1. WATER, SANITATION, AND HYGIENE (WASH)
THE CRITICAL IMPACT OF
WATER, SANITATION, AND HYGIENE (WASH)
ON CHILDREN’S NUTRITIONAL STATUS

2. Why is
WASH
so critical for the

3. What is WASH? SAFE DRINKING WATER
SANITATION: ALWAYS USING A SAFE, CLEAN TOILET
HYGIENE: HANDWASHING WITH SOAP

4. NUTRITION SPECIFIC INTERVENTIONS NUTRITION SENSITIVE INTERVENTIONS

5. How does inadequate WASH affect children?

6. What happens if there is inadequate WASH?
(open defecation, not handwashing with soap, drinking unsafe water)
Fecal-oral exposure
Environmental Enteropathy
Intestinal Worm Infections
Diarrhoeal Diseases
In healthy intestines, food is absorbed through the lining.
Prolonged exposure to fecal pathogens activates the immune system, resulting in flattening of the villi in the intestinal lining -which makes it harder for food, and easier for diseases, to get in.
Maternal Environmental Enteropathy is associated to reduced fetal growth, pre-term birth, and miscarriage or still birth.
Having nematodes inside ones body results to loss of blood and consequently anemia, which leads to leading to chronic fatigue and stunting (Black, 2013).
400 million school children globally have diminished learning abilities due to intestinal worm infections (UNICEF, 2014).
25% of stunting in 24-month-old children are attributable to having five or more episodes of diarrhea (Checkley 2008, Lancet).
High diarrheal disease burdens before 2 years of age are linked with delayed school entry and poorer performance on intelligence tests (Patrick et al, 2005; Lorntz et al, 2006).
272 million school days are lost each year due to diarrhea (UNICEF, 2014).
POOR NUTRITIONAL STATUS/ UNDERNUTRITION
Source: “Linking toilets to stunting” Sanitation and Stunting Conference, Delhi School of Economics; O. Cummings LSHTM

7. What happens if there is inadequate WASH?
POOR NUTRITIONAL STATUS / UNDERNUTRITION
Low Height for age
Low weight for height
STUNTED CHILD
WASTED CHILD

8. How can improved
WASH
contribute to a child’s first

9. How can WASH contribute to the 1,000 days?
Cochrane Review, 2013
WASH intervention effect is equivalent to a 15% reduction in global prevalence of stunting.
Pruss-Ustun, 2006
Improved WASH conditions can reduce parasitic intestinal infections such as worm infestation that impacts nutritional status.
Fewtrell Review, 2005
There is a strong evidence of a positive impact of WASH interventions on child infections.
Esrey 1996, multi-country analysis, sample size almost
Improvements in sanitation were associated with increase in height ranging from 0.8cm to 1.9cm. (decrease in stunting 4–37% (rural) and 20–46% (urban).
Luby, 2005
Children under 5 years in households that had undergone handwashing with soap promotion had a 50 % lower incidence of pneumonia than control groups.

10. How can WASH contribute to the 1,000 days?
6 MONTHS-2YEARS
PREGNANCY
0-6 MONTHS
Ensuring all pregnant women can access safe water and clean toilets, and can practice good hygiene – contributes to reducing maternal anemia and maternal Environmental Enteropathy;
Ensuring all health facilities have safe water supply and clean, functional toilets with handwashing facilities – contributes to ensuring deliveries are safe for mother and children.

11. How can WASH contribute to the 1,000 days?
6 MONTHS-2YEARS
PREGNANCY
0-6 MONTHS
Eliminating open defecation and ensuring safe disposal of children’s feces – contributes to a cleaner living environment, reducing infections (including diarrheal diseases, intestinal worms) and Environmental Enteropathy;
Ensuring use of safe water and good hygiene practices by family members – contributes to ensuring food hygiene and a cleaner living environment, reducing infections.

12. WASH
IN THE PHILIPPINES

13. Estimated WATER coverage (2015) Estimated SANITATION coverage (2015)
What is the WASH situation in the Philippines ?
Estimated WATER coverage (2015)
Year
Total improved
Piped onto premises
Other improved
Other unimproved
Surface water
1990
84%
25%
59%
12% 4%
2015
92%
43%
49% 5% 3%
(WHO/UNICEF Joint Monitoring Programme, 2015)
GOAL REACHED (86.5 %)
Estimated SANITATION coverage (2015)
Year
Improved
Shared
Other unimproved
Open defecation
1990
57%
14%
15%
2015
74%
18% 1% 7%
GOOD PROGRESS (GOAL FOR 2015: 83.8%)

14. Sanitation and Stunting in the Philippines

15. What needs to be done? National Sustainable Sanitation Plan (NSSP):
By 2022, all barangays should be declared Zero Open Defecation (ZOD)
By 2028, universal access to safe and adequate sanitation facilities
Recognizing the negative impacts on poor WASH, DOH came up with the NSSP.
National Sustainable Sanitation Plan contains the following targets:
2016: 60% of all barangays should be declared Zero Open Defecation (ZOD)
2022: All barangays should be declared ZOD
2028: Universal access to safe and adequate sanitary facilities
However, actual implementation of the plan has been hampered by: lack of clear accountabilities between 30 different government departments at national and subnational level, lack of designated resources to support rollout; no monitoring system in place to know what progress is being made

16. What needs to be done? Political leadership
Increased investment in WASH solutions
Demonstrating and documenting solutions and model approaches
Developing inclusive partnerships
CLTS is a tool to be able to reach ZOD - Innovative methodology for mobilising communities to completely eliminate open defecation (OD).
Communities are facilitated to conduct their own appraisal and analysis of OD and take their own action to become Zero Open Defecation (ZOD).
Recognition that merely providing toilets does NOT guarantee their use, nor result in improved sanitation and hygiene.
Behavior change is the key!

17. Invest in
WASH
for
AND BEYOND

18. For more information, please contact
Louise Maule
Chief
Water, Sanitation and Hygiene (WASH) Section
UNICEF Philippines
United Nations Children’s Fund
31st floor, Yuchengco Tower
RCBC Plaza
6819 Ayala Avenue
1200, Makati City
Philippines
© United Nations Children’s Fund
July 2015