Resiliency through integration: findings from a community-based project in Lake Victoria Basin

Abstract Background Communities around the Lake Victoria Basin experience many challenges, including dependence on dwindling natural resources for survival, pervasive poverty, food insecurity, poor reproductive health outcomes, and inaccessible health services. The Basin faces rapid population growth, substantial degradation, drought, dwindling biodiversity, and failing fisheries. Health of People and the Environment in the Lake Victoria Basin (HoPE-LVB) is an integrated population, health, and the environment (PHE) project in Kenya and Uganda that aims to reduce ecosystem degradation in the Lake Victoria Basin, while increasing access to essential public health services in project communities, through promotion of multisectoral collaboration. Methods Project staff conducted an internal evaluation of the project using secondary analysis of service statistics, a quantitative household survey, a self-administered questionnaire with health-care providers, focus group discussions with community members, and key informant interviews with community members and policy makers in the project areas. Findings Documented key results were also confirmed by a separate USAID-commissioned external evaluation. Apart from outputs such as trees planted, energy-saving stoves constructed, community members reached with PHE messages, and illegal fishing nets seized, we found communities spoke about “hope for a brighter future”, and the feelings of more control over their lives. More women delivered at health facilities, reducing the risks associated with home births, which was made possible by training of health workers. There was increased use of more effective contraceptive methods for families to achieve their desired family sizes. More than 1583 households became peer education sites to demonstrate hygiene and resource management behaviours. 44 beach management units that govern community fisheries were strengthened to demarcate protected breeding sites and enforce local fisheries bylaws. Due in part to the results of this project, the East African Community has developed a regional PHE Strategic Plan to guide member states to implement PHE measures across the Basin. Interpretation The project impacted gender relations, and community health and natural resource use behaviours. It increased women's participation in natural and financial resource management decisions and livelihood opportunities. Overall health-seeking behaviours improved and more women stated they could access contraception with support of their spouses. The project strengthened the governance and protection mechanisms around fishing, and affected the terrestrial ecosystem through tree planting efforts. The integrated and holistic nature of the HoPE-LVB project contributed to marked improvements in key drivers of long-term sustainable development among Lake Victoria Basin communities, strengthening the ability of households, communities, and the ecosystem's ability to cope with growing pressures within the Basin. Funding MacArthur, The David and Lucile Packard Foundations, USAID, BARR, and Winslow and Margaret Cargill Foundations.