WaterAid

Agency profile

Name: WaterAid

Address: WaterAid, 47-49 Durham Street, London, SE11 5JD, UK

Email: healthystart@wateraid.org

Website: www.wateraid.org/uk

Year founded: 1981

Chief executive: Barbara Frost

No. HQ staff: 289

No. staff worldwide: 1151

ENN interviewed Dan Jones and Megan Wilson-Jones from WaterAid for the Field Exchange agency profile slot. Megan is the Policy Analyst for health and hygiene in the global policy team, while Dan (no relation) is Advocacy Coordinator for Healthy Start, WaterAid’s current global advocacy priority to improve child health and nutrition by integrating water, sanitation and hygiene into health policies and programmes worldwide. Both used to work for RESULTS UK (which advocates for building the public and political will to end poverty) and, since they are relatively new to the organisation, checked in with some longer-serving colleagues to answer some of our questions. The answers were very interesting.

WaterAid was set up in 1981 by the UK water industry following a Thirsty Third World conference, which was prompted by the industry’s desire to respond to the UN Decade on Water. The UK water industry raised £25,000 and WaterAid was born, starting with projects in Zambia and Sri Lanka. Fast forward to 2016 and WaterAid has just celebrated its 35th anniversary. Its growth has been truly phenomenal: in the six years from 2009 to 2015, it provided 9.6 million people with clean water and a further 13 million with sanitation facilities. It also expanded its country programmes in that time from 22 to 37, including countries in Asia, Africa and the Americas. This year, WaterAid India became the first country programme to become a member of the WaterAid International Federation. The secretariat for the Federation is based in the UK and all members (Australia, Canada, India, Japan, Sweden, United Kingdom and United States of America) are involved in advocacy and fund-raising in respective countries.

Dan explained that WaterAid’s general operational model is to work with local partners to target the most marginalised communities. It is best known for its ‘taps and toilets’ programmes; a reflection of its founding by a group of water engineers. Over the years, the organisation has evolved into using a ‘transformation and sustainability advocacy-based model’, working closely with national governments, who are encouraged to take ownership of scaling up and delivering sustainable water, sanitation and hygiene (WASH) services for the whole population. This new strategy is much more about advocacy and exercising influence; WaterAid still supports on-the-ground programmes, but increasingly uses them to demonstrate what can be done to local, district and national decision-makers in order to provide evidence and support the government in scaling up and ‘owning’ the provision of national services. WaterAid also invests in work to enable citizens to claim their rights. As it looks to influence governments on how much and how they spend on WASH, it supports them in budget planning and tracking. It also looks at international institutions and donor agencies and how WASH needs to be integrated into health, nutrition and education, because WASH underpins many of the Sustainable Development Goals – as Megan puts it simply: “They all need WASH for success”. The ultimate aim is national-led plans that donors coordinate and harmonise funding streams behind; an ambition that explains WaterAid’s engagement with mechanisms such as the Sanitation and Water for All global partnership (SWA)¹; similar to the SUN Movement in the WASH world.

Megan explained that nutrition is a relatively new area of interest for WaterAid, as part of its expanding work on health. The growing evidence of links between WASH and nutrition, as well as critical work on environmental enteric dysfunction (EED), has helped promote greater focus on nutrition within the organisation. The World Health Organisation (WHO) estimates that half of all undernutrition is linked to infections caused by unsafe water, lack of sanitation and poor hygiene. Most member countries now have health advisors that cover nutrition, and country programmes are increasingly employing health and nutrition staff. Megan mentioned two recent WaterAid nutrition-sensitive WASH programmes. One is in Bangladesh, where the WASH programme has an element specifically to improve access to water for food production. The second, in Nepal, is collaboration with the Ministry of Health and builds hygiene and nutrition behaviour-change into the routine immunisation of rotavirus. WaterAid has just developed internal guidance material on how to improve the nutrition-sensitivity of WASH programmes.

Dan explained that the organisation still sees itself very much as a development agency with a focus on long-term sustainable programming, although emergencies do occur where they operate in fragile contexts. For example, in Nepal recently, WaterAid found itself working as part of the WASH cluster, contributing hygiene expertise to programming. The organisation has also been involved in the Ebola crisis in West Africa, as well as engaging in policy dialogues on anti-microbial resistance. Megan described how these experiences reinforced the vital importance and major gaps in provision of clean water, sanitation and good hygiene in hospitals and health clinics. (WHO estimates that, for example, 38% of healthcare facilities in low and middle-income countries lack access to clean water, making preventing and controlling infections impossible).

WaterAid is increasingly collaborating with the SUN Movement at global and national levels. The SUN Movement Secretariat has contributed greatly to WASH policy development at national level, with country staff becoming members of the national Civil Society Alliance. WaterAid has also recently become part of the new BabyWASH coalition, working closely with World Vision (lead) and others. This coalition is bringing together actors from Early Childhood Development, Nutrition, Health and WASH, and was launched at this year’s UN General Assembly.

WaterAid believes that multi-sector programming is essential to ending malnutrition. However, its recent Missing Ingredients report (summarised in this edition of Field Exchange), which analysed national nutrition action plans, found that apart from Timor Leste and Nepal, very few countries are comprehensively embedding and integrating WASH into these plans. Furthermore, very few WASH plans make reference to nutrition. Megan reflected that designing WASH programmes through a nutrition or health lens can lead to better quality programmes; for example by targeting programmes based on nutrition vulnerability. With regard to behaviour change, there is a real opportunity to come together and combine efforts – taking breastfeeding and food hygiene as examples, both involve changing behaviours, which is challenging. However, through utilising multiple delivery channels and delivering joint messaging, especially if one reinforces the other, this could lead to more effective and sustained behaviour change.

WaterAid is not a research-organisation and does not engage in randomised controlled trials, however it is well placed to contribute to the learning and evidence around delivering coordinated and integrated programmes, often described as operational research. Although the nutrition focus of its work has so far been on stunting (where there is the strongest evidence of a link between WASH and nutrition), it is likely that, given the increasing evidence of overlapping pathways for wasting and stunting, the attention of WASH actors like WaterAid may start to include a focus on wasting.

Our last question concerned the major challenges for scaling up nutrition-sensitive WASH programming. Dan reflected that, in order for WASH services to lead to nutrition outcomes,  the services must be utilised, and changing behaviours is very challenging. It requires understanding the specific context (knowing what motivates behaviours and what the barriers are), which is informed through rigorous, formative research. The typical time-frame of WASH programmes can also be problematic, as they are often too short to report nutrition impact unless followed for a number of years. Finally, stakeholders need to stop thinking in silos. Dan suggested that this occurs on multiple levels – programme silos, sector silos, divided ministerial responsibility in governments, and even silos within donors (humanitarian and development). This, he argues, needs to change.

WaterAid is a large and highly respected WASH agency that is starting to look at how policy and programming can best support nutrition. ENN greatly looks forward to including WaterAid learning in this relatively new area in future issues of Field Exchange.