Population, Health, and Environment

 

Welcome to the programmatic area on population, health, and environment (PHE) within MEASURE Evaluation’s Family Planning and Reproductive Health Indicators Database. This is one of the subareas found in the health service integration section of the database. All indicators for this area include a definition, data requirements, data source(s), purpose, issues and—if relevant—gender implications. PHE projects acknowledge and address the complex connections between humans, their health, and their environment. With the underlying philosophy being fundamentally one of integration, the key objective of these projects is to simultaneously improve access to health services while also helping communities manage their natural resources in ways that improve their health and livelihoods and conserve the critical ecosystems they depend upon. The key PHE indicators presented here do not focus specifically on any one area (population, health, or the environment), but rather address the integrated aspect of PHE programming and the effort to communicate and foster that integration. Key indicators to monitor and evaluate PHE can be found in the links at left.   Full Text Population, health and environment (PHE) projects acknowledge and address the complex connections between humans, their health, and their environment.  With the underlying philosophy being fundamentally one of integration, the key objective of these projects is to simultaneously improve access to health services while also helping communities manage their natural resources in ways that improve their health and livelihoods and conserve the critical ecosystems they depend upon. However, on the ground, PHE projects can look very different depending on the local interactions among population dynamics, human health problems, and the threats to local environmental conditions. The PHE approach to development has been applied at all levels—from the community to the national level, involving field operations to policy reform—in many regions of the world. What is common among the different PHE projects and programs is recognition that human populations can be one of the major threats to the environment they inhabit, that human health is inextricably linked to the environment, and that it is more effective to work across the human health and environment sectors than to pursue their interventions in isolation. Conservation and natural resource management organizations also believe that they can build more rapport with local communities by facilitating the delivery of needed health services. Health organizations find they are better able to reach underserved communities in remote areas by partnering with environmental organizations that are already established in those communities. By addressing basic health care problems in remote communities, who often have limited to no access to health services, PHE projects can also meet communities’ felt needs and improve their commitment to well-managed natural resources. When family planning information and services are widely available and accessible, couples are better able to achieve their desired family size. This not only directly impacts the well being of families, but also contributes to better management and conservation of natural resources and eases population pressures on local ecosystems.  Because there is significant diversity in how PHE projects are implemented on the ground, project designers and managers have to be creative in how they decide to conceptualize the linkages in their project sites between humans, their health, and their environment; and how they decide to program to these conceptual linkages. The key PHE indicators presented here speak to the USAID Global Health Initiative (GHI) principle of strategic coordination, integration, and partnerships to maximize benefits and increase impact by working across sectors.  They do not focus specifically on any one area (population, health, or the environment), but rather address the integrated aspect of PHE programming and the effort to communicate and foster that integration. ____________ References: Heather D’Agnes, preface to “A Guide for Monitoring and Evaluating Population-Health-Environment Programs.” USAID and MEASURE Evaluation, 2007. “Environmental Health at USAID”, accessed February 1, 2011, http://www.ehproject.org/phe/phe.html

Number of linked messages/materials created

Definition:

Each new communication material, such as an advertisement, video, or educational book, counts as a “created” message.  Materials that demonstrate and educate about the connections between population, health, and environment are considered linked messages.

Data Requirements:

Verification (typically on a quarterly basis) that a message has been created that examines a linkage between better human health and environmental quality. 

Data Sources:

Project records

Purpose:

Population-health-environment (PHE) programs often create messages to communicate PHE linkages.  This process indicator is meant to capture the creation of those messages that are cross-sectoral and are meant to communicate the interdependence of human health and the natural environment.

Issue(s):

Determining whether the message is linked could be subjective. This indicator does not give information about whether the linked messages were adopted, disseminated, or where they appeared. The indicator does not show whether the messages were clear and of high quality, or whether they reached the target audiences.

References:

Finn T. “A Guide for Monitoring and Evaluating Population-Health-Environment Programs.” USAID and MEASURE Evaluation, 2007.

Number of instances of population, health, or environment organizations addressing non-traditional audiences

Definition:

“Addressing” can include meetings, publications, coalitions, conferences, brochures, etc. Instances should be listed and described according to which PHE sector addressed a different sector or sectors, and on what topics (i.e., sector-specific or integration). Non-traditional audience means an audience that is in another sector from the one in which the addressee typically works.

Data Requirements:

Program or project records that systematically track instances of involvement and identify the audiences

Data Sources:

Project records, secondary records.

Purpose:

Using clearly defined terms in advance can reduce bias in collecting this indicator. When those addressing the audience work in a multi-sectoral setting or when the audience is multi-sectoral, this indicator may not give significant information. Its goal is to collect information about audiences being addressed by organizations that have not traditionally worked in a multi-sectoral setting.

Issue(s):

This is only a measure of the number of instances that the program

or project addresses non-traditional audiences. This indicator does not give information on the topics covered. It is easy to collect as long as project records have a systematic form of recording the instances in which the program or project is involved.

Number of instances of organizations facilitating access to services outside of their traditional sectors

Definition:

This indicator aims to capture instances where organizations implement a specific activity or group of activities outside their traditional sectors.  It targets population-health-environment (PHE) project implementation models where an organization that traditionally works in one sector (i.e., population, health, or environment) either works with an organization of a different sector or directly implements services traditionally provided by a different sector.

Data Requirements:

Record of the number of times an organization has facilitated access to a population, health, or environment service outside of its traditional sector

Data Sources:

Project records, secondary records.

Purpose:

The provision of health services is a new technical area for most employees of conservation organizations, and working with conservation organizations to provide health services is new to public health organizations. When one organization facilitates access to a service outside of its traditional sector, it is accepting or promoting an integrated approach to responding to community needs.  This is a proxy indicator for organization’s effort to participate in multi-sectoral or integrated projects.

 

Some organizations already provide services across sectors as part of their mission or established programs. The goal of this indicator is to capture those organizations

that make new or increased efforts to facilitate access to other sector services to communities outside of the longstanding tradition of their organization. This instance may be a single event or may be described once but comprising multiple activities/events in the context of a larger effort.

Issue(s):

This indicator does not measure the quality of the facilitation of services or what the access to services outside of their traditional sector entailed.

Percent of communities in target/project areas receiving all three PHE elements

Definition:

All three elements means that a community receives at least one service from each of the population, health, and environment (PHE) sectors from the same project in the same municipality or township over a defined period of time (generally quarterly or annually).  Examples of services include: distribution of insecticide-treated bed nets, provision of family planning (FP) services, administration of the tetanus toxoid vaccine, skilled birth attendant training, enforcement of environment protection laws, planting of trees, etc.

 

This indicator is calculated as:

 

(Total number of communities that receive at least one service each from the PHE sectors/ Total number of communities where the program is implementing activities) x 100

Data Requirements:

Verification of number of communities that have received all three PHE elements.  Data should be disaggregated by target or project areas.

Data Sources:

Project records

Purpose:

This is meant to capture those projects that are integrating aspects of the project by providing FP, health, and conservation-related activities in one community. This encourages the community to learn about the linkages between human behavior and the environment, as well as the health of the environment as integral to human health.

 

Projects should determine in advance which activities fall under which category (population, health, or environment). If the services and activities are provided

on a regional or country level, the denominator (the total number of communities where the integrated project is working) should remain constant to provide a baseline. This means that this indicator should be measured after the project has started implementation in all of the target communities and then measured over time to account for the degree to which each community is receiving all three elements.

Issue(s):

This indicator does not measure the quality of services provided or whether the services provided for each sector are consistent across all communities. In some cases, where there is a community-driven response for selection of activities, the ability of the project to provide at least one activity from all three sectors may be limited (according to community priorities and desires for services).

References:

Finn T. “A Guide for Monitoring and Evaluating Population-Health-Environment Programs.” USAID and MEASURE Evaluation, 2007.

Number of enabling local ordinances/policies supporting PHE

Definition:

An enabling policy refers to a policy that promotes integrated municipal and/or regional plans linking human and ecosystem health. This could be on a variety of topics or technical areas involving forests or marine ecosystems and different issues that enhance the quality of human life. The exact definition of “enabling” will differ by region, according to local ecosystem and community needs.

Data Requirements:

Evidence of ordinance, policy, or law.  Supporting documentation may include the ordinance, policy, or law itself, where or by whom it was issued or published, and an explanation of how it supports PHE integration.

Data Sources:

Secondary records (laws).

Purpose:

Some PHE programs work toward changing policy to improve the implementation of PHE projects. This helps to ensure local ownership and sustainability of PHE programs.  The adoption of ordinances and policies supporting PHE sometimes involve allocation of budgets from public sources for integration of services and activities.  Achieving enabling ordinances/policies is a strong indication that elements in local, regional, and/or national government are supportive of PHE integration.

Issue(s):

While this indicator gives information on increased willingness of officials to codify integration, it does not indicate whether there was a budget allotted for activities or service provision or whether any other action was taken in the community. However, most legislative processes involve long review and public debate and should be a good indication of the governmental commitment to integrating the locality/country approach to development.

 

Permission may be needed to research and track laws of another country or in a local setting. Strictly adhering to a predetermined definition of what exactly is an enabling ordinance or policy is important for consistency in collecting this indicator. Ordinances and policies generally take significant effort and time investment and may take years to achieve. If the ordinance also requires a budget allocation, projects could track the amount of funding appropriated connected with the PHE ordinance or policy.

References:

Finn T. “A Guide for Monitoring and Evaluating Population-Health-Environment Programs.” USAID and MEASURE Evaluation, 2007.