Showing posts from category community-based.
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Health and Harmony: Population, Health, and Environment in Indonesia
›Borneo’s Gunung Palung National Park is a microcosm of both the island’s ecological wealth and vulnerability. More than half of the park is undisturbed forest; the remainder, however, “is being torn down day after day” at an alarming rate, said Health in Harmony’s Nichol Simpson at an event on integrated approaches to population, health, and environment (PHE) programs in Indonesia. Alene Gelbard of the Public Health Institute’s Company-Community Partnerships for Health Indonesia (CCPHI) program joined Simpson on September 29 at the Wilson Center. Both speakers emphasized that no matter what issue a group works on, engaging local communities is essential for success.
The Destructive Cycle: Poor Health, Poor Environment
For Simpson, “the intersection between human and environmental health” is at the heart of Health in Harmony’s work. Health in Harmony opened Clinic ASRI in 2007, aiming to provide improved healthcare to villagers throughout Gunung Palung National Park while ending their dependence on illegal logging as a means of financial survival.
The area’s inhabitants were all too easily trapped in what Simpson called “the destructive cycle.” When faced by an unexpected medical emergency, families would go into debt to pay their medical bills. Health in Harmony found that of 232 local households surveyed, 13 percent had recently experienced a major medical emergency, at an average cost of $360. Most households in the area only hold around $260 in emergency savings, so to make up the difference, about a third turned to illegal logging to pay down their debt.
By deforesting the park, illegal logging worsens the health of nearby communities. For example, Simpson said that Clinic ASRI has seen a rise in cases of malaria and tuberculosis in the surrounding communities, in part because deforestation has increased the level of mosquito activity. The link between human and environmental health is clear, said Simpson: the people ASRI serves are “living it every day. They know the cause of this. And…they want it to stop.”
Protecting Natural Resources By Improving Health
The Health in Harmony clinic located in Sukadana, a small village sandwiched between Borneo’s coast and Gunung Palung Park, helps break the destructive cycle by treating patients regardless of their ability to pay. If patients do not have cash, they can barter for their care. In one case, a girl named Yani came to ASRI after her family incurred $500 over two months of visiting hospitals and traditional healers, none of whom could treat her condition. ASRI diagnosed and treated Yani for scabies. In exchange, her mother signed a pledge to protect Gunung Palung from logging and made the clinic a floor mat to cover the $1.50 bill.
By providing affordable, high-quality healthcare that is contingent upon pledging to protect the environment, Clinic ASRI improves human and environmental health in one fell swoop, said Simpson. “Because the infant mortality rate has decreased and you’re not overcompensating,” said Simpson, families can choose to have fewer children, using free birth control provided by ASRI.
“When you have fewer and healthier children, you’re investing in your education,” said Simpson. “When you’re investing in your education, you’re investing in your country and your community. This is the virtuous cycle. I didn’t invent it, but we are proving it in Sukadana.”
The communities around the clinic have embraced ASRI’s work, partnering with them to expand their services to address additional community needs, like training farmers in more productive organic methods and providing mated pairs of goats for widows, who pay ASRI back with kid goats and manure for fertilizer.
All but one of the 23 villages that ASRI services have been consistently free of illegal logging, according to monitors who visit them on a regular basis. “We’re proving the theory that we can protect natural resources by improving health,” Simpson said.
“Health Is Key to Sustainable Development”
Gelbard took a step back to talk about CCPHI’s experience establishing multi-sector partnerships among NGOs and corporations by building trust and enabling dialogue between the communities.
With corporate responsibility becoming more popular, “everyone’s talking about partnerships these days, and everybody’s partnering with everyone,” said Gelbard. “I don’t care what they call it – I care what they’re doing” and what results they achieve, she said. A successful partnership involves “all partners doing something more than just giving money.”
Gelbard said the 2004 tsunami reinforced the notion of corporate responsibility for a lot of companies operating in Indonesia. They saw that unless they branched out beyond their own walls and “did things to help strengthen communities,” efforts at corporate responsibility simply “would not benefit them in the long-run,” she said.
Through CCPHI, companies and NGOs have partnered on a wide range of efforts, including improving access to and funding for reproductive health services, improving sanitation by increasing access to water, and combating human trafficking by empowering girls and women.
Achieving the Millennium Development Goals will require increasing access to health care in a manner that reflects the needs of communities, she said. At its core, CCPHI’s work and the partnerships it facilitates are “based on the knowledge that health is key to sustainable development,” said Gelbard.
Event Resources
Sources: Alam Sehat Lestari, American Journal of Tropical Medicine and Hygiene, Company-Community Partnerships for Health Indonesia, ExxonMobil, The Guardian, Health in Harmony, National Geographic, PBS News Hour, Public Health Institute, Republic of Indonesia Ministry of Forestry, United Nations, World Wildlife Fund
Photo Credit: Used with permission courtesy of ASRI and Nikki See, Under-told Stories. -
PHE Is One Great Idea That Won’t Be On the Rio Agenda, Says Roger-Mark De Souza
›October 17, 2011 // By Sean Peoples“I am now serving as an example to other women in the community because I am not having any more children. I have received training in sustainable agricultural practices, I’m generating income, and I’m educating others,” said Berhane Ferkade, an Ethiopian farmer, to Population Action International’s Roger-Mark De Souza earlier this year. The 39-year-old mother of 11 become one of the community’s model farmers after working with LEM Ethiopia – a local population, health, and environment (PHE) development organization.
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Lisa Hymas on Envisioning a Different Future With Family Planning in Ethiopia
›ECSP caught up with Lisa Hymas, senior editor at Grist, last week during the first South by Southwest (SXSW) Eco conference and she spoke about her recent visit to Ethiopia to see the country’s community health extension program in action. “Ethiopia has a big challenge around population,” Hymas said, “but the government is committed to bringing that down.”
The government extension program places health-workers – young women, for the most part, who have received basic training – directly into each community, where they are able to give out immunizations, provide advice on nutrition, teach families how to properly hang bed nets to prevent mosquito-borne illnesses, and provide family planning services and advice.
Thanks to the program, these health workers and those in the communities they service can “envision very different lives for themselves than their mothers had,” Hymas explained. For instance, one woman recounted that her mother gave birth to 10 children, “and almost died giving birth to the last one, because there was no access to birth control, and there was no good access to health care.” In contrast, she is now able to have a career and to use family planning to delay and space her own childbearing.
For more on Ethiopia’s health extension program, see Schuyler Null’s report on visiting a village health clinic near the town of Fiche last spring. -
Rich Thorsten on Water Sanitation, Population, and Urbanization in the Developing World
›“For the first time in human history, more than one half of the world’s population now lives in urban areas, and some of the largest and fastest growing population centers in the world – countries like India, China, parts of sub-Saharan Africa – are in areas where water resources are becoming more and more scarce,” said Water.org’s Rich Thorsten in a recent interview with ECSP.
Thorsten serves as director of international programs for Water.org, which partners with local communities, governments, and NGOs across Central America, South Asia, and Africa to bring improved water sanitation to at-need rural and urban populations. He emphasized that ensuring access to clean water has a number of positive spillover effects, ranging from improved prospects for economic development to greater social stability, since access to non-polluted water supplies removes one potential source of tension within and between communities.
Community Health
The greatest benefit of improved sanitation services, however, comes in the form of enhanced public health outcomes. “I would definitely say there is a strong correlation” between the two, Thorsten asserted. “Water and sanitation-related diseases are related to the deaths of at least 3.5 million people every year in the developing world – not to mention millions of hours and dollars that are lost to treating health problems and coping with health problems as a result of poor [water] access and hygiene practices.”
Thorsten said that community participation has been a key aspect of ensuring the sustainability of Water.org’s projects. To pave the way for continued gains in economic development and public health, he said they work alongside water users, engineers, and government officials in target communities to make those parties stakeholders in the infrastructure development process. Fostering a sense of community ownership of sanitation projects helps reduce the likelihood that infrastructure will fall into disrepair or disuse after the initial programming intervention has been conducted.
Given that improving water-sanitation access for the world’s poor is a key element of the UN Millennium Development Goals, Thorsten said he is pleased the subject seems to be attracting more attention within the policymaking and development communities. Despite the positive momentum, however, he acknowledged the fight to ensure clean-water access for the developing world will remain an uphill battle.
“When one considers that….about 2.6 billion people lack access to basic sanitation, that there’s more people in the world that have access to a cell phone than a pit latrine or a toilet, it’s still a very daunting task that will require a lot more investment, commitment, and attention in order to improve the situation for billions of people,” Thorsten said.
Sources: UN.
The “Pop Audio” series is also available as podcasts on iTunes. -
Watch: Don Lauro on How Integrated Development Deepens Community Involvement
›September 7, 2011 // By Schuyler NullPopulation, health, and environment (PHE) projects address an impressive range of issues – natural resource management, family planning, maternal and child health, water, sanitation, nutrition, and strengthening health systems – but perhaps their most important advantage is the level of community involvement elicited, said long-time PHE expert Don Lauro in an interview with ECSP.
“There’s a depth to these programs,” Lauro said. Tools like rural participatory appraisal allow communities to map out their problems and then come up with solutions on their own. “If you get deep enough, it becomes they who own the project, and I think that that’s your ultimate goal,” he explained. “You have a much greater prospect for sustainability of that effort, no matter what happens to the funding.”
Lauro recently visited the USAID-funded BALANCED Project in Tanzania as part of a wider look at integrated development projects. He emphasized that what exactly this integrated approach is called – be it PHE, HELP, or HELPS – is insignificant; what matters is that these disparate elements are combined. -
Zo Zatovonirina, PHE Champion
Improving Human Health and Conservation in Madagascar’s Forest Communities
›This PHE Champion profile was produced by the BALANCED Project.
Madagascar is one of the world’s most unique ecosystems, with a total of eight plant families, five bird families, and five primate families that live nowhere else on Earth. Madagascar’s tropical forests and marine environments are home to endemic species of flora and fauna, although tragically 15 species are now extinct. At the same time, Madagascar is rich in freshwater resources, yet more than 60 percent of the island’s 19.7 million people do not have access to safe drinking water.Since 2003, Zo Zatovonirina has worked for Conservation International (CI) in Madagascar, and he has seen up-close the challenges of reaching remote forest communities, often requiring one- or two-day hikes over treacherous roads. As coordinator for USAID’s Healthy Families, Healthy Forests Program, Zo worked with two Malagasy nongovernmental organizations (NGOs), MATEZA, and the Association for Health Action and Security, to implement integrated population, health, and environment (PHE) approaches in response to community needs in the Ankeniheny Zahamena forest corridor in eastern Madagascar.
From 2003-2008, CI and partners reached more than 25,000 village residents with PHE messages; increased contraceptive prevalence in target zones from 17 percent in 2005 to 30 percent in 2008; constructed 3,000 latrines; and improved environmental health in all priority sites.
Today, biodiversity in Madagascar is under increased pressure, in light of political instability since 2009 and continued population pressures. Recognizing CI and partner experience and investments in conservation efforts to improve human well-being, USAID Madagascar and World Learning recently awarded a new 15-month grant to CI Madagascar and two Malagasy NGO partners – Voahary Salama and Ny Tanintsika – to implement an integrated PHE project in the southeastern Ambositra Vondrozo forest corridor. All three organizations have implemented PHE projects in Madagascar, and they have established trusting relationships with the people living in these fragile ecosystems.
Madagascar has a rich history of implementing successful PHE projects, and this project represents a new PHE pilot phase in the midst of political uncertainty. According to Zo, PHE approaches remain constant – simultaneously addressing several complex and linked problems such as poverty, child survival, and unsustainable dependency on natural resources. In Zo’s experience, CI’s PHE approach touches on all these aspects and delivers a pragmatic, integrated package of interventions designed to increase community capacity to better manage their health and environment. Utilizing PHE approaches, CI, Voahary Salama, and Ny Tanintsika will strive to reach communities for the first time ever with family planning, water, sanitation, and hygiene services while helping them conserve their biological heritage.
This PHE Champion profile was produced by the BALANCED Project. A PDF version can be downloaded from the PHE Toolkit. PHE Champion profiles highlight people working on the ground to improve health and conservation in areas where biodiversity is critically endangered.
Photo Credit: The forests of Madagascar, courtesy of Conservation International/Russ Mittermeier, and Zo Zatovonirina, courtesy of Conservation International. -
Leona D’Agnes on Evaluating PHE Service Delivery in the Philippines
›“By reducing population growth, we are going to have a better chance of sustaining the gains of an environmental conservation project,” said Leona D’Agnes in this interview with ECSP. D’Agnes, a technical advisor to PATH Foundation Philippines, served as lead author on a research article published late last year in Environmental Conservation titled, “Integrated Management of Coastal Resources and Human Health Yields Added Value: A Comparative Study in Palawan (Philippines).” The study provided concrete statistical evidence that integrated development programming incorporating population, health, and the environment (PHE) can be more effective in lowering population growth rates and preserving critical coastal ecosystems than single-sector development interventions.
“What set this research apart from earlier work on integrated programming was the rigorous evaluation design that was applied,” said D’Agnes. “What this design aimed to do is to evaluate the integrated approach itself. Most of the previous evaluations that have been done on integrated programming were impact evaluations — they set out to evaluate the impact of the project.” This most recent research project, on the other hand, sought to evaluate the effectiveness of cross-sectoral interventions based on “whether or not synergies were produced,” said D’Agnes.Although it took her team six years to generate statistically significant findings in Palawan, D’Agnes reports that the synergies of PATH Foundation Philippines’ PHE intervention took the form of reduced income poverty, a decreased average number of children born to women of reproductive age, and the preservation of coastal resources, which helped bolster the region’s food security.
Going forward, D’Agnes said, an integrated approach to environmental conservation should also prove appealing because of its cost effectiveness. “This has huge implications for local governments in the Philippines, where they are struggling to meet the basic needs of their constituents in the face of very small internal revenue allotments that they get from the central government,” she said. “They can really pick up on this example to see that at the local level, if somehow they can do this integrated service delivery that was done in the Integrated Population and Coastal Resource Management (IPOPCORM) model, that they’ll be able to achieve the objectives of both their conservation and their health programs in a much more cost-effective way, and, in the process, generate some other [positive] outcomes that perhaps they didn’t anticipate.”
D’Agnes expects the study’s results will prompt a fresh look at cross-sectoral PHE programming. “I hope that this evidence from this study will help to change the thinking in the conservation community about integrated approaches to conservation and development,” she said.
The “Pop Audio” series is also available as podcasts on iTunes. -
Nepal to East Africa: Population, Health, and Environment Programs Compared
›“Practice, Harvest and Exchange: Exploring and Mapping the Global, Health, Environment (PHE) Network of Practice,” by the University of Rhode Island’s Coastal Resources Institute and the USAID-supported BALANCED Project, explores the successes and challenges of their global population, health, and environment (PHE) network (with a heavy presence in East Africa). In order to increase support of the nascent PHE approach, the network seeks to shorten the “collaborative distance” between “PHE champions,” so they can develop a stronger body of evidence for the links between population, health, and the environment. In their analysis, the authors write that the network has facilitated the development of independent, information-sharing relationships between “champions.” However, they also observed shortfalls in the network, such as its limited reach into less technologically advanced yet more biodiverse regions, its bias toward BALANCED meet-up event participants, and its exclusion of those experts unlikely to be included in published works.In “Linking Population, Health, and the Environment: An Overview of Integrated Programs and a Case Study in Nepal” from the Mount Sinai Journal of Medicine, Sigrid Hahn, Natasha Anandaraja, and Leona D’Agnes provide both a broad survey of the structure and content of programs using the PHE method and an in-depth case study of a successful initiative in Nepal. Hahn et al. praise the Nepalese program for simultaneously addressing deforestation from fuel-wood harvesting, indoor air pollution from wood fires, acute respiratory infections related to smoke inhalation, as well as family planning in Nepal’s densely populated forest corridors. “The population, health, and environment approach can be an effective method for achieving sustainable development and meeting both conservation and health objectives,” the authors conclude. In particular, one benefit of cross-sectoral natural resource and development programs is the inclusion of men and adolescent boys typically overlooked by strictly family planning programs.
