WASH’ Nutrition

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1 Health workforce/human resources: Train and build capacity among health staff at the district, sub-district, and regional levels in delivering integrated WASH and nutrition messages and services, especially in difficult circumstances, such as humanitarian emergencies; advocate for the basic WASH and nutrition curriculums at all health system levels; organize regular information exchange sessions for WASH and nutrition staff, especially during the seasonal peaks of diarrhea, malaria and severe acute malnutrition. 2 Service delivery: Put more emphasis on improving quality of water used for appetite tests in nutrition centres; strengthen public health programmes and infrastructure for water and sanitation systems and regulate water providers to meet quality and equity standards; integrate promotion of child care practices, including proper hygiene, breastfeeding, complementary feeding, and deworming practices into the primary, secondary, and tertiary healthcare systems. 3 Health system financing: Emphasize the importance of WASH in nutrition advocacy campaigns; improve INGO/ consortium coordination for fundraising and financial support. 4 Medical products, vaccines and technologies: Strengthen supply chains to ensure access to supplements and nutritional products to treat and prevent micronutrient deficiencies and severe acute malnutrition. Harmonize distributions of water filters/purification systems to vulnerable households with distribution of folic acid/iron supplements to children and pregnant woman. 5 Leadership and governance: Advocate for WASH and nutrition strategy at the national level; work on improving coordination mechanisms between WASH and nutrition sectors and clusters (where applicable); establish a joint WASH and nutrition working group at the national/regional/local level. 6 Health information system (HIS): Improve accuracy, validity and standardization of WASH and nutrition data; support government in data analysis and utilization. Key messages on integrating WASH and Nutrition at the national level KEY MESSAGES Addressing the multi-dimensional, underlying causes of undernutrition requires building coalitions and partnerships as well as establishing coordination mechanisms at the national level. A multisectoral national approach is the key for sustained improvements in the nutritional status of the population. Different countries are at different stages when it comes to WASH and nutrition policy and strategy integration. Depending on the opportunities and challenges of each context, different approaches are to be used to develop or strengthen the national policy environment for WASH and nutrition integration. Public health and nutrition are interdependent. By integrating public health and nutrition efforts, existing resources can be leveraged to maximize impact. This requires integrating nutrition outcomes within the design, monitoring, and reporting system used by the Ministry of Health. Health systems play a key role in terms of WASH and nutrition integration. There are various opportunities for strengthening health system building blocks through alignment and integration of WASH and nutrition interventions. 106 WASH’Nutrition A practical guidebook
5. Integrating interventions in emergencies © Tdh/F. Stuzik In the last decade of the 20 th century, almost two billion people – a third of the world’s population – were affected by natural disasters, and 86% of these disasters were floods and droughts. 193 Along with food and shelter, safe water and sanitation are the highest priority interventions in emergency situations and of crucial importance for the health of affected populations. Unless adequate water and sanitation services are quickly provided and good hygiene is consistently practiced by emergencyaffected people, the risk of diarrhea, cholera, measles, scurvy, and other hygiene-related diseases rapidly increases. 194 This is true in all types of emergencies, from rapid onset natural disasters to long-term crises caused by a range of complex factors. Crisis victims represent around 310 million people a year including 172 million for conflict only and 139 million people for natural disasters. CE-DAT surveys send a clear warning that acute malnutrition is a growing problem in conflict-affected countries. 195 Given that unsanitary living conditions and associated diseases are directly linked to undernutrition and growth faltering, lowered immunity and increased risk of morbidity and mortality, incorporation of nutrition-specific objectives into WASH humanitarian responses is essential. Specific measures to strengthen the link between WASH and nutrition interventions and improve nutrition outcomes in emergencies include: Ensuring that WASH minimum standards for people affected by an emergency are met (see The SPHERE Project http:// www.spherehandbook.org/en/); The promotion of the WASH minimum package for health and nutrition centres (including mobile clinics); The integration of key nutrition messages in hygiene promotion strategies; Ensuring the access to water for the poorest through the avoidance of user fees or, for example, the provision of cash transfers to cover the costs associated with minimum levels of consumption; Ensuring that both WASH and Nutrition coordination platforms interlink during the preparedness, response and recovery phase of the programme; 193 - Humanitarian Coalition (2015) “Emergency Water, Sanitation and Hygiene” 194 - UNICEF (2014) “Emergency WASH” 195 - CE-DAT, 2012 and IFRC Report 2013 WASH’Nutrition A practical guidebook 107
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WASH’ Nutrition A practical guide
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WASH’Nutrition A practical guideb
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Table of Contents STATEMENT ON COPY
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ACKNOWLEDGEMENTS This guidebook has
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FOREWORD Undernutrition remains a s
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LIST OF BOXES BOX 1: Design charact
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NCD NGO NTD NTU ORS PEFSA V PHAST P
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The basics of undernutrition and WA
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1. DEFINING undernutrition Defined
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2. the main causes of undernutritio
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Chronic undernutrition impairs chil
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of undernutrition, the global probl
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The CMAM approach has four componen
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6. Global trends in undernutrition
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Today, the world’s attention is t
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Linking nutritional outcomes with t
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1. nutritional status and the WASH
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Figure 8: Median age-specific incid
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3. CONTRIBUTING WASH-related diseas
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Figure 12: The F-diagram - Fecal-or
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KEY MESSAGES Chapter 2 Despite not
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WASH’Nutrition strategy WASH’Nu
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1. Aligning WASH and Nutrition prog
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assessment, programme design and/or
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pile sorting 89 or focus group disc
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2.3. Formulation and financing of i
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Table 5: Common barriers and challe
Page 55 and 56: 3.1. Why targetiNG children, pregna
Page 57 and 58: 4. emphasis on behaviour change PIL
Page 59 and 60: 4.2. Barrier analysis Barrier Analy
Page 61 and 62: 4 Signing memorandum of understandi
Page 63 and 64: Table 8: WASH minimum package for h
Page 65 and 66: In remote regions, where infrastruc
Page 67 and 68: Table 10: WASH Minimum package for
Page 69 and 70: Better alignment and integration al
Page 71 and 72: integratING activities at different
Page 73 and 74: 1. at the individual and household
Page 75 and 76: Figure 17: Allocate a protected spa
Page 77 and 78: BOX 9: Five CRITICAL times for hand
Page 79 and 80: 1.7. Household water treatment and
Page 81 and 82: Food hygiene implies maintaining pr
Page 83 and 84: 1.10. monitoring of HOUSEHOLD WASH
Page 85 and 86: 2.1. Community access to WASH for i
Page 87 and 88: 2.3. Community engagement in safe e
Page 89 and 90: Sanitation marketing (SM) uses comm
Page 91 and 92: Table 12: WHO definition of environ
Page 93 and 94: BOX 13: Reducing animal waste conta
Page 95 and 96: 3. AT INSTITUTIONAL LEVEL (HEALTH C
Page 97 and 98: EXAMPLE FROM THE FIELD 14 Improvin
Page 99 and 100: EXAMPLE FROM THE FIELD 15 Improvin
Page 101 and 102: 3.4. WASH and nutrition in schools
Page 103 and 104: enefit when the main vectors for di
Page 105: Figure 23: Holistic approach to WAS
Page 109 and 110: Figure 24: DRM cycle, continuum and
Page 111 and 112: Promoting breastfeeding (and other
Page 113 and 114: 3) Hygiene promotion Hygiene promot
Page 115 and 116: Key messages on aligning WASH and N
Page 117 and 118: Monitoring and evaluation of integr
Page 119 and 120: 1. Monitoring integrated activities
Page 121 and 122: WASH Key indicators 1 Diarrhea prev
Page 123 and 124: © ACF Chad, 2016 Picture 11: Monit
Page 125 and 126: MOVING TOWARDS UPTAKE WASH’Nutrit
Page 127 and 128: 1. OPERATIONAL RESEARCH Beyond the
Page 129 and 130: Southampton University The Universi
Page 131 and 132: WASHplus Since 2010, the USAID-fund
Page 133 and 134: Table 16: Advocacy tools for promot
Page 135 and 136: LEARN MORE A follow-up document to
Page 137 and 138: Canada, the European Union, France,
Page 139 and 140: PROGRAMMATIC resources WASH’NUT A
Page 141 and 142: 1. PROGRAMMING EXAMPLE OF AN INTEGR
Page 143 and 144: 2. IDENTIFICATION MIRA (Multi-secto
Page 145 and 146: 3. FORMULATION EXAMPLE OF A WASH’
Page 147 and 148: EXAMPLE OF A WASH’Nutrition PROJE
Page 149 and 150: 4. FINANCING EXAMPLE OF A WASH’Nu
Page 151 and 152: 5. IMPLEMENTATION AND MONITORING ho
Page 153 and 154: 6. EVALUATION Examples of WASH’Nu
Page 155 and 156: WASH’Nutrition A practical guideb
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WASH’ Nutrition

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