JUNE 2009--Since the early 1990s, a few small-scale community programs in developing countries have been using integrated approaches that address population-health-environment (PHE) links in ecologically fragile areas. These projects have sought to increase access to family planning and health services, while simultaneously helping communities manage their natural resources.

In the latest issue of Focus, the Sierra Club's Roger-Mark De Souza provides some observations and recommendations based on his decade-long experience in the field. "PHE offers a step in the right direction—a flexible, innovative way for policies and programs to keep pace with today's rapidly changing world—and lays the foundation for empowering our children to manage these changes for generations to come," he says.

In two video interviews, De Souza argues that integrating PHE is particularly successful because it is an "empowering, logical extension of how people live their lives."

"When I see communities have a better understanding of how these issues interact and have an impact on their lives, they become very energized and enthusiastic. One woman said to me, 'I live my life in a way where all these things are integrated…so the solutions and the approaches that you are talking about make sense to me.'"

Why Integrate Population, Health, and Environment Programs?

Citing several recent assessments, De Souza's "The Integration Imperative" lists integration's benefits, including:

  • Encouraging men to get involved in reproductive health decisions and prompting greater participation by women in natural resource management.

  • Improving both reproductive health and coastal resource management more than single-sector programs.

  • Building trust with community members by providing an entry point that otherwise might be difficult for conservation programs to secure.

  • Offering common ground with family-planning opponents, who appreciate the environmental benefits and livelihood opportunities these programs deliver.

  • Increasing efficiency through economies of scale that allow for pooling expertise, leveraging efforts, and merging funds.

    Some Successful PHE Programs

  • In Uganda, on the perimeter of Bwindi Impenetrable National Park, program managers are exploring how population pressures affect endangered mountain gorillas, offering family planning services, and examining the links between animal and human health.
  • In Nepal, family planning is part of a community forest management program that is working to reduce human-wildlife conflict in rural areas.

  • In Zimbabwe, the faith-based NGO Catholic Relief Services and two community organizations are working together to improve the sustainable-livelihood and food-production skills of rural children vulnerable to HIV/AIDS.

  • In East Africa, the Population Reference Bureau is working with partners in Ethiopia, Kenya, Rwanda, and Uganda to create national PHE coalitions and regional networks that help build capacity and teach PHE methodologies.

    Challenges to Scaling Up PHE

    Despite these success stories, the field "is just beginning to develop scientific evidence to support the case for successful PHE impacts at scales beyond the community level," says De Souza.

    "More researchers should compare operational results from integrated programs to sectoral interventions in control populations to quantify PHE's effectiveness, as demonstrated by recent research from the IPOPCORM program in the Philippines," he says. "Others should build on their efforts by systematically gathering data, incorporating such experiments into their programs, and seeking greater engagement with academics and technical experts."

    "PHE advocates should use concrete indicators to prove to other NGOs and funders that the PHE concept is a good way to achieve development goals at scale," he argues. "The PHE monitoring and evaluation guide developed by MEASURE Evaluation offers a foundation for developing benchmarks, but more programs and policy activities need to use it to develop detailed, prospective monitoring and evaluation plans."

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