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Dam development improves water, food, and energy security but often with negative impacts on human health. The transmission of dam-related diseases persists in many dammed catchments despite treatment campaigns. On the Senegal River Basin, the transmission of Schistosoma spp. parasites has been elevated since the construction of dams in the late 1980's. We use narrative analysis and qualitative content analysis of archival documents from this setting to examine health as a component of the food-energy-water (FEW) nexus and understand priorities and trade-offs between sectors across the policy-to-practice continuum. We find that health is recognized as an important component of river basin development, but that priorities articulated at the policy level are not translated into management practices. Incorporating health as a management objective is possible without imposing substantial trade-offs to FEW resources. Coordinated research and surveillance across transboundary jurisdictions will be necessary to inform decision-making on how to operate dams in ways that mitigate their negative health impacts.

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