Max Healthy Village

Despite a dramatic decline in child mortality around the world, one third of all the children in South Asia will not reach their fifth birthday. Water- and sanitation-related diseases are one of the main causes of poor health, stunted growth and even death for children under five.

Worldwide, approximately 162 million children under five are stunted (too short for their age), and 40 per cent of them live in South Asia. Stunting is caused by inadequate nutrition and recurring infections in the first one thousand days of life. In Bangladesh, 36 per cent of children under five are stunted. Stunting is known to negatively impact cognitive and physical development, productive capacity and health.


Our programmes aim to give children under five a healthy start in life by reducing stunting and the incidence of faecal- and water-borne diseases. When it comes to fighting stunted growth, the most critical period is a child’s first one thousand days of life—but we don’t stop there. We target children up to age five because they are still extremely vulnerable and we want to make sure the healthy habits stick. Our approach focuses on WASH while also integrating nutrition and sexual and reproductive health. By engaging local stakeholders from the start, we catalyze lasting change in sanitation and hygiene behaviour in the entire community.

Our Max Healthy Village concept, makes good hygiene a matter of local pride. If a village meets six benchmarks of healthy practice and sustains the change for a year, it is declared healthy by local government officials and a sign is proudly placed for all to see. Not only do Max Healthy Villages improve community health, they guarantee better futures for children and their families.

To date, 15 villages have been officially declared healthy by local officials, and 62 are close to ‘graduating’, meaning they are currently under evaluation. This means healthier lives for 60,000 people, including roughly 6,400 children. To be declared a Max Healthy Village, at least 90 per cent of residents must maintain healthy practices (based on six benchmarks) for one year. In 2017, we also tracked the development of over 6,500 children under five in Bangladesh. While most programmes are still in the early stages, the preliminary results are encouraging. In our project area of Kalkini, Madaripur, for example, severe cases of stunted growth have decreased up to 30 per cent within two years.

Building Business

Another key element in our approach is the training of entrepreneurs. We engage local entrepreneurs in the sale of hygiene and sanitation products and services and provide them with training in marketing and sales. They, in turn, drive demand for affordable, quality sanitation while simultaneously improving their own livelihoods. One of the hallmarks that sets us apart is the amount of local leverage we mobilise: for every euro spent on improved sanitation, local communities and governments invest almost six. This in line with our pathway to sustainability: by the end of the programme, ownership of all activities is migrated to local stakeholders to ensure continuity.

In total, we aim to reach over 85,000 people, including 26,000 children under the age of five.

More about Max Healthy Village

In Bangladesh, we are piloting our Max Nutri-WASH approach which has an even greater emphasis on stunting and nutrition than Max-WASH II. Stunting is caused by inadequate nutrition and recurring infectious diseases in the first one thousand days of life. Research suggests that there is a strong link between stunting and safe water, sanitation and hygiene. By tackling open defecation, we prevent long-term exposure to faecal contamination and chronic intestinal infections in children, which lead to reduced absorption of nutrients. We hope that through our interventions, the overall health of these children will be sustainably improved over the long term.

Our programmes reach target groups via a community-led service delivery approach. We teach communities to monitor child development on their own. Mothers receive growth charting materials and small-group support to discuss strategies for raising healthy children. These sessions also allow them to compare their children’s growth, and in doing so, stimulate behaviour change in each other. Max Foundation also trains local entrepreneurs to sell and install hygienic latrines, who in turn become catalysts for community-wide behaviour change. The key to the programme’s success is in creating Max Healthy Villages, where the entire community becomes healthier.