Championing partnerships for nutrition

Undernutrition is an important and sensitive marker for poverty. It is caused by a variety of factors, with inadequate and unbalanced food intake being one. The vicious cycle of undernutrition and water, sanitation and hygiene (WASH) practice is well documented.  Studies have found remarkable reduction in undernutrition when the WASH situation improves. This is particularly true for stunting, which is an indicator of chronic undernutrition. The mechanism is rather straight-forward - better WASH condition reduces transmission of infections and intestinal parasites leading to better nutrition. Diarrhoea, a water-borne disease caused by poor WASH, alone is responsible for up to half of undernutrition in low income settings. Over 9 per cent of the global disease burden and 6.3 per cent of all deaths are associated with poor WASH conditions. World-wide, 844 million people do not have access to clean water and 4.5 billion people lack access to safely managed sanitation. The world made remarkable progress in recent decades with global income poverty reducing to just above 10 per cent. However, this has not been translated well in improving undernutrition. Still, 23 per cent or a staggering 155 million children are stunted world-wide. We almost know for certain that the affected individuals are the same - those whom we don't want to leave behind in the Sustainable Development Goals (SDGs).

Bangladesh has made impressive gains in many of its development indicators. However, more than a third of our children are still stunted. This is in spite of the food security that the country has largely been able to ensure for its population. The battle against undernutrition cannot be won unless and until we are able to ensure a balanced diet and clean water, safe sanitation and proper hygiene for all.

The SDG that the world has signed up for is a transformative agenda. Bangladesh's commitment to this agenda is reflected by a number of important steps that the government and the civil society have undertaken. The national plans including the 7th five-year plan have been aligned with the Agenda-2030. Mapping of the role of different ministries/departments in SDG implementation was done. A coordination mechanism with a senior secretary at the helm has been set up at the highest level. Other actions that have been taken include a data gap exercise and a financial needs assessment. The civil society, on the other hand, is not sitting idle. Their initiatives include, among others, the creation of a Citizens Platform for Implementation of SDGs in Bangladesh which has already undertaken several activities including organizing a citizens' conference on SDGs in November next.

The SDGs are closely interlinked and the level of their success will largely depend on how well the coordination mechanism works. Goal 2 of the SDG is on nutrition. Its success will require a good understanding of its links with other goals, and, fortunately, a good amount of discourse on this is already being seen. Because of its close connection, as mentioned earlier, a sustainable improvement in undernutrition is only possible when we simultaneously impact on the WASH situation, represented by Goal 6 in the SDGs. Bangladesh has done well in both water and sanitation but a lot need to be done on personal hygiene. Even among the richer sections, for example, only about 35 per cent of children's caregivers practise appropriate handwashing behaviour.

In practice, WASH and nutrition programmes work in isolation without much coordination between them. It is obvious that much headway can be made if critical WASH-sensitive elements are integrated into nutrition interventions and vice versa. For example, the nutrition workers in addition to their routine activities could motivate people on appropriate WASH practices at no or marginal extra costs. Similarly, the WASH programmes could co-locate their interventions in areas more vulnerable to undernutrition.

Fortunately, the development community is increasingly realising the potentials of leveraging WASH for nutrition and vice versa. At the World Water Week in Stockholm last August, two global initiatives promoting the SDGs 2 and 6, viz, the Scaling Up Nutrition (SUN) Movement and Sanitation and Water for ALL (SWA) respectively, joined hands by organizing jointly a workshop titled "SDG-synergies: Countries link WASH and nutrition to reduce malnutrition". With the privilege of being the only person who serves on the Lead Groups of both the initiatives, I was asked to open the discussions. Early experiences of integrating the two sectors were presented for four countries - Chad, India, Madagascar and Nepal which showed the promise of integrating/connecting the two sectors.

Two reports on how the two sectors can benefit from each other with specific recommendations were launched in the Stockholm meeting. The title of the current article is borrowed from one of the reports ("2+6=17: Linking WASH and nutrition -a blueprint for living SDG17", published by the German WASH Network), which makes the case that connecting actions on Goals 2 and 6 also advances global partnership for sustainable development (Goal 17).Forging effective collaboration at country-level policy planning and implementation may be formidable but, I am sure, is not impossible, for we all want to reach the SDGs and see that no one is left behind. With more awareness and a change of mindsets amongst stakeholders, this transformation can happen and it is already happening in some countries. We just need to scale it. There is hardly any choice as, by doing this, there is so much to gain for every woman, man and child everywhere.

The writer is Vice Chair of BRAC and member of the global Lead Groups for Scaling Up Nutrition (SUN) Movement and Sanitation & Water for All initiatives.

[email protected]