Health planners often conceptualize improved public health infrastructures, such as the provision of sanitary facilities, as keys to improved public health results. These improvements alone, however, rarely result in the anticipated health improvements. Changes in hygiene behavior, that is, in the way in which people utilize their existing resources along with improved infrastructure. are critical to achieving sustained improvements in public health conditions. This behavioral/human component tends to either be considered last in the planning process or, at best, is thought to happen once infrastructure improvements are in place. This article argues that such components need to be planned for and utilized in the overall planning of infrastructure improvements intended to change public health conditions of the peri-urban and rural poor.
Ecohealth is a process for identifying key environmental determinants causing mortality or morbidity and combating them by mobilizing multiple social sectors. Evolving out of the concept of environmental health, ecohealth provides a framework for long‐term sustainability. The health outcomes anticipated by environmental interventions are part of a long‐term agenda and require fundamental groundwork for the growth of community‐driven development. Building long‐term sustainability requires that two key approaches be developed through ecohealth. The first is the strengthening of local community institutions, whether formal or informal. The second is building financial mechanisms that are more diversified and less reliant on a single donor. As a result, the ecohealth system provides an opportunity for foundations to empower communities, build cross‐cutting cooperation, and gain knowledge through projects. If people's environmental behaviour is to change and be sustained in the long term to produce desired health outcomes, this will require all members of society to be capable of functioning within the existing institutional infrastructure. This means that not only do formal institutions need to become more accessible but also that concepts relating to local informal institutions must be incorporated into ecohealth projects. It is imperative that we identify and understand relevant local institutions and how they can be transformed so that new environmental forms of behaviour can be sustained and result in positive health outcomes. The intersection of environmental and health concerns provides an ideal area in which the gap between government and civil society can be bridged — not only providing solutions to ecohealth concerns, but building government capacity in general and making these positive changes sustainable in the long term. This article is a case study, based on several United Nations Foundation grants. It outlines the significance of traditional community organizations, the breadth of their long‐term relations with communities, their resources, and the adoption of sustained forms of behaviour. In addition, the article highlights the role that international foundations can play in creating innovative financing mechanisms through community‐based foundations.
Studies have documented the effect of guineaworm concerning days lost to agricultural work and drops in school attendance, but little is known about how the disease disables mothers and impairs their ability to care for their children and families. A pilot case study of 42 women in two rural Nigerian communities has been conducted to fill that gap. Guineaworm was responsible for half of child immunization defaulting and deterred women from using maternity services. Guineaworm kept women from their jobs and trades, costing an average of approximately $50 in lost income, a sizable chunk of a family's support considering the annual per capita income for the area is just over $100. Other problems experienced included loss of appetite and reduced food intake, unattended child illnesses, and disabling secondary infections resulting from unhygienic self-treatment. The ill women and her dependent children put great strain on the support network of family friends, a network already weakened in many cases when several other members were also afflicted with guineaworm. While further research is needed to learn more about this disabling disease, there is no excuse not to implement known guineaworm control interventions. The experience with mothers and children in Nigeria has shown that guineaworm control through water supply improvement should be a major child survival and development initiative.
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