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EHP Lessons from Benin, Madagascar, and Nicaragua
Joint presentation by Lisa Nichols, Chris McGahey, and Eckhard Kleinau of EHP:

Protecting the Health of Hurricane Mitch Victims in Nicaragua
Lisa Nichols, Partnership Coordinator/Activity Manager, EHP

EHP recently completed the Rural Water Supply, Sanitation, and Environmental Health Reconstruction Program—a USAID-funded activity to protect and improve the health status of families affected by Hurricane Mitch in rural or resettled population centers in Nicaragua. Strategies included increasing sustainable water supply and sanitation services, improving hygiene behavior, and providing community organizations and education programs for populations in affected areas.

EHP worked with six private voluntary organizations that were already established in Nicaragua before the hurricane. EHP provided grants, management, and technical oversight to support these organizations as they worked with communities, conducting hygiene education programs and reconstructing or building water and sanitation systems. The activity exceeded its objectives, reaching an estimated 215,000 beneficiaries and resulting in significant improvements in hygiene practices and health.

A significant impact of the activity was the adoption of what environmental health director of the Nicaraguan Ministry of Health termed a "new paradigm," shifting from interventions consisting solely of water and sanitation measures to interventions in preventive health that incorporate a central focus on water and sanitation.

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EHP Update: Lisa Nichols (EHP)	View	Download
EHP Nicaragua: Lisa Nichols (EHP)	View	Download

Governance, Community Mobilization, and Environmental Health in Benin
Chris McGahey, Coordinator for Community-based Programs, EHP

A team of governance and anthropology specialists has been mobilized by EHP to document lessons-learned from community management of environmental health in Benin.

Since September 1999, EHP has been working with USAID/Benin to optimize decentralized decision-making related to diarrheal disease prevention in selected medium-sized towns in Benin. This partnership project which engaged citizens and government in local communities, resulted in the provision of much wanted and much needed public latrines under well-structured management.

Participatory community health communication (PCHC) with “natural groups” in the communities has ensured proper use of the latrines by thousands of users and has led to improved hygiene behavior such as hand washing by users when leaving the facility.

Integration of Health, Population, and Environment Programs in Madagascar
Eckhard Kleinau, Senior Technical Director, EHP

Since 2000, EHP has been supporting a four-year program in biologically diverse systems in Madagascar, linking and integrating activities related to health, population, and environment (H-P-E). The program is implemented by national NGOs under the Malagasy partnership "Voahary Salama" with USAID and private sector funding.

Under the program, the Malagasy department for social statistics, which also implements the Demographic and Health Surveys (DHS), was contracted to conduct a baseline household survey in three eco-regions. Overall, communities targeted for H-P-E integration face poor outcomes in all three areas: only 1 in 7 households produces sufficient food; almost half of all children under 5 are chronically malnourished (stunted); deleterious slash and burn practices are admitted by over half of households; contraceptive prevalence rate of 9 percent for modern methods is low; the vast majority of households does not have access to safe water and appropriate sanitation; and less than 40 percent of children under 5 years are fully vaccinated. A major gap exists between knowledge and actual behaviors. Important barriers to appropriate health, population and environment practices seem to be related to household income and technical competency.

Based on information from the survey results and participatory assessments, model approaches to deliver integrated services in health, population, food security and natural resource management are developed and tested. The key approaches to deliver integrated services build on an "innovator model" already used by health and environment sector programs.

Community mobilization and social marketing techniques include champion communities, child-to-child and farmer-to-farmer education to rally first adopters of positive practices. Related Information, Education and Communication materials have been pre-tested and developed. Intensive cross-sectoral training of field agents and community animators has begun.

Lisa Nichols, Partnership Coordinator/Activity Manager: As Partnership Coordinator, Ms. Nichols' primary responsibility is to identify and organize opportunities for collaboration with partner organizations within EHP's Partnership Strategy. She is also the Activity Manager for EHP's Nepal program and EHP's C/IMCI activities. Prior to joining EHP Ms. Nichols was a senior health policy analyst at the Center for International Health Information, a USAID Global Bureau project, from 1995 to June 2000. Under the CIHI project she provided technical assistance in performance monitoring and indicator analysis to the USAID Global, Africa and ANE Bureaus. She assisted USAID mission health teams in Cambodia, Senegal, Rwanda, and the West and Central Africa Family Health and AIDS project in developing performance monitoring plans. Prior to this Ms. Nichols worked and resided in Sub-Saharan Africa - in Mali, Chad, DR Congo, and Burundi where she served in various functions: as assistant director of a PVO, as program manager of a USAID funded Child Survival Project, as an emergency relief program manager, as a secondary school teacher, and logistics and training advisor. nicholsls@ehproject.org

Chris McGahey, Coordinator for Community-based Programs: Chris McGahey is a senior associate and Environmental Health Specialist at ARD, a private consulting firm. He is also working full-time as the Coordinator for Community-based Programs for the USAID-funded Environmental Health Project (EHP). His professional and academic experiences have focused on establishing bridges among the engineering, civil society, social science, and public health professions to improve health. His current focus is on reducing diarrheal disease though integrated hygiene improvement. Field assignments have emphasized the design, implementation, and evaluation of participatory technical infrastructure improvement in informal urban communities. Mcgaheyc@ehproject.org.

Eckhard Kleinau, Senior Technical Director: Dr. Kleinau has more than 20 years of experience in medicine and public health, with an extensive background in operations research, health policy and program design, and monitoring and evaluation. His career includes work with USAID’s Measure Evaluation project, the BASICS child survival project, and the USAID maternal and child care program in Egypt. He has field experience as a resident in Burkina Faso, Cameroon, and Sierra Leone; and has provided technical assistance in Bangladesh, Bolivia, Burundi, DR Congo, Egypt, Eritrea, Ethiopia, Guatemala, Ivory Coast, Madagascar, Mali, Nepal, Niger, Nigeria, Philippines, Rwanda, Senegal, South Africa, Thailand, Togo, and Zambia, among many other assignments. Dr. Kleinau has extensive teaching experience including courses in operations research and statistics for graduate students at the University of New Hampshire, and short courses in monitoring and evaluation and information systems for health professionals. He is the author or co-author of numerous peer-reviewed papers. In addition to degrees in medicine from the Eberhard-Karls University in Tuebingen, Germany, he holds master's degrees in epidemiology and health policy and management and a doctoral degree in public health from the Harvard School of Public Health. Kleinauef@ehproject.org