AND

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Report of a National Seminar8-13 November 1998

PEEM SecretariatWorld Health Organization

Geneva 1999In collaboration with the Danish Laboratory

LimitedEnglish only

PANEL OF EXPERTS ON ENVIRONMENTAL MANAGEMENT FOR VECTOR CONTROL

WATER RESOURCES DEVELOPMENTAND VECTOR-BORNE DISEASES IN MALAWI

Report of a National SeminarBlantyre, 8-13 November 1998

PEEM SecretariatWorld Health Organization

Geneva 1999

About PEEM

Thejoint Panel of Experts on EnvironmentalManagement for Vector Control (PEEM) was established in 1981 to create a framework for inter-agency and inter-institutional collaboration with a view to promoting the extensive use of environmental management for disease vector control as a health safeguard in the context of land and water resources development projectsand for the promotion of health through agricultural,water resources, environmental,human settlement and health programmes and projects. The collaboration originatesfrom Memoranda of Understanding between three agencies (WHO, and UNEP) covering the areas of prevention and control of water-borne and water-associateddiseases in agricultural development, rural water supply and waste water use inagriculture, forestry and aquaculture. In 1991the three agencies were joined byUNCHS and mandate was expanded accordingly to include human settlements, urbanization and urban environmental management including urban watersupply, sanitation, drainage and solid waste disposal. The Panel’s current programme consists of activities under three headings: promotion, policy modification and technical cooperation; multidisciplinary research and development; and capacitybuilding in intersectoral decision-making.

Among the promotional activities of PEEM are short national Seminars for seniorgovernment officials. The Seminar reported on here was the fourth of its kind;previous Seminars were held in Kisumu, Kenya (1 Cotonou, Benin (1 993) andKafue Gorge, Zambia (1 995) and reports of these can be obtained from the PEEM Secretariat. The Secretariat of the Panel is located at WHO headquarters in Geneva,Switzerland.

About DBL

This Seminar was supported by the Danish Bilharziasis Laboratory, one of the PEEMCollaborating Centres, DBL is a private foundation operating within the framework of the Danish International Development Assistance (DANIDA) of the Danish Ministry of Foreign Affairs. mandate includes training, research and technicalcooperation in the area of water-related vector-borne parasitic diseases in the tropics.

The issue of this document does not constitute formal publication. It is not issued to the general public and all rights are reserved by the World Health Organization (WHO). Views expressed do not necessarily reflect the policies of the four United Nations agencies participating in PEEM. It should not be reviewed, abstracted, quoted or translated without the written permission of the World HealthOrganization. No part of this document may be stored in a retrieval system or transmitted in any formor by any means -electronic, mechanical or other- without prior written permission of WHO. Thedesignations employed in the map on the cover do not imply the expression of any opinion whatsoever on the part of the four agencies concerning the legal status of any country, territory, city or area or its authorities, or concerning the delimitation of its frontiers or boundaries.

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EXECUTIVE SUMMARY

A National Seminar on Water Resources Development and Vector-borne Diseases inMalawi was held at Ryall’s Hotel in Blantyre from 9 to 13 November 1998. The Seminar was attended by fifteen senior government officials representing eight ministries or authorities. In addition, representatives of a bilateral agency (DANIDA),civil society and the private sector attended. The Seminar was organisedjointly by the

Panel of Experts on Environmental Management for Vector Control (PEEM) and the Government of Malawi, with support from theDanish Bilharziasis Laboratory (DBL).

Ministries and authorities represented included Health and Population; Agriculture and Irrigation; Forestry, Fisheries and Environmental Affairs; Water Development; the National Economic Council; the National Research Council of Malawi; the Water Resources Board, and the Lilongwe Water Board.

The scope of the Seminar was limited to policy issues related to the association between water resources development and vector-borne diseases. Its main objective was to develop a consensus on options for the harmonization and adjustment of sectoral policies. This should ensure the effective consideration of environmental andhealth concerns in all phases of the project cycle in water resources development.

During the first four days, the Seminar established a comprehensive planning table for water projects (in particular for the provision of drinking water supply and forirrigation), with an indication when health considerations should enter into theprocess. The Seminar reviewed current sectoral policies, identifying in whichconnection they mention human health, and which components of the policies might have health implications that require an explicit position to be stated. Environmental Impact Assessment and the opportunities for strengthened Health Impact Assessment procedures provided an important focus of discussion.

The Seminar formulated detailed recommendations infive areas: Policy review and adjustment, Institutional Arrangements, Capacity Building, (iv) Technical Co-operation, and (v) Regional Co-operation.

On the fifth day of the Seminar, Principal Secretaries, or their representatives, of threeministries (Water Development, Health and Population, and Agriculture and Irrigation) and of the National Research Council of Malawi attended the Seminar. They were informed about its conclusions and recommendations. The latter were endorsed with minor amendments and are presented in the report of the Seminar. Inaddition, the Principal Secretaries recommended that action be taken in two specific issues, in order to facilitate a sustainable follow-up to the Seminar:

( I ) Policy adjustment and development of newprocedures to bring health into theearly of water resources development require a structure to which responsibility and accountability in these matters can be attributed.Strengthening existing structures is preferred over the creation new ones.Existing bodies in the various sectors that manage water resources (National Councilfor the Environment, National Irrigation Task Force and the WaterResources Board, example) should definitely consider health in their decision

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making process. Essentially, however, the co-ordination all cross-cuttinghealth issues falls within the mandate the Ministry and Population. The Minister Health and Population should consider strengthening the Environmental Health Department into an entity that has the capacities,capabilities andjurisdiction to deal with health in a cross-cutting manner. Itshould also ensure optimal communication on matters pertaining to health riskassessment and management between the health sector and other sectors, as wellas exchange information within the Ministry Health and Population. WHOshould provide the technical assistance needed and explore possibilitiesfinancial support to this structural reform in the health sector.

(2) An actionplan should beformulated as soon as possible the implementation the recommendations the Seminar. With thepermission theMinister Health and Population, the task co-ordinating the formulationthis action plan should be given to the Environmental Health Department. Itshould be developed in consultation with the other sectors involved and clearly delineate the responsibilities. It should also set criteria and provide a realistic budget on the basis which donor support can be sought.

The Seminar was well attended and participants as well as Principal Secretariestookan active part in the discussions. The Seminar resulted in a range of readilyimplementablerecommendations, and it is the sincere wish of both participants andPrincipal Secretaries that these are realised in the near future.

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TABLE OF CONTENTS

EXECUTIVE SUMMARY 3

ABBREVIATIONS 6

RECOMMENDATIONS

FLOW CHART OF PLANNING PROCEDURES

INTRODUCTIONObjectivesExpected outputs

SEMINAR PROCEEDINGS Opening ceremony Water-borne diseases in MaiawiIntroductory presentations Development of a comprehensive planning table Report of the working groups FieldtripClosing session with Principal Secretaries

PAPERS PRESENTED AT THE SEMINARIntersectoral collaboration for the incorporation of health safeguardsinto development projectsRobert Hans Verhoef and Lucy Clarke A general address on PEEM, SPFS, health, agriculture and water development in Malawi

The national environmental policy as it relates to waterand natural resources management in MalawiA. M. Banda, Environmental Affairs DepartmentWater resources development and vector-borne diseases in MalawiW. Limbe, Ministry of Health and Population Investment and development policies and procedures

National Economic Council Malawi’s policy framework for irrigation development C. P. Mzembe, Irrigation Department Water resources policy and management in MalawiP. W. R. Ministry of Water Development Policies governing the delivery of water in areas

L. Lilongwe Water Board

ANNEXES1. List of participants 2. Tentative programme3. Composition of groups4. .

5. Seminar evaluation Presentations from Kasinthula Research Station

7

10

121213

1313151616182223

25

32

34

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7076808186

Page 5

CHSU

DBL

DDC

DITF

EIA

ESAMI

HIA

NEC

NEP

NGO

NITF

NRCM

PEEM

SADC

SPFS

UNCHS

UNEP

WHO

Community Health Sciences Unit

The Danish Bilharziasis Laboratory

District Development Committee

District Irrigation Task Force

Department of Irrigation (Ministry of Agriculture and Irrigation)

Environmental Impact Assessment

Eastern and SouthernAfrican Management Institute

Food and Agriculture Organisation of the United Nations

Health Impact Assessment

Ministry of Agriculture and Irrigation

Ministry of Health and Population

Ministry of Women, Children and Community Services

Ministry of Water Development

National Economic Council

National Environmental Policy

Non-governmental Organisation

National Irrigation Task Fund

National Research Council of Malawi

Panel of Experts on Environmental Management for Vector Control

SouthernAfrican Development Corporation

Special Programme on Food Security (FAO)

United Nations Centre for Human Settlements(HABITAT)

United Nations Environment Programme

World Health Organisation

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RECOMMENDATIONS

Based on the outcome of the working group discussions, the following recommendations were formulated:

Policy review and adjustment

(1) The assistance of WHO, and other relevant agencies should be requested for the further development and completion of the environmental health policy by theMinistry of Health and Population. The development process should include adequate consultation with the other sectors to ensure that the health sector canrespond to their needs with respect to health risk assessment and management indevelopment projects.

(2) A revision of the NEC Project Planning Manual should be carried out to establish the role and procedures of Health Impact Assessments in development planning. At the next periodic review of the National Environment Policy the identified need for a Health Impact Assessment of development projects should be appropriately reflected. This should define HIA as a distinct component in the planning of future development projects, under the umbrella of EIA and payingdue attention to cross-cutting issues relating to community health status.

Review of the NEC Manual should be jointly undertaken by NEC and theMinistry of Health and Population. The Ministry of Health and Population should also assist the Environmental Affairs Department to fill in the details of health references in the National Environment Policy and harmonize its own policieswith the NEP.

(3) A joint review is recommended of the Irrigation Policy by the Ministry of Health and Population and the Irrigation Department to incorporate specific cross-cuttinghealth issues in the operational part of this policy. Technical input WHO and

into this process is desirable.

(4) The Ministry of Water Development and the Ministry of Health and Population should jointly review the policy addressing urban drinking water supply, so that it gives due consideration to the assessment and management of health risks resulting from harnessing water resources in reservoirs and dams. Mechanisms for integrating these concerns into the remit of the Ministry of Water Developmentshould include a Task Force established within the context of the relevant Water Boards.

(5) In the ongoing review of the Water Resources Policy, opportunities should be identified for its improvement in terms of setting clear criteria (including health criteria) for the development of rural drinking water supplies.

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InstitutionalArrangements

Existing fora for intersectoral dialogue should be used to their optimal potential to ensure that environment and health issues receive adequate attention, and clearprocedures should ensure that representatives of the different ministries communicate the information generated at such fora to staff in their respective ministries.

Intra-sectoral strengthening of the Ministry of Health and Population should beachieved as soon as possible in order to facilitate a strategic alliance with the

Affairs Department and strong partnershipswith other ministrieson issues relating to health risks assessment, health risk management and well-targeted strengthening of health services in the context of development projects.

Considerable development efforts already underway by the private sector andNGOs would benefit a strengthened regulatory role of public sector authorities with respect to the management of health impacts of development projects on affected communities.

Arrangements between the public sector and NGOs should aim at strengthening NGO efforts to achieve community empowerment, with the specific goal ofenlisting the communities involvement in the health impact assessment and healthrisk management processes.

Capacity building

(10) A wide-ranging training effort should be initiated in the field of waterresources development and human health, including the incorporation ofmodules in relevant curricula of institutes of tertiary education - specificmention was made of the new MPH course of the College of Medicine of the University of Malawi -,and the design of in-service training programmes for public sector officers.

The training of mid-level managers in relevant ministries in the area ofintersectoralplanning and decision making should be pursued through the implementation of the training course Health Opportunities inWater Resources Development.

(11)

Technical co-operation

(12) Jurisdiction concerning Health Impact Assessment (HIA), together withcapacities and capabilities of relevant government agencies should bestrengthened through financial input from external support agencies that help expedite the establishment of a sustainable institutional framework for HIA.

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should explore possibilities to provide financial assistance to themanagement of the Kasinthula Smallholder Sugar Scheme to assess the health risks caused by specific community and environmental risk factors in thescheme, followed by support for measures to reduce these risks.

SUCOMA should earmark part of its 1999 budget allocation for public health in the Kasinthula Scheme to environmental management interventions, including improvements in the supply and sanitation facilities.

Regional co-operation

(15 ) Both in terms of exchange of technical information and of comparingexperiences with respect to including health in development policies, links with other governments in the SADC region should be strengthened.

(16) A mechanism intersectoral dialogue should be installed so that prior to international conferences with multisectoral the delegate representing the Government can present a balanced position that takes different interests into account.

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11

INTRODUCTION

A National Seminar on Water Resources Development and Vector-borne Diseaseswas held at Ryalls Hotel in Blantyre, Malawi from 9 to 13November 1998. The Seminar was attended by fifteen senior government officials representing eightministries or authorities. In addition representatives of a bilateral agency (DANIDA), civil society and the private sector attended. A list of participants is presented inAnnex 1.

The planning of the Seminar started during an initial visit of the Executive Secretaryof PEEM to Malawi in July 1998. In September 1998 a steering group responsible for the organisation and preparation of the Seminar was established. The steering group consisted of staff the Ministry of Health and Population, the Ministry of WaterDevelopment, the Department of Environmental Affairs and the Department ofIrrigation as well as staff from the WHO office in Lilongwe. Additionally, the Danish Bilharziasis Laboratory (DBL) contributed the services of an MA student whoassisted the steering group in the preparations of the Seminar.

A programme was developed by the steering group (Annex 2) and participatingministries and authoritieswere invited to prepare presentations on current policies andtrends in policy development and adjustment in their respective areas ofresponsibility.

Blantyre was selected as the venue for the Seminar as its location allowed for a one-day fieldtrip to the Kasinthula Smallholder Sugar Scheme.

The Seminar was opened by the Minister of Health and Population, the Honourable Harry I. Thompson, MP, on 8 November and closed on 13 November with a sessionattended by Principal Secretaries relevant ministries and authorities.

OBJECTIVES

The Seminar had the following objectives:

To increase awareness among senior officials involved in policy making, of the cross-sectoral nature of environment and health implications of land and water resources development in Malawi;

To develop a consensus on options for the harmonization and adjustment of policies in order to ensure that environment and human health issues

associated with land and water resources development are effectively consideredat crucial decision-making moments in all phases of the project cycle. An adjustedpolicy framework will facilitate the incorporation of health safeguards into the design of land and water projects;

To strengthen institutional arrangements in support of an effective intersectoral dialogue during project planning, development and operation, to ensure policies

12

concerning environment and human health aspects of land and water developmentare applied; To set priorities for capacity building activities that will support and enable the opportunities of policy reform and strengthened institutional arrangements to be utilized with maximum benefit.

EXPECTED OUTPUTS

At the time of planning the Seminar, the following outputs were defined:

An updated table of water resources development planning in Malawi;

A situational analysis of current national water polices and strategies;

A situational analysis of current national health policies and the health status ofcommunities affected by water resources development;

A situational analysis of current polices, legislation and procedures relating toEnvironmental Impact Assessment and national plans for sustainabledevelopment;

A report containing the above information and recommendations on:

Options for follow-up action regarding national and sectoral policy review, formulation and adjustment;

Options for improved institutional arrangements between the relevant sectors: mechanisms for harmonization of sectoral polices; strengthening the position of health in the context of national

needs, options and priorities for capacity building. policies and legislation;

All the above outputs were achieved.

S E M I N A R PROCEEDINGS

Following are the highlights of the Seminar discussions.

OPENING CEREMONY

The Seminar was officially opened by the Minister of Health and Population,Honourable Harry I. Thompson, MP, after statements by Mr Robert Bos, WHOGeneva; Mr John Snell, Malawi; and Dr N. Teklemichael, WHO Representativein Malawi.

In his opening remarks, Mr Robert Bos (WHO) reported on the current restructuring at WHO headquarters. One of the nine new programme clusters, the Cluster of

13

SustainableDevelopment and Healthy Environments (SDE), is now mandated topromote risk assessment and management in relation to environmental determinants of health. It will also address the health impact of development policies and the issue of inter-sectoral action for health. When the concept of sustainable development was launched in “Our Common Future”, human health had been an, often implicit, dimension of environmental change. In “Agenda 2 1 the blueprint to achieve sustainable development in the 2 1 century, human health is mentioned explicitly inChapter 6 , addressing the traditional, mainly health services concerns, and implicitly, dispersed over the various chapters on natural resources in section 2. Inchapter 18, on fresh water resources, for example, specific reference is made to the need to safeguard health in water resources development planning. It was in connection with these cross-cuttingreferences to health throughout Agenda 21 that the national Seminar in Malawi was organised.

John Snell, FAO, pointed to the basic importance of sustainable development inensuring long lasting food security for all. In this regard the proper management andconservation of water, which is the single most important natural resource, isindispensable. In the future developing nations will to an increasing extent rely onirrigated agriculture for food production and there is a strong need to incorporate measures to protect human health as well as the environment in existing and futureirrigation projects. Since 1981 the Panel of Experts on Environmental Management for Vector Control has been developing and initiatingactivities with this aim. John Snell referred to the Seminar as one such activity coming at a very opportune moment, when the Government of Malawi is planning to promote small-scale irrigation as a means to increase food production. The has pledgedits support in working towards this goal of food security through the framework of the Special Programme on Food Security (SPFS), which focuses on water controlmeasures in smallholder agriculture. Mr Snell underscored that the importance of environmental protection and health safeguardscannot be overemphasised in thisconnection. He ended his statement by affirming the support of the in the follow-up to the recommendations of the Seminar.

In his statement Dr Teklemichael referred to the aims for sustainable development as formulated by the heads of Member States in “Agenda 21” in de Janeiro in 1992.He pointed out that one of the initiatives taken by the WHO in this regard has been the formulation of the WHO Global Strategy on Health and Environment. Among otherpoints this strategy emphasises that health is a cross-cutting issue and not a concern for the health sector alone. Instead, it is necessary for all involved sectors to address health issues at the planning and design stages of projects in order to obtain truesustainability. This is particularly important in southern Africa as droughts recurrently hit the region and governments in response to this accelerate the development of waterresources in order to ensure food security.Effects of large-scalewater developmentprojects are well documented.Impacts on health following smaller water developmentprojects are less known, but there is reason to believe that their cumulative effects are just as great. Dr Teklemichael emphasised that malaria and schistosomiasis continue to be major public health concerns and the strengthening of intersectoral collaborationand policy review and adjustment is important when attempting to mitigate theworsening situation.

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The Minister of Health and Population, the Honourable Harry I. Thompson, MP,officially opened the Seminar by stressing the need for deployment of effective risk assessment management strategies in connection with water development projects inMalawi. He therefore welcomed the timely opportunity given by the Seminar to assesscurrent policies and the degree to which they are suited to the task of managing health issues in a cross-cutting manner. He pointed to the problem that projects are often implemented without the necessary consultations between theconcerned sectors and without adequate support from other stakeholders. Thus the intentional impacts of projects are not felt among the beneficiaries. The Minister expressed the wish that the Seminar be fruitful and result in concise recommendations to be discussed thoroughly and possibly endorsed by the Principal Secretaries at the end of the Seminar.

WATER-BORNE DISEASES MALAWI

On the first day of the Seminar the scope, objectives and expected outputs of theSeminar were presented by Mr Robert Bos. Following the participants exposed the extent to which diseases endemic in Malawi are, in one way or another, associated with water. In a modified nominal group process an exhaustive list of diseases was composed and these were then divided into categories that defined their association with water.

The end result was as follows (some diseases come under more than one category and further definition is location-bound):

Water-borne diseases, diseases resulting a lack of safe drinking water: - diarrhoea1 diseases and cholera; - typhoid fever; - polio, hepatitis A;- non-communicable diseases linked to the long-term exposure to chemical

residues in water;

Water-washed diseases, diseases resulting from water contamination for lack ofadequate sanitation or from insufficient quantities of water to allow for proper hygiene:

-- amoebiasis and bacillary dysentery; - schistosomiasis (bilharzia); - trachoma and infections;

hookworm and other helminthic infections;

Water-based diseases: - schistosomiasis (bilharzia);

Water-related, diseases:- malaria;- filariasis;

Fierce animals with an aquatic habitat, in particular crocodiles and hippopotamus, arean important cause of trauma and mortality.

15

Other diseases mentioned in association with water but not of great public healthimportance or not present at all in Malawi include: guinea worm infection(dracunculiasis), river blindness (onchocerciasis), yellow fever and dengue fever.

INTRODUCTORY PRESENTATIONS

Mr Robert Bos presented a paper on intersectoral collaboration for the incorporation of health safeguards into development projects (see page 25 of this report for the unabridged paper). He pointed to the paradox that environmental issues areintersectoral by nature, but - due to the very nature of sectors - they are usually treatedin a one-dimensionalway within each sector (if treated at all). This procedure oftenhas an adverse effect on environment as well as health, and sectors then resort to afterthefact repair. There is a need for the incorporation of health safeguards in development projects at the early stages of planning, but often the health sector lacksresources for this kind of involvement and other sectors lack the expertise. Attempts in the 1970sand 80s at forming intersectoral committees overseeing developmentprojects did not succeed in incorporating health issues due to lack of own funding.Although Environmental Impact Assessments have been widely incorporated intoplanning procedures they rarely include proper appraisals of health risks. Mr Bosinvited participants to take the opportunity given by the Seminar to consider new possibilities for the incorporation of sustainable health safeguards into thepolicies.

Mr John Snell, FAO, presented main mandate to assist in the eradication of hunger and malnutrition and to promote sustainable agriculture and rural development(the unabridged paper starts on page 32). As part of these aims gives high priority to achieving food security, especially among low-income food deficientcountries. In working towards this goal irrigation plays a central role. Theintroduction of irrigation has both direct and indirect benefits to health in that dietsimprove and income increases.At the same time irrigation poses new challenges to the management of health and environment. In Malawi agriculture is the backbone of the economy. Agriculture supports 90 percent of the population and accounts for 35percent of GDP and 90 percent of foreign exchange earnings. Still 60 percent of Malawi’s 1 1 million people run out of food three to four months before the next harvest.In view of population growth, pressure on the land and drought,Malawi’s greatest need is to intensify and diversify production for household and national food security. Irrigation plays an essential role in this and the is assisting the Government inmeeting the challenges of smallholder irrigation as means to achieve food security.Thereis no doubt that for successful smallholder irrigation development and sustainable agriculture, health protection is important.

Mr Snell emphasised that the Seminarwas very timely and crucial to the agricultural,economic and social development of Malawi.

DEVELOPMENT OF A COMPREHENSIVE PLANNING TABLE

Participants worked in two groups in order to prepare a comprehensive table of the planning procedures for water resources development projects in Malawi. The table,

16

which was consolidated at a plenary session on the following day, is presented onpages 10-1 1 of this report.

In the table the current planning procedures are presented for two major types ofwater resources development projects in Malawi, the provision of drinking water supply and small-scale irrigation projects. Other types of water development projects, such as hydropower generation, aqua-culture and recreational uses of water, are also found in Malawi, but are currently not given the same national priority by theGovernment as the categories of projects mentioned above.

Planning procedures for drinking water supply is generally characterised by theinvolvement of many stakeholders through all project phases. Until 1994 the Ministry of Water Development was responsible for water supply all over Malawi. In order todivide the legislative and the executive functions of the Ministry three regional water boards and two urban water boards were then established with a mandate toadminister drinking water supply. In the rural areas this remains the responsibility of the Ministry of Water Development. The planning procedures for drinking water supply are currently in a state of transition, since the transfer of administration ofwater supply to the water boards is not yet completed. Furthermore, it is the intention to involve the relevant members of the NEC in estimating the need for anenvironmental impact assessment for each project. Generally, the internal funding of water development projects amounts to 20%.

Presently there are only two irrigation schemes in Malawi that can be classified as large-scale schemes. Thus the procedure outlined in the table accounts for medium and small-scale irrigation projects (defined as less than 500 ha). During the feasibility studies the District Development Committees are assisted by the local District Irrigation Task Force when assessing possibilities and constraints in irrigationdevelopment. The report to the NITF, whereafter construction is left tocontractors in the private sector and to the farmers. The procedure for initiatingirrigation schemes is currently undergoing changes towards a larger degree of decentralisation. It is the intention that the Irrigation Department have a facilitating role only in assisting farmers with design and finance. The internal funding ofirrigation schemes is usually between 10-20%.

These smaller irrigation projects are all part of a comprehensive national irrigation programme that have gone through an assessment and approval procedure involving the National Economic Council, which consists of representatives from the various line ministries, the Ministry of Finance, and donors, apart from the Ministry of Agriculture and Irrigation. It is the National Economic Council which decides what kinds of assessments - including EIA - are needed to appraise a programme.

For all types of projects the phases most effective for the incorporation of healthissues were plotted into the chart. Ideally health impacts should be considered through all phases of water development projects, and contrary to current practice, it isespecially important to consider health risks and opportunities during the early stages of project planning. In phases 2 and 3, where pre-feasibility and feasibility studies are conducted and design aswell as terms of reference for projects are determined, it isessential to integrate adequate measures of securing sustainable health. One possibility of ensuring this is to rapid or full Health Impact

17

Assessments as an integral part of planning procedures. Similarly, the consideration of health is crucial at the appraisal and negotiation phase to establish a basis for action during the construction and operations phase.

REPORT OF THE WORKING GROUPS

Following the presentation of policy papers starting on page 36 by the invitedministries and authorities, two working groups were establishedwith the remit to review specific policies and answer the following questions:

1.

2.

3.

4.

5 .

6 .

7.

Do the non-health sector policies address health issues specifically and if sowhich?

Which aspects of the non-health sector policies may have an impact on health,without mentioning this specifically?

Whenever health issues are addressed in these policies, do they consider health ina cross-cuttingmanner, or do they focus on the health services tasks of theMinistry of Health?

Does the health policy create an enabling environment for intersectoral action for health?

What are the options in all the policies your group is considering to include the assessment of health risks and the (environmental) management of those risks inan effective way?

In relation to the observations made under points 1-5and considering theconsolidated comprehensive planning framework, what options are there to strengthen the institutional arrangements to support intersectoral action between

the various ministries?

.the public sector and the private sector, and

the public sector and civil society?

What capacity building needs can you identify that should be implemented insupport of the proposed policy adjustment options and institutional arrangements?

The composition of the working groups is presented in annex 3. Working group 1reviewed the National Environment Policy and the National Water Resources Policy, while working group 2 reviewed the Irrigation Development Policy and the Policy on Urban Drinking Water Supply. Both groups reviewed the Health Policy. Forenvironment and irrigation complete policy documents were available,while for thehealth sector, the water resources development sector and the urban drinking water sub-sector the participants had to rely on the presentations given in the course of the Seminar.

The outcome of the working group deliberations with respect to the above questions ispresented below. Both groups agreed on questions 3 and 4: none of the policies gives due attention to the cross-cutting nature of health, and the health policy does notcontain any elements conducive to the creation of an enabling environment for intersectoral collaboration in support of health.

GROUP 1.

The starting point of the deliberations of Group 1 was the definition of health as given by the World Health Organisation: a state of completephysical, mental and social well-being, and notjust the mere absence of disease and infirmity.This broad concept of health implies the need to consider the health status of communities in addition to the delivery of health care services to combat disease. Following from this, the responsibilities of other sectors than the health sector for the health and well-being of communities also become apparent.

. Coverage of health in the National Environmental Policy.

Reference is made to health in the following sections of the policy document:

4.9, 4.10 and 4.1 1, 4.11,4.13,5.1, under the heading nutrition 5.3, in relation to fisheries 5.5,

5.7,5.10, in relation with tourism

where sanitation is mentionedwhere health is considered in relation to air quality and climatein relation to security and land tenure

where in the broader context of water, the provision of safe potable water is mentionedunder industry and mining, and

It was observed by the group that in none of these cases where a reference is made tohealth, there is a further specification of the relevant health problems. It appears that the Ministry of Health and Population is expected to fill in these details, in line with what is expected from all sectors on matters pertaining to their mandate.

. Coverage of health in the National Water Resources Policy

Deducing from the paper that was presented at the Seminar, the following sections ofthe National Water Resources Policy were listed as having a specific reference tohealth :

Page 6 water quality services Page 11 (point 2.8.2.) catchment protection regarding settlements and waste disposal Page 11 waste water management Page 12Page 15Page 15Page 16

provision of safe drinking water sanitation and chemical waste deficiency of policy on sanitation water allocation: water pricing in terms of affordability

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Aspects that potentially have an impact on health without referring to it specifically

In the National Environment Policy, first of all it was observed that while there isrepeated general reference to health, the specific associationbetween water resourcesdevelopment and vector-borne diseases is nowhere mentioned. It is missing inparticular from sections dealing with aquatic habitats and hydrological changes resulting from development projects.

The other observation with respect to the National Environment Policy concerned the lack of a specific reference to Health Impact Assessment in the context ofEnvironmental Impact Assessment. It was recognized that while health is normallyincluded in the checklist of any EIA, this does not guarantee a cross-cutting approachto health. The failure to include the health dimension of predicted environmentalchange is likely to lead to recommendations aimed at strengthening of health services alone. Opportunities to incorporate health safeguards in the project design andconstruction phases will be missed.

In the water resources policy the issue of water pricing has specific health implications that are not mentioned. Impediments to access to safe drinking water because of water pricing policies would seriouslyjeopardize the health of the poorest individuals and communities.

Two options to include health risks assessment and management were identified:

(1) a review of the overall satisfactory coverage of health issues in the National Environment Policy, in order to add specificity to the generic references.

(2) a revision of the Project Planning Manual of the National Economic Councilto ensure that Health Impact Assessment aspects are covered throughout the project cycle.

When considering the needs for improved institutional arrangements in thepublic sector, the group focused on the intra-sectoral situation in the Ministry ofHealth and Population. Changes that needed to be addressed urgently included:

(1) establishment of effective co-ordination between existing programmes in the Ministry is an essential pre-condition before intersectoral collaboration for health can be further developed. This co-ordination is now lacking and anyimprovement should be structural, so as to ensure that the coordination remains optimal in spite of changes in staff or the development of new programmes;

(2) the promotion of frequent reporting and discussion by controllers ofprogrammes of the Ministry to keep all staff informed;

(3) implementationof the recommendations emerging from the functional review of the Ministry’s organisational structure;

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(4)improvement in the Ministry’s career development programme and filling ofexisting vacancies, to ensure an effective and efficient delivery of programmesand services;

(5) considering that problems related to these internal institutional arrangements are effectively resolved, the use and effectiveness of existing fora for intersectoral collaboration, such as the Water Resources Board and theNational Council for the Environment should be optimized. Representatives ofdifferent sectors in these fora should improve the dissemination of theinformation emerging from them among staff in their own sector.

. With respect to capacity building needs, the following observations weremade:

(1) in addition to the points raised above with respect to improvements within the health sector, it was pointed out that human resources development planning in the health sector should partly be guided by the outcomes ofHealth Impact Assessments of development projects. In this way, the health services could prepare to meet the new needs of communities affected by suchprojects ;

(2) Existing Acts (including the Public Health Act of 1936) should be reviewed for the issue of health impacts of water resources development;

(3) the creation of focal points in ministries and the introduction of affordablecommunicationmechanisms and technology should be pursued in order toachieve effective networking;

(4) proper in-service training programmes should be instituted for public sector staff.

GROUP 2.

. Coverage of health in the Irrigation Policy

In the Irrigation Policy, health aspects are referred to on pages 6 and 9. The group feltthat, as a minimum, health issues could also be addressed under functionsdescribed on pages 19 and 20. It was, however, felt that a complete review, jointly bythe health and irrigationprofessionals, would ensure that health concerns areaddressed at appropriate junctures throughout the document.

The group reiterated the point that irrigation development has both positive andnegative impacts on health, but as already pointed out, the coverage of health in thispolicy leaves room for improvement.

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. Coverage of health in the urban water supply policy

With respect to urban drinking water supply, the policy focuses on health benefits implied by the service that is provided. The focus is on service delivery. There is,however, no attention in this policy for the health aspects that may be associated withthe harnessing of the water resource for the provision of urban drinking water, theconstruction of dams and reservoirs.

While water treatment has a positive health impact, the policy of water pricing may negatively influence equity: poor people will not have access to safe drinking water. The provision of water drainage and washing slabs as foreseen in the policydemonstrates a broader concern for health aspects in this connection.

. Institutionalarrangements and capacity building were covered in a more generic way by this group; it raised the following issues:

(1) the health sector should be included in the further development of the irrigation policy and in the functions delivered under the irrigation policy;

(2) existing steering groups on policy adjustment should ensure that health issues areincluded;

(3) public sector contacts with civil society should focus on information dissemination, awareness programmes and law enforcement;

(4) capacity building needs included education and training, strengthening of systems and infrastructure, community empowerment, accountability for community projects and inputs of resources and expertise.

FIELDTRIP

The participants visited the Kasinthula Smallholder Sugar Scheme', for theparticipants to observe and assess a range of fundamental health problems related to irrigation schemes. The chairman of the smallholders, members of staff from theKasinthula Research Station, and a teacher from the local school introduced participants to the scheme and presented their perspectives on the particular health issues that affect the communities around the scheme (Annex 4). A trip to central locations within the scheme illustrated a variety of health hazards related to water. Asparticipants moved around the scheme, the close interrelationshipbetween thephysical construction of the scheme, water management, farming practices, the availability and adequacy of health services and the health status of the communities living in and around the scheme became evident.

The Kasinthula Smallholder Irrigation Scheme was founded by the Government in 1968 as a 1

smallholder rice scheme, with an attached Research Station and a Fish Farming Station. In 1998 it was converted into a smallholder sugar scheme, producing sugar to the South African company ILLOVO Sugar Ltd. Presently 1200 ha is irrigated and of these 325 ha are farmed by 110 families. 11 villages of approx. 500 people each are situated in and around the scheme.

22

At the subsequent debriefing the Seminar summarised its observations in accordancewith the elements of a Health Impact Assessment2.

Community vulnerability - no access to safe drinking water - water quality is low- siting of the scheme close to villages - no community ownership - lack of sanitation- lack of firewood- sleeping habits outdoors during the hot season so that mosquito nets are of no

use)

Environmental receptivity - lack of canal maintenance - underutilization of fish ponds - erosion risk for lack of environmental management - obsolete structures where water collects to create breeding places - risk of fertiliser run-off (aquatic vegetation favours aquatic snails)

Institutional capacity - long distance to district hospital is a limiting factor - insufficient drug supply - insufficient among communities - no access to mosquito nets

CLOSING SESSION WITH PRINCIPAL SECRETARIES

For the last day of the Seminar Principal Secretaries from the ministries andauthorities represented at the Seminar were invited to participate in discussions on the outcome of the deliberations during the first four days. The Principal Secretary of theMinistry of Water Development, Mrs H. G. Kawalewale chaired this session.

During the discussion the following issues were raised:

Policies can only be effective when there is a work plan and proper follow-up. The work plan must reflect institutional to avoid undertaking parallel activities at the expense of addressing cross-cutting issues related to health during project planning and implementation. It was noted that health issues are often considered in passing without involving all stakeholders.

The Seminar noted with regret that the Public Health Inspectors Course at the Polytechnic was arranged without proper mechanisms for career development and follow-up activities. There was agreement on the need to identify a proper for the co-ordination of public health issues which must have a databank forinstitutional facilitation. This will ensure a team approach to tackling public health issues with proper integration and interaction.

The HIA elements used are based on a standard by Dr as described in Guidelines2

the vector-borne disease implication of water resources development, PEEM 1991

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The Seminar noted with appreciation efforts being undertaken in enforcing EIAs forall development projects. However, it was emphasised that EIAs must not onlyconsider what will happen to environment but must encompass all issues relating tothe human dimensions - including health impacts. The National Irrigation Task force,the Water Resources Board, the Technical Committee on the Environment and any other such bodies must work together to provide both EIAs and This will ensure that health, environment, development and any other cross-cutting issues areinterlinked and attended to as a package.

The Seminar further noted that the Department of Environmental Health in the Ministry of Health and Population needed to be strengthened and guided by a well-defined action plan with timeframe and frequent follow-ups. The Department needed to be more focused and better staffed with a wide spectrum of disciplines to handle allcross-cutting health issues. Consideration must, however, be given to the current financial burden of the Ministry of Health and Population. The invited delegatesobserved that the recommendations must stress the need forsupport and include all potential cooperating partners such as WHO and FAO.

The Seminar further acknowledged the importance of documentation as crucial andthe need to put this in the forefront for any project planning, implementation and project phase.

Finally, Dr Mwijeriwa proposed that the recommendations be endorsed subject to the suggested corrections and that an action plan must be appended to the recommendations.Dr Matabwa and Dr seconded the proposal.

The Seminar was closed (or, rather, in her own words, adjourned, in view of theongoing nature of the subject matter) by the Secretary for the National ResearchCouncil of Malawi, Dr (Mrs) Mwijeriwa, who stressed the need for continuity,intersectoral collaboration and policies.

24

PAPERS PRESENTED AT THE SEMINAR (Unabridged)

INTERSECTORAL COLLABORATION FOR THE INCORPORATION OF HEALTH SAFEGUARDS INTO DEVELOPMENT PROJECTS

Robert Bos, Hans Verhoef and Lucy Clarke

INTRODUCTION

The question we will be faced with in this Seminar is how government agencies and professionals from various sectors can work together to mitigate the health risks that result from water resources development, in particular the development of dams and irrigation schemes. The focus will be on thedevelopment of an effective policy framework that creates and enabling environment for intersectoral action. Related to this is the question how non-governmental organizations and external support agencies such as bilateral and multilateral aid agencies, banks and funds) can supportgovernments in their efforts to achieve this framework.

Governments can influence at different levels, through policies, programmes and projects. Macro-economic policies usually set the reference framework within which the various government sectors develop the criteria and procedures for the achievement of their objectives. Agricultural policies are therefore generally production oriented with a strong emphasis on food security. They are not likely toinclude public health considerations. The conventional view is that adverse health effects that are theresult of the development policies of non-health sectors should be redressed by an adequate response ofthe health care delivery system.

Projects for agricultural development, in particular irrigation development, and the construction ofreservoirs for drinking water supply or hydropower generation, commonly result in radicaldemographic and environmental changes which have a bearing on health hazards and health risks. The “hidden costs” for health can seriously offset the development gains intended by the project, inparticular for certain vulnerable groups. It should be recognized, however, that on the medium-term thedevelopment of improved farming systems in agricultural development projects also allow a greater potential for delivery of and access to health interventions than do the traditional farming systems. This is illustrated by the following points:

planning, design and development of medium to large scale projects is usually centrally managed and thus offer opportunities for the health sector to be actively involved in the decision-makingprocess;

health can (and should) be taken up in the economic analyses that make up the basis ofmaking about projects, so that part of the resources available for the project are allocated to cover the costs incurred by mitigating measures. These may be capital or recurrent costs;

in projects aimed at the production of cash crops, a proper pricing policy will allow farming families to increase their purchasing power, part of which may be used to buy medicine, mosquito nets or pay for improved health services; the physical environment of farming systems that are created by agricultural development projects is more easily controlled and as a consequence more amenable to environmental manipulation and modification than that of traditional systems.

Similarly, the construction of dams and the development of reservoirs offers opportunities to improve health. This is particularly true if an integrated river basin approach is taken and water management in

Robert Bos is the Executive Secretary of the joint Panel of Experts on Environmental Management for Vector Control (PEEM), located in the Cluster of SustainableDevelopment and Healthy Environments, World Health Organization, Geneva. This paper has beenadapted from a paper originally prepared by Hans Verhoef and Lucy Clarke for a National Seminar in Benin in Hans Verhoef is currently attached to the Agricultural University Wageningen, in Wageningen, Netherlands. Lucy Clarke is working for in London, UK.

1

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the basin can be greatly improved by drawing down and filling different reservoirs along the river. Ecological zoning and resettlement of people can be carried out bearing in mind risks and opportunities.

The health sector should be closely involved at all stages of the project cycle of water resources development projects: planning, design, construction and operation. The incorporation of engineering measures into the design, operation and maintenance of, for instance, irrigation schemes is primarily a responsibility of the agriculture and public works sectors, but it requires close collaboration and intenseconsultation with health experts. The health sector responsibilities in this connection include the verification of possible health impacts, provision of technical advice on appropriate measures andmonitoring of the health status of temporary labourers and project beneficiaries, which can consist of original inhabitants communitiesof resettled people. It is important to note that no package of mitigating measures, however comprehensive, will be able to address all health issues effectively. There always has to be an element of improved or at least modified health services to deliver the care that is needed by the communities at risk. This requires strengthening of the capacities and capabilities of the health sector, as well as improved The health sector can, however, only respond properly and timely if it isinvolved the earliest stages of project planning and if it can count on sharing resources with the other sectors involved in the project.

There are few examples in practice where this collaboration between the health sector and otherdevelopment sectors has been achieved. Different sectors have to compete for limited funds and tend tohave a self-centred perception of priorities in the overall national development programme. In mostcountries the Ministry of Health operates in isolation from development activities and it often does not have the capacity to participate as an equal partner in negotiations with other sectors. Collaboration isfurthermore hampered by differences in operations of the various sectors and different perceptions of time. Diseases create long-term problems that can be controlled, but, with few exception, can never be eradicated. therefore work through programmes aimed at long-term control of diseases that areconsidered of major public health importance. In contract, most other ministries have well-definedgoals which are set in the overall development plan and macro-economic framework. The role of limited projects is far greater in other sectors than it is in the health sector.

Conventionally, agricultural projects, contrary to health activities, contribute to the income at various levels of the economy, from the household level to the national government level. Expenditures for health improvements must be financed by the income-generating sectors. More recently, particularly since the publication of the World Bank Report Investing in Health there is a growing perception that the health sector is not just absorbing public sector resources, but that the outcome, animproved health status, may add more value to the development project than the cost incurred by health protective and promotional measures.

In many cases the initial savings made by focusing an agricultural development project exclusively onproduction oriented indicators will be much less once cost of the required strengthening of health services (in other words, the after thefact repair) is deducted, and this cost would have been much less,had mitigating measures be included in the original design and operations. Planners should therefore consider the maintenance of the community health status (and, where possible, the improvement of thishealth status) as one of the objectives of an integrated project. Part of the capital investments should beallocated to health safeguards and the project’s revenue should be used to finance recurrent costs of health risk management and health care for the farming families

The remainder of this paper will focus on irrigation projects as the primary targets for intersectoral action: of all water resources development projects, particularly in Africa, they tend to create the most important health risks and they offer the best opportunities for the incorporation of health safeguards. The opportunities for involvement of the health sector will be discussed for each ofthe following forms of irrigation development: small scale schemes, new large scale schemes and schemes which undergo rehabilitation.

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SMALL SCALE IRRIGATION SCHEMES

Governments are usually not directly involved in small scale irrigation development and sometimes not even aware of such schemes. The only health and engineering expertise likely to be available to smallscale irrigation projects are those provided by the District Health Officer and the District Engineer.They will benefit from the development of guidelines on standards and procedures to ensure minimumrequirements in design, operation and maintenance of the scheme. These guidelines should be incorporated in the training curricula of engineers. It must be emphasized that the enforcement ofstandards continues to be the responsibility of local and national authorities. Resources to enforcecompliance with standards are often the bottleneck in their effective application.

Engineers and disease vector control specialists be asked to teach some of the courses foragricultural extension workers or primary health care personnel, so that these know about the health benefits of environmental management measures. This will enable them, in to teach farmers about improved, safe agricultural practices, particularly in relation to irrigation water management.

In circumstances where small scale irrigation is organized by a community group rather than byindividual farmers, it may be possible to develop model bylaws which they can adopt as part of theirown constitution or internal rules. For example, doing the laundry in irrigation canals or neglectingtheir timely de-weeding may be made punishable by a fine imposed by the officers of the irrigationassociation. Alternatively, village councils can be advised to adopt such bylaws.

NEW LARGE SCALE IRRIGATION SCHEMES

Project cycles

Most projects that require funding by External Support Agencies have a phased planning process whichis known as the project cycle (see table at the end of this paper). It is important for the health sector todevelop a thorough understanding of the procedures that are involved in the planning, construction andoperation of development projects. This will allow a proactive approach in the establishment of linkswith other sectors. The table at the end shows the various phases in the project cycle, the activities thattake place during these phases and the outputs that should be achieved at the end of each phase toensure that health issues are adequately addressed in the planning process (see also 1991, for amore detailed description).

Institutional arrangements

Intersectoral collaboration tends to rely on the management of conflicting interests. Institutional arrangements conducive to intersectoral action must, therefore, be enforced the highest level ofexecutive power.

The development of a new irrigation scheme requires negotiations between various ministries, fundingagencies and farmer interest groups. The term institutional arrangements refers to the agreedadministrative and technical decision making procedures that formalize the contacts between theministries or other government authorities that are involved in the negotiating process underlying project development. Such flexible arrangements fit in a more rigid legal framework. They shouldresult in means to effectively execute tasks in a joint manner between agencies that may have a varying degree of responsibility in the project.

Effective institutional arrangements ensure a level of intersectoral collaboration that is appropriatemeeting national requirements. Such arrangements are not generated spontaneously; rather they arebased on the outcome of past experience (trial and error), and should be developed by an experienced“elderly statesman”-like person, who is perceived as unbiased by all sectors concerned. Experience from a number of countries shows that there are two basic models for the way in which different sectors can collaborate, make joint decisions and take joint action:

the establishment of inter-ministerial linkages through Memoranda of Understanding which outline the rationale for collaboration and which state a mutual commitment to reduce adverseeffects of development through early detection of potential problems and resource sharing fortheir prevention and mitigation.

21

the establishment of a special body with elevated executive power powers, which can operate in a fully integrated manner either by itself a River Basin Authority) or through existing structures Council for Integrated Rural Development or a National Water Council which coordinates activities by other government agencies).

It is of crucial importance that the text of the Memoranda of Understanding gives a clear division oflabour and the allocation of (donor) funds.

The creation of a national committee is only useful if it is given executive powers and funds toimplement its recommendations.

Environmental Impact Assessment (EIA)

A large number of developing countries has introduced procedures (and also legislation) requiring environmental impact studies in relation with development projects meeting certain criteria. Often, however, the bottleneck is the implementation of the recommendations of these studies. As a result, EIAs are not carried out or their recommendations are neglected. The reasons cited include institutional and administrative deficiencies, lack of trained scientific and technical staff, political manipulation andinsufficient financial resources. Some countries have reported EIAs of inadequate quality as a result oflack of trained personnel within government agencies to write up and evaluate the terms of reference (TOR), or with the local research institutions or consultancy firms, lack of expertise to properly carry out EIAs.

Sometimes the value of projects can be significantly enhanced by public health or safety components oreven parallel projects. For example, an irrigation project may benefit from the simultaneous provision of domestic water supply and sanitation facilities, to prevent or reduce the transmission of schistosomiasis, even if the cost incurred cannot be justified by the expected reduction of the disease prevalence alone. A more positive approach than an environmental (health) impact assessment should be an environment (health) opportunity assessment, which would give a broader mandate to investigatepossibilities of expanding planned projects with components that maximize total benefit or ofcombining projects which are mutually synergistic.

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TABLE: Critical phases during the project cycle

Major activities

Identification ofpotential projects

Initial design

Prefeasibilitystudy

Major activities

Prefeasibilitystudy

Feasibility study

decisions

Site under considerationor wil l not be further

nvestigated

Select options f o r design

the proposed projectand

macro-economicdevelopment policies ?

By a first roughestimate, is the proposedproject financiallyfeasible ?

Critical decisions

there a major obstacle from the environmental

health perspectivethat renders any furtherstudies useless ?

Will or will there not bea feasibility study ?

Decideon the procedurefor further planning,implementationandoperation of the project,to start with: draw upTerms o f Reference(TOR) f o r the feasibilitystudy.

Compositionof the

Timing of EIA and HIA

Arrangements between

team

activities

proponent andconsultants

Recommendedactionst o safeguard health

Screening: check withthe health sectorwhich health problems(are likely to) occur

Discuss with health authorities pastexperience o f healthproblems associated with different designs

The project proponent,in consultation withthe health authorities, t o carry out scopingbounding for a health impact assessment (inconjunction with anEIA)

Recommendedactionst o safeguard health

TOR f o r HealthImpact Assessment(HIA) should take into account:

community risk

menvironmentalrisk

risk

Current health

factors

factors

factors

conditions in theproject area, andhealth conditions in similar areas whereirrigation isoperational

Forecastingmethodology is presented in Birley(WHO, 1991)

Remarks

Rapid, in-breadthassessment t o identifyhealth hazards, based on

information

Initial contacts with thehealth ministry should bethrough theenvironmentalhealthdepartment

Existing mechanisms f o rintersectoral planningmay be reviewed andstrengthenednecessary.

Prefeasibility studiesoutline options andidentify knowledge gaps

Remarks

The decision on afeasibility study is apoint of no return: heavyinvestments in afeasibility study normallyimply that the projectwill go ahead in one f o ror the other.

IfTOR do not mention health, the healthhazards or risks are unlikely to be properlyinvestigated.

Data to be collectedinclude: local climaticdata, demographic data,data on geo-physicalcharacteristics (soil,hydrology) andagricultural practices (including livestock), health data (including

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Appraisal of the feasibility study

Appraisal of theEIA

Major activities

Financialnegotiations

Detailed designand construction

Implementationand monitoring

Hand-over to theregularadministration

Have studymethodologies (including EIA and HIA) beenrigorously applied?

Are conclusions solid andwithout bias?

Are recommendations(including those forhealth safeguards)technically sound, sociallyacceptableandeconomically feasible?

Critical decisions

Formulate and decide onan intersectoral actionplan for monitoring thehealth situation andcompliance with therecommendedsafeguards

Decisions concerning spatial distribution(scheme Infrastructureand human settlements);lay out of the hydraulicsystem; water supply and sanitation facilities;laundry faci Iities

How can a packageo frelevant activities besmoothly continued in thenew administrativestructure ?

Appraisal of the H I Areport by anintersectoral teamapplying well definedcriteria.

Recommendedactionsto safeguard health

Rigorous economicevaluation of theproposed hsafeguards (designchanges, mitigatingmeasures,environmentalmodification andmanipulation) to ensurea solid bargaining position in negotiations

Consult beneficiariesin the final designstages; report oncompliance with agreedmeasures; monitor theeffectiveness ofhealth measures and be alert f o runforeseen healthconditions, particularlyin relation withpopulation movement

Report on adequacy ofarrangements andresource allocation. Arrange for a handover of intersectoralcoordination. Ensure

distribution of diseasevcetors) and socio-cultural indicators; howthese variables willchange as a result of theproject; and, how thesechanges will affect localhealth risks.

I n countries where EIAis coordinated by anational Environment Council, this Council mayalso be the bestmechanisms t o appraiseHIA.

The appraisal should ensure that allstakeholders, a t all levels(SO also the provincialand district levels) havebeen properly consultedin the HIA process !

Remarks

A MemorandumofUnderstanding between the various sectorsinvolved in the action planshould facilitate itsimplementation, by defining responsibilitiesand accountability

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Evaluation Reviews byGovernmentauthorities andpossible donors

Phase in theproject

Do feasibility study andimpact assessmentprocedures have t o bechanged ?

Operation

I

Follow-up analysis and action

Major activities

Operation andmaintenance

Critical decisions

that health educationactivities areincorporated in variousdistrict level activitiesas appropriate

Measure changes inhealth status andcapacity o f the localhealth services to dealw i t h the new situation.Check cash flows thatare needed for aproper maintenance of

the system

Review operationalplans, introduce oradjust legislation ifneeded

Recommendedactionst o health

System maintenance.Regular strategicassessments of riskfactors. Monitoring o fhealth status andfarming practices. Health education,enforcement o foperational standards and procedures

Remarks

Decisionmaking in mostcases devolved t o thefarmer level

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A GENERAL ADDRESS ON PEEM, SPFS, HEALTH, AGRICULTURE AND WATERDEVELOPMENTIN MALAWI

J.

This National Seminar on Water Resources Developments and Vector-borne Disease Control is organizedjointly by the Panel of Experts on Environmental Management for VectorControl (PEEM) the Government of Malawi and the Danish Bilharziasis Laboratory. As we all know, PEEM was established in 1981 through a Memorandum of Understanding signed by the Heads of FAO,WHO and to promote the application of environmental management measures to controlborne diseases in water resources development projects with special reference to irrigation schemes. attaches great importance to the objectives of PEEM because sustainable food production and rural development cannot be achieved without ensuring good human health and a clean and safe environment.

I wish to illustrate the importance of health in the context of irrigation development and national food security.

The mandate of is to assist its Member Nations to eradicate hunger and malnutrition and promote sustainable agricultural and rural development. Within the framework of this mandate, gives highest priority to achieving food security, particularly among the low income food deficit countries. No doubt,irrigation plays an important role in achieving food security, particularly in the light of the more frequent and disastrous droughts that have plagued the African Continent. In its Special Programme for FoodSecurity (SPFS), has included water control as a key component in the National Programmes for foodsecurity and is providing technical assistance for pilot testing and demonstrating improved water controlmethods.

The direct and indirect health benefits of irrigation too are well recognized. Amongst the direct health benefits are improved diets from an increased production of staple foods, new opportunities for growing fruits and vegetables. An over-riding indirect health benefit is increased income. This gives rural communities the purchasing power for foods not produced on the farm. Improved incomes should alsopositively affect status by enablingpeople to spend more money on clothing, housing, sanitation andhealth.

However, water resources development and irrigation projects may cause many potentially undesirable impacts, particularly health risks, which, when not mitigated, threaten the well being of farmers as well asrural and urban communities in general. Among the health risks are the incidence of malaria andschistosomiasis,which are important vector-borne diseases in this country. It is also believed that irrigation developments in this country may have contributed to a more frequent outbreak of malaria andschistosomiasis.

Now, I wish to present a brief account of the importance of agriculture and the role of irrigation inincreasing agricultural production, and hence its role in food security in this country. Agriculture is thebackbone of the economy of Malawi, supporting 90 percent of the population and accounting for 35percent of GDP and 90 percent of foreign exchange earnings. However, agriculture grew at a rate of only1.6 percent a year between 1980 and 1994 which is less than half the rate of population growth of 3.6percent during the same period. farming is the major source of food production and recurrentdroughts severely threaten the ability of the country to feed itself. Indeed, 60 percent of Malawi's 11million people run out of food three to four months before the next harvest. Partly as a result, much of the population suffers and only two out of three children survive beyond five years of age.

The smallholder sector comprises some 2 million families, operating under customary tenure on 1.75million ha, and producing about 80 percent of food production (mostly for subsistence) and 10 percent ofagricultural exports. six percent of all households have holdings of less than 1 hectare. Thirty percentof rural households are headed by women (70 percent of the farmers are women) who have few productive assets and lack access to credit. For most rural households, food availability is dependent on the ability to generate off-farm income.

The country experienced severe drought in and and serious dry spells over a six yearperiod. In years of good rainfall, Malawi has been able to register respectable rates of GDP growth;in dryyears, the figure often negative.

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In view of population growth, pressure on the land and drought, Malawi’s greatest need is to intensify and diversify production for household and national food security. There are limited opportunities to do sounder agriculture - irrigation must play an essential role. Malawi’s irrigation potential is in theregion of 200,000 hectares (including irrigation of the so-called “dambos” or wetland depressions on towhich the growing population has been forced to move) At present, ha are equipped for full or partial control. Another 70,000 of dambos are cultivated by uncontrolled irrigation. Irrigation under full orpartial control is expensive: estimated capital costs for small-scale surface schemes are between6500. Capital costs for commercial sprinkler irrigation is between The performance ofsmallholders on the dambos is very poor. Crops are cultivated using a combination of residual moisture, water shallow supplies and reservoir storage. Water availability is determined by the rainfall of the preceding rainy season. Water management at the field level is poor; application techniques are simple, most often using only bucket irrigation. Other constraints for greater productivity are the high cost of inputs like fertilizer, seeds and pesticides, access to credit and marketing.

A major challenge is to increase the productivity of irrigation in the dambos, by adopting methods ofdambo development that are safe for the environment and for health. Access to water for irrigation must also be enhanced for upland farmers through water harvesting, construction of small dams and developingshallow aquifers and appropriately utilizing the water in the Lake Malawi.

The challenge for all smallholders will be to raise output while reducing costs. To achieve this farmers need access to cheaper, more water-efficient equipment. They need greater access to water resources through cheaper water development technologies and community-centred design and management techniques. And they need to benefit greater and improved extension, technical support and marketing services. These issues are at the heart of the Government and is doing what ever it can to assist the Government tomeet the challenges of small-holder irrigationas means to achieve food security.

There is no doubt that for successful smallholder irrigation development and sustainable agriculture, health protection is important. Thus this workshop is very timely and crucial to the agricultural, economic andsocial development of this country.

I want to take this opportunity to express my thanks to the national organizers of the Seminar and myappreciation of the good work done by my colleagues WHO, FAO, and I wish the Workshop success.

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THE NATIONAL ENVIRONMENTAL POLICY AS IT RELATES TO WATER ANDNATURAL RESOURCES MANAGEMENT IN MALAWI

A . M. Banda,Environmental Affairs Department

INTRODUCTION

Environmental management initiatives in Malawi date back to the pre-colonial period where natural resource management was practised but often in an uncoordinated manner and in most cases without any regard for sustainable existence. Often, this resulted in duplication of efforts and in certaincases negligence as one felt that somebody else would do it. At that time environmental management issues were taken into consideration but without any rules or guidelines. There were policies and legislation that were often not in harmony. Within this period up to early post-colonial period, local leaders were part and parcel of the management process and their own ways and means of managingthe environment. Within the early post-colonial days the system changed whereby control became solely in the hands of central government, in most cases without the involvement of local leaders and without any civic education on the necessity for conservation. This system of management seemed to work for some time but later came to face its own problems as communities took natural resources as government-ownedand therefore found reason for taking part in conservation. This was coupled withlittle understanding for the need for conservation and the feeling that natural resources are God given and should be protected by anyone. In the to late seventies, most policies and legislation were reviewed to take into consideration changes in attitudes,needs and requirements of regulatory institutions. In most cases this did not, however, take community participation into consideration. Mostcritical environmental management considerations came after the Earth Summit in Rio in 1992. This resulted in the formulation of the EnvironmentalAction Plan.

THE NATIONAL ENVIRONMENTAL ACTION PLAN (NEAP)

In realisation of the critical environmentalproblems Malawi is facing, and indeed following the Rio summit which took place in Rio de Janeiro in 1992, Malawi embarked on EnvironmentalManagement aimed at abating environmental degradation. One major result was the preparation of Malawi’s first National Environmental Action Plan (NEAP) which was prepared in a participatory process that involved all key line ministries, districts, local communities, and donors. It wasfinalised in mid 1994 and was formally launched in December 1994. The NEAP identified nine major issues in relation to the country’s developmental needs. These included soil erosion, deforestation, water resources degradation and depletion, depletion of fish stocks, threats to bio-diversity, degradation of human habitats, high population growth, climate change and air pollution and waste management.

Among the issues resulting in water resources degradation were;

1. Sedimentation 2. Biological contamination and3. Chemical contamination

The NEAP also analysed the social cost of water degradation as estimated at million as in 1994.It also analysed institutional and legal constraints for water resources management. It then maderecommendations for institutional and legal strengthening of institutions for proper management of the resources. Among the recommendations were the formulation and review of policies and legislation that would mitigate these problems.

NATIONAL ENVIRONMENTAL POLICY

Following the completion of the NEAP, the then Ministry of Research and EnvironmentalAffairs, prepared a National Environmental Policy followedby the Environmental Management Act. The National Environmental Policy (NEP) was prepared in order to provide a coherent framework forGOM environmental policies. It was approvedby Cabinet in January 1996. In order to implement the NEP, the Government of Malawi initiated an Environmental Support Programme (ESP). The objective

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of the ESP was to provide the policy framework and institutional capacity to implement the priority agenda identified by the NEAP. The ESP includes formulation of policy on environmental management and modification of existing policy on sustainable natural resources in favour of increased community participation in resource management. Under the ESP, NGOs and government agencies aim toinfluence communities to adopt more sustainable resource use practices, reducing degradation andincreasing conservation. In addition to supporting policy formulation and review, the programme includes institutional support and capacity development for EAD and line agencies involved in naturalresource management, environmental education, dissemination of environmental information to thepublic and training in environmental awareness and sustainable resource management in rural andurban communities. Several projects and project ideas have been identified and implemented since theinception of the ESP. Examples of these projects include;

2.3. Environmental Management Project (EMP)4.

The national bio-diversity programme 6. Capacity 217.

Institutional support for Environmental Management Sustainable Development Network Programme (SDNP)

Natural Resource and environmental Management project (NATURE)

The Education and Communication strategy which is under negotiation.

The NATURE programme is explained in detail below.

The Goals of the National Environmental Policy

The overall goal of the NEP is to promote sustainable social and economic development in thecountry through sound management of the environment. Specifically, it seeks to: (a) promote theefficient utilisation and management of natural resources; (b) facilitate the restoration and maintenance of essential ecosystems and ecological processes; (c) enhance public awareness of the importance ofsound environmental management; and (d) promote co-operation between government, local communities, NGOs, and the private sector in the management of the environment.

As regards the Water Resources of the country, the NEP specifically seeks to manage and use water resources efficiently and effectively so as to promote their conservation and availability insufficient quality and quantity.

Guiding Principles for Water Resources Management

The guiding principles for water resources management include: access for all people to clean potable water in order to reduce he incidence of water diseases and reduce the time devoted byindividuals to water collection; implementation of programmes in a manner that seeks to mitigateenvironmental degradation; consideration for safe disposal of waste water in the planning of waterdelivery services; integration of sanitation into the remit of the water supply sector; and, aprecautionary approach to water quality management being pursued with a focus on pollutionminimisation and prevention.

The NEP specifies guiding principles for both national and policies. At the national level, the NEP recognises that poverty is one of the root causes of environmental degradation. It also notes that proper economic incentives are more effective than enforcement to induce people toundertake sustainable resource use and thus calls for an enabling economic framework in which theopportunity cost of using natural resources is reflected in market prices. Finally, it states that local communities have a right to obtain a share of the benefits generated from sustainable utilization ofnatural resources on all public and customary lands.

It further notes that environment is a decentralized resource which government can neithermanage nor even control. Often, environmental outcomes are the by-product of non-environmentalchoices which people make in their production and consumption decisions. In thischanging, decentralized context, government has two principal roles: first, to set and enforce the “rulesof the game”, second, to provide outreach and support which increase knowledge and awareness of better options for sustainable resource management.

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Implementation of Policies

To facilitate the implementation of environmental policies and strategies, the NEP calls for: the creation of appropriate institutional mechanisms; a proper legal framework and laws; an integrationof environmental concerns into the national, regional and district planning system; the development ofa system and guidelines for environmental impact assessments (EIAs); training programmes to developcapacity for environmental management; increased environmental education and public awareness; the empowerment of local communities through community participation, and the mobilisation of the private sector and NGOs.

THE ENVIRONMENTAL MANAGEMENT ACT

The implementing legislation for the NEP is the Environment Management Act (EMA), which was approved by Parliament in June, 1996 and entered into force in October 1996. The Act sets the stage for regulation, monitoring, education and promotional activities and an environmental support programme (ESP).

Provisions of EMA Regarding Water Resources Management

This law requires the government to protect, conserve and manage the natural resources of the country. It calls for an integration of environmental concerns into socio-economic development plans, and requires that EIAs be carried out for projects which may have negative impacts on theenvironment. Guidelines for EIAs have already been prepared and approved by the NCE. The EMAalso covers pollution control through control of disposal of effluent and other wastes other than inaccordance with the Act and also specifies penalties for contravention of its provisions.

ENVIRONMENT AND NATURAL RESOURCE MANAGEMENT (NATURE)

Malawi has continued to make important progress in developing a co-ordinated approach toenvironmental management. As already mentioned, Government policy now recognises the fact that the sustainable utilisation of natural resources requires a co-ordinated and harmonised approach thatinvolves all sectors in environmental, local communities, NGOs and the private sector. It has therefore involved all these sectors in the implementation of programmes and management of the environment. Sectoral policies are in the process of revision to include community participation and management as important elements. The Natural Resource and Environmental Management Programme (NATURE) sought to address this issue. The program had a project assistance (PA) and non-project assistance components (NPA). As a tool for natural resource management process, the Governmentprepared a results framework at a workshop at Ku Chawe Inn in 1997 with several intermediate results.

A basic unifying element of all other intermediate results is the establishment of a comprehensive policy and legislative framework. The NPA component of NATURE intended to support reform of some existing policies. Specifically, it called for the establishment of a nationalenvironmental policy and the review and revision of policies and legislation in land,agriculture, water and irrigation, forestry, fisheries and wildlife in order to provide an enabling

for environmental management and conservation. Since 1995 inception, manynew policies and legislation have been adopted, including the National Environmental Policy (NEP), the Environmental Management Act (EMA), the National Forestry Policy, the Forestry Act and theFisheries Conservation and Management Act. Existing laws covering various sectors have either beenrevised or are in the process of being reviewed for consistency with the requirements of conserving andmanaging the environment, as identified in the NEP and EMA. In addition, new policies in fisheries,wildlife and land use and management are in an advanced state of development. Sectoral policies inother areas, however, such as energy and water resources, still need to be reviewed and appropriatelegislation revised or developed, as may be appropriate.

Hence the reforms have changed many of Malawi’s policies from a “command and control”approach to one that is community driven. Government policy now recognizes the fact that the

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sustainable utilization of natural resources requires the involvement of local communities, andthe private sector in the implementation of programs and management of the environment and that this must be based on a transfer of authority to the local level through empowerment of community-based organisations or

Co-ordination of environmental matters and implementation of the policy and Act is theresponsibility both of the Environmental Affairs Department (EAD) within the Ministry of Forestry,Fisheries and Environmental Affairs and the National Council for the Environment (NCE). Thelack of capacity and its positioning are the major constraints facing implementation ofthis policy and Act.

CHALLENGES

Despite formulation and review of policies there are several factors that continue to renderenvironmental management a big challenge. Unless these are adequately addressed, all our initiativesso farwill not achieve their final goals. These include but are not limited to:

1.2 .3.

4.5 .

6 .

Efforts still not fully co-ordinated;Public awareness is still not achieved to enhance sound environmental management; The empowerment of local communities through community participation, and the mobilisation ofthe private sector and NGOs still not a reality; Lack of mechanisms for enforcement of most legislation;Lack of alternatives for necessities that directly or indirectly result into environmental degradation; andLack of capacity for implementation of policies

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