It’s hard to imagine health-care facilities lacking something as basic as safe drinking water and effective sanitation—but in reality this scarcity is commonplace. This is partly a problem of infrastructure but also one of inadequate training, tools, and ongoing maintenance.
One of the organizations concerned with this problem is the Catholic Church. Its Dicastery for Promoting Integral Human Development, a department established by Pope Francis in 2016, is sponsoring a pilot project to provide water, sanitation, and hygiene (WASH) services in health-care facilities across impoverished regions of the world.
The Dicastery’s Prefect, Cardinal Michael Czerny, a Jesuit priest from Canada, highlighted its work at the World Water Forum, in Dakar, in 2022. “More than two billion people are deprived of access to clean water and sanitation,” he said. “Think of all the practical consequences that this can have, in particular for patients in health centers, for women in labor.”
He discussed the Church’s commitment further with Think Global Health.
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The Catholic Church can be considered the world’s largest “unified” health-care provider.
Think Global Health: Why, where, and how does the Catholic Church involve itself in health care?
Cardinal Czerny: With more than 5,300 hospitals, 14,400 dispensaries, and 530 leprosaria, the Catholic Church can be considered the world’s largest “unified” health-care provider. These health-care facilities are often located in remote and underserved communities. The church’s tradition prioritizes care for everyone, preferentially “the poor and the sick, those who are usually despised and overlooked, ‘those who cannot repay you,’” in the words of Pope Francis. Care is offered to all comers, without distinction of religion, nationality, ethnicity, or political affiliation.
Church health-care providers include religious congregations as well as dioceses, parishes, Catholic universities, and nongovernmental organizations such as Caritas. Some of them are partnering on the WASH initiative.
Think Global Health: Why is the Catholic Church particularly suited to address issues of water, sanitation, and hygiene?
Cardinal Czerny: No one needs lofty theological concepts to justify proper WASH. Without it, health care cannot be healthy. No treatment, no surgery, no delivery can be safely performed without meeting basic WASH conditions. Providing them for all is an elementary step toward equal human dignity and integral human development, which otherwise are at risk.
This is a clear example of the interconnected approach favored by Pope Francis. In his Laudato Si’, published in 2015, the word water appears forty-seven times. “Access to safe drinkable water is a basic and universal human right, since it is essential to human survival and, as such, is a condition for the exercise of other human rights,” it reads.
After the World Health Organization’s global assessments of WASH in health-care facilities, we promoted assessments of WASH conditions in a selection of 150 Catholic facilities in twenty-three countries that together offer health care to some twenty-eight million people annually. Africa represents the bulk of assessments; we also assessed facilities in the Philippines and Haiti.
Think Global Health: What have been some of the main findings?
Cardinal Czerny: Although our assessments were conducted throughout 2021, the conditions encountered were long term, not COVID related. The problems in Catholic-run facilities are the same as in others: lack of safe water, poor sanitation, neglect of cleaning protocols and routine maintenance, lack of spare parts, and inability to make repairs. In a few cases, the impediments were political or societal insecurity, prolonged turmoil, and violence.
We also learned that many facilities had not performed any detailed WASH assessments preceding our pilot initiative. That 45 percent of these Catholic facilities do not have a budget specific for WASH shows how easily this need is overlooked. We heard of a leprosarium that experienced a thirty-day water service interruption, pregnant women who have to carry water to a facility when about to give birth, facilities without functioning toilets. Obviously, patients are adversely affected, but medical workers, cleaners, chaplains, administrators, and families are also put at risk.
Think Global Health: What have been some of the biggest challenges, frustrations, surprises, successes?
Cardinal Czerny: WASH comes at a cost: not only new infrastructure and upgrades, but also training and maintenance. Ensuring the availability of water may require digging wells or drilling boreholes, analyzing or treating the water, properly disposing of wastewater and medical waste, and more. Buying sophisticated new equipment for other purposes can seem more important to staff — and more attractive to donors — than maintaining toilets, building placenta pits for safe disposal, and buying water filters.
Raising awareness and inspiring the interest of traditional Catholic donors and partners remains a challenge. Some have well-established procedures for making grants to address environmental or social justice issues, or medical equipment for pregnancy and neonatal care. All are important, but the danger is that fundamental WASH issues remain neglected.
Collaboration has been a major factor of success. Experts from the Caritas confederation and other partners such as Global Water 2020 tailored the assessment forms, helped facilities do their assessments, and provided financial support. Small facilities unable to prepare an application for funding, or an end-of-project report, received the necessary support to meet the challenge.
Improvements can be achieved incrementally. Catholic NGOs are training staff on hygiene, which is an important improvement that needs little or no budget. One facility already had toilets for men and women and, thanks to a grant, the Sisters could provide a larger cubicle to accommodate a wheelchair … an issue of human dignity.
Of the 150 facilities that participated in the survey, more than twenty have found financial assistance to implement some WASH measures and improve maintenance, as well as learning to provide donors with a transparent report once the project is completed.
Religious congregations, whose facilities were not included in the initial 150, are starting to evaluate the WASH conditions, applying the tools of assessment developed for the Dicastery.
WASH isn’t just Catholic. Religious organizations belonging to a variety of faiths sponsor, administer, and staff health facilities
Think Global Health: What happens next?
Cardinal Czerny: A great deal still needs to be done to finance improvements and favor sustainability. If a facility completes a new drainage system, builds a toilet, or adopts better WASH protocols, then three years from now, will these still be functional? The Dicastery is ready to facilitate contacts with the local Church to identify those needing support and to connect them with donors interested in offering financial assistance or technical or in-kind support.
Think Global Health: What does the Vatican hope to catalyze with this work?
Cardinal Czerny: The Dicastery begins by encouraging Catholic health-care personnel at the local level to identify needs and suffering related to this issue. Water is a powerful connector: long explanations are not needed to make people aware of its relevance for life, health, education, peace, and so forth. My hope is, thanks to the teaching and leadership of Pope Francis and to the efforts of many Catholic organizations, that WASH issues will receive more attention and become a real priority in more places.
Moreover, WASH isn’t just Catholic. Religious organizations belonging to a variety of faiths sponsor, administer, and staff health facilities. Everyone has the fundamental concern for humanity, and everyone can help to meet this basic need. The human right to drinking water and sanitation is an indisputable priority and, from a religious perspective, highly meaningful given the spiritual significance of water in all faiths.
EDITOR’S NOTE: This interview was conducted via email and has been edited for length and clarity.