(September 2006) How can isolated fishing communities reverse the double-edged sword of declining fisheries and growing families? And how can upland farmers better feed their families without destroying forest cover and increasing erosion?

An assessment that I led for the David and Lucile Packard Foundation and the U.S. Agency for International Development (USAID) found that an integrated approach to these issues that simultaneously addresses conservation, family planning, and health needs is providing successful models for action from the Philippines to Madagascar.

A Push Forward, Then a Setback

The early years of the new millennium were good ones for population-environment (PE) and population-health-environment (PHE) initiatives—led by the creation in 2000 of the Packard Foundation’s Population-Environment Initiative and by the initiation in 2002 of USAID’s Population-Health-Environment Program.

Both initiatives allocated money for family planning and reproductive health programs in areas where population growth threatened biodiversity or endangered species. Both programs funded community-based field projects that designed integrated methodologies to simultaneously achieve goals in various sectors. These programs built upon the experiences of a modest number of PE field projects that had been funded in the late 1980s by the Summit, Hewlett, MacArthur, and Turner foundations.

The Packard and USAID programs gave PE a timely push forward in countries such as the Philippines and Madagascar, supporting enough new pilot projects to allow sound judgment of whether this integrated approach would be successful in a variety of ecosystems and in different regions of the world. By 2003, 11 field projects were underway from Asia to Africa to Latin America, providing PE services in approximately 45 communities.

But the stock market collapse of 2000-2003 intervened. The resulting major reduction in investment resources led several foundations, including Packard, to reduce or eliminate funding for PE activities.

While USAID has continued funding PHE programs, the gradual reduction and eventual termination of Packard’s PE Initiative in 2005 meant that the overall worldwide level of PE funding in 2005 was substantially lower than in 2000. Many promising programs are in danger of shutting down, and there are almost no new resources available to expand PE/PHE programs.

USAID and Packard Assessments

In 2005, the Packard Foundation board of directors called for a program assessment of its PE Initiative to determine what this $16.5 million program had accomplished. The initiative had supported field projects in the Philippines, southern Mexico, Tanzania, and Madagascar that integrated conservation and family planning at community levels within selected areas of high biodiversity. Through separate grants, the Packard Foundation program also had supported PE leadership development and increased advocacy for and awareness of PE linkages.

USAID, which had cofunded some of the Packard projects and separately funded others, asked that its projects in the Philippines and Madagascar be included in the assessment. USAID also focused its PHE projects on biodiversity hotspots—often in national parks and protected areas—focusing on the communities that live in and around them. These field projects were commonly in regions that had population, health, and conservation indicators worse than the national or even provincial averages.

This assessment examined 11 field projects and 45 field sites and was equivalent to an evaluation of the “first generation” of PE and PHE field projects. In addition to the traditional program evaluation topics—whether the program funds were used well and the projects successful and sustainable—we also tried to find evidence to answer the major underlying question raised by critics of PE/PHE programs:

  • Do integrated PE/PHE projects have better results than “stand-alone” population and “stand-alone” environment projects?
  • Is there really any “value added” to using a two- or three-sector integrated approach?

Projects Were Inexpensive and Met Most Objectives Within 36 Months

This assessment found that almost all of these projects met most or all of their anticipated objectives within only nine to 36 months. The projects were also inexpensive, costing between $5 and $9 per beneficiary per year. And operational research showed that integrated projects also produced reproductive health and environmental outcomes superior to those of single-sector interventions.

A great deal has been learned about the details of PE projects, how they are best planned and best managed, and where they are most appropriate. The assessment found that the integrated approach has a strong appeal to clients (who do not compartmentalize their lives in single sectors); to local political leaders; and to implementing nongovernmental organizations (NGOs).

Other major conclusions included:

  • Inexpensive community mobilization techniques can mobilize rural communities and provide significant program results within one to two years. For example, the Champion Community approach in Madagascar, which is based on locally defined needs and encourages competition among communities, mobilized strong community participation in 10 sites to achieve clearly defined, multisectoral targets within a one-year period.
  • Health- and environment-based NGOs can adapt themselves to successfully implement two-sector (PE) or three-sector (PE plus health) community initiatives. In Madagascar, the Madagascar Green and Health Communities program worked primarily through health NGOs that learned to provide environmental services. In the Philippines, PATH Foundation Inc. worked primarily through environmental NGOs that learned to provide family planning and health services.
  • The model used for program integration (whether it’s one NGO that does both P&E with the same staff or with different staff members, or two NGOs working in coordinated fashion) is less important to project success than a series of other factors—experience, leadership, acceptance of the PE concept, and acceptability within the community.

Satisfying the Skeptics?

According to the results of both complex operational research and the views of NGO practitioners, the value added by these PE and PHE programs over single-sector programs was substantial and varied. (The operational research compared results from integrated program sites with sites where either just population or just environment activities were carried out.) Additional value could clearly be identified in three areas: family planning and health; coastal resource management (CRM) and natural-resource management (NRM) efforts; and program cost-savings and efficiencies.

  • Integrated PE projects bring several major advantages to family planning efforts: greater access to men, greater access to adolescent boys, and positive changes in the community perception of women and in women’s self-perception when they have access to and control of money and credit.
  • Family planning also benefits when it is packaged with the quickly perceived effects of health interventions, such as immunization and improved water quality.
  • PE projects add value to environment/conservation efforts via greater female involvement in CRM and NRM activities and organizations; increased participation of adolescents of both sexes; and providing an “entry point” for integrated projects to quickly and visibly respond to the community’s priority demands (often in health) and gradually gain its trust.
  • The inclusion of a microcredit component as part of PE programs appears to encourage even stronger community involvement in CRM and NRM activities and may increase these initiatives’ impact.
  • In programmatic terms, PE projects are typically both cost-efficient and cost-effective. A large number of NGOs have demonstrated that they can successfully implement integrated programs with the positive effects of expanding target audiences, reducing operating expenses, and fostering community goodwill and trust.

Future Directions for Integrated Initiatives

The projects reviewed have demonstrated that, based on their personal experiences, field-based practitioners and political leaders typically become strong advocates for the integrated PE approach. However, most donors and national governments are not familiar with the positive results of PE programs and, even if they are, still often find traditional sector-specific programming to be more bureaucratically convenient than integrated programs.

If integrated PE programming is to thrive rather than wither after its trial period, two key actions appear to be needed: aggressive advocacy and dissemination campaigns that highlight the successes of PE projects, and successful implementation of a “scaled-up” PE program that can affect the lives of a much larger target audience while becoming financially self-sustaining.

The Philippines provides the best opportunity for this scaling up to occur, and the Population Reference Bureau’s efforts to expand the application of PHE tools there as well as to increase Filipino program managers and policymakers’ knowledge and understanding of PE dynamics have an important role to play in these efforts.

The lessons learned from the Packard and USAID PE programs in the Philippines and Madagascar provide insights and guidance for program expansion in those countries and for new PE programs in other countries. A number of opportunities exist for the evolution of PE programs.

  • The government decentralization occurring in many developing countries may provide the opportunity to “break through” donor and central-government reticence to support integrated programs. Block grants are increasingly being provided by national governments and donors to decentralized government units. These “program” funds typically support the unit’s development plan, which could be designed on an integrated rather than a sectoral basis via support from community advocates and local NGOs.
  • Biodiversity “hotspots” and protected-area buffer zones are not the only areas where PE may be appropriate. Filipino PE proponents are experimenting with PE as a framework for disaster mitigation projects and urban-slum health and sanitation efforts.
  • A wide variety of PE-type integrated programs will need to be tailored to the particular needs of local populations. For example, HIV/AIDS has been added to some PE programs in South Africa. In upland Madagascar, improved water supply for agriculture and hygiene has been a key factor in attracting communities to participate in PE projects. The concept of integrated programs, including the key elements of family planning and natural-resource management, should be viewed as a concept that will evolve into different forms in differing settings.

Overall, the results of the first generation of PE field projects strongly suggest that an integrated approach to community environment and population/health issues can provide successful outcomes even in remote areas in a relatively short period of time and at low cost.

And despite the difficulties in breaking away from “stovepipe” funding and the institutional aversion to integrated projects, donors and host governments alike should take a closer look at the many advantages and synergies provided by integrated PE projects. They might well agree with the assessment’s conclusions that the time is ripe for scaling up these successful models to meet the livelihood and food-security needs of low-income populations.

John Pielemeier is an independent consultant who has led evaluations for environment, health, and integrated programs for a variety of funding agencies. He previously served in Africa, Latin America, and Asia with the Peace Corps and USAID.