“Synergy between WASH and nutrition” – It’s complicated

Sounds like a status message in Facebook. But that should pretty much sum up the relationship between WASH strategies and nutrition outcomes. Obviously, when there is unsafe water, pitiable and inadequate sanitation conditions with woeful hygiene practices, it will inadvertently lead to public health implications. This is especially critical, when we talk about the imminent health hazards, in overtly crowded and densely populated spaces filled with undernourished urban poor population with low economic background.

The reason and outcome of poverty itself are mutually exclusive for undernourishment in the urban poor populations. In addition to that, undernourished people with poor health are obviously more prone and vulnerable to WASH related infections, such as fecally transmitted infections including but not limited to diarrhea, environmental enteropathy, nematode infections and other intestinal infections.


There is an active, nasty cycle of WASH related infections and undernutrition. For instance, an under nourished person who is recently infected by diarrhea due to poor WASH practices, will have lower stamina and strength left in his/her body, as their capacity to absorb nutrients will have reduced on their way to recovery. So in the context of the urban poor, the nutrients absorption rate or the capacity of the undernourished person to take advantage of the nutrient / calories intake is significantly reduced. With poor immunity, under nutrition and lack of access to good healthcare, they will be more susceptible to subsequent infections, and the cycle continues, adding to their cup of woes.

The impact of poor sanitation practices and the resulting diarrheal infections, on under nourished children is much worse. It has been proven to cause growth stunting (low height-for-age), wasting (low weight-for-height), and underweight (low weight-for-age), and even child deaths. The micronutrients deficiency (in terms of Vitamin A, B12, Riboflavin, Folic acid, Iron and Zinc) that is evident among children and also women, exacerbates their vulnerability to WASH related infections. I don’t want to sound like an emissary of Doomsday. But the other associated fallouts that dampen the functioning of the system besides malnutrition, stunting in children, premature deaths, are wasted time and loss of productivity.

So in order to achieve a universal and sustainable outcome, it is imperative that we start to think on the lines of linking and establishing synergies between WASH plans and policies with nutrition strategies. We need to work towards demonstrating and bringing in WASH interventions by coalescing with nutrition programmes.

The key priorities would be to reduce the high malnutrition rate, to address the micronutrient deficiency, improve quality, coverage and access to water, sanitation and hygiene services and practice, adopting nutrition sensitive sanitation and holistic WASH related interventions, to improve the overall health of the populations and well, the betterment of humanity. Pretty lofty and ambitious one might say. Easier said than done, right! But in this so called post-truth and self-awareness era, as the popular saying goes, to making it count, if we do our bit to instill a systematic progressive change in our midst then we just might make a positive difference in the world.

References used:

http://riceinstitute.org/wordpress/wp-content/uploads/downloads/2013/04/rice-sanitation-stunting-brief.pdf (accessed on Mar 28, 2017)

http://thousanddays.org/wp-content/uploads/The-Impact-of-Poor-Sanitation-on-Nutrition-1.pdf (accessed on Mar 28, 2017)

https://www.unicef.org/media/files/IntegratingWASHandNut_WHO_UNICEF_USAID_Nov2015.pdf (accessed on Mar 28, 2017)

Suneethi Sundar
Specialist, TNUSSP

Will building toilets end Open Defecation?

Will building toilets solve the problem of Open Defecation? – Fecelore – Stories on Sanitation

Sanitation is the name given to the process, facilities and services employed towards the safe disposal of human waste – which includes feces and urine. Human waste unless properly disposed of, is not just really gross but also tends to be a major cause for several water-borne diseases like cholera, diarrhoea, gastro-enteritis and typhoid. According to the World Health Organisation, improving sanitation can have a hugely significant beneficial impact on the health of individuals and families.

Inadequate sanitation also has serious economic implications. The health impact of poor sanitation results in pronounced economic losses which come from direct medical costs of treating sanitation-related illnesses, and indirect costs due to reduced or lost productivity as a result of ill health. Infact, inadequate sanitation is said to have caused India considerable economic losses, equivalent to 6.4 per cent of India’s GDP in 2006, or Rs.2.4 Lakh Crore.

According to the UN report card, close to 946 million people in the world have little or no access to sanitation and continue to practise open defecation. According to 2011 census, 53.1% (63.6% in 2001) of the households in India do not have a toilet, with the percentage being as high as 69.3% (78.1% in 2001) in rural areas and 18.6% (26.3% in 2001) in urban areas. However, providing toilets alone cannot solve the problem of unsafe sanitation.

Addressing the sanitation problem is not just about eliminating open defecation by providing toilets, but also of ensuring safe disposal of the fecal waste without it being exfiltrated into the environment. Attention should be paid to the social and behavioral aspect of the community while formulating solutions for access to safe sanitation.


Looking beyond toilets

Will building toilets solve the problem of Open Defecation? – Fecelore – Stories on Sanitation

A close look at the ground realities will show us where the problem actually lies. For instance, it has been observed that toilets are being provided by the government and ULBs to end open defecation, but access to toilets continues to be a problem. A casual walk around any city or town would show us people urinating in public spaces because they do not have access to toilets. Providing toilets at random locations has not helped in solving the problem of open defecation or urination.

A news article in the Indian Express titled ‘It’s No Joke – State of the World’s Toilets’ by Water Aid said: “If all 774 million people in India waiting for household toilets were made to stand in a line, the queue would stretch from Earth to the moon and beyond. However, in places where toilets do exist, scant attention has been paid to the needs of women, children and people with disability. Access to clean and working toilet is a key to preventing open defecation, and beginning the journey towards safe sanitation.

Providing user-friendly and clean toilets in parks, bus stations, markets, petrol pumps, small restaurants and places of tourist interests should be made mandatory. If we continue providing toilets without looking into their access, maintenance and usability, it is unlikely that we will witness a real change as far as open defecation and open urination is concerned. Toilets with no water or unsafe toilets are only structures which will play little or no role in the long journey towards safe sanitation.

sancy photo