Recipe for success: how to end malnutrition
At current rates of progress we won’t end malnutrition by 2030. To do so, countries must integrate their nutrition and WASH (water, sanitation and hygiene) plans. But to what extent are governments ensuring this kind of collaboration? Sophie Durrans of the SHARE Consortium and London School of Hygiene and Tropical Medicine introduces our new analysis.
As the saying goes, too many cooks spoil the broth. However, sometimes it’s not about how many cooks are involved in the process, but about how effective they are at working together to reach a common goal.
This is true in the context of how countries approach nutrition and water, sanitation and hygiene (WASH) – having too many stakeholder groups involved isn’t always the issue. Rather, to achieve nutrition goals countries must ensure they’ve got the right sectors and ministries involved, and that they’re collaborating in the most effective ways.
Malnutrition is a major cause of child illness and morbidity, and the World Health Organization estimates that half of undernutrition is associated with diseases caused by poor WASH – the issues are inseparable. As we set to enter the third year of the Sustainable Development Goals (SDGs), progress is too slow to meet the target under Goal 2 to end all forms of malnutrition. Without integrated approaches bringing together nutrition and WASH – supported at both the global level and by national governments – progress will continue to be limited.
From ‘The missing ingredients’ to ‘The recipe for success’
In 2016, WaterAid and SHARE published a report, The missing ingredients, which highlighted the degree to which nutrition and WASH are coordinated and integrated in 13 countries’ national nutrition and WASH plans and policies.
After producing the report, we found that both WASH and nutrition sectors had an appetite for more analysis covering a wider range of countries. Action Contre la Faim (ACF), WaterAid and SHARE therefore analysed ten more countries across Sub-Saharan Africa and Southeast Asia, further developing criteria for analysing WASH plans, to produce The recipe for success. We also added donors into the mix, to understand the degree to which WASH is included in priority nutrition-sensitive interventions.
The right ingredients
The findings from our analysis of countries’ plans and policies reinforce the results from The missing ingredients – both studies showed there’s no silver bullet for integration, nor is there a single blueprint for how this can be done.
Our country analysis findings chimed with the results from our first report – the extent to which nutrition plans and policies prioritise WASH varied, and most WASH plans and policies seldom mention nutrition.
We wanted to suggest ways forward – our analysis revealed some of the key entry points and processes that can foster greater collaboration between nutrition and WASH stakeholder groups. These include: identifying entry points for integrated delivery (for example, behaviour change interventions targeting both WASH and nutrition); strengthening institutional mechanisms to allow for greater knowledge transfer; and understanding the barriers for cross-sectoral work and what incentives exist or can be created to improve the nutrition sensitivity of WASH programmes.
The role of donors
Our analysis of 13 donors included four categories:
- Multilateral institutions (African Development Bank, EU, World Bank, UNICEF)
- Bilateral national donors (Canada, Germany, Japan, UK, USA)
- Private/philanthropic foundations (The Children’s Investment Fund Foundation and the Bill & Melinda Gates Foundation)
- Global platforms providing non-financial support (Scaling Up Nutrition (SUN) Movement and Sanitation and Water for All (SWA) partnership).
Our findings show that although donors often miss key opportunities for multi-sectoral approaches they can play a breadth of roles to strengthen WASH and nutrition integration:
- Financing – Pledging ambitious commitments to nutrition-sensitive interventions can signal recognition of different sectors’ roles in improving nutrition, and can be used to encourage national governments to develop integrated approaches.
- Convening power – Through strong relationships with government ministries and other stakeholders at national, regional and global levels, donors can help galvanise more effective coordination.
- Research and evidence – Funding policy-orientated, operational research is vital to help document and share good programme practice.
- Global governance and technical support – Shaping processes, partnerships and initiatives will drive cross-sectoral collaboration, which will in turn guide national governments.
Our report culminates with a ‘recipe’, or toolkit, to stimulate debate and discussion of the options and opportunities to bring together WASH and nutrition policies and programmes. We also provide specific recommendations targeted at national governments; nutrition policy-makers and practitioners; WASH policy-makers and practitioners; donor agencies; and technical partners, civil society and global partnerships. We hope to offer food for thought, and encourage specific actions to end malnutrition.