Fifty years after independence, Uganda has one of the highest population growth rates in the world at 3.3 percent – a rate which puts the country on track to nearly double in population over the next two decades. More than 50 percent of the population is under the age of 18. This large youth cohort will ensure that the country continues to grow for decades to come, even if couples choose – and are able – to have smaller families. And according to the State of Uganda Population Report 2011, “with more than one million people added to the population every year, the quality of [health] service delivery will suffer.”

In 1962, Uganda had a population of about seven million people. Today, the population is five times larger (34 million) and the country is one of the most densely populated in Africa. As the population expands and people continue to primarily live off the land, natural resources are depleted, dilapidated, and degraded, which undermines the livelihoods of the people, attainment of the country’s National Development Plan and Millennium Development Goals (MDGs), and its aspiration of becoming a middle-income economy with healthy ecosystems by 2050.

As Uganda looks into the future, the critical questions are:

• How do population dynamics affect the environment?
• Could better access to reproductive health care make a critical difference in addressing environmental challenges?
• How do we protect ourselves from a warming world and adapt to climate changes?

Holistic Strategies, Multiple Benefits

Understanding the interaction between population, health, and environmental (PHE) variables can help us develop holistic strategies for sustainable human development. Often communities face problems that touch on all three of these components, as well as others like sustainable livelihoods and food security. Yet traditional development solutions are focused on a single sector and are not able to adequately address a community’s  needs.

At the most basic level, a PHE program is a coordinated set of activities that includes goals and interventions in the population, health, and environment sectors. The integration of multiple components has been shown to provide additional benefits by reducing costs and increasing effectiveness. Increasing access to family planning, a critical component of many PHE projects, stands out as one of the most cost-effective, cross-cutting interventions available. Promoting women’s reproductive rights and improving contraception access is also paramount to meeting the MDGs. PHE projects, with their integrated construction, provide a means for addressing multiple MDG and national development objectives. But the 2015 deadline agreed up for reaching these goals is fast approaching.

Assessing PHE in Uganda

Countries such as Ethiopia, Madagascar, and the Philippines are leading the way in implementing PHE programs. In Uganda, some NGOs and development agencies have begun designing PHE interventions, but comprehensive and supportive policies for PHE initiatives in Uganda do not yet exist.

The Uganda Population, Health, and Environment Working Group recently completed a country-level assessment of PHE in Uganda, which revealed tremendous development challenges in nearly all sectors. Currently the Ugandan government is grappling with universal primary and secondary education programs, community-based health service provision, conservation of protected areas (10 national parks, 12 wildlife reserves, 506 central forest reserves), and many other development programs. Utilization of single-sector approaches to address these development challenges in the country remains common. However, we also found successful PHE programs that were becoming more stable and expanding.

Conservation Through Public Health (CTPH) is implementing public health and conservation projects around Bwindi Impenetrable National Park. With population densities ranging from 200 to 600 people per square kilometer, conflict between humans and gorillas and other wildlife in the area is a problem. CTPH is using village health and conservation teams or community conservation health volunteers to deliver integrated health and conservation education and services at the household level. Over a period of four years, the project resulted into a 12-fold increase in new family planning users; improved human health (tuberculosis, hygiene, and sanitation); and improved gorilla health and conservation status. Following the success of CTPH, Bwindi and Mgahinga Conservation Trust has taken this community-based PHE approach to more parishes around the park.

The HOPE LVB Project (Health of People and the Environment in the Lake Victoria Basin)  is now replicating the same model in the fresh water ecosystem around the Lake Victoria Basin to improve public health and reduce unsustainable population growth and its attendant environmental degradation, deforestation, and overfishing. The project is being implemented in Wakiso and Mayuge Districts through a partnership between Pathfinder International, Ecological Christian Organization, CTPH, and OSIENALA (Friends of Lake Victoria) in neighboring Kenya.

Around the Bugoma and Wambabya forests in western Uganda, the Jane Goodall Institute and Heifer Project International work together to protect an important forest corridor for critically endangered chimpanzees.

Other integrated projects in Uganda, which may or may not call themselves “PHE,” include:

• The Uganda Network for Toxic Free Malaria Control, which promotes malaria control and family planning;
• Volunteer Efforts for Development Concerns, which promotes agricultural entrepreneurship alongside reproductive health in Nakaseke, Moyo, and Yumbe Districts; and the
• Straight Talk Foundation, which implements sexual reproductive and public health alongside ecological agriculture and tree growing in northern Uganda.

Maintaining the Momentum

Looking to the future, more integrated population, health, and environment projects are needed in Uganda to promote the health of people, conserve the environment, and lead to secure livelihoods. Uganda’s National Adaptation Program of Action mentions family planning as a climate change adaptation action, and the National Development Plan includes prominent environmental and health components as well. Integrated development can address many of these components together, and climate adaptation in particular may be one avenue for further integration into the PHE model.

Only by meeting demand for family planning and other health services, spreading sustainable livelihoods and agricultural training, and improving our understanding of how we interact with our natural resource base can Uganda achieve its development objectives in the coming years. PHE clearly has a role to play in that effort.

Gladys Kalema-Zikusoka is the founder of Conservation Through Public Health and a member of the Uganda Population, Health, and Environment Working Group. 

Sources: The Republic of Uganda, UN Population Division, UNFPA, Uganda Population Health and Environment Working Group.

Photo Credit: “Landscape of Uganda,” courtesy of Photo by Douglas Sheil/Center for International Forestry Research.