Africa has its share of challenges, but it also leads the way to create effective responses. Take the Lake Tanganyika area in Tanzania, for example. For those who live there, daily life is hard. There are few roads. Cellphone service is patchy. You must travel by boat for seven hours to reach the nearest hospital. And if you have an obstetric emergency, there is no doctor in your village to help you.
In these areas, 41% of women want to prevent or delay pregnancy but don't have access to contraception, according to the 2010 Tanzania Demographic and Health Survey. A baseline survey by the Nature Conservancy and Hess Environmental Economic Analyst in 2011 indicated that, on average, women here give birth to 6.7 children each.
Bearing and raising so many children means women don't have time to be involved in activities outside the home, limiting their ability to seek work or take part in local governance or civic activities.
Their health and wellbeing are directly dependent on their natural environment – an ecosystem of critical global significance, vital to national economics and increasingly at risk. Lake Tanganyika holds 17% of the Earth's fresh water and forms the western boundary of the Greater Mahale Ecosystem – a forested landscape of almost 2.02-million hectares. The area is marked by rich biodiversity, including 300 unique species of fish.
Pathfinder International, the Nature Conservancy and the Frankfurt Zoological Society have been working at Lake Tanganyika since 2011 under the umbrella of the Tuungane population, health and environment programme. It deals with issues in an integrated way, offering a holistic approach for increasing people's access to healthcare and economic opportunity while enabling them to sustainably manage their natural resources.
Combining health and environmental awareness
In the past, community health workers were trained only on specific health issues. When health workers visited households on their
regular rounds, men would often suggest that their wives were available, but
the men walk would away. Now, local health workers receive cross-training on agriculture, fisheries and the connections between household health, reproductive health and the environment. They are finding that both the men and the women are scrambling to be present during home visits so that they can receive information about the issues that matter most to them.
Traditional gender divisions are beginning to break down. More men are accompanying their wives to clinics for services such as family planning and prenatal care.
The integrated population, health and environment programmes enable the organisations to extend their collective reach and address the multifaceted issues faced by people living around Lake Tanganyika. Evidence is emerging that this approach may hold some of the keys to unlocking a more prosperous future.
When our project began, women said their families were not eating as many fish as they had five years ago, because there were fewer fish to catch. To replace the fish, families turned to agriculture. The resulting deforestation and the lack of governance of watershed areas led to high levels of sediment being washed into the lakes, further depleting fisheries and leaving families with even fewer options to secure their health and livelihoods.
In addition to training health workers to deliver integrated health and environmental messages, the project uses other strategies such as fostering "model households". These contain the elements likely to lead to improved health, food security, and economic and environmental sustainability: latrines, "tippy taps" for hand washing, dish racks, kitchen gardens, fruit trees, rain barrels, woodlots and advocates for family planning. These households, in turn, teach others.
Communal action for communal benefitThe Tuungane programme then works to build residents' capacity for managing resources that require communal action. Our support to establish beach management units – local groups that govern lake resources – has resulted in the protection of critical spawning grounds and in larger fish catch sizes.
More than 1 200 fishermen and other stakeholders have joined the beach management units and 13 villages have been verified as fisheries breeding sites by the Tanzania Fisheries Research Institute.
The project has also set up model fish-drying racks that eliminate sand, resulting in a threefold increase in their market price.
Another initiative was to help several villages set up savings and loan groups. These have already saved more than $350 000, enabling people to establish businesses to provide basic household goods, wholesale rice and other agricultural produce.
In addition, 12 health facilities have been refurbished and equipped, and staff members have been trained to provide a wider range of family planning services as well as emergency obstetric care. Already, 9 000 women are using family planning for the first time.
Our efforts are aimed at enabling people, especially women, to take control not only of their bodies but of their livelihoods too.
Taking control of lives and livelihoodsTake, for example, Zainabu John, who lives in the Lake Tanganyika region and is the mother of nine children. With each new pregnancy, she suffered extreme complications and her family struggled to pay for medical care and food.
Now she knows how to prevent getting pregnant again. "I am so happy to use family planning. Today I am healthy. I want continued health for my children and grandchildren … I have more time to work and earn money."
But projects that aim to safeguard people's health, livelihoods and the natural resources need to be supported by policies that create enabling environments for them to thrive.
The East African Community (EAC) convenes regularly to discuss how to plan for, fund, institutionalise and scale up such initiatives. Recently, various stakeholders, including Pathfinder International, met to finalise a strategic plan that will be presented to the EAC Council of Ministers for approval.
It is a critical step in the process of enabling governments to plan and budget cross-sectorally and thereby use scarce resources more efficiently.
Expanding support for integrated programmes will not only mean expanded sexual and reproductive health services and enhanced resilience, it will also help the global community move towards achieving the ambitious sustainable development goals, which aim to end poverty, protect the planet and ensure prosperity over the next 15 years.
Mustafa G Kudrati is Pathfinder International's country representative in Tanzania
Have something to say? Tweet or Facebook us on @Bhekisisa_MG
Comment: Mother and child health must improve
Health workers brace for an increased need for palliative care as waiting lists grow.
Have something to say? We can help you say it – but only if you promise to read this first.
In this township, alcohol makes violent men close to three times more likely to rape a woman.
Bhekisisa means "to scrutinise" in Zulu
In South Africa, Zulu patients who would like to be thoroughly assessed by a doctor, would ask the physician to "bhekisisa" them.