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Environmental Health Project II
Worldwide

GRAND PRIZE — OPERATIONS/MANAGEMENT

ENTRANT: CDM
ENGINEER IN CHARGE: J. Ellis Turner, P.E.

Project Description

As program manager for the 5-year United States Agency for International Development (USAID) Environmental Health Project II (EHP II), CDM provided leadership in alleviating environmental health-related challenges facing developing countries, reducing childhood illness and mortality, and preventing the spread of infectious diseases.

CDM led an eight-member consortium developing interventions; designing sustainable community-based activities; and implementing knowledge management in vector control, hygiene improvement, and water supply and sanitation infrastructure.

While EHP II initiatives spanned 34 countries, selected activities with worldwide impact and four representative landmark projects are highlighted here—extraordinary emergency response in the volatile West Bank; critical hurricane disaster relief in Nicaragua; precedent-setting population-health-environment initiatives in Madagascar; and a groundbreaking approach to urban health in India.

Integrated Approach
Worldwide. Extensive program required multi-disciplinary approach. EHP II was supported by an integrated, professional team focused on environmental health and emphasizing disease prevention, capacity building, and improved management of air, water, and land resources.

CDM managed an integrated team of engineers; social, public health, and institutional specialists; information managers; and economists.
CDM’s integrated approach—a collaboration among local, national, and international partners, such as UNICEF and the World Bank—developed and achieved shared goals and objectives to implement infrastructure, educational, and policy changes, improving lives.

Worldwide. To decrease infectious diseases, CDM developed the integrated hygiene improvement framework, a first-of-its-kind strategy that rapidly became the new global model.

The framework has been adopted by UNICEF, the World Bank, and the Water Supply & Sanitation Collaborative Council to strengthen health programs and save lives worldwide.
By identifying and linking the elements for improving hygiene—water and sanitation, behavioral change, and health-supportive policies—the framework fosters lasting change, while improving global health.

Quality
West Bank. CDM’s rapid response repaired damaged water systems and averted a health crisis. When war destroyed infrastructure and threatened public health, efforts turned to disaster relief. At the request of USAID, CDM formed the Emergency Water Operations Center (EWOC) to repair water systems, procure essential commodities, and restock supplies for hundreds of thousands of people without safe water.

Under EWOC, CDM addressed water supply, wastewater, pumping systems, and emergency supply needs, including restoring water to 10,000 people by installing 4 kilometers of pipes, only 3 weeks after a vital water system was destroyed.
When a 24-hour curfew left residents without water for more than 2 weeks, EWOC delivered bottled water and set up water filling points, supplying residents with their first potable water since the military curfew.
USAID performance reports provided outstanding evaluations:

“In a confusing and dangerous time, full of understandable distractions, CDM/EHP remained sharply focused. Responsiveness was exemplary, whether to changing demands from USAID or changing field conditions (e.g., riot, war).”
~USAID

Nicaragua. After Hurricane Mitch, CDM’s 28-month disaster relief project set a worldwide standard for disaster response and recovery by protecting public health through water and sanitation efforts.

Construction of 2,692 water supply systems, repair of 7,226 latrines, water and sanitation services to 40 clinics, and environmental health and hygiene education quickly alleviated the high risk of disease and improved health care for 215,000 hurricane victims in 289 communities by ensuring safe water and waste removal.
Among children under 5, diarrhea prevalence decreased 40 percent and correct hand washing more than doubled, while safe waste disposal increased 37 percent.

Originality and Innovation
Madagascar. CDM was the catalyst for an innovative approach to integrate population, health, and the environment activities that benefited 120,000 people and established a model for other organizations.

CDM created an award-winning organization to manage 20 partners integrating health, population, and the environment activities in 160 communities.
By increasing access to safe water and sanitation, and combining natural resource management with population and health interventions, CDM helped improve living conditions and prevent health problems.
Environmental resource management practices are now widely accepted, severe malnutrition in children under 5 has been cut by more than 60 percent, and contraceptive use doubled—reducing mortality, improving health, and strengthening communities.
India. CDM achieved sustained improvements in urban child health, providing care and relief to a woefully neglected, desperate population.
The 5-year program provided sustainable child health interventions—latrine construction, immunizations, neonatal clinic services, and hygiene promotion—improving life for 50,000 people in 73 slums and strengthening local health care systems.
CDM facilitated stakeholder dialogue by convening policymakers, planners, and program implementers to improve urban living conditions on a wider scale.

Complexity
Worldwide. CDM managed nearly 400 activities, with populations served ranging from 15,000 to 375,000 people, and led a consortium achieving critical USAID-established health goals. Innovative activities reduced childhood illness and mortality from diarrheal disease and malaria, while CDM’s multi-faceted framework became a worldwide model for far-reaching health improvements.

Madagascar. Extensive monitoring, evaluation, and operations research; management; national coordination; and information dissemination contributed to 40 population, health, and environment activities that significantly improved residents’ lives.

West Bank. CDM completed all tasks on schedule, despite extreme logistical challenges related to the ongoing violence—hazardous conditions, obstacles to moving equipment and people, and the rapid shift from a development-oriented program to emergency response.

During a prolonged 24-hour curfew, staff relocated equipment to their apartments, enabling them to continue working and ensuring that critical water services remained operational.
When incursions forced staff to relocate to a safer city, CDM established a new office within days and continued the technical assistance for re-establishing water supplies.

Social and Economic Advancement
Worldwide. Programs created accessible and affordable water supplies.

Continuous access to proper water supply and sanitation supports economic growth because healthy people can sustain their families and contribute to communities.

Madagascar. CDM improved community economic viability.

The number of households with access to safe water and basic sanitation increased, an indicator leading to good health.
Improved agricultural practices increased food security and allowed families to market produce for income.
Community outreach emphasized family planning, resulting in smaller, healthier families more capable of handling expenses and maintaining a higher standard of living.

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