World Water Week 2012

Seminar: “No Food and Nutrition Security without Water, Sanitation and Hygiene (WASH)”

Short film of the Seminar


Thilo Panzerbieter | >>Introduction

Oliver Cumming | >>WASH and Undernutrition

Robert Chambers | >>WASH and Nutrition

Almud Weitz und Juan Costain | >>Conditional Cash Transfer Programs

Robert Chambers | >>Community-Led Total Sanitation

Linus Dagerskog und Moussa Bonzi | >>Productive Sanitation


Oliver Cumming | >>WASH and Undernutrition

Robert Chambers | >>WASH and Nutrition

Almud Weitz und Juan Costain | >>Conditional Cash Transfer Programs

Kamal Kar | Community-Led Total Sanitation

Linus Dagerskog und Moussa Bonzi | >>Productive Sanitation

At the World Water Week in Stockholm, the world’s water experts meet every year to discuss the globe’s water and sanitation issues. The focus this year was the connection between “Water and Food Security”.

The German WASH Network together with the Water and Sanitation Program (WSP) of the World Bank convened a seminar titled “No Food and Nutrition Security without Water, Sanitation and Hygiene (WASH)”.

The seminar examined the widely neglected and underestimated nutritional impact of lack of safe WASH. It made apparent how governments and organisations can make a substantial contribution to food and nutrition security by considering and investing in WASH services.

The introductory presentation by Thilo Panzerbieter (German WASH Network) demonstrated how the seminar is embedded into this year’s conference theme and how WASH is linked to each of the four food security dimensions: (1) availability of food, (2) access to food, (3) use and utilisation of food and (4) the stability of the aforementioned dimensions over time. Although all these four pillars are equally important, the availability of and the access to sufficient food has been emphasised in the past while the third pillar tends to be widely neglected. The seminar therefore focuses particularly on the ability of the human body to efficiently absorb and metabolize the food that is available and how this is linked to WASH.

The presentation by Oliver Cumming (LSHTM) set the scene and reviewed the existing evidence regarding the nexus between WASH and undernutrition. At present around 30% of children in low-income countries under five years of age are chronically undernourished (UNICEF 2008) and an estimated 2.2 million deaths annually can be attributed to undernutrition (Black et al 2008). A significant body of evidence suggests that poor WASH services play a considerable role in undernutrition and stunting particularly among children in three key ways:

  • Repeated bouts of diarrhoea lead to malabsorption of nutrients, as part of the food will be excreted without being metabolised (leaky bucket syndrome).
  • Intestinal nematode infections like Ascaris and hookworm infections, with up to 2-3 billion affected people worldwide, claim nutrients for themselves so they are not available to be taken up by the human body
  • Faecal bacteria ingested in large quantities by young children living in unhygienic conditions can lead to permanent gut damage. This condition is characterised by increased gut permeability and reduced small-intestine surface area, which leads to nutrient malabsorption and consequently to undernutrition and stunting. This phenomenon is known as environmental enteropathy (see also Humphrey 2009)  and is currently being researched in a large study in Zimbabwe.

A review of more than 40 studies for food programmes in Africa found that even the most successful programmes only achieved 33% normalisation and thus only have a limited effect on the nutritional uptake of the affected population. It can be assumed that other environmental aspects like the access to WASH services play a much bigger role than currently recognized. At present there are three large studies under way in India, Bangladesh and Zimbabwe that will assess the effect of WASH, in this case particularly of sanitation, on undernutrition.

Robert Chambers from the Institute of Development Studies (IDS) then stated in his presentation that the link between WASH and nutrition can be seen as a professional blind spot in the current WASH discourse and that the fixation on measurable symptomatic diseases like diarrhoea is only the tip of the iceberg. Other rather asymptomatic faecally transmitted infections like environmental enteropathy and worm infections are hardly getting the necessary attention and there is reason to believe that they have a much bigger impact on the nutritional status and the stunting of children than currently recognized.

Subsequently, approaches for scaling-up WASH like Conditional Cash Transfers (CCT), Community-Led Total Sanitation (CLTS) and Productive Sanitation were presented using regional case studies:

This section started with a presentation by Almud Weitz and Juan Costain (WSP) talking about the efforts to link sanitation to Conditional Cash Transfers (CCT) in Indonesia and Peru. CCTs are an increasingly popular means to reach the most disadvantaged communities and households. Whilst CCTs have been used extensively in health and education, this is new ground for sanitation. More on results-based financing for sanitation can be found here.

Robert Chambers presented Community-Led Total Sanitation (CLTS) and how it is linked to nutrition security on behalf of Kamal Kar, who unfortunately was not able to participate. The original presentation from Kamal Kar can be found here (Präsentation müsste noch verlinkt werden).

The final presentation from Moussa Bonzi (INERA) and Linus Dagerskog (SEI) shared the experiences from a productive sanitation project in Burkina Faso. Whilst other presenters had focused on the risk posed by faecal waste, this presentation highlighted the opportunity. If managed safely, human waste can be used as fertiliser to increase agricultural productivity and can even become a motivating factor for people to strive for and demand sanitation.

In the last half of the seminar Sanjay Wijesekera (UNICEF) tasked the audience to reflect upon and discuss in rotating discussion groups why this link has not been dealt with so far and what needs to be done to address this link at all levels.

The discussion provided constructive impulses for promising ways forward and it became apparent that there is a need for more rigorous research, policy coherence and cooperation between the food/nutrition sector and the WASH sector. The need for a joint branding was articulated in order to better communicate this message to policy makers and the wider public. The participants came up with the following promising suggestion:



Convened by

German WASH Network

Water and Sanitation Programme / World Bank (WSP)


Co-convened by

UNSGAB (UN Secretary General Advisory Board on Water and Sanitation)

GIZ (Deutsche Gesellschaft für Internationale Zusammenarbeit)

BMZ (Federal Ministry for Economic Cooperation & Development)

SEI (Stockholm Environment Institute)

SIANI (Swedish International Agricultural Network Initiative)

RUAF (Resource Centres on Urban Agriculture and Food Security)

SuSanA (Sustainable Sanitation Alliance)

Chair of the Seminar

Sanjay Wijesekera – Chief of WASH, UNICEF


Invited Experts and Presenters

Thilo Panzerbieter Director, German Toilet Organization (GTO) and chair of the German WASH-Netzwerk

Oliver Cumming Policy Manager, SHARE Research Consortium at the London School of Hygiene and Tropical Medicine (LSHTM)

Robert Chambers Scientist, Institute of Development Studies (IDS)

Juan Costain Team Leader South Asia, Water and Sanitation Program/Worldbank (WSP)

Almud Weitz Team Leader East Asia, Water and Sanitation Program/Worldbank (WSP)

Linus Dagerskog Research Fellow, Stockholm Environment Institute (SEI)

Moussa Bonzi Scientist, National Institute of Environmental and Agricultural Research (INERA)

Arno Rosemarin Scientist, Stockholm Environment Institute (SEI)

Rene van Veenhuizen Program Officer, Resource Centres on Urban Agriculture and Food Security (RUAF Foundation)

Arno Coerver WASH-Coordinator Asia, Malteser International

Claudia Wendland Sanitation Expert, Women Engage for a Common Future (WECF)

Funded by

on behalf of