Authored by Evans A.K. Miriti

Communities in and around the Lake Victoria Basin experience a number of interconnected challenges, including dependence on diminishing natural resources, persistent poverty, food insecurity, poor sexual and reproductive health outcomes and inaccessible health services. At the same time, the ecosystem itself is being overused and destroyed. To address these related  challenges and foster healthy, engaged communities, Pathfinder International is advancing an integrated population, health, and environment (PHE) initiative called Health of People and Environment— Lake Victoria Basin (HoPE–LVB), in partnership with several environmental and health sector partners in Uganda, Kenya, and the US.(1) The HoPE-LVB project is being implemented in a combination of island, lakeshore, and inland sites in Uganda and Kenya. 

Applying a systematic scaling-up approach of “beginning with the end in mind," (2) the HoPE-LVB project has relied on advocacy to ensure project success and to create innovation and change across multiple-sectors and multiple tiers of organization. HoPE set out not only to ensure sustainable capacity would remain in the communities it served, but also to ensure that its efforts would yield supportive changes all the way up to the national and even regional East Africa levels. This brief discusses the project’s experience with advocacy, and offers lessons for other implementers on how to lay the groundwork to sustain integrated PHE projects at the sub-national level in Kenya.

Population and Environmental Dynamics within Homa Bay County, Kenya

Located along the shores of Lake Victoria, Homa Bay County is characterized by high population growth and high population density (currently at around 303 people per square mile, compared to the national average of 65.3). Homa Bay’s rapid population growth is largely attributed to high fertility rates, with an average of 5.2 children per woman. Attempts to address the rapid growth, through increasing access and quality of family planning services, is showing steady results; however, more needs to be done to reduce the multiple barriers to family planning use. 

The HoPE-LVB Project

To address these intertwined challenges, Pathfinder International, along with partner organizations, piloted an integrated Population, Health, and Environment project—Health of People and Environment in Lake Victoria Basin (HoPE-LVB) in the County. HoPE-LVB began implementation in 2012 in Uganda and Kenya with the goal of designing and testing a scalable model for integrating efforts to strengthen community and facility-based family planning services with maternal and child mortality prevention, environmental conservation, and environmentally sustainable livelihoods. In a departure from the prevailing paradigm of integrated PHE projects, HoPE-LVB sought to lay groundwork for future scale up of tested and successful interventions by: mobilizing and building the capacity of existing institutions and their personnel, as well as community structures; involving potential future implementation partners early and throughout the process; incorporating strong advocacy components; and maintaining focus on sustainability. 

Building Champions for Sustainability

With guidance from the community, the HoPE-LVB project has identified and built the capacity of community groups, creating a pool of multipurpose resource persons who serve as trainers of various project activities. In addition, the project developed a team of PHE champions comprised of local and county leaders who are deemed influential within and beyond their communities, to lead advocacy efforts. The champions were trained in the PHE approach through multiple briefings and a training curriculum, complete with take-home message kits and some training on group facilitation. Follow-up support was provided to ensure they were well-equipped and could advocate for the PHE integration agenda. The champions were tasked with spreading the word about the benefits of PHE, and promoting the integrated approach among communities and other development projects. Over time, the project has developed photo: over 200 community and County-level PHE champions. 

HoPE-LVB also worked with county officials to form a steering committee tasked with promoting the PHE approach as a mechanism for sustainable development. The steering committee meets quarterly to review progress, share ideas, and set new targets. 

Together with the steering committee, the HoPE-LVB project identified potential stakeholders who could support PHE in the County’s integrated development plan, workplan and budget documents. The HoPE-LVB project then organize meetings to alert leaders to the benefits of the PHE approach with a call to action to integrate planning across multiple sectors. The project’s strong advocacy focus generated broad interest within various departments in the County, persuading some County directors to join the steering committee, as well as supporting implementation of the project. 

The HoPE-LVB project has had an equally close working relationship with other single sector organizations to advocate for issues arising across the three sectors of Population, Health and Environment. Some of the successes arising from these include: providing technical support and information during the development of the Homa Bay County Family Planning Strategy in collaboration with another Kenya sexual and reproductive health organization, K-MET, and reviewing and improving the County Environmental Action Plan in collaboration with the Kenya Forest Services and National Environmental Management Authority. 

After two years of project implementation, project monitoring data showed substantial increases in family planning uptake and facility-based deliveries in all supported health facilities, especially among young mothers aged 12–24 years, as compared to the baseline. The contraceptive method mix at health facilities was expanded to include long-acting methods such as implants, IUDs and tubal ligation, and for community-based distribution, condoms, pills and CycleBeads. Environmental conservation indicators improved as well, showing increased use of energy saving stoves, and improved sustainable agricultural, agroforestry and fishing practices. A key finding from the midterm review was that integrating family planning and environmental interventions yields additional value for each area while also improving gender relations and male PHE champions lead advocacy efforts within and beyond their communities. Establishment of a County-Level PHE Steering Committee HoPE-LVB worked with County-level officials to form a steering committee with terms of reference. The Committee was tasked with promoting the integrated Population, Health and Environment approach, as a mechanism for sustainable development, to all stakeholders, including the County government. Interviews conducted during the midterm review also revealed a more optimistic outlook for the future among communities, and a willingness to pass on their knowledge to neighboring communities. With this evidence, the steering committee scheduled a meeting with the Homa Bay County Governor, H.E. Cyprian Awiti. This meeting sought to share insights on the opportunities and added value that integrated PHE implementation would yield to the County. The Committee further challenged the Governor to consider setting up an office to oversee integrated PHE activities within the County. Though new, the Governor welcomed the approach, praising its impressive outcomes within such a short time. He further pledged his support whenever called upon. Subsequent actions from his office included appointing a County focal person for PHE, sharing his enthusiasm for PHE with visitors from Siaya County, where HoPE-LVB has expanded into, and working on including PHE deliverables into activities of various departments.