Integrated WASH Response in Twic East County of Jonglei State, South Sudan The overall objective of this project is to provide lifesaving assistance to conflict-affected communities, through the provision of safe water, hygiene and sanitation in support of the prevention and treatment of malnutrition in Twic East, Jonglei State.

Twic East County in Jonglei continues to experience high levels of food insecurity, driving GAM rates well above the WHO Critical Level. According to the IPC analysis, it is expected that 65% (81,000) of the Twic East population will be in IPC Phase 3 (Crisis) or worse 56,000 (45%) will be facing Crisis (IPC Phase 3) and 25,000 (20%) will be experiencing Emergency (IPC Phase 4) levels of food insecurity between January and March 2019 (IPC, September 2018).The pre-harvest survey of May 2018 conducted by Tearfund in Twic East revealed a GAM rate of 24.1% (19.8-28.9, 95% C.I.) and a SAM rate of 4.9% (2.7-8.5, 95% C.I.). According to the WHO categorization of the public health significance of undernutrition, this is a critical level of acute malnutrition.

As such this project will address high rates of food insecurity and malnutrition through WASH interventions by integrating WASH in nutrition response through a famine prevention minimum package and will also provide timely, equitable access to safe water, sanitation and hygiene for IDPs, host communities and returnees, thus contributing to the WASH clusters strategy for 2019.
Tearfund will rehabilitate 30 boreholes in vulnerable communities, with high numbers of IDPs and returnees, to improve access to safe drinking water for IDPs and host communities. The sustainability and community ownership of the intervention will be facilitated through the formation and training of Water Management Committees who will receive resources to enable them to enact the Water Safety Plans that Tearfund will assist them in developing. Institutional latrines will also be constructed in four feeding centres to provide safe, dignified and gender appropriate sanitation facilities for women and girls, and which will also reduce open defecation from children under five, thereby reducing the transmission of feco-oral disease. This will be complemented by the provision of handwashing facilities in all feeding centres and stabilisation centres to ensure that good hygiene practices start in the feeding centre and are replicated in the home. Mothers and caregivers of children under five and pregnant and lactating women will be targeted for hygiene promotion and the awareness raising of good hygiene and sanitation practices. This will be delivered through pre-existing nutrition structures, such as Mother To Mother Support Groups, household visits for nutrition screening and feeding centre sessions, prompting positive behaviour change and reducing the incidence of waterborne and diarrhoeal diseases, primary causes of malnutrition. The most vulnerable, children under five with Severe Acute Malnutrition, will receive WASH NFIs upon discharge from the OTP/SC to ensure that improved hygiene practices can be implemented in the household.

The proposed action will enable Tearfund to provide critical services to the most vulnerable members in Twic East county, including IDPs and host communities, and break the link in the malnutrition-diarrhoea cycle, integrating WASH services into nutrition programming at each level, from the feeding centre to the household, thereby preventing malnutrition.