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WASH Poverty Diagnostic

Incentivizing collaboration to address childhood stunting

Craig Kullmann's picture

Childhood stunting is one of the most significant impediments to human development and economic growth, affecting approximately 155 million children under the age of five globally, with long-term consequences later in life such as impaired cognitive development, chronic disease, and lower earnings as adults. Evidence shows that there is an urgent need for collaboration between actions in water, sanitation, health, nutrition, and other sectors to effectively combat childhood stunting.
 

 
This was discussed during the recent World Bank-IMF Annual Meetings, where leaders from the World Bank and client countries met to talk about Changing Behaviors to Incentivize Collaboration to Address Childhood Stunting. Aimed to provide guidance on how to collaborate better across sectors and institutions, this event provided an opportunity to share the latest results from the global Water Supply, Sanitation, and Hygiene (WASH) Poverty Diagnostic Initiative, led by the World Bank’s Water and Poverty Global Practices in collaboration with the Health, Nutrition, and Population and Governance Global Practices.

When nutrition meets WASH: reflections from Ethiopia and Madagascar on fighting stunting

Claire Chase's picture

Co-author: Sophie Durrans, Research Uptake Officer at London School of Hygiene & Tropical Medicine

A child who is stunted early in life – who fails to grow as tall as expected for their age – often has reduced physical and mental development. Water supply, sanitation, and hygiene (WASH) influences a child's growth in multiple ways. Evidence across low and middle-income countries demonstrates that higher open defecation rates are associated with stunting and higher overall incidence of poverty.

Water and sanitation deprivation: What is next for Tajikistan?

Emcet O. Tas's picture
Also available in: Русский

Two years ago, I visited a village in Rudaki, a hilly district located to the south of Dushanbe, Tajikistan. It lies about forty kilometres from the capital, but it feels like a thousand kilometres away. On our drive up a hill, we saw women carrying buckets of water from a nearby spring. Moving further up, we saw children bathing and animals drinking from the same river. Once in the village, it was clear that life is largely shaped by water scarcity—the backyards were filled with pots and buckets, fuel and stoves for boiling water, and pit latrines that were no longer used because of lack of water. Although we could spot remnants of a once-functional water supply network, people living there had not had access to piped water for at least two decades. Without it, they were only able to practice the most basic forms of sanitation and hygiene. 
A community in Rudaki district, Tajikistan.
Photo credit: World Bank team.



The conditions we witnessed in Rudaki were harsh, but not rare. Located on the western tip of the Himalayas, Tajikistan is a country blessed with large fresh water resources in its lakes, rivers, and glaciers. Yet, access to safe drinking water and sanitation connected to a functioning sewer system is lacking, particularly for rural residents and the poor. Much of the existing infrastructure was built during the Soviet era and has not been upgraded for decades. Tajikistan is one of the few countries outside Africa that did not meet the Millennium Development Goal on drinking water and basic sanitation. Because poor water and sanitation conditions, together with poor nutrition and care, are key determinants of childhood stunting, Tajikistan’s childhood stunting rates remain high. Recent estimates indicate that in Tajikistan more than one in five children under the age of five are stunted and will not reach their full potential as adults.
 
In a new report, Glass Half Full: Poverty Diagnostic of Water Supply, Sanitation and Hygiene (WASH) Conditions in Tajikistan, we document the realities of Tajikistan’s WASH-deprived population. Our analysis builds on one of the largest data collection efforts of its kind – including national surveys of households and schools, water quality tests, ethnographic work, and case studies of existing WASH projects. It also includes poverty mapping and analysis of other secondary data, including a UNICEF nutrition survey that shared a subsample with our WASH survey.

Gender and sex inequalities in water, sanitation, and hygiene

Libbet Loughnan's picture

This blogpost is part of a series of thematic blogs for the World Bank's Water Supply, Sanitation, and Hygiene (WASH) Poverty Diagnostic.

Woman carries water containers near polluted stream and water pipe in Maputo, Mozambique

Addressing gender and sex inequalities in WASH is not only recognized in Sustainable Development Goals (SDGs) 4 and 6, it is central to the entire ambition of the SDGs themselves. Some water, sanitation, and hygiene issues are faced only by women because of their biological sex, whereas others are more influenced by gendered societal norms. To truly leave no one behind, we need to be mindful of and work against gender and sex inequalities in all development work. 
 
New World Bank research is a valuable contribution to doing just that.  ‘Reducing Inequalities in Water Supply, Sanitation, and Hygiene in the Era of the Sustainable Development Goals’ reveals that a drastic change is required in the way countries manage resources and provide key services, starting with better targeting to ensure they reach those most in need.  In many cases, this means women and girls. 

The biggest bang for our limited water and sanitation buck: can investing in small towns lead the way?

Aroha Bahuguna's picture



While the share of poor people in Sub-Saharan Africa decreased from 56 percent in 1990 to 43 percent in 2012, the region’s rapid population growth outpaced the decrease in poverty, resulting in higher number of poor people than before. More specifically, Africa’s urban population is expected to triple in size in the next half century, which is putting pressure on scarce resources in cities, exacerbated by capacity, budget and governance bottlenecks. The densely-populated areas with low levels of water and sanitation services pose a serious threat to public health – cholera epidemics have broken out in urban areas in several African countries in recent years.

Starting life strong in slums: the role of engaging vulnerable groups on sanitation and nutrition

Claire Chase's picture
This blog is co-authored with Lawrence Haddad, Executive Director, The Global Alliance for Improved Nutrition (GAIN)

Other co-authors: 
Beatrice Montesi, GAIN  
Martin P. Gambrill, The World Bank 
Rebecca Jean Gilsdorf, The World Bank

 
Children in a slum in Dhaka, Bangladesh.
Credit: UN Photo/Kibae Park

Crowded slums, poor sanitation and unhealthy diets.  It’s a potent cocktail and for too many families across the world, a daily reality.  Right now, an estimated one billion people live in slums and that number is expected to double by 2030. Slums are where the many deprivations facing the urban poor collide, including lack of access to clean drinking water, sanitation, safe and nutritious foods, sufficient living space, durable housing and secure tenure (UN Habitat).  They’re where human waste is routinely emptied into streets, canals, and garbage dumps. And where overcrowding and low rates of immunization and breastfeeding combine to exacerbate the already perilous problems children face.

Children growing up in these surroundings are at a higher risk of death and disease and are more likely to be chronically malnourished (Ezeh et al. 2017). For example, forthcoming World Bank research from Bangladesh shows that children living in slums are 50 percent more likely to be stunted than children living in other urban areas. This doesn’t just have implications for today - children who are stunted early in life go on to learn and earn less, and face a higher risk of chronic disease as they grow older. Tragically, these effects are often passed on to offspring, trapping families in poverty and malnutrition for generations, as per findings in a forthcoming World Bank report called Uncharted Waters.

Starting a marathon with a broken ankle: how poor water and sanitation sets children behind

Maximilian Leo Hirn's picture
Children in Koutoukalé, Niger

Have you ever wondered how your life chances are affected by where you were born? Odds of being born at all are already miraculously small, but only one in ten of us is born into the relative security of a high-income country. What if you are born in Niger or in the Democratic Republic of the Congo (DRC)? Before you could even walk or talk, your challenges would be daunting. That's because, despite progress, deaths of children under five years old are more than twenty times higher than in the EU and nearly ten times higher than in China.

Even if you survived, you would confront another major risk to your development: malnutrition. In Niger and DRC, almost one out of every two children is stunted. Stunting has significant and long-lasting negative effects on early childhood development, impeding physiological and mental development, and making small children more vulnerable to disease. Starting off in life stunted is akin to starting a marathon with a broken ankle.

The numbers are in: Water is key to poverty reduction and health

Guangzhe CHEN's picture
Celebrating World Water Day with the World Bank

Today, on World Water Day, we are humbled by the fact that over 663 million people on the planet still live without access to safe drinking water; 2.4 billion people lack access to basic sanitation services, such as toilets or latrines. With these challenges persisting around the world despite decades of hard work in the water and santiation sectors, are we at a point where we need to take a step back from current solutions and practices and do business differently?
 
The new Water Supply, Sanitation, and Hygiene Poverty Diagnostic (WASH PD) initiative suggests exactly that.
 
New findings from the WASH PD initiative (led by the World Bank Water Global Practice in collaboration with Poverty, Governance, and Health, Nutrition, and Population) for the first time advances our understanding in a systematic manner of the relationship between poverty and WASH at the country level. Our deep analysis of 18 countries—across six regions—provides us with new evidence of realities that must be acknowledged, and shows without a doubt that we must work together across sectors if we are to find solutions with sustained impacts on the ground.

How we help countries track and report on the Sustainable Development Goals on water, sanitation and hygiene

Ana María Oviedo's picture
Enumerators in Ecuador collecting water sample
for water quality test.
Credit: World Bank team in Ecuador

Over the last few years, the international community has been busy establishing new indicators for the Sustainable Development Goals (SDGs), which officially replaced the Millennium Development Goals (MDGs) for the period 2015-2030. SDG #6: Ensure access to water and sanitation for all, seeks to reduce the incidence of malnutrition, communicable diseases, and inequities that are directly related to lack of access to improved sources of drinking water (affecting 663 million people worldwide) and sanitation (which 2.4 billion people still lack). This new goal implies a commitment by countries to monitor and report on their progress, similarly to what was done for the MDGs, but with much more detail.
 
From MDGs to SDGs: What’s New for Water and Sanitation?
 
Under the Millennium Development Goals (MDGs), countries were requested to report the coverage of water and sanitation, distinguishing between “improved” and “unimproved” coverage. The WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP), established specific indicators for each, using definitions that could be captured with information from standard household surveys, which typically rely on self-reported questions on access to services collected from a nationally representative sample of households.