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MARCH 2016
WASH and Nutrition
Open the WASH ePaper in your browser
March 2016
 

WASH and Nutrition

The WASH ePaper is an online magazine published at regular intervals in German, English, French and Spanish. Each issue takes a closer look at a current key issue in the water, sanitation and hygiene (WASH) sector and related areas. It also provides updates on forthcoming national and international events, highlights current publications and projects, and reports on news from the sector. The WASH e-paper is published by the German Toilet Organization in close cooperation with the German WASH Network and the Sustainable Sanitation Alliance.

Issue #5

The fifth issue of the WASH ePaper is devoted to the topic "WASH and Nutrition" and is a follow-up document to the Bonn WASH Nutrition Forum (the Forum), which took place in November 2015 in Bonn, Germany. Linking WASH and nutrition has globally gained momentum. Strong scientific evidence on the relationship of poor WASH conditions and nutritional implications have emerged over the past years. Numerous countries already acknowledge the importance of adequate WASH in their nutrition strategies and call for WASH interventions to be scaled up along with nutrition actions. Beyond that, the German WASH Network and a broad coalition of renowned partners campaign globally for better collaboration between WASH and nutrition actors. The current issue provides an overview of the current state of discussion and presents the results and recommendations from the Bonn WASH Nutrition Forum.

CONTENTS OF THIS ISSUE


01   Why Link WASH and Nutrition?

02   The Bonn WASH Nutrition Forum 2015

03   Speaker Inputs & Mirror Sessions 

04   Key Recommendations of the Forum

05   Actors Represented at the Forum

06   Key Actors & Networks

07   Timeline: Relevant Dates in 2016-201707

08   Publications and Resources
 


01

Why Link WASH & Nutrition?

According to the World Health Organization (WHO) undernutrition is the outcome at the most immediate level of inadequate dietary intake and repeated infectious diseases. The major underlying causes - apart from food insecurity, inappropriate care practices and poor health sector performance - include the continuous exposure to adverse environmental conditions, which are often closely related to poor water, sanitation and hygiene practices. The resources available in a society and the context of their utilisation constitute the basic causes of undernutrition (please click on figure to enlarge).
A poor nutritional status has significant consequences for a child’s further development, including a higher risk of morbidity and mortality. According to the WHO, up to 45% of all under-5 child deaths globally are related to malnutrition. Out of these cases, it is estimated that approximately 50% are WASH-related and associated with faecally transmitted infections (FTIs) like diarrhea or intestinal worm infections caused by unsafe drinking water and/or poor sanitation and hygiene. The most critical period in a person’s development are the first 1000 days - beginning with conception, through a mother’s pregnancy and up until the age of two - during which children are particularly vulnerable to adverse effects of FTIs. Any damage done to a child’s physical growth, immune system and brain development during this period is usually irreversible.

On-going research shows that not only diarrhoea and intestional worm infections such as helminthiasis and schistosomiasis prevent the efficient absorption and utilization of nutrients, but also the environmental enteric dysfunction (EED), an asymptomatic syndrome causing chronic inflammation, reduced nutrient absorption of the intestine and a weakened barrier function of the small intestine, with children being most affected. The pathways along which pathogens can be transmitted are manifold, reaching from water and soil to flies and hands. Once brought in contact with food, pathogens can easily affect the intestinal tract.
According to the World Bank (2015) available evidence suggests that about 90% of the cases of diarrhea worldwide can be prevented by provision of an improved water supply, water safety planning, household water treatment and safe storage, improved sanitation facilities and hygiene promotion.

In addition to the direct links between WASH and nutrition, there are a variety of indirect implications. High distance from the household to water points and/or long access time to sanitation facilities reduces time for education, economic activities, care practices and good hygiene practices. Where safe water is available for purchase from vendors, high water prices often leave less money available for food and other necessities.
How can we optimize nutrition impacts?
 
Despite the good evidence of WASH being an underlying cause of undernutrition, Oliver Cumming (London School of Hygiene and Tropical Medicine) stressed at the Forum that the evidence of the direct impact of WASH interventions on the nutritional status has not been fully analysed and documented. New studies show that WASH plausibly affects growth in multiple ways although the magnitude of this effect is less clear. Implicit questions to be answered by both the WASH and Nutrition community are: What are the most effective interventions? Where do we need to focus efforts? Whom do we need to target? When do we need to target them? 

Future efforts for integrating WASH and Nutrition will have to take into account the analysis of costs (e.g. time spent in coordination) and benefits (e.g. health gains) as well as a better understanding on incentives of linking these two thematic areas. Integrated programming can happen at many levels and may take different forms. The WHO recommends to build on what exits, to increase integration only when worthwhile, document and reflect on lessons learnt and further refine and improve joint efforts. The following table adapted from WHO et al. (2015) shows key WASH and Nutrition practices, along with delivery strategies and settings (please click on figure to enlarge).
 
Please find the video incl. the presentation of Oliver Cumming (LSHTM) here


02

The Bonn WASH Nutrition Forum 2015

Since the Bonn Conference on the Water, Energy and Food Security Nexus in 2011, the link between WASH and Nutrition has been a key strategic area of focus of the German WASH Network. In an effort to place the issue on the international agenda, the network and its partners convened two seminars on WASH and Nutrition at the Stockholm World Water Weeks in 2012 and 2015. 

The initiative culminated in the Bonn WASH Nutrition Forum 2015 (Forum), the first international conference focused specifically on the WASH and Nutrition Nexus. The Forum intended to facilitate dialogue at the institutional and operational level. The event was organized by the German WASH Network in close cooperation with the German Federal Foreign Office and the German Federal Ministry of Economic Cooperation and Development. The global SWA Partnership and the global SUN Movement, along with several other networks and conference partners substantially contributed to the success of the Forum (please see logos above and Key Actors & Networks).

The Forum was funded by the Foundation Environment and Development North Rhine-Westphalia and Foundation for International Dialogue of the Savings Bank in Bonn. Additional support was provided by GIZ and WaterAid.
More than 100 participants from 23 countries attended the Forum. The participants represented a broad range of WASH and Nutrition stakeholders. Representatives of governments, research institutions, civil society and the private sector met for this international event at the headquarter of the German global broadcaster Deutsche Welle in Bonn. The Forum also acted as a kick-off event for the upcoming UN World Toilet Day 2015, entitled "Better Toilets for Better Nutrition".

More than 400 additional participants followed the live stream of the Forum via susana.org. German WASH Network would like to thank the SuSanA for being the online hosting platform of the Forum.
 
Please click here for the picture gallery


03

Speaker Inputs & Mirror Sessions at the Forum

At the heart of the Forum were “mirror sessions”, in which professional counterparts from WASH and Nutrition presented their respective functions, activities and positions. Dr. Uschi Eid, Chair of the United Nations Secretary General Advisory Board for Water and Sanitation (UNSGAB) chaired these sessions, including ensuing discussions to closer examine complementarities and possible connectivity points.

Please click on speakers' names to find the video and presentation.
Mirror Session 1: Global Monitoring

Bruce Gordon (Coordinator WASH and Health, WHO)
Lawrence Haddad (Senior Research Fellow, IFPRI)

 
The WHO recognises the importance of the health impact of WASH on nutrition outcomes. As a result it has teamed up with other organisations to create a publication, which was launched at the World Toilet Day celebrations in New York, one week after the Forum. Bruce Gordan gave a preview of this document, which you can find in the publications list below.

Data of the Joint Monitoring Programme for Water Supply and Sanitation (JMP) and of the UN-Water Global Analysis and Assessment of Sanitation and Drinking-Water Report 2013-14 (GLAAS) show an unequal distribution of WASH investments. Bruce Gordon mentioned the successes regarding global access to drinking water sources, but stated that stronger political will for sanitation is still required. Better sanitation is key to improving nutrition outcomes. It seems evident that significant investments for sanitation infrastructure will come from the individual households themselves. Government funds seldom reach rural regions, due to a lack of absorption capacities. Most investments are made in centralized supply systems in urban areas. 

Lawrence Haddad indicated that only limited data is available and that progress in combating malnutrition is very slow. Is this situation prevailing because of the lacking cooperation between WASH and Nutrition? Total diet must receive a higher priority, especially in the SDGs. Due to the limited financial resources available, he suggested to avoid unilateral investments in WASH or Nutrition. In addition to targeted measures to prevent malnutrition, the available data must be improved and governments should be encouraged to implement appropriate development goals.


Both Bruce and Lawrence agreed that it would make sense to include examples of WASH and Nutrition in both the GLAAS and Global Nutrition Report (please s. Key-Publications and Resources).
Mirror Session 2: Global Humanitarian Clusters

Jean Lapegue (Strategic Advisory Group, Global WASH Cluster, ACF)
Josephine Ippe (Global Nutrition Cluster Coordinator, UNICEF) 

 
Josephine Ippe and Dr. Jean Lapeque exchanged positions concerning the possible convergence of WASH and Nutrition in humanitarian crises. Particular potential lies in the fact that UNICEF is the lead organization for both sectors and has established existing structures that can be used. Within the humanitarian architecture UNICEF leads the Nutrition Cluster as well as the WASH Cluster at the global level and in most cases on the regional or country level. 

In order to strengthen the link of WASH and Nutrition it was suggested to promote the reciprocal inclusion of representatives of the other thematic area in cluster meetings. Other ideas included joint knowledge building and/or writing of a common position paper. The upcoming meeting of the Global Nutrition Cluster (30-31 March, Washington DC) will focus on inter-cluster relations and will include a discussion forum with experts on WASH, Health and Food Security.   
Mirror Session 3: Global Partnerships 

Catarina de Albuquerque (Executive Chair, Sanitation and Water for All Partnership)
Florence Lasbennes (Head of Secretariat, Scaling up Nutrition Movement)

 
The two speakers introduced the founding principles, organisational structures and objectives of the Sanitation and Water for All Partnership and the Scaling Up Nutrition Movement. There are many similarities: importance of a multi-stakeholder platform, bridging global efforts to country level and vice versa, the positive dynamics amongst neighboring countries, etc. Both speakers expressed a necessity and an interest to learn from each other. Intentions are there to invite each other to the respective other's events.

Florence Lasbennes highlighted that the water and sanitation sector has always been viewed as a key contributor to nutrition outcomes. She mentioned that she had counted 12 countries that have WASH investments as part of their national nutrition investments. This could act as a starting point for bringing the two communities together. She suggested a range of principles for working together, including coherent and articulated community level communication, geographic convergence, programmatic complementary and conceptional integration for planning, monitoring and evaluation.

Catarina de Albuquerque expressed clearly why the SWA Partnership welcomes a closer cooperation between WASH and nutrition actors: "First, without sanitation, measures to eliminate malnutrition are non-effective. Studies point out that poor sanitation contributes significantly to stunting. Sanitation and hygiene are good prerequisites for a healthy childhood, for dignity and for the individual's development ... Secondly, Scaling Up Nutrition is a movement that echoes our own partnership, and can provide us with many useful lessons on effective ways of working (amongst themselves and with external partners) and on political engagement processes. The inter-disciplinary vision of the Sustainable Development Goals is the perfect opportunity to reflect on our shared vision and how it can be translated into shared actions."
Mirror Session 4: Country Case South Sudan & Burkina Faso

Peter Mahal (Ministry of Water Resources and Irrigation, South Sudan)
Joséphine Ouédraogo/Baro (Ministry of Agriculture, Water Resources, Sanitation & Food Security)

Peter Mahal (Ministry of Water Resources and Irrigation, South Sudan) and Joséphine Ouédraogo/Baro (Ministry of Agriculture, Water Resources, Sanitation and Food Security, Burkina Faso) gave an insight into how WASH and Nutrition are addressed at government level in their respective countries.

The context in South Sudan is very challenging. After a long period of fighting for independence, South Sudan gained independence in 2011, but fell into internal conflict in 2013. As a result of the protracted crisis 57% of health and 40% WASH facilities were destroyed. Furthermore, displaced persons in new host communities increase the risk of famine, worsening the already poor nutritional status of the majority of the population. The limited WASH facilities has also led to a rapid increase in transmission of cholera and acute diarrhoea especially among vulnerable groups. Despite the high levels of malnutrition in the communities, response to address the situation remains slow due to limited capacity, partner presence and restricted access. Unless targeted strategies are adopted, the situation may lead to chronic malnutrition within communities with dire consequences. Conclusively, continuous support to Government and Development Partners against malnutrition is key. This can be done through increased partnership, improved community outreach and screening, strengthening existing supply chains, pipeline management and seeking innovative solutions. The instituional divide of the responsible line ministries for the relevant topics of WASH and Nutrition remains a challenge. 

Joséphine Ouédraogo/Baro refered to the ‘WASH in Nut Strategy’ developed in response to the 2012 nutrition crisis in Burkina Faso in joint collaboration between Government Ministries, UNICEF and the NGO sector. Three main approaches including geographical concentration of WASH interventions, skills and capacity strengthening of nutrition specialists and care takers and the promotion of a WASH minimum package were implemented to scale up services coverage. Communities with high prevalence in stunting were targeted with
CLTS and hygiene promotion activities. These actions were complemented by multi-actor responses to rehabilitate existing WASH infrastructure at household as well as institutional levels, targeting beneficiaries with severe acute malnutrition. Joséphine stresses the need for improved multi-sectoral coordination, planning and  implementation as well as joint monitoring of the investments.  
Mirror Session 5: Human Rights

Léo Heller (UN Special Rapporteur for the Human Right to Safe Drinking Water and Sanitation)
Hilal Elver (UN Special Rapporteur for the Human Right to Food)
Hannah Neumeyer (Human Rights Expert, WASH United)

The UN Special Rapporteurs, Léo Heller and Hilal Elver, sent video messages. Due to technical difficulties in showing them at the event, Hannah Neumeyer, Head of Human Rights Team at WASH United, gave a short input on the human rights, their validity and the implementation framework. The interactive involvement of the audience and the methodical presentation can be viewed on the SuSanA homepage.
Mirror Session 6: Global Civil Society Coalitions

Megan Macgarry (Communications and Campaign Manager, End Water Poverty)
Ben Hobbs (International Campaign Manager, Generation Nutrition)
Abigale Mupambi (SUN National Steering Committee Member, Zimbabwe)

Megan Macgarry spoke of the Forum as a vital stepping stone on the way to a Human Rights Roundtable, which EWP is planning in April 2016, bringing together the issues of water & sanitation, food security and housing. She highlighted the importance of working with other coalitions, like Generation Nutrition, to develop a joint civil society voice, reminding governments of their promises, fostering collaboration and maintaining focus on the most marginalised.

Ben Hobbs highlighted that the causes of undernutrition in children are diverse, so it makes sense for Generation Nutrition's (GN) campaign to be multi-sectoral – targeting policy-makers active in different areas. Including WASH NGOs in GN has helped to strengthen their messages on this theme and has also given these coalition members a new channel for their advocacy. So, it has been mutually beneficial. What remains is to convert the strong scientific evidence action at a programmatic and political level. GN will continue to campaign on the WASH-nutrition link in the period ahead. GN is calling on governments and donors to a) invest properly in WASH services for poor communities and b) ensure a better integration of existing WASH, health and nutrition programs. Both these things would help to bring down the number of under-five deaths due to undernutrition.

Abigale Mupambi expressed that CBOs are key in WASH and Nutrition, especially when deliberating about strategic partnerships between nutrition and WASH with a focus to improve service delivery. Due to the ground presence of CBOs they are well-informed of the problems that affect their communities. That automatically leaves them as the best formal structure to easily interpret commitments made at higher levels to benefit their communities. They are in the best position to lead, lobby and advocate for integrating WASH and nutrition in their communities using the indigenous languages of their people. Sustainability of implemented programs in integrating WASH and nutrition with the involvement of CBOs is guaranteed, since these structures have permanent residence in their communities. It is however key to note that anything done for the target group without them is not theirs, therefore a WASH-Nutrition collaboration without the targeted community involvement at all levels may face the risk of being disowned or misinterpreted by the targeted population and/or lack sense of ownership by the targeted people and likely to lose guarantee of its sustainability.
Mirror Session 7: Donors

Dr. Stefan Schmitz (Director, Special Initiative "ONE WORLD - No Hunger, BMZ)
Dr. Tania Rödiger-Vorwerk (
Deputy Director General, Sustainable Development, Natural Resources, Economic Issues and Infrastructure, BMZ)

Dr. Stefan Schmitz and Dr. Tania Roediger-Vorwerk presented a donor’s perspective, with a specific focus on the strategy of the German Federal Government and their implementation through the Special Initiative "One World, No Hunger”. Launched by the Federal Minister, Dr. Gerd Mueller, the initiative has positioned itself in the core of the German development assistance and alongside other focus areas. The programme is still in the development phase, but it already provides considerable investments, contributing to the fight against hunger. In order to implement a fully integrated approach to food security it combines both new and existing activities, including health and nutrition education and WASH components. Dr. Schmitz stressed that nutrition and food security programmes nearly disappeared over the past twenty years and highlighted the importance of political will and the role of the SUN Movement as the leading process, bringing together people from the practical level with policy makers. The BMZ committed itself to work with German Civil Society to bring the issue forward. A joint seminar at World Water Week 2016 and a publication are planned.
Thematic Speaker Inputs

The Forum was enrichted by further input presentations.
Please click on the input titles to watch the videos and the presentations.
 
Dr. Oliver Hoffmann
The Johanniter
Sphere Standards – WASH and Nutrition in Humanitarian Aid
Dr. Arne Panesar
GIZ / SuSanA
The SuSanA Network
Jeremy Shoham
Emergency Nutrition Network
The Emergency Nutrition Network
Erin Flynn
WaterAid
Dr. Marie T. Benner
Malteser International
Impact of FNS and WASH Interventions in South East Asia
Please click here to find all videos and presentations on SuSanA.org


04

Key Recommendations of the Forum

The Forum has produced results on many levels. In addition to tangible deliverables like timelines and a list of commitments, the organisers have compiled the results of the group works and the conclusions of the final panel in 6 key recommendations. The 6 key recommendations were carried by the Chair of the Forum, Dr. Uschi Eid, to the World Toilet Day celebrations in New York.
 
Create further Evidence on the Impact of WASH Interventions on Nutrition

The latest research clearly provides evidence of the adverse effects that lacking WASH has on the nutritional status, particularly on children. Enteric Pathogen Exposure can be reduced considerably by improved latrines, improved water supply and hand washing with soap, leading to documented positive health outcomes. However, the specific impact of WASH interventions on under-nutrition has not been fully analysed and documented. In the spirit of the SDGs the Forum recommends the systematic integration of monitoring systems for WASH and Nutrition, aligning to measure long-term public health outcomes. The relationship between research institutions and implementing agencies should be strengthened, in order to identify ways to reduce implementation inefficiencies.
Outcomes of development cooperation can be significantly improved when synergies between WASH and Nutrition are addressed

This calls for a) geographical focusing of WASH investments in high undernutrition prevalence areas (co-location), b) the consideration of joint priority intervention areas, like health facilities, but also the community, schools and household levels, c) the prioritisation of age groups and “the first 1,000 days period” as these are a critical window for effective WASH and Nutrition Interventions, d) engaging and empowering women, paying special attention to the mother child unit, and e) a stronger focus on the elimination and eradication of neglected tropical diseases (NTDs), such as soil-transmitted helminthiasis, guinea-worm disease, trachoma and schistosomiasis, which affect mainly children.
Using the SDGs to create an umbrella for sector integration

The Forum recommends that the sectors collaborate to produce an ‘umbrella-package’ of the key targets and indicators from across the SDGs and other existing commitments (e.g. the six global nutrition targets 2025) that – if realized - will support positive health outcomes and could/should be the focus points for action. This should/could be facilitated and sponsored by WHO and would be a useful guideline for governments and a framework for collaboration between actors.
Using the global WASH and Nutrition platforms for scaling-up

The ambitious global goals of the SDGs can only be achieved if the global investments in WASH and nutrition increase substantially. The two most important platforms of the global WASH and Nutrition architecture, the Sanitation and Water for All Partnership (SWA) and the Scaling Up Nutrition Movement (SUN) have made enormous progress over the last years in building up high level support and facilitating public commitments of numerous countries and donors. We recommend to support the global platforms in their efforts to foster collaboration and coordination across issues, sectors and stakeholders.
Identify quick wins and synergies between WASH and Nutrition

Both have health as their overarching aim, both rely on the same surveys. The promotion of joint assessments/ causal analysis and the development of corresponding indicators to guide implementers can be an opportunity. While doing so, be open for a more systematic integration of WASH and Nutrition.
Effectively changing behaviour is a core focus of both WASH and Nutrition

Pooling resources, identifying target behaviours and aligning effective behavioural change strategies can help to support better public health outcomes. This includes the identification of common target behaviors or practices, key messages, target groups and change agents like public health workers or religious leaders.


05

Actors Represented at the Forum

To promote networking and collaboration, the 50 institutions and organisations that were present at the Forum are presented in the diagram below. You will find a more detailed presentation of some selected actors below. On request, the Secretariat of the WASH Network can try to offer assistance in establishing contact with selected actors.
 


06

Key Actors & Networks

In this section we introduce the key-actors, global platforms and networks which are crucial for the furhter integration of WASH and Nutrition. Please click on the logo of the organisation of your choice to open their webpage.
Scaling Up Nutrition Movement (SUN)
 

SUN is a multi-stakeholder movement, which more than 50 countries have signed up to. It is founded on the principle that all people have a right to food and good nutrition. It unites people from governments, civil society, the United Nations, donors, businesses and research organisations who pull their acts together to eradicate malnutrition.  

 

Within the SUN Movement, national leaders are prioritising efforts to address malnutrition. Countries are putting the right policies in place, collaborating with partners to implement programmes with shared nutrition goals, and mobilising resources to effectively scale up nutrition, with a core focus on empowering women.

 

Within the SUN Movement, nutrition is not a sector, but rather an outcome of multi-sectoral efforts, including WASH. The SUN Movement networks more than 2,000 organisations, which are committed to supporting country-led national nutrition plans – including nutrition sensitive interventions, like WASH.


At the Forum, the SUN Movement took the challenge to count more national nutrition plans which include substantial WASH components.

Sanitation and Water for All Partnership (SWA)

SWA is a global partnership to achieve universal access to clean water and adequate sanitation. It consists of more than 100 partners (country governments, external support agencies, civil society organisations and other development actors) working together to catalyse political leadership and action, improve accountability and use scarce resources more effectively.

SWA facilitates a high level political dialogue, including Ministerial and High Level Meetings, and it has identified four critical collaborative behaviours to improve long-term sector performance and sustainability.

SWA recognises that the full realisation of its objectives requires cooperation with adjacent thematic areas like nutrition, education, health, climate change, human rights. In order to link more efficiently to the SUN Movement, a representative of SWA was sent to the last SUN Global Gathering. A representative of the SUN Movement was invited to the last SWA Partnership and Ministerial Meetings.
World Health Organisation (WHO)

 

Both WASH and Nutrition are important pillars of WHO’s global commitment for improved public health.


Together with the Food and Agriculture Organization (FAO) WHO is responsible for the International Conference on Nutrition (ICN) of the United Nations. The World Declaration and Plan of Action for Nutrition (1992) are results of this process, as well as the Rome Declaration and the Action Framework for Food Security (2014), which includes important recommendations for WASH as a key area of action. WHO and UNICEF collaborate on the maintenance and updates of global data for tracking the World Health Assembly targets and informing the Global Nutrition Report.


The WHO bianually publishes the “UN-Water Global Analysis and Assessment of Sanitation and Drinking-Water” (GLAAS), which presents data from 94 countries and 23 external support agencies. It offers a comprehensive analysis of strengths and challenges in WASH within and across countries.

 

Together with UNICEF, the WHO was tasked by the UN Secretary General to control and monitor the progress of the Millennium Development Goals on water and sanitation under the Joint Monitoring Programme. Both organisations sign responsible for the Global Action Plan for the prevention and control of diarrheal diseases, involving both WASH and Nutrition as fundamental areas of intervention.

 

In August 2015, the WHO issued a five year strategy for WASH and neglected tropical diseases.
United Nations Children’s Fund 
 
Based on its mandate to provide humanitarian and development assistance for children and mothers UNICEF has a leading role in WASH and Nutrition. UNICEF runs WASH programs in more than 100, Nutrition programs in more than 90 countries.

In the humanitarian system the global leading role of UNICEF is clearly defined under the Inter-Agency Standing Committee (IASC) cluster approach, which aims to ensure a better coordination in emergencies. At the global level UNICEF is both the WASH and the Nutrition Cluster Lead Agency and hosts the Cluster support teams (CAST) based in New York and Geneva.

In order to scale up WASH and Nutrition UNICEF actively supports and works through the global platforms SUN and SWA. It is a member of the SUN UN Network and hosts the SWA Secretariat in coordination with the Water Supply and Sanitation Collaborative Council (WSSCC).

In 2015 UNICEF and WHO have published a practical manual  titled "Improving Nutrition Outcomes with Better Water, Sanitation and Hygiene" (s. Current WASH publications).
Sustainable Sanitation Alliance (SuSanA)

SuSanA is an open international alliance with over 200 members who are dedicated to understanding viable and sustainable sanitation solutions. It links on the ground experiences with an engaged community made up of practitioners, policy makers, researchers, and academics from different levels with the aim of promoting innovation and best practices in policy, programming and implementation. The SuSanA has an open source library, supports dialogue through the open online discussion forum as well as face-to-face at different occasions.  SuSanA hosts 12 different working groups, which deal with a variety of issues pertinent to the sanitation sector.

SuSanA’s working group 12 "WASH and Nutrition" was founded at the Stockholm World Water Week in 2012. It has produced a fact sheet on the issue (see publication links below) and actively supported the Bonn WASH Nutrition Forum. SuSanA was also the Forum’s online hosting platform.
Emergency Nutrition Network (ENN)

The ENN is an open network set up to improve practice and strengthen the institutional memory of agencies involved in the emergency food and nutrition sectors. The ENN enables networking and learning to build the evidence base for nutrition programming. Its focus lies on humanitarian emergencies and other situations, where undernutrition is a significant chronic problem. The ENN captures the experiences of practitioners through publications (Field Exchange & Nutrition Exchange) and via its online technical forum.

The ENN deals with nutrition-specific programming (e.g. management of acute malnutrition) as well as with nutrition-sensitive programming, including health, agriculture and WASH.

At the Forum the ENN and the SuSanA met for the first time and realised that they have equivalent functions within their respective thematic areas. Both networks agreed to strengthen their ties and to further explore potential synergies of future collaborations. 

 
End Water Poverty

End Water Poverty (EWP) is a global civil society coalition campaigning to end the water and sanitation crisis. Established in 2007, EWP have now grown to over 350 members in more than 50 countries around the world, working in all regions.

The coalition is focused on advocacy and campaigns for the recognition and realisation of the human rights to water and sanitatoin and to achieve the new 2030 agenda, particularly Goal 6 on water and sanitation.

EWP campaigns at a national and regional level, creats and coordinates unifying global moments like e.g. the Water Action Month and facilitates civil society inputs into global processes including Sanitation and Water for All. 

EWP teamed up with Generation Nutrition in order to strengthen the link between WASH and Nutrition within global civil-society campaigns.
Generation Nutrition (GN)
 

GN is a global campaign, working to end child deaths from under-nutrition within a generation. It advocates for political will and leadership, calling for ambitious international and national targets on acute malnutrition. GN demands urgent action across sectors. It recognises the importance not only of access to nutritious food, but also of the availability of clean water, sanitation, hygiene, healthcare, and good care practices for babies and small children.


In its brand-new factsheet on WASH and Nutrition GN calls on governments to strengthen the linkages between WASH and nutrition in their policies and strategies, creating stronger institutional collaboration between their relevant ministries (please s. Key-Publications and Resources).

German WASH Network (GWN)

The German WASH Network unites 20 German not-for-profit NGOs, working in the field of water, sanitation and hygiene worldwide. The network aims to strengthen the WASH sector through advocacy work, knowledge sharing and specific project collaborations. Its members also work for a better integration of emergency, transitional aid and development cooperation.

With a range of member organisations specialised in strategic focus areas within the WASH and Nutrition realms, the German WASH Network first addressed the neglected relationship between WASH and Nutrition at the Bonn Conference on the Water, Energy and Food Security Nexus in 2011. Together with partners the network has since convened two seminars on WASH and Nutrition at the Stockholm World Water Weeks 2012 and 2015. These events led to the idea of organising the Bonn WASH Nutrition Forum 2015, the first international conference genuinely focused on the WASH and Nutrition Nexus.


07

Timeline: Relevant Dates in 2015 / 2016

Linking WASH & Nutrition – A Roadmap towards Better Health
SuSanA invites you to take part in the 7th Thematic Discussion taking place from 30 March until 13 April 2016
(for more information please click on the logo)
March 2016
Water Action Month
http://www.endwaterpoverty.org/campaign/water-action-month-march-2016
15 - 17 March 2016
SWA Ministers Meeting in Addis Ababa
22 March 2016
World Water Day
30 - 31 March 2016
Global Nutrition Cluster Meeting in Washington DC
March / April 2016
Thematic Discussion Series on WASH and Nutrition
http://www.susana.org/en/resources/thematic-discussion-series
18 April 2016
End Water Poverty Human Rights Roundtable, London
19 - 20 April 2016
Global Water Summit 2016 in Abu Dhabi
http://www.watermeetsmoney.com/
25 April 2016
World Malaria Day
http://www.worldmalariaday.org/
16 - 19 May 2016
Women Deliver Conference, Copenhagen, Denmark
http://www.womendeliver.org/conferences/2016-conference/
26 - 27 May 2016
World Humanitarian Summit, Istanbul
https://www.worldhumanitariansummit.org/
27 May 2016
8th annual WASRAG World Water Summit, Korea
http://www.wasrag.org/wws8-seoul-korea
25 - 27 May 2016
AfricaSan 4 in Dakar, Senegal
http://www.africasan.com/
28 May 2016
Menstrual Hygiene Day
http://menstrualhygieneday.org/
5 June 2016
World Environment Day
http://www.unep.org/wed/
11 - 15 July 2016
39th WEDC Conference
28 July 2016
6 Year Anniversary of the Human Right to Water and Sanitation
17 - 22 July 2016
UNCTAD meeting incl civil society forum, Nairobi
http://unctad14.org/EN/Pages/Home.aspx
4 August 2016
Rio Nutrition Summit
http://www.generation-nutrition.org/en/blog/rio-summit-golden-opportunity-eu-nutrition
August 2016
Stockholm World Water Week
http://www.worldwaterweek.org/
October 2016
UN High Level Panel of Experts
15 October 2016
Global Hand Washing Day
http://globalhandwashing.org/global-handwashing-day/
November 2016
SUN Global Gathering
 19 November 2016
World Toilet Day
November 2016
Global WASH Cluster Meeting in Kathmandu, Nepal
12 December 2016
Universal health coverage day
http://universalhealthcoverageday.org/about/
 2016
Possibly WASH and Nutrition event in Namibia (Hon. Mr. Angula)
April 2017
SWA High-Level Meeting, Washington DC


08

Key-Publications and Resources

Upcoming:  WASH ´ Nutrition Operational Manual

Author: Jovana Dodos et. al
Publisher: 
ACF, UNICEF and ECHO
Year/Location: Upcoming (2016)
 
ACF, UNICEF and ECHO are going to launch a practical guidebook for humanitarian workers on increasing nutritional impact through alignment and integration of WASH and nutrition programs at the Stockholm World Water Week 2016.
Upcoming:  WASH Benefits

Author: N.N.
Publisher: 
University of California, Berkeley, Bill and Melinda Gates Foundation 
Year/Location: Upcoming (2016)
 
The publication will present the results of a randomized control trial to measure the impact of water quality, sanitation, handwashing, and nutritional interventions among newborn infants in rural Bangladesh and Kenya. The studies will measure primary outcomes after two years of intervention. The study will be published at the end of 2016, including earlier previews at various events, including World Water Week.
Improving Nutrition Outcomes with Better Water, Sanitation and Hygiene: Practical Solutions for Policies and Programmes

Author: N.N.
Publisher: 
World Health Organization, UNICEF, USAID
Year/Location: 2015
 
This publication, jointly prepared by WHO, the United Nations Children’s Fund (UNICEF) and the United States Agency for International Development (USAID), summarizes the current evidence on the benefits of WASH for improving nutrition outcomes and describes how WASH interventions can be integrated into nutrition programmes. It provides practical suggestions, targeted at nutrition programme managers and implementers, on both “what” WASH interventions should be included in nutrition programmes and “how” to include them. It also seeks to help the WASH community to better understand their role, both as providers of technical expertise in WASH interventions and in prioritizing longer-term improvements to WASH infrastructure in areas where under-nutrition is a concern.
The Global Nutrition Report 2015: Actions and accountability to advance nutrition and sustainable development

Author: L. Haddad et.al.
Publisher:
International Food Policy Research Institute (IFPRI)
Year/Location: 2015, Ney York, USA
 
The Global Nutrition Report (GNR) provides a global profile and 193 country profiles on nutrition for each of the United Nations’ 193 member states, and includes specific progress for each country. In 2014 a consortium of nations, organizations, researchers, and academics has released the GNR, the first-ever comprehensive narrative on global health and country-level progress toward reducing malnutrition across the globe. It was a centerpiece of the Second International Conference on Nutrition (ICN2) in Rome on 19-21 November, organized by the UN Food and Agriculture Organization and the World Health Organization.
The Power of WASH: Why Sanitation Matters for Nutrition

Author: D. Spears, L. Haddad
Publisher: WaterAid, WEDC, Share
Year/Location: 2015, UK

 
Water, sanitation, and hygiene can have a profound effect on health and nutrition. A growing base of evidence on the link between sanitation, child height, and well-being has come at an opportune time, when the issue of sanitation and nutrition in developing countries has moved to the top of the post-2015 development agenda.
The role of water, sanitation & hygiene in the fight against child undernutrition

Author: Generation Nutrition Global Campaign Team
Publisher: Generation Nutrition, End Water Poverty, WaterAid
Year/Location: 2015, UK

 
This factsheet is the first in a series by Gereration Nutrition looking at different ways of preventing child undernutrition, and focuses on Water, Sanitation and Hygiene (WASH). It explains how WASH and Nutrition outcome for children are intimately linked and how improved WASH reduces undernutrition, thereby helping to break the cycle of poverty and transform people's lives.
The Power of WASH: Why Sanitation Matters for Nutrition

Author: A. Chitty
Publisher: SHARE Research Consortium, UK; UNICEF, India
Year/Location: 2015, India

 
With 165 million children suffering from chronic undernutrition (being stunted) and 52 million suffering from acute malnutrition (being wasted), more concerted and cross-sectoral action is needed. Improving WASH in the context of nutrition programming offers one important opportunity to do this. This paper summarises the evidence for the impact of poor sanitation on nutritional outcomes and highlights the potential offered by greater integration of WASH within nutrition policy and programmes.
Small Doable Actions: A Feasible Approach to Behavior Change

Author: N.N.
Publisher: WASH plus
Year/Date: 2015, Washington D.C., USA

 
WASHplus incorporates a small doable action approach to change WASH and household air pollution practices in its global- and countrylevel activities. Rather than promoting the ideal WASH practices (e.g., build and use a flush toilet or insist that all family members wash hands at all five critical junctions using running water and soap), it constructs a continuum of behaviors that span from unacceptable to ideal. Small doable actions (SDAs) are behaviors that are deemed feasible to perform in resource-constrained settings, from the householder point of view, and effective at personal and public health levels.
How to better link WASH and nutrition Programmes

Author: N.N.
Publisher: Concern Worldwide
Year/Location: 2014, UK

This paper aims to provide some practical guidance on how water sanitation and hygiene (WASH) programmes can be more nutrition-sensitive and how nutrition programmes can incorporate more WASH aspects. It should be useful for all project staff working in nutrition and WASH programmes when WASH and/or a nutrition programme are in operation.
Integrating water, sanitation, and hygiene into nutrition programming

Author: N.N.
Publisher: WASH plus, USAID
Year/Location: 2013, Washington D.C.,USA

 
Unsafe water was considered the primary cause of diarrhea in children transitioning from an exclusive breastfeeding diet, but recent evidence also points to unsafe food. The brochure highlights some WASH interventions that can prevent diarrhea and under-nutrition even in hygiene-challenged environments.
Water, Sanitation, and Hygiene in Nutrition Efforts: A Resource Guide

Author: I. Neequaye and C. Keltne
Publisher: WASH Advocates
Year/Location: 2015
,
Washington, USA

This resource guide provides recent reports, manuals, strategies, examples of advocacy efforts, and other resources that cover WASH and global advocacy along with relevant organizations in the WASH advocacy field. This guide can serve as a tool for professionals, implementers, and advocates looking to pursue and promote WASH advocacy efforts.
ACF WASH in Nut - Poster

Author: J. Lapegue
Publisher: ACF International
Year/Location: 2014, France

 
The poster illustrates the impact of water, sanitation & hygiene interventions on the nutritional and health status of children under 5 years old and mothers.
SuSanA Factsheet WASH in Nutrition

Author: J. Lapegue, R. Lozano, K. Lellouche, J. Onsurbe, A. Coerver, S. Simon, R. Gensch, A. Schmidt
Publisher: SuSanA WG 12
Year/Location: 2015
, Germany

 
This document is a compilation of main facts, existing evidence and remaining research gaps regarding the link between inadequate sanitary conditions and its underestimated impact on undernutrition and stunting, particularly for children under five years of age. This is a draft version.

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Contact  Jan Emmel  jan.emmel@germantoilet.de

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