Costs and health impacts of inadequate water sanitation and hygiene in Zambian primary healthcare facilities 2022
1
Programmes, Wateraid Zambia, Lusaka, Zambia
Popul. Med. 2026;8(Supplement Supplement 1):A1879
ABSTRACT
INTRODUCTION:
Access to adequate water, sanitation, and hygiene (WASH) services is essential for infection prevention and control and the achievement of Universal Health Coverage (UHC). Many Zambian healthcare facilities operate without basic WASH infrastructure, contributing to the burden of healthcare-associated infections (HAIs) and antimicrobial resistance (AMR). This study estimated the national health and economic cost of inadequate WASH in healthcare facilities.
METHODS:
A cost-of-illness model adapted from World Health Organization and World Bank frameworks was used to calculate direct healthcare, productivity, and mortality costs associated with HAIs in 2022. The model covered all levels of healthcare facilities. Data inputs included national hospital admissions, WASH coverage, pooled HAI incidence (12.76 percent), AMR proportion (50 percent), and average additional hospital stay (5–10 days). Sensitivity analyses varied infection rate, fatality, and length of stay.
RESULTS:
An estimated 242000 HAIs occurred in 2022, causing approximately 25100 deaths and costing 674 million United States dollars. This included 115 million in healthcare expenditure, 16 million in productivity losses, and 543 million in mortality costs. About half of all infections were associated with AMR. The per capita HAI cost of 5.74 United States dollars exceeds the 1 United States dollar required to provide basic WASH in healthcare facilities, demonstrating the cost-effectiveness of preventive WASH investment.
CONCLUSIONS:
Inadequate WASH imposes a significant financial and health burden on Zambia’s primary healthcare system. Strengthening WASH infrastructure and infection prevention measures is essential to reduce preventable deaths, enhance patient safety, and accelerate progress toward UHC.
Access to adequate water, sanitation, and hygiene (WASH) services is essential for infection prevention and control and the achievement of Universal Health Coverage (UHC). Many Zambian healthcare facilities operate without basic WASH infrastructure, contributing to the burden of healthcare-associated infections (HAIs) and antimicrobial resistance (AMR). This study estimated the national health and economic cost of inadequate WASH in healthcare facilities.
METHODS:
A cost-of-illness model adapted from World Health Organization and World Bank frameworks was used to calculate direct healthcare, productivity, and mortality costs associated with HAIs in 2022. The model covered all levels of healthcare facilities. Data inputs included national hospital admissions, WASH coverage, pooled HAI incidence (12.76 percent), AMR proportion (50 percent), and average additional hospital stay (5–10 days). Sensitivity analyses varied infection rate, fatality, and length of stay.
RESULTS:
An estimated 242000 HAIs occurred in 2022, causing approximately 25100 deaths and costing 674 million United States dollars. This included 115 million in healthcare expenditure, 16 million in productivity losses, and 543 million in mortality costs. About half of all infections were associated with AMR. The per capita HAI cost of 5.74 United States dollars exceeds the 1 United States dollar required to provide basic WASH in healthcare facilities, demonstrating the cost-effectiveness of preventive WASH investment.
CONCLUSIONS:
Inadequate WASH imposes a significant financial and health burden on Zambia’s primary healthcare system. Strengthening WASH infrastructure and infection prevention measures is essential to reduce preventable deaths, enhance patient safety, and accelerate progress toward UHC.
| eISSN: | 2654-1459 |
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