“Boil some water!” Most of us recognize this phrase as a universal symbol of hygiene. It has appeared in childbirth scenes in literature and cinema, from historical dramas to contemporary films.

We’ve known that boiling water eliminates pathogens since Louis Pasteur demonstrated the link between microbes and disease in the 1860s. But the practice is far older. Sanskrit and Egyptian texts from before 2000 BCE mention using boiled water for purification, and Hippocrates (circa 400 BCE) specifically recommended boiling water for childbirth care.

In the 21st century, it’s hard to believe that 8% of maternal deaths during childbirth and the postpartum period are still directly linked to unhygienic conditions, with the use of contaminated water remaining one of the main risk factors.

The data from the International Federation of Gynecology and Obstetrics (FIGO) is striking: during pregnancy, consuming unsafe water can lead to infections such as malaria, typhoid, and dysentery, significantly increasing the risk of maternal death, miscarriage, or stillbirth. This is an endemic reality in communities where more than 411 million people worldwide still rely on water that lacks basic safety standards.

The lack of hygiene in rural African areas has led governments to encourage women to give birth in health centres, where they are expected to receive safer medical care. However, the risks persist when these centres lack clean water, basic sanitation, and minimum hygiene measures. Mothers and newborns remain exposed to preventable infections that, all too often, prove fatal.

In Sierra Leone, we are tackling an unacceptable reality head-on through a new project in partnership with World Vision. This sub-Saharan country faces some of the world’s worst indicators in access to water, sanitation, and hygiene (WASH):

• 900,000 people rely on surface water sources.
• More than 1.4 million practice open defecation.
• Six million still lack improved sanitation facilities.

In the Kono District, Foidu Mongor, Gbamadu, and Luama communities are among the most disadvantaged. Local health centres report the persistent presence of endemic diseases such as diarrhoea, acute respiratory infections, malnutrition, and parasitic infestations—ailments that have plagued these areas for decades.

But the problem doesn’t stop at the community level. The health centres themselves have become hotspots for the spread of infections. They lack basic WASH infrastructure to ensure safe patient and healthcare staff conditions. Critical areas like delivery rooms, latrines, and handwashing stations fail to meet minimum hygiene standards.

The consequences are devastating. Sierra Leone continues to record some of the highest maternal and neonatal mortality rates in the world. For every 1,000 births:

• More than 13 mothers lose their lives.
• 34 newborns do not survive.
• 82 infants die before their first birthday.
• 111 children die before the age of five.

Geographical isolation makes the situation worse. Pregnant women and other vulnerable groups face enormous challenges in reaching health centres due to poorly maintained roads. The shortage of healthcare workers and the general lack of basic hygiene knowledge further increase the vulnerability of these communities.

Our intervention highlights the severity of the deficiencies in these health centres and aims to reverse this critical situation. We are:

• Drilling three wells to provide clean water for patients and healthcare staff.
• Building three safe latrines, accessible to people with disabilities and gender-separated, with dedicated spaces for menstrual hygiene.
• Constructing ash pits, placenta pits, and incinerators to improve medical waste management.

A critical but often overlooked issue in these centres is the disposal of sharp waste—items like hypodermic needles, cannulas, and glass ampoules—that can cut or puncture the skin and pose a high infection risk if not properly handled. These materials can transmit diseases such as hepatitis B, hepatitis C, and HIV, so to mitigate this risk, sharp waste must be disposed of in puncture-resistant containers or buried in specially designed pits, which are facilities we are incorporating into our project.

Additionally, we are expanding the delivery room and supplying essential materials for infection prevention and control, ensuring excellent safety for both mothers and newborns.

Through the  WASH in Health Care Facilities program, the WHO and UNICEF emphasize that access to clean water, sanitation, and hygiene in health centres is essential to reducing maternal and child mortality. It is also a fundamental pillar for achieving the goals of Good Health and Well-being (SDG 3) and Gender Equality (SDG 5).

It’s crucial to remember that maternal, neonatal, and child mortality is only the tip of the iceberg. According to UNICEF, nearly 1,000 children die every day from diarrheal diseases linked to contaminated drinking water, poor sanitation, or inadequate hygiene practices.

This is a clear example of how SDG 6—ensuring clean water and sanitation for all—is a key driver in achieving other Sustainable Development Goals.

Despite its critical importance, many health facilities worldwide still lack basic services:

• In 2022, only 78% of healthcare centres had basic water services, leaving 1.7 billion people without reliable access to safe water during medical care.
• Access to handwashing facilities is even worse: 3.4 billion people lacked proper stations with water and soap in healthcare centres.
• Regarding sanitation, in 2023, data from 51 countries revealed that fewer than 36% of health facilities had basic sanitation, with sharp inequalities across regions.

Our experience in other health centres—such as the Chengelpattu Hospital in India and our collaborations during the COVID-19 pandemic in Mali and Brazil—reinforces the strong connection between SDG 6 and the concept of health system self-sufficiency.

In India, for example, our aid projects operate in regions where a lack of healthcare resources, coupled with endemic diseases and the absence of safe water and sanitation, leads to the death of around 10,000 children each year. We encounter similar situations in Sub-Saharan Africa.

All these experiences align with the guidelines of the Water, Sanitation, and Hygiene Facility Improvement Tool (WASH FIT), launched by the WHO in 2015. This tool addresses basic water and sanitation needs and incorporates critical dimensions such as climate resilience and the evolving needs of healthcare facilities.