Moving from ‘why’ to ‘how’: integrating WASH and nutrition for improved child health

on
3 April 2017
Jeannine prepares a meal for her family in Bekalalao, Madagascar. WaterAid/Kate Holt

To meet the Sustainable Development Goals on nutrition and water, sanitation and hygiene (WASH) we will need better integration. To help maximise our impact on nutrition, WaterAid has produced new guidance on planning WASH programmes through a nutrition lens. Megan Wilson-Jones, Policy Analyst for Health and Hygiene, walks us through some of the guidance’s key tips for integration.

Earlier this year, the Scaling Up Nutrition (SUN) Movement and the Sanitation and Water for All(SWA) partnership came together to agree a joint programme of work to support the integration of water, sanitation and hygiene (WASH) and nutrition. This was in response to the growing body of evidence highlighting the importance of poor WASH as a major underlying cause of undernutrition.

The SUN Movement and SWA partnership are global entities that have been instrumental in driving progress on improving nutrition and WASH, respectively, around the world. The Sustainable Development Goals (SDGs) have stimulated much debate on how to deliver better integration across sectors to maximise impact, drive cost-effectiveness and improve sustainability. New partnerships and innovations for development are urgently needed to deliver on this ambitious agenda. Despite the rhetoric of the need for greater integration, understanding what this looks like in practice is challenging.

Enhancing the nutrition impact of our work

WaterAid is grappling with the issue of how to integrate WASH with nutrition programmes, and how to ensure our WASH interventions deliver the maximum impact on nutrition outcomes – often referred to as increasing the ‘nutrition-sensitivity’ of the programme.

As an example, maximising the impact on a nutrition outcome such as stunting would mean ensuring WASH programmes are designed to prevent all possible faecal–oral transmission routes, in order to reduce infections caused by poor WASH and contribute to the greatest possible reduction in stunting.

We have developed new programmatic guidance to ensure a more systematic approach to working with nutrition stakeholders and planning WASH programmes through a nutrition lens. Building on experience and existing resources, the note includes specific steps and actions that can be taken at different stages of WaterAid’s Programmatic Approach to enhance the nutrition impact of our work.

Key ways to integrate WASH and nutrition

An example of a concrete action that can be taken for each stage of the Programmatic Approach is summarised below.

How to integrate WASH and nutrition through WaterAid’s Programmatic Approach:

  1. Contextual analysis: Understanding the particular WASH and nutrition challenges in a setting is a critical first step. Nutrition data can help inform where to target WASH programmes. This requires analysis of existing data such as prevalence of stunting, diarrhoea and anaemia.
  2. Work in partnership: Participate in nutrition platforms such as the SUN movement, which bring together different sectors and stakeholders across government, civil society organisations and private sectors.
  3. Delivery of services: Ensuring sustained and effective hygiene behaviour change is essential to realise the nutritional benefits of WASH programmes. The key behaviours include exclusive breastfeeding, food hygiene, handwashing with soap at critical times, milk and household water treatment and storage, and safe disposal of child faeces.
  4. Capacity, knowledge and accountability: Staff and other stakeholders from either nutrition or WASH programmes often lack the technical expertise of the other, so short briefings, meetings, trainings, and seminars that bring nutrition and WASH actors together can be good opportunities to build knowledge and understanding.
  5. Influencing and advocacy: Analysing national nutrition plans and policies for the inclusion of WASH can help inform the gaps (see WaterAid’s report ‘The Missing Ingredients’). A strong national multi-sectoral nutrition policy and plan that recognise the importance of WASH for nutrition outcomes pave the way for the development of integrated programming at all levels. Ensuring WASH sector plans and policies consider the impact on nutrition and identify opportunities to collaborate will also be important.
  6. Continuous analysis, learning and reflection: Developing baselines with both nutrition (e.g. stunting and diarrhoeal prevalence data) and WASH components (e.g. access and use data) will allow assessment of progress. Therefore where possible nutrition surveys should seek to include WASH indicators, and, similarly, WASH surveys and baselines should include nutrition measurements.

More detailed information can be found in the full guidance note and translations are available here >

A woman holds rice that she has grown. Antsirabe, Madagascar, April 19, 2016. WaterAid has been working in the school and  community for more than three years.WaterAid/ Kate Holt
A woman shows the rice she has grown in Antsirabe, Madagascar.

Partnership and innovation for success

Achieving the SDGs, including Goal 2 on nutrition and Goal 6 on WASH, will require new ways of working, new partnerships and greater innovation. Through our Programmatic Approach, we seek to contribute to understanding of how integration of WASH and nutrition can be delivered in practice, and in doing so will support the efforts of the new SUN–SWA partnership.

Success of the new partnership will require all partners to contribute by sharing experiences and lessons learned to deliver sustained improvements in nutrition and WASH.

Do you have an example of integrating WASH and nutrition in a project or programme? Please share it with us in the comments below or at [email protected].

Megan Wilson-Jones tweets as @MegsWJ