The overall methodological framework of the study is as follows:

Prepare a City profile - brief background to the city
Identify planners (and any future environmental health interventions)	Select neighbourhoods (based on size and other characteristics)
Inform and gain interest of planners in the project	Approach residents (at levels of household, interest groups, CBO/NGO leaders)
Investigate existing decision-making processes of planners	Identify and understand residents' priorities and develop residents' lists of indicators
Explore perceptions and the space for dialogue between residents and planners
Engagement - between planners and residents discussing indicators
Survey of indicators
Discussion of results with all stakeholders

Study Locations

Four study teams in different sites were involved in the project and explored different levels of service provision and planning. These included:

Answers to research questions

1. Can residents' priorities be ascertained and expressed as a set of indicators?

Yes, they can, if the question at hand is one where residents believe that such indicators can help. But some issues may be too sensitive (culturally or personally) to express, and for others the whole context of "environment" may be unimportant relative to such issues as employment or the family.

2. Can a consensus be reached within a group of residents on a list of indicators?

It may be more realistic, and no less useful, to aim for a list of indicators that is representative of residents' needs, rather than reflective of a consensus, given that few geographically determined "communities" are homogeneous, but rather constitute a mixture of overlapping interests and groups distinguished by wealth, religion, gender, political allegiance, type of housing, access to environmental infrastructure etc.

3. Can indicators be used to achieve a stage of engagement / dialogue between residents and planners?

A variety of factors determine whether or not service planners and residents can be brought together. If dialogue is further defined as something productive with 'meaningful' and 'real' outcomes then even more factors come into play. Residents have been relatively easy to engage in dialogue where people think it is worthwhile for them; government staff have found it more difficult to engage, possibly because the motivation to depart from current practice is less obvious. A question then arises as to what the community can do alone. This was explored in Howrah.

4. Can indicators influence environmental health decision-making to produce interventions closer to the needs of the community?

This question is largely unanswered because of the short life of the project. Perhaps indicators can serve as a way of voicing what the community want in a way that government can understand. But whether or not the process is taken up is a separate issue. It appears that the process is more likely to work within a donor-funded project - where local decision-making processes are influenced and altered by the conditionalities of aid. Without some external incentive to adopt such an approach, there is less hope for indicators to play a part within the existing planning practice. However, as the trend of service privatisation increases, such indicators could play a vital role in planning and monitoring services.

It seems likely that dialogue using community-based indicators will only impact on service provision where there is 'buy-in' to the process from the major stakeholders within both municipalities and communities. The process may however have greater potential if built into external support projects when local decision-making is altered to some degree. Methods of ensuring that community priorities are incorporated into municipal decision-making need further exploration.

1. Hunt C, Cairncross S, Dubey M, Kolsky P, Lewin S, Mukherjee R, Ramaswamy V, Revi A, Stephens C & the Sustainable Indicators Team. Community-based environmental health indicators; a useful tool in facilitating dialogue between communities and planners? Report of a study on the sustainable use of urban environmental health indicators in four developing country cities. Submitted to Urban Health and Development Bulletin. December 1998.

2. S Lewin, P Urquhart, D Kilian, N Strauss, C Hunt, S Cairncross, C Stephens, P Kolsky and the 'Sustainable Indicators' Group. Restructuring: problem or opportunity? Results and methodological reflections from a study of policy making at the environment/health interface of local government in Cape Town, South Africa' Systems Practice 98: Dealing with Complexity in Policy Formation, Cape Town, South Africa, 23-27 November 1998.

3. Hunt C, Cairncross S, Dubey M, Kolsky P, Lewin S, Mukherjee R, Ramaswamy V, Revi A, Stephens C. Community-based environmental health indicators. Conference paper pre-prints: 24th WEDC Sanitation and Water for All Conference, Islamabad, September 1998.

4. Hunt C, Cairncross S, Dubey M, Kolsky P, Lewin S, Mukherjee R, Ramaswamy V, Revi A, Stephens C. The use of community-based environmental health indicators in the provision of basic urban services. Abstract book: 1st World Congress of Health and Urban Environment, Madrid, 6-10 July, 1998.

5. Hunt C. Community-based environmental health indicators. Epidemiology, Vol 9, No. 4, July 1998 Suppl. 408.

6. Hunt CJ Standing in Line. The Health Exchange, August 1997; 12-13.

7. Hunt C & Lewin S Sustainable use of urban environmental health indicators. Urbanisation and Health Newsletter, No. 33, June 1997, Medical Research Council of South Africa.

In the Indian cities, community groups in several neighbourhoods decided to continue to use the indicators they developed to monitor their environment and lobby for improved service provision. In Cape Town, a further workshop and policy brief were requested by environmental managers. The findings are also being used in the development of an Environmental Plan for Cape Town. In addition, the project findings have been presented at four international conferences.

Tel: 0171 927 2440
Fax: 0171 636 7843
Email: c.hunt@lshtm.ac.uk