We want everyone to have the same chance of starting life in good health. Healthy Start is our global campaign focused on improving the health and nutrition of newborn babies and children through clean water, decent sanitation and good hygiene.

Every minute a newborn baby dies from infection caused by a lack of clean water and an unclean environment. Each year, more than 300,000 children under five die from diarrhoeal diseases caused by poor water and sanitation. Many more suffer serious effects such as undernutrition and stunting that affect them well into adulthood. To end this crisis, we advocate integration of access to water, sanitation and hygiene promotion into health policy and delivery locally, nationally and internationally.

The links between dirty hands, dirty water and infant mortality have been known for more than 150 years – this is not a puzzle waiting for an answer, but an injustice waiting for action. The time for change is now. We work with key partners and forge alliances to effect the changes that will make the difference nationally and internationally.

We are calling for:

  1. National governments to make water, sanitation and hygiene (WASH) services part of all plans to reduce infant mortality and improve nutrition.

  2. Every healthcare facility to have clean running water; safe, separate and accessible toilets for men and women; and functional sinks with soap in all treatment and birthing rooms.

  3. Healthcare workers to commit to practising and promoting good hygiene.

  4. Monitoring and assessment of progress towards universal health coverage to include data on the availability of WASH services in healthcare facilities and households.

  5. Joint cross-sector action to achieve the Sustainable Development Goals (SDGs), recognising that achieving Goal 6 – water and sanitation for all by 2030 – will be fundamental to ending malnutrition (Goal 2) and to ending preventable newborn and child deaths and achieving Universal Health Coverage (under Goal 3).

Practical pathways to integrate nutrition and WASH

With Action Against Hunger, we conducted research in Madagascar, Cambodia and Ethiopia to assess the successes of, challenges to and opportunities for greater coordination between work to improve WASH and nutrition. Our report highlights 7 entry points for improvement.

Image: WaterAid/ Ernest Randriarimalala

Newborn survival

Three babies die every five minutes in Sub-Saharan Africa or Southern Asia from highly preventable causes such as diarrhoea, sepsis, meningitis and tetanus – all of which are strongly linked to unhygienic conditions.

Research shows that ensuring every baby has a healthy start would dramatically reduce their risk of contracting those infections. In one study, if both mother and birth attendant washed their hands before the birth and before handling the newborn child, a baby’s chance of dying in the first month more than halved.

One of the founding principles of healthcare is 'First do no harm'. Without adequate WASH, this principle cannot be upheld. It is hard to imagine that there is any medical professional, health department official or health minister who is unaware of the risks of exposing babies to infection through unclean birth conditions and poor hygiene practices. And yet, women are still giving birth in environments that do not have clean water, soap and sanitation, attended by carers who cannot or do not observe basic hygiene practices.

The latest available data from WHO and UNICEF show a shocking situation:

  • More than half (50.4%) of healthcare facilities in least-developed countries, and one in four globally (24%), do not have clean water on site. That's 1.8 billion people who have no clean water at their healthcare facility; 712 million have no water at all.
  • One in ten healthcare facilities globally (10%) have no sanitation services.
  • Globally, one in three healthcare facilities do not have adequate hand hygiene facilities where care is given.
  • Only three in ten healthcare facilities in least-developed countries have the ability to safely dispose of medical waste.

The tragic consequences highlight shocking global inequality. For example, babies born in hospitals in low- and middle-income countries are up to 20 times more likely to develop neonatal sepsis than are hospital-born babies in high-income countries like the UK.

We want to end such inequalities, by making sure everyone, everywhere has access to clean water, sanitation and hygiene by 2030. Governments must ensure all healthcare facilities are equipped with water and sanitation facilities as a matter of urgency, and they must be held to account for ensuring these standards are met.

Find out more in our report Transforming health systems.

Child nutrition

Malnutrition is more than hunger. It is a global crisis that is hurting the most vulnerable people the most, undermining many areas of development such as expanding access to quality education, and every year reducing GDP by up to 11% across Africa and Asia. And it is closely linked to unclean water, inadequate sanitation and poor hygiene.

More than 150 million children around the world are stunted, their physical, cognitive, social and emotional development irreversibly damaged by a lack of vital nutrients in the first thousand days of their lives, from conception to age two. The links between nutrition and WASH are both direct and indirect. When children drink dirty water and get severe diarrhoea or intestinal worms, they can't absorb the nutrients they need to grow properly. A quarter of all stunting is attributed to five or more episodes of diarrhoea before the age of two. Estimates suggest that poor sanitation is the second leading risk factor for stunting worldwide.

Indirect links between nutrition and WASH are also important. For example, women and girls are responsible for water collection in eight out of ten households with water off-premises, and collectively across the world spend nearly 200 million hours every day collecting water. That is time they are unable to spend in school, or caring for and feeding young children, exacerbating the risk of malnutrition. Many nutrition interventions are delivered in healthcare facilities. How can they be effective when more than half of healthcare facilities in least-developed countries do not have clean water on site?

The goal of ending malnutrition by 2030 (SDG 2) cannot be achieved while one in ten people globally do not have clean water close to home, and 2 billion people – one in four – do not have a decent toilet of their own.

Our Healthy Start campaign calls on governments and donors to recognise that access to WASH is fundamental to ending malnutrition. WASH and nutrition need to be integrated in national strategies and plans, with joint multi-sector action, and increased domestic and international funding for WASH as a key ‘nutrition-sensitive’ intervention. By ensuring this, we can set every child on the path to a healthier life.

Find out more in our report 'Practical pathways to integrate nutrition and water, sanitation and hygiene.'

For more information about Healthy Start please contact [email protected]


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