Bakari Itembe, a Beach Management Unit member from the village of Katumbi stands on the shores of Lake Tanganyika. (Photo by Ami Vitale)

Five years ago, Bakari Itembe stopped fishing with mosquito nets in the shallow waters of Lake Tanganyika near his home in western Tanzania. Instead, he began protecting fish breeding stocks by using legal fishing nets and following local regulations to avoid taking fish from demarcated breeding sites. Already, stocks of the tiny, sardine-like, dagaa fish he catches are recovering, giving him a more-stable income. There’s no longer any need for him to clear trees in the nearby forest, which is home to endangered chimpanzees, in order to create farmland and grow crops just to make ends meet.

In addition, with a loan from a new community bank, his wife, Fatima Itembe, has started a business that dries fish to sell in the market, boosting the family’s income. The couple and their seven children have meanwhile grown healthier thanks to investment in the village clinic, which now provides adequate medical supplies such as vaccines and contraceptives; advice on pregnancy and newborn care; and information on preventing diseases through better water, sanitation, and hygiene practices around the lakeshore and within households.

Like many families in their community, the Itembes have faced complex challenges, and their story illustrates how health, livelihood, and environment are interlinked. What’s not so typical is how they overcame those challenges.

In 2010, our organizations—the reproductive health and family planning nonprofit Pathfinder International and the environmental organization The Nature Conservancy—decided that by working together, we could accelerate each other’s goals and achieve greater things. Two years later, we launched a project called Tuungane (Kiswahili for “Let’s unite”), with a collaboration commitment of at least 10 years. The project’s focus is a 4.8-million-acre forested landscape in western Tanzania—an area that rises steeply from the shores of Lake Tang­anyika within the Greater Mahale ecosystem and that is home to more than 90 percent of Tanzania’s endangered chimpan­zees. Mahale National Park encompasses about 400,000 acres of this ecosystem, yet 70 percent of the chimpanzee population lives outside of the park’s boundaries. The project works with Tanzania National Parks and other government bodies on forest management, agriculture, and fisheries, as well as primary health care, livelihoods, and governance for local families. It is a version of population, health, and environment programming (PHE) that integrates action in all three areas into one combined approach.

Chimpanzees in the forest at Mahale National Park on Lake Tanganyika in Tanzania. (Photo by Ami Vital)

The Nature Conservancy believed the partnership would help it get further faster, simply because local people say reproductive health is one of their primary needs. Conservation priorities become more relevant when a fisheries officer can also talk to his fisherman groups about the availability of fish stocks to meet the needs of growing families and the health benefits of spacing their children. Similarly, Pathfinder understood that many people rely on their environments for either sustenance or livelihood as a matter of survival, and that managing natural resources for the future is critical to their long-term health and well-being.

Joint benefits

Our multipronged approach, and the trust it has generated in communities to take on new health-seeking and environmental conservation behaviors, has already translated into tangible improvements across the region. In 2011, 60 percent of families in the area struggled to meet basic needs. By 2016, that dropped to 39 percent. In the same period of time, contraceptive use among married women increased from 17 percent to 25 percent. Pregnant women are getting the prenatal care they need from improved, clean, and well-lit facilities, and women with high-risk births are now systematically sent to the regional hospital, which can handle blood transfusions and other obstetric emergencies in Kigoma, about 100 miles away.

Meanwhile, the amount of land under conserved status has tripled, encompassing one-third of the 4.5 million-acre ecosystem. Augmenting Mahale Mountains National Park are 700,000 acres of new District Forest Reserves and 500,000 acres under local management in Village Land Forest Reserves. In addition, the project has introduced 15 new beach management units and 15 new fish reserves, where breeding grounds are off limits for fishing. These units also fine trespassers, enforce bylaws, and earn landing fees for catch brought ashore.

We have achieved these goals by helping people work together to address diverse problems simultaneously. The Tuungane project team (consisting of The Nature Conservancy and Pathfinder staff) recruits and trains community volunteers who are interested in the concept of PHE and applying it to improve their lives. These volunteers become members of so-called “model households.” By demonstrating improved hygiene and sanitation practices, practicing climate-smart farming (such as planting drought-resistant crop varieties), using energy-saving stoves, and holding open discussions about the benefits of family planning, the volunteers lead neighbors by example. The project includes training health staff at upgraded clinics to dispense better treatment and provide advice on reproductive health. Meanwhile, microfinance provides seed funding—mainly to women—for small business ventures such as sewing machines for tailors and start-up inventory for a new village shop that brings necessities closer to home. New community governance committees demarcate and manage their sections of the lake together to protect the forest they live alongside, and monitor the status of health facilities to report to local government administrators.

Tanzania’s government is now using Tuungane as a model for its National PHE Strategic Plan, increasing its annual family planning budget allocation from $2.2 million to $6.2 million. Tanzania’s district governments are also providing funds for Tuungane-initiated activities.

Learning together

Our two organizations have made progress on how best to operate together. We’ve forged a joint monitoring and evaluation framework; set up joint transportation, housing, and communications for Tuungane field staff; and hired experts willing to both learn from one another, and live and work in isolated rural locations.

Based on these experiences, we have a few recommendations for other integrated PHE projects. First, establishing a joint vision and long-term commitment from the beginning gave us equal stakes in the project and its outcomes. We recommend partners design and begin to implement the project together, rather than build individual sectoral programs with the idea to combine them later. Second, partners should invest in robust joint monitoring and evaluation frameworks. These systems of assessment take time to develop and are best done iteratively. Last, we suggest that projects secure early funding that is flexible and supportive of innovation and integration.

Thanks to an integrated approach to chronic challenges, life for the Itembe family and their neighbors is improving in many different ways that, taken together, will support longer-term, holistic change in the region.

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