The number of people, where they live, and

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1 Makig the Lik SAUDI ARAB RED SEA ERITREA YEMEN P O P U L A T I O N R E F E R E N C E B U R E A U G DJIBOUTI SUDAN INTEGRATING POPULATION, HEALTH, AND ENVIRONMENT IN TANZANIA by Melissa Thaxto ETHIOPIA SOMALIA Box 1 The umber of people, where they live, ad how they live, all affect the coditio of the eviromet. People alter the eviromet by clearig lad for developmet, usig atural resources, ad producig wastes. Chages i evirometal coditios, i tur, affect huma health ad well-beig. Rural poverty, a high populatio growth rate, deforestatio, ad fresh water scarcity, for example, all pose challeges for policymakers i Tazaia ad elsewhere i Africa (see table, page 2). While liks amog populatio, health, ad the eviromet are sometimes ackowledged i atioal-level policies ad developmet strategies, most developmet efforts cotiue to employ a traditioal sectoral approach, aliged with the divisio of govermet services ad istitutioal structures. I doig so, opportuities for achievig superior results i cost-effectiveess, Tazaia Populatio, Health, ad Eviromet (PHE) Assessmet This policy brief is based o the Tazaia PHE Assessmet writte i 2007 by the late Dr. N.F. Madulu, formerly of the Istitute of Resource Assessmet (IRA)/Uiversity of Dar es Salaam ad the members of the Tazaia PHE Assessmet team: Dr. Hussei Sosovele, IRA ad World Wide Fud for Nature; Grace Lusiola, EgederHealth; Joseph Kihaule, Vice Presidet s Office (VPO-Eviromet); Arold Mapiduzi, VPO-Natioal Evirometal Maagemet Coucil (NEMC); ad Jamal Baruti, Lake Victoria Evirometal Maagemet Project (LVEMP). The Populatio Referece Bureau coordiated a comparative study of populatio, health, ad eviromet itegratio ad cross-sectoral collaboratio i East Africa. Teams from Ethiopia, Keya, ad Tazaia assessed the state of PHE itegratio i their respective coutries, icludig idetifyig relevat stakeholders; assessig the policy eviromet for cross-sectoral collaboratio; highlightig the most saliet populatio, health, ad eviromet issues; ad describig the curret state of itegratio amog projects, programs, ad policies. The methods used for this assessmet iclude a review of relevat policies, laws, ad project documets; key iformat iterviews; ad field visits to case study sites. The Tazaia PHE Assessmet was made possible with fudig from the U.S. Agecy for Iteratioal Developmet (USAID). RWANDA BURUNDI DEM. REP. OF CONGO UGANDA ZAMBIA KENYA TANZANIA MALAWI MOZAMBIQUE Dar es Salaam INDIAN OCEAN programmatic ad admiistrative efficiecies, ad programmatic outcomes by employig a itegrated, holistic approach may be missed. The Populatio, Health, ad Eviromet Approach to Developmet The populatio-health-eviromet (PHE) approach to developmet recogizes the itercoectios betwee people ad their eviromet ad supports cross-sectoral collaboratio ad coordiatio. As its ame suggests, the approach places particular emphasis o the populatio, health, ad eviromet sectors; however, the uderlyig philosophy is fudametally oe of itegratio. It ca accommodate other sectors, such as agriculture ad educatio, ad ca be successfully applied to a rage of developmet goals, from poverty reductio to food security to geder equity. To explore the opportuities for ad challeges of cross-sectoral collaboratio ad itegrated programmig i Tazaia, a assessmet of the overall state of itegratio was recetly udertake by a iterdiscipliary team led by the Istitute of Resource Assessmet at the Uiversity of Dar es Salaam (see Box 1). The assessmet showed that most but ot all of Tazaia s major sectoral policies recogize populatio-health-eviromet iterrelatioships, but that cross-sectoral MADAGA B R i g i g I f o r m a t i o t o D e c i s i o m a k e r s f o r G l o b a l E f f e c t i v e e s s

2 2 PRB Makig the Lik 2007 Childre walk alog the beach at Paje o the east coast of Zazibar. Populatio, Health, ad Eviromet Treds i Tazaia, 1990 to 2005 PHE Idicator Aroud 1990 Aroud 2005 % Chage Populatio size (millios) a Populatio growth rate (% per year) b 2.8 ( 78-88) 2.9 ( ) +3.6 Populatio desity (people per km2 of arable lad) b Total fertility rate (lifetime births per woma) c Moder cotraceptive use (% of curretly married wome usig moder methods) c ( 85-90) Life expectacy at birth (years) d 48.5 ( 90-95) 52.5 ( ) +1.9 Ifat deaths (< age 1) per 1,000 live births c Child deaths (< age 5) per 1,000 live births c Percet childre uder five stuted c Urba growth rate (aual percet) b Urbaizatio (percet urba of total pop.) b HIV prevalece e 6.8 Percet of populatio livig o less tha US$2 per day f 90 Percet rural populatio with access to improved water source (2002) f 62 Deforestatio (% lad forested) g Not available or ot applicable. Sources: a. [Tazaia] Plaig Commissio, Populatio Plaig Uit, Tazaia Populatio ad Developmet, accessed Oct. 16, b. Tazaia Populatio ad Housig Cesuses, 1978, 1988, 2002, Growth rates refer to periods ad c. Tazaia Demographic ad Health Surveys, 1991/92 ad 2004/05. d. UN Populatio Divisio, World Populatio Prospects ( accessed Oct. 17, 2007). e. Tazaia HIV/AIDS Status, accessed Oct. 17, f. C. Haub, World Populatio Data Sheet 2005 ad 2006 editios. g. Globalis Iteractive World Map: forested area, globalis.gvu.uu.edu, accessed Oct. 17, Lydia Marti, Courtesy of Photoshare collaboratio ad itegrated programmig at the district ad commuity levels are rare. 1 Tazaia s Developmet Policies Natioal Developmet Visio 2025 I 1999, Tazaia uveiled a ew developmet pla kow as the Natioal Developmet Visio 2025 (Visio 2025). This was the first ew logterm visio for Tazaia s atioal developmet sice the Arusha Declaratio of 1967, which established may of the coutry s log-stadig ideals such as atioal uity ad self-reliace. Visio 2025 is meat to update its earlier developmet pla to take ito accout curret ecoomic realities such as itese global market competitio. Visio 2025 sets out ambitious goals for high ad shared ecoomic growth, high-quality livelihoods, peace, stability ad uity, good goverace, high-quality educatio, ad iteratioal competitiveess. Visio 2025 aspires to trasform Tazaia from oe of the least-developed coutries to a middle-icome coutry by I additio, Visio 2025 stipulates that fast ecoomic growth will be pursued while reversig the curret degradatio of Tazaia s forests, fisheries, fresh water, soils, ad biodiversity, ad the accumulatio of hazardous substaces i the atio s air ad water. Natioal Strategy for Growth ad Reductio of Poverty The Natioal Strategy for Growth ad Reductio of Poverty (NSGRP, 2005) is a atioal framework that puts poverty reductio high o the coutry s developmet ageda. The NSGRP is based o the goals of Visio 2025, ad also takes ito accout the Milleium Developmet Goals (MDGs) to reduce poverty, huger, diseases, illiteracy, evirometal degradatio, ad discrimiatio agaist wome by The NSGRP calls for ehaced participatio of civil society, the private sector, ad local ad iteratioal parterships i social ad ecoomic developmet. The strategy outlies goals, targets, ad actios for three critical areas: ecoomic ad icome growth; improvemet of quality of life ad social well-beig; ad goverace ad accoutability. The ultimate goal is to achieve sustaied, broadbased, ad equitable ecoomic growth through commuity participatio, good goverace, ad local govermet actios.

3 PRB Itegratig Populatio, Health, ad Eviromet i Tazaia Agriculture remais the most importat sigle sector i the ecoomy i terms of its cotributio to gross domestic product (GDP), employmet provisio, ad poverty reductio. 2 Because the agricultural sector is expected to lead the ecoomy for years perhaps decades to come, it is the mai focus of the NSGRP. Eve with excellet average aual growth 5.8 percet aually betwee 2000 ad 2004 the agricultural sector lags behid the aual growth rate target of 10 percet by Competitiveess i agriculture is ad will cotiue to be challeged by a high AIDS prevalece. With a ifectio rate of 7 percet, AIDS is hiderig the productive capacities of households: It is estimated that betwee 1985 ad 2020, the disease will cost Tazaia 13 percet of its agricultural labor force. 4 The NSGRP idetifies eviromet as a crosscuttig theme ad recogizes that the majority of the populatio, especially i rural areas, deped o such atural resources as forests, fisheries, ad soils for their livelihoods. However, the NSGRP makes oly a passig referece to Tazaia s populatio growth. It does ot icorporate curret populatio treds ito the discussio o poverty, livelihoods, ad evirometal sustaiability. 5 Populatio Treds ad Policies Tazaia has udergoe profoud demographic chage sice its idepedece from Great Britai i The populatio has more tha tripled i less tha four decades from 12 millio i 1967 to 38 millio i Forty-four percet of Tazaia s populatio is uder age 15, makig Tazaias amog the yougest populatios i the world. 6 Populatio growth has bee cosistetly high over the past 40 years, ragig from 2.6 percet per year i 1967 to a all-time high of 3.2 percet i Sice the, growth gradually declied to 2.9 percet. 7 The coutry s populatio is projected to reach 70 millio by Wome s health status cotiues to be compromised by early ad repeated pregacies ad iadequate family plaig ad materal health care services, especially i rural areas. The Tazaia Demographic ad Health Surveys (DHS) idicate that the total fertility rate (lifetime births per woma) has stalled at 5.7, 9 with sigificat geographic disparities: The rate is 6.5 amog rural wome ad 3.5 amog urba wome. High fertility has implicatios for both ifat ad materal A Maasai ma i Arkaria, Tazaia, ad his five childre stad by the corral where the family keeps the valuable cattle that provide them with utritio. morbidity ad mortality. Data from the 2004/05 DHS show that pregacy-related mortality has ot improved over the past decade. 10 Durig the same time period, the proportio of births atteded by traied persoel has dropped from 44 percet i 1990 to 36 percet i Tazaia s Natioal Populatio Policy (NPP) was revised i 2006 to provide a framework for itegratig populatio variables i the developmet process. Cross-sectoral collaboratio is a hallmark of the revised policy, which states that the NPP will be implemeted through a multi-sectoral ad multi-dimesioal, itegrated approach. Furthermore, it recogizes the likages betwee populatio dyamics ad quality of life o oe had, ad eviromet protectio ad sustaiable developmet o the other. 11 Ulike the NSGRP, this policy makes a explicit lik betwee a high rate of populatio growth ad adverse impacts o various sectors of the ecoomy ad the coutry s eviromet. Amog its policy objectives are to ehace itegrated plaig, sustaiable use, ad maagemet of atural 2004 Peter Verbiscar-Brow, Courtesy of Photoshare

4 4 PRB Makig the Lik Ashley Piset, Courtesy of Photoshare Boys gathered for the Africa Medical ad Research Foudatio (AMREF) Boaza i Dar es Salaam, Tazaia. resources, alog with equitable allocatio of safe ad clea water i rural ad urba areas. 12 Health Malaria is the prime killer of childre i Tazaia, while HIV is the largest cause of adult mortality. HIV mortality was the mai reaso that life expectacy dropped from 52 years i the late 1980s to 49 years i the early 1990s. Recet data idicate substatial reductios i ifat ad uder-5 mortality 13 ad more modestly reduced rates of child malutritio, though the prevalece of stutig (chroic malutritio) i childre is still high at 38 percet. Life expectacy is estimated at 53 years i the period. More effective prevetio ad treatmet of malaria are likely to be importat cotributors to improved health, especially i reducig ifat ad uder-5 mortality. 14 Immuizatio rates have bee sustaied at a high level; however, substatial urba-rural, regioal, ad socioecoomic differeces remai. Rural poor childre are more likely tha their urba couterparts to die. Those who survive are more likely to be malourished. 15 Tazaia s urba populatio has grow at a rapid rate: more tha 6 percet per year for the past three decades. About 23 percet of the populatio ow lives i urba areas. Evirometal problems are serious i the uplaed, ofte cogested settlemets. There is lack of separatio betwee hazardous ad ohazardous idustrial, domestic, ad hospital waste, ad poor maagemet of ladfills. Idustrial effluet, oxious gases, ad vehicular exhausts pollute water i lakes, rivers, ad the ocea, ad the air i major urba ceters like Dar es Salaam, Mwaza, Arusha, ad Mbeya. Rapid urbaizatio has led to the depletio of forest resources oce foud aroud cities ad tows, icreased health hazards ad pollutio, ad itesified poverty. Nearly two-thirds of rural households i Tazaia have access to a improved source of drikig water. 16 More tha 90 per cet of households report havig toilet facilities mostly pit latries but the available data caot reveal whether these costitute basic saitatio. 17 There is a close lik betwee water supply, saitatio, hygiee practices, ad waterbore diseases such as cholera. Sice the first major cholera epidemic was reported i Rufiji i souther Tazaia i 1977, cholera has spread to most regios of the coutry ad has remaied a chroic problem ever sice. I some regios like Dar es Salaam, cholera ca be cosidered edemic. Diarrheal diseases such as cholera remai a major cause of child morbidity ad mortality, especially i urba areas. Over the past decade, access to health services has improved, especially i urba areas where private-sector ivolvemet i provisio of health services has developed. I rural areas, however, iadequate medicie supplies ad too few skilled health providers cotiue to plague the coutry s health sector. Improvemet i health will require greater cross-sectoral cooperatio ad coordiatio, especially betwee the Miistries of Educatio ad Culture; Agriculture ad Food Security; Water; ad Commuity Developmet, Wome, ad Childre, as well as ogovermetal orgaizatios. The 2003 Natioal Health Policy, alog with the Natioal Developmet Visio 2025, expad the scope of the health policy to iclude additioal aspects of huma health, such as food self-sufficiecy ad geder equality ad empowermet. Evirometal Challeges ad Resposes Biologically, Tazaia is oe of the wealthiest atios o Earth ad is a globally recogized atural heritage site. 18 Its diverse terrestrial, marie, ad freshwater ecosystems provide habitat for a wide array of plat ad aimal species. Home to the fifth-largest umber of species i Africa, Tazaia is a megadiversity coutry oe of a few atios that together accout for a disproportioately large percetage of global diversity.

5 PRB Itegratig Populatio, Health, ad Eviromet i Tazaia More tha 25 percet of Tazaia territory ejoys some level of protective status, icludig 15 percet set aside for biodiversity coservatio. About 50 percet of the total lad i Tazaia is covered by forests ad woodlad ad 40 percet by grasslad ad scrub. Oly 6 percet to 8 percet is cultivated. Tazaia s Participatory Poverty Assessmet (2002/03) cofirmed that most people i the coutry directly deped o the eviromet ot oly for icome-geeratig activities, but also to provide their basic eeds, such as food, buildig materials, fuelwood, ad medicie. 19 At the same time, the atural resource base cotiues to deteriorate as a result of deforestatio, overgrazig, overfishig, iappropriate farmig methods ad soil erosio, pollutio, ad biodiversity loss. 20 Iadequate accoutability ad goverace ad istitutioal weakesses have cotributed to losses from such atural resource reveue sources as forestry, fisheries, ad mierals. The govermet of Tazaia desiged ad implemeted evirometal policies aimed at improvig coservatio ad maagemet of atural resources ad people s well-beig; 21 raisig public awareess about evirometal issues ad the liks betwee eviromet ad livelihoods; ad promotig iteratioal cooperatio o the eviromet ageda. Tazaia s Natioal Evirometal Policy (1997) liks major evirometal problems to demographic factors ad outlies the eed for cross-sectoral collaboratio to achieve positive evirometal outcomes: Demographic factors ad treds have a syergetic relatioship with developmetal ad evirometal issues. I ay case, a rapidly growig populatio, eve with very low levels of cosumptio per capita, implies icreasig cosumptio i absolute terms. This affects the use of lad, water, eergy ad other atural resources. I view of the multiple likages ivolved, evirometal policy objectives o populatio must have a broader focus tha cotrollig umbers. Populatio programmes are more effective whe implemeted i the cotext of appropriate cross-sectoral policies [ad] withi a holistic view of developmet. The policy also directly recogizes public health issues ad the likages betwee water, saitatio, hygiee, ad waste disposal: Box 2 Populatio, Health, ad Eviromet Likages i Tazaia: The Experiece of the Usagu Plais Situated i Tazaia s Souther Highlads, the Usagu-Ihefu ecosystem cosists of the Great Ruaha River, a large atural etwork of wetlads, ad expases of fertile soil. Rich i biodiversity, the ecosystem supports a wide rage of ecoomic activities, such as hydropower, large-scale agriculture ad platatios, miig, tourism, ad small-scale farmig ad fishig. Recet years have witessed sigificat decreases i dry seaso flows i the Great Ruaha River, to the extet that log stretches of the river are completely dry for up to three moths a pheomeo ukow prior to Studies have cocluded that raifall ad stream ruoff from the highlads have ot chaged; rather, large-scale dry seaso water extractio from the Great Ruaha ad its tributaries by large rice irrigatio schemes, uplad tea ad coffee estates, exotic wood platatios, ad miig activities, ad the presece of more tha 30,000 small ladholders has profoudly altered the level ad flow of the river s water. The rich atural resource base of the area has provided substatial improvemets i the livelihoods of the local people, ad may immigrats have moved to the area sice the 1960s to take advatage of ecoomic opportuities available there. (The populatio growth rate i the Great Ruaha River catchmet was 4.8 percet betwee 1967 ad 1978, ad has sice dropped to 2.2 percet.) But with the decrease i the river s water volume, huma ad evirometal health have suffered. Rural poor commuities have lost a importat source of fresh water for drikig, domestic use, ad farmig; the establishmet of a game reserve to protect ecologically importat swamps ad wetlads has excluded livestock keepers from pricipal waterig ad grazig areas; the area has witessed icreased coflict betwee farmers ad livestock keepers over dwidlig water resources; decreased river water levels ad flows are affectig the breedig, survival, ad behavior of wildlife, with possible implicatios for wildlife tourism; ad, perhaps of most cocer to the govermet, decreased water flows have sigificat detrimetal effects o hydroelectric geeratio, possibly affectig atioal developmet over the log-term. By 2005/06, the problem had become so acute that the govermet, through the Vice-Presidet s Office, desiged ad implemeted a strategy to address water use ad water maagemet i the Usagu Plais. The strategy called for the immediate resettlemet of livestock owers ad their families. Because the process lacked commuity participatio ad was swiftly implemeted, a sigificat loss of livestock ad other properties resulted, alog with a disruptio i local livelihood activities. Despite large umbers of people ad livestock beig removed from the Usagu wetlads, dry seaso water flows i the Great Ruaha have ot stabilized. The case of the Usagu Plais demostrates the iextricable liks betwee populatio, health, ad eviromet, ad uderscores the importat role that both policy ad commuity participatio play i developmet plaig ad implemetatio. Referece: Ndalahwa Fausti Madulu et al., Populatio, Health, ad Eviromet Itegratio ad Cross-Sectoral Collaboratio i East Africa: Tazaia Coutry-Level Assessmet (2007), available from popref@prb.org.

6 6 PRB Makig the Lik 2007 Box 3 Spotlight o Miig To esure the log-term sustaiability of miig i Tazaia, the itegratio of evirometal ad social cocers ito the mieral developmet program is imperative. I the past, evirometal maagemet ad the eforcemet of the health ad safety regulatios i miig operatios were hidered by lack of coordiatio, isufficiet operatioal fuds, ad iadequate expertise. As a result, there has bee a icrease i the ucotrolled extractio of mierals icludig gold, diamods, base metals, ad gemstoes ad i the use of usafe miig methods. This has led to severe evirometal damage ad to appallig livig coditios i miig commuities. Miig camps are ofte plagued by poor saitatio, lack of safe drikig water, high cogestio, ad poor hygiee. To address these problems, govermet policy madates actios to reduce or elimiate the adverse evirometal effects of miig; improve health ad safety coditios i miig areas; ad address the special eeds of wome, childre, ad the local commuity. The Evirometal Maagemet Act No. 20 of 2004 provides directives regardig maagemet of miig areas, but the capacity to esure compliace ad implemet madates remais iadequate. Referece: Ndalahwa Fausti Madulu et al., Populatio, Health, ad Eviromet Itegratio ad Cross-Sectoral Collaboratio i East Africa: Tazaia Coutry-Level Assessmet (2007), available from The mai health objective of the Natioal Evirometal Policy is to protect public health i the broad sese of promotig huma well beig ad iformed participatio i primary evirometal care. The policy objectives to be pursued are: 1) Provisio of commuity eeds for evirometal ifrastructure, such as safe ad efficiet water supplies, sewage treatmet ad waste disposal services; ad 2) Promotio of other health-related programmes such as food hygiee, separatio of toxic/ hazardous wastes ad pollutio cotrol at the household level. Despite these policy statemets made a decade ago resource degradatio ad pollutio have cotiued to be major problems, due i part to the failure to implemet policy recommedatios ad madates. Moreover, the failure to adequately egage commuities i the plaig ad implemetatio of developmet schemes has hampered efforts to reverse evirometal degradatio ad improve health status at the local level (see Box 2, page 5). To overcome these shortcomigs, the govermet has reewed its efforts to stregthe huma ad istitutioal capacity for the effective implemetatio of evirometal policies. These efforts iclude the developmet of a Capacity Buildig Program (CBP) to implemet the Evirometal Maagemet Act (2004); the developmet of Eviromet Maistreamig Guidelies; ad the developmet ad itegratio of eviromet-specific idicators ito the NSGRP moitorig framework. Furthermore, the govermet with leadership from the Vice Presidet s Office (VPO) has take sigificat steps to maistream eviromet ito its poverty reductio process through a ew (2007) partership with the Uited Natios Eviromet Programme (UNEP). UNEP s Poverty ad Eviromet Project will cotribute to the VPO s efforts to maistream evirometal cocers ito the Natioal Strategy for Growth ad Reductio of Poverty. It will do this by improvig uderstadig of eviromet-poverty likages, stregtheig the govermet s capacity to implemet evirometal policy that beefits the poor, developig tools for the itegratio of eviromet ito developmet plas ad budget processes, ad icreasig effective participatio of stakeholders i eviromet ad developmet policymakig ad plaig pocesses. 22 Itegratig PHE i Tazaia: From Policy Madate to Commuity Actio Results from the PHE assessmet suggest that while some policies i Tazaia such as the Natioal Populatio Policy ad the Evirometal Policy recogize the liks amog populatio, health, ad eviromet issues, few policies have helped implemet practical itegrated programs at the village ad district levels (see Box 3). Natioal policies are geerally ot well kow or uderstood at the district ad grassroots levels. Poor awareess, i tur, has made it difficult for district-level plaers to tur atioal policies ito appropriate itervetios i the field. Visio 2025 admits past shortcomigs i implemetatio: Tazaias have developed a propesity to prepare ad proouce plas ad programmes, ad ambitios which are ot accompaied by effective implemetatio, moitorig ad evaluatio mechaisms. As a result, implemetatio has bee weak. 23 I a effort to empower local ad district govermets to tur policy directives ito commuity actios, the govermet is implemetig a decetralizatio program through its Local Govermet Reform Program. I effect, decetralizatio meas passig the powers, fuctios, resources, ad resposibilities from cetral govermet to local govermet, ad from higher levels of

7 PRB Itegratig Populatio, Health, ad Eviromet i Tazaia Box 4 Lake Tagayika Catchmet, Reforestatio, ad Educatio (TACARE) Project, Jae Goodall Istitute (JGI) Implemeted by the Jae Goodall Istitute i 1994, the TACARE Project works i 24 villages ad serves more tha 200,000 people i Kigoma regio, which borders the Gombe Natioal Park i wester Tazaia. The TACARE program aims to protect globally importat biodiversity ad promote the sustaiable use of atural resources at a ladscape scale through a commuity-cetered coservatio approach. To achieve its goal, the TACARE Project has developed a portfolio of activities that address commuity-idetified socioecoomic eeds ad promote coservatio ad sustaiable atural resource maagemet. These programs are i agriculture ad agro-forestry, family plaig ad reproductive health, water ad evirometal saitatio, HIV/AIDS, commuity developmet (microcredit, fuel-efficiet stoves, social ifrastructure), ad evirometal educatio. The TACARE Project has helped the commuities with which it works to obtai better access to health services, safe water, ad educatio through the costructio of dispesaries, sprig protectio structures, gravity water schemes, classrooms, ad vetilated improved pit (VIP) latries. TACARE also coducts regular coservatio outreach activities, providig traiig, support, ad supplies to farmers who adopt more evirometally sustaiable agricultural practices such as cotour farmig, platig ative grasses o slopes susceptible to erosio, ad platig multipurpose trees. I additio, JGI supports structured lad use plaig at the village level i 13 commuities whose lad overlaps the Greater Gombe Ecosystem. This work relies o existig Tazaia statutes ad govermet structures to guide plaig activities, ad has resulted i the adoptio of formal Participatory Village Lad Use Plas i all 13 villages. The TACARE Project social ifrastructure model requires that local commuities establish their ow project priorities ad that they provide oe-fourth of the total cost ad much of the labor required to complete each project. The commuity cotributio builds a importat sese of owership withi the village which has cotributed to project success. However, TACARE depeds o heavy ivestmets from doors, makig log-term sustaiability of the project ucertai. Referece: Ndalahwa Fausti Madulu et al., Populatio, Health, ad Eviromet Itegratio ad Cross-Sectoral Collaboratio i East Africa: Tazaia Coutry-Level Assessmet (2007), available from popref@prb.org. Box 5 Sustaiable Coastal Commuities ad Ecosystems (SUCCESS-Tazaia) Project, Tazaia Coastal Maagemet Partership (TCMP) The SUCCESS Project (formerly the Populatio, Equity, AIDS, ad Ecosystems Project) was lauched i 2004 to promote improved biodiversity coservatio through the sustaiable use of coastal resources, while also seekig to ehace the quality of life of coastal people i Tazaia. The project works i eight villages (total populatio 13,000) borderig o or surrouded by the Saadai Natioal Park, about 200 kilometers orth of Dar es Salaam o the Idia Ocea. The project coducted a threats assessmet i 2004 to determie how HIV/AIDS affects the eviromet i this locatio. The assessmet cocluded that HIV/AIDS-affected households deped more tha oaffected households o wild foods, wildlife, medicial plats, timber, ad fuelwood as sources of food, icome, ad health services. Specific itervetios bega i 2005 to address evirometal degradatio ad ill-health i the coastal commuities. Alterative livelihoods such as paprika farmig ad milkfish culture which do ot further stress the coastal resources or threate coastal biodiversity were itroduced i six of the eight villages. Other itervetios iclude usig fuel-efficiet stoves ad establishig wood lots so local residets do ot have to resort to cuttig magroves or coastal forests for fuelwood. The project also commuicates culturally appropriate messages, maily though commuity theater performaces, to reduce risky sexual behavior ad promote evirometal stewardship. By 2006, positive results were evidet: More tha 400 stoves were beig used by village households savig approximately 600 tos of fuelwood aually, ad demad for the stoves remais strog. I additio, there is some evidece of behavior chage i the commuities as a result of the popular theater performaces. For example, the commo practice of marryig off youg girls to older me has become icreasigly stigmatized, ad parets ow ofte reject short-term marriages betwee visitig fisherme ad local girls. Coastal villagers are also requestig that their leaders provide space for fish markets i the village ceters, rather tha forcig wome to buy fish o the beaches where they are vulerable to beig sexually assaulted or exploited. These are importat social chages that SUCCESS ad other health ad eviromet programs are buildig upo as work cotiues i these villages. Referece: Ndalahwa Fausti Madulu et al., Populatio, Health, ad Eviromet Itegratio ad Cross-Sectoral Collaboratio i East Africa: Tazaia Coutry-Level Assessmet (2007), available from popref@prb.org.

8 8 PRB Makig the Lik 2007 Box Geoffrey Cowley, Courtesy of Photoshare A youg mother i Tazaia teds a potato garde ear the shore of Lake Victoria. Lake Victoria Evirometal Maagemet Project (LVEMP) Lake Victoria is the world s secod-largest body of freshwater. The lake ad surroudig areas are of eormous ecoomic importace to approximately 30 millio people who live alog the shores of the three coutries it touches: Ugada, Keya, ad Tazaia. Populatio desity i the Lake basi is above the atioal average i all three coutries; the populatio growth rates i the riparia commuities are amog the highest i the world. The three Tazaia regios that border Lake Victoria Kagera, Mara, ad Mwaza have populatio growth rates betwee 3.1 percet ad 3.3 percet. The atural resources of the lake basi are used to obtai food, shelter ad eergy; to secure residetial ad idustrial water supply ad trasport eeds; to irrigate farmlad; ad to dispose of huma, agricultural ad idustrial waste. I recet decades, with growig populatio ad developmet, the multiple activities i the lake basi icreasigly coflict with each other, ad threate the log-term health of the lake ecosystem. Heavy huma demads o the lake have caused the lake to udergo substatial chages sice the 1970s. These iclude massive algae blooms, icreased frequecy of waterbore diseases, water hyacith ifestatios, ad overfishig ad oxyge depletio at lower lake depths, threateig fisheries ad biodiversity. The cosequeces are potetially irreversible evirometal damage, hardship to the poor, ad serious health cocers. The Lake Victoria Evirometal Maagemet Project (LVEMP) is a comprehesive program aimed at rehabilitatio of the lake ecosystems for the beefit of the people i the catchmet ad the atioal ecoomies of which they are part. The objectives of the program are to: 1) maximize the sustaiable beefits to riparia commuities from usig resources withi the basi to geerate food, employmet ad icome, supply safe water, ad sustai a disease-free eviromet; ad 2) coserve biodiversity ad geetic resources. The first phase of the project ( ) was implemeted with fudig from the Global Eviromet Facility (GEF), the World Bak, the govermets of Tazaia, Keya, ad Ugada, ad several doors. Phase I focused o fisheries maagemet, water hyacith cotrol, water quality improvemet, lad use ad wetlads maagemet, ad support for istitutios for lake-wide research ad data collectio. Despite the extremely high populatio growth i Lake Victoria commuities, populatio issues icludig the eed for family plaig services were ot addressed i the first phase of the project. Health issues were addressed through educatio campaigs that highlighted the liks amog water quality, saitatio, ad huma health; ad through the buildig ad staffig of ew dispesaries. Curret challeges for Phase II, lauched i 2005, iclude scalig up iitial pilot activities i health, microeterprise, ad educatio; maistreamig project activities ito the district developmet plaig process to esure the sustaiability of the project itervetios; ad icorporatig family plaig ad reproductive health itervetios ito project plas ad activities. Referece: Ndalahwa Fausti Madulu et al., Populatio, Health, ad Eviromet Itegratio ad Cross-Sectoral Collaboratio i East Africa: Tazaia Coutry-Level Assessmet (2007), available from popref@prb.org.

9 PRB Itegratig Populatio, Health, ad Eviromet i Tazaia local govermet to the commuity. This brigs resposibility ad authority to the level where resources are beig used. Tazaia s Visio 2025 reiterates the cetral govermet s commitmet to decetralizatio: It is emphasized that the Developmet Visio s implemetatio be [very] participatory. For it is oly through such a participatory process that the Developmet Visio will acquire a people-cetered ad people-drive character which is the mai foudatio for obtaiig the people s geuie commitmet towards esurig the realizatio of their goals. Tazaia ca draw o lessos from a umber of itegrated commuity-based projects from aroud the world where decetralizatio has bee practiced. Results from a 2005 review of itegrated programs i the Philippies ad Madagascar, for example, offer some evidece of the beefits of a collaborative, holistic approach to developmet. 24 Oe of the most valuable beefits of itegrated programmig accordig to the results of operatioal research ad the views of NGO practitioers is the potetial for reachig expaded target audieces. 25 PHE programs have bee especially effective i icreasig the participatio of wome i coservatio activities ad the participatio of me ad youth i family plaig ad health activities. Itegrated programs have also documeted reduced operatig expeses by avoidig duplicatio ad redudacy ad stregtheig cross-sectoral coordiatio at the local level; by galvaizig ad maitaiig greater commuity goodwill ad trust; ad by icreasig wome s status ad self-perceptio i project areas, especially whe PHE programs iclude microcredit or other livelihood activities. Eve with all the beefits associated with itegrated programmig, there are may challeges to makig these itegrated projects work. Fudig for itegrated programs is limited ad isufficiet huma resources ad istitutioal capacities have costraied PHE iitiatives. Despite these challeges, some successful itegrated projects ad local iitiatives have brought positive chage to people ad the eviromet i Tazaia. Three projects highlighted i the Tazaia PHE assessmet Lake Tagayika Catchmet, Reforestatio, ad Educatio (TACARE) Project; Sustaiable Coastal Commuities ad Local wome i Magu, Tazaia, have empowered themselves through workig together. Ecosystems (SUCCESS) Project; ad Lake Victoria Evirometal Maagemet Project (LVEMP) are examples of the differet types of itegrated programs that are addressig populatio, health, ad eviromet cocers i a holistic maer (see Boxes 4, 5, ad 6, pages 7 ad 8). I 2005, the Strategy to Protect Water Sources ad Catchmet Areas i Tazaia was implemeted through the Vice Presidet s Office. Plastic bags ad other types of plastics were baed to protect drikig water sources, keep sewage drais clear, ad reduce the amout of garbage i public spaces. Alterative, evirometally friedly packagig materials are beig promoted i a coutry-wide educatioal campaig. Next Steps Toward Greater Cross- Sectoral Collaboratio The Tazaia PHE assessmet cocluded that there are may challeges to achievig effective cross-sectoral collaboratio i Tazaia, icludig the eed to review sector polices to accommodate recet policy chages ad atioal obligatios such as the NSGRP ad the MDGs Aa Gerrard, Courtesy of Photoshare

10 10 PRB Makig the Lik 2007 Much more research is eeded o populatiohealth-eviromet iteractios o the commuity ad atioal scale to support the creatio of robust, evidece-based policies ad approaches. To ecourage research o PHE issues i East Africa, the Lake Victoria Research Iitiative (VicRes) supports iterdiscipliary ad multidiscipliary research that would cotribute toward poverty reductio ad evirometal restoratio i the Lake Victoria Basi. 26 Research projects are meat to ehace kowledge o lad-huma-eviromet iteractios to justify itervetios relevat to poverty reductio, improved health, ad evirometal restoratio, ad to cotribute to effective decisiomakig. Researchers must have the skills to effectively commuicate their fidigs to decisiomakers so research results ad data are used routiely ad appropriately i policymakig. To this ed, the Istitute of Resource Assessmet (IRA) at the Uiversity of Dar es Salaam itroduced a ew master s program i 2005 that icludes modules o PHE likages ad policy commuicatios for evirometal researchers. The modules were developed i part from traiig programs coducted by the Populatio Referece Bureau ad IRA from 2001 to 2004, ad offer a model for additioal capacitybuildig programs i Tazaia. At the programmatic level, rigorous project evaluatios ad operatios research are eeded to scietifically quatify the beefits ad shortcomigs of itegrated programmig. These types of data are ecessary to iform project desig ad implemetatio; gai policy support for cross-sectoral collaboratio at the district ad village levels; ad secure ad maitai fudig for commuitybased itegrated projects. Documetatio ad dissemiatio of lessos leared ad best practices for itegrated PHE programmig will also lay the ecessary groudwork for scalig-up PHE efforts i Tazaia. 27 To more fully itegrate populatio, health, ad eviromet cocers ito atioal policies ad commuity developmet programs, several steps are suggested: Cotiue to icorporate Visio 2025 ad NSGRP (2005) objectives ito atioal policies, strategies, plas, ad programs. Maitai a effective policy advocacy campaig to raise awareess ad wi support of policymakers at district ad atioal levels for cross-sectoral collaboratio. Harmoize sector policies to clarify priorities ad resposibilities for implemetig crosssectoral iitiatives. Stregthe istitutioal capacity especially at district levels to implemet policy madates ad desig itegrated programs that have the support of commuities ad local orgaizatios, ad esure that moitorig ad evaluatio (M&E) systems are i place to documet results. Prepare ad istitute appropriate legislatio ad fiscal arragemets to facilitate the implemetatio of policies that call for cross-sectoral collaboratio. Dissemiate best practices, research, data, evaluatios, ad resources o PHE likages ad itegrated approaches to developmet to ogovermetal orgaizatios ad policymakers. Work with the media to ecourage ad build capacity for reportig o populatiohealth-eviromet issues i local ad atioal ews outlets. Work with uiversities to desig ad implemet capacity-buildig programs such as short courses ad workshops o PHE likages ad cross-sectoral approaches. Create fudig mechaisms for iterdiscipliary research ad rigorous project evaluatios. Raisig awareess of the liks betwee populatio, health, ad eviromet amog policymakers, developmet plaers, ad project implemeters; stregtheig istitutioal capacity for cross-sectoral collaboratio; ad esurig fudig ad support for rigorous iterdiscipliary research ad program evaluatios are essetial for successful PHE itegratio i Tazaia. Progress i these areas will lay the foudatio for more effective, participatory developmet efforts that icrease huma well-beig ad sustai healthy eviromets.

11 PRB Itegratig Populatio, Health, ad Eviromet i Tazaia Refereces 1 Ndalahwa Fausti Madulu et al., Populatio, Health, ad Eviromet Itegratio ad Cross-Sectoral Collaboratio i East Africa: Tazaia Coutry-Level Assessmet (2007), available from prb@prb.org. 2 Agriculture cotributes over 50 percet of Tazaia s GDP, employs over 80 percet of the total labor force, ad provides 75 percet of total export value. Govermet of Tazaia, Vice Presidet s Office, Natioal Strategy for Growth ad Reductio of Poverty (Dar es Salaam, Tazaia: Gov. of Tazaia, 2005), accessed olie at o Oct. 16, Govermet of Tazaia, Vice Presidet s Office, Natioal Strategy for Growth ad Reductio of Poverty. 4 Food ad Agriculture Orgaizatio (FAO), AIDS A Threat to Rural Africa: Fact Sheet, accessed olie at o Sept. 24, The Natioal Strategy for Growth ad Reductio of Poverty otes that after takig accout of the populatio growth rate, per capita ecoomic growth rates are more modest ad ot yet sufficiet to geerate sigificat poverty reductio. Govermet of Tazaia, Vice Presidet s Office, Natioal Strategy for Growth ad Reductio of Poverty. 6 Carl Haub, 2007 World Populatio Data Sheet (Washigto, DC: Populatio Referece Bureau, 2007), accessed olie at o Sept. 20, Tazaia Populatio ad Housig Cesuses, 1978, 1988, Growth rates refer to 1978 to 1988 ad 1988 to [Tazaia] Populatio Plaig Commissio, Populatio Plaig Uit. Accessed olie at idex.html, o Oct. 17, The total fertility rate (TFR) estimated i the 1991/92 Tazaia Demographic ad Health Survey (TDHS) was 6.3 childre per woma. However, the 2004/05 TDHS TFR of 5.7 is statistically the same as the 5.8 estimated by the 1996 TDHS ad the 5.6 from the 1999 Tazaia Reproductive ad Child Health Survey (TRCHS). There is o evidece of fertility declie over the past decade. 10 The 2004/05 TDHS showed a materal mortality ratio (MMR) of 578 materal deaths per 100,000 live births, statistically uchaged from the 1996 TDHS MMR of Govermet of Tazaia, Miistry of Plaig, Ecoomy, ad Empowermet, Natioal Populatio Policy accessed olie at o Oct. 16, Govermet of Tazaia, Miistry of Plaig, Ecoomy, ad Empowermet, Natioal Populatio Policy From the 1999 ad 2004/05 TDHSs, ifat ad uder-5 mortality declied as ifat deaths fell from 99 to 68 per 1,000 births ad child deaths from 147 to 112 per 1,000 live births. Natioal Bureau of Statistics (NBS) [Tazaia] ad ORC Macro, Tazaia Demographic ad Health Survey (Dar es Salaam, Tazaia: Natioal Bureau of Statistics ad ORC Macro, 2005). 14 Isecticide-treated mosquito ets, or ITNs, are a primary health itervetio to reduce malaria trasmissio i Tazaia. Widespread use of ITNs would likely reduce mosquito desity ad bitig itesities. About 16 percet of childre ages 0-5 sleep uder a ITN; 31 percet sleep uder ay et. NBS [Tazaia] ad ORC Macro, Tazaia Demographic ad Health Survey Uited Natios Developmet Programme (UNDP), Tazaia Poverty ad Huma Developmet Report 2005, accessed olie at o Oct. 16, Access to a improved water source refers to the percetage of the populatio with access to drikig water from a improved source, such as a household coectio, public stadpipe, borehole, protected well or sprig, or raiwater collectio. Uimproved sources iclude vedors, taker trucks, ad uprotected wells ad sprigs. World Health Orgaizatio ad Uited Natios Childre s Fud, Meetig the MDG Drikig Water ad Saitatio Target, accessed olie at www. who.it, o Oct. 16, Govermet of Tazaia, Miistry of Plaig, Ecoomy, ad Empowermet, Natioal Populatio Policy Natural heritage site is a desigatio of the Uited Natios Educatioal, Scietific, ad Cultural Orgaizatio (UNES- CO) for places with outstadig physical, biological, ad geological features. 19 The Participatory Poverty Assessmets (PPA) is a qualitative assessmet coducted to provide isights o people s perceptios of poverty ad effects of public policies ad istitutioal chages ad goverace o their livelihoods. The PPA describes various dimesios of vulerability ad cotributes to a better uderstadig of vulerable social groups, causes of impoverishmet, ad protectio ad risk maagemet. Uited Republic of Tazaia, Vulerability ad Resiliece to Poverty 2002/03, Tazaia PPA: Mai Report (Dar es Salaam, Tazaia, 2004). 20 Over 60 percet of the area covered by forests i 1920 has bee deforested ad about 0.5 percet of curret forest area is beig lost aually, accordig to the Plaig Commissio s Natioal Populatio Policy. 21 Tazaia has specific atioal policies o forests, mierals, wildlife, fisheries, lad use, ad water. View all of Tazaia s atioal policies olie at 22 Uited Natios Eviromet Programme, Poverty ad Eviromet Project: Tazaia Profile, accessed olie at org o Sept. 20, Govermet of Tazaia, Tazaia Natioal Developmet Visio 2025, accessed olie at o Sept. 27, Joh Pielemeier, Review of Populatio-Health-Eviromet Programs Supported by the Packard Foudatio ad USAID, accessed olie at o Sept. 4, Pielemeier, Review of Populatio-Health-Eviromet Programs Supported by the Packard Foudatio ad USAID. 26 For more iformatio about the Lake Victoria Research Iitiative, go to 27 The term scalig up i this cotext refers to oe or more of the followig: implemetig PHE projects i ew geographic areas or expadig curret projects to iclude etire ladscapes or ecosystems; icludig domais outside populatio, health, ad eviromet sectors such as educatio ad agriculture; or egagig ew audieces ad/or reachig more beeficiaries withi the same project or geographic area.

12 12 PRB Makig the Lik 2007 PRB s Populatio, Health, ad Eviromet Program works to improve people s lives aroud the world by helpig decisiomakers uderstad ad address the cosequeces of populatio ad eviromet iteractios for huma ad evirometal well-beig. For more iformatio o the PHE program, please write to popref@prb.org. The Populatio Referece Bureau iforms people aroud the world about populatio, health, ad the eviromet, ad empowers them to use that iformatio to advace the well-beig of curret ad future geeratios. For more iformatio, icludig membership ad publicatios, please cotact PRB or visit our website: Policy Briefs i PRB s Makig the Lik Series: Itegratig Populatio, Health, ad Eviromet i Ethiopia (2007) Itegratig Populatio, Health, ad Eviromet i Keya (2007) Itegratig Populatio, Health, ad Eviromet i Tazaia (2007) Likig Populatio, Health, ad Eviromet i Fiaaratsoa Provice, Madagascar (2006) Breakig New Groud i the Philippies: Opportuities to Improve Huma ad Evirometal Well-Beig (2004) Ripple Effects: Populatio ad Coastal Regios (2003) Wome, Me, ad Evirometal Chage: The Geder Dimesios of Evirometal Policies ad Programs (2002) Childre s Evirometal Health: Risks ad Remedies (2002) Ackowledgmets Melissa Thaxto prepared this policy brief i collaboratio with the Tazaia PHE assessmet team members Hussei Sosovele, Istitute of Resource Assessmet (IRA)/Uiversity of Dar es Salaam ad World Wide Fud for Nature; Grace Lusiola, EgederHealth; Arold Mapiduzi, Vice Presidet s Office (VPO) Natioal Eviromet Maagemet Coucil (NEMC); Joseph Kihaule, VPO Divisio of Eviromet; ad Jamal Baruti, Lake Victoria Evirometal Maagemet Project (LVEMP). Thaks also to Roger-Mark De Souza, Sierra Club; ad Nia Pruy, Charles Teller, ad Richard Skolik of PRB for reviewig various drafts of the brief ad providig isightful commets ad suggestios. The PHE Assessmet team ad the author of this brief recogize the valuable cotributios of Professor N.F. Madulu through his research ad teachig to better uderstadig PHE likages. Professor Madulu s utimely passig, just after the first draft of the assessmet report was completed, has saddeed all who kew him. The assessmet report ad this policy brief are dedicated to Professor Madulu. Fudig for this policy brief was provided by the U.S. Agecy for Iteratioal Developmet, uder the BRIDGE Project (Cooperative Agreemet GPO-A ). Fidig the Balace: Populatio ad Water Scarcity i the Middle East ad North Africa (2002) All publicatios are available o PRB s website: POPULATION REFERENCE BUREAU 1875 Coecticut Ave., NW, Suite 520, Washigto, DC USA Tel.: Fax: popref@prb.org Website: POPULATION REFERENCE BUREAU PRINTED WITH SOY INK TM