Practical pathways to integrate nutrition and water, sanitation and hygiene (WASH)

Posted by
WaterAid and Action Against Hunger
Madagascar, Cambodia, Ethiopia, Nutrition, Health, Leadership, advocacy and influencing, System strengthening
Raoly, 29 and her daughter, Natasha, at the water point, six months after the arrival of water in their village. Tsarafangitra village, Belavabary commune, Moramanga district, Madagascar, March 2018.
Image: WaterAid/ Ernest Randriarimalala

Investing in the nutrition of children is crucial if countries are to nurture the human capital necessary for social and economic development. Improvements in water, sanitation and hygiene (WASH) services are critical for the success of such investments. Our research in Madagascar, Cambodia and Ethiopia reveals opportunities and pathways for combining WASH and nutrition efforts to better tackle undernutrition.

Global brief: Practical pathways to integrate nutrition and WASH

In partnership with Action Against Hunger, we conducted qualitative research with key stakeholders in Madagascar, Cambodia and Ethiopia to assess the successes of, challenges to and opportunities for greater coordination between efforts to improve WASH and nutrition. All three countries have shown progress in driving collaboration between nutrition and WASH, and all three studies presented opportunities to step this up.

In our global brief we bring together commonalities and key enablers, or pathways, for progress to collaborate and integrate WASH and nutrition policies and programmes in countries with high undernutrition burden. Only by working together can we drive lasting change and achieve the Sustainable Development Goals.

Download the brief:

Watch our short film on the brief's key messages:

During the Scaling Up Nutrition Global Gathering in Kathmandu, Nepal, in November 2019, we led the organisation of a workshop on integration of nutrition and water, sanitation and hygiene. You can download a summary note in English here and French here.


More than one child in three in Ethiopia is stunted, irreversibly damaging their physical and cognitive development, and limiting their future prosperity. This case study recommends how the Government can move from political commitments to effective, integrated action on nutrition and WASH.

Despite Ethiopia's impressive poverty reduction in recent years, malnutrition remains a huge threat to public health. The Government has gone some way to recognising the importance of WASH to combating malnutrition, recently making important political commitments to an integrated, multisectoral approach. To assess the successes, challenges and opportunities, and make recommendations for greater integration between WASH and nutrition in Ethiopia, WaterAid and Action Against Hunger conducted a qualitative analysis with stakeholders from national and sub-national government, bilateral and multilateral donor agencies, and NGOs.

Watch our short interview with Action Against Hunger's Andualem Fekadu:


32% of children under five in Cambodia are stunted. This case study from Cambodia highlights the need for integrated action on nutrition and water, sanitation and hygiene (WASH).

An ambitious economic development agenda and a mature recognition of interlinkages between the Sustainable Development Goals means Cambodia has the potential to achieve rapid reductions in malnutrition levels through integrated action on nutrition and water, sanitation and hygiene (WASH). Despite this favourable position, significant challenges remain at both national and sub-national levels. This case study seeks to uncover those challenges, identify opportunities and encourage the Royal Government of Cambodia and development partners to sustain integrated action on combating chronic malnutrition.

Watch our short interview with Dr Chea Samnang, Chair of Cambodia's Sub-Working Group on WASH and Nutrition:


With almost half of children suffering from chronic malnutrition, Madagascar has one of the highest rates of stunting in the world. Improving children's health and nutrition is not only a moral imperative, but failure to do so undermines all other efforts to stimulate economic progress and development in the country.

Action Against Hunger and WaterAid developed this case study to document and share lessons from Madagascar's experience in advancing integration between the WASH and nutrition sectors at policy, institutional coordination and practical levels.

Watch our short interview with Ambinintsoa Raveloharison, former National Coordinator of the National Nutrition Office, Madagascar: