Incorporating institutional and legalrequirementsby Robert Bos

'Snail scouts' - health workers looking for snails which transmitschistosomiasis. Co-operation between health workers, agriculturalists andengineers must be established from the beginning.

Institutional arrangements are an essentialcondition of environmental management ofvector control in resource development projects.The author describes four models, and concludesthat good legislation is vital.

Intersectoral collaboration hasoften been unjustifiably describedas simply the process whereby anagency belonging to one publicsector lends assistance to anotheragency in a different sector. Theaddition of a drainage componentto an already existing andoperational irrigation scheme withthe primary objective of reducing aschistosomiasis problem thatintensified following the scheme'sdevelopment is, according to thisview, a good example of suchcollaboration. In recent years, theconcept has evolved, principallyunder the influence of the report ofthe World Commission onEnvironment and Development.Currently, the above examplewould still be considered a positivecontribution by the agriculturesector towards the correction of adeteriorated health situation,provided of course the constructionof the drainage component is for amajor part funded by the former.It would, however, be argued thatthe fact that such remedial action isnecessary clearly indicates thatintersectoral collaboration has beenfunctioning far from optimally atcrucial stages of project planning,design and implementation.

In the full significance of theterm, intersectoral collaborationimplies that:o The components of a national

development plan are considered in aholistic way, and that all public sectorsthat may be affected by them in anindirect way are identified at an earlystage.

o For each component the sectorsidentified as relevant review their policiesfor mutual compatibility, and jointlysolve policy incompatibility.

Robert Bos is secretary of the joint WHO!FAO/UNEP Panel of Experts onEnvironmental Management for VectorControl (PEEM), in the Community WaterSupply and Sanitation Unit of the Divisionof Environmental Health, World HealthOrganization, Geneva, Switzerland.

o The sectors maintain a dialogue whichpermits them to stay informed of eachothers potential, progress andconstraints.

o At the project planning stage thepossibilities for the sharing of resourcesin further project development arecarefully investigated and defined.

o At the implementation phase themonitoring of indicators is expandedbeyond those strictly of interest to thesector that is the primary beneficiary ofthe project.

o Evaluation is not only carried out on ashort-term sectoral basis, but also on amedium-term, multisectoral basis. Inother words, the overall effect on humanwelfare should be assessed as the finalindicator for success.

This comprehensive concept of

intersectoral collaboration can onlybe achieved within an adequateinstitutional framework. Theagreements between differentsectoral bodies concerning the flowof decision-making processes, thedivision of responsibilities andlabour, and the sharing of resourcesare generally referred to asinstitutional arrangements.

This paper reviews someexamples of such arrangements inthe context of environmentalmanagement to prevent or mitigatethe vector-borne disease problemsassociated with water resourcesdevelopment development withspecial attention to the legislativeaspects.

The Tennessee ValleyAuthority, USAThe Tennessee Valley Authority(TVA) was created in 1933 as a

WATERLINES VOL.9 NO.2 OCTOBER 1990 23

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Agriculture or the Department of theInterior. Rather, TV A was placed in arole of persuading, by demonstration andother means, departments and agenciesto adopt policies, procedures, andmethods contributing to integratedresource development.

At the start of TVA threeimpoundments already existed onthe Tennessee River. Surveys in thevicinity of one of these lakes showedmalaria prevalence rates of between35 and 65 per cent. It was clear,therefore, that the Authority mustestablish a programme to controlthis severe health problem with itsbroad implications for the economicand social development and thewell-being of the people of theregion.

Based on studies andrecommendations by the UnitedStates Public Health Service in theearly 1900s, regulations had beenadopted by various southern statesgoverning the conditions underwhich water might be impounded.The purpose was to minimize thepotential hazards to public health.These regulations stipulated thatany person, corporation or agencywanting to impound water orchange the levels of existingimpoundments must first obtain apermit from the respective StateBoard of Health. The regulationsfurther specified certain vectorcontrol actions that were to betaken to ensure that disease-transmitting mosquitoes werecontrolled.

Foremost among thesespecifications were guidelines forreservoir-basin preparation, waterlevel regulation, shorelinedrainage, and aquatic weed control.With these regulations already inplace in the Valley States, TVA waslegally obliged to include mosquitocontrol in its regional developmentplans. In support of theseregulations and to ensurecompliance, it prepared a series ofvector control specifications foreach of its planned reservoirs, equalto or surpassing State requirements.Thus, legislation was a key "elementin ensuring that mosquito vectorcontrol measures were incorporatedinto the planning and developmentof water resources projects, and ithelped to eliminate conflicts ofcompeting interests.

TVA has been recognized formore than fifty years as a uniquepublic model for the integrateddevelopment of an entiregeographic region. A comparisonbetween the socio-economic

Act areumque

Four points in the 1933fundamental to thisinstitutional set up:o The Act provided the Authority with a

high level of autonomy in conducting itsbusiness. TV A has its own legal statusand does not have to refer back to theUS Justice Department for legal matters,as other Federal agencies do; and it hasgreat financial flexibility, as it receives alump sum from Congress every year, isallowed to invest proceeds from onesector into the development of another,and only returns the overall net proceedsto treasury at the end of the fiscal year.

o The Act delegates the planningresponsibilities entirely to the Authority.It must, however, implement its plansthrough the existing Federal and Statestructures.

o The Act focuses economic developmenton a river basin strategy. This avoids onepractical problem often faced in aregional development approach: thedelineation of an appropriate region.Quite often regions have been definedalong geo-political boundaries, with theeconomic rationale as a secondaryconsideration. By taking a river, itsprincipal tributaries, and theaccompanying watershed as thedevelopment focus, the definition isclear-cut. Moreover, because the river isa prominent factor in the ecology of awatershed, a river-basin strategy makesit easier to assure that regionaldevelopment provides a long-termecological protection.

o The Act avoided the supplanting orduplication of the roles by other FederalGovernment agencies already at work inthe region, like the Department of

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regional development agency by anAct of the United States Congress.It was one element in a broadprogramme designed to bring thenation out of severe economictroubles. Its structure makes itunique among federal agencies:TVA is an independent agency andnot part of any federal cabinetdepartment. Consequently, inter-departmental conflicts are limited.The TV A Act provides it with theadministrative freedom to meet thespecial requirements of itsprogramme and to adopt themethods of administration ofsuccessful private as well as publicenterprise.

TVA programme activities arehandled by three major offices. TheOffice of Power and Engineering isa self-financing operation derivingfunds from the sale of electric powerto 160 distribution systems andselected industrial and governmentcustomers, altogether a US$ 4billion per year operation.Activities of the two other majororganizational structures withinTVA, the Office of NaturalResources and EconomicDevelopment and the Office ofAgricultural and ChemicalDevelopment, are primarily fundedthrough congressional appro-priations.

24 WATERLINES VOL.9 NO.2 OCTOBER 1990

The tell-tale nodules of river blindness. Irrigation projects that will changeconditions in local water must be assessed for health implications beforethey go ahead.

The Mahaweli AuthorityA master plan for the developmentof the irrigation and hydropowerpotential of the Mahaweli River andits tributaries in Sri Lanka wasdrawn up by UNDP and FAO in1968, and envisaged thedevelopment of 360,000 hectares ofland in the Mahaweli and adjacentbasins and the production of508MW of hydropower. Theoriginal programme was scheduledto be completed in thirty years. In1978 it was revised to an acceleratedversion which aimed to irrigate120,000 hectares of new land andto generate 470MW of hydropower.

The implementation of theaccelerated Mahaweli Develop-ment Programme was begun in thatsame year by the Ministry ofMahaweli Development. It soonbecame evident, however, that themanagerial capacity andadministrative procedures of agovernment ministry were less thanideal for the implementation of adevelopment programme of thatsize on an accelerated basis.Therefore in 1979 the MahaweliAuthority, a governmentcorporation, was set up by an Actof Parliament. The Act provided forthe Minister in Charge of theProgramme to declare, with theapproval of the President, any areawhich could be developed withinthe water resources of the Mahaweli

situation in the Tennessee VaHeyin the 1920s and 1930s and thepresent-day situation in manydeveloping countries has often beendrawn. Consequently, the transferof the TVA model to thosecountries has been frequentlyadvocated for major naturalresources development projects. Infact, in a number of countriesattempts have been made to copythe TVA approach. It is important,however, to bear in mind thedifferences between the TennesseeValley situation and the conditionsfound in many developingcountries, and to assess the valueof the aforementioned fourfundamental points of the TVA Actunder such conditions.

Clearly one cannot simplyduplicate the exact combination ofstrategies used elsewhere, becauseeach region represents a uniquepattern of resource and economicproblems and opportunities. Anessential difference between theTennessee Valley and mostdeveloping countries is that theregionally focused TVAprogramme was neverthelesscarried out within the nationalcontext, through existing agenciesand with federal financial support.Most developing countries will nothave the economic strength toinitiate such a major resourcedevelopment project by themselves.

This means that external fundingfrom bilateral or multilateral donorswill need to be attracted. If, in sucha case, drastic measures are nottaken to ensure that part of thefinancial resources is channelledthrough to national ministries forthe strengthening of their executiverole, then there is a considerablerisk that a development authoritywill overpower other nationalbodies because of itsdisproportionate financial strength.Not only will this situation result ina less than optimal collaborationwith existing government bodies,but it is also likely to drain skill andknow-how from these bodies infavour of the newly created entity.While great caution is thereforenecessary to transfer the managerialstructure of TVA, the integratedriver basin approach is certainly ofvalue in regional developmentanywhere, and is being adopted inmany countries with great benefit.Particularly from the ecologicalperspective, which is so acutelyrelevant to the distribution ofvector-borne disease, theestablishment of river-basin

development authoritiesimportant contributionsustainable development.

IS antowards

Ganga or any other major river a'special area', where the Authoritycould exercise all or any of itspowers, duties and functions.

The functions of the Authority inrelation to these special areas weredesignated in the Act as comprising:

o Planning and implementing the MahaweliGanga Development Scheme includingthe construction and operations ofreservoirs, irrigation distributionsystems, and installations for thegeneration and supply of electric energy.

o Fostering and securing the full andintegrated development of any SpecialArea.

o Optimizing agricultural prod-uctivity and employment potential andgenerating and securing economic andagricultural development within anySpecial Area.

o Conserving and maintaining the physicalenvironment within any Special Area.

o Furthering the general welfare andcultural progress of the community withinany Special Area.

o Promoting and securing the participationof private capital, both internal andexternal, in the economic and agriculturaldevelopment of any Special Area.

o Promoting and securing the co-operationof Government departments, Stateinstitutions, local authorities, publiccorporations and other persons, whetherprivate or public, in the planning andimplementation of the Mahaweli GangaDevelopment Scheme and in thedevelopment of any Special Area.

The powers of the MahaweliAuthority cover a wide range ofactivities, from the construction ofirrigation and drainage works andstructures and hydropowerinstallations to watershed manage-ment and the control of soil erosion,and from settlement andresettlement of persons on lands,

oJ:~cmE~c~u.i

WATERLINES VOL.9 NO.2 OCTOBER 1990 25

farms and properties in any SpecialArea to the organization of farmertraining services, farmer creditfacilities and agricultural inputs intofarming systems.

The Mahaweli Act provides forthe Authority to give special orgeneral directions to governmentdepartments and corporations,requiring these entities to performany functions and duties deemednecessary by the Authority in anyof the Special Areas. The MahaweliAuthority can, furthermore,establish departments or agenciesunder its control for the purpose ofdischarging any of its functions.

From this it is clear that thepowers of the Mahaweli Authoritylargely surpass those of TVA. Inaddition to planning, design anddemonstration, it is also responsiblefor programme implementation andit can create its own structurethrough which to carry out itsexecutive functions. The exampleof how public health is dealt with(based on information received in1984 and updated in 1987)illustrates the functionalimplications of this mandate. TheMahaweli Authority recognizedthat the Ministry of Health hasprimary responsibility for deliveryof both preventive and curativehealth services in the entirecountry. The Mahaweli EconomicAgency (MEA) has also been maderesponsible for health care deliveryin the downstream areas,supplementing efforts of theMinistry of Health in preventiveand curative services, includinghealth education. The institutionalarrangements which were originallyestablished consisted of theappointment by the Ministry ofHealth of a Deputy Director toliaise with the Mahaweli agencies,and the creation of a standingcommittee on health withrepresentatives from MEA, MECA(the Mahaweli Engineering andConstruction Agency) and theMinistry of Health.

The Mahaweli Authority has, toa certain extent, copied thegovernment structure and hasundertaken tasks which could havebeen implemented by existinggovernment agencies had theexternal funds been channelleddifferently. The flexibility of TVAwhich was purposely built into the1933 Act of Congress which limitsthe Authority's powers to planningand demonstration has, in the caseof the Mahaweli Authority, givenway to a structure with greater

similarity to government agenciesthan to private enterprise. Thehealth activities of the MahaweliAuthority exemplify this: they areof the conventional health servicestype. MECA's involvement inhealth infrastructure improvementand MEA's responsibilities forhealth care delivery are typicallysectoral. Opportunities for a moreintersectoral approach towardspublic health, by considering it inthe design of the structural lay-outof irrigation and drainage works,seem for the most part to have beenmissed.

In fact, the planning, design andconstruction of the irrigationschemes appears to have beencarried out with strictly sectoralgoals in mind: how to achieve thelargest command area feasiblewithin the geo-physical constraintsposed by the dry zone area. Someconcessions were made for wildlifeconservation, but the design ofwater delivery systems, humanresettlement programmes andirrigation management lackessential health safeguardcomponents of the environmentalengineering type.

PhilippinesThe two public sectors in thePhilippines directly concerned withvector-borne diseases are bothorganizationally subdivided. Thewater resource development sectorconsists of some twenty differentagencies; in the health sector, themalaria eradication service and theschistosomiasis control and researchservIce.

Faced with an intensification ofactivities in the water resourcessector, the Philippines authoritiescreated in 1974 the National WaterResources Council which, withregulatory/executive as well asadvisory functions, was to co-ordinate water resources dev-elopment at a national level,consistent with principles ofoptimum utilization, conservation,and protection, to meet present andfuture needs.

It was recognized that malaria,and to an even greater extentschistosomiasis, needed to beconsidered in the context of waterresources development. Theschistosomiasis control componentin the context of irrigationdevelopment requires an input fromthe engineering side and from thehealth services. The engineeringpart consists of the improvement of

existing drainage channels and theconstruction of new ones; theimplementation of improved watermanagement schemes; theconstruction of footbridges; theconstruction of health centres; andthe development of rural drinking-water supply.

ImplementationmechanismThe mechanism for theimplementation of a schistosomiasiscontrol programme in an irrigationproject in the Philippines dependedat that time on whether theprogramme was one of severalcomponents of an integrated areadevelopment project, or a com-ponent of an irrigation developmentproject in the strict sense. In anintegrated area developmentproject the National Council onIntegrated Area Development wasthe principal executive agencyresponsible for the implementationof the programme, with theNational Irrigation Administration(NIA), the Ministry of PublicWorks and Highways (MPWH) andthe Ministry of Health (MOH) asco-operating agencies. On the otherhand, if the programme was acomponent of an irrigation project,then NIA was the principalexecuting agency with MPWH andMOH as co-operating agencies.

Taking the latter case as anexample, the intersectoralcollaboration was as a rule definedin a memoranda of understanding(MOD) between the executiveagency (NIA) and the co-operatingagencies. The MOD with theMinistry of Health described theduties and responsibilities of bothagencies with respect to theschistosomiasis control programme.Thus the MOH was responsible forthe health services component,except where it related to ruralwater supply and sanitation, whichwas the responsibility of theMPWH. In this collaborativeframework, the NIA providedlogistical support to employeesfrom other agencies stipulated towork for the programme. Thedisbursement and management ofthe bilateral or multilateralcomponent of the healthprogramme funds included in theirrigation project budget wasadministered by NIA. The MOH,on the other hand, controlled thenational counterpart funds for thehealth component.

26 WATERLINES VOL.9 NO.2 OCTOBER 1990

In the Philippines the waterresource sector was and continuesto be very heterogeneous. At thenational level several ministries maybe involved in the planning andexecution of medium- and large-scale projects; at loweradministrative levels small-scaleprojects may be initiated. Withinthe macro-economic policyframework each of the separateentities will have its own policiesaimed to achieve an individual setof objectives through effectiveimplementation of its programme.There will be a range of sectoralpolicies, only loosely inter-connected and sometimes evenconflicting. The establishment of aco-ordinating body, such as theNational Water Resources Council,with policy review and adjustmentin its terms of reference, seems afirst prerequisite to make sectoralpolicies compatible.

The institutional arrangements asthey were established in thePhilippines in the 1970s are true tothe concept of intersectoralcollaboration. They provide theframework for multidisciplinaryplanning, and prescribe a divisionof labour and the channelling ofexternal funds, and define inputsfrom various sources. ThePhilippines model would seemsuitable for replication in similarsettings. Effective intersectoralarrangements do not, however,generate spontaneously. Differentsectors are used to competing forlimited funds and tend to have aself-centred perception of nationalpriorities. The arrangements willtherefore have to be enforced fromthe highest executive levels.Moreover, the arrangements areephemeral. As political systemschange, governments arereorganized and national dev-elopment plans modified, existingarrangements may becomeoutdated from one day to another,or disappear altogether.

EthiopiaSometimes intersectoral colla-boration develops from the bottomup rather than from the top down,and this has happened in. Ethiopia.Ethiopia belongs to those East-African countries where substantialwater resources remain to bedeveloped for agriculturalpurposes. Aware of the healthimplications of irrigation develop-ment, a group of interestedscientists took the initiative to

demonstrate the value ofmultidisciplinary collaboration in aproject to control urinaryschistosomiasis in the AmibaraIrrigation Scheme in the MiddleAwash Valley. This successfulcontrol effort attracted theattention of various ministries andinstitutions and culminated in theformal establishment, in 1985, of aCommittee for Inter-institutionalCollaboration. This group bringstogether their expertise inengineering, agriculture, vectorecology and disease epidemiology,and aims to develop an intersectoralapproach towards the preventionand control of water resourcesdevelopment associated vector-borne diseases.

The establishment of the CIC wasformalized in a memorandum ofunderstanding, spelling out thespecific objectives and functions. Itwas initially signed by the NationalResearch Institute of Health, theWater Resource DevelopmentAuthority, the Institute ofPathobiology of Addis AbabaUniversity, the OccupationalHealth Unit of the Ministry ofIndustries and the NationalProgramme for the Control ofMalaria and Other Vector-borneDiseases. Participation is open toall relevant governmentinstitutions.

Following the success of theAmibara Irrigation Scheme, variousad-hoc working groups of the CIChave started activities, including ahealth and environmental impactassessment as part of a feasibilitystudy on the Gilgel Gibe hydro-electric project and anenvironmental health impactassessment and appropriate designof a monitoring programme for amaster drainage operation of theMelka Sadi and Amibara areas.

The Committee for Inter-institutional Collaboration has beencarried by the enthusiasm of itsmembers, and this has led toimmediate results. The political willto make this group a formal part ofthe Ethiopian decision-makingprocess with regard to waterresources development has,however, so far been insufficient.As a result the expertise availableis not utilized to its full potential.The solution again points in thedirection of the development ofproper legislation, which wouldmake the screening of any newwater resources developmentproject by the CIC compulsory.

ConclusionsFor each institutional environmentthe optimal construction will haveto be designed; a mere copying ofstructures- that have provensuccessful elsewhere is usually lessthan satisfactory. Good legislationis the only way to ensure continuityin intersectoral collaboration, whichis prone to deteriorate in times ofeconomic decline, political changeor instability. In this connection itis important to note thatenvironmental legislation is nowbeginning to take shape in manydeveloping countries. Environ-mental issues, by definitionmultisectoral in nature, require avast range of suprasectoral andsectoral laws. EnvironmentalImpact Assessment is now no longerjust a condition imposed bymultilateral and bilateral donors,but is also legally required fordevelopment projects in manycountries. The enforcement of thelaw and the follow-up andimplementation of EIAs, however,remain problematic. Bye-laws andother regulations imposed by localgovernment have gained inimportance, particularly in the faceof spreading urbanization. Acomparison of malaria cases in thefour major cities in India clearlyindicates the importance of theirstrict enforcement. In Indian citiesmalaria transmission is mainlylinked to the breeding of vectors inborrow pits of construction sites andin rooftop water tanks. In Bombay,where the engineering code ofpractice and constructionregulations are well spelled out andstrictly enforced, the number ofmalaria cases have fluctuated in thepast five years between 833 and4,073. In Calcutta, Delhi andMadras, where legislation isincomplete or not enforced withsimilar vigour, these figures are,respectively 8,285-26,056; 14,423-38,108 and 30,771-51,376.

ACKNOWLEDGEMENTSThe factual information on TVA, theMahaweli Authority, the Philippines,Ethiopia and India has been drawn fromworking papers prepared by a number ofmembers of the WHO/FAO/UNEP Panel ofExperts on Environmental Management(PEEM). Shortly, a case study on waterresources development and vector-bornediseases in Kenya will be published by thePEEM Secretariat, WHO, Geneva.

Opinions expressed in this paper are theauthor's only, and do not necessarily reflectthe official policies and views of the WorldHealth Organization.

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