A Cause for Celebration: Global Handwashing Day 2016

By Hanna Woodburn, The Global Public-Private Partnership for Handwashing

Nutrition
Click this image to download the Social Media Toolkit and view other Global Handwashing Day graphics

Every October 15, hundreds of thousands of schools, community groups, organizations, and governments join together to promote handwashing with soap and celebrate Global Handwashing Day. This year is no different. Handwashing with soap is most often promoted by the water, sanitation, and hygiene (WASH) sector, but the impact of good WASH services and practices extend beyond this sector alone. Clean hands are important for achieving benefits in a range of sectors, such as nutrition.

Undernutrition is the underlying cause of 45% of child deaths and contributes to 73% of diarrheal deaths each year. A child might survive being plagued by undernutrition during their first years of life, but the effects will be with them a lifetime as, for 161 million children, undernutrition leads to stunting. Good handwashing practices can help reduce undernutrition by 50% and access to soap can significantly help ward off diarrhea, thereby reducing the likelihood of stunting and its lifelong impacts on brain development. What is more, in one study, the mortality rate among neonates whose birth attendants and mothers had good handwashing practices was approximately 40% lower than those whose birth attendants and mothers had poor handwashing practices.

Integrating WASH with nutrition and early child development (ECD) interventions enables projects to tackle undernutrition in a more comprehensive way. Handwashing can be strategically integrated into various programs; doing so can render the design of activities more efficient and strengthen outcomes. Given the clear links between handwashing and other sectors, Global Handwashing Day presents an opportune time for those who work in the nutrition or early child development sectors to promote integrated interventions.

Global Handwashing Day—October 15—is a global advocacy day dedicated to increasing awareness and understanding about the importance of handwashing with soap as an effective and affordable way to prevent diseases and save lives. The theme for Global Handwashing Day this year is “Make handwashing a habit!”

Habit formation is a new area of focus within behavior change and the WASH sector. This theme emphasizes that handwashing must be practiced regularly to have an impact on health and wellbeing. For organizations working in nutrition or ECD, this theme can be easily modified to highlight the impact of hygiene on integration. For instance, an organization could say, “Make handwashing a habit because it prevents diarrhea!” or “Make handwashing a habit because it improves nutrition!”

The founder of Global Handwashing Day, the Global Public-Private Partnership for Handwashing (PPPHW), encourages organizations that work in the nutrition or early child development to celebrate hygiene this October 15. To learn more about Global Handwashing Day, find resources for celebrations (such as a Planner’s Guide or social media toolkit), and more information about the theme, please visit www.globalhandwashingday.org or contact the PPPHW via email.

 

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Silos should be used for storing grain, not delivering development programs

Originally published on the PPPHW blog.

Pwr-of-integrationBy Hanna Woodburn, The Global Public-Private Partnership for Handwashing (PPPHW)

On June 13, 2016 FHI 360 hosted Greater than the Sum of its Parts, a first-ever FHI 360 summit on integrated development. Over the past two years, FHI 360 has embarked on a journey to dig deep into both the “why” and the “how” of integrated development. At this event, speakers shared what they’ve learned about integration, both what has worked and what challenges remain.

The Global Public-Private Partnership for Handwashing has also started to explore integration through our work with the Clean, Fed & Nurtured community of practice. From my experience with the community of practice, and my own lens of working for a public-private partnership, there were a few key takeaways that emerged.

First, a challenge. Over lunch, I was discussing the definition of integration with my tablemates. For some, it was assumed that integration meant collaborating around implementing a project with a different sector. For instance, this could entail sharing family planning messages at childhood vaccination appointments. Others felt that integration could be much broader and include working with a range of actors, such as governments partnering with non-profits. I remarked that this reminded me of vertical and horizontal supply chain integration in the private sector. Integration, whether vertical or horizontal, seeks to maximize value and harness synergies, but in practice it is realized differently. Likewise, integrated development is a spectrum and actualized in a myriad of ways and contexts. Clarifying our language around integration will help ensure greater success in knowledge sharing and practice going forward.

Second, as Tricia Petruney with FHI 360 said, history shows that integration from the top-down simply has not worked. To be certain, integration champions at all levels of leadership are essential to fostering an integration-friendly environment, but, as Curtis Palmer, country director for PACT Nepal said, “People know better than I do what their real needs are.” The “meat” of integration should come from the local level. It should be driven by conversations with stakeholders about what they actually need and want.

This opportunity, to harness local knowledge and commitment, was reiterated in the comments made by Robert Mwadime from Uganda. In his storytelling session, he commented that integration requires fine-tuning, which means that failure, in some form, is inevitable. Through ongoing learning, flexibility, and leadership, the Community Connector project he runs was able to identify and reach excluded constituencies. Just like integration isn’t a “one-size-fits-all” approach, it also isn’t a “one and done” approach. Projects must be able to both measure their success as well as correct the course as needed.

The evidence shows that integration makes sense. There are a multitude of opportunities for integration; still there are also challenges which much be addressed. Not only does integration yield returns in efficiencies, but the new Sustainable Development Goals demand integration. It is only through common sense, cross-sectoral collaboration that we can hope to achieve these aspirational targets. People don’t live lives in silos, and our solutions should reflect that reality.

 

 

Heading West—an Expression of Multi-Dimensionalism within the CORE Group

By Renuka Bery, USAID WASHplus Project, and Nora Zenczak, ChildFund International

Change is in the air. It’s been many years since CORE Group has held its twice-annual meeting on the west coast—that is until this year’s Spring Practitioners Conference, which was held in Portland, and attracted new vigor and potential members into its fold. Additionally, the meeting provided an opportunity to introduce CORE’s new Executive Director, Lisa Hilmi. Lisa has worked in over a dozen countries and joins CORE most recently from MedStar Franklin Square Medical Center in Baltimore where she was both a clinical and research nurse.

The 2016 Spring Practitioners Conference theme, Achieving Health for All Through Multi-Dimensional Approaches, was both provocative and timely, as many organizations are exploring sectoral integration in their approaches and programming. Multi-dimensionalism was woven throughout the entire conference as participants grappled with how to recognize and address the extent to which health influences other aspects of development. The core hypothesis is that working at different levels and with a range of stakeholders to achieve more comprehensive change will lead to improved and sustained individual health and well-being within the global context and evolving landscape.

Shawn Baker, director of nutrition for the Bill and Melinda Gates Foundation, gave the keynote address that outlined the ways in which the Foundation is broadening nutrition efforts across dimensions within its structure and in its grant making. Participants noted that Shawn might be the most quoted keynote in CORE’s history! Later, Tim Frankenburger from Tango International discussed the components of resilience and the need to track changes in resilience over time because shocks and stressors can quickly change the landscape. Communities recovering from sequential shocks can lose resilience and households with higher self-efficacy were less likely to engage in negative coping strategies. This can lead to a vicious cycle where downstream effects impact people’s ability to protect themselves and thereby reduce resilience.

Circuit table discussions were particularly rich—this year there was an offering of 19 topics and a series of small group discussions of 20 minutes. Each table group brought out different dimensions of integrated health programming and sought to encourage thoughtful reflection to make the conversation different and meaningful.

As usual, CORE offered a wide variety of concurrent sessions with a large dose of participatory engagement. One of our favorites was Integrated Childhood Development: The Whole-Child Perspective—organized and facilitated by Clean, Fed & Nurtured—that featured Dr. Lia Fernald from the University of California-Berkeley School of Public Health, who infected the room with her enthusiasm in sharing new and fascinating findings on multi-sector early childhood development (ECD). An interesting take-away was her finding in one study that while integration was not detrimental, it did not improve results either. Participants engaged with Dr. Fernald and with practitioners in water, sanitation, and hygiene (WASH), ECD, and nutrition to dig deep into the “who, what, how, and why” of undertaking quality programming for young children. The working group meetings were efficient, productive, and focused on work planning and activities to undertake between now, the CORE Fall meeting, and beyond.

It is fun to see some of the same, familiar faces at the CORE meeting engaging in interesting work, but also connecting with new enthusiasts eager to learn and bring new ideas to old problems. Portland brought a new energy and laid back undercurrent to the meeting—a nice change from the intensity of Washington, D.C.

“What Gets Measured, Gets Done: Identifying Integrated Indicators that Count”

By Bijan D. Manavizadeh

Imagine a two-year old child is sitting on a three-legged stool. If one or two legs are stronger than the other, the stool would not be stable and the child would be at risk of harm. Yet, if the stool has been properly constructed, with resources to ensure all three legs are strong and secure, then the stool would be durable and the child would be at a reduced risk of harm. The same principle is applicable to key factors of growth and development in early childhood—such as water, sanitation, and hygiene (WASH), nutrition, and early childhood development (ECD).

This metaphor was the crux of the Clean, Fed & Nurtured (CF&N) side session at the George Washington University Global Health Mini-University on March 4. Presentations by CF&N members Merri Weinger (USAID), Monica Woldt (FANTA III), and Julia Rosenbaum (USAID WASHplus) outlined the “why” and the “how” of developing and measuring indicators for integrated global health programs to better promote essential multi-sector collaboration of WASH, nutrition, and ECD.

In the first part of the session, the speakers shared evidence supporting the link between the three sectors of WASH, nutrition, and ECD and promoted cross-sectoral collaboration. In the second part, they addressed integral questions, such as:  Which indicators need to be defined? How do we evaluate them? What kind of research is needed to develop more appropriate indicators for successful integration?

As a program officer for the Global Public-Private Partnership for Handwashing, I know the implications that WASH interventions can have on health and development, but I did not know the full extent to which poor WASH practices can inhibit nutrition and ECD. This what I learned and what needs to be done.

What we do know? The first 1,000 days of life—from conception to age two—is the most critical period of cognitive and motor function development in a person’s life. Evidence shows that WASH interventions can prevent diarrhea, which if left untreated can lead to undernutrition and poor physical and cognitive growth. Frequent bouts of diarrhea tend to lead to a reduced appetite and poor absorption of nutrients from the food children do consume. This leads to a vicious cycle. Undernourished children are more susceptible to contracting parasites, viruses, and bacteria that lead to diarrhea. This cycle of diarrhea and undernutrition leads to stunting, which can have lifelong implications as it prevents children from reaching their full potential, both physically and mentally. In the long term, this can lead to negative outcomes in school, in professional settings, and in society.

Cycle

Why cross-sectoral collaboration? Growing evidence indicates that through integration we can harness synergies. Multifaceted problems need multifaceted solutions. Integration provides the opportunity for streamlining messages and greater efficiency in program delivery. However, there are challenges. Funding, staff motivation and workload, coordination among agencies and organizations are some of the many hurdles that must be overcome. Another hurdle is the lack of common indicators, which inhibit the measurement of program effectiveness.

Why focus on integrated indicators? Properly defined indicators for integration mean that we can learn which interventions worked and which failed to meet expectations. Each of the three sectors represented in CF&N have their own indicators with varying degrees of strength. Indicators that correspond with integrated programs will allow us to better know if our hypothesis—that integrating WASH, nutrition, and ECD will have a greater impact—is correct. We know that indicators developed and utilized must be SMART: specific, measurable, achievable, reliable, and time bound. But, we also know that there is more work to be done. The evidence base for three-way integration is growing, and the development of indicators is a crucial step as we move forward.

How do we move forward? During the second segment of the session at the Mini-University, the audience engaged in a discussion of what is needed to move forward by sharing ideas on ways to identify and develop indicators for integration, as well as methods for overcoming gaps and challenges of delivering integrated interventions.

Increased advocacy with donors is needed, integration must be incorporated at the service delivery level to not overburden families, and a broader range of partners, stakeholders, and implementers must be brought into the conversation. Simply put, more dialogue and a greater emphasis on developing frameworks with indicators that function along a continuum are both needed.

Robust, comprehensive, measurable, and integrated indicators will generate more evidence that will allow us to better hone our work. Ultimately, as the WASH, nutrition, and ECD sectors further collaborate and forge stronger bonds, a broad set of health, nutrition, and child development indicators will be essential to demonstrating impact. Certainly, the challenge is great, but we believe that through our joint efforts we can make a greater impact than we could alone.

 Find a list of proposed CF&N indicators here. To view the presentation for “What Gets Measured, Gets Done,” please click here.

Taking Action and Marching for Improved WASH and Nutrition this Month

Originally published on the Global Public-Private Partnership for Handwashing’s Website

The beginning of March here in Washington, DC is oftentimes accompanied by signs of an impending springtime. Slowly the days get a little bit longer and the cold winter winds begin to subside. For many, as trees and plants begin to bloom, springtime brings to mind new life. The first few days of spring are tenuous, and the same is true for the first months of a baby’s life. It is, thus, fitting that March kicks off two advocacy campaigns—Water Action Month and #March4Nutrition—that address significant issues of child survival.

Image from MCSPglobal

While to the casual observer, these two campaigns might seem very different, they in fact are incredibly intertwined. Water, sanitation, and hygiene (WASH) interventions are critical allies in the fight against undernutrition, particularly in the first 1,000 days of life. This is because undernutrition is not only caused by a lack of food, but also the body’s inability to absorb nutrients from food.

Undernutrition and diarrhea form a vicious cycle, where children with diarrhea both eat less and are less able to absorb essential nutrients. Likewise, undernourished children are more susceptible to diarrheal diseases. WASH interventions can significantly reduce the risk of diarrheal disease; handwashing with soap alone can do so by up to 50%.  As such, improved access to WASH can help interrupt this cycle.

Undernutrition is the underlying cause of 45% of child deaths each year, but its impact is also much broader with lasting consequences for growth and development.1 Undernutrition manifests itself through reduced growth rate—or stunting—in early childhood. And, while the physical effects of stunting (reduced stature) are most visible, the negative repercussions that stunting can have on the cognitive development of children are lasting. Ultimately, undernutrition can have life-long consequences.

This is why we must continue to explore collaboration across the WASH and nutrition sectors. Evidence continues to emerge indicating that WASH and nutrition integration makes good sense. In Ethiopia, for instance, one study found that WASH interventions reduced the prevalence of stunting by 12 percent.2

Given the positive synergies between sectors, we are working to drive forward thinking around integration. To this end, we are proud to partner with colleagues from both the nutrition and early childhood development sectors in the Clean, Fed & Nurtured community of practice. This month we will celebrate Water Action Month and #March4Nutrition by sharing information and resources around WASH and nutrition integration with weekly facts on Twitter and blog updates with links to some of our favorite WASH and nutrition publications.

An estimated 860,000 deaths per year due to undernutrition can be prevented through WASH. So, please join us this month. Follow #WaterActionMonth and #March4Nutrition online and learn more about these key public health interventions.

 

  1. Black R et al. 2013. Maternal and Child Undernutrition and Overweight in Low-Income and Middle-Income Countries. The Lancet. 382 (9890): 427–451.
  2. Fenn, B., et al. (2012). An evaluation of an operations research project to reduce childhood stunting in a food-insecure area in Ethiopia. Public Health Nutrition.17, 1-9.

Rationale for a new community of practice exploring how we can help babies be Clean, Fed & Nurtured

By Hanna Woodburn

Originally published June 14, 2013 on the Gates Foundation Impatient Optimists blog.

In early May a gBangladesh woman and child GM (2)roup of experts gathered in a Washington, D.C. conference room. Such meetings are commonplace in this town, particularly within the international development community. But this meeting was different, not because it connected luminaries and experts, but because they represented three different sectors—water, sanitation, and hygiene (WASH); nutrition, including infant and young child feeding (IYCF); and early childhood development (ECD). Representatives of these sectors came together to explore ways to work toward a common goal: ensuring that babies around the world are Clean, Fed & Nurtured.

The participants largely determined the course of the meeting, organizing working groups on topics that most interested them. Before parting ways, delegates from academia, funding organizations, international NGOs, and the private/commercial sector made personal commitments for actions to kickstart integration of the three sectors within their spheres of influence.

The science is becoming clearer: for children to reach their full human potential both physically (including to prevent stunting) and cognitively, improving food intake alone is not enough. An estimated 165 million children under 5 years of age have significantly impaired physical growth and are unable to reach their full potential. Increasingly, we see that to tackle stunting at scale, we must work together.

Recently, governments, donors, and private sector organizations made a significant commitment to reaching the benchmarks established in the Global Nutrition for Growth Compact. To achieve these objectives, it will be essential that intersecting disciplines are no longer placed in separate silos. Certainly progress has been made in this regard.

As The Lancet asserted in the June 2013 series on maternal and child nutrition, integration among complementary program interventions—including WASH, nutrition, and ECD—has the potential to increase efficiency and enhance benefits. We could not agree more.

While adequate nutrition in the first two years is critical to prevent stunting, research also points to the important role of ECD, including early childhood stimulation, to support brain development and to strengthen the impact of nutrition interventions. And increasingly, evidence links WASH interventions to improved child growth.

The experts have previously worked on two-way integration. WASH + nutrition sectors have lately shown a lot of collaboration. Likewise, ECD + nutrition researchers are putting the finishing touches on a special issue of Annals of New York Academy of Sciences on integrated interventions in nutrition and child development (watch for this issue by end of 2013). But rarely do programs or studies put a focus on all three sectors.

How might this new focus on the Clean, Fed & Nurtured baby shift the ways we promote child growth and child development? Participants’ commitments were concrete. Members of one NGO, who represented all three sectors, pledged to work together to choose at least one country where they can “collectively put our heads together to influence programs.” A leader in WASH pledged to encourage that sector to add the indicator for child stunting (height for age) into the WASH evaluation plans. The author of an internationally sanctioned guide for child health, nutrition, and child care announced that there is still time to build in guidance on WASH – under-represented in earlier versions – and asked meeting participants for contributions. A small group stepped up to define a set of “essential hygiene actions,” offering programmers an add-on to the existing “essential nutrition actions.” Participants offered to make immediate modifications to build integration into programs they are designing, conference themes they are developing, or studies they are about to launch.

The Clean, Fed & Nurtured consultative meeting demonstrated nascent steps toward these integrated objectives, but we cannot go it alone.

Practitioners, keep an eye out for opportunities for integration. Prepare programs to train, equip, and evaluate frontline field agents in each of these areas.

Researchers, help us fill the gaps in the evidence. What indicators should an integrated program include? How can frontline workers and families integrate multiple household practices to promote child growth and development?

Finally, join in these evolving conversations by inquiring, sharing successes, and disseminating pertinent research. Right now, the primary vehicle for doing so is a new Clean, Fed & Nurtured LinkedIn Group, which we hope you will contribute to. We can also be found on Twitter, @thrivingbaby, and ask you to begin using #CleanFedNurtured.

Promote the idea, promote the brand, promote the practice!

At the May 2013 Clean, Fed & Nurtured meeting, we made small, accessible commitments to build upon. How can you do the same?

Co-sponsors of Clean, Fed & Nurtured Consultative Meeting: Alive & ThriveFHI 360, the Global Public-Private Partnership for HandwashingSave the ChildrenUSAID and WASHplus.