1. Safe Drinking Water and Clean Hands: Essential Nutrients! Presented at: Knowledge, Tools and Lessons for Informing the Design and Implementation of Food Security Strategies in Asia November 14, 2011 Rochelle Rainey, Ph.D. Senior Advisor, Environmental Health USAID/Washington DC

2. Objectives 1. To understand the connections between undernutrition and WASH* 2. To understand ways to prevent diarrhea and undernutrition 3. To understand options for integrating WASH into agriculture programs for improved nutrition 3. Global Contribution of Undernutrition to Child Mortality Diarrhea: 17% of all child deaths Undernutrition contributed to 73% of these deaths Diarrhea 17% 73% 4. Co-habitation with domestic animals Lack of access to adequate safe water Dirt floors Crowded housing Poor diet Lack of refrigeration Lack of/poor medical care Breastfeeding / weaning practices Lack of access to sanitation Inadequate handwashing Poverty Lack of knowledge War, conflict THE VICIOUS CYCLE Diarrhea Exposure to feces Malnutrition Decreased immunity Poor drainage Decreased immunity 5. Nutrition Program Intervention Points Feces in the environment Child Exposed to Feces Diarrhea/ Worms In Child Improved Resistance Nutritional Status -healthy birthweight -exclusive breastfeeding -complementary feeding -micronutrients (Zn, Vit A, Fe) Measles Vaccinations Bednets Case Management -oral rehydration therapy -Zinc -continued feeding -deworming -timely care seeking Primary Prevention of Diarrhea 6. This is PRIMARY PREVENTION Fields Fluids Fingers Flies Feces Food New Host Hand Washing Source: Wagner and Lanoix, 1958 Water Quality Water Quantity Food Hygiene Hand Washing Sanitation WORMS! 7. Key Hygiene Behaviors Point of use drinking water treatment and safe storage Handwashing with soap at critical times Use of basic sanitation Food handing and safe storage Behaviors must be correct, consistent, and sustained to get desired health impact! 8. Enabling Environment (mobilization, policies, financing) Access to Hardware and/or Products Formative research, marketing, education, promotion Sustainable Improvements in Water, Sanitation and Hygiene Behaviors FRAMEWORK FOR PREVENTION 9. Mothers of small children wash hands with soap before preparing food, and air dry Comprehensive strategy for: Communication Training Infrastructure Product Mobilization Policy Financing Demos Flipcharts Contest for healthy families Complete education kit with games Theater, songs Sports star Global Handwashing Day Health Agents: -Proper hand washing -Basic water issues -How to conduct household and community meetings Community members: -Pump repair -Soap making -Proper hand washing Creation of water committees Community participation in decision making Engage women AND men Professional/ service organization Water sources Installation of taps and sinks near latrines and kitchens Availability of soap Soap Basins Sinks Soap making kits Plumbing supplies Advocacy on hand washing Inclusion of govt. health agents in program Include in curricula at all levels, teacher training as well as schools Social marketing Voucher system Water committee collection for handwashing stations Small grants Public private partnerships with soap makers 10. Improved Nutritional Status especially of Women and Children Improved access to diverse and quality foods Improved nutrition and hygiene related behaviors Improved utilization of maternal and child health and nutrition services Increased resilience of vulnerable communities and households Improved agriculture productivity, improved markets, increased agricultural value chain on and off farm jobs Health Nutrition and WASH Framework Governance, Education 11. Access to agricultural inputs and technologies to diversify food production at household and community level Access to water sources and fertilizer to improve diverse food production (household/community) Multiple-use water systems, ecological sanitation Improve knowledge of seasonally available nutritional foods for different age groups based on geographical region, climate and cultural traditions Improve quality control systems for complementary foods Improve post harvest storage and food processing techniques to retain or improve nutritional value of food Improved use of household resources to access diverse nutritious foods Improved access to diverse and quality foods 12. Household Nutrition Behaviors Household Hygiene Behaviors Community level behaviors Community water and sanitation committees Community nutrition monitoring Sanitation demand creation Improved nutrition and hygiene related behaviors 13. Treatment of acute malnutrition Micronutrient Supplementation Antenatal and postnatal services integrate nutrition and WASH counseling Facility-based training on counseling, provide materials Growth Monitoring and Promotion services improved at community and facility Integrate nutrition and Family Planning counseling and services Improved access to sanitation infrastructure, and water for production and consumption uses, along with training in hygiene promotion, at schools and health facilities Latrine and water point construction, rehabilitation and maintenance, along with hygiene promotion Strengthen nutrition activities in facility-based Integrated Management of Childhood Illness (IMCI) Improved utilization of maternal and child health and nutrition services 14. Improved community-based initiatives to mitigate nutrition shocks Integrate nutrition into existing Early Warning Systems Improved community-based feedback mechanism for nutrition monitoring Improved water resource management infiltration/check dams, water storage, rainwater harvest, water efficiency Improved access and correct, consistent, sustained use of basic sanitation Community Led Total Sanitation (CLTS) Increased resilience of vulnerable communities and households 15. Conclusions and Recommendations Look for opportunities for synergy with agriculture and economic growth programs Use all available channels in community, engage men and women in WASH and nutrition Focus on small do-able steps to improve WASH and nutrition behaviors Facilitate private sector engagement 16. Thanks for your time! Questions? Rochelle Rainey USAID/Washington rrainey@usaid.gov Locally produced water filters, Cambodia