This story first appeared on the WHO website here and has been reblogged.
Two years ago, Hamidou Samakan, chief of the village of Yarou Plateau in Mali, noticed significant changes in the neighbouring village of Gouna. The village was clean and there were no faeces to be seen. People were building affordable latrines, sweeping common areas, and chlorinating their drinking water.
Back in Hamidou’s village, people were still defecating in the open. Few households had latrines, and diarrhoea and under-nutrition were common.
Gouna was participating in a community-led total sanitation activity, aimed at stopping open defecation. The WASHplus project, funded by the United States Agency for International Development (USAID) and led by FHI 360 and in partnership with CARE and Winrock International, is working with communities in Mali to improve water, sanitation and hygiene (WASH) and reduce diarrhoel diseases and under-nutrition.
It turned out that the community-led total sanitation approach, designed to trigger feelings of shame and disgust, was working beyond the village of Gouna.
“Having seen what was happening in our neighbour’s community, we decided to improve the sanitation condition in our village,” says Hamidou.
In nearly a year, Yarou Plateau has built more than 60 latrines and rehabilitated ones that had never been used.
The role of WASH in nutrition
Despite progress in recent years, defecating in the open is still a common practice in Mali. More than 1.5 million Malians – or 10% of the population – defecate in the open, which means that diseases like diarrhoea and intestinal worms can spread quickly.
“When people were defecating in the open in many of these villages, flies were taking the diseases from the faeces onto the food they were eating,” says Sahada Traore, WASHplus project leader at CARE International Mali.
Faecal matter was also contaminating villagers’ hands, water jugs and homes.
While inadequate dietary intake and disease, including diarrhoea, are the primary causes of under-nutrition, lack of access to safe drinking water and sanitation, along with the absence of good hygiene practices are some of the key underlying causes of under-nutrition globally and especially in Mali.
When children have diarrhoea, they eat less and are less able to absorb and use nutrients from their food. In turn, under-nutrition makes them more susceptible to diarrhoea and the cycle repeats.
Improving nutrition outcomes
To help combat this issue, WHO, in collaboration with USAID and UNICEF, are calling for nutrition and water, sanitation and hygiene (WASH) programmes to work together to maximize nutrition gains and meet important global targets.
A new report, “Improving nutrition outcomes with better water, sanitation and hygiene: practical solutions for policies and programmes”, recommends high-impact WASH interventions, such as improving access to latrines, be integrated into nutrition programmes around the world.
“Both WASH and nutrition are the basis for primary prevention. We now have the evidence and emerging examples of successful integrated approaches that improve people’s health,” says Dr Maria Neira, Director of WHO’s Department of Public Health, Environmental and Social Determinants of Health.
Additional WASH and nutrition interventions recommended include increasing water supply, handwashing with soap, ensuring safe household water management through treatment and storage, screening children for under-nutrition, exclusive breastfeeding and diversifying children’s diets with local products.
One village at a time
In Mali, community members in 180 villages, supported by USAID’s WASHplus, have built their own latrines – more than 9000 in 2 years. Each village identified the best ways to reduce open defecation and received guidance to construct the right latrines for their environment.
To date, 128 of these villages have been certified free of open defecation, meaning every household in the village has access to a covered latrine to reduce flies, and soap and water for handwashing.
“There is no more open defecation in these villages, and we’re starting to see a reduction in cases of diarrhoeal diseases as well as undernourished children,” says Traore.
Beyond building latrines, behaviours have also changed. People are now using latrines, washing their hands, and treating and safely storing their drinking water.
Prior to implementing the WASHplus project, experts in WASH and nutrition in Mali worked separately. The water programmes built water points often next to fields where people defecated, and nutrition programmes focused on teaching breastfeeding and preparing nutrient-rich foods.
“No one was connecting the dots when it came to open defecation,” Traore explains. “The water supply people did not talk to the nutrition people when they were designing and implementing programmes, and thus we weren’t seeing any reduction in diarrhoea or under-nutrition.”
But this is now in the past, he says. “We work together more now and we’re seeing less under-nutrition because, alongside the delivery of key nutrition interventions, people are drinking safe water, using latrines and washing their hands.”