ENVIRONMENTAL DETERMINANTS AND MANAGEMENT SYSTEMS FOR HUMAN HEALTH AND ECOSYSTEMS INTEGRITY IN AFRICA

Synthesis Report on the evaluation of implementation of The Libreville Declaration

SYNTHESIS REPORT ON THE EVALUATION OF IMPLEMENTATION OF THE LIBREVILLE DECLARATION | i ACKNOWLEDGEMENTS ENVIRONMENTAL DETERMINANTS AND MANAGEMENT SYSTEMS FOR HUMAN HEALTH AND ECOSYSTEMS INTEGRITY IN AFRICA

Synthesis Report on the evaluation of implementation of The Libreville Declaration ACRONYMS ACKNOWLEDGEMENTS

This report was prepared by the following members of AEO3 Third Africa Environment Outlook NDP National Development Plan the WHO-UNEP Joint Task Team (JTT) for the Health and AfDB African Development Bank NPJA National Plans for Joint Action Environment Strategic Alliance: Lucien Manga, Tim Meredith, CEMAC Central African Economic NHPSP National Health Policies, Strategies Magaran Bagayoko, Waltaji Terfa, Solomon Nzioka, Bernadette and Monetary Community and Plans Ramirez, Hawa Senkoro, Inoua Boubacar, and Pierre Quiblier. CTT Country Task Team PPHACC PanAfrican Programme for Adaptation EA Environmental Audit to Climate Change Plans The report was further reviewed, finalised and adapted EAP Environmental Action Plan PRSP Poverty Reduction Strategy Paper by the Technical and Scientific Committee of the Second EIA Environmental Impact Assessment SADC Southern African Development Community Inter-ministerial Conference on Health and the Environment EMA Environment Management Act which met in September 2013 in Libreville, Gabon. EPA Environment Protection Act SAICM Strategic Approach to International Chemicals Management HESA Health and Environment Strategic Alliance Secretariat: SANA Situation Analysis and Needs Analysis IDSR Integrated Disease Surveillance World Health Organisation: Lucien Manga, Magaran and Response SOE State of the Environment UNDP United Nations Development Programme Bagayoko and Tim Meredith. IMCHE Inter- Ministerial Conference United Nations Environment Programme: Pierre Quiblier, on Health and Environment UNEP United Nations Environment Programme JTT Joint Task Team UNESCO United Nations Education Scientific David Ombisi and Angel Luh. and Cultural Organisation MDG Millennium Development Goals The report was reviewed technically, proof read and edited MoHSW Ministry of Health and Social Welfare UNFCC United Nations Framework Convention on Climate Change by Cheryl Goldstone and design and layout by Patricia Carey. MOP Meeting of Partners WHO World Health Organisation Photography IRIN Irinnews.org; Cover: Shutterstock NAP National Adaptation Plan

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ACKNOWLEDGEMENTS ii ACRONYMS iii EXECUTIVE SUMMARY 1 1 INTRODUCTION 2 2 EVALUATION APPROACH 6 2.1 Country-self assessment report 6 2.2 Assessment of intersectoral programmes and projects 6 2.3 External evaluation 6 2.4 Evaluation of the HESA secretariat (JTT) 6 3 GENERAL FINDINGS 7 3.1 Number of priority Libreville Declaration activities being implemented at country level 7 3.2 Number of countries implementing each of the 11 priority Libreville Declaration activities 7 3.3 Issues addressed by the intersectoral projects (n=18) assessed 7 3.4 Coordination and funding of intersectoral projects 8 3.5 Health and programme outcomes 8 3.6 Contribution of the JTT 8 3.7 Summary of country profiles against 11 Libreville Declaration priority actions 10 4 ACHIEVEMENTS AND CHALLENGES 11 4.1 Establishing a health and environment strategic alliance, as the basis for plans of joint action 11 4.2 Integration of health and environment linkages in policies, strategies, regulations and national The Libreville Declaration on Health and UNEP Joint Task Team (JTT) The evaluations also showed development plans 11 and Environment in Africa, adopted established in 2009 as the Secretariat that progress is being made by in 2008, represents the umbrella for the Health and Environment countries in addressing the identified 4.3 Implementing priority intersectoral programmes at all levels, aimed at accelerating achievement framework upon which African Strategic Alliance (HESA). challenges. The outcomes of the of MDGs 12 countries and their development The evaluations confirm that the implementation of the Declaration 4.4 Establishing or strengthening health and environment institutions 13 partners address the environmental key health and environment range from country ownership of the 4.5 Supporting knowledge acquisition and management to identify knowledge gaps and research priorities determinants of human health and challenges in the African region process, enhanced awareness and and to support education and training at all levels 13 ecosystems integrity in a coherent continue to be provision of safe increased dialogue between the two 4.6 Establishing or strengthening systems for health and environment surveillance to identify emerging fashion. In 2013 the Secretariat of the drinking water, sanitation and sectors, to identification of national risks, in order to manage them better 13 Health and Environment Strategic hygiene services; management priorities. However, much still needs 4.7 Enforcing compliance with international conventions 14 Alliance (HESA) commissioned a set of water, soil and air pollution; to be undertaken in order to ensure 4.8 Setting up national monitoring and evaluation mechanisms to assess performance in implementing of four complementary evaluations vector control and management of that this political commitment is fully priority programmes 14 to assess national and regional chemicals and wastes; food safety; translated into action. level progress in the five years since 4.9 Instituting the practice of systematic assessment of health and environment risks 15 environmental health of children and This second synthesis report the adoption of the Declaration. 4.10 Developing partnerships for targeted and specific advocacy on health and environment issues 16 women; and health in the workplace. highlights achievements in executing The assessments consisted of: These risk factors are exacerbated the priority actions included in 4.11 Achieving a balance in the allocation of national budgetary resources for intersectoral health (1) Country-self-evaluations of by the negative impacts of climate the Libreville Declaration and and environment programmes 16 their efforts in implementation change, unplanned urbanization, Luanda Commitment, and identifies 5 LESSONS LEARNT 17 of the Declaration; (2) An in- uncontrolled rapid population implementation challenges, potential 6 RECOMMENDATIONS 18 depth assessment of intersectoral growth and urban migration. These for enhancing what is already 6.1 Scale up the implementation of multi sector projects in all countries: 18 projects and/or programmes being factors increase pressure on already working well as well as opportunities 6.1 Increase investment for the implementation of the libreville declaration 18 implemented in selected countries; overburdened health systems which for improvement. Recommendations 6.3 Intensify advocacy efforts that stress the promotion of the linkages in health and environment as (3) An external evaluation conducted function in the context of paucity are made to address these issues and by an independent consultant; and a contribution to sustainable development: 18 of qualified human resources and build on the lessons learnt. (4) An internal evaluation of the shortage of financial resources. 7 CONCLUSION 18 contribution made by the WHO

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The First Inter-Ministerial The Declaration further calls upon mandated to perform the functions in addressing the top ten health and countries experience in implementing country level achievements in Conference on Health and United Nations Environment listed in Box 2 to support countries in environment priorities agreed upon in the Libreville Declaration. These six selected countries (IMCH/3/ Environment in Africa was held from Programme (UNEP) and World Health the implementation of the Libreville Luanda; (2) portraying initial outcomes evaluations were conducted in 2013 INH4). It included assessing the 26 to 28 August 2008 in Libreville, Organization (WHO) to “support, Declaration. and co-benefits of intersectoral action and consisted of four separate, but entire implementation process at Gabon. The conference was attended along with other partners and donors, on local communities and in relation complementary exercises covering the national and regional levels. by Ministers of Health and Ministers including the African Development Biennial roadmaps and workplans to the MDGs; and (3) strengthening years (2009-2012) since its adoption of the Environment from 52 African Bank (AfDB) and the African sub- spell out the milestones and key the HESA. in 2008. Collectively they provide o An internal evaluation to assess countries and culminated in the regional economic communities, the activities to be undertaken by the a comprehensive account of the the contribution of the Joint adoption of the Libreville Declaration implementation of this Declaration, and JTT at national and international The Second Inter-Ministerial progress made towards achieving Task Team (JTT) established in on Health and Environment in to increase their efforts in advocacy, in levels. The first roadmap covered Conference on Health and the commitments in the Declaration 2009 as the Secretariat for the Africa. Signatories committed their resource mobilization and in obtaining the period 2009-2010. It focused Environment in Africa took place two and addressing the linked health and Health and Environment Strategic countries to implementing 11 priority new and additional investments in mainly on the development of tools years later (November 2010) in Luanda, environmental priorities listed in the Alliance (HESA). It examines actions aimed at establishing an order to strengthen the strategic alliance for Situation Analysis and Needs Angola. This Conference aimed at Luanda Commitment. The following JTT achievements at policy, effective platform to address the between health and environment”. Assessments (SANA), preparation of sustaining the political commitment is a list of the four individual programmatic and institutional environmental impacts on health and country planning guides and support and endorsing the commitments in assessments that contributed to levels in relation to its mandate accelerate progress towards attaining In response to this call, a Joint Task activities to conduct the SANAs, as the Libreville Declaration to enhance the overall evaluation: (IMCH/3/INH5). the Millennium Development Goals Team (JTT) was established in 2009 well as organization of the Second intersectoral actions for sustainable o A self-evaluation by countries (MDGs). This would be achieved as the Secretariat for the Health and Interministerial Conference on Health development. A synthesis report through preparation of national This second synthesis report, through strengthening systems, Environment Strategic Alliance (HESA). and Environment in Africa. prepared for the Conference detailed profiles that describe efforts Environmental Determinants and increasing resources, improving JTT core partners are WHO, UNEP and a comprehensive situation analysis made by each country in the Management Systems for Human capacity and coordination as well as AfDB. Other partners such as France, The second roadmap spanned the two of the environmental determinants implementation of the Libreville Health and Ecosystems Integrity in Africa: implementation of integrated strategies World Meteorological Organisation year period 2011-2012. It aimed and related risks to human health, Declaration from 2008 to 2013. Synthesis Report on the Evaluation to address linked issues of health and (WMO) and the Secretariat of the at achieving three objectives: ecosystem integrity and relevant Data was collected using a of Implementation of the Libreville the environment. The 11 commitments United Nations Framework Convention (1) demonstrating evidence of effective management systems in Africa. standardised tool (IMCH/3/INH2). Declaration, presents a summary of contained in the Libreville Declaration on Climate Change (UNFCCC) also intersectoral collaboration between This presented a first-time the findings in the four individual are listed in Box 1. participate as members. The JTT is health, environment and other sectors opportunity to identify evidence- o An in-depth assessment reports, highlighting the degree to based regional priorities. of intersectoral projects which the Libreville Declaration and and/or programmes being Luanda Commitment have catalysed The ministers agreed on the ten top implemented in six selected the envisaged policy, institutional priority issues linking health and countries. This assessment was and investment changes in the areas environment to be addressed by conducted by the Country of health and environment in Africa. member states in the forthcoming Task Teams (CTTs) and aimed It underscores the achievements in years and adopted the Luanda to document outcomes and/ carrying out the actions delineated Commitment (Box 3). or impacts of health and in the Libreville Declaration and environment intersectoral action the Luanda Commitment, the In preparation for the Third Inter- on the ground (IMCH/3/INH3). implementation challenges and Ministerial Conference on Health and opportunities, extrapolates lessons Environment the Secretariat of the JTT o An external evaluation learnt in the process, and proposes commissioned a set of evaluations conducted by an independent recommendations to address these to provide a clear picture of the consultant to provide qualitative challenges and build on the successes achievements and challenges that and quantitative analyses of identified in the evaluations.

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BOX 1: Commitments in the Libreville Declaration for Health and BOX 2: JTT FUNCTIONS Box 3: Top 10 Health and Environment in Africa, 29 August 2008 Increase their support for the Environmental Priorities 1. Establishing a health-and-environment strategic alliance, as the basis for implementation of the Libreville identified in the Luanda plans of joint action; Declaration and strengthen Commitment 2. Developing or updating our national, sub-regional and regional their Joint Task Team to serve 1. Provision of safe frameworks in order to address more effectively the issue of environmental alongside countries as the drinking water impacts of health, through integration of these links in policies, strategies, Secretariat for the Health and 2. Provision of sanitation regulations and national development plans; Environment Strategic Alliance and hygiene services at the international level; 3. Ensuring integration of agreed objectives in the areas of health and 3. Management of environment in national poverty reduction strategies by implementing Broaden the participation environmental and priority intersectoral programmes at all levels, aimed at accelerating of other relevant health risks related to achievement of the Millennium Development Goals (MDGs); intergovernmental climate variability and organizations, development 4. Building national, sub-regional and regional capacities to better prevent change including rise in banks and regional economic environment-related health problems, through the establishment or sea level particularly communities in the Health and strengthening of health and environment institutions; affecting Small Island Environment Strategic Alliance Developing States 5. Supporting knowledge acquisition and management in the area of as formal members; health and environment, particularly through applied research at local, 4. Sustainable development of Establish a mechanism to sub-regional and regional levels, while ensuring coordination of scientific forests and wetlands facilitate access by countries and technical publications so as to identify knowledge gaps and research 5. Management of water, to existing financial resources priorities and to support education and training at all levels; soil and air pollution, and for health, environment, and biodiversity conservation 6. Establishing or strengthening systems for health and environment sustainable development, surveillance to allow measurement of interlinked health and environment especially climate change funds; 6. Vector control and impacts and to identify emerging risks, in order to manage them better; management of chemicals Present the experience (particularly pesticides) 7. Effectively implementing, national, sub-regional and regional mechanisms obtained in Africa through and wastes (including for enforcing compliance with international conventions and national implementation of the Libreville biomedical, electronic regulations to protect populations from health threats related to the Declaration to other regions and and electrical wastes) environment, including accession to and implementation of the Bamako relevant international forums. Mauritiana Convention by those countries that have not yet done so; 7. Food safety and food Mali Senegal Chad security including the 8. Setting up national monitoring and evaluation mechanisms to assess Gambia “The Luanda Conference is a milestone Guinea-Bissau performance in implementing priority programmes and peer review management of Guinea mechanisms to learn from each other’s experience; as the health and environment sectors genetically modified Ethiopia Sierra Leone Cote d’Ivoire organisms in 9. Instituting the practice of systematic assessment of health and environment become credible and strategic partners. Benin Togo Cameroon risks, in particular through the development of procedures to assess impacts I leave this meeting further convinced food production Ghana Equatorial Uganda Guinea on health, and to produce national environment outlook reports; 8. Environmental health Congo Kenya that the future of Africa is not cast Gabon Sao Tome & Democratic of children and women Principle 10. Developing partnerships for targeted and specific advocacy on health anywhere. It is we who determine this Republic of Burundi the Congo and environment issues aimed at institutions and communities including 9. Health in the workplace United by our commitments, our determination Republic of Tanzania youth, parliamentarians, local governments, education ministries, civil and our actions.” 10. Management of society and the private sector; and natural and human Comoros Mr Mounkaila Goumandakoye (Regional Director and 11. Achieving a balance in the allocation of national budgetary resources for Representative of UNEP in Africa at the 2nd Interministerial induced disasters intersectoral health-and-environment programmes. Conference on Health and Environment in Africa, Luanda 2010) Zimbabwe Mozambique

Botswana Madagascar

Swaziland

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Synthesis Report 2 was compiled from a desktop review of community involvement; (iv) funding availability; and (v) its 3.1 Number of priority Libreville Declaration activities and environment into their national poverty reduction the four key assessments undertaken in 2013. They provide focus on at least one of the top 10 health and environment being implemented at country level strategies. However, while progress has been good at the an analysis of the progress made in the implementation of priority issues in the Luanda Commitment. For each selected Information from completed forms is available for twenty level of policy development, there has been markedly the Libreville Declaration and Luanda Commitment from project, the assessment included analysis of the project nine (29) out of the forty seven (47) Afro countries that are slower implementation in the areas of balance in the budget different perspectives. The evaluations cover the period proposal, desk review of project-related reports, field visits signatories to the Declaration - a survey response rate of 62%. allocation (3%), promoting partnerships for advocacy (17%), 2009-2012. The section below provides a short summary of to the project implementation sites, and interviews with the Of the 29 countries that completed the questionnaire, none developing mechanisms to assess impacts (21%), monitoring the methodological approach utilised for each of the four project-implementing partners and beneficiary communities. have implemented all of the 11 Libreville Declaration actions. and evaluation and capacity building (31% each). The number component evaluations. Finally, the CTT prepared a county report that was submitted Two countries, Ethiopia and Mozambique, have implemented of countries implementing each of the 11 priority activities is to the Secretariat (IMCHE/3/INF 3). 10 of the 11 actions, whilst three countries (Benin, Sierra Leone indicated in Figure 2 below. 2.1 Country-self Assessment Report and United Republic of Tanzania) implemented 9 actions, two The JTT Secretariat prepared a simple tool for evaluating 2.3 External evaluation countries (Congo and Ghana) 8 actions and one country (Sao Figure 2: Number of countries implementing each of the 11 the implementation of the Libreville Declaration and sent The external evaluation was conducted from April to Tome and Principe) 7 actions. The remaining 21 countries priority activities in the Libreville Declaration it to all countries in the African region. The evaluation form July 2013. It was carried out in two phases. The tools and implemented six (6) or fewer of the 11 actions. The number of was completed jointly by relevant officers in the Ministry of methodology were developed during the first phase and countries according to the total number of priority Libreville 1 Environment and the Ministry of Health in each country and country visits were conducted in the second. The initial phase Declaration activities being implemented in that country is Balance in budget allocation submitted to WHO during the period May to June 2013. The included a desk review of available documents and selection illustrated in Figure 1 below. y Promoting partnerships and advocacy 5 vi t survey tool used open-ended questions structured around of countries to form part of the evaluation. Countries were i t 6

c Mechanisms for impact assessment A the following five areas: (1) Description of the institutional classified according to three categories, namely: (1) countries Figure 1: Number of countries according to the number of y

t 9 i M&E mechanisms arrangements established to steer and coordinate that have completed their SANA and developed their priority Libreville Declaration activities implemented r o i implementation of the Libreville Declaration; (2) Description National Programme of Joint Action (NPJA); (2) countries that r 14

P Mechanisms for compliance with conventions of the major joint actions that have been undertaken by the have initiated their SANA; and (3) countries where the process 6 n o i 6 10 t Strengthening of surveillance systems Ministry of Health, the Ministry of Environment and other has yet to start. A total fo five countries, covering all three a r a

l 13 relevant ministries and institutions; (3) Description of the categories, was selected to participate in the assessment. In 5 c Knowledge acquisition and management e main outputs resulting from the above actions; (4) Status each country, the following officers served as key informants D 9 e

l Capacity building l of progress and achievements in relation to the 11 priority for the evaluation: focal points “Health and Environment” at i 4 20 re v actions agreed upon in Libreville; and (5) Description of the WHO country offices, members of CTT, Senior managers 4 4 Integration of H&E issues in policy b i efforts made by the Government to address any of the ten in the Ministry of Health, and in the Ministry of Environment, L National policy frameworks 21 priorities of the Luanda Commitment. The information Head of Technical Services of the Ministry of Health and the 3 3 3 26 derived from the completed forms assisted in providing Ministry of Environment involved in the implementation Health and Environment strategic alliance country-specific profiles and a regional overview of the of the Declaration, members of civil society and partners. 2 Number of countries level of implementation of commitments in the Libreville Evaluation findings and recommendations were compiled by 2 2 2 2 Number of countries Declaration (IMCHE/3/INF 2). an independent consultant (IMCHE/3/INF 4). 1 1 3.3 Issues addressed by the intersectoral projects 2.2 Assessment of Intersectoral Programmes and Projects 2.4 Evaluation of the HESA Secretariat (JTT) (n=18) assessed 0 0 The assessment was conducted on 18 projects being This is an internal evaluation of the contribution of the Eleven Ten Nine Eight Seven Six Five Four Three Two One The documented projects in the six countries assessed focus implemented in six selected countries - Ethiopia, Gabon, JTT, as the HESA Secretariat at international level, to the on one or more of the 10 issues prioritised in the Luanda Kenya, Mali, Republic of Congo, and Sierra Leone. The implementation of the Libreville Declaration. It examines Commitment. They target the wider population while paying assessment aimed to enhance insights on health and achievements of the JTT, since its establishment in 2009 Number of the 11 Libreville Declaration activities implemented particular attention to the most vulnerable groups, especially environment intersectoral projects and programmes being till 2012, at policy, programmatic and institutional levels in women and children. For example, all projects that are focused implemented in countries that have established a Country relation to the requests made by Ministers of Health and 3.2 Number of countries implementing each of the 11 on water are directly relevant to women and children. Of the Task Team (CTT) and completed their Situation Analysis the Environment in Africa (Box 2). This evaluation focused priority Libreville Declaration activities 18 projects, 10 addressed water and/or sanitation issues, and Needs Assessment (SANA) process. Assessments were on reviewing progress and outputs in implementing the Analysis of the country self assessment survey by activity 4 were on climate change and 5 on chemicals and waste. conducted between September and December 2012 roadmaps discussed in Section 1 above. It was carried out reveals that the majority of countries (90%, n= 26 out of Disaster management, health in the workplace and the using a standardised tool for the “Assessment of current in a systematic and stepwise manner and consisted of: a) 29) who responded to the survey have established HESA, management of forests and wetlands were not addressed by health and environment intersectoral action at the country Formulating tangible expected outcomes based on the 72% (n=21 out of 29) have developed national policy any of the selected projects. The spread of projects according level”. The process was overseen at national level by the duties and responsibilities assigned to WHO and UNEP in frameworks to address the effects of environment on health, to each of the 10 priority health and environment issues is CTT and regional coordination was undertaken by the JTT. the Libreville Declaration and the Luanda Commitment; and 69% (n=20 out of 29) have integrated issues of health illustrated in Figure 3 on the next page. Intersectoral programmes and projects were identified by b) Identifying main outputs/deliverables set in the two the CTTs and 18 were selected according to the following roadmaps; c) Matching the outputs/deliverables with the criteria: (i) multisectoral nature of the project to be reviewed; expected outcomes; and d) Conducting an analysis of issues (ii) its potential contribution to the attainment of MDGs; (iii) and challenges (IMCHE/3/INF 5).

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Figure 3: Number of intersectoral projects according to the 3.5 Health and programme outputs 10 priority activities in the Luanda Commitment The intersectoral projects demonstrated direct positive impacts on the environment and on the health of populations in the affected communities. These outcomes 0 Outcomes Activities/Outputs Status Deliverables Comments Disaster management contribute towards achieving strategic objectives defined 0 in national development plans and the MDGs. Intersectoral 1. Increased Finalize, print and disseminate Fully achieved Report finalized, printed and This report is also available Workplace health advocacy the Report of the First Inter- disseminated to member on the website of the Health projects have the potential to multiply benefits and broaden ministerial Conference states and partners. and Environment Strategic 4 Alliance (HESA) Women and children impacts and thus contribute to the objectives of more than Update and maintain the HESA Fully achieved The HESA website is The web site is not being one MDG. For example, the water and sanitation country Food safety and security 4 Website maintained and curated updated regularly projects/programmes contribute to all, except MDG 8. by UNEP Vector control & management of chemicals 5 & waste Furthermore, the assessment established the effective Meeting of Partners (MOP) Partially achieved Two partner meetings held Meetings are expected to be held annually value of collaboration between the health and environment Management of water, soil & air pollution 3 Compilation of ongoing country Partially achieved Assessment tools prepared; Assessment done in 4 of the sectors and highlights the immense potential the Libreville support from WHO and UNEP assessment conducted in 5 countries that have NPJAs Management of forests & wetlands 0 Declaration holds for improving this alliance. 4 countries Third Africa Environment Fully achieved AEO3 prepared AOE3 will be printed and Management of climate change risks 4 Outlook (AEO3) disseminated shortly 3.6 Contribution of the JTT 7 2. Resources Development of proposals Partially achieved Donor mapping conducted; The resources are not Sanitation & hygiene services The evaluation also showed that the work of the JTT has mobilized for resource mobilization fund-raising proposals / yet available for contributed to achievement of the following six outcomes: investment plans prepared implementation 3 by 5 countries Safe drinking water 1. Heightened advocacy on health and environment; Preparation of Country Partially achieved Tools for NPJA prepared; NPJAs were developed by Luanda commitment health and environment priorities 2. Increased resources to address linkages between health Strategic Plans Joint plans developed 12 out of 47 countries Number of projects and environment issues; Completion of SANAs and NPJAs at Partially achieved SANA tools developed 34 out of 47 countries 3. Strengthened intersectoral collaboration between the the country level SANA conducted in completed SANAs. 34 countries Guidance & tools were 3.4 Coordination and funding of intersectoral projects health and environment sectors; provided to the 47 countries in the All 18 intersectoral projects were coordinated by multisectoral 4. Strengthened country systems for the management of African Region committees involving all relevant stakeholders representing priority health and environment issues; 3. Strengthened Meeting of Regional Directors (RD) Fully achieved Meeting of RD convened; JTT expanded to include AfDB, specific ministries, agencies, the private sector and civil 5. Enhanced Implementation of health and environment alliance to establish the WHO-UNEP Joint JTT established and 14 UNFCCC and WMO between Task Team working sessions held society. Partial funding was provided by some national conventions; and health and governments indicating national commitment towards 6. Integrated environment and health surveillance. environment sectors their implementation partners – a key factor in leveraging Second Interministerial Conference Fully achieved IMCH 2 IMCH2 held in 2010 in Luanda resources from the private sector and other external funding. Demonstration of synergies on Partially achieved Tools for assessing Assessment report submitted ongoing sectoral projects and intersectoral action developed by 4 countries programmes Assesment conducted in 4 countries Organize the IMCHE 3 Not achieved –

Strengthening and functioning of Partially achieved HESA arrangement endorsed the HESA secretariat JTT working sessions held 4. Strengthened Development of the SANA Fully achieved Guide for SANA, NPJA and 34 countries have SANA, country systems criteria, indicators, tools and assessment of intersectoral 12 of these countries have methodologies actions developed developed NPJA Establishment of Country task Partially achieved CTT were established in all 34 See above teams for SANA SANA countries 5. Enhanced Preparation of the Pan African Fully achieved Framework developed, PPHA endorsed by both Implementation Programme for Health Adaptation endorsed and disseminated. RC62 and AMCEN; of Health and to Climate Change regional plan of action 2012- Framework on Chemical Environment 2016 developed Management endorsed conventions by AMCEN

Participation of convention Fully achieved Secretariat of UNFCCC, BAEL secretariat to MOP Convention attended in MOP 6. Integrated Establishment of the Expert Group Partially achieved A concept note of the Collaboration has been environment networks endorsed by established with ECEH Bonn, and health partners in MOP2 Germany; Funding proposal surveillance developed system established

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3.7 Summary of country profiles against 11 Libreville Declaration priority actions Regional achievements and challenges in the implementation Table 1 below provides a summary of the 29 available self reported country profiles against the 11 Libreville Declaration of the Libreville Declaration and Luanda Commitment Box 4: Establishment of HESA in Ghana priority actions. are presented in this section against the backdrop of the The National Committee on Health and Environment 11 priority actions listed in the Libreville Declaration. The Strategic Alliance (HESA) was inaugurated on 24th TABLE1: SUMMARY OF COUNTRY PROFILES AGAINST 11 LIBREVILLE DECLARATION PRIORITY ACTIONS accompanying boxes highlight country progress and October, 2012. It is jointly operated under the achievements. auspices of the Ministry of Health and the Ministry of Environment, Science, Technology and Innovation. 4.1 Establishing a health and environment strategic alliance, as the basis for plans of joint action

Achievements Challenges The Declaration stipulates the establishment of country- Some countries have not utilised existing or established new specific Health and Environment Strategic Alliances (HESA) structures to link health and environment, which impedes as the cornerstone for coherently addressing the environ- formal intersectoral collaboration. It was also noted that in a Health and Environment Health Environment and Strategic Alliance (HESA) National policy frameworks Integration health of and environment issues National in Growth for Framework Strategic and Poverty Reduction Capacity Building knowledge or Acquisition management surveillance Strengthening systems Mechanismsfor compliance with conventions international Mechanisms for monitoring and evaluation of assessment of Mechanisms impacts partnerships Promoting for advocacy theBalance budget in allocation TOTAL mental determinants of human health and ecosystem number of countries the function of the CTT was limited to Benin ü ü ü ü ü ü ü ü ü 9 integrity. Most countries have utilised existing structures and the accomplishment of the SANA. Botswana ü 1 institutions as opportunities for building a strategic alliance Burundi ü ü 2 for integrating health and environment activities as opposed Furthermore, members of the CTTs, which are multisectoral Cameroon ü ü ü ü ü ü 6 to establishing a new structure (i.e. HESA). The advantage and predominantly represented by Health, Environment, Chad ü ü ü ü ü ü 6 of this approach is that implementation of the Libreville Agriculture, Academia, and Research and Management Declaration becomes institutionalised. of Water Resources, are expected to provide feedback to Comoros ü ü 2 their supervisory authority. However, in the absence of a Congo ü ü ü ü ü ü ü ü 8 Most countries have established a Country Task Team HESA or equivalent structure, they lack a clear mandate to Cote d’Ivoire ü ü ü ü ü ü 6 (CTT) which has been instrumental in conducting the implement the decisions and resolutions of the CTT. This Dem. Rep. of Congo ü ü ü ü ü 5 Situation Analysis and Needs Assessment (SANA) and lack of institutional anchoring could hamper the effective Equatorial Guinea ü 1 developing National Plans for Joint Action (NPJA) informed functioning of the CTTs. by the SANA. A total of 34 countries have established a CTT Ethiopia ü ü ü ü ü ü ü ü ü ü 10 and completed a SANA, 12 countries have developed NPJAs, 4.2 Integration of health and environment linkages Gabon ü ü ü 3 and 7 countries have developed multisectoral programmes in policies, strategies, regulations and national Gambia ü ü ü 2 and projects (Figure 4). development plans Ghana ü ü ü ü ü ü ü ü Achievements 8 Figure 4: Number of countries implementing selected A total of 23 countries have integrated the management of Guinea ü ü ü ü 4 activities for intersectoral programming health and environment issues into their policies, strategies Guinea-Bissau ü ü ü 3 35 and national development plans. These include the National Kenya ü ü ü ü 4

34 34 Development Plan and the National Health Policies, Strategies Madagascar ü ü ü 3 30 and Plans (NHPSP), Environmental Action Plan (EAP), National Mali ü ü 2 Plan of Adaptation to Climate Change, and other strategic 25 Mauritania ü ü 2 or operational documents of the health and environment sectors. These countries have increasingly updated their Mozambique ü ü ü ü ü ü ü ü ü ü 10 20 legislative and regulatory frameworks for environmental Sao Tome & Principe ü ü ü ü ü ü ü 7 health. Similarly, most of their health programmes take 15 Senegal ü 1 into account environmental issues such as vector control; Sierra Leone ü ü ü ü ü ü ü ü ü 9 preparation for and response to epidemics; food security;

10 12 Swaziland ü ü 2 monitoring of the quality of drinking water; environmental Number of countries of Number sanitation; control of nuisance attributable to noise and Togo ü 1 5 7 odour; waste disposal and health care waste management; Uganda ü ü ü 3 evaluation of the environmental impact of projects whenever 0 United Republic of Tanzania ü ü ü ü ü ü ü ü ü 9 CTT SANA NPJA Multisectoral necessary, health and control of hazardous chemicals in the Zimbabwe ü ü ü ü ü 5 established completed developed programmes workplace; preparing for mass casualties and natural disasters. TOTAL 26 21 20 9 13 10 14 9 6 5 1 developed Activity

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change adaptation in the health sector under the auspices at the national level, and in terms of sensitization, information, 4.5 Supporting knowledge acquisition and management Box 5: Development of linked Policies, Regulations of the United Nations Development Programme (UNDP); communication and education of all actors at all levels to to identify knowledge gaps and research priorities and to and Plans in Mauritius and the Strategic Approach to International Chemicals support intersectoral cooperation. support education and training at all levels Mauritius has made considerable progress in the Management (SAICM) for sound management of chemicals. Achievements development of policies and strategies in most 4.4 Establishing or strengthening health and environment In 13 countries, policies to improve training on health and sectors. A good number of health and environmental Several countries have taken steps to fast track the institutions the environment have been defined through the creation problems are addressed by legislative measures, achievement of impacts at the community level. This had Achievements of institutions that ensure the acquisition of knowledge including the Public Health Law and the Law on Foods been made possible either through existing projects that Existing institutions in nine countries have been maintained at different levels. In these countries there are some and Regulations. Issues related to water quality and have been realigned within the objectives of the Libreville and strengthened with new staff; working equipment; and on-going inter-university cooperation programmes noise are governed by the Law on Protection of the Declaration, or launching new demonstration projects facilities. These include well established institutional linkages aimed at strengthening research capacity in the field of Environment. Since 2008, the Government embarked following the adoption of the Libreville Declaration. between policy and implementation levels and strengthening health and environment. Some universities have courses on the development of a national plan for sustainable coordination of health and environment sectors for effective in environmental science, biodiversity, control of diseases development (MSI), which is structured in such a way implementation of health and environment activities. Efforts and climate change. More specifically, some countries as to influence existing policies and improve new Box 6: Intersectoral Approach to Accelerate have been made towards building human capacity for inter- have initiated training programmes with the support of policies for reducing the effects of climate change. Achievement of the MDGs in Kenya sectoral activities and development of budgets based on bilateral and multilateral partners. Some curricula have been This great vision should help promote the relationship Vision Kenya 2030: The objective of the social pillar is health and environment priorities. revised to take into account the dimensions of environment between health and environment through several to invest in the population with a view to improving and health. actions defined in this plan. the quality of life for all Kenyans by focusing on social welfare projects in the areas of education and training, Box 7: Strengthening Health, Science and health, environment, housing and urbanization, Environment Institutions in the United Republic Box 8: Establishing an Environmental Health Challenges social development, children, youth and sports. The of Tanzania Research Agenda in the United Republic of Tanzania The development of robust and sound legislative frameworks, implementation of Vision 2030 helped to achieve Existing institutions have been maintained and A national Environmental Health, Hygiene and policies and plans that link health and environment is the following objectives in 2012: (1) increasing from strengthened with additional staff; functioning Sanitation Research Agenda has been developed by the hampered by the lack of adequate relevant expertise. 1.7% to 4% tree coverage in the forest; (2) reducing equipment; and facilities. Some of these include Ministry of Health in collaboration with stakeholders. by half environment-related diseases. The main Higher Learning Institutions like Muhimbili University The Agenda highlights the Environmental Health 4.3 Implementing priority intersectoral programmes at strategies comprise the promotion of conservation of of Health and Allied Sciences, Ardhi University priority issues that require research. all levels, aimed at accelerating achievement of MDGs the environment, improvement of the strategies for and University of Dar es Salaam. Above all, some Achievements managing the control of pollution, expansion of waste institutions have introduced courses on Environmental The SANAs have revealed that intersectoral actions that treatment systems, improvement of the preparation Health. An Environmental Health Practitioners’ Council Challenges contribute towards the achievement of the MDGs have been for disasters and improvement of the capacity to adapt has also been established to monitor the ethics of Few countries have a policy and a common research agenda implemented in 7 countries. These programmes focused on to climate change. Environmental Health Practitioners. on health and the environment. priority areas such as: management of risks related to climate variability and change, including rise in sea level particularly 4.6 Establishing or strengthening systems for health and affecting Small Island Developing States; provision of Challenges Challenges environment surveillance to identify emerging risks, in sanitation, hygiene services and safe drinking water; and The assessment of 18 projects/programmes in six countries There is an apparent lack of a clearly defined regional research order to manage them better Environmental Impact Assessment. (IMCHE/3/INF 3) revealed the consistent lack, at national and capacity building agenda or programme with particular Achievements level, of institutional frameworks and national governance emphasis on health and environment, as well as regional In most countries, there is a National Multisectoral Committee At a policy level, a total of 22 countries have included in strategies to support multisectoral collaboration. Concerted mechanisms for coordinating research and capacity building for Emergencies, responsible for monitoring preparedness their PRSPs or NDPs, strategies that can accelerate the action is essential to effectively address the challenges on health and environment. and response to health emergencies. In some countries, development of intersectoral projects on health and the related to specific issues such as water, sanitation, climate environment. These documents generally aim to promote change, chemicals and waste. In this context, the assessment universal access to basic social services and social protection, revealed the effective value and great potential of the prevention and management of risks and disasters. Several Libreville Declaration in generating collaboration that has sectoral policies have been well implemented according to direct positive impacts on the environment and on the health the priorities of the Luanda Commitment. These include: of the affected populations. These outcomes contribute access to safe drinking water; access to sanitation through to achieving strategic objectives defined in national ATP approaches; solid waste management; health and development plans and the MDGs. nutrition; and vector control. In most of the countries, priority interventions aiming to achieve the MDGs include sound and The assessment also indicates that much more needs to be sustainable management of pesticides; strategy for climate done particularly in terms of the institutionalization of HESA

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health and environment monitoring is conducted by Ministry Challenges of Health and Local Government Authorities in collaboration Box 10: High-level Ministerial Coordination Box 11: Environment and Health M&E Mechanisms None of the countries reported a specific formal integrated with other stakeholders. Environmental Impact Assessment Committee for Implementation of International in the United Republic of Tanzania monitoring and evaluation mechanism for health and (EIA), Integrated Disease Surveillance and Response (IDSR), Conventions in Mauritius Environment and Health monitoring and evaluation environment programmes. With regard to peer review, and Environmental Audits (EA) serve as the major monitoring Mauritius has signed several conventions and protocols programs are found under the Division of Environment no formal mechanisms have been reported. Furthermore, systems in the countries. In some countries, there is an early related to the environment and health. Measures were of the VPO, the Environmental Health Section of when it comes to implementation, performance warning system for drought and flood, as well as climate adopted by the different stakeholders, namely the MoHSW through the legal arm of EMA (2004) and monitoring and evaluation are less prioritized. Though based malaria forecasting jointly implemented by the Ministry ministries and nongovernmental organizations inter the Public Health Act (2008) respectively. Similarly, performance assessment mechanisms exist in the 2 of Health and National Metrological Agency established alia for the implementation of these conventions. environmental monitoring and evaluation is also sectors, they are not interlinked. Vertical programmes have through the Meteorological Center in the country. Hence, the law on protection of the environment (EPA) conducted by the National Environment Management their M & E activities. Several countries lack clearly defined was amended to put in place a high-level ministerial Council as empowered by EMA (2004). The Annual national indicators to measure the performance of joint coordination committee for implementation of the Health Statistical Abstracts highlights the status health and environmental programmes. Box 9: Integrating Health and Environmental conventions and evaluation of progress made. of water and sanitation; occupational health and 4.9 Instituting the practice of systematic assessment of Impact Assessments in Ghana The Government of Mauritius has also integrated a plan safety, and environmental degradation and is health and environment risks Collaboration of the health sector with the for implementation of international agreements on produced annually. On the other hand, the Division Achievements Environment Protection Act (EPA) to integrate the environment and health into its 2005-2010 Programme. of Environment produces a report biennally and this A total of eight countries reported the practice of assessment of health impacts with the Environmental One of these agreements was the Bamako Convention report highlights the environmental status and the systematic assessment of health and environment risks Impact Assessment (EIA) Guidelines for the Oil and Gas which was adopted by the country. extent of degradation and pollution. as well as existence of legislation and regulations on developments is an initial attempt to institutionalize African Peer Review Mechanism in Mozambique environmental impact assessment. Some countries integrated monitoring procedures within EIA. As The African Peer Review Mechanism is undertaken reported that they also use the Strategic Environmental a follow-up to this, preparations are afoot towards Challenges periodically, in collaboration and consultation with Assessment to identify major environmental or social establishing a secretariat within the Occupational Whilst policies are in place concerted efforts are still required various stakeholders, as part of good governance, consequences associated with policies or plans. Health Programme to be responsible for on-going for strengthening the implementation of these conventions. at the national, provincial and district levels. monitoring of commitments made by operators within 4.8 Setting up national monitoring and evaluation Representatives of the various sectors such as public, their EIA reports. It is hoped that this will be extended mechanisms to assess performance in implementing private, civil society, communication agencies, social, to the other extractive industry sectors. priority programmes diplomatic corps, international cooperation partners, Integrating Health and Environmental Information Achievements etc. participated. Twelve editions of progress reports in the DHIS2 in Zimbabwe In nine of the countries, monitoring and evaluation of health have been drafted. The country modified the District Health Information and the environment occur at the top policy level. Sector- System (DHIS2) to synchronize health and environment specific performance management mechanisms also exist. information obtained from various governmental departments in the country.

Challenges The National Multisectoral Committees for Emergencies deal only with contingency plans for the health sector.

4.7 Enforcing compliance with international conventions Achievements Countries are signatories of several international agreements and conventions on Health and Environment. Most of these agreements and conventions have a national focal person and mechanisms exist to ensure their application. The main conventions being effectively implemented in most of the countries include the Stockholm Convention on Persistant Organic Pollutants (POP), Basal Convention, Biodiversity, UNFCCC, and the Convention on Biological Diversity.

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Challenges • The Libreville Declaration has contributed to the challenges: (i) lack of a permanent institutional framework Box 12: Correlating the health and environmental In all countries, specific communications units exist within achievement of the following six outcomes: (i) heightened to implement the Declaration; (ii) lack of a formal framework effects of Climate Change in Kenya individual programmes or departments. However, their advocacy on health and environment; (ii) increased for resource mobilization for joint actions; (iii) low level of There is systematic production of reports correlating activities remain sectoral. resources to address health and environment linkage issues; involvement of other partners in the process (WHO and health effects to climate change or degradation of (iii) strengthened intersectoral collaboration between the UNEP are involved in the programme at country level); health and environment sectors; (iv) strengthened country (iv) poor dissemination of documents; (v) very low level of the environment. The reported trends provide useful 4.11 Achieving a balance in the allocation of national systems for the management of health and environment commitment from the highest authorities of the country information for assessing changes in the environment budgetary resources for intersectoral health and priority issues; (v) enhanced implementation of health and (President, Prime Minister) in the process of implementation and defining priorities. The State of the Environment environment programmes environment conventions; and (vi) integrated environment of the Declaration despite political reforms initiated; and (SOE) report covers priority environmental issues that Intersectoral programmes do not yet have enough and health surveillance. (vi) low level of expertise in health and environment at the have a direct or indirect bearing on human health and budgetary resources. Budget for public institutions in charge country level. the environment. The report generally comprises a of health and environmental issues (including research • Tangible achievements were made in relation to the health component which highlights priority health institutes) are insufficient with respect to their specifications. normative work, particularly in convening meetings for • There are several opportunities which countries and environment issues. In most countries, there is still no financial allocation health and environment (IMCHEs, MOPs), advocacy and can leverage to optimise the implementation of the for specific research on the links between health and strengthening country systems through provision of Declaration, such as: (i) the existence of a political framework in several countries that could help Challenges environment, or financial resources specifically allocated to guidance, tools and methodologies. For example, the consolidate the HESA for effective implementation of the Regulatory oversight for environmental impact assessments joint health and environmental interventions. The allocation establishment of the CTTs in countries that have completed Libreville Declaration; (ii) the existence in the majority (EIAs) rests with national environmental authorities. for the implementation and monitoring and evaluation their SANA constitutes a breakthrough in strengthening of countries of sectoral coordination frameworks for No country reported that the health impacts of policies, of programmes and national priority projects also country systems for managing health and environment health and environment that could be called upon to plans, or projects are systematically considered. In almost all remains insufficient. linkages at the country level. establish interdepartmental coordination frameworks countries, the systematic assessment of the environmental • The SANA exercise has enabled the development of of joint actions; (iii) the existence of sector performance and health impact is limited to the implementation of national capacities for policy reviews within the health and monitoring and evaluation systems that could be used development projects. environment sectors. In countries undertaking a SANA, to harmonize the monitoring of joint actions; (iv) the national experts have been able to identify policy gaps and 4.10 Developing partnerships for targeted and specific availability of a growing number of health adaptation to contradictions, and propose the necessary alignments in advocacy on health and environment issues climate change plans (PASCC), which facilitate updating these sectors. Achievements of the health development plans for sustainable In five countries, the Libreville Declaration has contributed • The CTTs have provided opportunities for experts with development objectives; (v) the existing experience in to building and improving partnerships for targeted and different perspectives to engage effectively in a technical implementing national health and environment joint specific advocacy on health and environmental issues. These and scientific dialogue, and to reach consensus on the actions between the two sectors could be capitalized partnerships include networks on health and environment status and relative importance of environmental risk on to accelerate the implementation of the Declaration. such as Forum for Environment, WASH Movement, WASH factors that impact on health, development as well as on • The “level of distribution” of the Declaration in the public Media Forum, WASH Multi-stakeholders Forum and ecosystems preservation. As a result of SANAs and because domain (e.g. using search engines such as Google) reveals Consortium for Population, Health and Environment. of this dialogue, it has been easier for decision-makers from a higher frequency of citation by international than the various sectors concerned to agree on national and national organisations (cited twice as often by international continental priorities for health and the environment. Box 13: Advocacy Networks for Health and the organizations). International organizations who have cited Environment in Ethiopia and Sierra Leone • Despite the JTT’s leadership and coordination role, as well the Declaration most often are UN specialized agencies as the guidance provided to countries, implementation There are number of networks and partnerships (WHO, UNEP, UNESCO), the Francophone Youth Parliament of the Declaration at the country level continues at a on health and environment such as Forum for and the International Press dealing primarily with African slow pace. The number of countries that have completed Environment, WASH Movement, WASH Media Forum, issues (Afrik Info). SANAs and prepared their NPJAs remains below the WASH Multi- stakeholders Forum and Consortium for • At the national level, ministries directly involved in expected target. The HESA was only able to convene two Population, Health and Environment. the implementation and the national press quote meetings of partners over a four-year period. The IMCHE Public Private Partnerships for Malaria Control and Safe this Declaration. Regional organizations do not do was institutionalized with the aim of being held every two Water Supply in Sierra Leone so as often. The Libreville Declaration has been cited years but only two conferences have been held so far. The by the Central African Economic and Monetary Public –Private partnerships including companies e.g. Secretariat has also made limited progress in the two key Community (CEMAC) and Southern African Development Mining and Bioenergy companies’ involvement in the areas of communication and resource mobilization. control of malaria and provision of water supply; as well Community (SADC). This low ‘visibility’ could be • The generally low level of implementation of the Libreville as participation in pilot projects and development of a contributing factor to the slow implementation of the Declaration could be associated with the following policies and strategies. Declaration at the country level.

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6.1 SCALE UP THE IMPLEMENTATION OF MULTI SECTOR and financial partners in the country. These frameworks PROJECTS IN ALL COUNTRIES: should support countries to develop relevant investment • Establish a functional coordination body for imple- plans on health and the environment; mentation, monitoring and evaluation of joint activities on • Establish special funds dedicated to health and the health and environment. If possible, place the secretariat environment and, if possible, encourage the creation of under the auspices of the highest authority in the country national agencies responsible for the mobilization and (President or Prime Minister); management of these funds. • Extend the membership of the CCT to all relevant national 6.3 INTENSIFY ADVOCACY EFFORTS THAT STRESS THE partners and create a steering committee responsible PROMOTION OF THE LINKAGES IN HEALTH AND ENVI- for the technical coordination and monitoring of the RONMENT AS A CONTRIBUTION TO implementation of operational plans; SUSTAINABLE DEVELOPMENT: • Integrate all national projects/programmes on health and • Support the establishment of national observatories environment into national development plans; on issues of health and environment, and entrust them According to the World Health Organization (WHO) with the mandate for advocacy and monitoring the • Establish a national database integrating key information implementation of health and environment related laws, an estimated 23% of all deaths in Africa are the from all sectors involved in health and the environment; regulations, conventions and agreements signed by the • Strengthen regional and sub-regional training and research country; result of avoidable environmental hazards such as programmes in health and environment, and support • Set up, in all countries, an information platform on climate countries in strengthening their capacity to that of experts. contaminated water, poor hygiene, inadequate change and health related issues and key results of 6.2 INCREASE INVESTMENT FOR THE IMPLEMENTA- projects, programmes and studies of impact on health and sanitation, poor water resource management, TION OF THE LIBREVILLE DECLARATION: the environment. • Step up the provision of technical support on issues of use of unsafe fuels, atmospheric pollution and health and environment and extend it to all the technical poor infrastructure. 7 CONCLUSION

The overall evaluation of the implementation of the Libreville of countries and monitoring and evaluation of priority Declaration revealed that countries have integrated the programmes needs to be strengthened. management of health and environment issues into their development plans through adaptation of their legislation The evaluation also demonstrated the extent to which the and their policies on health and environment. However, the HESA Secretariat has assumed the role and responsibility implementation of the eleven priority actions stipulated in assigned to WHO, UNEP, AfDB and the partners in the the Libreville Declaration remains variable at the country Libreville Declaration and the Luanda Commitment. The level. The country coordination committees are not yet analysis showed that while the Secretariat has satisfactorily established in all countries. Similarly, a number of countries undertaken its normative functions, progress at country level have yet to complete their SANA exercise and develop their has been variable. NPJA. Capacity building is being undertaken in a number

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