Happy second anniversary Healthy Start
WaterAid’s global advocacy priority, Healthy Start, aims to improve newborn and child health by integrating water, sanitation and hygiene (WASH) into health policy and practice. Dan Jones, WaterAid’s Advocacy Coordinator, reflects on our progress so far.
This month marks two years since WaterAid launched our ‘global advocacy priority’ known as Healthy Start – the mid-point in what was originally conceived as a four-year global effort. Our staff are working across national, regional and international levels to persuade governments and international agencies that greater integration of WASH within health policies and programmes will drive substantial gains in the health and wellbeing of newborn babies and children in the crucial first 1,000 days of life.
While our advocacy continues apace, in the next few months we will also reflect on our progress, the challenges we’ve faced, and how we can adapt and improve.
Signs of positive change
As anyone working in advocacy will know, it can be difficult – and incredibly frustrating – to understand the impact we are having (see Kate Norgrove’s excellent blog on this topic). Change can be incremental or sudden, frequently driven by politics, personalities, and forces beyond our control. The change we see, and which we can attribute to our own efforts, will only ever be the tip of the proverbial iceberg.
Yet we can see enough signs of positive change to feel reasonably confident that we are heading in the right direction, and that we are doing so across multiple 'domains of change'.
Across multiple contexts, we have seen ministers and elected representatives making public commitments to improve health–WASH integration. In Cambodia, for example, the Deputy Prime Minister recently presided over the country’s first ever national conference on WASH and nutrition. Co-organised by WaterAid Cambodia, the conference saw participants from four ministries, sub-national level government, and vice-governors from ten provinces grappling with how to reduce malnutrition through improved WASH. In Mali, the WaterAid team has used 'shock tactics' – filming the poor state of hospitals without functioning toilets and taps even close to the parliament building – to secure written commitments from MPs.
Commitments to policy change
Beyond just politicians making easily broken promises, we have seen some of these translate into real commitment to changes in policy and policy-making processes. For instance, WaterAid Madagascar secured a commitment from the National Office of Nutrition to ensure integration of WASH in the update of the national nutrition action plan.
WaterAid teams are working with the health sector and health workers to strengthen knowledge and skills about the crucial importance of WASH to quality healthcare, infection prevention and control, and safe births. In Tanzania, this has resulted in Zanzibar’s Ministry of Health launching a 'Water, Sanitation and Hygiene in Healthcare Settings Facilitators Guide', supported by training for frontline healthcare workers.
Dr Ibrahim Kabole at the launch of 'Wash in Healthcare Settings Facilitators Guide', Tanzania.
'Insider' advocacy tactics alone can fail to put enough pressure on decision-makers to drive real change. Sometimes, public pressure is vital to forcing those in power to shift from the status quo. In India, public launch events for Healthy Start across five cities, including one in Delhi attended by the Minister of Health, brought media and social media attention to the poor provision of WASH in many Indian healthcare facilities. Similarly, our new global campaign for midwives, nurses and doctors, created in partnership with health professional associations, aims to raise these voices – of those struggling to provide healthcare in often terrible conditions – to the fore of this debate.
Partnerships beyond the WASH bubble
"No longer business as usual" is how Abigail Nyaka of WaterAid Malawi describes their 'Deliver Life' project, funded by the UK Aid Match scheme, which aims to improve WASH in healthcare facilities in the marginalised districts of Kasungu, Nkhotakota, and Machinga. And this has been a key mantra throughout WaterAid as we challenged ourselves to break out of our traditional 'taps and toilets' WASH bubble to establish new collaborations with health and nutrition specialists. From the maternal health experts The Soapbox Collaborative in Malawi, to the International Coalition for Advocacy on Nutrition (ICAN), and from Amref Health Africa in Tanzania to the new BabyWASH global coalition, we have focused on new ways of working and new people to work with. At the international level we have worked hard to be just as active in forums like the World Health Assembly and Women Deliver conference as we have in bringing new issues to our more traditional spaces like Stockholm World Water Week.
Shifting global governance
Although national governments will be central in delivering more effective WASH–health integration, international institutions are key in shaping norms and global standards, and, by doing so, setting expectations for governments to meet. We’ve seen substantial progress on this front, working closely with WHO to support the Global Action Plan on WASH in Healthcare Facilities, and helping to spark new collaboration between the global platforms for WASH and nutrition – the Sanitation and Water for All (SWA) partnership and the Scaling Up Nutrition (SUN) movement.
And the challenges?
Of course, it hasn’t all been positive, or easy. Healthy Start is symbolic of major shifts in WaterAid’s strategy and ways of working – towards greater cross-sector integration, and towards transformative change at scale driven by advocacy and influencing. We are striving to find the right approach in each context that balances the insider, top-down – friend of government, with the outsider, bottom up – empowerment of citizens to demand their rights. This work is pushing many of us out of our comfort zones and into intimidating new spaces.
We have learned that building our confidence in engaging the health sector is as much about 'just getting out there and starting conversations' as it is about learning new jargon.
We have also realised that seeking greater integration and breaking down sector siloes puts us in the middle of one of the biggest buzzwords of the new sustainable development agenda. 'Integration' may be sexy, but it’s not easy. We may advocate that nutrition and WASH must be tackled together, but what does that mean in practice? Governments and donors are increasingly asking us for the answers – the examples of good programmes and the proof of value for money. Not easy, and something we will need to work with many of our new partners to get better at.
Taking the time to reflect, honestly and openly, on our challenges as well as our successes is fundamental to adapting and improving. Through this approach, I have great confidence in the power of WaterAid and those who work with us to help achieve the world we all want – where every child has a healthy start in life.