Credit: MamaYe!/Sierra Leone
Innovation in hand-washing, Sierra Leone

Nutrition, water, sanitation and hygiene

Making sure that everyone has access to nutritious food, safe water, sanitation and hygiene are Sustainable Development Goals and critical determinants of health.

Good nutrition from birth helps protect a child against infectious disease and to reach their full development potential. Water, sanitation and hygiene (WASH) are essential and enable improvements in child nutrition. Integration of nutrition and WASH programming makes both good technical and economic sense. This needs a multisectoral approach.

We have worked in partnership with governments and their line ministries, NGOs and community groups to create integrated health, nutrition and WASH interventions that have been taken to scale for maximum impact.

We have done this by:

  • Working across sectors to provide the evidence for targeting interventions for greatest impact, on undernourished adolescent girls, mothers and children under two.
  • Scaling up participatory learning and action approaches that empower communities to make choices and prioritise actions to undertake in their villages
  • Supporting community-led total sanitation (CLTS) to enable communities to establish improved sanitation practices and become free from open defecation
  • Strengthening management information systems to monitor, review and improve the efficiency of implementation of CLTS and to gauge the progress made in achieving sanitation, hygiene and nutrition objectives.

In Odisha, India, our integrated health, nutrition and WASH work, contributed to a decline in the prevalence of child stunting from 45 percent to 34 percent between 2006 and 2016. Data generated by the programme reinforced the need for a stronger multi-sectoral approach to nutrition at policy, planning and implementation levels.

In Sierra Leone, water and sanitation was one of the seven ‘enablers’ monitored in Facility Improvement Team,  used to assess the readiness of facilities to provide Emergency Obstetric and Newborn Care .

Breastfeeding and improved feeding practices is a key feature of the MamaYe campaign of the Evidence for Action programme. The MamaYe website provides a bank of evidence and resources on all aspects of maternal and newborn health, which can be accessed by both health professionals and the public. Visitors to the site can search through government papers, infographics, academic journals and more to learn about nutrition and maternal and newborn health in low-resource settings.


  • The number of people with access to drinking water rose from 18 million to 21 million between 
    2008 and 2015

  • In Sierra Leone, FIT scorecards motivated Medicos Del Mundo to fix damaged water pipes

  • In Odisha, the under-five mortality rate dropped from 9% to 3% between 

Our experts

  • Alison Dembo Rath
    Alison has over 20 years’ experience in design, management, monitoring and evaluation of health systems development programmes at policy and implementation levels. Building on her early career in UK nursing, Alison has particular expertise in delivering quality maternal and newborn health services. Alison has experience across Sub-Saharan Africa and Asia, managing UK Aid-funded maternal health and health sector programmes in India and Nepal.

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