8 practical ideas to link more WASH and Nutrition programmes

  • franckconcern
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8 practical ideas to link more WASH and Nutrition programmes

Dear all,

It’s great to see that we are slowly building up on this idea that WASH and nutrition should be more linked and integrated within the same programmes.

As a WASH technical advisor in regular contact with 19 WASH programmes, I’m more particularly interested in the practicalities: what can a WASH Programme Manager plan to work towards more integration between WASH and nutrition?

Following different exchanges at the recent WEDC conference, find below a summary of some ideas for discussion:

1. Because the growth of children is a strong concern for parents, it can be used as an argument when promoting latrine - as now the link is well established between stunting and oral-faecal contamination/environmental enteropathy.

2. Hygiene promotion activities: When possible, prioritize activities to prevent contamination of children through soil/dirty hands. In this regard, innovative activities still need to be defined as the main recommendations – that is to say: focus on hand washing with soap for children under 2, promote the delimitation of space for children to play (=close playgrounds), animals containment - are unfortunately irrelevant when compared to the reality of people’s conditions of life in many countries (=children being carry in different places, animals being left free to find food on their own).

One simple measure could be to increase access to rugs as children playground: rugs marketing approach, with or without subsidisation, or free distribution (according to the context of intervention).

Innovative activities could include specific games/stories for young children to increase their negative perception of touching animals faeces.

3. Stronger focus on safe disposal of children faeces as young children usually defecate in the direct surroundings of the household where they spend a lot of time: work with children caretakers to promote the habit of bringing children faeces to the latrine pit.

4. When available, use Child height as an indicator: stunting is a sensitive and useful outcome measure of the impact of a WASH intervention(not diarrhea)

5. Minimum joint activities to be planned are for the WASH team to ensure access to safe water and safe disposal of excreta in nutrition/health centres where the organisation is already developing its nutrition/health activities => WASH facilities to be built in each of these health/nutrition centres.

6. Idea of using nutrition/health centres as a place to identify priority households or communities to be visited by the hygiene promotion team: if a family has a lot of children with stunting, they will be prioritised for the door-to-door campaign on hygiene promotion/ If a community has a higher percentage of stunting children they will be prioritised for hygiene promotion campaigns.

7. Promote the idea of one single hygiene promotion team for both nutrition, health and WASH programmes activities. IF not possible and at least, ensure that the content of the messages used by the different teams is consistent. For instance, situations were reported where the nutrition and WASH teams were not promoting the same number of critical moments for hand washing, which can be confusing.

8 In general, planning joint meeting between nutrition/Health and WASH team to share vocabulary: WASH practitioners having usually an engineering background and Nutrition/Health practitioners a medical one, they tend to talk different languages and are working within different frameworks.

Please let me know what you think of these ideas and feel free to be critical and/or propose others.
Amicalement
Franck Flachenberg
Concern Worldwide environmental health technical advisor

Franck Flachenberg| Environmental Health Technical advisor| Concern Worldwide
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  • muench
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Re: 8 practical ideas to link more WASH and Nutrition programmes

Dear Franck,

I really like your list of ideas on "what can a WASH Programme Manager plan to work towards more integration between WASH and nutrition?". It's great to think about such easy practical steps.

You mentioned the WEDC conference: was WASH & nutrition a big topic there? Who were the main actors?

Were you also part of this WASH & nutrition meeting in Stockholm where Rob recently posted the minutes here:
forum.susana.org/forum/categories/131-wg...er-week-sept-4#10390

One thing that struck me from these minutes (I am a firm believer in using the right terminology):

Robert Chambers (IDS): Plea to use the term faecally transmitted infections (FTI) instead of waterborne diseases, diarrheas etc. as it is more inclusive (incl. worm infections, tropical enteropathy, asymptomatic diseases etc.)


Would you agree with this?
I noticed your 8th point said something similar:

8 In general, planning joint meeting between nutrition/Health and WASH team to share vocabulary: WASH practitioners having usually an engineering background and Nutrition/Health practitioners a medical one, they tend to talk different languages and are working within different frameworks.


Do you have some examples of such terms that have led to confusion before or terms that are not common to both groups?

Regards,
Elisabeth

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(Funded via GIZ short term consultancy contract)

Dr. Elisabeth von Muench
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  • exobarbiche
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Re: 8 practical ideas to link more WASH and Nutrition programmes

Safe playgrounds...I agree it can be irrealistic in some sahelian context. My own kid in Madrid is putting in his mouth some random stuff the whole day...good thing we do not have chicken yet at home! But some improvements or sensitization can be done, with child protection/psychosocial colleagues. See picture i took in august in a random house in suburbs of Bangui
while visiting well rehab project

Otherwise, there is always the promotion to wash the toddlers regularly with soap (hands, butts...)
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  • franckconcern
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Re: 8 practical ideas to link more WASH and Nutrition programmes

Thanks Elisabeth,
Please find below the answer to your questions:

1/ Who were the main actors of the " WASH and nut" discussion at the last WEDC conference: It was a side event organised by WEDC. For more details, you can contact: Anne Blikinshopp / WEDC conference manager.

2/ Would you agree with using the term faecally transmitted infections (FTI) instead of waterborne diseases : I would say it depends of the context and objectives of the programme you are working on. For global environmental enteropathy, it clearly makes sense as the contamination pathways are not necessary implying water.

3/ Do you have examples of terms that have led to confusion before or terms that are not common to both nutrition and WASH groups?
My colleague, Anne Bauby, WASH PM in Chad, who raised this point, stressed the fact that for instance the age classification in use in the nutrition sector were new to her WASH team.

Regarding the 8 activities proposed: do you have any other ideas about practical aspects that should be taken into account when promoting further integration between WASH and nutrition programmes ?

Amicalement
franck

Amicalement
franck

Franck Flachenberg| Environmental Health Technical advisor| Concern Worldwide
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  • franckconcern
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Re: 8 practical ideas to link more WASH and Nutrition programmes

About Safe Playground: thanks for the nice picture Jean-Christophe!
Wherever relevant, promoting locally-made rugs to be used as playground should definitely be considered as an option for our WASH/Nut teams.
Amicalement
franck

Franck Flachenberg| Environmental Health Technical advisor| Concern Worldwide
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  • milli
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Re: 8 practical ideas to link more WASH and Nutrition programmes

Dear Franck,

I like the idea of integrating WASH and nutrition and working interdisciplinary since the subjects are overlapping. Both of them deal with health issues and the implementation of health centers that cover both seems reasonable to me.

Another link could be the use of excreta in agrigulture. This could be interesting in communities that grow their own food. Promoting WASH and applying methods that improve soil fertility and agricultural earnings could represent a synergy too.

Reuse in agriculture can have positive effects on nutrition (more food security) as well as negative effects (if untreated excreta is used, it could lead to more worm infections and other diseases).

Another interesting aspect in this context of WASH and nutrition are helminth infections, which are caused by lack of sanitation and which can lead to malnutrition (and to anaemia) if the worm population inside the person gets so large that they take away the calories from the host. Do you have any information on how much malnutrition could be reduced by if we could eradicate helminth infections?
Guinea worm disease is close to being eradicated ( en.wikipedia.org/wiki/Dracunculiasis ) but all the other intestinal worms are far from being eradicated
( en.wikipedia.org/wiki/Helminthiasis#Epidemiology )...

Best regards,
milli

Danijela Milosevic
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  • franckconcern
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Re: 8 practical ideas to link more WASH and Nutrition programmes

Thanks Mili for your inputs.

Regarding the use of excreta for agriculture: i'm far from being a specialist in such domain but although I'm a big fan of the idea (closed loop system) I must admit, at least for Concern, we haven't yet managed to implement successful pilots in this matter (we tried in Uganda and Haiti). So I agree that any team that aims at linking more WASH with other sectors should consider it but from my side, i'm still looking for successful experiences implemented by generalist INGOs. Otherwise, I know that NGOs specialised in this domain, such as SOIL in Haiti,do have good results but they do spend a lot of means (financial,human ressource expertise) and can allow long time to the process for it to be successful. I'm not sure one could do the same in a integrated programme with many other objectives to link WASH and nut and agriculture. Well, this is an open debate of course!

We (=Concern) are currently piloting the use of excreta for agriculture purpose in Dar-ed-Sila region in Chad (based on past lessons learned)but only at a very small scale.
If interested, I'll ask our WASH PM, Anne Bauby, to let us know what the results are as the mid-review took place recently.
Edit on 14 Sept. by moderator: See here on the forum: forum.susana.org/forum/categories/92-nut...by-concern-worldwide

As for your other question: Do you have any information on how much malnutrition could be reduced by if we could eradicate helminth infections?
Unfortunately, I don't know the answer but I will ask my nutrition colleagues. Unless someone else on the forum can answer it?

Amicalement
franck

Franck Flachenberg| Environmental Health Technical advisor| Concern Worldwide
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  • milli
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Re: 8 practical ideas to link more WASH and Nutrition programmes

Dear Franck,

I don't have practical experience but I understand your point that organizations that are not specialized in reuse of excreta might not have enough resources for implemeting the reuse strategy successfully.

Actually I would be very interested in your mid-term results which you mentioned (piloting the use of excreta for agriculture purpose in Dar-ed-Sila region in Chad). I could imagine other forum users too.

Furthermore, I am working with Elisabeth to improve the wikipedia page on reuse of excreta and am curious about any additional information that I could use...(or to know about things that you think are missing)

en.wikipedia.org/wiki/Reuse_of_excreta
(see also here on the discussion forum: forum.susana.org/forum/categories/17-fer...ossible-improvements )

Best regards,
milli

Danijela Milosevic
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  • WASHanna
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Re: 8 practical ideas to link more WASH and Nutrition programmes

Hi Franck,

Thank you for sharing this information and the outputs from WEDC. We have been working on a Community of Practice that you might find interesting called Clean Fed & Nurtured. It seeks to explore integrations between WASH, Nutrition, and Early Childhood Development. In fact, safe child play spaces has been a topic that we have discussed. I think joining this group might be of interest to you.

More info here: aliveandthrive.org/clean-fed-nurtured-event-highlights/
Email sign up here: globalhandwashing.us3.list-manage.com/su...cf29d1&id=99d2b28a55

Hanna Woodburn
Acting Secretariat Director
Global Public-Private Partnership for Handwashing
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