Dear all,

It has been great to hear different perspectives over the course of this thematic discussion on WASH and nutrition, particularly to see an increased focus in this area.

It was helpful to hear experiences from the SUN CSN and WASHplus on different country experiences. Importantly this highlights that programmes don’t always need to be designed in a fully integrated way, and this depends on the context and particular needs of communities. Dan Campbell made the point that policy engagement is vital for integrating WASH and other interventions that impact on nutrition, in particular through a strong national nutrition policy that recognises WASH and supports a multi-sectoral approach. It is also clear that while we have enough evidence to show the links between WASH and nutrition, we know far less about how this can be done –in particular what implementation modalities will lead to sustained impact.

At the end of the day, both sectors have a shared goal of improving the health and wellbeing of people, and therefore this provides strong incentives to work together with this shared goal in mind. Furthermore, behaviour change is a key aspect for both improving nutrition and hygiene, which provide a further rationale for working together – building on each sectors expertise and delivery platforms. It is also often the same populations which both WASH and nutrition programmes are trying to reach so there are opportunities to better target services through collaboration and coordination.

WaterAid and SHARE are in the process of analysing a number of national nutrition and WASH sector plans to understand the degree to which each sector is integrating the other. A short report will be published in May and we hope this will build on our understanding of the different policy approaches being taken in a number of different countries.

Look forward to collaborating further with others interested in this topic!

Cross-posted from ENN: www.en-net.org/question/2445.aspx

What are recommendations from the nutrition to the WASH community? What are possible incentives to better link the sector policies?

I am writing on behalf of Cara, SUN CSN Snr Country Support Adviser. Thank you, Cara, for your post!


I think there are some good examples of this in country. For example in Ethiopia at a local woreda level multisectoral platforms are being created in some places for all sectors to come together and plan interventions strategically. This includes ensuring a strong link between WASH and nutrition through bcc and provision of clean water. Happy to catch up on this in due course but strong collaboration and clear reporting indicators are two areas I think are critical to this working.
Cara.

Creating the right incentives for integrated policies and programmes

Over the course of the thematic discussion, a strong case for linking WASH and nutrition has been made, along with some discussion on how this has been achieved in different settings. However, ensuring a sustained integrated approach across sectors at scale is particularly challenging. Key differences in the each sectors approach, funding streams and primary outcomes of interest can hinder efforts to foster greater collaboration and coordination.

While attending the Bonn WASH and Nutrition Forum in October 2015, I was struck by Lawrence Haddad’s comment that the although the incentives for the nutrition sector to integrate WASH components into their plans and policies are clear, there is less clarity on the motivations for the WASH sector to incorporate nutrition elements, and thereby develop more ‘nutrition-sensitive’ approaches. While there are many challenges to overcome when developing integrated approaches such as shared objectives, joint indicators, monitoring mechanisms and institutional structures to facilitate cross-sectoral working, a key question which arguably underpins much of this is what role incentives play in facilitating integrated policy making across WASH and nutrition sectors?

Incentives for WASH into nutrition
• There is strong recognition that nutrition is a multi-sectoral issue, and that addressing malnutrition will not be achieved through nutrition-specific interventions alone. Evidence shows that that scaling up coverage of the core set of nutrition-specific interventions to 90% in high burden countries will only reduce stunting by 20% globally. The multiple pathways through which WASH directly and indirectly impact on nutrition has provided a clear rationale for embedding WASH components into nutrition policies and plans. Combined with emerging evidence that the links between WASH and nutrition may be stronger than originally understood, the incentives for the nutrition sector to include WASH interventions in efforts to tackle undernutrition are stronger now than ever.

But what is the role of the WASH sector? Is this to design appropriate interventions which can be easily embedded into efforts to improve nutrition (i.e. “WASH in nutrition”) or is there a broader goal to better integrate two distinct sectors with the same goal of improving health?

Incentives for nutrition into WASH
• There is increasing interest from governments and donors to design and implement nutrition-sensitive WASH programmes. Although WASH interventions have the potential to improve nutrition, WASH programmes are not nutrition-sensitive by nature unless designed in such a way to incorporate specific nutrition goals and actions. However, the incentives for the WASH sector to make programmes more nutrition-sensitive are not always clear, especially when this has the potential to be more challenging to design, more costly to implement and require additional expertise and indicators to report on. That said, integrating nutrition and WASH can offer unique opportunities to drive progress on WASH goals, while leveraging investments across the two sectors to maximise impact and improve cost-effectiveness. For example, using nutrition data to more accurately identify populations at need of WASH may improve targeting of services to those most in need. Furthermore, delivering joint nutrition and hygiene messages may reinforce each of the different behaviours, thereby having the potential to contribute to sustained behaviour change – a key focus, and ongoing challenge, of the WASH sector.

Some questions for discussion:
1. Are incentives important to drive integrated policies across WASH and nutrition sectors?
2. If so, what can be done to create better incentives (or better communicate the opportunities and actions) for the WASH sector to integrate nutrition?
3. What level do these incentives exist?

Looking forward to hearing thoughts and reflections on these!