(November 2007) The integrated population-health-environment (PHE) approach to development recognizes the interconnectedness between people and their environment and supports cross-sectoral collaboration and coordination. As its name suggests, the approach places particular emphasis on the population, health, and environment sectors; however, the underlying philosophy is fundamentally one of integration. It can accommodate other sectors, such as agriculture and education, and can be successfully applied to a range of development goals, from poverty reduction to food security to gender equity.

The Population Reference Bureau coordinated a comparative study of population, health, and environment integration and cross-sectoral collaboration in East Africa. Teams from Ethiopia, Kenya, and Tanzania assessed the state of PHE integration in their respective countries, including identifying relevant stakeholders; assessing the policy environment for cross-sectoral collaboration; highlighting the most salient population, health, and environment issues; and describing the current state of integration among projects, programs, and policies.

Three policy briefs highlight this PHE approach in Ethiopia, Kenya, and Tanzania.

Ethiopia

"Integrating Population, Health, and Environment in Ethiopia" is based on the Ethiopia PHE assessment written by Dessalegn Rahmato, Yeraswork Admassie, and Yared Mekonnen in 2007. (PDF: 1.01MB)

The methods used to conduct the assessment in Ethiopia included a review of relevant government policies and project documents, key informant interviews, and focus group discussions. The Ethiopia PHE assessment was made possible with funding from the David and Lucile Packard Foundation.

Ethiopia's diverse cultural, religious, and linguistic heritage reflects its location at the crossroads of Africa and the Middle East. Some of the first human settlements arose in this region, which means that Ethiopians have interacted with their natural environment for millennia. The ox-plow system—the dominant form of agriculture in Ethiopia—arose in the highlands more than 2,000 years ago. The highlands are also home to moorland, grassland, and woodland habitat, which contain considerable biodiversity. Despite some species loss, Ethiopia still claims a wealth of natural resources, though it is increasingly under threat.

In recent decades, this ancient center of more than 100 ethnic groups has been known for recurrent famines, epidemics, and conflicts. However, policymakers within and outside Ethiopia are determined to break the cycle of food insecurity and poverty through sustained economic growth, while preserving the country's unique natural heritage. A development model that integrates population, health, and environment factors may be the best way to achieve these goals. A versatile development model that strives to integrate population and environment has been implemented in countries similar to Ethiopia in recent years, with encouraging results. Known as cross-sectoral or integrated population, health, and environment (PHE), this holistic approach has potential for application in Ethiopia and is compatible with the government's new poverty reduction strategy.

Kenya

"Integrating Population, Health, and Environment in Kenya" is based on the Kenya PHE assessment coordinated by the National Coordinating Agency for Population and Development (NCAPD) and conducted by the University of Nairobi and the Kenya PHE task force between October 2006 and April 2007. (PDF: 337KB)

The methods used to conduct the assessment in Kenya included a review of relevant government policies and project documents, key informant interviews, site household surveys, and focus group discussions. The Kenya PHE assessment was made possible with funding from the U.S. Agency for International Development (USAID).

Kenya faces tremendous development challenges in nearly all sectors: Poverty is endemic, deforestation is continuing, and infant mortality remains high. Still, most development efforts—whether by government or nongovernmental organizations—focus resources and expertise on one particular area, such as reforestation or improving maternal and child health, rather than integrating interrelated concerns into a holistic approach. While a number of policies and programs linking population, health, and environment concerns have been tried in Kenya, an assessment of the overall "state of integration" had not been undertaken until recently. The lessons from this assessment, undertaken by the National Coordinating Agency for Population and Development and the University of Nairobi, suggest that integrated programs require greater efforts in planning, coordination, and communication, but they can yield substantial rewards for communities and the environment, including reduced dependence on forest resources, greater food security, cleaner drinking water, and increased access to health services.

Tanzania

"Integrating Population, Health, and Environment in Tanzania" is based on the Tanzania PHE assessment written in 2007 by the late Dr. N.F. Madulu, formerly of the Institute of Resource Assessment/University of Dar es Salaam, and the members of the Tanzania PHE assessment team: Dr. Hussein Sosovele, IRA and World Wide Fund for Nature; Grace Lusiola, EngenderHealth; Joseph Kihaule, Vice President's Office (VPO-Environment); Arnold Mapinduzi, VPO-National Environmental Management Council; and Jamal Baruti, Lake Victoria Environmental Management Project.
(PDF: 961KB)

The methods used to conduct the assessment in Tanzania included a review of relevant policies, laws, and project documents; key informant interviews; and field visits to case study sites. The Tanzania PHE assessment was made possible with funding from the U.S. Agency for International Development (USAID).

The number of people, where they live, and how they live, all affect the condition of the environment. People alter the environment by clearing land for development, using natural resources, and producing wastes. Changes in environmental conditions, in turn, affect human health and well-being. Rural poverty, a high population growth rate, deforestation, and fresh water scarcity, for example, all pose challenges for policymakers in Tanzania and elsewhere in Africa. While links among population, health, and the environment are sometimes acknowledged in national-level policies and development strategies, most development efforts continue to employ a traditional sectoral approach, aligned with the division of government services and institutional structures. In doing so, opportunities for achieving superior results—in cost-effectiveness, programmatic and administrative efficiencies, and programmatic outcomes—by employing an integrated, holistic approach may be missed.