Connecting environment, health and livelihoods: how community experiences inform integrated programming in Rukiga District, Uganda.

Introduction: The climate crisis has profound effects on people's lives, particularly those reliant on subsistence agriculture and ecosystem goods for their livelihoods and health. There is growing recognition of the interconnections between human health, environmental degradation and climate change, but little research on the pathways of these interconnections that could inform programme development and little attention given to community experiences and perspectives that provide essential insights into how cross-sector programmes could better address health, livelihoods and environmental needs.

Methods: Between April and June 2021, we conducted in-depth interviews and focus group discussions with residents across eight parishes affected by climate change in Rukiga District, Uganda. We investigated peoples' perceptions and experiences concerning health, climate, environment and livelihoods, then codeveloped integrated cross-sector solutions with non-governmental partners to respond to identified challenges. We analysed data using thematic content analysis.

Results: Community members articulated how increasingly unpredictable seasons and rainfall patterns lead to crop failures, soil erosion and flooding exacerbated by widespread practices of tree cutting and growing non-native plants. The burning of upland and wetland vegetation caused further degradation, reducing access to clean water. These led to inadequate nutritious food and malnutrition. Respondents noted that large family size puts pressure on available land, yet they have poor family planning services and information. Men who could not provide for their families reportedly spent money on alcohol; behaviour which was associated with gender-based violence.Community experiences and viewpoints were discussed at workshops and meetings with non-governmental organisations and health partners to identify key evidence-based interventions and develop integrated messaging to address the interconnected needs articulated by community members.

Conclusion: Listening to the experiences and views of community members is essential to designing impactful, sustainable programmes to address interconnected health, environment and livelihood needs. Researchers can broker this through formative research and cocreation workshops with local responders.