David Ogden, EHP/Nicaragua Chief of Party, congratulates Swaleh Karanja, Executive Director of Save the Children USA/Nicaragua, whose organization was selected as one of five grantees to participate in the Water and Sanitation Rehabilitation Project.

Back issues of What's New: January 2000 at EHP   February 2000 at EHP March 2000 at EHP

EHP is providing technical assistance to USAID Nicaragua�s disaster relief and rehabilitation program in the wake of Hurricane Mitch. EHP�s task is to coordinate a fast-track project to reconstruct rural water and sanitation systems in areas hard hit by the storm. The work of reconstruction will be implemented by local PVOs with full participation of communities.  The first implementation hurdle has been cleared with the award in late March of $5.0 million in grants to five local PVOs.  (For more information about this project, see January 2000 and February 2000 at EHP.)

Richard Adams, USAID/Nicaragua Project Officer (second from right), attended all grant signing events; his colleague, Earle Lawrence, Health Development Officer (far right), was also on hand when David A. Ogden and Nakor'd Garc�a, Subdirector of Alistar/Nicaragua, signed the grant agreement.

Anthony Stahl, Executive Director of ADRA (Adventist Development and Relief Agency), at the signing event.

Nicolas Berlanga of Acci�n Contra El Hambre (Action Against Hunger) at the signing event.

The signing with Plan International was carried out via express mail.

Grant proposals were evaluated and scored by EHP/Nicaragua, with recommendations being reviewed by the USAID Mission and ENACAL-GAR (the Nicaragua rural water and sanitation agency) using specific review criteria. Interested PVOs had a chance to discuss the criteria in November 1999 during the project start-up workshop. The top scoring proposals were selected; no other grants could be awarded because of funding limits.

March 7-9, EHP held a workshop on behavior change and monitoring and evaluation for the PVO finalists. Two key workshop presenters, EHP Project Director, Dr. O. Massee Bateman (right) and Dr. Vilma L�pez, the staff health specialist for the project, are shown here with Chief of Party David A. Ogden.

Workshop participants included representatives from the five PVOs plus other sector agencies. They exchanged ideas about their experience with behavior change and monitoring and evaluation and agreed to work collaboratively to build on one another�s strengths.  Several participants pose for a group shot: left to right, Bayardo G�mez (Acci�n Contra El Hambre), Damarys Zepeda (ENACAL), Vivian Siervo (EHP/Nicaragua), Mary Luz Duss�n (ProSalud), Janet Meza (Plan International), and Jeny Saenz (Save the Children).

All grantees are committed to including hygiene behavioral change as part of their work in communities. Research has clearly shown that water and sanitation infrastructure alone do not have a great impact on diarrheal disease reduction unless they are accompanied by health-enhancing behaviors, such as hand washing at specific times, safe water storage, safe disposal of babies' feces, consistent latrine use for all family members, etc.

The EHP web site will provide monthly updates on this ambitious project, based on reports received from the EHP project office in Managua. The project�s seven staff members pose outside the office, left to right,  Vilma L�pez, Olmedo Altamirano, Vivian Siervo, Nydia Betanco, David A. Ogden, William D�az, and Ligia Perez.

Communities around Two Environmental Corridors in Madagascar
To Be Site of Integrated Health/Population-Environment Activities

EHP is engaged in designing a new field activity in Madagascar in one of its key program areas: integrating health/population and environment programs. The activity, now known as the Integrated Programs Initiative (IPI), looks for synergies and improved sustainability through linking community-based interventions in natural resource management, health, and family planning. It has three objectives:

• To develop and test model approaches for linking natural resource management, health, and family planning activities on the community level.
• To evaluate the effectiveness of such linked approaches and document lessons learned.
• To implement the activities in a way that relies on existing resources and programs and strengthens local capacity.

EHP Senior Technical Director, Eckhard Kleinau, EHP consultant Steve Denison, Matthew Lynch, Office of Health and Nutrition, and Mai Hijazi, Office of Population, returned from a planning trip in mid-March. While in country they identified over ten organizations working in the buffer zones of two "environmental corridors" or habitats that play a critical role in biodiversity, water supply, and food security. (Click here for a map of the project areas.)  The organizations enthusiastically backed the IPI concept and pledged to provide in-kind support to the IPI. The partners are the Madagascar National Population Office, Landscape Development Interventions (LDI), Private Agencies Collaborating Together (PACT), John Snow Inc. (JSI), Linkages, Measure Communication, Madagascar Institute for the Conservation of Tropical Environments (MICET), Adventist Development and Relief Agency (ADRA), Tany Meva Foundation, the Development Department of the Church of Jesus Christ in Madagascar (SAF/FJKM), Conservation International, and the World Wildlife Fund. In addition, the Michigan Population and Environment Fellow will work with the Malagasy IPI Coordinator to carry out the preliminary work of launching IPI.

EHP will provide a long-term advisor in Antananarivo (the capital city) to coordinate the activity and technical assistance in monitoring and evaluation. EHP also has the means to provide micro-grants to fund small-scale integrated community-based projects.

The two pairs of photographs below illustrate IPI�s basic concept. Evidence that changes in the environment affect human health is well established. IPI takes a practical approach and addresses links among projects to increase the access to health and environmental interventions significantly while relying mainly on existing project resources. An obvious one is the link between improved food security and health in communities where half of all children are malnourished. How can such links be strengthened? Farmers that are educated in increasing crop variety through market gardens should know about the role of vegetables and livestock in improving the diet of women and children. Likewise, women that receive education in nutrition at a nearby community health center should be aware where to get hands-on instructions about improved agriculture. Alternative farming methods have to be non-destructive, because deleterious agricultural practices, such as deforestation through slashing and burning (that may result from charcoal production), evidently lead to environmental problems such as soil erosion. This in turn affects the availability and quality of drinking water, which has clear health implications. And conversely, the lack of family planning services and high birth rates exert pressure on the environment that leads to losses of at least 100,000 hectares of rain forest every year. Where the trees are gone biodiversity is threatened, and with it the survival of unique animal species and invaluable medicinal plants.  A still unresolved issue is how to achieve greater involvement of women in agriculture and environment activities and men in family planning.

The EHP web site will continue to report on the IPI as it takes shape.

Mapping Reveals Malaria Risk Areas in Mozambique�s Capital City

EHP is assisting the Department of Health Services within the Mozambique Ministry of Health to improve data management, analysis, and mapping capabilities in support of the country�s malaria control program. To date, EHP-coordinated activities have focused on developing basic skills among participants, gathering and organizing data, and defining data collection protocols and database structures. Personnel have applied new skills by investigating patterns of malaria occurrence in the capital city, Maputo.

These activities are beginning to change the way the Ministry of Health uses data to make decisions about malaria control activities. A computer-generated map of malaria cases in Maputo was assembled using data from four hospitals. The map revealed that a large proportion of malaria cases in the city arises from a relatively small area bordered by wet lowlands. (Click here to see the malaria map produced.)  Given this information, the ministry has become interested in exploring the potential for using environmental management to reduce vector populations in the affected area, but the nature of such actions cannot be decided until basic entomological surveys are conducted in the high-incidence areas. As the investigation proceeds, other areas of concentrated occurrence may also be identified.

The EHP local staff have also been called upon to help the Ministry of Health track the rising number of cholera cases following the disastrous storms of January-February. The maps dramatically portray the increase in cholera cases between February 2000 and March 2000.  This and other information is being provided to various government ministries and relief agencies to support their flood relief activities.