Healthcare sanitation covers the water, toilets, hand-hygiene facilities, waste systems and environmental cleaning that support care delivery. The latest global estimates describe 2023 facility conditions, while a detailed Dhaka hospital study shows how functionality, cleanliness and user loads can vary within selected tertiary hospitals.
Key Healthcare Sanitation Statistics
The most broadly useful figures are:
- 9% of health care facilities serving 743 million people had no water service globally in 2023.
- 8% of health care facilities covering 660 million people had no sanitation service globally in 2023.
- 9% of health care facilities covering 722 million people had no hygiene service globally in 2023.
- 42 of 72 countries with estimates exceeded 75% basic water-service coverage in health care facilities in 2023.
- 11 of 51 countries with estimates exceeded 75% basic sanitation-service coverage in 2023.
- 21 of 47 countries with estimates exceeded 75% basic hygiene-service coverage in 2023.
- Basic water-service coverage ranged from 60% in sub-Saharan Africa to 76% in Northern Africa and Western Asia in 2023.
- 37% of facilities in fragile contexts lacked a basic water service in 2023.
- Basic sanitation-service coverage ranged from 22% in sub-Saharan Africa to 36% in Northern Africa and Western Asia in 2023.
- Basic hygiene-service coverage was 34% in sub-Saharan Africa and 58% in Northern Africa and Western Asia in 2023.
- Basic waste-management service coverage was 26% in sub-Saharan Africa and 40% in Northern Africa and Western Asia in 2023.
- 1.6 billion people in fragile contexts lacked basic sanitation at health care facilities in 2023.
- 1.5 billion people in fragile contexts lacked basic waste management at health care facilities in 2023.
- 1.3 billion people in fragile contexts faced inadequate environmental cleaning at health care facilities in 2023.
- 31% of observed toilets were non-functional across 12 selected Dhaka hospitals during July–December 2022.
- 65% of observed toilets were unclean across those 12 Dhaka hospitals during July–December 2022.
- Government-hospital outpatient toilets in the Dhaka study had an overall user-to-toilet ratio of 214:1.
- Private-hospital outpatient toilets in the Dhaka study had an overall user-to-toilet ratio of 94:1.
Contents
- Global healthcare sanitation access
- Regional and fragile-context healthcare sanitation data
- Healthcare hygiene and handwashing statistics
- Healthcare waste management and environmental cleaning
- Dhaka hospital toilet functionality and cleanliness
- Healthcare sanitation capacity and service standards
Global Healthcare Sanitation Access Statistics
WHO and UNICEF’s Joint Monitoring Programme (JMP) measures services at health care facilities, not households. In 2023, the global estimates identified substantial gaps across water, sanitation and hygiene.
| Service status, 2023 | Facilities or people affected | Definition or scope |
|---|---|---|
| No water service | 9%; 743 million people | No source, an unimproved source, or an improved source more than 500 metres away |
| No sanitation service | 8%; 660 million people | No toilets or only unimproved sanitation facilities |
| No hygiene service | 9%; 722 million people | No functional hand-hygiene facilities at points of care or toilets |
Source: WASH in health care facilities 2023 data update: special focus on primary health care.
Coverage also varied by the number of countries with available estimates. Basic water service exceeded 75% in 42 of 72 countries, while basic sanitation exceeded 75% in 11 of 51 countries and basic hygiene exceeded 75% in 21 of 47 countries.
These country counts are conditional on reporting availability and are not population-weighted global coverage rates. JMP estimates use the latest available country, area or territory data, so they may not reflect rapid deterioration during conflict or crisis.
Regional and Fragile-Context Healthcare Sanitation Data
The 2023 regional estimates show that sanitation-related services were generally lower than water coverage in the two SDG regions with enough data for comparison.
| Measure, 2023 | Sub-Saharan Africa | Northern Africa and Western Asia |
|---|---|---|
| Basic water service | 60% | 76% |
| Basic sanitation service | 22% | 36% |
| Basic hygiene service | 34% | 58% |
| Basic waste-management service | 26% | 40% |
Source: WASH in health care facilities 2023 data update: special focus on primary health care.
The regional figures are based on available country data. Only these two SDG regions had enough data for a hygiene estimate, and waste-management coverage had no sufficient global estimate.
Fragile contexts had especially large service gaps. In the 60 OECD-defined fragile contexts analyzed for 2023, 37% of facilities lacked a basic water service, 54% lacked basic hygiene services, and only 25% had basic waste-management services.
The same analysis estimated that about 2 billion people lived in fragile contexts in 2023. Within that population, 1.6 billion lacked basic sanitation at health care facilities, 1.5 billion lacked basic waste management, 1.3 billion faced inadequate environmental cleaning, 1.1 billion were affected by poor hygiene practices, and 717 million lacked basic water services.
Only 15 of the 60 fragile contexts were classified as extremely fragile under the OECD framework used by JMP. That is a classification detail, not a measure of sanitation performance.
For least developed landlocked countries, 42% of facilities had basic waste-management services and 37% had basic environmental-cleaning services in 2023. In fragile contexts, 34% had basic environmental-cleaning services, but the latest available country data may not capture current conflict or disaster conditions.
Healthcare Hygiene and Handwashing Statistics
Facility hygiene service is a structural measure: it records whether functional hand-hygiene facilities are available at points of care or toilets. It does not measure whether staff or patients actually washed their hands, how often they did so, or the quality of technique.
Globally, 9% of facilities had no functional hand-hygiene facility at points of care or toilets in 2023. Basic hygiene service coverage was 34% in sub-Saharan Africa and 58% in Northern Africa and Western Asia, while 54% of facilities in fragile contexts lacked basic hygiene services.
The earlier 2019 global baseline reported that 1 in 5 health centres had no sanitation service. That baseline defined no sanitation as unimproved toilets or no toilets and predates the 2023 update, so it should not be read as a directly comparable time-series value.
The CDC reports that about 1 in 38 hospital patients in the United States has at least one healthcare-associated infection on any given day. This is an HAI prevalence statistic, not a sanitation-only outcome; healthcare-associated infections have multiple causes and exposures.
Source links: WASH in health care facilities: Global baseline report 2019, About Healthcare-Associated Infections (HAIs).
Healthcare Waste Management and Environmental Cleaning Statistics
Waste management and environmental cleaning are tracked separately from water, sanitation and hygiene service ladders. In 2023, 22 of 66 countries with waste estimates exceeded 75% basic waste-management coverage, while 9 of 39 countries with cleaning estimates exceeded 75% basic environmental-cleaning coverage.
Only one SDG region had enough data for a basic environmental-cleaning regional estimate in 2023. This describes the reporting system’s data coverage, not the quality of cleaning in every facility.
The available regional waste estimates were 26% basic waste-management coverage in sub-Saharan Africa and 40% in Northern Africa and Western Asia. The corresponding figures were 42% in least developed landlocked countries and 25% in fragile contexts.
Environmental cleaning coverage was 26% in Northern Africa and Western Asia, 34% in fragile contexts and 37% in least developed landlocked countries. Environmental cleaning is distinct from sanitation, and inadequate cleaning is not itself a direct measure of infection incidence.
The JMP’s fragile-context analysis covered 60 countries, areas and territories. Because service estimates use the latest available data, they may lag rapid changes in crisis settings.
Dhaka Hospital Toilet Functionality and Cleanliness Statistics
A peer-reviewed PLOS One study assessed 12 major tertiary hospitals in Dhaka, Bangladesh, during July–December 2022. The sample included 10 government and 2 private hospitals, excluded primary-care hospitals and community clinics, and therefore was not a citywide or national census.
The hospitals had 250 to 850 beds each, averaging 422 beds per hospital. Observed toilets ranged from 43 in one 300-bed government specialized hospital to 430 in one 500-bed government medical college hospital, while the two private 500-bed hospitals had 86 and 59 toilets.
Daily toilet users ranged from 826 to 20,899 per hospital. Patients had an average of 2.2 caregivers visiting or staying for care, a study-specific input used to estimate toilet demand.
| Dhaka hospital toilet finding | Result | Scope |
|---|---|---|
| Non-functional toilets | 31% | 12 selected hospitals |
| Unclean toilets | 65% | 12 selected hospitals |
| Unclean government-affiliated toilets | About 70% | Government hospitals in the sample |
| Notably dirty and unusable government-affiliated toilets | About 27% | Government hospitals in the sample |
The study defined functionality using factors such as an unbroken toilet, an unblocked pit and water for flush or pour-flush toilets. Cleanliness was based on the study checklist and operational definitions, rather than a universal standard.
Area-specific results also varied. Functionality was 45% in diagnostics, pharmacy and blood-bank areas of government hospitals, 56% for male staff toilets in specialized hospitals, and 59% for male patient toilets in specialized hospitals.
Healthcare Sanitation Capacity, User Loads and Service Standards
The Dhaka findings connect sanitation access with demand. Outpatient government-hospital toilets had an overall user-to-toilet ratio of 214:1, compared with 94:1 for outpatient private-hospital toilets; the private comparison includes only two hospitals.
For inpatient services, the study reported an average user-to-toilet ratio of 20:1 and described this as aligned with the cited WHO WASH FIT guideline for staff and patient/caregiver toilets. The result does not establish adequacy for every user group or setting.
The study also found lower cleanliness associated with toilets used by more than 30 people. This is a study-specific association and does not prove that the threshold causes uncleanliness.
The planning references cited in the study include these standards and recommendations:
- WHO WASH FIT guidance recommends one additional toilet for every 20 to 25 patients or caregivers, plus one per 50 additional patients or caregivers.
- WHO WASH FIT guidance recommends a 2:1 female-to-male toilet ratio for outpatient and caregiver services.
- Bangladesh’s 2021 national WASH standard recommends one toilet for every six inpatient beds.
These are planning recommendations or national standards, not universal legal requirements or measured outcomes in every healthcare facility. The Dhaka study’s results are best interpreted alongside its selected-hospital design, its study-specific cleanliness definitions and its estimates of staff, patients, caregivers and other users.