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It¡¯s recess time, and primary school students of Huaichai village are enjoying their recreation time in a large field next to their school building. When they need a bathroom break, students must traverse the field and down the hill to the closest latrines. They then walk back up the hill, across the field, and to the school building, where water buckets and soap are available.

Ms. Phaeng Soulichanh, school principal, is happy that most students already understand proper handwashing practices, and that the teachers consistently reinforce this message, while making soap available. However, she admits, the facilities they have to work with are not ideal.

¡°We would like toilets closer to our school, so they are more convenient for preschool and first grade students to use. These students cannot go to toilets by themselves and a teacher needs to accompany them,¡± she says. ¡°The school needs hand washing sinks and faucets,¡± she continues, gesturing to the current system of water buckets, used to compensate for seasonal water shortages.

Huaichai village is among those that will benefit from the new Scaling-Up Water Supply, Sanitation and Hygiene Project. The project focuses on improving water access, particularly at schools and health facilities, in provinces with the highest rates of malnutrition in Lao PDR: Phongsaly, Huaphan, Xieng Khouang, and Oudomxay, where Huachai is located.

In areas of Lao PDR with poor sanitation, health issues such as stunting due to malnutrition remain critical issues. Stunting affects over one third of children under five nationwide, and can limit children¡¯s brain development, school performance, and eventual employment, keeping communities in poverty. The Human Capital Index evaluation of Lao PDR reflects the detrimental impacts this has on the next generation. Lao children born today only reach 45% of productivity they could have if afforded full health and education. This represents a loss of both economic and human potential for Lao PDR¡¯s development.

Water, sanitation, and hygiene plays a key role in reducing malnutrition, as evidence across low and middle-income countries shows that higher open defecation rates are associated with stunting and higher overall incidence of poverty. Access to food, health service and a healthy environment, and good caring practices are considered essential for good nutrition outcomes. But no one of these three essential elements (food, health or care), is sufficient in and of itself. For example, an abundance of food may do little to nourish communities that are in constant contact with fecal germs, where water and excreta-related diseases are spread as a result of inadequate sanitation, water supply and hygiene practices. Malnutrition can be widespread even in regions with plentiful supplies of affordable food because this food is not well absorbed by the body.

Experience from countries that have successfully reduced stunting rates shows that to move the needle, development initiatives must target both immediate and underlying causes, considering multiple sectors. For this reason, the Scaling-Up Water Supply, Sanitation and Hygiene Project will go hand in hand with projects in other sectors impacting nutrition, such as diversified food production, nutrition, and social welfare, which will operate in the same communities.

¡°We want our students to wash their hands as frequently as possible to reduce the potential of contracting diseases. Hands are the breeding places of diseases,¡± Ms. Soulichanh says. With the upcoming support to her village, she looks forward to seeing her young students growing up stronger and taller, to reach their full potential.