1. Integration of Water, Sanitation, & Hygiene
Islamic Republic of Afghanistan
Afghanistan Conference on Sanitation
2016
Integration of Water, Sanitation, & Hygiene
(WASH) & Nutrition in Afghanistan: Preliminary
Landscape Analysis Results
Dr. M. Akbar Sabawoon
Integrated Hygiene, Sanitation, and Nutrition (IHSAN) project

2. Initiative for Hygiene, Sanitation & Nutrition (IHSAN)
The IHSAN consortium, led by FHI 360 with five NGOs (AKF, IRC, HADAAF, CHA and SRTRO), will implement & scale up evidence-based nutrition and water, sanitation & hygiene (WASH) interventions to improve nutritional status of women & children <5 years old, focused on the first 1,000 days (beginning of pregnancy - 24 months of age)

3. INTRODUCTION
Afghanistan ranks among 20 countries with highest child<5 stunting prevalence
Recognition of links between under-nutrition, diarrheal illness, & hand hygiene/waste management increasing
These links require multisectoral involvement when crafting policy & programming

4. Nutritional status of children 0-59 months in Afghanistan

5. Micronutrient deficiency prevalence in Afghanistan
Deficiency/ Women of Children ( Adolescent
Condition Reproductive months) girls (10-19
Age ( years)
years)
Anemia % % %
Iron % % Deficiency
Vitamin A % % deficiency
Zinc % % deficiency
Iodine % % deficiency
Vitamin D % %
deficiency

6. Links between WASH & nutrition
There are direct links between sanitation practices and nutritional outcomes like diarrheal diseases resulting from poor hygiene causing micronutrient deficiency.
World Health Organization estimates that up to 50% of childhood under-nutrition is associated with poor WASH practices (Pruss-Ustun et al., 2008)

7. PURPOSE
We conducted a landscape analysis through stakeholder interviews & consultation to describe progress to date on WASH-nutrition integration & potential gaps to guide future endeavors

8. METHODS Data were collected by:
Document review
Meetings with key informants.
Data were mapped & critically reviewed to identify current status & gaps.
Recommendations were drafted based on identified gaps.

9. Findings
Of 24 stakeholders met, nutrition programming has expanded substantially in the last 4 years:
2 large-scale community-based malnutrition management programs (NERS, PD Hearth) in 12 provinces, supplementing acute malnutrition treatment through BPHS facilities.
National-scale in-service nutrition training program (SOP) for BPHS providers. Approximately 11,050 BPHS staff trained in all provinces.
Policy: Nutrition Action Framework, now integrated within the Afghanistan Food Security & Nutrition Agenda, provides strategy & organizational structure for high-level multisectoral coordination.

10. IDENTIFIED GAPS Gaps identified by stakeholders:
Only 40% of BPHS facilities provide >1 nutrition service;
Lack of high-level political support for multisectoral coordination; &
Distribution of nutrition & WASH programming not always in highest-need areas.
Gaps identified in preliminary analysis:
Multisectoral WASH programming does not include nutrition
Lack of community-based programming integrating both WASH & nutrition behavior change communication; &
Relatively reduced reach of multisectoral efforts for WASH at provincial level.

11. RECOMMENDATIONS Greater integration of WASH sectors needed.
Specific recommendations include:
Development & monitoring of community-based WASH-nutrition programming;
High-level political support within relevant line ministries for existing policy initiatives; &
Documentation of lessons learned to develop evidence base for best integration practices.

12. Thank you!