SuSanA - Forum Kunena Site Syndication Wed, 01 Jul 2015 06:33:19 +0000 Kunena 1.6 SuSanA - Forum en-gb Integrating WASH & Nutrition Learning Brief, June 2015 - WASHplus - by: campbelldb Integrating WASH and Nutrition Learning Brief, 2015.

Since 2010, the USAID-funded WASHplus project has been engaged both at the global and country levels in stimulating the discussion and improving the evidence base around integrating WASH into nutrition programming, sharing experiences and approaches to integrating the two sectors. This Learning Brief describes WASHplus country activities in Bangladesh, Mali and Uganda, global knowledge sharing efforts and other WASHplus activities.]]>
Nutrition and WASH Tue, 30 Jun 2015 15:37:06 +0000
Re: USAID Implementation Brief on WASH and Nutrition, 2015 - by: F H Mughal
That brief was nice. Normally, we talk about WASH alone, adding nutrition only at times. The brief has brought WASH together with nutrition to the fore.

The Peru figures are impressive:

. Stunting decreased from 54 to 37 percent
• Anemia prevalence dropped from 76 to 52 percent
• Low serum retinol, an indication of vitamin A status, dropped from 30 to 5 percent

This shows how great the combined impact of WASH and nutrition is.

Hope, you will produce more such briefs in future.


F H Mughal]]>
Nutrition and WASH Sun, 28 Jun 2015 06:22:33 +0000
USAID Implementation Brief on WASH and Nutrition, 2015 - by: campbelldb USAID Implementation Brief was recently added to the USAID website.

Key Messages
1. Positive nutritional outcomes are dependent upon WASH interventions and nutrition actions.
2. Poor WASH conditions create an additional burden of undernutrition.
3. Many opportunities for co-programming WASH in nutrition programs exist and are described here.]]>
Nutrition and WASH Fri, 26 Jun 2015 15:02:37 +0000
Re: WATSAN-AGRICULTURE: Improving on the Nexus among Water Quality and Quantity, Sanitation, Hygiene, and Agriculture - by: usmansus Thanks for the interest you showed for our research activities.
I would like to highlight the general research questions we are trying to address in Ethiopian context. When we look into the watsan-agriculture nexus, we consider not only health but also nutrition outcomes. There is a strong linkage between watsan and nutrition in developing countries. Poor watsan is a leading causes of diarrhea and other infection which leads malnutrition especially for under five children while agriculture is a sources of more nutritious food to achieved improved nutrition.
Having said that, here we are specifically trying to look into the role of small scale irrigation as a source of domestic water supply (through multiple water use) and a source of more nutritious food to enhance improved health and nutritional benefits. However, there are also downside and unintended outcomes of irrigation. The quality and quantity of drinking water can easily become affected through irrigation agricultural practices (for instance, increased use of pesticides and chemicals). Moreover, irrigation might serves as a vector-breeding habitats which affect people’s health. Therefore, if we recognized the multiple use of irrigation water and both water supply, sanitation and agriculture are managed in a holistic view and in direct support for improved health and nutrition outcomes, multiple benefits such as improved health and nutrition outcomes might be achieved and trade-offs reduced.
Here I have put down some preliminary results from simple tabulation results. So far the data show us that:
  • Controlling for distance to water sources, irrigator agricultural households had greater per capita per day water consumption compared to non-irrigator agricultural households.
  • The mean values of Escherichia coli (E.coli) bacteria is higher for irrigator households
  • Incidence of diarrhea and malaria diseases are higher in irrigator household members than non-irrigator household members
  • Children living irrigator households are more likely to be underweight and stunted than children living in non-irrigator households which is basically what we are not expected.
  • Among irrigators, however, households who use irrigation water for domestic purposes have poor domestic water quality but lower incidence of diarrhea diseases.

To answer your question regarding the behavioural change perspective, some of the challenges are, first, there is a lack of awareness of the need to treat drinking water. People’s perception regarding drinking water quality is that clean water is ‘clean water’. Second, open defecation is a norm and wide spread in the study areas and this might be dangerous as most community water sources are unprotected. Moreover, most households believe that child faeces is not as pathogens as adult ones and they do not contain them safely. Therefore, awareness campaign at community level and training program at schools may be helpful to bring the desired level of awareness in our context.
Finally, I would say my work is at an infant stage to come up with concrete policy recommendations or scaling-up issues regarding the watsan-agri nexus. But, I promise that I would update my new results and progresses on the forum in the next few months.
If you have any further questions or comments, I would be happy to discuss with you.

Nutrition and WASH Fri, 26 Jun 2015 08:53:48 +0000
Irish Aid seminar - Shit Stunts: Refocusing Priorities in Nutrition and WaSH - by: campbelldb Integration of Nutrition and WaSH programmes was the key topic discussed at the multi sectorial panel seminar hosted by Irish Aid, the IFGH and the Development Studies Association of Ireland on the 19th May.

Jacinta Greene and Dr. Sean Farren of DSA Ireland introduced the panel of speakers, consisting of Professor Robert Chambers, Research Associate at the Institute of Development Studies; Niall Roche, WaSH / Environmental Health consultant; Mags Gaynor of Irish Aid; and Kate Golden, Senior Nutrition Advisor to Concern Worldwide. Attendees drew from anthropologists, health professionals, nutritionists, WaSH advisers, NGO programme managers, researchers and policy makers.

Links to the presentations and a summary of the seminar are on the WASHplus WASH Nutrition Library.]]>
Nutrition and WASH Thu, 25 Jun 2015 17:33:59 +0000
Re: WATSAN-AGRICULTURE: Improving on the Nexus among Water Quality and Quantity, Sanitation, Hygiene, and Agriculture - by: antonini
Thanks for raising these very interesting questions - which we are acutally trying to address with our research activities! Most of our researchers just got back from the field and are still cleaning and evaluating their data! I think that we can give general answers to these questions only when data from the 4 countries is ready to be compared. Especially in terms of policy recommendations and upscaling, I hope that the results will show whether we can come up with "global" recommendations or if you really need to look at and adapt to local settings.

In terms of reaching more people, we are planning to organize a workshop later this year in each of the study countries to share our findings with local institutions and policy makers. We also would like to provide feedback to the communities that were involved in the surveys.

To give you an overview on first recommendations and challenges (esp. in terms of behavioural change and competition in water demand), I am calling on my colleagues who have been out in the field to share their impressions! As soon as a synthesis from the 4 countries is available, I will share the information on this platform!

Nutrition and WASH Thu, 25 Jun 2015 13:08:56 +0000
Re: WATSAN-AGRICULTURE: Improving on the Nexus among Water Quality and Quantity, Sanitation, Hygiene, and Agriculture - by: KimAndersson Thanks for introducing your interesting project on the links between watsan-agriculture, and for providing information of the different project components. Interesting to see how you are working with the watsan-agri nexus from a hygiene/health point of view. Currently at SEI we are looking more on the links from an integrated resource perspective (e.g. safe reuse of sanitation waste as fertilizers), so it would be interesting to see how these two approaches could complement each other.

I would therefore like to know more about your findings related to the goals and objectives you have set up.
With the progress you have had so far, how would you summarize your main policy recommendations regarding minimizing trade-offs and achieving synergies between watsan and agri? For example, have you encountered critical competition between water demand for irrigation and WASH-activities, if so how could these be mitigated?
From a behavioural change perspective, what have been the major challenges and how have these been tackled? Have you encountered significant differences between the countries you are working in?
Do you already have ideas on strategies how your initiative could be scaled-up to reach more people? E.g. are there existing institutional structures in the countries that could be used for up-scaling?

Looking forward to hear more about the lessons you are gaining from your project.

Best regards,
Nutrition and WASH Tue, 23 Jun 2015 08:15:10 +0000
Re: WATSAN-AGRICULTURE: Improving on the Nexus among Water Quality and Quantity, Sanitation, Hygiene, and Agriculture - by: antonini
Please note that an updated version of the WATSAN-Agriculture project website is online now! Follow this link for more information:

Nutrition and WASH Wed, 17 Jun 2015 12:33:42 +0000
Toilets and nutrition (article from Zimbabwe: Nutrition puzzles: the shit factor) - by: morgan
I thought this article may be of interest to some of your readers, It was sent to me by a colleague. The article was written by Prof. Ian Scoones, based in the University of Sussex, UK, who is working in Zimbabwe. His article (below) seems to reveal that the efforts of Zimbabwe’s Ministry of Health and Child Welfare in promoting improved sanitation in the rural areas on a huge scale over many decades has paid dividends in addition to those expected.

The MOHCW, through its Department of Environmental Health, Environmental Health Technicians and Village Health Workers who operate down to village level, have been promoting improved hygiene, food handling, improved (often family based) water supplies and improved sanitation for generations in this country and it seems this effort has paid off in many ways including the improvement of nutritional status of the rural folk, according to Ian Scoones report. A surprising result, perhaps. So the MOHCW deserves a well done pat on the back for their efforts.

I should also mention that back yard gardening is very commonly practiced all over Zimbabwe – urban, peri-urban and rural. And the construction of family owned wells is common in areas where the ground water table is not too deep. Well water is used not only for domestic purposes, but frequently also for watering back yard gardens. Countless thousands of family owned wells are in daily use - the actual number is unknown. Such back yard methods have been used for generations – they have become absorbed into traditional practice. The MOHCW also promoted the construction and use of improved family wells on a wide scale in former years (the Upgraded Family Well Program) and many if not most were associated with back yard vegetable gardens.

In more recent years vegetable growers, operating in the rural areas, have expanded their production on a co-operative and commercial basis and fresh vegetables are shipped into the cities daily, to be sold from large numbers of roadside venders. Zimbabweans are very resourceful - it seems to be part of their culture - but driven even more strongly in recent years.

Peter Morgan

Added by moderator (EvM):

The Article by Ian Scoones
Nutrition puzzles: the shit factor

(read it online to see all the hyperlinks in the article)

Posted on May 11, 2015 by ZimSitRep_W — 1 Comment ↓
via Nutrition puzzles: the shit factor | zimbabweland 11 May 2015
A few years ago I posted a blog titled ‘Nutrition Puzzles’. Today, the puzzles seem a bit nearer to resolution. And the answer may be shit.

The earlier blog was prompted by the huge and massively expensive nutrition survey that was sponsored by a range of international aid donors. It showed to everyone’s surprise that, despite the crisis, nutrition indicators across Zimbabwe, including in rural areas, were not as disastrous as expected. Indeed, they were better than most neighbouring countries, including South Africa.
Why was this? I suggested a number of reasons. First, the availability of food was higher than many had assumed – and this was due to underreporting, and especially the production that was occurring in the new resettlements. This line of argument was reinforced in the discussion about the mismatch between ZimVac assessments of food insecurity and realities on the ground, commented on in another blog.

Second, and perhaps most intriguingly, it could also be due to the level of sanitation in Zimbabwe, reducing the effect of diarrhoea, but also crucially many other often subclinical and continuously debilitating faecally-transmitted infections, including environmental enteropathy, other intestinal infections and parasites. In a 2009 article in the Lancet, Jean Humphrey, working in Zimbabwe, argues that a combination of poor sanitation and poor nutrition can have major effects, resulting in effects on growth, even though nutritional intake remains high. The massive investment in toilet building – dating from the colonial period – has meant that protected toilet coverage is large in Zimbabwe, including in rural areas. The famed ‘Blair toilet’ -nothing to do with Tony, but the product of Zimbabwe’s Blair Institute from the 1970s (and the work of Peter Morgan) has had a major impact, providing cheap, sanitary toilet options across the country, reducing open defecation to a minimum.

Shit makes a big difference to nutrition, as work by the Community Led Total Sanitation (CLTS)initiative and others is showing. As Robert Chambers puts it “shit stunts”. CLTS is a global movement pioneered by Kamal Kar to encourage community-led behaviour change around sanitation. It has facilitated major unsubsidised investments in toilet building, and changed behaviours around shitting outside on a massive scale across particularly Asia and Africa.

Asia in particular is an enigma. Despite the Green Revolution, growing incomes and better metrics on all sorts of counts, nutritional deprivation is widespread. This, Chambers and colleagues argue, may well be due, in significant part, to poor sanitation. The puzzle for southern Africa is different. Zimbabwe may be an enigma in its own region but in reverse: it has higher nutrition indicators than perhaps would be expected. But the explanation may be the same: shit (or the lack of it) counts. Zimbabwe’s sanitation revolution has happened over many decades. Maybe the impacts on nutritional status are being seen in its seemingly anomalous comparative statistics.
The CLTS research, published as an IDS Working Paper by Robert Chambers and Gregor von Medeazza, argues that nutritional indicators have to be understood as a combination of food intake and health status. 5 As must be addressed – the traditional indicators of food availability and access. But also three other less understood As: absorption, antibodies and allopathogens. Clearly genetics matter too, and often confound some of these data (including I suspect in Zimbabwe, given the anomalies in height to weight ratios in different parts of the country). But taking only ‘environmental’ influences for now, the focus on food intake (quantity and quality – and so availability and access) may miss a big part of the story. If nutritional uptake by the body – and so how tall, fat/thin, and healthy you are – is significantly affected by environmental enteropathy, as well as micro-parasites and pathogens, then forgetting this dimension is a big mistake.

The paper has a striking graph from India correlating the percentage of households practising open defecation in different Indian States (both urban and rural) and stunting
This focus on food availability and access, rather than a more holistic assessment of food, environmental health, sanitation and nutrition is almost universal. Take the Global Nutrition Report, a new initiative from IFPRI, and involving my home institution IDS too. This compiles reams of statistics on every country, inevitably of varying quality (they seem to draw from the joint UNICEF, World Bank and WHO database, and so Zimstat data, for Zimbabwe). The report presents the data in a series of graphs and tables, but does not offer an integrative analysis.
A comparison across countries though is instructive – although it may be influenced by uneven data. For example, if we compare Zimbabwe with its now economically successful neighbour Zambia, nutritional indicators are better for Zimbabwe. For example, stunting of under 5s is 29-36% for the data shown in Zimbabwe (from 1994-2012), while in Zambia it ranges from 46-58%. And this despite Zimbabwe’s lower GDP growth rates, an ailing economy and assumed food insecurity rife across the country.

As before, both explanations may be required: there’s more food than we thought, and there’s less shit. But as with the wider commentary about nutrition, the Global Nutrition country reports don’t make the link and stick to an aggregate picture. The bigger puzzle lurks within and across these data. Work on shit and nutrition suggests an important hypothesis though, but despite the obvious policy implications this has largely been ignored. Maybe Zimbabwe is more like Kerala, and Zambia more like West Bengal (see graph above)? According to the data presented in the Global Nutrition country reports, 43% of people have unimproved facilities or openly defecate in Zambia, while this figure is 33% in Zimbabwe.
I heard recently that new work on nutrition in the new resettlement areas of Zimbabwe is being proposed as an extension of the earlier ZHRDS survey carried out from the 1980s. This is excellent news, and will fill an important gap to our knowledge of the impact of land reform, exploring a dimension that our team hasn’t been able to tackle. Earlier work on old resettlement areas showed intriguingly that, despite improved indicators of production, income, asset ownership and the rest, resettlement households often had poor nutrition indicators compared to their communal area counterparts. The research put this down to higher household sizes and the need to share food and income among more people. This is certainly a plausible explanation – and one that we have discussed for new resettlement households. But perhaps there was another reason – a lack of toilets and poor sanitation.

In our work in Masvingo and Mvurwi we have looked at toilet building since settlement. Certainly in the early years as people carved out homesteads and villages toilets were few and far between, but the numbers have grown rapidly (completely unsubsidised by government, donors or NGOS, and often using the classic Blair design). 83% and 63% of households in the A1 sites in Mvurwi and Masvingo had built a toilet by 2014 and 2012 respectively in our sample. Because these facilities are often shared in villages, basically everyone has access to a toilet. Resettlement households definitely value toilets. Toilet building has been a key part of the investments in new resettlements. Based on estimates of the cost of building (materials, not labour), we worked out that households in our sample had spent on average the equivalent of around US$150 since settlement on toilet building.

The impetus of CLTS programmes is not it seems needed to build them, and people have recognised the importance of sanitation over many, many decades of exposure to various programmes. I have no idea whether this cultural and social history of toilets has affected attitudes to shit in different ways to other countries in the region, but it’s an interesting question worthy of some comparative research, along the lines of the India study mentioned earlier.

As new work on nutrition in new resettlements is undertaken I hope the ‘shit factor’ is added into the hypotheses and research design. Working this out and establishing the evidence base may have major implications for policy – not only in Zimbabwe, but also the region. If addressing poor nutrition is a goal for sustainable development – as it should be – then building more toilets may be as important as growing more food.

This post was written by Ian Scoones and appeared first on Zimbabweland]]>
Nutrition and WASH Fri, 12 Jun 2015 10:10:47 +0000
Re: 8 practical ideas to link more WASH and Nutrition programmes - by: muench
Thanks for sharing this information from Chad. Are there any documents about your project which you could share or perhaps post some photos?

You mentioned ecosan and UDDTs... It's a common question how the costs of UDDTs could be reduced to make them more competitive with simple pit latrines... There are actually various ways to do it.

I think you might enjoy reading these two previous forum threads from Uganda and Peru:
Operating costs of dry sanitation (UDDTs) - and is 5% of household income a reasonable target?

Low-cost UDDTs in Adjumani, Northern Uganda - supported via surcharge on water bill

And also, it would be nice to include your integrated programme in the SuSanA project database here:

If you send me the basic information (title of project, organisation, duration, website link), I can easily get that done.

Kind regards,
Nutrition and WASH Tue, 09 Jun 2015 10:59:43 +0000
Re: The Hgh Level Panel Report on Water and Food Security - by: joeturner]]> Nutrition and WASH Wed, 03 Jun 2015 07:39:47 +0000 The High Level Panel Report on Water and Food Security - by: madeleine This report propose a number of policy recomendations for different actors; governments, private sector and civil society .This report will be decided upon by the memberstates, civil society and the private sectore at the annual meeting Committee for Global Food Security taking place in Rome in october this year.

This report emphases that safe drinking water and sanitation are fundamental to human development and well being. Yet inadequate access to clean water undermines people’s nutrition and health through water-borne diseases and chronic intestinal infections.”

The importance and value of safe reuse from wastewater for Global Food Security is also emphasized in this report. In other words a very important state of the art document from the Global Food Security community incorporating the importance of Sanitation and reuse. A good read ! Enjoy !]]>
Nutrition and WASH Wed, 03 Jun 2015 05:44:07 +0000
USAID WASH and Nutrition Webinar - by: campbelldb
Recording of the webinar:
Nutrition and WASH Thu, 28 May 2015 17:39:33 +0000
Re: WATSAN-AGRICULTURE: Improving on the Nexus among Water Quality and Quantity, Sanitation, Hygiene, and Agriculture - by: antonini
The hygiene awareness posters that were designed for the WASH intervention work in Bangladesh can now be viewed in the SuSanA Library.

The poster on food hygiene below was prepared by our PhD student Monirul Hasan. You can read his impressions and the experiences he made during his fieldwork below the poster! It would be great to receive your feedback and learn more about your impressions if you have designed similar posters for your interventions!


What were your experiences for designing the poster? Do you have any advice on how to design a WASH poster (DOs/DON’Ts)?

It was exciting for me to design the poster. At first I was struggled with the messages of the poster that can support my intervention. Later on, designing the poster was challenging as the real photos of the items were not encouraged. Lastly, we planned to sketch those items. But difficult thing was to find the right person who can do it. I had contacted several persons who are good in fine arts and also professionally working as cartoonist. But most of them couldn’t show up with the final outcome because of their lack of interest and commitment. So working with poster became frustrating at that time. Later on I found one of them who fulfill this commitment and finally could submit the work. I was really pleased with her works and the quality of the poster.

- Decide first what could be the messages regarding the intervention
- Make a preliminary idea or sketch to the artist or cartoonist.
- Make sure the characters in the poster can represent the context and localities of the intervention.
- Rightly place the messages in right order with proper illustration.
- Print the poster in a PVC paper so that after printing it can last for several months.

- Don’t put lot of things in the poster. Make it as simple as possible.
- At first lot of things can come up, but be precise.
- Put enough space between messages, so that it can be understandable.
- Make it self-explaining.

What were your experiences in the field in terms of acceptance and understanding of the messages? Did people show interest or was the intervention work rather a nuisance for them as they had other things to do?

The poster was welcomed by the households. But they wanted more (such as refreshment, gifts etc.) along with the poster. Most people understood the character in the poster and the messages. The organization of the training session was challenging as some of the households failed to participate in the session as they had other works to do. Although making frequent request to attend, the participation rate in the session was close to 70%. But all households were given poster and also conveyed the messages by personally going to each households as some households couldn’t able to attend. So ensuring the maximum participation was the most challenging part of the intervention.
People showed interest about the poster because they mostly didn’t know those messages from the scientific point of view. They actually learned new things from the poster with scientific proof (they get the test of E.Coli result in their hand during the training sessions).

Do you have any preliminary results or observations at this stage?

The preliminary result still is not ready. But the feeling from the field work is that most households adopted some of the hygiene messages and also started investing in this hygiene related issues. Hand washing has been increased. Water handling is improved and many households started boiling water for drinking purpose. The count of E.Coli also reduced after the intervention.

What are your lessons learned/recommendations if you had to prepare another WASH poster in the future?

If I have to prepare another WASH poster in future, I would recommend to start working on the country perspective to know about the existing practices and then design the messages based on the cultural and context specific terms which can be used to draw cartoons self-explaining. Because at the end, the poster will remain in the households.]]>
Nutrition and WASH Thu, 28 May 2015 09:32:26 +0000
USAID webinar on WASH and nutrition (today, 26 May, 4 pm CEST Europe time) - Connection between undernutrition and lack of access to water, sanitation, hygiene services - by: muench today (at 4 pm CEST Central Europe Standard Time, e.g. Berlin), this could be an interesting webinar by USAID:

WASH and Nutrition
May 26, 2015 at 10:00 am Eastern Time (Washington, D.C.)/14:00 GMT

Overcoming undernutrition is a great challenge that will require both WASH and nutrition interventions. Elizabeth Jordan, from USAID’s Global Health Bureau, will discuss the connection between undernutrition and lack of access to water, sanitation and hygiene (WASH) services and highlight opportunities for integrated programming to achieve better health outcomes.

From this page:

Registration link:

Might see some of you there...]]>
Nutrition and WASH Tue, 26 May 2015 10:36:45 +0000