WASH’ Nutrition

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Table 11: Integrating WASH into nutrition counselling and health promotion Selected WASH behaviours, the most relevant for nutrition and health counselling Hand washing with soap at critical times Point-of-use water treatment Hygienic use of latrine Safe disposal of child feces Food hygiene education How? Community-based outreach visits through health care workers present a good opportunity to promote desired WASH behaviours. For instance, growth monitoring and promotion or complementary feeding and encouraging a proper diet can be promoted together with hand washing with soap at critical times, including demonstrations to reinforce these behavioural practices and emphasize safe drinking water along with dietary diversity. For example, the ACF mission in Burkina Faso initiated community-based prevention and treatment of diarrhea with ORT/Zinc, combined with WASH kits distribution and hygiene promotion. Community health workers trained on both key WASH and nutrition behaviours organized a comprehensive communication and awareness-raising campaign in targeted villages to get the message across about the prevention and treatment of diarrhea with ORT/Zinc and importance of adopting good hygiene practices (hand washing at critical times, household water treatment) for improving the health and wellbeing of children. Reference materials Nutrition, Hygiene and Health Promotion Training: https://www.humanitarianresponse. info/en/system/files/Nutrition%252CH ygiene%2520%2520and%2520Health %2520Promotion%2520Training%252 0Guide_%2520Training%2520for%25 20Trainers.pdf ACF guide on integrating WASH and MHCP activities for better humanitarian projects: http://www.actioncontrelafaim.org/ sites/default/files/publications/fichiers/ integrating_wash_and_mhcp.pdf UNICEF nutrition counselling materials in English and French: http://www.unicef.org/nutrition/ index_58362.html Desirable WASH and nutrition practices can be demonstrated during family counselling. Hand washing can be incorporated into all counselling and promotional materials as the first step before preparing food, eating or feeding a child. Promotion of nutrition-sensitive WASH actions can be provided during community group sessions or club meetings or in marketplaces, religious centres or schools, knowing that people may be more likely to perform and adopt a desired behaviour if people that they respect do so. 86 WASH’Nutrition A practical guidebook
2.3. Community engagement in safe excreta disposal and IMPROving hygiene Community engagement in water and sanitation service delivery is the key for ensuring project sustainability and accountability. 143 ‘Engagement’ refers to a range of activities and approaches that are undertaken at various degrees by different actors, ranging from public consultation to active participation in the design and delivery of projects. 144 Different WASH community engagement approaches, such as CLTS or PHAST (Participatory Hygiene and Sanitation Transformation, see Example from the field 9), could be used to improve hygiene behaviours, reduce diarrhea and other diseases and improve nutrition and health outcomes. Total sanitation is defined as zero open defecation and 100% of excreta hygienically contained (Cairncross, 2006). The elimination of open defecation is associated with a decrease in stunting of 4 to 37 % in rural and 20 to 46 % in urban settings (Ejemot, et al., 2008). NOTE EXAMPLE FROM THE FIELD 9 Using Care Group Volunteers to communicate health messages to mothers - an example of integrated WASH and nutrition messaging from Mozambique The project was carried out by Food for the Hungry/Mozambique (FH/M), in collaboration with the Ministry of Health and with additional technical support from staff at Food for the Hungry’s Global Service Centre. The project took place from 2005–2010 in 7 districts of Sofala Province, which have a combined population of 1.1 million people. FH/M selected the project area because it had high levels of undernutrition and low coverage of key child-survival interventions. The area is almost entirely rural, and many villages are at considerable distance from a health facility. With the help of community leaders, FH/M first identified all pregnant women and mothers of children under 24 months old in the project area (the beneficiaries of the project). They then organized these mothers into blocks of 12 households and asked each group to elect a Care Group Volunteer (CGV) who would serve and promote behaviours with mothers throughout the project. Approximately 12 CGVs met together in a Care Group every 2 weeks with a paid project supervisor (called ‘‘promoter’’) to learn a child survival health message or skill. Over the following 2 weeks, each CGV then met with the 12 pregnant women/mothers of children under 24 months old for whom she was responsible (from 12 nearby households) to share the messages and skills they had learned, sing a flipchart with drawings to assist in conveying the behaviour change messages. CGVs met with these women either individually during one-on-one home visits or in small groups in their catchment area (with follow-up home visits to those who missed the small-group meetings). They delivered the entire set of messages over approximately a 2-year period. In the early intervention area, the messages were delivered twice. International and local staff from FH/M developed the series of 24 messages collaboratively that CGVs delivered to promote good nutrition (exclusive breast feeding, complementary feeding, vitamin A supplementation, taking iron/folic acid supplements during pregnancy and lactation, deworming children every 6 months, etc.) and to prevent and control diarrheal disease (promotion of safe water and hand washing as essential nutrition actions, proper disposal of feces by constructing and using latrines to prevent diarrhea, teaching mothers how to use ORS). The following household behaviours promoted by the project all significantly increased when comparing endline with baseline measures: Improved nutrition (exclusive breastfeeding, appropriate complementary feeding, adding oil to weaning foods, and ingestion of vitamin A rich foods) Diarrhea treatment (provision of increased fluids for childhood diarrhea, continued feeding with diarrhea, and knowledge of how to prepare ORS correctly) Diarrhea prevention (hand washing and point-of-use water purification in the home) Besides having mothers in the project areas improving their treatment and prevention of diarrhea over time, undernutrition among children 0–23 months old declined significantly and rapidly in the project areas, at about 4 times the rate of decline among children 0–59 months old nationwide. 143 - WSUP (2013) “Getting communities engaged in water and sanitation projects: participatory design and consumer feedback” 144 - Ibid WASH’Nutrition A practical guidebook 87
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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
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
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Page 51 and 52: 2.3. Formulation and financing of i
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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: 2.1. Community access to WASH for i
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
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
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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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WASH’ Nutrition

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