Integrated Development: Population, Health, and Environment in East Africa, and Future Directions in Policy and Practice

The population-health-environment (PHE) community must harness the momentum generated by the PHE conference held in Addis Ababa, Ethiopia, in November 2007, argued Environmental Change and Security Program (ECSP) Director Geoff Dabelko at a January 15, 2008, meeting that served as the launch for ECSP's new series "PHE: Building the Foundation for the Next 10 Years."

Integration Brings Better Benefits

While development programs can incorporate a wide variety of sectors—including population, health, environment, agriculture, livelihoods, microcredit, and education—the guiding principle of integrated programs is that "integrating across these fields brings better benefits" than addressing them in a single-sector fashion, said U.S. Agency for International Development (USAID) Population-Environment Technical Adviser Heather D'Agnes. She explained that interactions between population dynamics and environmental and human health are particularly strong in remote areas close to biodiversity "hotspots" because people depend on the land for their livelihoods and often have little access to health services—especially family planning.

One-sixth of the world's population growth is occurring in or near areas with high levels of biodiversity, so integrated PHE programs have the potential to simultaneously protect vital ecosystems and improve the health and economic opportunities of millions of people. For instance, high population growth, environmental degradation due to climate change and destructive agricultural practices, and limited access to family planning and other health services have led to poverty, drought, and famine in Ethiopia. But integrated PHE programs sponsored by NGOs like LEM Ethiopia work with rural communities to implement sustainable agricultural practices, develop alternative livelihoods like beekeeping, and provide access to family planning and other health services.

It is particularly important to expand PHE programs into East Africa, said D'Agnes, as the people in this region have poor access to health services, high rates of population growth, and sometimes severely stressed environmental resources such as land and water. In addition, they want the services that PHE programs offer, as evidenced by East African participants' tremendous enthusiasm at the November 2007 conference. Ethiopians understand the linked problems of population growth, environmental destruction, and poverty, said Sahlu Haile, who heads the Packard Foundation's activities in Ethiopia. However, they often lack the resources—family planning, conservation technologies, and alternative livelihoods—to break this destructive cycle.

Successes of the East Africa Conference

More than 200 development practitioners from around the world, including many from Rwanda, Uganda, Tanzania, Kenya, and Ethiopia, attended the "Population, Health, and Environment: Integrated Development for East Africa" conference, which was sponsored by the Population Reference Bureau (PRB) and LEM Ethiopia and funded by USAID and the Packard Foundation. The three-day conference attracted considerable media attention, including a front-page story in the Ethiopia Herald, and featured remarks by Ethiopian President Girma Wolde-Giorgis, as well as Ethiopia's ministers of health, environment, and agriculture and rural development. In addition to the media coverage and high-profile speakers, PRB President Bill Butz credited the "enormous diversity of the participants" with the conference's success.

Before the conference, many of the attendees did not know other individuals and organizations pursuing integrated development approaches, said Butz. PRB is capitalizing on the person-to-person connections forged at the conference by helping create the East Africa PHE Network, said PRB Policy Analyst Melissa Thaxton, who organized a two-day coalition-building workshop to plan and design the network. The network seeks to achieve its vision—"an Eastern African region where men, women, and children are healthy, the environment is conserved, and livelihoods are secure"—by accomplishing its three goals:

• Enhancing the policy environment for cross-sectoral collaboration and PHE integration in East Africa;
• Improving institutional capacity to implement integrated PHE development strategies; and
• Increasing community awareness of PHE and community capacity to design, implement, and monitor integrated initiatives.

Each of the five countries will have its own semi-autonomous team, but the teams will do similar work, including training policymakers on PHE basics, creating and disseminating PHE information, and compiling data on PHE projects within their countries.

While Thaxton focused on developing a network of East African development practitioners, Kathleen Mogelgaard of the Audubon Society and Sarah Fairchild of the Sierra Club led U.S. volunteers and activists on a study tour of USAID- and locally funded Ethiopian PHE sites designed to inspire them to be articulate advocates for these programs. The joint tour allowed the organizations to pool their resources to meet their shared goals—educating U.S. opinion leaders, decision-makers, and the general public on global population-environment links; advocating for greater U.S. funding for bilateral and multilateral family planning programs and policies; and increasing support for greater integration of population and environment development initiatives. Stories and photographs from the tour will be featured in the July/August issue of Sierra magazine.

One participant reported that her organization has found study tours for lawmakers and their staffers an invaluable advocacy tool—well worth the time and expense involved in planning and conducting them. Follow-up after these tours is also crucial, she said; reunions for participants and joint lobbying sessions help preserve the knowledge and enthusiasm generated by the trip. Another participant added that a site visit gives the individuals and organizations running PHE projects—who are often marginalized in their own communities or by their own governments—credibility in their community and pride in being part of a global movement.

What's in a Name?

The participants wrestled with the challenge of what to call integrated PHE projects. While "PHE" is a short, recognizable term (and, according to Thaxton, helps promote the value of integrated projects to policymakers), many practitioners do not use—or even recognize—the acronym. Instead, they describe their projects as "integrated development," "ecosystem services," or "Nature, Wealth, and Power" projects. Additionally, the "PHE" acronym does not appear to include other aspects of development—such as microcredit, girls' education, water and sanitation provision, and agriculture—that could be integrated into a single project.

The difficulty, agreed the participants, is finding a term that is recognizable and inclusive without recalling the mistakes of the integrated conservation and development projects (ICDPs) of the 1990s, which struggled to meet the expectations of funding agencies and project recipients due to their overly broad approach. Several participants noted that it is critical to work with the priorities of local people when designing, implementing, and naming an integrated development project. Settling on a name may be more important to funders and international NGOs than to practitioners on the ground.

Future Directions in Policy, Practice

The participants suggested various innovative ways to promote, expand, and improve integrated PHE programs:

• One participant suggested that PHE advocates and practitioners focus more strongly on how PHE programs can help achieve the Millennium Development Goals (MDGs). She believes NGOs and community-based organizations might attract more donors if they emphasized, for instance, how PHE programs contribute to poverty reduction, the first MDG.
• Another participant urged the communications staff of the NGOs involved in funding and supporting PHE programs to work together to identify the most effective language for promoting integrated development projects.
• ECSP's Dabelko commented that NGOs should encourage the academic community's interest in studying and evaluating integrated development programs, since professors and researchers have the skills, money, and time to conduct research that NGOs cannot. According to another participant the academic community has recently shown increasing interest in studying PHE projects.

USAID's D'Agnes expressed her optimism about the future of PHE, arguing that there are many opportunities to bring new players—for instance, the philanthropic branches of companies like Johnson & Johnson, which supports the World Wildlife Fund—to the table to support the third generation of integrated PHE projects. Sharing her optimism, another participant pointed out that communities in the field have pressured WWF and Conservation International to continue and expand their PHE programs—thus demonstrating that users want the "better benefits" brought by PHE.

Drafted by Rachel Weisshaar and edited by Meaghan Parker.