Creating sustainable environmental health conditions by redefining municipal roles and responsibilities: experiences from Tunisia and Ecuador

The multiple and interlinked problems that plague most peri‐urban communities can only be successfully addressed and resolved if roles and responsibilities of all actors in the urban setting are redistributed. This will require fundamental changes in the way municipalities work and define their accomplishments. Behaviour needs to change at all levels, beginning with public sector institutions responsible for communities. Without changes at the municipal level, requisite changes at the community level to remedy the root causes of environment‐related illness, do not occur. Public sector institutions and communities, working as partners with clearly defined roles and responsibilities, and, most importantly, with mutual trust, can together make real progress toward improving health and well‐being in peri‐urban settlements. This article discusses two recent projects sponsored by the Environmental Health Project of the U.S. Agency for International Development (USAID): an 18‐month pilot project to improve peri‐urban environmental health in two cities in Tunisia, and a project in Ecuador to support the Ministry of Health in combating cholera in affected provinces. The following examples, methodology, and results may be useful to officials and donor organizations in designing environmental health projects.