Healthy Village Summary
Max Foundation and Plan International developed an innovative five-year (2020 – 2025) integrated
Water, Sanitation and Hygiene (WASH), food and nutrition security programme. The ‘Healthy Village 
Programme’ aims to reduce stunting and water- and faecal-borne diseases in a sustainable manner and
works with the Government of Ethiopia. 
The Programme is focused on reaching approximately 400,000 people living in poverty, (pregnant and 
lactating) women, children with a focus on under two, and adolescents as parents of tomorrow who do 
not have sufficient access to clean water and sanitation, are food insecure and/or have poor nutritional 
status. 
Through learning, evidence and engagement with Government, the Healthy Village Programme
 supports ongoing and emerging programmes, e.g. large-scale government programmes. While we aim for national impact, field implementation will be in four selected woredas of Government of Ethiopia’s Seqota Declaration programme Despite progress, malnutrition remains a major cause of illness and mortality among children under five in Ethiopia. Ethiopia’s national stunting rate has been steadily decreasing over the years and is currently at 37%. Stunting cannot be “treated” and should therefore be prevented continuously throughout the most critical period of human development - the first 1,000 days from conception to a child’s second birthday. During this period, adequate nutrition is essential for healthy physical growth and brain development.

Undernutrition can already begin in utero with an undernourished mother who cannot provide her child with sufficient nutrients at the foetal stage. Underweight or stunted women are likely to give birth to underweight or stunted children. Growth faltering in this period will have irreversible consequences (i.e., developmental deficits) for this child later in life. Stunting is an intergenerational problem.

Meaningful and adequate nutrition and WASH integration requires a good understanding of the complex causes and determinants of undernutrition. The focus of the sector is shifting from the immediate determinants (e.g. dietary intake) to the underlying causes (e.g. poor WASH, gender inequality) of undernutrition. We assume that by taking into account the WASH and nutrition nexus our long term objective can be achieved: Reduced stunting and incidence of water- and faecal-borne diseases in Ethiopia among children under two years of age. 

Our vision is that every village in Ethiopia becomes a Healthy Village – enabled via national mainstreaming of the Healthy Village Programme with the Ethiopian government.

The Programme consists of three strategies: 
1.	Healthy Village Implementation: Stimulating demand creation at community level, and gender-transformative behaviour change for better WASH and improved food security and nutrition for child health. 
2.	Evidence and Learning: Gathering and sharing evidence of integrated WASH & nutrition initiatives such as the Healthy Village approach and farmer technologies to enable replication and scale-up and contribute to the growing body of knowledge on the impact and efficacy of WASH & nutrition initiatives. 
3.	Engagement: Supporting the Government of Ethiopia to reduce stunting and reach WASH and food & nutrition targets laid out in relevant policies and approaches by engaging with government institutions and structures at national, regional, district and local levels. Max and Plan joined forces to develop this Programme concept for Ethiopia, based on learnings from the Healthy Village approach which Max created in Bangladesh and Plan’s in-country integrated WASH and FNS approach. Specifically for food- and nutrition security, Wageningen Environmental Research (WENR) will be involved as technical partner. 

We aim to break sector silos of food and nutrition security and WASH to tackle stunting and improve under two child health from more than one angle. We believe it will lead to better results. While many speak about integrated programmes, there are still few practical examples. As an innovative, potentially scalable ‘speedboat’ programme we emphasize evidence and learning and engagement as well as Healthy Village field implementation, aiming for adoption and mainstreaming of our approach’s best practices in ‘tanker’ programmes undertaken by large institutions such as, principally, the Government of Ethiopia (GoE), but also UNICEF and others. Towards this, the Healthy Village Programme is characterised by a strong ‘Evidence & Learning’ and ‘Engagement’ approach, whereby information on what works (evidence) will be actively shared with (engagement) the GoE and other major stakeholders. The Healthy Village Programme aims to reach approximately 327,492 beneficiaries living in poverty, (pregnant and lactating) women, children with a focus on under two, and adolescents as parents of tomorrow who do not have sufficient access to clean water and sanitation, are food insecure and/or have poor nutritional status. 1. Food and Nutrition Security: By promoting (the production of) nutritious food, dietary diversity and improving food storage, the availability and intake of (micronutrient-rich) nutritious food at household and community level will improve. We will include ‘Essential Nutrition Actions’ (ENA) such as improving (breast)feeding and caring practices, food hygiene, homestead, greenhouse and school gardening, entrepreneurs selling nutrition products, and nutrition-sensitive agriculture. Child Growth Monitoring is a key tool in the Healthy Village Programme, providing data to monitor Programme impact on stunting reduction and triggering parents. 

2. Hygiene and sanitation: By promoting improved sanitation and hygiene behaviour at community and household level, investments in and proper use of WASH infrastructure will increase. Our approach builds on Community Led Total Sanitation, includes Baby WASH and goes beyond Open Defecation Free to improved sanitation and hygiene. Decreasing water and faecal-oral (both human and animal) contamination will contribute to an improved nutritional status. 

3. Water and Multiple Use Systems (MUS): The focus is on water in service of food security. By promoting Multiple Use Systems, the availability of safe water for drinking, domestic needs (personal hygiene) and (small scale) agricultural production, including rearing livestock, will increase. The provision of water close to home will reduce time for fetching water. By addressing the local water value chain, through reusing, recycling and retaining of water (e.g. grey water), water from source to tap and beyond will be valued. 

4. Entrepreneurship and Access to Finance: Entrepreneurship for sanitation (latrines, handwashing devices), hygiene (soap, menstrual pads), and nutrition products such as micronutrient-rich foods (vegetables, eggs) will be supported, so that local market supply will increase. Youth employment for new entrepreneurs will be stimulated. Only if finance for entrepreneurs and customers (households, communities) is accessible (through microfinance institutions and Village Saving and Loan Associations (VSLAs), capital investment for WASH and nutrition products and services will increase, so that the increased demand (because of changed behaviour) will be met. 

Gender: We will work through a Gender Transformative Approach in all Programme elements, based on the assumption that addressing root causes of inequality and discrimination (norms, beliefs) will increase universal access and use of WASH and nutrition services and contribute to greater inclusion in society and benefits beyond WASH and food and nutrition. Including women in decision-making will improve Programme outcomes as well as empower them in the community and households. Current and prospective mothers (women and adolescent girls) and fathers are key to influencing practices that affect child health. Influential community members and traditional leaders must be engaged as well to address gender inequalities and ensure sustainable child health outcomes. 

Climate Resilience: Droughts, flooding and erratic rainfall are a risk that can lead to lower agricultural production, increased food and nutrition insecurity, and WASH slippage. Climate-proof mitigation and adaptation measures must be taken into account. By building responsiveness of local management and support structures, strengthening local supply and demand, and climate adaptation measures, we will increase the likelihood of climate-sensitive agricultural production and WASH services being sustained. We anticipate that this will improve household and community resilience.

The Healthy Village programme includes an Evidence and Learning component in order to gather information about what works in reducing stunting and incidence of water- and faecal-borne diseases in Ethiopia for children under two. The aim of the Evidence and Learning strategy of the Programme is to gather evidence and best practices of concepts (including the Healthy Village concept) in close cooperation with a research partner. In the short term, this information can be used to adapt the Programme where necessary. In the long term, this will ultimately result in capacity strengthening and upscaling within the WASH and nutrition sectors in Ethiopia and beyond. 

The Evidence and Learning strategy will deliver the content for the communication and capacity development activities developed within our Engagement component. This evidence will be actively shared with the Ethiopian government, existing ‘tanker’ programmes (existing large-scale governmental programmes) like the Seqota Declaration, the One WASH programme, the Multi Sectoral Woreda Transformation Plan, and other major stakeholders so we can all jointly work towards the elimination of stunting and incidence of water- and faecal-borne diseases for children under two years of age. We aim to set a process in motion with engaged stakeholders and systems and encourage replication and expansion to other woredas and regions. 
Financial: Through strengthening Village Savings and Loans Groups, financial means will be more available in the community for purchase of services and materials. Through a partnership with finance institutions, access to micro-credit for entrepreneurs will be strengthened. 
Technical: All technical solutions used in this programme respond to people’s demand. We support stakeholders in choosing technical solutions which can be maintained, repaired and replaced easily. 
Social: In order to achieve lasting social change, we develop interventions that are gender transformative, inclusive, demand-driven, culturally sensitive and needs-based. 
Environmental: Mainstreaming climate resilience through all programme interventions ensures the approach considers sustainable adaptation and mitigation strategies, as well as endeavoring to reduce negative environmental impact. 
Institutional: Through its close engagement with the Ethiopian government the partners ensure that the programme aligns well with existing government policies and procedures and other stakeholders’ initiatives.