Sustainability from the Ground Up - Working on Reproductive Health and the Environment in Communities

Robert Engelman

Involving Governments

In the mid-1990s, Population Action International began convening meetings in Washington on the reproductive health and natural resource conservation linkage in communities. These gatherings took place roughly once a year, initially informally but by the early 2000s more ambitious and engaging more speakers and attendees. (See, for example, the 2001 conference report, Planting Seeds, Meeting Needs: New Partnerships for Community-Based Resource Conservation and Reproductive Health.) In 1998, after staff visits to projects integrating reproductive health and natural resource conservation in Nepal, India, the Philippines, Uganda, Mali and Ecuador, PAI published Plan and Conserve: A Source Book on Linking Population and Environmental Services in Communities. The report documented the history of thinking about integration in community development, and the community-based population and environment concept itself. And it profiled 42 such projects in developing countries — beginning a published, and later a Web-based, inventory of qualifying projects that continued until recently. National organizations such as the American Public Health Association and private and public donors took an increasing interest in the idea of sustainable community development based on an integration of environmental and reproductive health concerns.

A year after publication of Plan and Conserve, Engelman, then PAI’s Vice President for Research, served as a non-governmental member of the U.S. delegation to a conference convened by the General Assembly of the United Nations to review the five years of progress that followed the 1994 International Conference on Population and Development. Under the leadership of Julia Taft, a former President of InterAction then serving as U.S. Assistant Secretary of State for Population, Refugees and Migration, the U.S. delegation was active nations to craft the July, 1999, report of a committee of the General Assembly that emerged from the conference. The statement urged governments to “develop and expand integrated community-based approaches to sustainable development.”

Already the governments of three developing countries were beginning to experiment with such approaches, including the linking of environmental activities in primary health and family planning clinics (Mexico) and various levels of health ministry involvement, including with family planning provision, in governmental efforts on the environment (Uganda and Madagascar). Some U.S. private donors, notably the Summit Foundation and the David and Lucile Packard Foundation, were now funding significant efforts not only at documentation and communication (in the case of PAI) but actual implementation of integrated projects.

A weakness in such implementation, however, soon began to concern both governments and private donors: How could anyone know that connecting reproductive health services with activities aimed at improving environmental sustainability actually improved either human health or the natural environment? Or, even if they did, that the linkage was more cost-effective than traditional development efforts that worked to accomplish comparable results without integrating or even linking such disparate fields and activities? Success stories were abundant, thanks in large part to PAI’s documentation efforts. But could success be measured, replicated, and scaled up, so that integrated projects began to leverage environmental and health improvements not just in a few hundred communities, but in hundreds of thousands?

The questions were hard to answer, and though there has been progress in measurement, monitoring, and evaluation, the questions linger still. It has proven hard to development measurable indicators of effort and outcome in the process of integration. PAI mounted an early effort as early as the United Nations’ Cairo +5 conference, with the 1999 publication of Forging the Link: Emerging Accounts of Population and Environment Work in Communities. Three years later, the PAI conference on community-based population and environment — Planting Seeds, Meeting Needs 2002: Measuring Progress in Community-Based Conservation and Reproductive Health — focused on the all-important issue of measurable evaluation of this linkage to see whether it could hold its own in an increasingly challenging funding environment for international reproductive health, development and environmental conservation. This effort has since then been taken up by USAID — as part of a broader supporting role for PHE, and at a critical time.