Exploring Program Integration of WASH in the First 1,000 DaysConcept map for WASH integration in the...
Transcript of Exploring Program Integration of WASH in the First 1,000 DaysConcept map for WASH integration in the...
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