Are population-environment (PE) and population-health-environment (PHE) programs more effective than single-sector approaches? Can these integrated programs improve the quality of life for Malagasy or Filipino villagers? The Packard Foundation's board of directors hired consultant John Pielemeier to answer these questions and also analyze the long-term sustainability and growth of PE/PHE programs. On September 7, 2005, he presented the review's findings at an event sponsored by the Wilson Center's Environmental Change and Security Program.

In the population and conservation communities, integrated approaches are far from standard practice and often greeted with skepticism. Yet, nearly all of the programs Pielemeier reviewed met most or all of their anticipated objectives and "showed enough results in reproductive and environmental sectors to support integrated programs," he said. He also noted that these "inexpensive community mobilization techniques can provide results within 9 to 36 months." The final review emphasizes the added value of integrated programs: "Although operational research results may not always be statistically significant, the on-the-ground results have been significant enough to convince most PE/PHE practitioners that integrated programs have better reproductive, health, and conservation outcomes than single-sector programs."

Pielemeier spent much of his career as an interdisciplinary international development specialist, serving as USAID mission director in Brazil, USAID/W office director for South Asia, and as a special assistant in the office of the USAID administrator. Now an independent consultant, Pielemeier has contracted for USAID and the United Nations, among others. For this review, Pielemeier collected data from more than 80 sites that were under the auspices of either Packard Foundation's Population-Environment Initiative or USAID's Population-Health-Environment Program. The data included questionnaires, field visits to the Philippines and Madagascar, as well as in-person, phone, and email interviews with local practitioners, leaders, donors, mayors, and other program contributors.

Family planning programs showed positive results when integrated into environmental programs. Men in integrated settings are "more likely to accept contraceptives for themselves and their wives. They're more willing to distribute information," Pielemeier said. He noted that family planning efforts also showed better results when implemented alongside quick-impact health interventions, such as programs that provided immunizations and improved water quality.

Integrated approaches also improved natural resource management and coastal resource management activities, leading to greater involvement by women and adolescents of both sexes. Women, Pielemeier noted, have historically been the hardest to involve in these programs due to the traditional male domination of most resource management activities. For example, in the Philippines, men have traditionally performed coastal resource management assessments; but when activities were integrated, women began patrolling marine protected areas, joined formerly men-only conservation organizations, and became treasurers of local organizations.

Integrating micro-credit programs into population activities also brought positive changes for women. With access to money and credit, women were seen and began to see themselves as both economic and political "players" in the community, and thus more in control of their future.

In many regions, communities see more immediate need for family planning and health programs than environmental ones. Through integrated approaches, however, NGOs can enter communities by offering family planning and health services and then leverage the trust they have built to implement other programs. Pielemeier cited the example of a World Wildlife Fund director in Madagascar, who will not attempt to implement an environment program in or around a protected area without first involving a local health NGO: "[The WWF director] said that, as a matter of course, when they're going to work in Madagascar, they're going to start with family planning."

Using local NGOs is also effective on a programmatic level, as integrated approaches have proven extremely cost-efficient. Involvement on the local level lowered operating expenses for transportation and training, for example, and had the beneficial side-effect of saving communities time while building their goodwill and trust.

In his executive summary, Pielemeier compiled a comprehensive list of program opportunities that provide "next steps" for organizations implementing integrated programs. Pielemeier identified several successful models, such as the Champion Communities initiative in Madagascar, that can be replicated elsewhere. He also noted that the ability to "scale up" local initiatives that produce positive results—projects such as the PATH and SAVE projects in the Philippines—should appeal to potential funders.

While Pielemeier provided detailed information on how and when to implement integrated programs, where remains a subject of debate. "If you have limited resources, it's hard to know where to put them," Pielemeier said. "If your metric is ‘what gets you the most bang for your buck,' you're going to spend your time in the big cities. Some people are more challenging, difficult, and expensive to reach." However, Pielemeier did identify three areas where PE/PHE programs have proven effective:

• In biodiversity "hot spots" and protected areas;
• Where the natural resource base is being depleted due to rapid population growth; and
• Where demographic, health, or poverty indicators are worse than the norm.

Rachel Nugent—the event's discussant and the project director of Bringing Information Into Decision-making for Global Effectiveness (BRIDGE)—emphasized the importance of advocacy as programs grow. She noted, "Once you get up to a high-enough level—a policy level—you run into barriers, and advocacy work becomes especially important." Pointing to the success of integrated programs in the Philippines, Nugent listed several factors that contribute to program growth and success, including the involvement of legislators, continued community activism, coalition building, information sharing, and technical advice.

Drafted by Alison Williams.