COWASH Partnership to Integrate Water and Nutrition at Scale

A new partnership in Ethiopia is showing how to integrate nutrition into large-scale water infrastructure, without building parallel programmes. COWASH IV Ethiopia and Max Foundation Ethiopia are joining forces to test how Max Foundation’s Healthy Village approach can integrate within COWASH’s established community-managed water systems across rural Ethiopia.

Rather than creating new structures, the partnership layers nutrition services, behaviour change, and local entrepreneurship support onto COWASH’s existing platform, which already reaches over 1 million people through community water points, Water and Sanitation Committees (WASHCOs), and local financing mechanisms.

Building on Strong Foundations

Over recent years, COWASH has built sustainable, community-managed water and sanitation systems across 104 districts in 8 regions of Ethiopia. Communities manage their own water infrastructure, make decisions through WASHCOs, and use savings groups to finance improvements. In parallel, Healthy Village Ethiopia has demonstrated that combining water, sanitation, nutrition, and nutrition-sensitive agriculture significantly improves child growth and health outcomes. This partnership brings those strengths together, adding nutrition-focused interventions for children under two and pregnant and lactating women to COWASH’s proven water delivery systems.

Joint team assessment community gathering in a pilot woreda in Central Ethiopia

How the Collaboration Works

The partnership uses a layered approach:

– COWASH provides the foundation: Community-managed water infrastructure, governance through WASHCOs, local financing mechanisms, and alignment with government systems at district, regional, and federal levels.

– Max Foundation integrates nutrition services: Growth monitoring and counselling through Health Extension Workers, nutrition-sensitive agriculture training for Agricultural Extension Workers, community cooking demonstrations, and support for local entrepreneurs to deliver nutrition products alongside sanitation supplies.

– Joint implementation: Shared trainings, supervision, and reporting—delivered in collaboration with Ethiopia’s Seqota Declaration programme, the government’s national commitment to ending child malnutrition.

Why Integration Matters

Children who frequently experience diarrhoea from unsafe water can’t absorb nutrients properly, no matter how well-fed they are. And improved nutrition doesn’t prevent illness if families lack access to clean water and sanitation. When water and nutrition services work separately, progress stalls. When they work together through the same community structures, the combined effect is greater.

Ethiopia’s government recognises this. The Seqota Declaration calls for approaches that bring multiple sectors together, and the Ministry of Health’s Malnutrition-Free Village model incorporates lessons from several partners, including Max Foundation’s Healthy Village approach.

A Model for Scale

This partnership isn’t a standalone pilot, it’s designed to generate evidence for two major scale-up pathways:

– COWASH Phase V: Informing the next phase of Ethiopia’s largest community-managed water programme

– Seqota Declaration national scale-up: Demonstrating how integrated water and nutrition services can work through government systems

By building on COWASH’s existing infrastructure rather than creating parallel systems, the collaboration shows a practical pathway to joined-up, government-aligned programming—exactly where sustainable scale becomes possible.