Key Details
The WHO–UNICEF report Progress on Water, Sanitation, Hygiene, Environmental Cleaning and Waste Management in Health Care Facilities 2015–2025 provides India’s first complete estimates across all five service areas. The figures show that access to water and hygiene is approaching universality, while sanitation and cleaning remain the larger quality-of-care gaps.
Service | India | Global |
|---|---|---|
Basic water | 97% | 85% |
Basic sanitation | 73% | 40% |
Basic hygiene | 94% | 72% |
Basic environmental cleaning | 78% | 59% |
Basic waste management | 89% | 71% |
New Indian administrative data substantially expanded global monitoring coverage and contributed to the first global estimates covering all five services.
India’s Remaining Gaps Are Concentrated in Sanitation and Cleaning
India performs above the corresponding global estimates in every category. Its strongest results are in basic water and hygiene, available in 97% and 94% of health facilities, respectively.
The national figures nevertheless leave around one-quarter of facilities without basic sanitation and more than one-fifth without basic environmental cleaning. These are not simply infrastructure gaps: they concern whether facilities can provide safe, usable and dignified care.
A facility meets the basic sanitation standard only when improved toilets are usable and include appropriate provision for staff, women, menstrual hygiene and people with limited mobility. Environmental cleaning requires both formal protocols and trained cleaning personnel.
Rural Facilities Require Greater Attention
The national averages conceal substantial rural–urban differences:
Service | Urban Facilities | Rural Facilities |
|---|---|---|
Basic sanitation | 86% | 71% |
Basic environmental cleaning | 93% | 76% |
For India, the next stage is therefore not limited to installing additional taps or toilets. It involves improving service quality in rural and primary-care facilities through reliable supplies, trained personnel, inclusive sanitation and routine supervision.
This is particularly important because lower-level facilities are often the first — and most frequently used — point of contact with the public health system.
Kayakalp Has Taken Facility Standards to Scale
The report highlights India’s Kayakalp initiative, launched by the Ministry of Health and Family Welfare in 2015 to strengthen cleanliness, infection prevention, sanitation, waste management and quality of care in public health facilities.
Its approach combines:
internal facility assessments;
peer assessments by trained teams;
independent external verification;
common scoring standards; and
recognition and performance incentives.
The number of facilities complying with Kayakalp standards increased from 100 in 2015–16 to 51,707 in 2024–25. Participation has also expanded from hospitals to smaller primary-care facilities, including Ayushman Arogya Mandirs.
Kayakalp demonstrates that structured assessment and incentives can operate across a large public health system. The next test is whether formal compliance consistently translates into reliable services and safer experiences for patients and health workers.
Global Sanitation Standards Reveal the Difference Between Access and Usability
Globally, 89% of health facilities had some form of sanitation, but only 40% met the basic service standard. Among facilities assessed:
76% had improved toilets designated for staff;
55% had sex-separated facilities;
51% had toilets accessible to people with limited mobility; and
49% had provision for menstrual hygiene.
A further 11% of facilities, serving an estimated 936 million people, had no sanitation service.
These findings show why counting constructed toilets can overstate progress. Functionality, accessibility and suitability for different users determine whether sanitation actually supports safe health care.
Monitoring Must Move Beyond Infrastructure
The report cautions that even the “basic” classification does not capture every aspect of service quality. Water indicators may not reveal shortages during the day, inadequate storage or insufficient quantities. Hygiene benchmarks do not establish whether facilities exist at every clinical point where they are needed.
Patient and staff experience, service reliability and infection-prevention outcomes must therefore complement infrastructure indicators.
Global trends also require careful interpretation. Water coverage rose from 76% in 2015 to 85% in 2025, but changes in the countries providing data affect comparisons for hygiene and waste management. Comparable global trends are not yet available for sanitation and environmental cleaning.
What Is WASH in Health Facilities?
Water, Sanitation and Hygiene (WASH) refers to the basic services needed to keep health facilities safe and hygienic. The report also assesses environmental cleaning and health-care waste management because both are essential for infection prevention.
Policy Relevance
Priorities should shift towards sanitation and cleaning. These are now India’s largest gaps among the five monitored service areas.
Rural and primary facilities need targeted support. National averages should not obscure weaker sanitation and cleaning coverage outside urban facilities.
Inclusive design must become routine. Toilets should meet the needs of staff, women, menstruating users and people with limited mobility.
Cleaning requires a functioning system. Trained personnel, protocols, supplies and supervision matter as much as equipment.
Kayakalp assessments should track service reliability. Compliance data can be supplemented with unannounced checks, patient feedback and infection-prevention outcomes.
Facility-level data should remain public and comparable. Regular reporting can identify geographic and institutional gaps hidden by high national coverage.
Follow the Full Report Here: WHO–UNICEF: Progress on Water, Sanitation, Hygiene, Environmental Cleaning and Waste Management in Health Care Facilities 2015–2025