Inadequate access to safe water and sanitation services coupled with poor hygiene practices continues to kill, sicken and diminish opportunities of millions of people in developing countries. Various interventions to improve drinking water quality and service levels, sanitation and hygiene (WSH) have been applied, albeit in isolated approaches. Relevant literature focused on assessing the cost and health effectiveness of such approaches. In parallel, irrigation in agriculture, which affects all the water cycle and thus drinking water quality and quantity, has been developed without looking into the consequences for WSH. In this paper, argue that the ‘nexus’ approach should take peoples’ multiple water needs as a starting point for providing integrated services and thus move beyond conventional sectoral barriers of domestic and productive sectors. Isolated approaches have their drawbacks missing out on positive externalities on health and nutrition outcomes. Also argue that (the prospect of) a holistic approach including WSH and agriculture sectors for a long term health and nutrition impact should be explored. The paper reviews the body of literature dealing with WSH and irrigation agriculture, synthesizes the remarks thereof and concludes with suggestions to unravel the ‘nexus’ between WSH and agriculture for a long term health and nutrition impact.