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environmentally-sustainable plan in that it is cognizant of and seeks to be responsive to the environmental components of health risks and trends.

There has been an increase in prevalence of malaria in traditionally malaria-prone areas such as the Coast and Western Kenya, but also a new trend towards increases in malaria in highland areas, especially after heavy rains, where it has rarely or never been seen before.  The latter trend is particularly troubling because limited natural resistance exists in that area.  The causes for this increase are not well understood, but likely are partly due to increased trends of agricultural conversion from woodland and forest.

Whereas the under-five mortality rate for children in Kenya was in a steady decline for the last 50 years, it has recently swung upwards again to 112 per 1000 live births an increase of 24 percent from the last decade according to the 1998 Demographic Health Survey for Kenya.  This is probably related to a number of factors, and again it is not clear what links there are to environmental degradation or related environmental health parameters (e.g., deficiencies in water, sanitation, drainage, leading to diarrheal disease, malaria transmission, etc.)  

With a continuing upward trend in the prevalence of HIV/AIDS in Kenya, comes the need to develop programs of HIV/AIDS and STI prevention and treatment services at the community level throughout the country.  This brings with it health-care waste management issues and related if relatively modest risk of disease transmission and environmental contamination  

Improvements in women and children health and reductions in fertility overall in Kenya can only reflect positively on the country environmental future, both in relation to USAID/Kenya programs, and more broadly. Likewise, programs intended to stem the tide of HIV/AIDS in Kenya will have a salutary effect on the country health and economy. However, several explicit steps will be taken to enhance the contributions of this SO to environmental sustainability in Kenya, while also enhancing health outcomes.  

First, the SO team will ensure that a Pesticide Evaluation Report and Safe Use Action Plan (PERSUAP) is developed in connection with its promotion of insecticide treated netting (ITN) for malaria control.  This will be done in conjunction with the Kenya Medical Research Institute and related programs supported by USAID, WHO and other donors, and the Programmatic Environmental Assessment of ITN being organized by AFR/SD. In this way, unintended negative health risks associated with inappropriate insecticide use will be avoided or minimized.

Second, the SO team will seek to understand better the environmental components of health problems in Kenya, as part of the child survival program.  Pertinent analyses being produced by Macro International, the Ministry of Health, the World Bank and others will be taken into account.  If during the implementation of SO3, linkages to environmental changes are established, the SO team will work to enhance the sustainability and impact of its program in appropriate ways, such as including education about these linkages in its outreach efforts in child survaival/reproductive health/family planning and HIV/AIDS services.

Third, the SO team will encourage the Ministry of Health and other appropriate actors to ensure that WHO guidelines and standards are applied to the management of healthcare wastes, esp. those associated with testing and treatment of HIV/AIDS-affected persons.

All these approaches are addressed and encouraged through the environmental review process to which all the SO programs are subjected, and all new implementation mechanisms will be likewise.

Explicit linkages to environmental sustainability in Kenya and possible synergies with the proposed environment program will be sought at this time. Any activity related to environmental health, such as in SO 4 influenced interventions by CBOs in environmental sanitation and health services, would benefit by including components of the SO 3 child survival, malaria, maternal health and HIV/ADIS services, and the like.SO 3:  Reduce fertility and the risk of HIV/AIDS transmission through sustainable, integrated family planning and health services.

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Kara PagePage 5010/23/2006

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