Frequent readers of New Security Beat are no strangers to the PHE approach to development – projects, often community-based, that integrate population, health, and environmental programming in a single intervention. Practitioners suggest that such integrated programming is more effective and efficient than running simultaneous siloed projects, each focusing on a narrower objective. But does the evidence support this conclusion? How effective is the PHE approach?

Monitoring and evaluation has traditionally been difficult for PHE projects. The integrated nature of programming means that results can emerge on different time frames and some benefits, like the added value from integration (efficiency, cross-pollination between target audiences, etc.), are difficult to capture.

A new synthesis report from the Population Council’s Evidence Project and Population Reference Bureau hopes to capture the results emerging from a new generation of PHE projects. The report demonstrates that the approach can be effective in diverse settings around the world, with data from 35 projects in Africa, Asia, and Latin America. In addition to summarizing the knowledge base, the report looks at what is being measured, gaps in understanding, and successes and challenges. Results were gathered from peer-reviewed articles, the 2013 International Population, Health, and Environment Conference, project reports, report summaries, and other publicly available documents.

Heavy on Family Planning, Light on Environment

Data on family planning – expanding access and use is one of the primary goals of most PHE projects – is among the most consistently reported results. Monitoring family planning outcomes is, after all, relatively standardized. The synthesis report found, however, that projects gathered different kinds of information on family planning. Some measured contraceptive prevalence rate, some measured couple years of protection, and some tracked knowledge and acceptance of modern methods of family planning, making it difficult to compare results from different projects.

Many of the health interventions implemented by PHE projects have clear links to either population or the environment. Maternal and child health programs commonly feature a reproductive health component, for example, and interventions focusing on clean cookstoves and water, sanitation, and hygiene improve both human health and protect the surrounding environment.

Projects found that health programming can be a good entry point into communities. By implementing health programs which quickly produce results, like child immunization campaigns, projects are better positioned to introduce programs which take longer to produce positive results, like reforestation or other environmental activities.

Data on environmental interventions was scarcer. Results from environmental interventions can be harder to measure, especially in the limited timeframe of most projects. Instead of measuring the actual impact on the environment, many projects instead focused on measuring the attitudes and behaviors of community members toward natural resource management practices like reforestation or sustainable fishing. Projects have measured positive changes ranging from reductions in destructive fishing techniques and increases in fish yields to reforestation and increased uptake of clean cookstoves, which burn less firewood.

Many projects include other program activities as well. Some have provided training on alternative livelihoods, for example, which allow community members to provide for their families without destroying the local environment. Similarly, projects which promote good nutrition also improve the health of community members, especially women and children. Most, however, tend to not collect the information needed to document their impact on livelihoods, nutrition, food security, or resilience.

This is also true for activities related to increasing community resilience to climate change. While some projects are beginning to incorporate adaptation to climate change in their programming, climate change activities are not yet standard components of PHE interventions. Tools are becoming available for measuring and applying climate change data at the local level, creating opportunities for future projects to demonstrate the links between PHE, climate change, and resilience, but they are just beginning to be adopted.

Some PHE projects also use the integrated approach to address gender dynamics. Many work to increase men’s support of and involvement in family planning. Conversely, some use non-traditional entry points like clinics and literacy classes to encourage or enable women to be involved in conservation efforts. Others have found that the integrated message especially resonates with young people, encouraging them to participate in both natural resource management and activities promoting positive messages about sexual and reproductive health.

The Measurement Imperative

This synthesis of results makes clear PHE projects are improving the health, wellbeing, and environment of households and communities across diverse settings and landscapes. But, as has been recommended in the past, the authors call for more efforts to document the impact of integration.

Projects should focus on data collection as they begin and reach out to organizations with more experience in monitoring and evaluation if necessary. As challengers to the status quo of more siloed approaches to development, PHE projects need to measure what makes them different, specifically the added benefits of integrated programming as well as the project’s impacts on livelihoods and other aspects of community development beyond health and the environment.

By improving the monitoring and evaluation of PHE projects to document evidence of the benefits across each sector, current programs can provide a firm foundation for expanding the approach.