Exploring Program

Integration of WASH in the

First 1,000 Days CRS Integrated Nutrition Conference

14-15 September 2015, Nairobi

John Collett, World Vision

Outline

The study

Why focus on the first 1,000 days?

Evidence for integrating WASH

Integration examples, barriers and opportunities

Concept map for WASH integration in the first 1,000 days

WASH integration study in East Africa

Overall Purpose: Exploratory research on existing good practices and opportunities for integration within ongoing WASH, MNCH, Nutrition, and ECD programs

Objectives:

– Identifying “portals of entry”

– Mapping current WASH best practices

– Implementation challenges, opportunities and gaps

– Drafting BabyWASH Concept, M&E Framework and Theory of Change

Methods:

– Regional and national data analysis

– Literature review

– Key informant interviews

– Field visits

Why focus on the first 1,000 days

Health and well-being of mother and child from conception to two years old

Preventing maternal and child deaths

Young children getting the best start in life for developing to reach their full productive potential

It’s not only about mothers and young children – it involves fathers, grandmothers, siblings and other

caregivers too!

Pre-conception Conception 1st Tri 2nd Tri 3rd Tri BIRTH 1 week 1 month 6 months 1 year 18

months 2 years

Beyond 1,000 days

Abortion 9.6%

Indirect: Pre-existing medical conditions 12.8%

Indirect: HIV-related causes 6.4%

Indirect: Other causes 9.3%

Embolism 2.1%

Hypertension 16%

Hemorrhage 24.5%

Sepsis 10.3%

Complications, obstructed labor, and other 9%

Causes of maternal and child mortality

Preterm complications

15.4%

Sepsis 6.7%

Intrapartum complications

10.5%

Other neonatal

causes 11.4%

Pneumonia 13%

Diarrhea 9%

Malaria 7%

Injury 5%

Measles, AIDS, meningitis, pertussis 8%

Other 15%

Maternal mortality Sub-Saharan Africa, 2003-2012

Child mortality Global, 2013

Why focus on the first 1,000 days

30%

45%

55%

70%

Why focus on the first 1,000 days

Hotspots of vulnerability - maternal mortality and morbidity

T1 T1 T1 T2 T2 T2 T3 T3 T3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

11-17% of maternal deaths occur during birth

50-70% of maternal deaths occur in the first two days postpartum

Mother’s security

Mother’s health & nutrition

Mother’s psycho-social well-being

BIRTH

A n t e n a t a l c a r e P o s t n a t a l c a r e

Low birth weight infants have increased risk of early growth retardation, infectious disease, developmental delay & death during infancy & childhood

Why focus on the first 1,000 days?

Hotspots of vulnerability - child mortality in the first 1,000 days

About 40% of the 8 million U5 deaths occur during the first 28 days: preterm complications 14%, intrapartum complications 10%, sepsis 6%, other 10%

Child safety

Child health & nutrition

Child physical & cognitive

development

Child psycho-social well-being

BIRTH

About 30% of U5 deaths attributable to 3 infectious diseases: pneumonia 13%, diarrhea 10%, malaria 7% - mostly in first 2-3 years

Rotavirus diarrhea – neonates & young infants

Over one third of all U5 deaths are linked to malnutrition

Babies born in a WASH-safe setting are three times more likely to survive than babies born in an unsafe setting.

Initiation of breastfeeding in first hour has multiple benefits for both mother & child

T1 T1 T1 T2 T2 T2 T3 T3 T3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Why focus on the first 1,000 days?

Hotspots of vulnerability – child morbidity in the first year

1 2 3 4 5 6 7 8 9 10 11 12

6 - 12 months, baby is on the move: scooting, crawling, exploring & sitting. PREVENT INGESTION OF DIRT & FECES. DOMESTIC HYGIENE. HAND HYGIENE. DIARRHEA CASE MANAGEMENT. CLEAN & SAFE PLAY SPACE

Introduction of complementary feeding & drinking to baby that’s been exclusively breastfed for first 6 months. ENSURE FOOD AND DRINK HYGIENE

Child safety

Child health & nutrition

Child physical & cognitive

development

Child psycho-social well-being

9 -12 months, infant starts pulling up to stand & cruising around by hanging on. Begin feeding themselves. CLEAN & SAFE EATING PLACE.

Baby begins grabbing & gripping objects in their hands. PREVENT INGESTION OF DIRT & FECES. DOMESTIC HYGIENE. HAND HYGIENE

Toddler takes first steps. ENSURE SAFETY

E x c l u s i v e b r e a s t f e e d i n g

Baby begins finger sucking & placing things in their mouth. PREVENT INGESTION OF DIRT & FECES. DOMESTIC HYGIENE. HAND HYGIENE

4 – 6 months, baby is reaching & rolling. ENSURE SAFETY

1 : 1 i n t e r a c t i v e p l a y f r o m 1 m o n t h o n w a r d s

I m m u n i z a t i o n

C H I L D F E C E S M A N A G E M E N T

Evidence for integrating WASH

WASH and Maternal, Newborn and Child Health

Distance and difficulty to water source: 200 million hours per day

spent by women in Sub-Saharan Africa. Inadequate weight gain during

pregnancy, weaker recovery post-birth, overall increased risk of diarrheal

disease, intestinal worms, and anemia.

WASH-safe birth place: babies born in a WASH-safe setting are three

times more likely to survive than babies born in an unsafe setting

Household sanitation and hygiene – including hand washing and

child feces management: environmental enteropathy, diarrheal

disease, intestinal worms, anemia, and acute respiratory infection

WASH is a key component for the prevention and control of five

neglected tropical diseases

Evidence for integrating WASH

WASH, Nutrition and Early Childhood Development: Environmental Enteropathy

Chronic fecal-oral contamination

Chronically inflamed small intestine

Reduced nutrient absorption

Permanent damage to the microbiome by the age of 3 years

Reduced capacity for healthy growth

Impaired brain development

Nutrition alone is not enough to fully address

malnutrition and child development

Main findings of the study

Current areas of integration

Timed and Targeted Counseling (multi-country)

Positive Deviance/Hearth (multi-country)

Village-Based Child Nutrition Centers (Rwanda)

Integrated Learning Site (Kenya)

Aligned with government policies and vision

Flexible implementation structures

x No targeted WASH interventions for first 1,000 days, except hand washing

x ECD poorly represented

Integrated Learning Site: Cross functional team

Resilience & livelihoods

Health

WASH

Sponsorship

Integrators

From silos and

lack of

coordination

Cross functional roles,

collaboration, results oriented

Example of successful WASH integration

Main findings of the study

Barriers to integration

Organizational structure

Limited integration at strategy level

Siloed sectors

Focus on sector-specific objectives

Knowledge gaps

Donors

Staff

Beneficiaries

Concept map for WASH integration in first 1,000 days

Thank you!