Produced by Cheryl Margoluis, Cara Honzak, and Laurel Lundstrom, Pathfinder International, and Théa Klement, The Access Challenge

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Handwashing station in a model household,  Tanzania, Pathfinder International, 2018 

(Photo credit: Cheryl Margoluis)

Pathfinder-Nature Conservancy Partnership: Promoting Health Through Healthy Environments

March 10, 2020

Challenges facing human health and the environment are complex and closely intertwined. It takes innovative, multi-sectoral partnerships that focus on health promotion through healthy environments—like Tuungane—to effectively address these challenges that disproportionately face the most vulnerable communities in the world.

Tuungane is a population, health, and environment (PHE) program led by a partnership between Pathfinder International, a sexual and reproductive health organization, and The Nature Conservancy, a conservation organization. PHE programs integrate voluntary family planning, health care, and natural resource management into a unified approach to make communities and their surrounding ecosystems healthier and more resilient to economic and environmental shocks.

Tuungane, which operates in 36 remote and rural villages around Lake Tanganyika in Western Tanzania’s Greater Mahale Ecosystem, has worked with and through local communities in the Greater Mahale to improve their health and give them better access to family planning; to help them meet daily household needs through income generation and access to clean food and water; and to encourage their adoption of sustainable practices for managing natural resources.  

This unusual partnership between two organizations exemplifies how different sectors working across separate sustainable development goals can collaborate to reach new and remote populations and simultaneously develop solutions to complex problems. Lessons from Tuungane can teach other global development actors and governments how best to create a comprehensive universal health coverage package that will reach more people with required health services through a lens of health promotion and sectoral coordination: creating a political climate that is not only #HealthForAll but also All for Health.

Life in the Greater Mahale 

The Greater Mahale Ecosystem is home to one of the world’s natural treasures—Lake Tanganyika. The lake holds nearly one-fifth of the world’s fresh water and more than 250 native species of fish. Despite the promise of this natural resource, when Pathfinder and The Nature Conservancy began the Tuungane partnership in 2011, the communities and the environment in which they lived suffered from the convergence of several factors: extreme poverty, rapid population growth, and isolation.


With few options for earning a living, most people in the Greater Mahale region relied on the lake for fishing and land for farming, putting great strain on their natural resources. By 2011, fishing opportunities had become increasingly scarce because of overfishing, and agricultural production had slowed due to land degradation—placing communities at risk of food shortages. At the same time, many in the villages had misconceptions about contraception, and women were delivering their babies at home—sometimes dying without medical care. 

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Women’s Conservation Savings Group, Pathfinder International (Photo credit: Cheryl Margoluis)

The Tuugane Integrated Approach

Pathfinder International and The Nature Conservancy partnered to address these issues through an integrated approach—one cognizant of the inherent connection between the health of the communities in the Greater Mahale Ecosystem and the health of their environment. The two organizations have worked together to build trust with local communities, gaining their buy-in and support for adopting new practices that can improve their health and the environment simultaneously. This integrated approach included multi-sectoral interventions, such as:


  • Community conservation banks: Community members pooled their money, creating community conservation banks to start environmentally friendly businesses while simultaneously receiving information on family planning and reproductive health, natural resource management, and water, sanitation, and hygiene (WASH)

  • Model households: More than 5,758 households modeled positive health and natural resource management behaviors that diffused throughout the community, encouraging better attitudes in their communities toward conservation and family planning, and increasing community participation in efforts to improve health and use natural resources sustainably.

  • Integrated information, education, and communication: The project increased people’s understanding of how their health was linked to the health of the environment – that they could not have a healthy family without a healthy ecosystem. The model household, for example, enabled families to see these links more clearly – such as how good WASH practices affected their health and their clean water supply.   


And everyone benefited.


The communities were better able to prevent disease and promote an enabling environment for growth and development. They used health services more frequently and many learned about contraception options available to them. They adopted sustainable fishing practices and learned to earn an income through eco-friendly livelihoods, like making and selling clean cookstoves, empowering them economically while protecting their environment. They used less charcoal through better forest management while adopting WASH practices that prevented disease and improved the health of households. 


Pathfinder developed a strong relationship with the communities through their community health work, helped along by The Nature Conservancy’s physical operations presence. The two organizations have a mutually beneficial relationship. Pathfinder brought sexual and reproductive health information and services into nontraditional spaces, such as natural resource management committees and forest guard trainings led by The Nature Conservancy.


Conversely, through Pathfinder, The Nature Conservancy was able to improve the health of the communities with which they were working, fostering a stronger relationship with the communities and helping them to understand how the health of the ecosystem is integral to maintaining their own health.


Public health and environmental systems became stronger and better able to serve communities through targeted health promotion activities. Activities include updating infrastructure, supporting the procurement of essential supplies and medicines, training for facility-based staff and community health workers, and adopting new local laws and enforcement authority to regulate fishing and use of land for agriculture. 

  • Increased contraceptive use, resulting in 62,000 couple years of protection generated (contraception given to a couple for a year)

  • Improved attitudes toward contraception and reduction in unmet need for family planning through engagement of women interested in birth spacing 

  • Very first carbon project created with Carbon Tanzania, protecting 216,000 hectares of forest and enabling eight villages to earn money by selling carbon credits 

  • 9,124 farmers practicing climate-smart agriculture, increasing crop yields, combating sediment running off into the lake, and using organic fertilizers and seed varieties 

  • 23 Beach Management Units established, effectively monitoring and protecting 39,734 acres of water

Tuungane Project: Notable Results

Toward Health For All

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Women’s Conservation Savings Group, Pathfinder International (Photo Credit: Cheryl Margoluis)

Tuungane demonstrates how an integrated approach and resource pooling improves health promotion and prevention capacity at the community and regional levels.  By addressing the environmental determinants for health and the human determinants for environmental health together, communities are better able to create healthier families and a more sustainable environment for growth and development.


Health promotion is at the root of universal health coverage. Lessons learned from partnerships like Tuungane provide leaders with a model for developing UHC in a cohesive manner that addresses the inherent interconnections between human health and environmental health. This type of model is especially relevant in Africa, where a multi-stakeholder approach to disease prevention and health promotion is so integral. There need to be opportunities for engagement with governments across Africa so that they can adapt and apply such approaches within their own health systems, as Tanzania has started to do. 

Multisectoral development partnerships, like the Pathfinder-Nature Conservancy collaboration, are essential to reaching the Sustainable Development Goals (SDGs), and particularly for finding opportunities to take unified action toward achieving multiple SDGs — such as in SDG3 (healthy lives) and SDG13 (climate action), simultaneously. These types of partnerships allow us to reach a wider audience with our messages, engage last-mile communities, and create sustainable impact through behavior change that results from the connection that people make between their health, their environment, and their development.