On a bus ride from Enugu to Abuja three weeks ago, I found myself in conversation with a fellow passenger -- a chatty schoolteacher who had just returned from a nutrition seminar. She spoke endlessly about food insecurity in Nigeria, the importance of a balanced diet, and the need for families to replace junk food with more protein, especially in their children's lunch packs. Nodding along, I asked if Water, Sanitation and Hygiene (WASH) had been discussed in the seminar and with raised eyebrows, she asked, "WASH? What does WASH have to do with nutrition?"
This got me thinking, if someone so invested in nutrition has never considered the link between poor sanitation and malnutrition, how many others are unaware?
WASH plays a vital role in determining how the body processes food. It is not just about what people eat, but also about whether their bodies can absorb the nutrients. When a person drinks contaminated water and lives in an unsanitary environment, they are prone to illness and may experience persistent diarrhoea, which, over time, leads to malnutrition.
Malnutrition in every form presents significant threats to human health. The World Health Organisation (WHO) states that roughly 50% of malnutrition cases are linked to recurrent diarrhoea and intestinal infections due to people's lack of access to sufficient and safe drinking water and poor sanitation facilities.
Nigeria in view
Discussions about malnutrition often begin and end with food, what people eat, how much they consume, and whether they can afford a balanced diet. While these are important, we need to broaden the conversation. Actively talking about water, sanitation facilities, and hygiene practices in communities is just as critical and deserves equal attention.
It has been recorded that over 95 million Nigerians lack basic sanitation, with 48 million practicing open defecation, among which 18 million are children.
In 2024, Borno, Adamawa, and Yobe states experienced a significant nutrition crisis, which was worsened by severe food and economic crises and a lack of access to clean drinking water and sanitation services. The situation is projected to worsen between June and August 2025, and this crisis is unfolding in states where access to safe water and sanitation is already critically low.
The 2025 WASH Sector Humanitarian Needs Overview in northeast Nigeria reveals that 22% and 21% of households in Adamawa and Borno, respectively, rely on unimproved water sources, with 6% of households in Yobe State facing the same issue. The same applies to sanitation, as 30% of households in Adamawa State, 36% in Borno State, and 43% in Yobe State use unimproved sanitation facilities.
Urgent intervention is needed; if not, the double burden of widespread food insecurity coexisting with poor WASH conditions will further worsen what is already a deepening crisis.
The Federal Government of Nigeria, led by the Ministry of Budget and Economic Planning, is currently undertaking a review of the national policy for food and nutrition, originally established in 2016, in a bid to address emerging challenges and enhance the country's approach to nutrition. Some of the efforts of the 2016 policy include the creation of a national nutrition budget line and nutrition department in several ministries, the launching of the National Multisectoral Plan of Action for Food and Nutrition (NMPFAN), amongst others.
Even though the 2016 policy mentioned WASH in relation to nutrition, specific goals and actionable strategies were not established, largely ignoring the role of WASH in implementation. The current review, however, presents an ample opportunity to actively implement WASH interventions into Nigeria's national nutrition framework.
Lessons from Rwanda and strengthening the N-774 Initiative
Rwanda's Gikuriro Programme serves as a good example of a successful intersection of nutrition and WASH.
Gikuriro, which translates to "good growth" in Kinyarwanda, embodies the Catholic Relief Services (CRS) and Netherlands Development Organisation operational approach to improve the nutritional status of women of reproductive age and children aged under 5 years (especially in the first 1000 days of life) in Rwanda.
The programme -- which was launched from 2015 to 2020 to tackle both malnutrition and WASH to enhance health outcomes, recorded improved hygiene and sanitation practices for 570,000 households and increased access to clean water for over 345,000 Rwandans in eight districts.
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A key strength of this intervention is that it was treated as a multisectoral strategy where the government of Rwanda's Community-Based Food and Nutrition Program and Community-Based Environmental Health Promotion Programme (CBEHPP) were delivered as a single intervention that complemented each other.
The Gikuriro project also aimed to improve the nutritional status of women of reproductive age and children under five, focusing on the first 1,000 days, from conception to a child's second birthday.
Nigeria can adopt a similar integrated approach that combines nutrition and WASH interventions to tackle malnutrition more effectively.
Additionally, the N-774 initiative -- a community-centric approach aimed at directly combating malnutrition by delivering tailored nutrition interventions to each of Nigeria's 774 local government areas (LGAs) is another avenue to prioritise WASH. By allocating specific funding for the sole purpose of developing and maintaining WASH infrastructure in communities, WASH interventions are not just "paper policies" but practical solutions that can improve the lives and well-being of millions of Nigerians.
