Hi everyone,

Thank you for your thoughtful posts!

As representatives of the Generation Nutrition France campaign (see Ben Hobbs’s post above, he coordinates the international campaign), we are very interested in this discussion since it really fits into Generation Nutrition’s vision of the fight against undernutrition. The whole point of our campaign is to bring together partners working in different fields related to undernutrition, in order to develop a multisector approach to the issue. Among those partners is Coalition Eau, a network of French NGOs campaigning for access to water and sanitation for all.

We mostly do advocacy work toward French decision-makers, in order for them to take the subject of nutrition into account and take ambitious measures to fight against undernutrition across the globe. This includes both fostering nutrition-specific initiatives, but also acknowledging nutritional impacts when developing projects in other areas such as health, food security, gender or WASH.

Generation Nutrition France was born in 2014 and has developed several recommendations on WASH and nutrition to improve the French development aid. The most recent ones are outlined in our 2016 position paper (which will normally be released today on our website!) :
- Increasing the funds dedicated to WASH toward the most vulnerable populations, who are the first to suffer from the lack of access to WASH triggering undernutrition, in particular those living in rural or suburban zones.
- Reinforcing interventions having an important impact on the reduction of hydric diseases leading to undernutrition : awareness-raising toward hygiene and access to sanitation, which lags behind.
- Improving the coordination between policies, programs and actors of WASH and nutrition, and supporting “WASH-in-Nut” strategies already in place in several of French cooperation’s priority countries.

In order for these recommendations to be implemented, our goal is to meet with key actors in the French political and development spheres : MPs (mostly those interested in development/foreign affairs, public health, water issues), members of ministerial cabinets (foreign affairs, development, Prime Minister), people from the French development agency (AFD), civil servants in key areas such as the Treasury or decentralized cooperation.
In parallel, of course, we should try to raise awareness about this issue among the general public. The ultimate goal is to make the decision-makers feel like this is an important topic, and that they have no other choice but to make bold moves to fight more and better against undernutrition (especially given the fact that 2016 will be full of opportunities for nutrition : Nutrition for Growth, beginning of the Decade of Action on Nutrition, World Health Assembly…).

In 2015, for the first time, the members of the French inter-Ministerial working group on nutrition (gathering ministries, NGOs, think tanks, the French development agency, and including several Generation Nutrition France partners) have achieved to come up with a nutrition roadmap for French development aid. It is an important first step, although this roadmap is not yet financed nor politically endorsed (both things that are part of our asks for 2016). Of course, this roadmap includes elements about multisector approaches to nutrition and the integration of malnutrition in France’s health, food security and WASH development strategies.
This roadmap is the outcome of a collaborative process, and I think it demonstrates what DanJones said above : it’s vital that we find new ways to improve coordination and collaboration on these issues of WASH and nutrition. I believe that’s what entities such as the French inter-Ministerial working group on nutrition and Generation Nutrition are trying to do.

Coalition Eau & Generation Nutrition France

This post is on behalf of the Scaling Up Nutrition (SUN) Movement Secretariat

Hello to everyone,
We sincerely appreciate the discussions in the various threads on WASH - Nutrition linkage, which have been constructive, informative, and hopeful. They capture much of the thinking to date, while proposing new ideas, and opportunities.

Multiple publications have documented the growing interaction, taking place in so many countries at national and community level, between Governmental entities, organizations and programmes tackling WASH and those tackling Nutrition. To reflect and support this trend, and attest to the growing body of evidence for WASH-Nutrition linkages, the Scaling Up Nutrition (SUN) Movement and Sanitation and Water for All (SWA) have, since 2015, been developing a working relationship. The objectives and activities of this collaboration will take shape in 2016, inspired by the six recommendations of the Bonn WASH Nutrition Forum 2015, which centered: on generating evidence, linking with the SDGs, realizing quick wins, synergies and behavior change, and scaling-up through the established the country platforms both initiatives support.

Some of the priorities of the SUN Movement align well with the objectives of the collaboration, and are being refined using a WASH-nutrition linkages lens. For example, the tracking and analysis of nutrition budgets and expenditures will increasingly highlight WASH investments by national nutrition programmes. Cross-country experience-sharing on incentives, that catalyze and sustain inter-sectoral collaboration across Ministries and Departments, will use WASH as a case subject. SUN Government Focal Points and national multistakeholder platforms are key audiences, and sources, for the growing evidence of WASH-Nutrition linkages, and are well positioned to relay it. And finally, the SUN Movement’s on-going support for strengthening the policy and budget cycle can promote engagement with WASH throughout.

The SUN Movement is looking forward to continuing and intensifying its collaboration with SWA.

Sergio Cooper Teixeira
Policy Adviser
SUN Movement Secretariat

Hi Dan,
No problem, maybe I did not put the question in the right topic. Will check the other thread!
Cécile

Hi Cecile - sorry I think our posts overlapped so I didn't address your questions! In fact I'm not sure I could, since I'm not a programme person. But I wonder whether our colleagues from ACF or Care who led the earlier discussion on ' How can we effectively implement integration ' might have some suggestions for you?

Hi all,

Big thanks to Keiron, Roland, Ben and Charles for sharing your reflections on this topic, these are all really useful points for me and I hope for others as we work collectively to keep pushing forward the agenda of more effective integration of Nutrition and WASH. I'm conscious that this online discussion is due to close shortly, so just wanted to summarise a few key points for the benefit of all, and also to highlight a few next steps and ideas that WaterAid are pursuing where we'd love to keep collaborating.

I also wanted to encourage people to take a read of the final part of the discussion 'the complexities of policy-making' being led by my colleague Megan, who has raised some interesting questions about how we can incentivise integration and understanding the benefits for the nutrition community to integrate WASH, and for the WASH community to integrate nutrition - click here to go straight to that .

Here's three key points from this advocacy discussion:

• Our advocacy strategies and tactics have to change and be adaptable depending on our audience (or 'target') eg. communities/general public may need an approach focused on awareness-raising, educational and seeking to change behaviours. Whereas government or donor decision-makers may need to hear arguments and evidence about the economic benefits of integration (or the economic losses of lack of integration), or perhaps about value for money. It's also crucial to make sure you understand your target's own agenda, and try to align with that. eg. a donor agency whose primary focus is on gender may be persuaded by WASH-Nutrition integration if we focus on the benefits for maternal health and on girls' access to education.
• It's vital that we find new ways to improve coordination and collaboration[/b] between agencies, between sectors, between NGOs and between different parts of government. Too often people are working in siloes and don't see enough of an incentive for them to work in a more integrated way.
• We need tangible evidence of integrated projects that are achieving improved outcomes to help persuade decision-makers to support further expansion of integrated approaches. It's not enough to talk in theory - we need to get practical. I like Roland's point about starting small but action-focused with a small group of organisations, projects or countries that start to plan and implement integrated interventions. Let's not assume the development world can be transformed overnight, but let's not wait for 'more evidence' before beginning to take steps and instead 'learn by doing'.

As Ben says, I think we do need to 'institutional' this dialogue in order to move forward - building on discussions like the Bonn WASH-Nutrition forum and this online discussion, but beginning to create new processes for joint working, coalitions and events to keep driving this agenda forwards and showcasing success.

For WaterAid's part, we are indeed working on an advocacy report analysing the extent to which nutrition policies and plans of different countries integrate WASH, and vice versa. We're hoping to publish that in May and to present it in a few different forums such as during European Development Days in June, Stockholm World Water Week in August, and in events surrounding the Rio summit. We look forward to keeping this discussion going and learning together how we can drive greater action on this issue.

Hi everyone,

Let's say I want to integrate WASH and nutrition in a project. As a WASH expert I will start by running a baseline study which usually includes a KAP survey. I have more or less 70 standard questions which will be asked to the respondents to identify their socio-economic profile, water, sanitation and hygiene behaviours.

If I want to integrate the nutrition component, which questions should I ask? What are nutrition KAP surveys about ? What do you eat for breakfast and lunch and diner ? How do you nutrition people translate this into calories or sufficient nutrient intake ?

Is there anything that should be done differently during the study ? Measuring children? Weighing them ? Measuring the wrist ?

Are there any existing standard questionnaires integrating WASH and nutrition questions ?

I tried to "play" with EPI info. I thought this could be a good tool to integrate WASH and nut since it is originally aimed at epidemiological survey. My idea was to try to create a standard KAP survey that I could use in my next assignments to enhance the quality of the study and depending on the strategy of the project, to include nutrition and health monitoring "seriously". But oh my ! I could do with a week training on the tool. I also don't know what questions I should include and I don't want to come up with a 140 questions questionnaire...

Are there any existing training workshops to build up our capacities as Wash people or nutrition people to run good surveys integrating both components ?

Thanks

Cécile

Hi to all

First of all thanks for being part of this forum, My name is Charles Mnyororo from Tanzania, current am working with local NGOs called Sustainable Environment Management Action (SEMA) as Program officer for WASH Project.

I see good conversation on this platform, i would like also to contribute on Integration of WASH and Nutrition, the more important thing required to the areas which the project of either of these two component are conducted it required to be implemented together. Why? Wash is all about hand washing practices, keeping the environment clean and friend to all all ages ( meaning Children, adult and Elders) and when you talk about Nutrition its basically on human health therefore we can not get a good health if we keep aside environment but unfortunately in some area there are nutrition project proceeding without Wash worse still the WASH status to the community are very bad, from this scenario we need to advocate that if we need to help the community and we need to achieve the target this things required to be implemented together

Hi,

It's nice to be able to take part in this online discussion. Thanks SuSanA for organising it!

I am a campaigner working to get governments to end child deaths from malnutrition. As everyone knows, tackling malnutrition requires action across a range of sectors since the causes of malnutrition are broad. Poor WASH is a key underlying cause of malnutrition, so it makes sense for nutrition campaigners to engage in this issue too.

Generation Nutrition - the name of the campaign I am working on - developed in 2015 a number of resources exploring the links between WASH and malnutrition (or undernutrition to be 100% technically accurate). The main audiences for these resources were non-specialist policy-makers and also the general public. Our animated video on sanitation and nutrition can be downloaded here:

And our WASH-child nutrition factsheet is available here: www.generation-nutrition.org/sites/defau...sheet_no._1_wash.pdf

I agree with Dan that it's not enough for people to know about an issue for something to be done about it (i.e. knowledge of the evidence of the link between poor WASH and undernutrition). If we are going to really change things, we need to convince governments that this issue should be made a priority. There are calls for an integrated response to many different issues (for example, climate change to name but one). Why should our theme be elevated above the rest in terms of importance?

In my view, I think that we are still lacking some convincing arguments about why WASH must be included in nutrition plans (and vice-versa). I concur with the comment by 'kaudain' that the economic impacts of excluding WASH would be one route to explore, although I am not sure how you would go about assessing this!!! Perhaps another would be for SuSanA or others to showcase examples of where WASH and nutrition plans have already successfully combined. What were the tangible benefits for poor communities?

I know that WaterAid have embarked recently on some research that is checking on the extent of integration of WASH and nutrition plans at the country level. One idea might be for us to work together to highlight the positive examples that come out of this study, using the Stockholm WWW event on nutrition and WASH as a bit of a springboard. Policy-makers are more likely to be convinced I think by 'good news' stories.

A second area to consider would be how to institutionalise a bit more this dialogue. For example, a colleague of mine here mentioned the idea of getting the Scaling Up Nutrition (SUN) Movement to engage more on this topic. This might be worth exploring. What about possible support from other actors, such as FAO, WHO, UN Water, G7, etc?

Regards,
Ben Hobbs
Campaign Manager, Generation Nutrition

I am writing on behalf of Roland Frutig, who coordinates water projects in Maharashtra, India. Thank you, Roland, for sharing your experience and views!

Dear Colleagues,

I highly appreciate the comment given as it speaks out what is missing today. We have thousands of players in the development field of activities but no real cooperation or coordination in the process. Everything is there, nothing is missing for an integrated development that is considering all the different aspects of relationships between nature and human beings, which is the basis of any development. We don’t work together but have extensive discussions who has to be integrated where. All the specialists want to have a leadership function. Everybody tries to extend their activities from their point of view, from their speciality or their competences. But what actually would be needed is that all the specialists join hands and work together. It’s again the question of WeQ is more than IQ.

I’m sure if we would try to organize – first online and then in reality – a get together with the organizations or people of all major subjects to sort out how a cooperation can be fruitful and put into action plans, nobody would still need to run for finances. From the Paris Summit we know that everybody actually should know this that only a cooperation can solve these huge problems. But still we are all fighting for individual subjects. We should bring together a small number of interested people to start an action plan with a certain number of projects in different regions. What we need are exposure hubs, where people and politicians can see how it can be done and what the concepts and costs are. We have enough papers that are explaining what we should do but no good and documented integrated projects. It’s not a question of money. Money is available if good projects are there.

We all know that the poor people can only solve their problems if they stand together. So why do we think that we don’t need to do the same?

Kind regards

Roland Frutig
Coordinator

Thanks Keiron, these are really good ideas for influencing both at the public/community level and in terms of policy-makers.

Public/community - integrating water, sanitation and hygiene messaging into nutrition/food safety awareness-raising and behaviour change trainings and events.

Policy-makers - focusing on the economic impact of NOT integrating WASH and Nutrition (and perhaps the positive economic benefits of taking joint action?) - do people know of good statistics or sources for this kind of information?

What other ideas do people have for advocacy strategies and tactics to drive action by governments and other decision-makers for better integration?

I also just found this new World Bank report 'Multisectoral approaches to improving nutrition: water, sanitation, and hygiene' which may help us to hone our messaging - see the first chapters on 'Why WASH is important for nutrition' and 'Why Nutrition is important for WASH'.

With regards to integrating WASH and nutrition: for the public I think it's important to highlight the risk of food contamination and food-borne infectious diseases that can contribute to increased morbidity and mortality, particularly in vulnerable populations - hence the need for improved hygiene in food preparation and even storage. This can be achieved by implementing the WASH factor into planned or existing nutrition education programmes at the community level.

For the policy maker and other stakeholders, I believe emphasising the medium/long-term economic impact of ignoring the synergy of WASH and nutrition by quantifying economic losses (e.g. DALYs and other productivity measures) can help to put a face to the magnitude of the problem. Providing a description in financial terms as an investment that will yield returns may encourage such parties to make and fulfil those needed long-term commitments.

Hi everyone,

Thanks very much for this really useful discussion and for the opportunity to contribute to it. As I’ve said in previous posts, I am NOT an expert on WASH and Nutrition – I am very much learning. My focus and my background is on advocacy and influencing. So for me the key question is: How can we ‘make friends and influence people’ in order to achieve the change we seek?

From the discussion so far, it strikes me that we’re all essentially in agreement – that there is real value to achieving effective integration of WASH and Nutrition in order to improve child and maternal health, reduce stunting, and ultimately to contribute to ending malnutrition, ending poverty and enabling individuals, communities and countries to achieve their potential. Our consensus is very much in line with the new sustainable development agenda – “integration” is one of the hottest ‘buzzwords’ of the new Global Goals. I’ve had plenty of conversations where policymakers and advocates have stood together, said “Ah yes, integration is the key”, and nodded our heads in wise agreement. So since we all agree, why isn’t it happening already?

I’m being deliberately simplistic here, but for me it is crucial that we connect the dots between the technical experts (like many of you) who understand the interconnections between WASH and nutrition, and the decision-makers who agree with the principle of integration but don’t know how to implement it, or perhaps have other priorities like winning elections, pleasing those who support them, or meeting the demands of donors.

So how can we analyse the context for securing change? This week I’m at WaterAid’s ‘Global Advocacy Convention’, a big gathering of our advocacy staff from across the world. We spent some of today analysing the political drivers of change and assessing our advocacy theories of change – reminding ourselves that simply increasing a decision-maker’s knowledge about an issue is rarely enough to actually achieve change – it’s as much about politics and power as it is about awareness and understanding ( WaterAid’s ‘Advocacy Sourcebook’ , though now a bit old, is a great starting point for learning how to analyse power and politics, as well as providing loads of useful tools and templates on different aspects of advocacy).

Advocating for integration is undoubtedly complex – we need to collaborate in new partnerships, influence at local, national, regional and international levels, and take advantage of ‘moments’ such as this summer’s ‘Nutrition for Growth’ summit at the Rio Olympics to secure real and tangible commitments from national governments, donor agencies and others that we as advocates can hold them accountable for.

So – what ideas do you have for ‘advocating for integration’ of WASH and nutrition? Here are a few questions to prompt your thinking:

How can we ‘tell the story’ of WASH and nutrition in a way that engages and convinces people?

How can we go beyond the buzzword ‘integration’, and offer tangible evidence of what works?

Who do we need to work with to have greater influence? Who are the ‘unusual suspects’ and how do we avoid the ‘echo-chamber’ of talking to ourselves?

How can we improve our ability to hold decision-makers to account, so that warm words in pledges and policies are translated into action and change on the ground?

Is the Rio Nutrition for Growth summit a good influencing opportunity, or a red herring?

Looking forward to hearing your reflections!