International Journal of Public Health

, Volume 59, Issue 6, pp 913–921

Water, sanitation, hygiene, and nutrition: successes, challenges, and implications for integration

Original Article

DOI: 10.1007/s00038-014-0580-8

Cite this article as:
Teague, J., Johnston, E.A. & P. Graham, J. Int J Public Health (2014) 59: 913. doi:10.1007/s00038-014-0580-8



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.


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.


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.


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.


WASH Nutrition Integration Program 

Supplementary material

38_2014_580_MOESM1_ESM.pdf (67 kb)
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 (134 kb)
Supplementary material 2 (PDF 135 kb) Online resource 2: Full codebook from analysis of interviews focusing on integration of WASH and nutrition

Copyright information

© Swiss School of Public Health 2014

Authors and Affiliations

  • Jordan Teague
    • 1
    • 2
  • E. Anna Johnston
    • 1
  • Jay P. Graham
    • 1
  1. 1.George Washington University Milken Institute School of Public HealthWashington DCUSA
  2. 2.WASH AdvocatesWashington DCUSA

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