Water and sanitation in integrated Population-Health-Environment

interventions: A case study from Ethiopia

Peter Winch

pwinch@jhsph.edu

Climate change adaptation

As climate change and environmental degradation continue and intensify, donor agencies are starting to ask: What activities should be fund to promote climate change adaptation?

Examples of funders/programs are:

– Green Climate Fund http://gcfund.net

– USAID Feed the Future http://feedthefuture.gov

How people view the problem and the possible solutions

The problem: Multiple impacts

Water availability and quality

Soil erosion

Food production

Health

Loss of biodiversity

Employment, livelihoods

The solutions: Need multiple components

Water and sanitation

Agriculture

Nutrition

Disease prevention

Family planning

Livelihoods

PHE Programs: One way to “package” the solutions

The programs implement Population, Health and Environment interventions. Interventions aim to be integrated, mutually-reinforcing, e.g.

– Family planning decreases pressure on the environment, improves maternal and child health

– Environmental improvements promote health and nutrition

Where do PHE programs come from?

Many have evolved organically over time

Organizations or projects:

– Start out addressing one single problem.

– Over time, they take on other problems in response to community needs.

– Eventually an integrated program emerges.

PHE Research to Date

Limited evidence base a challenge for the approach

At present:

– <10 articles about PHE in the international literature

– 1 study measuring impact

– Nothing in the literature about PHE in Ethiopia

Process evaluation of PHE programs in Ethiopia

PHE Process Evaluation: Research Questions

1. What strategies do organizations* use to implement population, health, and environment interventions?

2. To what extent do the PHE programs integrate across sectors?

* Member organizations in PHE Ethiopia Consortium - http://phe-ethiopia.org

PHE Process Evaluation: Data collection Consortium

headquarters Individual NGOs

ENWRA REST

Site Addis Ababa Mettu woreda in Oromia Region

Bala woreda in Tigray Region

Number of interviews with staff and professionals

9 16 14

Number of focus groups with beneficiaries

0 2 2

Case study of EWNRA: Ethio-Wetlands and Natural Resource Association

Location in Ethiopia

EWNRA: Initial focus on conservation of wetlands

Formed in 1999 by UK-Ethio research institution partnership

First Ethiopian NGO to focus on wetlands conservation.

2001: Mission widened to implementation of integrated development/environment projects

Addition of Population and Reproductive Health components

Recognition of population pressure and links to environmental degradation

– Farmers converting forests and wetlands to farmland due in part to population pressure

2005: EWNRA added family planning and reproductive health activities

– Oromia Region has traditionally had highest unmet need for family planning

2009: EWNRA starts community-based distribution of FP methods

Differing justification for FP and birth spacing in PHE program

Conventional argument

Childbearing at very young and at older ages is greater risk for maternal mortality

Closely spaced births lead to greater maternal and <5 mortality

Smaller families are healthier families

Can invest more in care and education of each child

Argument in PHE program

Larger families put more pressure on the land degradation less productive less

income for family

Larger families mean each generation has less land per person less

income per person

Other activities in the integrated package (1)

Component Activities

Population Ensure contraceptive supply Sale of contraceptives at PHE kiosks PHE peer educators => Promote family planning, explain how population affects environment and health

WASH and water-related

Rehabilitation of wetlands Community-Led Total Sanitation Latrine building Protection of springs, hand pump installation Two types of committees See next slide

Water-related committees Water, Sanitation & Hygiene Committees

– 1 village, 7 members, at least 3 must be women

– Monitor and maintain water points, usually shallow handpumps; Protect springs

– Coordinate with other development efforts

Micro-watershed committees / Integrated Watershed Management Committees

– Protect and restore wetlands

– Ensure that villagers follow soil and water conservation measures

– Coordinate with local offices for agriculture, education and health

Construction of water points

Other activities in the integrated package (2)

Component Activities

Agriculture and natural resources

Training on improved farming techniques Supply of seeds and seedlings e.g. Vetiver grass Introduction of improved beehives Construction of terraces, tree planting to address erosion Livestock and natural resources management

Economic develop-ment

Women’s Savings Groups Sale of commodities e.g. improved cookstoves Livelihood diversification

In general, EWNRA trained me, they supplied seeds for me, now I am doing well. Now I supply food for my family, I sell it for income generation. My children are now very well educated. We have a hope for the future.

- Participant of a Model Farmers Focus Group

WASH in PHE

An opportunity, but also a challenge

PHE programs likely to get increasing support from donors interested in climate change adaptation

The scope is broad: Watersheds, water availability, erosion control, sanitation etc.

– Difficult to implement all components with high technical quality

Challenges for WASH in participation in PHE programs

Determine how to best integrate WASH into comprehensive strategies for climate change adaptation

Ensure that specific WASH-related behaviors are promoted effectively

Demonstrate the impact, when wide range of interventions are being implemented

Develop sound technical guidance for how to implement the WASH components

Acknowledgements: Ethiopia PHE Ethiopia Consortium Staff

Jimma University

Ato Kora Tushune

Ato Zewdie Birhanu

Ato Yohannes Kebede

Ato Dereje Geleta

EWNRA

Ato Afework

Ato Tilahun Semu

W/ro Chaltu

Negash Teklu

Kristen Stelljes

Mekelle University

Ato Aklilu Kedanemariam

Ato Bisrat Woldeselasie

Ato Alemu Kiros

REST

Ato Tesfaye Gebreyes

Ato Belay Ali

Ato Habtegiorgis Alemu

Ato Desta Yalew

Acknowledgements: Baltimore Sam Donovan, Lianne Gonsalves and Victoria Ryan

Kristyna Solawetz Hulland

Julia DeBruicker Valliant

Ben Zaitchik, Caitlin Kennedy, Ariel Greenberg

Ben Hobbs, Cindy Parker, Katie Lima

Funding:

– E2SHI

– Center for Global Health

– Boren Awards