Addressing environmental health issues in the peri-urban context : lessons learned from CIMEP [community involvement in the management of environmental pollution] Tunisia

Implemented by the Environmental Health Project (a follow-on to the Water and Sanitation for Health [WASH] Project) and entitled Community Involvement in the Management of Environmental Pollution (CIMEP), the initiative was designed to develop partnerships between national decision makers, municipalities, and communities to extend municipal services to peri-urban communities. This report describes the methodology used in the 18-month CIMEP pilot project in Tunisia and provides a case study of the project itself. The methodology used involved skill-building workshops, on-the-job follow-up, policy maker roundtables, and microprojects/interventions. At the end of the project, local government officials and leaders reported on the results. They looked at community-level behavior changes -- related to clinic usage, housing, water, garbage, and wastewater -- and institutional behavior changes. As a result of the CIMEP interventions, the local population began to understand that environmental health conditions have an impact on physical and mental health. Some specific behavior changes included corralling animals, building latrines, using trash containers, and cleaning up neighborhood garbage. The behavior of municipal officials also changed. They have begun to perceive poor communities as having resources to offer and have begun to use participatory methods with community members to identify the priority environmental health issues. Communities now feel a sense of ownership for local projects and contribute more than is required of them. Finally, government officials and municipal staff have a heightened awareness of peri-urban problems and interest in community environmental health improvements. The following lessons were learned. (1) The process for addressing environmental health conditions in peri-urban communities must be immediate, directed, and sustained, and interventions must provide concrete results in a short time frame. (2) Differing concepts of participation can hinder the use of participatory techniques by stakeholders and the policy changes required to sustain them. (3) Municipal strengthening approaches need to include both participation and privatization in a complementary fashion. (4) Municipalities can realize significant cost savings (in Tunisia it was 20%-40%) by using participatory techniques. (5) Behavioral indicators can be very effective tools for communities to monitor their own progress in alleviating adverse environmental health conditions. (6) Microprojects were crucial to the success of the project. The integration of "process" and concrete "products" work together to achieve effective results. They reinforce trust between the public sector and communities. (Author abstract)