Key Action Areas Research Articles

Health and wellbeing needs and priorities in mining host communities in South Africa: a mixed-methods approach for identifying key SDG3 targets

BackgroundThe global mining industry has an opportunity to mobilize resources to advance progress against the Sustainable Development Goals (SDGs). In 2018, the Anglo-American Group outlined aspirations for mining host communities to meet the SDG3 health targets. To progress from aspiration to action we designed and implemented a mixed-methods approach to attain a deeper understanding of the health and wellbeing priorities within the local context of host communities of fifteen mines in South Africa.MethodsTo identify local needs and priorities relating to SDG3 targets in host communities, stakeholder workshops and key informant interviews were conducted between June and August 2019. A baseline assessment of health data, related to each of the SDG3 targets and indicators and to each host community location, was also conducted. Findings emerging from the qualitative and quantitative baseline assessments were compared to identify the extent to which health issues aligned and health and wellbeing priority areas for action.ResultsA total of 407 people participated in the workshops, and 85 key informants were interviewed. Quantitative data were available at sub-national level for seven of the nine SDG3 targets and eleven of the 21 indicators. Key priority areas for action identified through alignment of the qualitative and quantitative data were maternal mortality (SDG3.1), HIV (SDG3.3.1), tuberculosis (SDG3.3.2), substance abuse (SDG3.5), and road traffic accidents (SDG3.6) We found consistency in the individual, interpersonal, community, societal, and structural factors underlying these priority areas. At a structural level, poor access to quality healthcare was raised at every workshop as a key factor underlying the achievement of all SDG3 targets. Of the five priority areas identified, HIV, TB and substance abuse were found to overlap in the study communities in terms of risk, burden, and underlying factors.ConclusionsWe demonstrate a mixed method approach for identifying local health needs and prioritised SDG3 targets in mining host communities. Consistency in reporting suggests the need for effective, efficient and feasible interventions to address five priority areas. Given the prominent economic role of the mining sector in South Africa, it can play a critical role in implementing programmatic activities that further progress towards achieving the SDG3 targets.

Abstracts Presented at the 2nd Annual Advancing Healthcare Innovation Summit: Nov 11, 2022, Cincinnati, OH

Abstracts Presented at the 2nd Annual Advancing Healthcare Innovation Summit: Nov 11, 2022, Cincinnati, OH

Ensuring the Long-Term Provision of Heathland Ecosystem Services—The Importance of a Functional Perspective in Management Decision Frameworks

The ecosystem services framework can be used as a way of balancing economic, ecological and societal drivers in land management decision-making processes. As heathland management is typically linked directly to services, the aim of this study was to quantify trade-offs related to the effects of five common heathland management measures (grazing, mowing, burning, choppering, and sod-cutting) using quantitative data from empirical studies within a northwestern heathland in Germany. Besides important services (groundwater recharge and quality, carbon stocks and appreciation by the general public) we included ecosystem functions (balances of nitrogen, phosphorus and major cations) and the net cost of management implementation as trade-off components. We found that all management practices have advantages and disadvantages leading to unavoidable trade-offs. The effect of a management practice on the trade-off components was often closely related to the amount of biomass and/or soil removed during a management cycle (Rannual). Choppering and sod-cutting (large Rannual by involving soil removal) were very good at maintaining a low N system whilst concurrently increasing groundwater recharge, albeit at the cost of all other components considered. If the aim is to preserve heathlands and their associated ecosystem services in the long-term this trade-off is inevitable, as currently only these high-intensity measures are capable of removing enough nitrogen from the system to prevent the transition to non-heather dominated habitat types. Our study, therefore, shows that in order to maintain structural integrity and thereby the service potential a habitat provides, management decision frameworks may need to prioritize ecosystem functioning over ecosystem services. Burning and mowing (low Rannual) were best at retaining phosphorus, cations and carbon and had the lowest costs. Grazing (intermediate Rannual) provided the highest relative benefit in terms of groundwater quality and appreciation. Together these results can help identify management combinations in both space and time, which will be more beneficial for functions and services than management practices considered in isolation. Furthermore, our study assists in recognizing key areas of action for the development of novel management practices and can help raise awareness of the diversity of rare species and potential benefits to people that protected cultural landscapes provide.

Variety of Strategies in Primary Education: The Responses of the Four UK Nations to the COVID-19 Crisis

<p style="text-align:justify">This article analyses the strategies of the four United Kingdom (UK) nations to mitigate the impacts of primary school closures and the shift to remote learning due to the outbreak of the Coronavirus disease (COVID-19) pandemic. A theoretical framework based on a combination of the field literature of strategy and public value was developed to analyze their initiatives. This is a qualitative and exploratory study, and its data was collected from each country’s website, research papers, and media news. The findings reveal five key areas of action: remote learning; keeping schools open to assist vulnerable students and key workers’ children; access to the Internet and electronic devices to mitigate the digital divide; free meals to disadvantaged learners; and students’ assessment. The analysis suggests that the four nations initially adopted a coordinated action and gradually followed three different paths: deliberate strategies, adjustment to the pandemic situation, and development of emergent strategies. The variegate of strategies show the innovative capacity of the countries and the search for public value. Further research is suggested to address the impact of the strategies.</p>

Social Cohesion as the Missing Link between Natural Resource Management and Peacebuilding: Lessons from Cocoa Production in Côte d’Ivoire and Colombia

Social cohesion plays a key role in processes of peacebuilding and sustainable development. Fostering social cohesion might present a potential to enhance the connection of natural resource management and peacebuilding and better functioning of sustainable land use systems. This contribution explores the nexus between social cohesion, natural resource management, and peacebuilding. We do so by (1) reviewing literature on the three concepts and (2) studying four different key action areas in the context of sustainable cocoa production for their potential to enhance social cohesion, namely (a) agroforestry; (b) cooperatives; (c) certification schemes; and (d) trade policies. Research is based on experience from cocoa production in two post-conflict countries, Côte d’Ivoire and Colombia. Our findings show that by fostering environmentally sustainable agricultural practices, these key action areas have a clear potential to foster social cohesion among cocoa producers and thus provide a valuable contribution to post-conflict peacebuilding in both countries. However, the actual effects strongly depend on a multitude of local factors which need to be carefully taken into consideration. Further, the focus in implementation of some of these approaches tends to be on increasing agricultural productivity and not directly on fostering cocoa farmers’ wellbeing and societal relations, and hence a shift toward social objectives is needed in order to strengthen these approaches as a part of overall peacebuilding strategies.

Opportunities and challenges of human–python conflict intervention in local communities adjacent to Nyanga National Park, Zimbabwe

AbstractConservation of wildlife often results in the protection of endangered species, like the Southern African python (Python natalensis). However, wildlife tends to occur both in protected areas and human settlements and the latter results in human–wildlife conflict (HWC). Often when the species involved threaten human life and/or livestock, wildlife authorities react through Problem Animal Control (PAC). The successes and challenges of this practice often vary. We present opportunities and challenges in the practical interventions to minimize human–python conflict by the Zimbabwe Parks and Wildlife Management Authority (ZPWMA) in communities adjacent to Nyanga National Park (NNP). We draw on station reports and reactions of human–python conflicts (2013–2020), our involvement with communities when human–python interactions occur, and discussions with stakeholders, extension officers, and wildlife rangers and managers responsible for coordinating PAC programs. We observed that the number of human–python conflict reports have decreased in the past 5 years. Furthermore, ZPWMA's efforts to resolve HWC through PAC reactions in concert with education and awareness, as well as collaborating with stakeholders, contributed to addressing the conflict. We propose four key action areas to strengthen intervention plans and procedures. The action areas involve (i) establishing the population and distribution structure of P. natalensis, (ii) evaluation of successes of capture and release, (iii) establishing the link between python age and involvement in human–python conflicts, and (iv) assessing community perceptions towards human–python conflict reports and interventions by the ZPWMA.

Pressure Injury Surveillance and Prevention in Australia: Monash Partners Capacity Building Framework.

A hospital-acquired pressure injury (HAPI) is a common complication across the globe. The severity of HAPI ranges from skin redness and no skin breakdown to full skin and tissue loss, exposing the tendons and bones. HAPI can significantly impact the quality of life. In addition to the human cost, this injury carries a high economic burden with the cost of treatment far outweighing the preventative measures. The HAPI rates are a key indicator of health services performance. Globally, healthcare services aim to reduce its incidence. In Australia, the federal health minister has prioritised the need for improvement in HAPI surveillance and prevention. Capacity building is vital to optimise pressure injury (PI) surveillance and prevention in acute care services. In this perspective article, we provide a framework for capacity building to optimise HAPI prevention and surveillance in a large cross-sector collaborative partnership in Australia. This framework comprises six key action areas in capacity building to optimise the HAPI outcomes, such as research, organisational development, workforce development, leadership, collaboration, and consumer involvement.

Enhancing the use of exposure science across EU chemical policies as part of the European Exposure Science Strategy 2020–2030

BackgroundA scientific framework on exposure science will boost the multiuse of exposure knowledge across EU chemicals-related policies and improve risk assessment, risk management and communication across EU safety, security and sustainability domains.ObjectiveTo stimulate public and private actors to align and strengthen the cross-policy adoption of exposure assessment data, methods and tools across EU legislation.MethodsBy mapping and analysing the EU regulatory landscape making use of exposure information, policy and research challenges and key areas of action are identified and translated into opportunities enhancing policy and scientific efficiency.ResultsIdentified key areas of actions are to develop a common scientific exposure assessment framework, supported by baseline acceptance criteria and a shared knowledge base enhancing exchangeability and acceptability of exposure knowledge within and across EU chemicals-related policies. Furthermore, such framework will improve communication and management across EU chemical safety, security and sustainability policies comprising sourcing, manufacturing and global trade of goods and waste management. In support of building such a common framework and its effective use in policy and industry, exposure science innovation needs to be better embedded along the whole policymaking cycle, and be integrated into companies’ safety and sustainability management systems. This will help to systemically improve regulatory risk management practices.SignificanceThis paper constitutes an important step towards the implementation of the EU Green Deal and its underlying policy strategies, such as the Chemicals Strategy for Sustainability.

7.A. Round table: Multilateral Partnerships to achieve the SDG5: Gender Equality, and to combat COVID-19

Gender Equality is vital for a peaceful, prosperous, and sustainable world for all individuals. Care- and help-seeking behaviour is strongly associated with health status, but, also gender, with women's health strongly correlating to that of the whole family and directly linked to the wellbeing of all members in our communities, and the resilience and sustainability of health systems. Health and social care delivery has been lacking a gender-centred approach, with a two-prong effect, on professionals/workforce (hierarchies and leadership imbalance) and on users/recipients/care seekers (lack of gender-sensitive care provision). The COVID-19 pandemic is a global health threat and societal challenge that has already exacerbated pre-existing structural gender inequalities. It is, therefore, imperative to rebuild a better, gender-equal society for the future. This crisis has highlighted the roles of women in the health workforce, incl. as informal carers for vulnerable adults and children. The increase in gender-based violence has also come to the spotlight, due to lockdown measures, implemented to combat COVID-19, resulting in serious physical and mental harm, as well as socioeconomic damages. Furthermore, sexual and reproductive health rights have been particularly affected due to pre-existing barriers across Member-States placing additional strain on individuals and systems. All these compounding factors also result in further limiting access to leadership positions for women. This roundtable aims to capture the perspective of our interdisciplinary panelists from leading European and global institutions to comprehensively map the needs, priorities, and key action areas of public health, in order to achieve gender equality and empower all women and girls across the globe.Objectives Assess the roles of women in the health workforce, to highlight gender inequalities, and to discuss regional differences across the European Region;Present and discuss the new Gender Equality Index 2021 (to be released end of Oct 2021), which will focus on health in relation to gender equality, covering mental health, sexual and reproductive health and pandemics of communicable diseases, and in particular of COVID-19;Combine the perspective of academia, multilateral bodies, practitioners and NGOs, for concerted action to combat the increase in sexual and domestic violence, and toBridge disparities and overcome barriers to gender-sensitive health and social care services for all women, incl., migrant and refugee populations. The roundtable brings together for the first time EUPHA, WHO, UN Women, and of the European Institute for Gender Equality, in a joint effort for European and global public health, to support our workforce and safeguard the future. Mindful of the role women in health and social care, we also include panelists from the International Confederation of Midwives and from NGOs working in the field of combating violence against women.Speakers/Panelists Carlien Scheele European Institute for Gender Equality, Vilnius, Lithuania Alia El Yassir UN Women, Istanbul, Turkey Victoria Vivilaki International Confederation of Midwives, Den Haag, Netherlands Iveta Nagyova PJ Safarik University, Department of Social and Behavioural Medicine, Kosice, Slovakia Pille Tsopp-Pagan Women against Violence Europe Network, Vienna, Austria Key messages We need to join forces to fight sexual and domestic violence, as major public health threats globally, considering their worsening during the COVID-19 pandemic.Women account for the majority of caregivers and healthcare workers, especially nurses, explore the untapped potential of midwives, and step up efforts to strengthen protection and support.

Barriers and Facilitators to COVID-19 screening at Jaipur International Airport, India.

Airports pose a possible threat in facilitating global disease transmission within the community which may be prevented by rigorous systematic entry-exit screening. Rajasthan Government has taken precautionary action at Jaipur International airport by screening passengers. The present article describes the entry-exit screening along with stakeholder perception on the barriers and facilitators associated with the screening. Secondary data was obtained from the Rajasthan Medical & Health Department team to categorize passengers for risk of COVID-19. A mix-method inductive-deductive thematic analysis was conducted. A total of 4565 passengers (Males=4073 and Females=492) with 23 suspected cases were screened during an outlined period of declaration of Pandemic to Lockdown in India (11 th to 24 th March 2020). The mean age of passengers was 40.95 ± 7.8 years. The average screening time per passenger was 2-3 minutes with a load of 25-90 passengers per team per flight. Fishbone analysis of screening revealed barriers like poor cooperation of passengers, masking symptoms, apprehension, and stigma related to quarantine. Inadequate human resources and changing guidelines overburdened healthcare providers. Perception of risk, and social responsibility of travelers together with supportive organization behavior act as facilitators. Overall, groundwork on airport screening was insightful to propose key action areas for streamlined screening in limiting transmission.

A review of the library and information science profession in the Maldives: Development, challenges and opportunities

The Republic of Maldives, a small island developing state in the Indian Ocean, has achieved upper-middle-income and high human development category status, and one of the strongest information and communications technology infrastructures in South Asia. However, the country’s library and information science sector, which saw its inception over seven decades ago, has yet to advance beyond the initial development phase. This article traces the emergence of the library and information science sector in the country and draws attention to the myriad challenges faced by it. The article is also an attempt to draw the attention of government decision-makers and motivate them to understand and resolve the difficulties faced by the library and information science sector through engaging library and information science employers, educational institutions, professional trainers, and library and information science professionals. Some concerns are identified and five key action areas with associated action steps are suggested. These may resonate with other small developing countries that are facing similar scenarios.

Beyond the Guidelines: How We Can Improve Healthcare for People With Tuberous Sclerosis Complex Around the World

BackgroundTuberous Sclerosis Complex International (TSCi) is a consortium of organizations that supports individuals with tuberous sclerosis complex (TSC) around the world. To improve care for TSC on a global level, TSCi identified the need to expand understanding about existing resources available in other countries, what individuals and caregivers value in TSC care, key gaps between needs and reality in each country, and ways these gaps can be addressed by advocacy organizations around the world. MethodsAn iterative, mixed methods approach (the Improving Care project) was adopted to incorporate views from diverse members of TSCi. Through idea generation, a collection of qualitative open-ended responses and concept elicitation, we were able to build consensus where shared experiences and opinions were identified. ResultsThe research performed as a part of the Improving Care project revealed a significant gap between the guidelines and what is actually available to people with TSC worldwide. Three key priority areas of action to improve this gap were identified: (1) implementation of the guidelines; (2) access to TSC expertise, and (3) coordinated and integrated health care. ConclusionsThere are significant opportunities for key stakeholders, including organizations, clinicians, and researchers to improve care for individuals with TSC on both local and global levels. Working across stakeholder groups and utilizing TSC organizations are essential to ensure that the advances in TSC research benefit people living with TSC around the world.

Adaptive Health Financing: Budgetary and Health System Responses to Combat COVID-19

Health financing policies are an essential element of health system responses to COVID-19. Sound policies help ensure there are sufficient resources to combat COVID-19, that the resources are disbursed rapidly, and that resources are spent in an effective manner. The effective implementation of such policies depends on budget and health officials working together closely to bring about co-ordinated actions. This policy brief analyses how OECD member countries have adapted health financing policies to combat COVID-19, and how such policies may need to continue to adapt as the pandemic evolves. It reviews how countries have provided additional budgetary resources to the health sector to combat COVID-19. It also maps out the key areas of joint action by budget and health officials to plan, implement and review the necessary health financing measures needed to combat COVID-19.

Cultivating community resilience: How North Carolina's Food Council is facilitating an effective response during COVID-19

Since the onset of the COVID-19 pandemic, the North Carolina Local Food Council has strengthened its role as a cohesive and effective organization during a public-health crisis to share challenges, devise solutions, and build resilience across local food systems in North Carolina. The Council includes representatives from 21 organizations working across the state, as well as three representatives from regional local food councils. The Council’s response to the pandemic addressed three key areas of action: (1) Coordinate responses across multiple sectors; (2) Enhance collaboration across the food supply chain; and (3) Facilitate data collection and public messaging. This paper describes the positive impacts the Council has had across North Carolina on consumers and producers of local food as a result of this collaborative network and long-established relationships across the state. Now, more than ever, the relationships and collaborative efforts of statewide organizations and partners are needed. The Council’s crisis response has been strong because of the long-standing relationships of its members and its ability to share resources quickly, allowing it to work toward coordinated responses. The work of the North Carolina Local Food Council can serve as a model for other states that have state-level local food coun¬cils or want to develop them. In addition, the Council’s work demonstrates how collaborations among statewide partners can foster resilience within local food systems, particularly during a public health crisis.

Supporting efforts to address malnutrition in the context of the COVID-19 pandemic in India: An emergency need

India has been on a steady march to address malnutrition in the last decade. The nutrition community has worked on building consensus on key actions, implementation platforms were put in place and financing for nutrition slowly increased. Under the strong leadership of the Prime Minister, a revolutionary program to address malnutrition was launched in 2018. As actions under the mission accelerated, the COVID-19 pandemic arrived in early 2020. Affecting health systems, food systems, nutrition programs, social safety nets, and the economy, the pandemic has the potential to exacerbate the challenge of malnutrition in multiple ways. India can mitigate some of the possible ways in which COVID-19 will affect malnutrition but will require strong leadership and continued commitment, adaptation of the national nutrition mission, strengthening of the social safety net and innovative evidence-based data to take informed decisions, implement them and ensure feedback to take necessary corrective action. In this article, we outline some challenges and key areas for action. We conclude that India's nutrition journey is too important to be derailed by a crisis like COVID-19. This is a clarion call for the nutrition community in India to rally strongly to support continued attention to malnutrition in all its forms, to generate relevant evidence, and to support and engage all of society to urgently and adequately address malnutrition in the context of the COVID-19 pandemic. We have come too far to turn back now.

Steering a Green, Healthy, and Inclusive Recovery Through Transport

The pandemic and resulting economic fallout have upended mobility. This report, with the Transport Decarbonisation Alliance (TDA), evaluates how countries, cities, and companies have allocated funds, directed policies, or launched actions that impact the transport sector. It provides evidence of how these interventions could shape long-term economic recovery that addresses climate, health, safety, and equity goals. This study analyzes roughly US$298 billion in global stimulus funds committed to the transport sector between March 2020 and February 2021. Of these funds, roughly 44% have gone to subsectors with positive implications for climate and sustainability goals. We are at a critical moment to steer national investments, local and country-level regulations, and private-sector commitments toward sustainable transport. The paper identifies several intersectional opportunities and explores five key opportunities and action areas for transport decarbonization and public-private participation for countries, cities, and companies. These areas are public transport, walking and bicycling, vehicle electrification, rail, and research and development (R&D). Actions in these areas can help decarbonize transport while creating jobs, increasing equity, improving road safety, and reducing air pollution.

A multifaceted approach to science

The Science Council of Japan (SCJ) was established in 1949 with the goal of promoting and developing science. It represents the science community across various disciplines, including the life sciences, natural sciences, engineering, humanities and social sciences. Part of the SCJ's role involves considering and advising on key issues, and it represents, both domestically and internationally, more than 840,000 scientists across Japan. Its key action areas are: providing policy recommendations to the Government, with several key national laboratories having been established, as well as participation in the Antarctic observation project; promoting networking between scientists; raising awareness of the importance of science within society; and engaging in international activities that can further its goals. A key tenet for the SCJ is that 'science is the foundation upon which a civilized nation is built' and this informs its operations. The Society reports on critical issues of national and international concern and announces its findings as comments from the SCJ president. It makes these available to the general public with a view to promoting the role of science within society. FOr example, it has presented reports and statements on topics including gene-edited babies and research for military security. As the Japanese representative organisation of a G7 country, the SCJ meets with the other national science academies to discuss and develop government recommendations. The council works closely with around 1,700 science and research groups, encouraging collaboration and also supports networking through organised district conferences.

The health and well-being effects of drought: assessing multi-stakeholder perspectives through narratives from the UK

The global literature on drought and health highlights a variety of health effects for people in developing countries where certain prevailing social, economic and environmental conditions increase their vulnerability especially with climate change. Despite increased focus on climate change, relatively less is known about the health-drought impacts in the developed country context. In the UK, where climate change–related risk of water shortages has been identified as a key area for action, there is need for better understanding of drought-health linkages. This paper assesses people’s narratives of drought on health and well-being in the UK using a source-receptor-impact framing. Stakeholder narratives indicate that drought can present perceived health and well-being effects through reduced water quantity, water quality, compromised hygiene and sanitation, food security, and air quality. Heatwave associated with drought was also identified as a source of health effects through heat and wildfire, and drought-related vectors. Drought was viewed as potentially attributing both negative and positive effects for physical and mental health, with emphasis on mental health. Health impacts were often complex and cross-sectoral in nature indicating the need for a management approach across several sectors that targets drought and health in risk assessment and adaptation planning processes. Two recurring themes in the UK narratives were the health consequences of drought for ‘at-risk’ groups and the need to target them, and that drought in a changing climate presented potential health implications for at-risk groups.

Pharmacist-led transitions of care for older adults at risk of drug-related problems: A feasibility study.

Transitions of care (TOC) is one of three key action areas identified in the World Health Organization (WHO)'s third Global Patient Safety Challenge, Medication Without Harm, released in 2017. Systematic reviews have shown that TOC interventions can improve health outcomes, although few studies have evaluated the role of the community pharmacist. To evaluate the feasibility of a pharmacist-led TOC intervention for older adults at risk of drug-related problems. Pragmatic feasibility study conducted in hospital and community pharmacies in a health region of Quebec, Canada. The interventions consisted of a pharmaceutical care plan developed by the hospital pharmacist and transferred at hospital discharge to the patients' community pharmacist, who completed patient consultations in the week following discharge and monthly for six months thereafter. Feasibility evaluations included recruitment, retention, time required, types of interventions, and modified classes of medications, based on clinical data entered in an electronic health record accessible to clinicians in all settings. Of the 90 recruited patients, 76 were discharged with a pharmaceutical care plan. The mean age of these 76 subjects was 79.5 years, and 52.6% were female. The most frequent inclusion criteria were 15 or more medications (57.9%), two or more emergency department visits (past three months), or one or more hospitalization (past twelve months) (42.1%). The hospital pharmacist interventions took a mean time of 222min. The community pharmacist interventions took a mean time of 52min and 32min for the first and subsequent visits, respectively. Therapeutic goals were documented for 60.5% of patients. This study shows the feasibility of implementing a pharmacist-led TOC intervention in the Canadian context. Development of the TOC model in three health regions is currently being pursued along with the inclusion of primary care clinics who recently added pharmacists to their interdisciplinary teams.

Characteristics of, and uncertainties about, illegal jaguar trade in Belize and Guatemala

Recent reports of jaguar trade have emerged throughout Latin America, but, although trade is now considered a high-priority threat to jaguars, its characteristics remain largely unknown. We aimed to gain a deeper understanding of the status of jaguar trade in Mesoamerica, focusing on Belize and Guatemala. We used key-informant interviews to explore the pathways behind the jaguar trade chain, identify the characteristics and motivations of the actors involved, and investigate the drivers and enabling factors behind jaguar trade. We distinguished between concrete evidence and strong beliefs or assumptions, thereby highlighting key areas for conservation action and of uncertainty. Our results suggest that jaguar trade is present in Belize and Guatemala, although current examples suggest it is a domestically-focused and opportunistic activity, rather than an organized international trade. Key drivers included human-wildlife conflict, opportunistic hunting, Chinese demand, drug trafficking, migration, and tourism. The areas of higher uncertainty are the role of external actors and drivers, and of commercial motivations. The main legal and institutional challenges to address this threat include the lack of resources, ineffectiveness of law enforcement, animosities between communities and the government, corruption, outdated legal systems, missing evidence, the lack of mandate of wildlife authorities and safety concerns. Key priorities for conservation interventions and research to prevent jaguar trade from escalating in these countries are to invest in local communities living in proximity to jaguars, while also investigating the role of external actors in jaguar trade, which remained largely uncertain throughout this study.