Early Childhood Matters 2018

Why water, sanitation and hygiene (WASH) are fundamental to early childhood development

Amy Keegan, Policy Officer, WaterAid, London, UK

WaterAid is an international not-for-profit organisation fighting to make clean water, decent toilets and good hygiene normal for everyone, everywhere. We transform millions of lives every year. But why is this especially relevant to early childhood development? Access to water, sanitation and hygiene (WASH) is a prerequisite for a healthy child. Not only do WASH services benefit the immediate dignity and safety of the child and mother, they also provide long-term health, social and economic benefits.

Often the positive impacts of health interventions for children in one area are undermined by lack of WASH in another, for example:

  • Nutrition programmes often focus on food and nutrient intake and neglect factors that hinder nutrient absorption such as recurrent diarrhoea, intestinal worms and other enteric infections associated with dirty water and unsanitary conditions (Cumming and Cairncross, 2016).
  • While efforts to reduce maternal and newborn mortality often focus on increasing facility-based births and emergency obstetric care, newborns and mothers are frequently exposed to life-threatening infections via unhygienic birth conditions in facilities that lack basic requirements such as clean running water. In low- and middle-income countries, 38% of health facilities lack access to a basic water source (World Health Organization (WHO) and UNICEF, 2015).
  • Children may be de-wormed, but then quickly and continuously be reinfected through poor WASH in schools and at home (Danaei et al., 2016).

Sustainable WASH services within households and communities, healthcare facilities and schools are fundamental basics underpinning almost every aspect of early childhood development. It is therefore essential that WASH services are considered a key component of early childhood programmes in order to support the development of a happy, healthy child and mother.

Improving cross-sectoral approaches to early childhood requires better sharing of experiences of integration. The case studies described below highlight where WaterAid is contributing to better integration of WASH into health and nutrition policies and programmes. We are using our experience to advocate for governments and donors to invest in integrated approaches which deliver improved and sustainable health outcomes for children.

Nepal: integrating hygiene into immunisation programmes

In 2014, WaterAid supported Nepal’s Ministry of Health to launch a pilot project in four districts to incorporate hygiene promotion into immunisation programming. The sessions used games that build on emotional drivers of behaviour – such as nurture, affiliation, disgust and social status – in an aim to change norms in areas such as exclusive breastfeeding, handwashing with soap, food hygiene, faeces management, and treatment of water for milk. The sessions reached 38,000 caregivers through 2200 trained female community health volunteers.

An independent evaluation showed the intervention was effective in improving all key hygiene behaviours, from 2% during baseline to 54% after implementation. Prevalence of diarrhoea fell from 20% during baseline to 5% during the follow-up survey. The government is now aiming to scale-up this approach nationwide.

Photo: Ernest Randriarimalala/WaterAid

Madagascar: integrating WASH and nutrition policy

In Madagascar, nearly half of all children under 5 are stunted; almost half the population lack access to drinking water, and 90% to sanitation (WHO and UNICEF, 2017). An estimated 50% of undernutrition is associated with repeated diarrhoea, intestinal worms and other infections directly resulting from inadequate WASH (Prüss-Üstün et al., 2008). In response, the Government of Madagascar’s National Action Plan for Nutrition Phase III (2017–2021) sets out a multi-stakeholder, multi-sector approach to improve coordination mechanisms on WASH and nutrition, and align actions around a common results framework.

To reinforce and accelerate these national efforts, the Scaling Up Nutrition (SUN) Movement and the Sanitation and Water for All (SWA) Partnership have established a global partnership on Nutrition and WASH focused on advocacy, and identifying and sharing good practices. Partners, including WaterAid, have supported this effort by launching new advocacy reports, such as The Recipe for Success (WaterAid et al., 2017) and The Missing Ingredients (WaterAid and SHARE, 2016), which outline a toolkit for integration of WASH nutrition.

WaterAid is also one of the member organisations in the BabyWASH Coalition (babywashcoalition.org), which advocates for more integrated programming, policymaking and funding in the areas of WASH, early childhood development, nutrition, and maternal, newborn and child health.

References can be found in the PDF version of the article.

Also in this edition of Early Childhood Matters

Think Future – a gathering of unlike minds in support of early years innovation Innovation Edge is a grantmaking and investment platform focused on the early years. We source and support unconventional ideas that seek to positively transform foundational life experiences for the 4… Read more Read full ECM article
IDELA: leveraging child-centred evidence to change policy, practice and investment As investments in young children increase, fundamental questions remain about which approaches will produce the best outcomes for the most children. Holistic and common metrics are needed to meaningfully compare… Read more Read full ECM article
Childcare from the perspective of women informal workers Women informal workers across the world have set out their demands for quality public childcare services through a campaign organised by the research-action-policy network WIEGO (Women in Informal Employment: Globalizing… Read more Read full ECM article
Moving the needle on employer- supported childcare: from business case research to action In both developed and developing countries, new parents facing the challenge of accessing reliable and quality childcare often have to make a difficult decision – whether to stay in the… Read more Read full ECM article
Pollution and child development Pollution is the largest environmental cause of disease and death in the world today. Pollution is responsible for 9 million deaths per year – 16% of all deaths worldwide –… Read more Read full ECM article
Lifelong impact of nutrition in the first thousand days after conception Chronic non-communicable diseases such as Type 2 diabetes, cardiovascular disease and obesity are reaching epidemic proportions worldwide, accompanied by severe impairment of quality of life and huge cost of medical… Read more Read full ECM article
It takes a city: making early childhood a strategic priority in Tel Aviv When our Urban95 programme began to work with the Municipality of Tel Aviv-Yafo, we initially thought about what programmes and activities the municipality might implement. We have since come to… Read more Read full ECM article
Urban95: creating cities for the youngest people Cities can be wonderful places to grow up, but they can also pose serious challenges for healthy child development. The Bernard van Leer Foundation’s Urban95 initiative seeks to make lasting… Read more Read full ECM article
A Better Start: tackling inequity through community-wide action on early childhood development Developmental scientist Clyde Hertzman famously documented how ‘social environments and experiences get under the skin early in life in ways that affect the course of human development’ (Hertzman and Boyce,… Read more Read full ECM article
Using technology to train health workers to treat maternal depression at scale: a new model from Pakistan Maternal psychosocial well-being is important for early child development. In countries where maternal depression is high and there is a lack of mental health specialists, community health workers can be… Read more Read full ECM article