“Put ‘Em Together, It Just Makes Sense!” Successes and Challenges in WASH & Nutrition

Feb 19, 2015


Jordan Teague
Program Associate, WASH Advocates

Jordan hanging out with her newest source of inspiration for her work in WASH: her third niece.

Over the last few years with my four nieces and nephews, I have become intimately familiar with breastfeeding, poopy diapers, introductions to solid foods, potty training, and the process of cognitive development in young children, among many other things. All along, we've had running water that was safe to drink, toilets to flush, a place to dispose of diapers, and a sink with soap to wash our hands. During each of their first 1,000 days I have hardly worried that they might have too many bouts with diarrhea or other illnesses that would cause them to suffer from undernutrition. The same cannot be said for many other aunties, mothers, and families around the world. In places where WASH conditions are poor, even if there is enough food to eat, children can suffer from undernutrition due to frequent diarrhea or a condition called environmental enteropathy.

Recognition of this relationship has been gaining momentum in the WASH and nutrition sectors over the last few years. In the Lancet series on nutrition in 2013, WASH was named a nutrition-sensitive intervention. A core component of the Scaling Up Nutrition Movement's Framework for Action is a multi-sector approach to integrating nutrition, including WASH. USAID released its Multi-Sectoral Nutrition Strategy in 2014, which includes WASH as a high-impact action for improving nutrition and has “committed to making its nutrition initiatives more effective” by integrating WASH components as essential in all its nutrition programs.

Enthralled by the impact that nutrition in the first 1,000 days has on the rest of a child's life and even more fascinated by the effect that WASH has on nutrition, I set out in 2013 to research how WASH and nutrition were being integrated, what was working, and why. Very quickly, my research turned into why weren't WASH and nutrition being widely integrated and what needs to be done to make that happen. I interviewed key stakeholders in both the WASH and nutrition sectors on the barriers these organizations encountered when attempting to integrate these two sectors and what solutions there might be to these challenges.

Stakeholders identified 11 common barriers to integration. The top five were:

-          Insufficient or siloed funding

-          Staff capacity and/or interest

-          Lack of knowledge of different sectors and programs

-          Lack of coordination between sectors

-          Lack of evidence of the collective impact of integration


“It takes a new way of thinking about programming”

Fourteen action items or next steps were identified as enablers for effective integration, and the five most commonly mentioned were:

-          A comprehensive strategy for integrated programs

-          Coordination and communication between sectors

-          Integrated funding and donor support for these efforts

-          Increased evidence of the collective impact of integration

-          Leadership to drive these efforts forward

These findings result in a few concrete next steps for the WASH and nutrition sectors. Operational research is needed in order to generate the evidence base of the additive or multiplicative effects of integrated programs and to formulate a standard methodology for integration. Donors need to supply flexible funding that can be used for innovation and to integrate programs in appropriate contexts. The WASH and nutrition sectors should improve knowledge sharing and increase cross-training of staff. Finally, we need to design incentives in these programs for staff to work in collaboration toward common goals and objectives. A lot of smart people are thinking about and doing these things, and I look forward to seeing where WASH and nutrition integration goes from here!

To learn more, visit the following links:

-          The full paper and presentation

-          WASHplus and their WASH & Nutrition Library

-          The 1,000 Days partnership

-          Scaling Up Nutrition

-          WASH Advocates' fact sheet and resource guide on nutrition

-          Clean, Fed, & Nurtured

-          The WASH Benefits Study



-- Jordan Teague is the Program Associate at WASH Advocates and the proud auntie of one handsome nephew and three beautiful nieces.