Environmental Health Project (EHP)

The Environmental Health Project (EHP) provided global leadership in the development, implementation and promotion of new and improved, cost-effective environmental health interventions. This included field support for diarrheal disease prevention through safe water supply, adequate sanitation and hygiene promotion at the household and community levels. The Manoff Group was a partner on the USAID-funded project, led by Camp Dresser and McKee (1993-2004).

The Manoff Group provided technical assistance to country programs on public awareness of water and sanitation issues and behavior change communication for improved practices related to environmental health. In addition, The Manoff Group managed country activities, designed programs, and prepared several documents on the subject for global or regional use. Selected activities include:

  • Successful work on lead abatement in Romania and technical assistance for a project to reduce lead exposure in urban Lima
  • In conjunction with PAHO, Plan International, and other PVOs, providing ongoing technical assistance to hygiene promotion pilot projects in the Dominican Republic, Nicaragua, and Peru. Monitoring studies found evidence of significant impact on behaviors and diarrhea incidence

  • Technical assistance to a large-scale water and hygiene program, implemented through NGOs, in DR Congo

  • Coordinating behavioral work on hand-washing and diarrhea prevention and treatment in the West Bank, introducing new and important work with water distributors delivering water using tankers

  • Writing several global guides, including a guide on training in Behavior-Centered Programming for environmental health and a manual distributed by PAHO, “Improving Health through Behavior Change.” The manual provides guidance on planning and managing aspects of behavior change processes, as well as when and how to access specialized skills focused on hygiene promotion.

EHP in Benin: Raising gender status...

The Manoff Group managed the EHP II project in Benin, Gestion Communautaire de Santé Environnementale (GESCOME). This multi-year activity engaged citizens and government in local communities and resulted in the provision of much wanted and needed public latrines and water points. The work was part of a diarrheal disease prevention and governance project in Benin that included neighborhood water and sanitation infrastructure user/management committees.

The project introduced the concept of gender awareness to the region. When GESCOME began, the municipal environmental health teams were almost exclusively male. Most had one female representative who generally sat silently in meetings. One all-male municipal team explained to The Manoff Group manager that the broken water spigots on their GESCOME micro-project potable water source were due to the “stupidity of the women” who rested their full pots on the spigots before continuing to lift the pots from the ground to their heads (rather than perhaps a design flaw that did not include a place to rest the pots).  The Manoff Group saw a need for gender awareness/equality training and perhaps a shift in the gender balance on the municipal teams.

We created a locally specific gender-based curriculum on integrating gender in WASH participatory community health communication training, which included each municipal team. At the same time, we suggested to the Departmental Environmental Health Committee, which oversaw the municipal teams, that it might be a good idea to have at least one more women on each municipal team. The Departmental Team, which contained both male and female representatives of relevant ministries at the departmental (district) level, decided that half the members should be female. A little over one year later, women served in equal numbers on the teams and reported an elevation in their status: In a region where witchcraft is taken seriously, no woman had ever been accorded the honor and trust to cook for the Prefect (head of the department) and his guests.  Now women, in addition to men, were honored with this trust.  This was something women were very proud of.  Women remembered the gender training and said, it opened their eyes “that we are just as good as men.”

... and engaging communities

GESCOME successfully applied participatory community health communication, an innovative approach to cooperative learning by community and public health personnel. This ensured proper use of latrines and led to improved hygiene behavior including handwashing after latrine use, covering food and use of water jars. There was also a change in the understanding of causes of diarrhea and an increase in participatory decision-making, cooperation between local government and citizens and commitment to finding solutions to health problems. The activity introduced community participation in monitoring and evaluation to stakeholders.

Local Government Support for Community Management of Environmental Health in Benin (2003)