Population, Health, and Environment: Integration of Health, Environment, and Development in the Lake Victoria Basin through the PHE Approach
Funding Approach: Single Funded with Co-benefits. Geographic Approach: Co-located. Sectors Integrated: Health, Biodiversity, and Water.
The Lake Victoria Basin is endowed with a variety of natural resources that support an estimated population of 42 million people across Kenya, Uganda, Burundi, Rwanda, and Tanzania. This population is among the poorest and most food insecure in all of East Africa due to declining land productivity, soil degradation, desertification, deforestation and loss of biodiversity, livestock and crop diseases, declining fisheries, industrial pollution, and poor development and trade policies. More than 80 percent of the population relies on fishing and agriculture for sustenance and economic gain, and poverty-related environmental pressures, such as unsustainable fishing and agricultural practices as well as forest clearing, are compounded by poor health and rapid population growth. Additional challenges include lack of access to quality health services and limited livelihood opportunities. Collectively these factors interact in a vicious, complex cycle with impacts on local ecology, maternal and child health, social relations, and the local and regional economy.
Population, health, and environment (PHE) programming aims to address the complex connections between humans, their health, and their environment by implementing integrated activities that simultaneously improve access to health services — including reproductive health care and family planning — while also helping communities manage natural resources and conserve critical ecosystems. Integrating voluntary family planning and reproductive health care with broader development and environment interventions builds community self-reliance and enables a more resilient population and environment, particularly where population pressures exacerbate unsustainable natural resource use and food insecurity.
Since 2011, the Health of People and the Environment in the Lake Victoria Basin (HoPE-LVB) activity has delivered integrated PHE interventions through a model household approach that promotes health-seeking behaviors and natural resource management at the household level. Household interventions focus on sustainable agriculture, tree farming, improved water, sanitation and hygiene practices, voluntary family planning, and energy-saving cookstoves. Model households serve as role models and teachers to other families in target communities, which supports sustainability and ability to scale-up. The “model households” intervention exemplifies PHE integration by tangibly demonstrating and reinforcing the behaviors that help families develop in healthy and environmentally sustainable ways. These integrated interventions have achieved lasting behavioral change impacts on community health and natural resource management.
Measuring the Added Value of PHE Efforts Across Sectors
To measure impacts, HoPE-LVB has used both quantitative and qualitative methods. In particular, qualitative analysis provided important insights into how integrated PHE efforts add value. In the PHE context, “value-added” efforts are those that produce results for other sectors. For instance, HoPE-LVB improved women’s knowledge of natural resource management through alternative livelihood interventions, which decreased unsustainable behaviors, such as cutting wood for use as firewood, and improved natural resource management. In addition, the income from these livelihood interventions also gave women the confidence and ability to spend money on their children’s health and schooling needs, improving health and education outcomes.
A USAID-funded external evaluation also found that integrated PHE interventions measurably contributed to cross-sectoral outcomes. PHE integration helped deliver family planning and reproductive health care to remote communities and created local support for these services and for natural resource management efforts. As a result of increased community support for reproductive health care, the evaluation found that births at health facilities increased six-fold in Uganda and five-fold in Kenya from 2012 to 2016, leading to reductions in maternal and related infant mortality. At the same time, HoPE-LVB protected fish breeding zones, planted trees, and constructed energy-efficient stoves. Notably, the activity has observed multiple benefits across sectors such as increased food security, increased access to safe WASH, increased gender equity, and empowerment of marginalized community members, including women and youth.
Lessons Learned
Develop and use common tools to demonstrate harmony among team members and interventions.
Create an integrated PHE conceptual framework, theory of change and logical framework, joint monitoring, evaluation, and learning plans, joint work plans, and policy advocacy plans. Employ tools and monitoring frameworks to foster a shared sense of purpose.
Take time to learn about other sectors.
Hold cross-sectoral orientation sessions for staff to familiarize them with other sectors’ terminology and indicators. Ensure staff develop common language to communicate effectively with colleagues from other sectors and discuss how interventions in one sector support interventions in another.
Employ data for evidence-based decision-making and adaptive management.
Use quantitative and qualitative data to examine and improve program interventions.
Be realistic about the complexity, time, and cost associated with monitoring and evaluating integrated programming.
Secure funding for an evaluation at the project or activity start and develop a strong monitoring, evaluation, and learning plan. Budget time and resources for cross-sectoral monitoring, evaluation, and learning. Advocate with multiple donors for using a single reporting format, which can streamline reporting processes and reduce costs and staff time. Raise awareness among donors on the value of integration and cross-sectoral indicators and mixed methods research to measure results.
Learn More
Explore more case studies on the USAID Biodiversity Integration Case Competition website.
Learn more about biodiversity integration with other USAID technical sectors on the Biodiversity Conservation Gateway.
For more information on HoPE LVB’s work on biodiversity conservation and PHE, please visit the Pathfinder International project page and a recent evaluation of the project.
Contact
Clive Mutunga, Senior Technical Advisor, Population, Environment and Development, USAID Bureau for Global Health
