The missing ingredients

4 min read
Image: WaterAid/Kate Holt

WaterAid and SHARE launch a report today highlighting the degree to which national nutrition and water, sanitation and hygiene (WASH) plans and policies are coordinated and integrated to end malnutrition. As world leaders gather in Brazil for the Nutrition for Growth event organised by the Olympic host nation to discuss progress in ending malnutrition, Megan Wilson-Jones, Policy Analyst for Health and Hygiene at WaterAid UK, discusses the study’s main findings.

Everyone knows that a good recipe requires all the right ingredients, in the right quantity, and of the best quality. The same could be said for how a government needs to address the nutrition of its population – a complex issue influenced by a multitude of factors and therefore requiring a host of interventions, or ingredients, for success.

Around the world, 159 million children under the age of five suffer stunted growth, resulting in largely irreversible impairments to their physical, mental and emotional development. Although much progress in nutrition has been made around the world, it has been far too slow. 

As the world enters a new era of development, one that aims to end poverty and malnutrition by 2030, the lessons of the past decade provide important insights and opportunities to drive the progress needed to achieve the Sustainable Development Goals (SDGs). The ambitious SDGs require a transformational shift towards much greater coordination and collaboration across sectors, in order to deliver sustainable and effective change at scale.

Evidence shows that scaling up interventions that tackle the immediate causes of malnutrition is insufficient to overcome the challenge. A more comprehensive ‘recipe’ requiring a mix of ‘ingredients’ from multiple sectors is critical to address both the immediate and underlying causes of malnutrition. 

With an estimated 50% of undernutrition associated with infections caused by poor WASH, better coordination, collaboration and integration across nutrition and WASH programmes is paramount to improving nutrition and health outcomes.

Nutrition index: the analysis

In 'The missing ingredients' we analysed 13 countries’ national nutrition and WASH plans and policies, to understand the degree to which nutrition and WASH are coordinated and integrated in respective plans and policies. The infographic below highlights the key findings from the analysis of nutrition plans, indicating that Timor-Leste and Nepal have the strongest plans in terms of embedding WASH components. 

On the basis of the results of this research, and supplemented by existing evidence and experience, five key findings are:

  1. WASH into nutrition varies widely. All nutrition plans and policies analysed recognise the importance of WASH; however, the degree to which WASH is embedded within plans in terms of objectives, targets, interventions and indicators varies significantly across countries. 
  2. Nutrition into WASH is limited. Very few WASH plans reference nutrition or identify opportunities to integrate with nutrition and health programmes and campaigns. The exception was Liberia. 
  3. One size doesn’t fit all. There is no single blueprint for how WASH should be embedded in nutrition plans, nor for how WASH programmes can be made more nutrition-sensitive. However, consideration of some key principles and approaches could help drive progress. For example, designing WASH programmes to target populations most vulnerable to nutrition and/or identifying opportunities to integrate activities such as those related to behaviours such as personal and food hygiene and breastfeeding could result in more joined-up approaches. 
  4. Continuum approach. Working together should not be thought of in a binary way – it is not simply working together or not, but rather should be considered along a continuum, with different degrees or approaches to collaboration. At the lower end this may simply involve sharing of information and targeting different programmes to the same populations, while at the other end of the spectrum this can look like a more integrated programme, involving the same staff and a single budget. 
  5. Policies and plans alone are not enough. The success of programmes will require more than just a good plan. However, plans and policies are a core part of the process of outlining the mechanisms and systems required to allow more joined-up working to advance nutrition and WASH goals.

This is a crucial moment

Today world leaders will gather as the Rio Olympic Games begin, to discuss progress and challenges in ending malnutrition. The ‘Nutrition for Growth’ event hosted by the Government of Brazil is part of an ongoing partnership between the governments of Brazil, Japan and the UK to ensure bold commitments are made in the fight to end malnutrition. 

The event today, and the next phase of Nutrition for Growth, is a crucial moment to raise the profile of nutrition, but without concerted efforts and attention on addressing the underlying causes of malnutrition such as WASH, there’s no hope that the commitments emerging during the next phase of Nutrition for Growth will lead to ending this blight on the lives and life chances of millions of children. 

Download The missing ingredients report >

Megan Wilson-Jones tweets as @MegsWJ