WASH’ Nutrition

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1.4. “Small Doable Actions” for improving WASH conditions and Nutrition outcomes “Small Doable Actions” is an effective approach for addressing communities that are facing constraints with finding sufficient resources by themselves to initiate improvements in their WASH services and facilities or adopt expensive, “ïdeal” solutions from the start. This approach encourages households to move step by step in adopting better WASH practices, with a minimum need for additional resources. It involves: 1 Assessing current household WASH practices; 2 Identifying existing good WASH practices to be reinforced or modified; 3 Identifying feasible incremental steps that move people from a current practice toward the ideal practice; 4 Identifying practices to be improved and negotiated with family member(s). 125 For example, an interim step or small doable action from not washing hands with soap and water after visiting the toilet, to washing hands correctly with ash after visiting the toilet. Although the behaviour might not be an “ideal” practice, a broader number of households are likely to adopt it because it is considered feasible within the local context. The “Small Doable Actions” approach has the potential to lead to further improvements in behaviour, when/if resources become available. 126 Picture 2: Example of “Small Doable Action” for hand washing from Myanmar Plastic bottles with screw caps filled with water, and a hole pierced in the bottom, can provide a convenient flow of water when the screw cap is loosened to let air in and allow water to flow from the hole. After washing the hands, simply tighten the screw cap again and the water flow will stop. © Arno Coerver, Malteser Interventional, 2015 LEARN MORE More about “Small Doable Actions” approach: http://www.fhi360.org/sites/default/files/media/documents/Sol_681_014421.pdf 1.5. Improving hygiene practices: hand washing at critical times When done properly and at critical times (Box 9), hand washing has a huge potential to prevent diarrhea and other fecal-oral diseases. Good hand-washing practice should include water, a washing agent such as soap or ash and a drying phase (or alternatively, hand rubbing with an alcohol-based solution). While hand washing at any time would be a good practice and beneficial, nutritionists do not recommend the promotion of hand washing before breastfeeding. IYCF tries to remove as many barriers to breastfeeding as possible, so adding hand washing would be creating another barrier and would reduce the times and commitment of mothers to exclusively breastfeed. In a household setting, a hand washing station or other enabling products such as “tippy taps” should be located in close proximity to the latrine or the food preparation area. Hand-washing stations influence individuals’ opportunities to adopt a behaviour, regardless of their ability and motivation to do so. An emerging hypothesis is that convenient and easy access to both water and soap at critical times is a key behavioural determinant of hand washing with soap among women and children. If a busy mother needs to look for soap before preparing a meal, or a child does not have easy access to water and soap after using the latrine, the probability of hand washing with soap actually taking place is lower. 127 125 - WASHPlus (2014) “Integrating Safe Water, Sanitation, and Hygiene into Infant and Child Nutrition Programmes; A Training and Resource Pack for Uganda” 126 - Ibid 127 - WSP (2010) “Insights from Designing a Hand washing Station for Rural Vietnamese Households” 76 WASH’Nutrition A practical guidebook
BOX 9: Five CRITICAL times for hand washing with soap 1 After defecation 2 After cleaning a baby’s nappy/ handling children’s feces 3 Before preparing or cooking food 4 Before eating 5 Before feeding a child 2 3 4 1 5 More about hand washing: http://www.globalhandwashing.org Figure 19: A counselling card highlights when to wash hands with soap Source: WAShPlus (2015) “WASH and Nutrition in Mali”. EXAMPLE FROM THE FIELD 5 Negotiating improved WASH and nutrition practices with mothers of infants in Mali The USAID-funded WASHplus programme in Mali was designed as an integrated WASH and nutrition programme from the start. District officials from the Ministry of Health identified the 180 intervention communities as areas with high rates of stunting and extremely poor access to and use of sanitation facilities. In addition to traditional nutrition-specific interventions such as the management of moderate acute malnutrition, WASHplus is using the “Small Doable Actions” approach to negotiate improved WASH and nutrition practices with mothers of infants. Working through community health workers, WASHplus promotes an integrated set of “Small Doable Actions” that support the following improved WASH and nutrition conditions in the targeted households: hand washing with soap, safe disposal of feces, safe water treatment and storage, exclusive breastfeeding and complementary feeding. Community health workers use the counselling card (Figure 19) to explain to caregivers when to wash hands. After 30 months of implementation, the project has some impressive results: Over 9,500 latrines built or rehabilitated by households Almost 11,000 hand-washing stations installed by households 76% of target villages certified as open-defecation free 20,000-30,000 water treatment tablets purchased/distributed to target households each month 40% fewer health centre admissions reported for severe undernutrition with complications from intervention villages WASH’Nutrition A practical guidebook 77
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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
Page 25 and 26: The CMAM approach has four componen
Page 27 and 28: 6. Global trends in undernutrition
Page 29 and 30: Today, the world’s attention is t
Page 31 and 32: Linking nutritional outcomes with t
Page 33 and 34: 1. nutritional status and the WASH
Page 35 and 36: Figure 8: Median age-specific incid
Page 37 and 38: 3. CONTRIBUTING WASH-related diseas
Page 39 and 40: Figure 12: The F-diagram - Fecal-or
Page 41 and 42: KEY MESSAGES Chapter 2 Despite not
Page 43 and 44: WASH’Nutrition strategy WASH’Nu
Page 45 and 46: 1. Aligning WASH and Nutrition prog
Page 47 and 48: assessment, programme design and/or
Page 49 and 50: pile sorting 89 or focus group disc
Page 51 and 52: 2.3. Formulation and financing of i
Page 53 and 54: 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: Figure 17: Allocate a protected spa
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 and 106: Figure 23: Holistic approach to WAS
Page 107 and 108: 5. Integrating interventions in eme
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
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1. OPERATIONAL RESEARCH Beyond the
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Southampton University The Universi
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WASHplus Since 2010, the USAID-fund
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Table 16: Advocacy tools for promot
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LEARN MORE A follow-up document to
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Canada, the European Union, France,
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PROGRAMMATIC resources WASH’NUT A
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1. PROGRAMMING EXAMPLE OF AN INTEGR
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2. IDENTIFICATION MIRA (Multi-secto
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3. FORMULATION EXAMPLE OF A WASH’
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EXAMPLE OF A WASH’Nutrition PROJE
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4. FINANCING EXAMPLE OF A WASH’Nu
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5. IMPLEMENTATION AND MONITORING ho
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6. EVALUATION Examples of WASH’Nu
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WASH’Nutrition A practical guideb
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