In Lake Victoria and Lake Chilwa basins, interconnected development challenges defy sectoral boundaries, said experts at the Wilson Center on February 10. According to Deepa Pullanikkatil of Leadership for Environment and Development and Doreen Othero of the Lake Victoria Basin Commission, growing populations, shrinking resource bases, and persistent human health concerns demonstrate the need for integrated development approaches that combine population, health, and environmental (PHE) interventions. “We need different sectors working together to achieve the greater goal,” said Pullanikkatil.

Climate Adaptation Effort Finds Unexpected Barriers

Lake Chilwa is a United Nations-recognized biodiversity hotspot in southern Malawi – a nation where roughly 6.3 million inhabitants live below the poverty line, 50 percent of women marry before the age of 18, and unmet need for family planning is 27 percent, said Pullanikkatil. Vulnerable populations around the lake are highly dependent on natural resources and are growing rapidly. According to Pullanikkatil, the environmental challenges facing the basin – including climate change, periodic drying of the lake’s saline waters, deforestation, sand mining, and overfishing– are deeply intertwined with population dynamics and the health of surrounding communities.

Family planning was banned in Malawi between 1964 and 1994, contributing to a trebling of the national population over the past 40 years. The population surge has not only put mothers at risk and led to some of the world’s highest maternal mortality rates, but also contributed to a rapid decline in arable land and water availability, said Pullanikkatil. Malawi’s shrinking resource base has particularly significant, cross-sectoral implications given that 85 percent of its population relies on agriculture for a living.

The links between population, health, and the environment became clear to Pullanikkatil while working on the Lake Chilwa Basin Climate Change and Adaptation Program. Halfway through what began as a strictly environmental project, her team found that women were not participating at expected levels. When surveyed, women indicated that health problems related to bilharzia (a water-borne illness formally known as schistosomiasis), as well as the substantial time they spend rearing children, prevented them from taking part.

Though Pullanikkatil and her colleagues were environmental rather than health experts, they responded by conducting a formal bilharzia study, the first of its kind in the area, which found prevalence rates as high as 49 percent. Further investigation revealed the disease was spreading through irrigation schemes promoted as climate change adaptation measures.

“The snails that harbor the schistosome parasites like the water in the irrigation schemes because it’s fresher than the water in the lakes,” said Pullanikkatil. “Well-intentioned technologies such as irrigation [were] unknowingly increasing bilharzia prevalence.” The study, published in a peer-reviewed journal, helped convince skeptical policymakers to increase the availability of bilharzia medication in the region, effectively linking climate and health policy.

Pullanikkatil’s team adopted an advocacy approach to family planning and population issues by developing radio listener clubs. The clubs helped raise awareness of contraception options while empowering community members, said Pullanikkatil, and they were reportedly successful in preventing at least one child marriage.

“An Icon For This Planet”

With a surface area of 68,870 km² and a catchment area of 180,950 km², Lake Victoria is Africa’s largest and the second largest freshwater lake in the world. Three of the five countries in the East African Community share the lake’s waters and all five countries share its basin: the Republics of Burundi, Kenya, Rwanda, Uganda, and the United Republic of Tanzania. The lake’s importance extends beyond the region, however: “We are talking about an icon for this planet,” said Othero.

The transboundary basin supports a diverse population of 40 million people, many of whom compete for scarce resources across ill-defined political borders. In some areas women have as many as 15 children, child and maternal mortality rates are exceedingly high, fishing communities face a 26 percent HIV prevalence rate, and girls often miss school to scavenge for water, said Othero. At the same time, growing environmental concerns like pollution, invasive water hyacinth, and overfishing threaten local livelihoods and place added pressure on shared natural resources.

Though the Lake Victoria basin has received substantial donor funding over the past two decades, Othero said development efforts have had little impact. The reason, she argued, is that population issues have been largely excluded.

In her view, a PHE approach can address this deficiency while overcoming the limitations of more traditional, single-sector development. “We want to integrate population and health into environmental conservation projects funded by different donors,” she said. “So what we are telling them is ‘Look, we are not going to change your objectives, we are not going to change to goals. We are only adding value.’”

Othero works within the Lake Victoria Basin Commission, which has a number of NGO and government partners, to strengthen support for PHE across the East African Community. Realizing PHE’s added value requires “robust advocacy and meticulous coordination,” she said. She also broke with convention by suggesting a top-down approach to PHE advocacy is the most appropriate, provided it is backed by strong evidence: “We all know that bottom-up approaches are usually the best. But there are situations when you may want to climb the tree from the top.”

The Lake Victoria Basin Commission’s work has garnered political buy-in from key actors at multiple levels, resulting in projects like the Health of People and Environment Lake Victoria Basin (HoPE-LBV) project, led by Pathfinder International. HoPE-LBV has been successful in a number of ways, said Othero, including helping to shift prevailing gender roles by encouraging men to engage in family planning and reproductive health and by encouraging women to engage in sustainable livelihoods and natural resource management.

Policy Implications and Future Directions

While PHE’s potential for addressing multi-sectoral development challenges is clear, further research is needed to strengthen the case for the approach over traditional programming. This need was acknowledged at a congressional briefing following the event, organized by the Sierra Club and Population Action International, in cooperation with the office of Representative Barbara Lee (California).

Othero and Pullanikkatil were joined by Beverly Johnston of USAID and Eleanor Blomstrom of the Women’s Environment and Development Organization to discuss PHE in support of a bill sponsored by Lee that would recognize “the disparate impact of climate change on women and the efforts of women globally to address climate change.”

Johnston and Blomstrom emphasized that PHE offers valuable opportunities to “stretch our development dollar” and better address gender inequities, respectively. However, each of the speakers also recognized the need to fill remaining knowledge gaps. Attendee Robert Engelman, president of the Worldwatch Institute, noted that his organization is initiating a soon-to-be-announced research effort to expand the case for PHE.

Effective development requires systems thinking, said Pullanikkatil at the Wilson Center, but “donors are still funding in silos.”

“Our project started as a purely environmental project, and we were also thinking in silos. And from the communities, they told us: they live integrated lives.”

Event Resources:

• Photo Gallery

Sources: African Geographical Review, UN Population Division.

Photo Credit: U.S. Geological Survey.