The Health of People and the Environment in the Lake Victoria Basin (HoPE-LVB) project seeks to reduce threats to biodiversity conservation and ecosystem degradation while simultaneously increasing access to family planning and reproductive health services to improve maternal and child health in project communities in Uganda and Kenya. By integrating the delivery of reproductive health, livelihood, and conservation education and services in these communities, HoPE-LVB is improving reproductive health and natural resource management in the basin more successfully than programs focused exclusively on reproductive health or the environment. Unlike many natural resource projects, the HoPE-LVB project started out with the idea of scaling up from a few villages to include more of the basin and eventually more of the African Great Lakes region. Because they began with the ideas of scaling up the project, the transitions have been easier and they have learned many valuable lessons that have allowed them to put together a minimum package of interventions for the region.
In the eleven countries of the African Great Lakes region, nearly 40 percent of the population lack improved water while almost 75 percent lack improved sanitation. This, combined with a high dependence on agriculture, leads to increased pressure on resources and a high prevalence of water-borne diseases, both of which can lead to increased human health concerns and higher mortality rates. People living in the area need access to health services and the power to sustainably manage their natural resources.
Community-based, small-scale efforts to address issues of population, public health, and environmental conservation and sustainable livelihoods, known as population, health and environment (PHE) approaches, have been common throughout many areas of the world in recent years. The Health of People and Environment in the Lake Victoria Basin (HoPE-LVB) Project is one such PHE approach. The project seeks to reduce threats to biodiversity conservation and ecosystem degradation in the LVB while simultaneously increasing access to family planning and reproductive health services to improve maternal and child health in project communities in Uganda and Kenya. By integrating the delivery of reproductive health, livelihood, and conservation education and services in these communities, HoPE-LVB is improving reproductive health and natural resource management in the basin more successfully than programs focused exclusively on reproductive health or the environment.(1)
The main strategic objective of the HoPE-LVB project is to develop and test a scalable model for building capacity and promoting an integrated set of population health and the environment interactions that can be adopted by local communities as well as local, national and regional governments. The project works closely with several existing community groups and interventions include improving the skills of service providers in the region, conducting Population, Health and Environment (PHE) community dialogues, outreach and door-to-door education, and supporting the establishment of PHE-village communities. Together with the communities, the project has identified and is supporting model households who are willing to demonstrate PHE-oriented lifestyles and approaches and share their knowledge and skills within and outside of their communities.
The project also has a major focus on advocacy at the district, county, and national levels in all three sectors of population, health, and the environment.
Most PHE efforts have been small-scale pilot projects that address the PHE needs and rights of the community. These projects have been successful and proven that such integrated projects can have multiple benefits, although the small-scale and short durations of these projects do not adequately allow for future expansion or long-term sustainability in the region. The HoPE-LVB project set out to build the possibility of expansion into their work from the start. They partnered with a World Health Organization created group, ExpandNet, which is a global network of public health professionals who seek to advance the practice and science of scaling up, and applied a tool called Beginning with the end in mind: Planning pilot projects and other programmatic research for successful scaling up.(2) This tool provides 12 recommendations to help lay the groundwork for future success as a project is scaled up.
The linked publication speaks in more detail about the many ways the HoPE-LVB project is working with the end goal of scaling up their project. Key project actions that have been undertaken to date include:
- Engaging key stakeholders in a participatory interview process to gather perspectives about proposed interventions.
- Analyzing proposed interventions based on stakeholder input and available project capacity.
- Continuing stakeholder dialogues and setting up multi-sectoral steering committees in project areas.
- Tailoring the interventions to local institutional and sociocultural settings.
- Working to keep innovations as simple as possible while still working across multiple sectors to meet community needs.
- Dedicating funding for strategic advocacy actions and engaging stakeholders at multiple levels to act as champions for project expansion.
- Proceeding with caution before expanding—waiting until data have been analyzed and financial support is available.
At the conclusion of the pilot project, monitoring data were reviewed and key informant interviews were undertaken with a variety of stakeholders. The team hoped to gain insight about what worked well and what did not, so they could plan a minimum package of what HoPE interventions would include and how implementation can be further simplified.
Specific lessons that emerged from this project include:
- Ongoing, meaningful stakeholder engagement will significantly shape the design and implementation of project actions.
- Multi-sectoral projects are complex and striving for simplicity in interventions is challenging.
- Projects that address a strongly felt need in the community often experience pressure for scale up before data have been reviewed or funding has been secured.
- Until interventions are fully developed and tested, some areas of attention will not be fully anticipated at the start of the project or at the time of proposal writing. This may make securing funding difficult.
Designing and implementing a project in ways that look ahead to future scaling up and sustainability means being thoughtful about who is engaged in the process. Collaborating with governments as partners and establishing long-term project buy-in even during a pilot phase differs from many typical projects, but taking these steps has allowed the HoPE-LVB project to enhance the local relevance of proposed actions and increased the likelihood of their sustainability and scalability.
1. Ghiron, L., et al. 2014. “Beginning with sustainable scale up in mind: initial results from a population, health and environment project in East Africa.” Reproductive Health Matters 22(43):84-92
2. Expand Net, World Health Organization. Beginning with the end in mind: planning pilot projects and other programmatic research for successful scaling up. Geneva:WHO; 2012