Abstract
Objectives
This study explores the integration of water, sanitation, and hygiene (WASH) and nutrition programming for improved child health outcomes and aims to identify barriers to and necessary steps for successful integration.
Methods
Sixteen semi-structured in-depth interviews were conducted with key stakeholders from both the WASH and nutrition sectors, exploring barriers to integration and potential steps to more effectively integrate programs.
Results
Key barriers included insufficient and siloed funding, staff capacity and interest, knowledge of the two sectors, coordination, and limited evidence on the impact of integrated programs. To achieve more effective integration, respondents highlighted the need for more holistic strategies that consider both sectors, improved coordination, donor support and funding, a stronger evidence base for integration, and leadership at all levels.
Conclusions
Organizations desiring to integrate programs can use these results to prepare for challenges and to know what conditions are necessary for successfully integrated programs. Donors should encourage integration and fund operational research to improve the efficiency of integration efforts. Knowledge among sectors should be shared and incentives should be designed to facilitate better coordination, especially where both sectors are working toward common goals.
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References
Axelsson R, Axelsson S (2006) Integration and collaboration in public health—a conceptual framework. Int J Health Plan Manag 21:75–88
Bhutta Z, Ahmed T, Black R, Cousens S et al (2008) What works? Interventions for maternal and child undernutrition and survival. Lancet 371:417–440
Black R, Victora C, Walker S, Bhutta Z et al (2013) Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 382(9890):427–451
Cairncross S, Curtis V (2003) Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. Lancet Infect Dis 3(5):275–281
Cuesta J (2007) Child malnutrition and the provision of water and sanitation in the Philippines. J Asia Pac Econ 12(2):125–157
Dangour A, Watson L, Cumming O, Boisson S et al (2013) Interventions to improve water quality and supply, sanitation and hygiene practices, and their effects on the nutrition status of children. Cochrane Database Syst Rev (Online) 8:CD009382
Dewey K, Mayers D (2011) Early child growth: how do nutrition and infection interact? Matern Child Nutr 7(3):129–142
Dorion C, Hunter P, Van den Bergh R, Roure C et al (2012) Does village water supply affect children’s length of stay in a therapeutic feeding program in Niger? Lessons from a Médecins Sans Frontières program. PLoS One 7(12):e50982
Lin A, Arnold B, Afreen S, Goto R et al (2013) Household environmental conditions are associated with enteropathy and impaired growth in rural Bangladesh. Am J Trop Med Hyg 89(1):130–137
Lush L, Walt G, Cleland J, Mayhew S (2001) The role of MCH and family planning services in HIV/STD control: is integration the answer? Afr J Reprod Health 5(3):29–46
Norman G, Pedley S, Takkouche B (2010) Effects of sewerage on diarrhoea and enteric infections: a systematic review and meta-analysis. Lancet Infect Dis 10(8):536–544
Pickering A, Davis J (2012) Freshwater availability and water fetching distance affect child health in sub-Saharan Africa. Environ Sci Technol 46(4):2391–2397
Prendergast A, Kelly P (2012) Review: enteropathies in the developing world: neglected effects on global health. Am J Trop Med 86(5):756–763
Prüss-Üstün A, Corvalán C (2006) Preventing disease through healthy environments: toward an estimate of the environmental burden of disease. World Health Organization. http://www.who.int/quantifying_ehimpacts/publications/preventingdisease.pdf. Accessed 2 Apr 2014
Prüss-Üstün A, Bos R, Gore F, Bartram J (2008) Safer water, better health: costs, benefits and sustainability of interventions to protect and promote health. World Health Organization. http://whqlibdoc.who.int/publications/2008/9789241596435_eng.pdf. Accessed 2 Apr 2014
Ramakrishnan U, Lowe A, Vir S, Kumar S, Mohanraj R et al (2012) Public health interventions, barriers, and opportunities for improving maternal nutrition in India. Food Nutr Bull 33(2 suppl):S71–S92
Walker C, Rudan I, Liu L, Nair H et al (2013) Global burden of childhood pneumonia and diarrhea. Lancet 381:1405–1416
Weiser S, Young S, Cohen C, Kushel M et al (2011) Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDs. Am J Clin Nutr 2011(94 suppl):1729S–1739S
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38_2014_580_MOESM1_ESM.pdf
Supplementary material 1 (PDF 68 kb) Online resource 1: Interview guide that explores actions taken to integrate WASH and nutrition programming, barriers and challenges to integration, and ideal conditions for the integration of those programs
38_2014_580_MOESM2_ESM.pdf
Supplementary material 2 (PDF 135 kb) Online resource 2: Full codebook from analysis of interviews focusing on integration of WASH and nutrition
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Teague, J., Johnston, E.A. & P. Graham, J. Water, sanitation, hygiene, and nutrition: successes, challenges, and implications for integration. Int J Public Health 59, 913–921 (2014). https://doi.org/10.1007/s00038-014-0580-8
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DOI: https://doi.org/10.1007/s00038-014-0580-8