Interim evaluation of the environmental health project (EHP)

The project is being implemented by Camp, Dresser & McKee (CDM). Evaluation covers the period 4/94-8/97. The project, which for the past 2.5 years has been increasingly devoted to activities under the Global Bureau's Center for Population, Health and Nutrition, Office of Health and Nutrition's (G/PHN/HN) results framework, has made innovative contributions toward disease prevention, enhanced urban environmental quality, and improved municipal services in developing countries worldwide. Principal accomplishments are as follows. In the area of diarrhea prevention, EHP's approach of community-based action and hygiene promotion, which complements the efforts of other preventive projects, such as breastfeeding and immunization initiatives, has been accepted in varying degrees in Zambia, Ecuador, Bolivia, Jamaica, and Haiti. In Zambia and Bolivia, the activities are implemented in conjunction with child survival programs. EHP has helped CARE to increase community participation in its water supply and sanitation activities, published a primary prevention cost-effectiveness study that has earned international attention, and collaborated with UNICEF in the publication of a sanitation programming handbook. Towards the goal of malaria prevention, EHP has, in Zambia, introduced a Geographic Information System (GIS) for risk mapping, gained policy support for community-based health planning and action, conducted chloroquine sensitivity testing that led to changes in treatment policy, and prepared guidelines for assessing the feasibility of insecticide-impregnated bednets. In addition, the project helped plan Africa Integrated Malaria Initiative activities in Malawi and Kenya, implemented malaria activities in Bolivia, Peru, and Eritrea, and is expected to launch a malaria activity in Nigeria. EHP is also providing TA to the Vector-Borne Disease Control Center (VBDC) in Nepal. In the area of environmental risk assessment, EHP has worked with urban planners in two regions in India; replication is expected. Risk assessment has played a key role in the project's community-based work in Zambia, Ecuador, and Bolivia. Using its Applying Community Involvement in Managing Environmental Pollution (CIMEP) approach, EHP has increased community participation and collaboration in solving environmental health issues in urban Tunisia and rural Ecuador. Plans are underway for a CIMEP activity in Benin. Also, a community-based participatory approach was used in Slovakia, Haiti, and Jamaica, and in curriculum development in Romania. EHP has already confirmed or anticipates behavioral change in 11 countries as well as the Central American region as a result of its efforts. Important progress has been made in developing behavioral indicators and tracking results in Tunisia and Ecuador. Through field collaboration with behavior change-focused projects, EHP has had a positive impact on child survival/health and peri-urban activities. The project has strengthened environmental and health institutions serving the urban poor, and assisted with sector decentralization and privatization, in part through tools such as computerized water management models, GIS, monitoring and evaluation, and public sector training in service delivery and community collaboration. This work has taken place in 19 countries. Despite funding and contracting constraints, the project has developed a broad range of linkages and partnerships with multilateral institutions, donors, and community-based organizations, helping USAID and host-country clients with priority setting and planning. USAID missions and regional urban development offices (RUDOs) have been highly satisfied with the project's work in developing indicators, results packages, and evaluations for other programs and activities. Recommendations have influenced program and priority changes within portfolios. EHP's work on indicators is found in a number of the project's field reports and other documents (e.g., on Haiti and Ecuador and in the CIMEP manual). EHP has established an Information and Communication Unit (ICU) that provides a comprehensive range of library and information services to EHP, USAID, and the wider environmental health community. Finally, the project has provided a wide range of assistance to USAID missions and host governments outside of the G/PHN/HN results framework, including assistance to Egypt in the area of abatement of lead exposure, to Slovakian cities in addressing environmental health issues, and an emergency assessment of environmental risk factors contributing to a cholera outbreak in Gaza.