Terms of Reference for the PHE baseline study in Northern Kenya

Background

Awareness about the connections between the global environment and human health is not a new concept. Linking the conservation of biodiversity directly to human well-being is, however, a relatively new idea.

On a global scale, there are many known benefits of biodiversity, namely health, nutrition, climate regulation, water regulation etc.

On a local scale this relationship is even more apparent. Many areas in a given ecosystem perceived as extremely rich in biological resources, are also home to rural communities who depend on these resources for their livelihood.

Specifically, there are many ways in which local population rely on conservation of biodiversity to ensure their good health, these includes, traditional medicines based on local plants and animals, food and ecosystems services among others.

Well managed ecological systems are a source of drinking water, they form and retain soil and maintain crop yields among other benefits. This interaction also flows in the other direction, with strong healthy communities more able to sustainably utilize their environments in ways which protect the biodiversity and preserve the resources.

Unfortunately it is also apparent that damage to environments can have negative impacts on health and wellbeing, whilst unhealthy, vulnerable populations will be less able to manage their environments in sustainable ways.

To further explore this link, The International Planned Parenthood Federation, IPPF and IUCN, the International Union for Conservation of nature, have been working since 2006 to strengthen understanding of the linkages between HIV and the Environment.

Studies were conducted in Uganda, Kenya, Tanzania and Ethiopia to understand the impact of HIV on the environment and how natural resources were being utilized as coping strategy for AIDS affected households. These studies were enriched with extensive community dialogue to capture local lessons, particularly from communities that are heavily affected by HIV.

In preparation of this publication a consultative workshop was organized to disseminate and analyze the findings of the study.

During this workshop priority issues were identified including promoting further collaboration between HIV and conservation actors, capacity building and policy development and expanding the scope of this work beyond HIV to encompass the wider field of the interactions between Population Health and sustainable environmental management.

As follow up to these recommendations, IUCN and IPPF propose to implement activities in Northern Kenya to generate experience in integrating Population Health and Environment in the field and to bring the lessons into policy dialogue from local to national level.

The intervention will build on existing experiences in both the environmental and health sectors and use a collaborative approach to bring the sectors together, identify practical options for synergy between health and environment, and work through local communities and local government to strengthen the institutional arrangements for integrating population health and environment.

The aim of this project is to nurture and capitalize on connections between health and conservation in ways that simultaneously advance both human development and biodiversity conservation.

In drylands, there are a range of underlying drivers of ecosystems degradation including poverty, food security, gender inequality and health. It is clear that many dryland communities rely heavily and directly on biodiversity around them for survival and they most often strive to conserve it.

In light of this naturally occurring incentive to conserve, this project will explore the synergy and relationship between population health and environment, with particular interest in determining the extent to which community-based health interventions can provide conservation benefits, and how efforts to manage and preserve the environment can have positive outcomes on health and wellbeing.

At the end of this project we envisage to understand, and programmatically link health and conservation within project activities in a way that optimizes conservation success and improves the health status of the population.

Project Goals and Objectives

The Project Goal is: “Support Sustainable Dryland Livelihoods by Building Capacity of Government to Integrate Population Health and Environment”. It contributes strongly to IUCN’s Regional Drylands Program Goal for Eastern and Southern Africa: “Dryland ecosystems are sustainably managed to protect biodiversity and contribute to local livelihoods and national economies”.

IPPF Africa Region has identified Population Health and Environment as a key strategic area during its next 5 year planning period 2011 – 2015. This project therefore directly contributes to this key result area as it will build on the work that the two institutions have being doing on strengthening evidence on PHE linkages and using such evidence will influence policy and more importantly support sustainable livelihoods. This project addresses the broader Population Health and Environment linkages as part of the learning process.

Interactions between Population Health and the Environment

Humans and other species rely upon natural ecosystem processes and ecosystem services for their very survival. As human population has grown, overuse or misuse of the environment and impairment of its ability to provide ecosystems services have led to shortages in the supply of critical human and other species’ requirements.

The last decade has witnessed an increase in the awareness and interest in the complex interactions among population, health and the environment (PHE). Myriad studies have brought to light a series of interacting and complex relationships, many with negative feedback loops, between population health and the environment.

The connections between population health and the environment are subtle, bi-directional, and involve indirect as well as direct pathways.

The recent publication by IUCN and IPPF highlights a number of topics that link PHE including: food insecurity, natural resource use, agriculture, land tenure and use, the fisheries, gender, orphans and vulnerable children, migration, crisis situations, climate change, effects of environmental interventions on population health, and workforce and human capacity impacts of diseases such as HIV/AIDS among others.

These disciplines relate population health and the environment at different levels including the household level, community level and at the global level.

Rationale for the baseline study

This project contributes towards the overall goal through the following four results:

1. Policy Dialogue at community, county and national level to integrate population health and environment
2. Demonstrate sustainable Dryland Natural Resource Management in a context of social/demographic change
3. Promote and implement health interventions that address determinants of sustainable natural resource management
4. Knowledge Management to understand demographic and social processes, identify good practices and to inform policy dialogue

The baseline will gather information on all four result areas, collecting data on the current state of policy and practice with regards to PHE and the impacts that these have on the state of health and environment in the project sites of Garba Tula and Garissa.

This study will provide a baseline against which the project outcomes (and potentially impacts) can be monitored over the project life. It will also enable IUCN and IPPF to ensure greater learning within the wider field of PHE, and to support in scaling up experiences within wider drylands of Kenya.

The project implementation processes followed on the ground, and the lessons that are gained from this work, will be documented in detail towards the end of the project and used to develop recommendations for IUCN, IPPF and other agencies, government planners, and other International organization.

Terms of Reference for the Baseline Study

The purpose of the baseline is to measure the status of all things which the project anticipates to change by the end of the project implementation. Therefore, the baseline study should cover all result areas as described in the project document and the consultants are expected to produce baseline report for the two project sites.

The information generated will be used in setting the indicators and mechanisms to track the project progress.

Specifically, the study will provide information on the following:

Baseline study to demonstrate demographic and social processes, land tenure and governance arrangement and their link to Population Health-Environment

• Demographic and social data – recent census figures, rural-urban shift, out-migration and remittances, poverty data, health services coverage and access, education availability, enrolment rates , major health issues/diseases.
• Governance data - Land tenure arrangements (statutory and customary), NRM governance structures (Formal and traditional) – Garba Tula information already available)
• Environmental data: livelihood practices, state of the rangeland, availability of water points, land use changes, the extent of degradation
• Use the conceptual framework from our 2010 publication with the University of Washington to identify cause-effect relationships between PH&E in the project area

Study of existing Sustainable Natural Resource Management (SNRM) practices.

• Recent or current SNRM initiatives in study areas, elements of success, significant gaps (e.g. rangelands management, forest management, integrated water resource management, ecosystem approaches)
• Major constraints and opportunities to NR governance and management
• The extent to which SNRM activities have had a positive impact on health outcomes (direct or indirect).
• Based on the analysis make recommendations for good SNRM activities and particularly those which have clear health and wellbeing benefits

Study of the existing community health system in the project area(s)

• Recent or current Health Initiatives in study area, elements of success, gaps, alternative service delivery options
• Constraints and opportunities for different approaches to health service delivery
• Establish the existing models of service delivery especially with regard to reproductive health services and information; specifically evaluate the Nomadic clinic model.
• Assess the viability of the MOH strategy of using retired health workers in community service delivery (are these available, what are the training needs if they are, what the recommended remuneration/motivation package is?)
• Determine to what extent the national community health strategy has been implemented in the project sites; what are the gaps especially with regard to an integrated PHE approach
• Determine the level of male involvement in Reproductive Health (RH) programmes and opportunities for enhancing it and Identify potential entry points for male involvement in RH within the existing and potential environment and population programmes
• Identify good practices in RH service delivery that can be strengthened and scaled up
• The extent to which health initiatives have had a positive impact on natural resources and the environment, both direct and indirect
• Make recommendations for good health delivery systems, ensuring adaptation to the local context and integration of PHE, to promote additional environmental benefits.

Establish status of women’s rights and the impact on maternal and child health.

• Relate the current status with the new constitutional dispensation and document areas for possible intervention
• Determine existing customary and traditional services and decision making process that impact on the health especially reproductive health of women and girls in the project area to inform project intervention

Policy

• Identify the current policies on PHE, and the extent to which health and conservation are integrated at the district level
• Identify the current policies to support more sustainable NRM, local NR rights, land tenure and governance institutions taking into consideration the new constitution
• Identify the current policy options for appropriate health service delivery – which policies support or impeded different Good Practice options, upcoming opportunities to dialogue with government over these policies.

Monitoring and Evaluation

Through this analysis the baseline study should:

• Create measurable outcome-level indicators on project targets and results and set benchmarks for monitoring and evaluation of the progress based on the project document and logframe
• Suggest simple, appropriate and cost effective means to measure the changes by the project intervention and communication strategy
• Help develop brief M&E of project interventions.

Time Frame

The consultants should be available to commence the work in the second week of October, 2011 and finalize the assignment by end of November, 2011.

The first draft report should be shared in third week of November 2011, whilst the final report should be produced by end of November.

Within this overall time frame, the detailed timeline of deliverables for consultants are:

Deliverables	Deliverable date
Anticipated appointment date	30th September
Attend consultative briefing session & sign contract	5th October
Commence the assignment, desk review and field mission to both Garissa and Garba Tula	5th October
Submit draft report	15th November
Present the findings of the study at a feedback workshop with steering committee.	21st November
Submit Final Report	End of November

The team of consultants will work independently; however IUCN and IPPF team will coordinate and provide timely inputs. The selected consultant will prepare an inception report with a clear work plan within seven days after signing the contract. The proposed baseline study will have to be completed within 30 days from the date of contract signed

The Consultancy team

As per the elaborate Terms of Reference, this assignment requires a team of experts to deliver. We anticipate engaging one lead consultant who will manage the task supported by two other consultants to be engaged at thematic level (Environment and health).

The lead consultant should have expertise and experience in environment and health issues, with at least master’s degree in the relevant field and with over 5 years progressive working experience in the field of PHE with proven skills and experience in conducting elaborate baseline surveys.

Good understanding of PHE policies and extensive publication on PHE will be prerequisite. He/she will be supported by team of other two consultants with expertise and experience on environment and health discipline respectively.

All applications (both technical and financial) should be sent to Guyo M. Roba (guyo.roba@iucn.org) with the subject line: “Baseline study on PHE” not later than 27th September, 2011