Intersectoral (in)activity: towards an understanding of public sector department links between water, sanitation and hygiene (WASH) and childhood undernutrition in South Africa D J Momberg 1,2, *, P Mahlangu 1,3 , B C Ngandu 1 , J May 2 , S A Norris 1,4 and R Said-Mohamed 1,2,4 1 SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa, 2 DSI-NRF Centre of Excellence in Food Security, University of the Western Cape, South Africa, 3 Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa and 4 DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa *Corresponding author. SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 7 York Rd, Parktown 2193, Johannesburg, South Africa. E-mail: douglas.momberg@wits.ac.za Accepted on 23 March 2020 Abstract Associations between different forms of malnutrition and environmental conditions, including water, sanitation and hygiene (WASH), contribute to poor child health, nutritional status and physical growth. The primary responsibility for the provision of water and sanitation, as a basic service and human right, lies with the State, as such, a number of stakeholders are involved. Despite relatively high levels of WASH infrastructure coverage in South Africa, enteric infections and stunting remain high for a middle-income country. The aim of this study is to elucidate the landscape of WASH in South Africa in relation to nutritional status of children under the age of 5 years in the South African, Gauteng and City of Johannesburg contexts. The authors detailed the national and provincial public sector departments and through purposive sampling proceeded to map the various departments and associated policies that are responsible for the provision of WASH facilities, as well the nutritional status of children. Of the six policies identified for review, three mentioned WASH, nutrition and children; however, none explicitly linked WASH to nutrition- al status in children. An in-depth review and analysis of these three crucial policy documents was conducted. Finally, a set of expert interviews were conducted and a consensus development conference convened, with experts at the intersection between WASH and nutritional status. The authors found that the public sector would benefit from better integration of the concept of WASH into their policy, planning and implementation frameworks. The WASH sector should emphasize the role in which WASH plans consider the impact of WASH on the nutritional status of children. The various public sector departments involved in WASH service provision, and other WASH stakeholders, including community-based organizations, non-governmental organizations and intergovernmental organizations, should be involved in the decision-making of the nutrition sector. Keywords: South Africa, WASH, nutrition, policy, children VC The Author(s) 2020. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 829 Health Policy and Planning, 35, 2020, 829–841 doi: 10.1093/heapol/czaa028 Advance Access Publication Date: 14 June 2020 Original Article Downloaded from https://academic.oup.com/heapol/article/35/7/829/5857276 by Western Cape University user on 06 January 2021