Design and management of development projects to avoid health hazards.

By drawing from the examples of two dissimilar irrigation development projects it is concluded that for the success of a healthy land development project: (i) by deliberate design a suitable management organization must be set up which has the willing support of all the interested parties, which is given substance by statute and loan agreement, and which has the active support of government; (ii) the staffing should be headed by an enthusiastic person of high rank to provide historical continuity with an adequate secretariat to give effective technical and administrative support; (iii) a deterioration in health may actually threaten the continued existence of a development programme, and health services should be considered part of the development process and integrated with it at all stages from initial planning to several years after commissioning; (iv) health programmes should be responsive to the changing health needs of the settled populations which should be monitored to allow appropriate intervention and which must involve community participation; (v) although the operation of nationally accepted levels of health care facilities should be the responsibility of the national health authority, interventions attributable to the development should be part of the development cost; (vi) interventions should be based on pre-project epidemiology surveys and forecasts of its changes taking account of the disease experience of the settlement populations; (vii) to limit intervention to disease specific problems begs the basic issues. It should be possible to provide better cost-effective health facilities for populations of development projects than for their rural counterparts because they are better defined and more settled; (viii) such interventions by way of changes in fundamental design criteria for the primary engineering works are unlikely to be cost effective; (ix) adequate health facilities must be in place and capable of operation before settlement commences.