November 16, 2022

By: Sarah V. HarlanElizabeth Tully

This post was originally published on the Knowledge SUCCESS website. To view the original post, click here.

A new Knowledge SUCCESS learning brief documents the sustained impact of activities started under the Health of People and Environment–Lake Victoria Basin (HoPE-LVB) project, an eight-year integrated effort that ended in 2019. Featuring insights from HoPE-LVB stakeholders several years after the project’s closure, this brief offers important lessons learned to help inform future design, implementation, and funding of cross-sectoral integrated programs.

About HoPE-LVB

The Population, Health, and Environment (PHE) approach addresses interconnected challenges faced by communities in the most biodiverse and ecologically rich areas of the world. These challenges are particularly apparent among communities living in and around the Lake Victoria Basin—who experience pervasive poverty, food insecurity, poor sexual and reproductive health outcomes, and often inaccessible health services. At the same time, the ecosystem itself faces degradation and diminishing natural resources, which are crucial for the survival of communities around the Basin.

The Health of People and Environment–Lake Victoria Basin (HoPE-LVB) project was implemented in response to these interconnected challenges. HoPE-LVB was a cross-sectoral, integrated PHE effort implemented by Pathfinder International and a range of partners in Kenya and Uganda during 2011–2019. Planned and implemented “with the end in mind,” it had a sharp focus on sustainability and establishing multi-sectoral partnerships and practices from the outset.

Overall, HoPE-LVB improved FP/RH and environmental outcomes in the project area—and led to institutionalization of PHE in the surrounding communities.

A woman and child walk together near the Lake Victoria basin in Kenya. Photo Credit: Lucas Bergstrom
A woman and child walk together near the Lake Victoria basin in Kenya. Photo Credit: Lucas Bergstrom

About this Stock-Taking Activity

While an external evaluation in 2018 documented the results of the successful project, partners and donors were interested in learning about the ongoing sustainability of HoPE-LVB activities to draw lessons for designing future projects. In 2022, USAID, through the Knowledge SUCCESS project, collaborated with philanthropic partner Preston-Werner Ventures to conduct a rapid stock-taking exercise to:

  1. Document continued implementation of HoPE-LVB activities in project communities
  2. Report the status of systems, networks, and policies set up during HoPE-LVB
  3. Identify challenges and opportunities for continuing PHE activities
  4. Outline recommendations to improve the scale-up and sustainability of current and future cross-sectoral programs

To gain this information, we conducted a desk review and interviewed HoPE-LVB project staff from global, national, and community levels; community members from HoPE-LVB sites; and government officials from Kenya and Uganda. This learning brief summarizes the results of this stock-taking exercise, and is anticipated to inform stakeholders—including funders, policymakers, and advocates—on the enhanced design, implementation, and funding of cross-sectoral integrated programs to ensure sustainable development planning and programming.

What the Stock-Taking Activity Found

Continued sustainability of cross-sectoral activities in HoPE-LVB communities

A girl picks vegetables from the garden in Kenya. Photo Credit: C. Schubert

A girl picks vegetables from the garden in Kenya. Photo Credit: C. Schubert

In this post-project stock-taking activity, we found that the impact of the HoPE-LVB project is still apparent, largely due to the extent to which HoPE-LVB focused on scale-up and institutionalizing PHE systems and processes from the start. Improving decision makers’ knowledge of PHE—and cultivating strong PHE champions and networks—helped HoPE-LVB advocate for PHE mainstreaming. The resulting policies and operations plans are still active, albeit rebranded to suit local contexts.

The HoPE-LVB model transformed the way the global PHE community plans and implements multi-sectoral programs. Even several years after its closure, the framework, with model households as its center, is still being adopted and scaled up by new partners, funders, and organizations, using evidence from HoPE-LVB communities. Policies informed by HoPE-LVB continue to influence the development landscape, particularly in East Africa. And communities in rural Uganda and Kenya continue to apply the PHE model, using capacity built during the project and consulting HoPE-LVB legacy tools and guidance.

Challenges in sustaining PHE activities

However, while PHE champions are still implementing many of these activities, a variety of challenges—including the competing demands of the COVID-19 pandemic—have slowed momentum in many settings. Therefore, to continue integrating PHE into development work in the HoPE-LVB communities and beyond, it is important to continue advocating for broad-scale commitment and funding. This will ensure that governments and partners can continue to achieve the holistic goals of multi-sectoral programs, from the national to the community level.

A community health worker speaks to a man and woman in Uganda. Photo Credit: Charles Kabiswa, Regenerate Africa
A community health worker speaks to a man and woman in Uganda. Photo Credit: Charles Kabiswa, Regenerate Africa


Overall, participants pointed to the importance of initiating broad policy and funding advocacy at the start of a multi-sectoral project such as HoPE-LVB. They reiterated the importance of sustained partnerships with key stakeholders, including those in government, to ensure long-term commitment to PHE programs. Participants also pointed to the need for sub-national advocacy for PHE budgets, especially in countries like Kenya where financial decisions are often made at the district level. Finally, this stock-taking exercise demonstrates the importance of following multi-sectoral projects in the years following their closure—to understand which elements are continuing, identify challenges that prevent successful integration, and document insights to inform the design of future programs. Examining HoPE-LVB’s impact after the project staff, funds, and other input from outside donors ceased allowed us to examine elements of sustainability, institutionalization, and adaptation.

Conclusion: Beginning projects with the end in mind

Designing and implementing projects with a deliberate focus on institutionalization and sustained development outcomes should be the norm, particularly for cross-sectoral programs. When these projects consider scale-up and sustainability from the outset, they are more likely to lead to commitments by local governments and continued refinement and implementation by communities, therefore yielding greater long-term contributions to the Sustainable Development Goals.

Finally, while donors often work in five-year project cycles, it is crucial to conduct post-project evaluations—or rapid stock-taking activities like this one—to fully recognize the project’s impact, identify challenges, and share important insights and lessons learned to inform future cross-sectoral programming.

For more information

About HoPE-LVB
The HoPE-LVB project was implemented by Pathfinder International in partnership with Ecological Christian Organization, Osienala, Nature Kenya, Conservation through Public Health (CTPH), and ExpandNet. The project was funded by the David and Lucile Packard Foundation and the John D. and Catherine T. MacArthur Foundation, with additional support from the United States Agency for International Development (USAID) via the Evidence to Action, IDEA, PACE, and BALANCED projects, and the Winslow and Barr Foundations.

The HoPE-LVB project was implemented in a combination of island, lakeshore, and inland sites in Uganda and Kenya. The project catchment area comprised sites located in Uganda’s Mayuge and Wakiso districts, as well as in Kenya’s Siaya and Homa Bay counties.