... Whatistheroleofthehealthsystem in co‐ordinating, managing and deliveringintegratedprogrammesforimprovingthehouseholdenvironment,giventhemulti‐sectoralnatureoftheproblems and thefrequentinvolvementofNGOs, and otheragencies/donors? ... Whatadditionalissuesforscalingupneedtobeconsideredforintegratedapproaches,over and abovethosepertainingtoscalingupofothercommunityhealth and development projects and programmes?Issues in evaluatingtheaddedvalueofintegratedinterventionsTheassessmentofwhetherornot‘synergies’fromtheintegrateddeliverybring‘addedvalue’ in termsofhealthimpacts (and theinputs,process and outputsthatultimatelyleadtohealthimpacts),iscomplex.Robustquantificationofaddedvalueforhealthoutcomes–true‘interactions’resultingfromthebenefitsofreducingdiarrhoea and respiratory (and potentiallyother,e.g.malaria)morbidityatthesametime–wouldbeverycomplex and expensive, and likelyrequiresomeformoffactorialstudydes ... Toexaminetheadded‐valueofintegratingthesetwoinitiatives, in awaythatcontributestoanincrease in healthimpact,aswellassustainability and adoptionofuse. In consultationwithAFRO and CountryOffices,twoproposalswerechosen,one in Cameroon, and theother in Kenya.TheCameroonpilotproposalwassubmittedbytheHealthProgrammeoftheGermanTechnicalCooperation(GTZ).Fuel‐efficientstoves and point‐of‐usechlorinationmethodshavebeenintroducedintoanongoingWATSANproject in Mambanda,aninformalsub‐quarterofDoualaaccommodatingover1250households.TheWATSANactivitiesincludewell‐chlorination,latrine‐building,healtheducation,aswellaswastewater and solid‐wastemanagement.ThesecondproposalwassubmittedbytheSafeWater and AIDSProject(SWAP),anNGOreceivingsupportfromtheCentersforDiseaseControl(CDC).SWAPproposedtointegrateIAQ and HWTS in 10outof60villagesenrolled in theNyandoIntegratedChildHealth and Education(NICHE)project in Nyanzaprovince,Kenya.NICHEisaprojectattemptingtoincreaseaccesstowatertreatment,nutritionalproducts, and insecticidetreatednets.Thepilotshadatimeframeof18months,fromJune2008toNovember2009.Itwasenvisagedtoholdafollow‐upmeeting/internalevaluation/workshopattheendofthisperiod,theobjectives and activitiesofwhicharethesubjectofthisdocument.1.2EvaluationTermsofReferenceTheevaluationofthese projects, carriedoutbyWHOConsultants(AS and NB) in December2009,hadthefollowingobjectives:1....