In the last 5 years, Lake Victoria water level has seen a dramatic fall that has caused alarm to water resource managers. Since the lake basin contributes about 20% of the lakes water in form of discharge, with 80% coming from direct rainfall, this study undertook a satellite analysis of the entire lake basin in an attempt to establish the cause of the decline. Gravity Recovery And Climate Experiment (GRACE), Tropical Rainfall Measuring Mission (TRMM) and CHAllenging Minisatellite Payload (CHAMP) satellites were employed in the analysis. Using 45 months of data spanning a period of 4 years (2002)(2003)(2004)(2005)(2006), GRACE satellite data are used to analyse the variation of the geoid (equipotential surface approximating the mean sea level) triggered by variation in the stored waters within the lake basin. 776 J.L. Awange et al. TRMM Level 3 monthly data for the same period of time are used to compute mean rainfall for a spatial coverage of .25 • × .25 • (25 × 25 km) and the rainfall trend over the same period analyzed. To assess the effect of evaporation, 59 CHAMP satellite's occultation for the period 2001 to 2006 are analyzed for tropopause warming. GRACE results indicate an annual fall in the geoid by 1.574 mm/year during the study period 2002-2006. This fall clearly demonstrates the basin losing water over these period. TRMM results on the other hand indicate the rainfall over the basin (and directly over the lake) to have been stable during this period. The CHAMP satellite results indicate the tropopause temperature to have fallen in 2002 by about 3.9 K and increased by 2.2 K in 2003 and remained above the 189.5 K value of 2002. The tropopause heights have shown a steady increase from a height of 16.72 m in 2001 and has remained above this value reaching a maximum of 17.59 km in 2005, an increase in height by 0.87 m.Though the basin discharge contributes only 20%, its decline has contributed to the fall in the lake waters. Since rainfall over the period remained stable, and temperatures did not increase drastically to cause massive evaporation, the remaining major contributor is the discharge from the expanded Owen Falls dam.

Small-scale pilot projects have demonstrated that integrated population, health and environment approaches can address the needs and rights of vulnerable communities. However, these and other types of health and development projects have rarely gone on to influence larger policy and programme development. ExpandNet, a network of health professionals working on scaling up, argues this is because projects are often not designed with future sustainability and scaling up in mind. Developing and implementing sustainable interventions that can be applied on a larger scale requires a different mindset and new approaches to small-scale/pilot testing. This paper shows how this new approach is being applied and the initial lessons from its use in the Health of People and Environment in the Lake Victoria Basin Project currently underway in Uganda and Kenya. Specific lessons that are emerging are: 1) ongoing, meaningful stakeholder engagement has significantly shaped the design and implementation, 2) multi-sectoral projects are complex and striving for simplicity in the interventins is challenging, and 3) projects that address a sharply felt need experience substantial pressure for scale up, even before their effectiveness is established. Implicit in this paper is the recommendation that other projects would also benefit from applying a scale-up perspective from the outset.

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