Feed the Future
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The WASH and Nutrition Nexus: Addressing Child Stunting Through Water, Sanitation, and Hygiene

This blog post was written by Becky Manning (USAID/BFS/SPPM).

Water, sanitation, and hygiene are necessary for healthy populations, safe food, and sustainable development. In recognition of this truth, USAID established its first global Water and Development Strategy for the period 2013-2018. The goal of this Strategy is to “save lives and advance development through improvements in water supply, sanitation, and hygiene (WASH) programs, and through sound management and use of water for food security.”

On April 1, 2014, USAID invited Dr. Francis Ngure, of the World Bank, to present upon and discuss the current strategic and operational approaches that link WASH to nutrition programming. You can download the presentation slides here.

In his presentation, Dr. Ngure highlighted the benefits of cross-sectoral efforts to address stunting, and new evidence that shows how WASH affects early child development. WASH can affect child development through inflammation, stunting, and anemia. A key link between poor hygiene and developmental deficits may be a prevalent subclinical condition of the gut, environmental enteropathy (EE).

Though early child development research and programs provide an abundance of support in the areas of nutrition, stimulation, and child protection, the programs lack evidence-based interventions to provide clean play and feeding environments. It is important to keep a hygienic environment to limit fecal-oral exposure. The concept of “baby WASH” has been recommended as an additional component of early childhood development programs.

These findings call attention to the reality that although nutrition-specific interventions—such as improved infant and young child feeding—have helped achieve modest improvements in child growth across developing nations, two thirds of the average height deficit in Asian and African children remains unresolved. A cross-sectoral approach to nutrition programming is key, and WASH needs to be a high priority.

Ngure’s bottom line was that evidence supports the integration of WASH and nutrition programming. His recommendations, based on the approach of “thinking multi-sectorally but acting sectorally,” included:

  • Strengthen the enabling environment for WASH and nutrition integration at various administrative levels and with donors.
  • Utilize the evidence base for advocacy and to increase understanding of nutrition in WASH and other sectors.
  • Implement joint training to combat sector silos through training and capacity building.
  • Allow nutrition evidence to influence WASH targeting; view WASH through a nutrition lens.
  • Develop an effective monitoring and evaluation framework by:
  • Including nutrition-sensitive indicators in WASH projects;
  • Identifying context-specific WASH indicators that predict nutrition outcomes; and
  • Developing operational measures of environmental hygiene.

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