1 ’s PHE Spotlight V. 1 No. 1 Produced by: PHE-Ethiopia Consortium

Prepared by: Cassie Gardener, PHE-Ethiopia Consortium Intern, April 2010

Edited by: Annie Wallace Befekadu Refera Negash Teklu

Sponsored by: Population Reference Bureau  Health Families  Healthy Environment

Map of the site Bale Mountains National Park

Total Population of the Woreda and composition woreda Population Number Male =19,244,278 Female=19,870 Total= 39,114 (Source: Statistics Abstract 2007) INTRODUCTION ince the November 2007 Regional Conference: Population, Health and SEnvironment (PHE): Integrated Development for East Africa which was held in Addis Ababa, there has been a burgeoning movement for PHE integration throughout Ethiopia. The PHE-Ethiopia consortium was formed in 2008 to provide coordination and capacity-building to around 40 members. PHE Ethiopia Consortium defines its approach: “Population, Health and Environment (PHE) interventions in Ethiopia are a holistic, participatory development approach whereby issues of environment, health and population are addressed in an integrated manner for improved livelihoods and sustainable well being of people and ecosystems.” 1 The context for applying an integrated approach toward improved livelihoods is clear, considering Ethiopia’s vast deforestation, land degradation, rapidly growing population, high rates of unmet need for family planning and maternal mortality challenges, not to mention how climate change will exacerbate them.2

Similarly to the benefits of PHE initiatives around the world and pilot projects in Ethiopia in Tigray by Relief Society of Tigray (REST), in Amhara by Lem Ethiopia, in the SNNPR, by Lem Ethiopia in by Ethio-Wetlands and Natural Rehabilitation Association(EWNRA) and Lem Ethiopia, have so far been found to be cost efficient, and effectively expand target audiences, build and maintain community goodwill trust, and increase women’s status and self- perception. Within this report I will discuss how within just one year, the PHE approach implemented by the Movement for Ecological Learning and Community Action (MELCA) organization in the of Southeast Ethiopia successfully sustained protected natural areas, and benefited the communities that depend on them.

PROJECT OVERVIEW

The Bale Mountains in Southeast Ethiopia are a little-known biodiversity treasure. Ethiopia accounts for 55% of the highlands of tropical Africa; among which the Arsi-Bale massif is the most notable area. The highest peaks of this massif are found in the Bale Mountain range that hosts a high number of endemic flora and fauna. The Bale Mountains National Park (BMNP) which was established in 1962 is located inside Bale Mountain range. The Bale Mountains National park plays a critical role in protecting biodiversity that provide major sources of water, food, and habitats for rich ecosystems, and support the tourism industry which is a potential source of income for local communities and the Nation, in general.

For the southeast of Ethiopia and parts of Somalia, the Bale Mountain watershed is a source of mineral-rich water, firewood, grazing land, medicinal plants and food for many thousands of households. The area serves as a source of rainfall for

Ethiopia’s PHE Spotlight V. 1 No. 1 4 agriculture and is of critical importance for perennial water for the arid lowlands of Ethiopia.

The Bale Mountains National Park (BMNP) was established to protect the Mountain Nyala, the Ethiopian Wolf, and some endemic bird species. It is estimated that if conservation efforts fail and resources continue to be exploited, more species of mammal will become extinct than in any other area of similar-sized mountain region worldwide. The Bale Mountains are formed to the west, north and east by an extensively formed plateau of about 2,500m. They rise to a high altitude plateau the greater proportion of which is over 4,000m. The second highest peak in the country, Mount Tullu Dimtu, that rise 4, 377 meters above sea level is found inside the Bale Mountains National Park . This plateau falls away rapidly to the south at the Harena escarpment.

The Bale Mountains National Park is arguably most famous for hosting half of the entire Ethiopian wolf population, the world’s rarest canid, dwindled down to a mere 250 population as a result of human interaction, and Mountain Nyala , which is also endemic and an endangered species.

Ethiopian Wolf Mountain Nyala

The region has been virtually depleted of indigenous Juniperous procera and Hagenia abyssinica tree species that are longer-lasting, more additive to the soil and disease/drought resistant than faster-growing cypresses and eucalyptus, which are sometimes grown as replacements. It has been estimated that if people continue to exploit the Bale zone’s resources in an unsustainable way, more species of mammal would go extinct than any other area of equivalent size on the globe.3

As in many parts of rural Ethiopia which face grave livelihood and health challenges affecting diminished agricultural land and a rapidly growing population, local people are increasingly forced to cut trees for fuel and timber to feed and provide for their families.

5 Ethiopia’s PHE Spotlight V. 1 No. 1 Many are not well aware of basic hygiene and sanitation, and little or don’t use family planning methods because they believe they must have “all the children that God sends them.”

That’s why MELCA, an organization which means “a Ccrossing point on a river” or “fiord” in Amharic and Oromo languages and stands for “Movement for Ecological and Community Action,” in partnership with Bale Eco Region, Farm Africa and SOS Sahel joint project, Frankfurt Zoological Society, Saint Louis Zoo, Green World Campaign, Gaia Foundation, and Arsi Bale Rural Development Program has been working to conserve the environmental and cultural resources of Bale since 2005. They do this through research, advocacy, and their successful environmental education program called SEGNI. SEGNI means “seed” in the and stands for “Social Empowerment through Group and Nature Interaction.” SEGNI empowers youth as “eco-advocates” through the transformative power of 5-day nature excursions in Bale Mountains National Park, whereby selected elders transfer cultural and ecological knowledge to around 20 participants 12 times each year. After participating in the SEGNI program, youth return to their schools to establish SEGNI Clubs that collect plant and animal specimens which they keep in cultural huts to continue to train and educate their peers, families and community members on the importance of their region’s cultural and ecological resources. Through their efforts, MELCA has conducted over 50 SEGNI programs to nearly 1,000 people, organized 25 SEGNI Clubs in local schools, given conservation and entrepreneurship trainings to over 600 people, and raised over 500,000 indigenous trees for community distribution. Most importantly, they have built essential, trusting relationships with the community at all levels, from health workers and woreda (district) experts to youth, families and elders.

Intergenerational transfer of knowledge

Ethiopia’s PHE Spotlight V. 1 No. 1 6 Since March 2008, MELCA has implemented an integrated Population, Health and Environment (PHE) project in the Bale Region at the community and school level funded by Engender Health from the David and Lucile Packard Foundation. After conducting a baseline data assessment, they chose to run their pilot project in the Hore Soba community of Dinsho, which showed the most need and opportunity for interventions based on a number of criteria: 1. The community is a buffer zone to the National Park, so interventions here will have a greater impact on the surrounding ecosystems; 2. High population growth in the area leads to expanding agricultural land and high rates of deforestation; 3. There is great lack of awareness and acceptance of family planning due to religious reasons, and the 15 km walk to the nearest woredas (district) health clinic further limits access to family planning, leading to unmanageable family sizes and high maternal mortality rates; and 4. MELCA has already intervened with conservation trainings in this community, so they have established infrastructure to implement the project.

In Hore Soba, they gave PHE awareness-raising trainings to 160 community members, of which 53 were females. They also gave PHE trainings to leaders within the broader Dinsho, Robe and areas, including 72 agriculture, rural development and health extension workers, and 45 government and woreda (district) officials. Meanwhile, of the 24 schools where they have SEGNI Clubs, they chose the best 8 model schools where leaders have initiated the most awareness raising activities to join with Women’s and Anti-AIDS Clubs and form PHE Clubs.

Some of PHE training participants 7 Ethiopia’s PHE Spotlight V. 1 No. 1 MELCA did this through training 60 school directors and club leaders on PHE, as well as providing ongoing resources such as mini-media equipment (stereo, microphone, tape recorder) and nursery equipment.

Handover of mini- media and agricultural tools For one of model schools

Like many integrated development projects in their initial stage, MELCA was originally unclear about what PHE meant or how to implement it. But they gained clarity at the PHE Project Design and PHE Monitoring and Evaluation workshops held in November 2008 by PHE Ethiopia Consortium. They understood soil conservation, watershed management, and species protection, but how could they also encourage community members to space their children, prevent HIV/AIDS and end maternal mortality? In addition, they ameliorated this confusion by discussing the on-the-ground issues at the joint training for the 72 Health Extension Workers (HEW) and Development Agents, who were central to the project implementation. After an introduction to what PHE means and why it’s important, HEWs and DAs discussed how population, health and environment challenges intersect with community members’ daily lives. They designed concrete action plans to apply the PHE approach, according to specific output indicators including family planning users, maternal mortality rates, deforestation rates, numbers of toilets and waste- disposal pits, and numbers of awareness-raising workshops held. They chose these indicators to maximize on their existing government-funded work and compare how the integrated PHE approach contributed to better results from the baseline data assessment. Throughout the year, MELCA gave consecutive workshops to train the 160 community members which included 60 student club leaders and school directors and 45 government and woreda officials. With everyone on the same page about what PHE means within the local community context they set to work in a collaborative fashion. Ethiopia’s PHE Spotlight V. 1 No. 1 8 INITIAL SUCCESS

As a result of just one year of PHE integration efforts, the Bale area achieved unprecedented results in increasing awareness and usage of family planning methods, adopting health and sanitation measures, and regenerating forests and land with nurseries and tree-planting. All activities expected to improve people’s livelihoods. In addition to awareness-raising to more than 10,000 people, they more than doubled family planning users and distributed over 60,000 tree seedlings to the community. Although little investment was made into the project results so far show that it has been successful for a number of reasons:

Table 1. Result

Kebele (Village) # Family Planning # Toilet # Awareness Users Facilities Workshops

Before After Before After Before After

Hore Soba 892 2068 109 509 --- 1,000

High Community Involvement in PHE and Women’s Roles in Reforestation

From the planning stage up to implementation it was important that MELCA involved and mobilized the community to ensure they fully embraced the PHE concepts and initiated many of the project’s successful outcomes on their own. Volunteer committees formed in both the Hore Soba community and the other kebeles where MELCA didn’t have capacity to provide direct follow-up. These comminitees were created in order to continue informal awareness-raising and training efforts. Woreda representatives said “the project first targeted key community gate-keepers such as religious and influential leaders, and through them the community mobilized and brought about rapid attitudinal change towards environmental protection and increaesd use of family planning.” It was also important that women were involved in the project’s reforestation efforts, including the leader of the Women’s Affairs Association in Hore Soba and the religious leaders’ wives. A member from the women’s group said, “In the past we didn’t have any knowledge on the effect of environmental degradation, particularly deforestation. Now we clearly understand and face, the adverse effect, and we are striving to improve our biodiversity.”

9 Ethiopia’s PHE Spotlight V. 1 No. 1 Some Community level awarness, PHE participants

Religious Leaders’ Support of Family Planning

Religious leaders’ support of the project was essential for community mobilization around the PHE approach. By inviting five religious leaders to the community trainings and explaining the benefits of family planning for improving livelihoods and protecting the environment, they changed their minds about the acceptability of contraception methods. They now are not only aware of the benefits of family planning, but they tell their followers about it within a PHE framework. A religious leader named Sheik Hassen said, “After the PHE training, we have good awareness of population, family planning, health and environmental issues. Population growth has an effect on the community, environment, and forest resources, and leads people to poverty. Now, we understand that child spacing is better. Even now my wife is using family planning services.” Another religious leader, Sheik Mohammed Siraj Hadji Hussien, said “based on the Holy Koran, family planning is not forbidden. We have discussed this at meetings, and reached a consensus that family spacing is not a problem. Rather, giving birth without having enough money to provide the children with adequate food, clothes, health care, shelter and school, and exposing children to different stresses, is really a problem and sin.” They also said that now family Ethiopia’s PHE Spotlight V. 1 No. 1 10 planning is considered the same as using any kind of medicine that is important for health care. Health Extension Workers said, “In the past, we had few family planning clients, but now the number of clients receiving family planning methods, especially long-term methods, is increasing. This is mainly because religious leaders are preaching the importance of using family planning services for maternal and child health in particular, and for the balance of family size in general.”

Intersectoral Collaboration Among Governmental Workers

Through the joint training, Health Extension Workers and Development Agents worked together collaboratively on planning, implementation and strengthening their efforts in a number of ways. Dinsho Woreda Health Office Head said, “Our health extension workers are working hand in hand with their counter part development agent, both have a common plan, support each other and implement together.” Health Extension Workers say that “in the past, we didn’t work with the Development Agents, and we didn’t know about agriculture, rural development or their effects on health. Now we understand their effects on each other, and we’re able to teach families about tree-planting, and follow-up with them too. Similarly, Development Agents teach family planning and follow-up with them. It makes our work easier that we’re supportive of each other.” Woreda experts say that their collaborative work is more beneficial to the community because it doesn’t support people’s time with multiple meetings. Since Health Extension Workers can teach on environment and Development Agents can teach on family planning in their home-to-home visits, they are better able to fill in the gaps to holistically meet household needs. Woreda experts also say this leads to more integrated households. “Previously, one family might plant trees but not have a toilet. Now, farmers recognize the importance of all three issues for their improved livelihoods—having a clean compound, planting trees, and using family planning.”

School Involvement in PHE Awareness Raising

As a result of training the SEGNI, Women’s and Anti-AIDS Club leaders on the PHE approach have collaboratively worked together to create integrated messages on birth spacing and land preservation in the form of dramas, poems, riddles, question and answer sessions, and songs. It was beneficial for MELCA to work with model schools that have committed directors and club leaders, since they easily incorporated PHE messages into their existing activities. Fatiya, a 21-year old female student in 8th grade, said “Before the coming of PHE, I’d been working only on SEGNI and knew only about biodiversity and culture. But now, I clearly understand health and population issues, including HIV/AIDS, taught to me by my peers. By having the integration of clubs, we’ve strengthened our power to accomplish more.”

Similarly to how the Hore Soba community galvanized around PHE on their own, school directors and club leaders were responsible for many successful outcomes by their own initiative. For example, teachers at Fincha Bamoo Elementary School 11 Ethiopia’s PHE Spotlight V. 1 No. 1 steered the PHE Club to use their own funds to commission a PHE-trained artist to create “PHE Story Boards,” which compare large, unhealthy families with degraded land to small, healthy families with forested land. The mini-media enabled students to amplify these messages to a wider youth and community audience, reaching over 10,000 people throughout the area and garnering television coverage during regional celebration days. Now with 178 PHE Club members, school directors and students are spreading the benefits to communities; students are convincing their families of the benefits of family planning, health interventions and fuel-saving stoves, and the teachers and school directors are working closely with students’ parents. Students outside the PHE club can clearly articulate why family planning is important for birth spacing, maternal mortality, HIV/AIDS and protecting the environment. Most of this is due to schools’ mini media efforts.

One of school students’ art works on PHE awareness raising stage performance

Ethiopia’s PHE Spotlight V. 1 No. 1 12 LESSONS LEARNED AND CHALLENGES

Since this was the first time and year that MELCA, an environmental organization, implemented the PHE project, it’s clear that the project’s reproductive health and family planning components could be strengthened. MELCA and governmental workers require more technical assistance, project funds and capacity-building in order to meet community needs and follow-up from PHE trainings. For example, Health Extension Workers said, “We expect to face problems in distributing long-term family planning methods in the future. First, we need training in order to understand and deliver the methods ourselves. Second, we aren’t able to provide services when we are asked for them, because we must refer them to the woreda distributor which is a far walk from Hore Soba. After the training, most people want to use long-term family planning right away, so we should be able to meet immediate needs and not risk losing their interest.”

In addition, while most beneficiaries fluidly discussed population growth’s pressure on natural resources, many didn’t clearly articulate how enhanced reproductive health and women’s status are solutions. Finally, cultural challenges persist, since Health Extension Workers said that even though family planning is accepted by religious leaders, women may still feel ashamed for taking family planning simply because they don’t know the benefits.

13 Ethiopia’s PHE Spotlight V. 1 No. 1 CONCLUSIONS AND RECOMMENDATIONS

Although the project is in an early stage, it appears capable of being scaled up with little investment through additional trainings to surrounding communities, more nurseries on new technologies and local trees and mini media resources, and capacity-building to MELCA, HEW and DA staff to better meet community needs and follow-up. With increased reproductive health training in particular, it is believed that MELCA will be more successful in implementing the PHE integrated approach to improve the standard of living of communities in the Bale Region. As a result, this will reduce the impact of population growth and deforestation on Bale Mountains National Park, protecting the biodiversity of the region for Ethiopia and the global community for future generations, and increase the resilience to the climate change vulnerability.

About Cassie Gardener

Cassie Gardener served as a PHE-Ethiopia intern from March-April, 2010, helping to create brochures, write the first-ever newsletter, give presentations, and go on field visits to PHE project sites to produce two reports. Previously she was the National Organizer for the Global Population and Environment Program at the Sierra Club, the largest and oldest grassroots environmental organization in the U.S. Cassie traveled throughout the U.S. organizing and training youth advocates who recognize the interconnectedness of population growth, natural resource consumption, sexual and reproductive health and rights, and sustainable, healthy communities.

SOURCES

1.- PRB: “Making the Link: Integrating Population, Health and the Environment in Ethiopia,” 2007 2.- Definition developed by PHE-Ethiopia members at General Assembly Meeting in November, 2009 3.- Hillman, J.C. (1988). The Bale Mountains National Park area, southeast Ethiopia, and its management. Mountain Research and development, 8:253-258.

Ethiopia’s PHE Spotlight V. 1 No. 1 14 Ethiopia’s PHE Spotlight Interview with Ato Million Belay

PHE: May you introduce your self please?

Ato Million: My name is Million Belay, I am the Director of MELCA Mahiber I am married and a father of three children.

PHE: Could you tell us about your project sites and their progress? Million Belay Ato Million: MELCA has three project sites, two in Oromia Regional State and the other one in SNNPR. The Oromia sites are found in Bale zone and the other in Finfinne Special zone around Menagesha Suba forest area. Our project in SNNPR is found in Sheka Zone where one of the biggest natural forests is found.

Regarding their progress, all of MELCA’s projects are doing very well. Our projects focus on the culture and indigenous knowledge of the community and its relation with nature, the protection of the environment and natural resources conservation. We work with the community towards bringing about sustainable development. To that effect we have designed a program called SEGNI whereby the youth in schools learn about nature and culture and the inter-relationship between these two components. They also connect with themselves and in this way we create leaders which take initiatives to transform their environment for a sustainable life. We also focus on creating the means for intergenerational learning; a mechanism whereby the youth learn from elders the culture and how the generations before have protected the environment and conserved natural resources through traditional and customary practices.

We also work on advocacy to raise the awareness of the various stakeholders in the environmental issues. In this regard at the national level, we have had workshops with FDRE parliament members and at regional level we prepare awareness 15 Ethiopia’s PHE Spotlight V. 1 No. 1 raising forums with the different stakeholders such as law enforcement organs, the judiciary, from regional to woreda levels as well as women and youth group, elders and clan leaders. That is because we believe that these groups have the primary responsibility to protect the environment and conserve the forest.

We also work on development which is based on people’s perception of their environment and their dreams for the future. We do not support top down development models as they disrupt people’s lives and lead them in to poverty.

We are pioneering an innovative participatory mapping methodology including Participatory 3 Dimensional Modeling, GPS and GIS based participatory mapping and Geo-referenced Sketch Mapping. This is helping to develop a Participatory Natural and Cultural Resources Management Plan where communities will have legally recognized conservation areas. These Community Conserved Areas will be principally managed by local communities, which is a breakthrough in the management categories of Ethiopia’s protected areas and in line with current development in IUCN protected area category.

The other area that we are working on in the Bale project site is PHE which is an important component. But we have a different dimension of health. We believe that the local or traditional health system that the community has is as important; as MELCA we promote both the traditional and modern health systems. We are working in schools. We organize activities on raising the awareness of the school community. We did it in three woredas. Development workers are now in the kebeles; they work in the kebeles. When one health worker goes to a household he will teach them about the environment in addition to health. We have also approached the local religious leaders.

We worked with the government officials on advocacy. We had one advocacy forum at federal level. We had it also at zonal level and woreda level. So our PHE work evolves on advocacy at community level, also.

PHE: Who funds the different site projects?

Ato Million: We have many funders; small and big. For example our Sheka project is funded by Norwegian Peoples’ Aid (NPA), and the Netherlands, the Bale project was funded by Engender Health and is being funded by Farm and SOS Sahel, Frankfurt Zoological Society, Green World and the St. Louis Zoo, and the Suba Sebeta project is funded by the Swedish Society for Nature and Conservation and the Finland Embassy. There are also many others, as well.

PHE: How did you start the PHE approach in Bale?

Ethiopia’s PHE Spotlight V. 1 No. 1 16 Ato Million: I think I was invited by the Packard Foundation, at that time by Ato Sahlu Haile who was the Ethiopia Country Representative and had a discussion with him. At that time I think there was a discussion at the Packard Foundation on how to engage on the concept of PHE, integrating population, health and the environment. I met a range of consultants including heads of Packard and I asked if we could apply for funding. So we applied and got the funding through Endanger Health. Later, I was invited to attend a meeting where PHE issues were discussed. Our staff also received different PHE-related trainings from the PHE consortium. That is how we started it applied for it after long discussions and going back and forth.

PHE: Are there any PHE approach lessons that you have learned from Bale to your other sites?

Ato Million: I think there are lots of lessons to be learned. Using clubs in schools is important. There are clubs including health, population, sport, science, etc. Each club has its own approach. And each approach has its own merits. We combined the clubs on the issue of PHE. We gave them mini media materials and with that they effectively promoted the idea of PHE in a coordinated manner. So we learned that coordination between and among the objects running different ideas would be fruitful. Secondly in every community there are traditional and religious beliefs, knowledge and practices that are very important. So it is critical to approach elders or religious leaders and make them agents of social change. Thirdly I think in every Kebele in Ethiopia there are five government workers going door to door to promote government’s approach toward health and development. They reach the community day to day. We use these people to promote the PHE approach in the community. And also we found the trainings provided by PHE consortium very important for making all those who participated to have a good concept of the interrelationship among population, health and environment. So the PHE approach has an overflow to other projects.

PHE: How do you assess the approach in consolidating the sustainability strategy of your sites?

Ato Million: I think we still need a little bit of support. Even if we gave the little money that we obtained to the schools, it is very limited; we bought them mini media materials. The project period is also limited; we can’t think of sustainability within one year. To do something more significant we need more time and also more money. That is what we need to establish sustainability. We have to, I think, mainstream the agenda and we need more time to do that.

PHE: How is the PHE approach conceptually?

17 Ethiopia’s PHE Spotlight V. 1 No. 1 Ato Million: I think we used to separate things that are not in fact separable. When one deals with health he obviously cannot avoid the issue of environment or population. These three elements are very much interrelated in the local community. We cannot effectively work on one without touching the other. So PHE is promoting dealing with these in an integrated manner. It is working on the local community, the NGOs and the academia and all other stakeholders to adopt that thinking. To say I am working on health or environment or population in a specific way does not work. Even if the ultimate goal is conservation, I think we can adapt the PHE approach to our local thinking. And that is crucial for us.

PHE: As a member of the PHE Ethiopia Consortium how do you assess your relationship with the consortium? Areas for improvement?

Ato Million: I have not had the chance to visit other PHE project sites, but I have participated on different PHE presentations and found that it is one of the most active consortiums. I personally feel that we are applying a different approach and that gives a chance to learn from each other. Through the consortium, different workshops are organized to build the capacity of members or implementers. They are also trying to create a strong link between the local civil societies and the international partners; trying to bring outsiders mainly from USA, I found it very important. So I think it is one of the most vibrant civil societies in Ethiopia.

Ethiopia’s PHE Spotlight V. 1 No. 1 18 19 Ethiopia’s PHE Spotlight V. 1 No. 1 Ethiopia’s PHE Spotlight V. 1 No. 1 20