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

Nutrition, water, sanitation and hygiene

Making sure that everyone has access to nutrition, safe water and sanitation are human development goals and a critical determinant of good health. Yet the health of a large number of people is still compromised by poor water, sanitation and hygiene (WASH).

Every year, approximately two million children under five years of age die of diarrhoea, which is easily preventable. Around half of these deaths occur in India alone. An integrated approach to health, nutrition and WASH programming makes both good technical and economic sense.

We work in partnership with governments, NGOs and community groups to create integrated health, nutrition and WASH interventions that can be taken to scale for maximum impact.

We do this by:

  • 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
  • Giving health planners the evidence required to focus services on those most at need, particularly undernourished adolescent girls, mothers and children under two.

In Odisha, India, our integrated health, nutrition and WASH work, including our support to CLTS, has had a significant positive impact on the health of the population. Every week new villages and Panchayats are declared open-defecation-free. The momentum created has helped mobilise practical measures to accelerate and multiply attainment of open-defecation-free status across the state. District collectors now closely monitor sanitation improvement efforts in their districts and work with private markets to ensure the supply of sanitary materials to meet newly created demand for toilets among rural communities.

In Sierra Leone, water and sanitation is one of the seven ‘enablers’ monitored in Facility Improvement Team (FIT). It is used to assess the readiness of facilities to provide Emergency Obstetric and Newborn Care (EmONC). FIT results are shared with our partners in a user-friendly scorecard format so that facilities can improve their readiness to provide good quality services. A facility is certified as EmONC-compliant when the criteria for all seven enablers are met  – water and sanitation, staffing, drugs and supplies, electricity, referrals, equipment, and blood storage and laboratory.

Breastfeeding is a feature of the MamaYe campaign of the Evidence for Action (E4A) programme. During World Breastfeeding Week, the MamaYe country programmes used powerful infographics and images to engage a wide variety of stakeholders. This included presenting evidence of its effectiveness alongside instructional videos on breastfeeding practices.

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.


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% betwwen 2005-2014

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

Our experts

  • Alison Dembo Rath
    Alison Dembo Rath leads Options’ health systems work, with a particular focus on South Asia. She 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 nursing in the UK, Alison has particular expertise in delivering quality maternal and newborn health care services. Alison has experience of working across Sub-Saharan Africa and Asia, managing UKAid-funded maternal health and health sector programmes in India and Nepal.

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More about Options
Established in 1992, Options has worked in over 50 countries. We lead and manage health sector programmes on behalf of international donors and national governments.
Established in 1992, Options has worked in over 50 countries. We lead and manage health sector programmes on behalf of international donors and national governments.

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