WASH in Health & Communities Eastern Equatoria has a population of little over 1 million people and 50% of them are in need (HNO 2021). The state shares a border with Uganda and Kenya, and because of cross border movements, there is an increased risk of spread of infectious diseases (as seen in the past with Ebola and COVID-19 (C-19)), and more stress is put on the limited existing services. This is exacerbated with the (expected) return of refugees and IDPs who previously sought refuge in the neighbouring countries and other states in South Sudan. During 2020, some 120,000 people returned to Eastern Equatoria and another 60,000 people were displaced. Additionally, insecurity and flooding are as well affecting access to basic services and markets. Most of the state is in severity level 3 or higher with 42% of the population in IPC3 or worse (severely and acute food insecure) (IPC report November 2020).  
Magwi County has a population of 258,400, consisting of Acholi and Madi ethnic tribes, largely practicing subsistence farming and raising cattle’s, goats and sheep. Most of the crops are produced and consumed locally and some of the crops are sold. The county is located within South Sudan’s greenbelt region, making it a key area of food production for the country’s food supply. Its proximity to the major trade routes in South Sudan has historically allowed farmers to sell their crops in major markets such as Juba and Torit, however, growing insecurity across Magwi County since 2016, as well as ambushes and banditry along main roads, have contributed to food insecurity. This is evidenced by the increase in IPC classification from Stressed (IPC Phase 2) levels in 2016 to Crisis (IPC Phase 3) levels in 2021 (IPC report November 2020). According to the HNO 2021, some 50-100K people are in need; continued conflict as well as lack of livelihood opportunities and access to land continue to cause displacement in Magwi.
Despite the signing of the peace agreement in 2018 and the official end of the civil war, the security situation in South Sudan remains tense. With the formation of a unified government, the former warring parties have agreed on a common strategy and the first important steps toward rebuilding the state have been initiated. Even though most of the former conflict parties are involved in this process, violent attacks and clashes between different armed forces and individuals ("unknown gunmen," bandits, rebels, splinter groups) continue to occur locally. The causes of the attacks and local fighting are complex, with unemployment and a lack of prospects among the youth and ethnic conflicts contributing to the conflict. This ongoing conflict, as well as the lack of livelihood opportunities and access to land, continues to lead to displacement in Magwi. There are currently an estimated 9,000 internally displaced persons (IDPs) and 6,000 (returned) refugees living in communities in the project region. As part of the target communities, they benefit from the project's measures just as much as the longer-established residents.  In order to meet the needs of the different stakeholders and to prevent possible conflicts, all stakeholders (including the local population, internally displaced persons and refugees) are involved in the project initiation. At project initiation, the most vulnerable HHs are identified to directly benefit from the proposed interventions. For this purpose, a so-called Beneficiary Selection Committee (BSC) is organized involving all community groups, project staff, County Agriculture Department staff, Relief and Rehabilitation Commission representatives, key decision makers (Chiefs), and women and youth representatives. The Relief and Rehabilitation Commission is the local security authority that, among other things, monitors the IDP situation and coordinates care or (re)integration of IDPs. The committee jointly sets the conditions for beneficiary selection and carries out mobilization, identification and registration of project beneficiaries. Community leaders* are encouraged to involve the community to protect women and other people with special needs. Their concerns and needs are included in the support provided. Community involvement is expected in all activities, e.g., women are involved in site selection for well repair to ensure that the selected sites are nearby, safe to access, and safe for children to access. Community feedback will be sought through additional focus group discussions and one-on-one meetings and will be considered during implementation.
Nutrition: The feasibility study confirmed the levels of food insecurity of the targeted communities, with 38.7% of the households (HHs) facing poor or borderline Food Consumption Scores: having inadequate access to food or being able to meet minimum food needs while at the same time depleting livelihood assets. Although 81% indicated to have a kitchen garden, and 64% of the people indicated that agriculture and the sale of crops was their main source of food income, still 90% of the respondents indicated that they experienced food shortages. This was confirmed with 41% of the HH consuming only 1 meal a day; the kitchen gardens don’t provide sufficiently for the HH let alone for selling at the market. Last year’s crop yields were low, caused by crop pests and diseases (58%), heavy weed infestation (30%), as well as limited rainfall (23%), and a lack of knowledge on improved farming techniques (67%).  
Next to food insecure, the study shows that people are also livelihood insecure: 82% indicated to have lost employment/ reduced salary, amongst others due to the C-19 pandemic. FGDs showed that any opportunity to provide for their families is used, including small livelihood opportunities like fishing, hunting and brewing alcohol. Despite this, 71% of the HHs indicated to have applied negative livelihood coping mechanisms over the last 7 days (selling of productive assets, general reduction of all expenses and harvesting immature crops). Coping mechanisms also include early marriage and child labour, causing serious protection issues. The negative coping mechanisms applied are likely to have longer-term negative or irreversible effects on overall livelihood and food security of the households. The local implementing partner is aware of the vulnerability of children and youth and has a clear child protection policy that prevents any kind of child labor and thinks about the protection of children in the project at all levels. The use of child labor in Cordaid South Sudan programs or Cordaid South Sudan funded programs is strictly prohibited and all staff* are expected/required to support this code.

Another important factor in food and nutrition insecurity is the weak institutional structures in South Sudan that have little financial, technical, and human capacity to make structural progress. In the area of food and nutrition security, one of the key players is the County Agricultural Department (CAD). The CAD is a government department responsible for the agricultural sector at the county level. The main role of CAD is to coordinate all agricultural activities with the State Ministry of Agriculture (MoA) and to support partners in the delivery of agricultural services. It is headed by the CAD director, a technical person appointed by the MoA, with four assistant directors, each responsible for the livestock, forestry, fisheries, and arable subsectors. The CAD Director also appoints an Agriculture Extension Worker (AEW) in each payam (district) who is responsible for agricultural activities and coordination with the CAD at the district level. Most CAD staff/AEWs have little expertise in modern agricultural practices and technologies. 
The county departments are subordinate to the respective ministries, but currently do not receive any direct financial support from the government for training, equipment, transport costs, etc. The various departments are often supported by NGOs. Often, the different departments are supported by NGOs and the UN to create and strengthen important capacities. Without this external support, the County Departments are hardly functional. The support of the County Departments by different partners is coordinated through arrangements (Cluster Meetings, NGO Forum) and based on needs identified e.g. in studies. In the past, and especially during the war, many of the local actors relied on external support to remain functional. Despite limited support, local authorities have been extremely committed and motivated and have been instrumental in the sustainability of projects in the past. Their commitment and supervision is often critical to the continuation of activities even after funding has ended. The capacity of local authorities thus plays a decisive role in the sustainability of local water, health and food supply. Local authorities also have a special role to play in the peace process and in strengthening local structures. In addition, trends can be observed that the support of local authorities by the national government tends to increase. 
The County Agriculture Department or County Agricultural Extension Worker indicated in the interviews that it needs support in providing agricultural training to communities to improve crop yield and diversity, food intake and food security, and increase livelihood opportunities. In 2020, approximately 4,000 farmer received training on various agricultural techniques. However, the feasibility study shows a clear need, and the households interviewed reported not having received any training to date. Also, no other actor in the project region currently conducts agricultural training.
WASH: Communities also have WASH concerns: although most respondents (93%) indicated to have a water source, 60% indicated to have challenges with access to water. Challenges include the distance to the water source with around half of the respondents mentioning that they need to walk more than 30 min. This is also confirmed by REACH (WASH assessment Feb 2021), showing that 56% of the people in Magwi require more than 30 min to access water. Nearly a quarter mentioned that the water doesn't look good and 22% said that the water smells badly. The latter 2 challenges imply that water is obtained from an unsafe source. With very few people treating the water, this is a major public health risk and the distance to the source is a protection risk, especially for women and girls as they are often tasked to fetch water. People also indicated that they have sufficient water for drinking and cooking only. This may imply low hygiene practises which is affecting women/Pregnant and Lactating Women (PLW), children under 5 (CU5), girls, elderly and ill people disproportionately. It was as well indicated that many water sources have broken down or are contaminated due to practices such as defecating and bathing directly in the water streams. Some 70% of HHs report members affected by a water or vector-borne disease, and lack of access to water has led to tension and conflict between communities over competition of already scarce resources. 
Although 73% of the respondents indicated to have access to a latrine, 60% is sharing a latrine. People therefore are likely to practise open defecation. This is confirmed by REACH (WASH assessment Feb 2021) indicating that in 60-80% of the communities less than half of the people make use of the latrine. There also exists some harmful gender practices and social norms in Magwi, for example the belief that women cannot use the latrines as they should not get their faeces mixed with that of men as it brings bad omen, resulting in open defecation. Furthermore, according to the HNO, Magwi is in severity scale catastrophic regarding mine action, which is increasing risks for women and children in particular when practising open defecation.
Access to water should be improved by rehabilitating broken down boreholes, while at the same time increasing awareness raising on good hygiene practices to reduce diseases. As hygiene practises are low, involving the communities from the beginning of the project, working through existing social structures, like BOMA health workers and WASH management structures, will support a more sustainable outcome of the project, which was also indicated by the communities.

Health: The health system in South Sudan is only partially functional. Of the estimated 2,300 health facilities nationwide, about 1,300 are not functional. In principle, all public health facilities are under the responsibility of the Ministry of Health. However, a large number of the functioning facilities are underfunded and poorly staffed and equipped. A majority of the health facilities in South Sudan are supported by international donors such as UNICEF, Health Pooled Funded (HPF) and IMA World Health. 
In the project region, the running and staffing costs of health facilities are subsidized through an ongoing HPF program implemented by a consortium of Cordaid South Sudan and Health Link South Sudan. The program aims to sustain health services in the region, promote health services in communities, improve supply management and efficient use of funds in health facilities, and enable health services to be provided at a discounted rate. According to the HNO 2021, Magwi is in severity scale ‘extreme'. At health facility level, Magwi County has 22 functioning Health Facilities (HF) (98% of the respondents indicated to have a HF available), however health care services are poor with poor and/or inadequate infrastructures for safe delivery of services: the respondents indicated lack of materials (39%), lack of sufficient staff (16%) and long waiting lines (12%) as main barriers to health care. Due to the C-19 pandemic access to basic WASH supplies at HFs has increased over the last year, however, there is a constant lack of essential WASH supplies like soap and PPEs, and health care waste management systems are not fully functioning: some HFs do not have appropriate incinerators or incinerators in bad shape, while others need a placenta pit. 
Water is available in the HFs, but 20% of the assessed HFs have non-functional water sources and in only 20% of the assessed HFs there is piped water available. Most of the water sources are a well or borehole, and water shortages are faced. Water is not treated in 80% of the HFs, and with low hygiene practises and no proper water handling, risk of (waterborne) diseases is increasing. 

90% of the HFs have latrines, but the number of latrines is not sufficient, 40% has gender sensitive/improved latrines, only 1 HF has disability inclusive latrines, and in 1 HF there is no latrine at all. Improving WASH services at HF level will improve the quality of care provided, with regards to IPC, patient safety and in particular child and maternal health, as well as improve inclusiveness and reduce protection issues. 

Poor access to clean water, hygiene and sanitation services at HF and community level, combined with high levels of food and nutrition insecurity, compromises people’s health and nutrition conditions, and it is disproportionately affecting the most vulnerable people such as PLW, CU5 and IDPs, and contributes as well to high level of child mortality. Insufficient access to food, poor health services, the lack of safe water and sanitation, and inadequate child and maternal care are underlying causes of food and nutrition insecurity. - 35,000 people from 8 communities in Magwi, Eastern Equatoria State make use of adequate WASH services in the communities and at Health Facilities and adequate livelihood opportunities At the start of the project, the most vulnerable HHs will be identified who will benefit directly from the proposed intervention, this is organised through the establishment of beneficiary selection committees (BSC) in which all groups of the community are represented. The BSC shall be comprised off Cordaid staff, CAD staff, RRC staff, Chiefs, women and youth representatives; the committee shall set up the terms and conditions for beneficiary selection, and they will conduct the mobilization, identification and registration of project beneficiaries. Community leaders will be encouraged to involve the community to protect women and other people with specific needs (PSN). Their concerns and needs will be included in the assistance. Community involvement will be anticipated in the various activities, for example women will be involved in site selection for repairing wells to ensure that selected sites are nearby and can be reached safely and are safe for children, and feedback from the community is requested through FGDs, KIIs and one-on-one interviews.