff.

This problem is particularly significant for hospital-acquired infections. Reliable water is essential for hand hygiene and cleaning, sanitary facilities are needed to safely remove human waste, trained cleaners are needed to decontaminate surfaces, and a proper waste system is needed to prevent contact with contaminated materials. These elements work as a unified system: the failure of one component reduces the effectiveness of the others.

The WHO also links the quality of environmental cleaning and other sanitation measures to combating antimicrobial resistance. The more frequently infections spread in healthcare settings, the more patients require antimicrobial treatment and the greater the pressure to select for resistant microorganisms. Therefore, improving sanitation infrastructure is considered one component of the global strategy to combat antimicrobial resistance.

WHO and UNICEF place special emphasis on maternity and neonatal services. Without water, clean surfaces, adequate toilet facilities, and access to handwashing, truly safe childbirth cannot be guaranteed. For this reason, sanitation infrastructure is simultaneously linked to goals of reducing maternal, newborn, and under-five mortality, as well as ensuring universal access to quality health care.

There is progress, but the world moves at very different speeds.

Despite these alarming figures, the new report also documents significant improvements. Over the decade from 2015 to 2025, the share of healthcare facilities with basic water supply increased from 76% to 85%, with basic hygiene from 55% to 72%, and with proper healthcare waste management from 59% to 71%. The most notable improvement occurred in the area of hygiene.

However, comparing these indicators requires caution. The composition of countries with available data changes over time. For example, for basic sanitation, the 2025 global estimate is based on data from 70 countries, for water supply – 84 countries, for hygiene – 67 countries, for healthcare waste management – 79 countries, and for clean cleaning – 54 countries. Therefore, some changes may partially reflect changes in the data base itself.

The authors specifically warn that the data do not always reflect the situation as of the end of 2025. The Joint Monitoring Programme uses the latest available national data, which may have been obtained earlier in some countries. This is especially important for countries that experienced war, political crisis, economic shock, or natural disaster after the data were collected, as their sanitation infrastructure may have rapidly deteriorated.

Nevertheless, the volume of information is gradually increasing. The number of countries for which assessments are available for all five components simultaneously has increased from 29 in the previous update to 39 in 2025. WHO and UNICEF consider further development of national monitoring a key condition for progress: countries are now being asked to assess not only the availability of infrastructure but also its reliability, safety, cleanliness, accessibility, and actual suitability for patients.

Where progress was observed from 2015 to 2025

Indicator	2015	2025	Change
Basic water supply	76%	85%	+9 p.p.
Basic hygiene	55%	72%	+17 p.p.
Handling medical waste	59%	71%	+12 p.p.
Basic sanitation	there is no comparable global assessment	40%	the trend has not yet been calculated
Ecological cleaning	there is no comparable global assessment	59%	the trend has not yet been calculated

Due to the changing composition of countries, estimates of dynamics need to be interpreted with caution. [8]

WHO and UNICEF are demanding a shift from infrastructure construction to monitoring its actual operation.

One of the report's key findings is the need to change the very approach to monitoring. It's not enough to simply report that a hospital has running water, a toilet, or a waste storage room. It's important to know whether the system operates daily, whether water is available when needed, whether the restrooms are accessible to people with limited mobility, and whether staff actually follow approved cleaning procedures.

This is a fundamental difference between infrastructure "on paper" and a functioning sanitary system. For example, a faucet is of no use if the water is only available for a few hours a week, and a toilet installed is inaccessible to a patient in a wheelchair. Similarly, the presence of cleaners does not guarantee infection control if they are not trained in proper surface disinfection. This is why new standards are increasingly assessing the quality and functionality of services.

Political attention to the problem is also increasing. In May 2026, the United Nations General Assembly adopted a new resolution calling on states to develop national standards, regularly monitor the sanitary conditions of health care facilities, and create funded plans to ensure reliable water, sanitation, hygiene, waste management, and energy services.

Thus, the published figures are more than just a ranking of hospital sanitary conditions. They reveal a fundamental contradiction in global healthcare: humanity has high-tech surgeries, sophisticated drugs, and molecular diagnostics, yet a huge number of patients still receive medical care in places without guaranteed access to water, safe toilets, or proper cleaning. WHO and UNICEF consider closing this gap a fundamental requirement for safe and high-quality healthcare.

Key figures of the study

Fact	Meaning
Medical facilities with basic sanitation	40%
Medical facilities without sanitary services	11%
People associated with unsanitary institutions	936 million
Basic water supply	85%
Basic hygiene	72%
Basic eco-cleaning	59%
Basic waste management	71%
Institutions without environmental cleaning	18%
The population associated with them	1.5 billion
Basic sanitation in sub-Saharan Africa	23%
Basic Sanitation in Central and South Asia	55%
Basic sanitation in the most vulnerable groups of countries	about 19%

[9]

News source

World Health Organization & UNICEF. Progress on water, sanitation, hygiene, environmental cleaning and waste management in health care facilities 2015-2025. Geneva: World Health Organization; 2026. 116 p. ISBN 978-92-4-012459-2.