Sustainable Funding Mechanisms Research Articles

Improving access to primary health care through financial innovation in rural China: a quasi-experimental synthetic difference-in-differences approach

BackgroundInadequate financing constrains primary healthcare (PHC) capacity in many low- and middle-income countries, particularly in rural areas. This study evaluates an innovative PHC financing reform in rural China that aimed to improve access to healthcare services through supply-side integration and the establishment of a designated PHC fund.MethodsWe employed a quasi-experimental synthetic difference-in-differences (SDID) approach to analyze county-level panel data from Chongqing Province, China, spanning from 2009 to 2018. The study compared the impact of the reform on PHC access and per capita health expenditures in Pengshui County with 37 other control counties (districts). We assessed the reform’s impact on two key outcomes: the share of outpatient visits at PHC facilities and per capita total PHC expenditure.ResultsThe reform led to a significant increase in the share of outpatient visits at PHC facilities (14.92% points; 95% CI: 6.59–23.24) and an increase in per capita total PHC expenditure (87.30 CNY; 95% CI: 3.71-170.88) in Pengshui County compared to the synthetic control. These effects were robust across alternative model specifications and increased in magnitude over time, highlighting the effectiveness of the integrated financing model in enhancing PHC capacity and access in rural China.ConclusionsThis research presents compelling evidence demonstrating that horizontal integration in PHC financing significantly improved utilization and resource allocation in rural primary care settings in China. This reform serves as a pivotal model for resource-limited environments, demonstrating how supply-side financing integration can bolster PHC and facilitate progress toward universal health coverage. The findings underscore the importance of sustainable financing mechanisms and the need for policy commitment to achieve equitable healthcare access.

Research gaps and priorities for quantitative microbial risk assessment (QMRA).

The coronavirus disease 2019 pandemic highlighted the need for more rapid and routine application of modeling approaches such as quantitative microbial risk assessment (QMRA) for protecting public health. QMRA is a transdisciplinary science dedicated to understanding, predicting, and mitigating infectious disease risks. To better equip QMRA researchers to inform policy and public health management, an Advances in Research for QMRA workshop was held to synthesize a path forward for QMRA research. We summarize insights from 41 QMRA researchers and experts to clarify the role of QMRA in risk analysis by (1) identifying key research needs, (2) highlighting emerging applications of QMRA; and (3) describing data needs and key scientific efforts to improve the science of QMRA. Key identified research priorities included using molecular tools in QMRA, advancing dose-response methodology, addressing needed exposure assessments, harmonizing environmental monitoring for QMRA, unifying a divide between disease transmission and QMRA models, calibrating and/or validating QMRA models, modeling co-exposures and mixtures, and standardizing practices for incorporating variability and uncertainty throughout the source-to-outcome continuum. Cross-cutting needs identified were to: develop a community of research and practice, integrate QMRA with other scientific approaches, increase QMRA translation and impacts, build communication strategies, and encourage sustainable funding mechanisms. Ultimately, a vision for advancing the science of QMRA is outlined for informing national to global health assessments, controls, and policies.

Navigating Hurdles: A Review of the Obstacles Facing the Development of the Pandemic Treaty.

The emergence of the COVID-19 pandemic has served as a call for enhanced global cooperation and a more robust pandemic preparedness and response framework. As a result of this pressing demand, dialogues were initiated to establish a pandemic treaty designed to foster a synchronized global strategy for addressing forthcoming health emergencies. In this review, we discussed the main obstacles to this treaty. Among several challenges facing the pandemic treaty, we highlighted (1) global cooperation and political will, (2) equity in access to resources and treatments, (3) sustainable financing, (4) compliance and enforcement mechanisms, (5) sovereignty concerns, and (6) data sharing and transparency. Navigating the hurdles facing the development of the pandemic treaty requires concerted efforts, diplomatic finesse, and a shared commitment to global solidarity. Addressing challenges in global cooperation, equitable access, transparency, compliance, financing, and sovereignty is essential for forging a comprehensive and effective framework for pandemic preparedness and response on the global stage.

Blueprint for Blue Carbon: Lessons from Seychelles for Small Island States

Blue carbon has been proposed as a nature-based solution for climate change mitigation; however, a limited number of published works and data and knowledge gaps hinder the development of small island developing states’ (SIDS) national blue carbon resources globally. This paper reviews the blue carbon ecosystems of Seychelles as a case study in the context of SIDS, comparing estimations by the Blue Carbon Lab and recent blue carbon (mangrove and seagrass) evaluations submitted to the Seychelles national government. Mangroves (2195 ha, 80% in Aldabra Atoll) and seagrasses (142,065 ha) dominate in Seychelles, with coral reefs having the potential for carbon sequestration (169,000 ha). Seychelles is on track to protecting its blue carbon, but these systems are threatened by rising sea levels, coastal squeeze, erosion, severe storms, and human activities. The importance of carbon inventories, accounting institutions, and continuous monitoring of blue carbon systems is discussed. Blue accounting is necessary for accurate accounting of carbon sequestration and carbon storage, generating carbon credits, and representing impactful reductions in greenhouse gases for NDCs. Challenges and opportunities include policy legislation regarding ownership rights, accreditation and certification for carbon credits, sustainable financing mechanisms like natural asset companies and blue tokens, local engagement for long-term success, and carbon market dynamics following COP27. The restoration and regulation of blue carbon resources for optimal ecosystem services delivery, carbon inventories, and blue carbon policy are recommended development priorities. Blue carbon ecosystems have the potential to contribute to NDCs of SIDS while simultaneously offering sustainable development pathways for local communities through the multiple ecosystem services they provide.

Mental health integrated care models in primary care and factors that contribute to their effective implementation: a scoping review

BackgroundIn the state of Victoria, Australia, the 111-day lockdown due to the COVID-19 pandemic exacerbated the population’s prevailing state of poor mental health. Of the 87% of Australians who visit their GP annually, 71% of health problems they discussed related to psychological issues. This review had two objectives: (1) To describe models of mental health integrated care within primary care settings that demonstrated improved mental health outcomes that were transferable to Australian settings, and (2) To outline the factors that contributed to the effective implementation of these models into routine practice.MethodsA scoping review was undertaken to synthesise the evidence in order to inform practice, policymaking, and research. Data were obtained from PubMed, CINAHL and APA PsycINFO.ResultsKey elements of effective mental health integrated care models in primary care are: Co-location of mental health and substance abuse services in the primary care setting, presence of licensed mental health clinicians, a case management approach to patient care, ongoing depression monitoring for up to 24 months and other miscellaneous elements. Key factors that contributed to the effective implementation of mental health integrated care in routine practice are the willingness to accept and promote system change, integrated physical and mental clinical records, the presence of a care manager, adequate staff training, a healthy organisational culture, regular supervision and support, a standardised workflow plan and care pathways that included clear role boundaries and the use of outcome measures. The need to develop sustainable funding mechanisms has also been emphasized.ConclusionIntegrated mental health care models typically have a co-located mental health clinician who works closely with the GP and the rest of the primary care team. Implementing mental health integrated care models in Australia requires a ‘whole of system’ change. Lessons learned from the Mental Health Nurse Incentive Program could form the foundation on which this model is implemented in Australia.

Critical Success Factors for Deployment of Primary Health Care Networks and their Impact in Kenya

The Government of Kenya through the Bottom-up Economic Transformational Agenda (BETA) acknowledges Primary Health Care (PHC) as a cost-effective and efficient means to achieve Universal Health Coverage (UHC). The aim is to enhance equitable access to high-quality and affordable healthcare for all Kenyan citizens. Primary Health Care Networks (PCNs) are gaining traction as the main mode of achieving PHC in Low- and Middle-Income Countries, and Kenya is no exception. In Kenya, PCNs approach seeks to empower local communities at subcounty level through mobilizing resources and strengthening their decision-making authority to address context specific healthcare needs. The investment in PCNs is geared towards advancing equitable access to quality healthcare at the community level, mitigating fragmentation of health care services, strengthening preventive and promotive healthcare hence creating a more resilient and efficient healthcare system. The Ministry of Health in Kenya, in collaboration with County Governments and Development partners, initiated a Rapid Results Initiative (RRI) to deploy PCNs across the country in August, 2023. The goal was to establish 315 Primary Health Care Networks (PCN) across the 47 counties in Kenya. This was preceded by a Pilot phase in 3 Counties (Kisumu, Garissa, and Kwale) which was conducted in 2021. The pilot phase informed cost-effective approaches for the deployment and critical success factors for scale-up of PCNs countrywide. The nationwide deployment of PCNs followed a 10-step process of establishing PCNs as stipulated in Kenya PHC Guidelines. Data on experiences, progress in implementation and lessons learnt was abstracted from grey literature including reports from PCN establishment at County level, Stakeholder meetings through Accelerator and Sustainability taskforce and data from PCN observatory. The average time taken to establish a PCN was 3 weeks and costed approximately USD 34,000 for its full establishment. As at 20th December, 2023 (within 4 months of initiating the RRI), of the target of 315 PCNs, 93(30%) PCNs were fully established, 27(9%) PCNs were in progress and 195(62%) yet to start. Out of the 47 counties, 37(79%) counties have at least a fully established PCN, 4 Counties are in the process of establishing the first PCN and 6 are awaiting partner readiness. The eight main critical success factors for successful establishment included: County ownership and commitment, availability of Key Policy guidelines and strategies for reference, funding from development partners and donors, leveraging on existing National and County governance structures, multisectoral collaborations and partnerships, tracking of PCN establishment through National PCN observatory and Community engagement. Key process enablers to successful role out included: Meaningful engagement of development and implementing partners, Execution through County trained TOTs, Community engagement through Community Health Workforce and support from National Government. Over time, the Established PCNs in 3 pilot counties have demonstrated significant reduction in facility based maternal mortality, increased access to NCD screening services, coordinated health care workers through MDTs and improved forward and backward referrals. Additionally, incorporated innovation models within PCNs have improved access to medical supplies and specialized healthcare services at level 2 and 3 facilities. To achieve successful scale up of PCNs and sustainability for impact it is critical to contextualize PCNs to the County needs, establish sustainable primary health care financing mechanism for PCN activities, Strengthen PCN governance structures and utilise PCN observatory to continuously track PCN performance measurements and decision making. Adoption of a unified focus on PCN performance improvement including one PCN strategy, one action plan on how to optimally implement PCNs and one monitoring framework is critical. If implemented successfully, PCNs will contribute to long term social return on investments and improved health indicators for the Country

US Medical-Legal Partnerships to Address Health-Harming Legal Needs: Closing the Health Injustice Gap.

The medical-legal partnership (MLP) model is emerging across the USA as a powerful tool to address the adverse social conditions underlying health injustice. MLPs embed legal experts into healthcare teams to address health-harming legal needs with civil legal remedies. We conducted a narrative review of peer-reviewed articles published between 2007 and 2022 to characterize the structure and impacts of US MLPs on patients, providers, and healthcare systems. We found that MLPs largely serve vulnerable patient populations by integrating legal experts into community-based clinical settings or children's hospitals, although patient populations and settings varied widely. In most models, healthcare providers were trained to screen patients for legal needs and refer them to legal experts. MLPs provided a wide range of services, such as assistance accessing public benefits (e.g., Social Security, Medicaid, cash assistance) and legal representation for immigration and family law matters. Patients and their families also benefited from increased knowledge about legal rights and systems. Though the evidence base remains nascent, available studies show MLPs to be associated with greater access to care, fewer hospitalizations, and improved physical and mental health outcomes. Medical and legal providers who were engaged in MLPs reported interdisciplinary learning, and healthcare systems often experienced high returns on investment through cost savings and increased Medicaid reimbursement. Many MLPs also conducted advocacy and education to effect broader policy changes related to population health and social needs. To optimize the MLP model, more rigorous research, systematic implementation practices, evaluation metrics, and sustainable funding mechanisms are recommended. Broader integration of MLPs into healthcare systems could help address root causes of health inequity among historically marginalized populations in the USA.

FinTech and sustainable financing for low carbon energy transitions: A biodiversity and natural resource perspective in BRICS economies

BRICS countries grapple with formidable challenges, declining biodiversity, and energy crises. This study examines the transformative potential of financial technology and sustainable financing in driving low-carbon energy transitions. It aims to achieve two objectives: first, to investigate the effectiveness of FinTech and sustainable financing in driving low-carbon energy transitions; and second, to probe the relationship between these mechanisms and the imperatives of biodiversity and sustainable natural resource utilization in the context of BRICS economies. Through the application of advanced econometric techniques such as fully modified OLS (FMOLS), dynamic OLS (DOLS), fixed effect-OLS (FE-OLS), and Method of Moments Quantile Regression (MMQR), this study investigates the impact of FinTech, sustainable financing, and biodiversity and natural resource utilization on low-carbon energy transitions. Our empirical findings underscore a robust, long-term co-integrating relationship among low-carbon energy advancement, financial technology, financial development, biodiversity preservation, and natural resource utilization. Notably, both FinTech innovations and accessible sustainable financing mechanisms positively influence the adoption of low-carbon energy practices. Moreover, economies rich in biodiversity and with higher income levels exhibit a strong inclination toward low-carbon energy sources. However, overreliance on natural resource extraction hampers the sustained adoption of low-carbon energy practices. This study recommends strategies that leverage FinTech and sustainable financing, while emphasizing the importance of safeguarding natural resources and promoting environmental management. These measures effectively address the energy crisis and foster policies and practices for low-carbon energy transitions.

Examining the use of psychiatric collaborative care and behavioral health integration codes at federally qualified health centers: A mixed-methods study.

Despite evidence to support the integration of behavioral health and physical health care, the adoption of Integrated Behavioral Health (IBH) has been stymied by a lack of reliable and sustainable financing mechanisms. This study aimed to provide information on the use of Psychiatric Collaborative Care Model (CoCM) and behavioral health integration (BHI) codes and the implementation of IBH in federally qualified health centers (FQHCs). This cross-sectional, mixed-methods study involved an electronic survey of administrators and follow-up qualitative interviews from a subset of survey respondents. Quantitative data were analyzed using descriptive analysis and thematic coding was used to analyze qualitative data to identify salient themes. Administrators (N = 52) from 11 states completed the survey. Use of CoCM (13%) or BHI codes (17.4%) was low. Most administrators were not aware that CoCM (72%) or BHI codes (70%) existed. Qualitative interviews (n = 9) described barriers that further complicate IBH and code use like workforce shortages and insufficient reimbursement for the cost to deliver CoCM services. Although FQHCs are working to meet the needs of the communities they serve, a lack of billing clarity and awareness and workforce issues hinder the adoption of the CoCM. FQHCs face many demands to provide care to safety net populations, yet are not fully equipped with the resources, workflows, staffing, and payment structures to support CoCM/BHI billing. Increased financial and logistical support to build practice infrastructure is needed to reduce the administrative complexity and inadequate reimbursement mechanisms that currently hinder the implementation of the CoCM and integrated care delivery. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Exploring challenges and recommendations for verbal autopsy implementation in low-/middle-income countries: a cross-sectional study of Iringa Region—Tanzania

BackgroundVerbal autopsy (VA) plays a vital role in providing cause-of-death information in places where such information is not available. Many low-/middle-income countries (LMICs) including Tanzania are still struggling to yield...

Rationalizing Taiwan’s climate action based on oceans: ineffective governance, aspiring international participation, unrealized universal values, and a new window of blue carbon ecosystem measure

Characterized by unique practices of self-imposed voluntary commitment, the formulation of Taiwan’s climate action has been informed by the logic of appropriateness, which is norm-guided without regard to consequences. However, ineffective governance exhibited in the gap between governance incapability and overcommitted contribution, aspiring international participation, and realization of universal values hindered by a developmentalism mindset altogether reify that Taiwan’s climate action has turned out to be an unrealistic ideal. It requires due consideration of socially constructed roles and matching obligations (the appropriateness concern) on the one hand, and promulgation of actions made upon rational choice along with well-defined interests (calculation of consequences) on the other hand, to deliver Taiwan’s voluntary commitments while living up the name and substance of an earth citizen. Taiwan’s effort at developing the blue carbon ecosystem (BCE) measure may open a new window of opportunity, whereby a paradigm shift in transforming the appropriateness logic to the appropriateness-consequence compound is discernible. The key lies in integrating the developmentalist drive for growth and the rising environmentalist demand while engaging, substantially and extensively, members of those affected communities with more accessible and sustainable financing mechanisms.

Investing in global health security: Estimating cost requirements for country-level capacity building.

The COVID-19 pandemic has highlighted critical gaps in global capacity to prevent, detect, and respond to infectious diseases. To effectively allocate investments that address these gaps, it is first necessary to quantify the extent of the need, evaluate the types of resources and activities that require additional support, and engage the global community in ongoing assessment, planning, and implementation. Which investments are needed, where, to strengthen health security? This work aims to estimate costs to strengthen country-level health security, globally and identify associated cost drivers. The cost of building public health capacity is estimated based on investments needed, per country, to progress towards the benchmarks identified by the World Health Organization's Joint External Evaluation (JEE). For each country, costs are estimated to progress to a score of "demonstrated capacity" (4) across indicators. Over five years, an estimated US$124 billion is needed to reach "demonstrated capacity" on each indicator of the JEE for each of the 196 States Parties to the International Health Regulations (IHR). Personnel costs, including skilled health, public health, and animal health workers, are the single most influential cost driver, comprising 66% of total costs. These findings, and the data generated by this effort, provide cost estimates to inform ongoing health security financing discussions at the global level. The results highlight the significant need for sustainable financing mechanisms for both workforce development and ongoing support for the health and public health workforce.

PP111 Reimbursement And Payment Models: A Survey Of Stakeholders’ Current Experiences And Future Outlook Within The Dutch Policy Setting

IntroductionThe constant evolution of high-priced hospital drugs with large uncertainties are increasingly challenging the sustainability of many healthcare reimbursement systems. Consequently, more attention is paid to exploring innovative payment and reimbursement models that may contribute to sustainable healthcare funding mechanisms yet still ensure timely patient access to health intervention. However, more insight is needed into the experiences of stakeholders involved in making payment and reimbursement arrangements as they may play an essential part in successfully implementing innovative reimbursement and payment models in the future.MethodsBetween May and July 2021, a survey was sent out to Dutch stakeholders directly or indirectly involved in payment and reimbursement agreements. The survey questioned the current use of and future preferences for reimbursement and payment models for high priced hospital drugs using Likert scales. Results were analyzed using descriptive statistics.ResultsOur inquiry shows that currently financial-based reimbursement models are applied most often, especially discounts due to their simplicity. In the future, outcome-based reimbursement models are preferred more, particularly pay-for-outcome. The main challenge for implementation is generating evidence in practice.Upfront payment is currently the most frequently applied payment model, according to the respondents, whereas delayed payment models are preferred to be applied more often. Particularly payment at outcome-achieved models are preferred but they can be administratively difficult to arrange.The respondents are moderately satisfied with the payment and reimbursing system in the Netherlands, arguing that especially transparency about the final agreement and mutual trust could be improved.ConclusionsDespite the preference healthcare payers have for using outcome-based reimbursement models and delayed payment models, currently they are rarely applied. The insights from our survey can provide Dutch stakeholders with future direction when implementing innovative reimbursement and payment models. Attention should be paid to which barriers are currently perceived and how policy structures can facilitate implementation. Further research should focus on exploring which combinations of reimbursement and payment models are most likely to be successful in the Netherlands.

The evolution of mental health related policies in China: A bibliometric analysis, 1987-2020.

Since 1987, the Chinese government has promoted public mental health by continuously implementing mental health related policies. This research attempts to reveal the distribution and characteristics of mental health related policies. In addition, it can help stakeholders evaluate whether the environment for policy implementation has improved and identify key points in the development of the overall mental health system. We used a bibliometric approach to analyze the evolution of mental health related policies in China from 1987 to 2020. A total of 239 mental health related policies were collected from Beida Fabao and official Internet websites of governmental departments. Co-wording, social networks, and citation analysis were applied to explore the evolutionary features of such policies. The evolution of policy development showed that the number of mental health related policies in China has been increasing and their content has been enriched. Over time, mental health related policies not only gradually expanded its focus on common mental disorders, but also included an increasing number of keywords related to service provision, organization and administration. However, most policies were implemented independently by separate agencies and the number of policies jointly implemented by different agencies only accounted for 32.64% of all the policies implemented. The Ministry of Health (MOH) is at the core of the collaborative network associated with implementing mental health related policies in China. The environment associated with the implementation of mental health related policies in China is gradually improving. However, cross-sector collaboration among different agencies needs to be strengthened and financial support for related resources needs more attention. A clear division of responsibilities among various agencies and a sustainable financing mechanism are essential to the development and implementation of mental health related policies.

Plenary 4 Reorienting health services: the transformational potential of health promotion

Abstract Over the past decades, in Europe, the nature of our disease burden has shifted from more communicable and acute to chronic diseases such as cardiovascular diseases, diabetes, cancer and mental ill health. These diseases usually manifest themselves later in life, but they are not necessarily related to biological ageing. They mostly result from an accumulation of unhealthy living patterns since childhood and across the life course. Consumption of processed foods high in fat, salt, and sugar, smoking, excessive alcohol use, too little physical activity and too much stress all contribute to the growing and worsening burden of chronic diseases. These behaviours in turn are shaped by the social, environmental, cultural and economic conditions in which we live, grow, work and age. Once they have developed, chronic diseases can be difficult, or even impossible to cure. Our health services, with a traditional curative approach, are not equipped for this chronic epidemic. There is an urgent need to shift our health services away from the predominant focus on cure and towards prevention, and for policy makers to invest in ensuring healthy living environments and societies. Health promotion and enabling people and population groups to increase control over their health, particularly those facing disadvantage, has the potential to transform our health services, and is critical to ensuring their resilience and sustainability. Despite a growing awareness of the need for change, reorienting structures and systems in practice is challenging, as people can be resistant to change. Siloed approaches within the health sector, but also between social, health, and education sectors continue to prevail, and it is not always easy to find the right levers for change and to build bridges across administrations. This is compounded by a lack of infrastructure, organizational and workforce capacity for health promotion, and sustainable financing mechanisms. Much innovative work is however taking place, which we can learn from and scale up. This plenary session will provide examples of different ways in which health-promoting approaches can reorient health services, strengthen health-promoting and community oriented primary care and prevent chronic diseases. It will highlight what we can learn from behavioural and cultural insights and social prescribing, as well as integrated community initiatives to further support people, across the social gradient, to lead and to maintain healthy lives. It will discuss target setting for further advocacy among policy makers. Speakers: Rüdiger Krech WHO, Geneva, Switzerland Susan Michie University College London, UCL Centre for Behaviour Change, London, UK Jan De Maeseneer European Commission Expert Panel on Effective Ways of Investing in Health and Ghent University, Belgium Jet Bussemaker Council of Public Health & Society, Netherlands, Leiden University Medical Center, Leiden, Netherlands Cristiano Figueiredo USF da Baixa, Central Lisbon Health Centre Cluster, National School of Public Health, NOVA University Lisbon, Portugal

Research on the optimization of financing scheme of long-term care insurance in China based on system dynamics simulation.

ObjectiveThe aging population in China highlights the significance of long-term care insurance (LTCI). This study provides policy suggestions for China to establish a sustainable LTCI financing mechanism by predicting the trend of funds balance and screening the appropriate financing scheme.MethodA system dynamics model (SDM) of LTCI funds was constructed by clarifying the current situation and its main influencing factors of revenue and expenditure of LTCI funds in China. Also, through literature research and expert consultation, we found the intervention goals and predicted the changing trend of LTCI fund balance from 2020 to 2050 under different intervention schemes.ResultsThe SDM of LTCI financing passes the dimensional consistency test, structural test, and historical test. Therefore, it can objectively reflect the structure and behavior of the financing system. It is found that the factors affecting the revenue and expenditure system of LTCI funds mainly include economic factors, demographic factors, and other factors. By adjusting three intervention indicators, namely, individual payment rate, reimbursement proportion, and severe disability rate, this study produces 45 financing combination schemes. By comparing the changing trend of LTCI fund balance under different intervention schemes, according to the screening principle, five better financing schemes are finally selected. These five financing schemes have no deficit and excessive balance in the forecast period, which is in line with the principle of sustainability. It can provide a reference for the selection of financing schemes in pilot areas.DiscussionThis study has optimized the policy of the LTCI financing mechanism, determined the suitable LTCI participants, financing channels and levels, and screened out the suitable LTCI financing policy optimization scheme for China. By appropriately increasing the individual payment rate, strengthening the disability intervention of the elderly, formulating scientific and objective disability evaluation standards, and finally establishing a dynamic financing adjustment mechanism of LTCI. This study can provide a basis for the scientific formulation of the LTCI financing mechanism in China and provide a reference for developing countries to establish a sustainable LTCI.

The decline of large carnivores in Africa and opportunities for change

Large carnivore populations are in decline across the globe due to the destruction of their natural habitat and targeted persecution by the human species. Africa is home to one of the last remaining intact guilds of terrestrial mega-carnivore taxa and includes species that occupy a unique role in ecosystem function and in human evolutionary history. The rapid disappearance of large carnivores from the African landscape is therefore particularly alarming and several species are predicted to soon be extirpated outside of protected areas. Developing solutions addressing the drivers of decline are complex due to Africa's rapid human population growth and land use patterns, cultural and traditional values among rural communities, and regulations governing lethal control programs and the trophy hunting industry. There is also a critical need to consider the intrinsic value of the carnivore guild in the discourse as having a value beyond that which benefits humans. Lessons can be learned from a few programs that combine good governance and regulation, effective law enforcement, strong community participation and sustainable funding mechanisms to conserve carnivores at landscape scales. Integrating these criteria into a workable model and employing an evidence-based and adaptive approach is central to implementing long-term solutions for carnivore-human coexistence. Africa can become a global leader in the conservation of biodiversity by demonstrating resilience, collaboration and ingenuity to reverse the current trend, and restore and protect these charismatic carnivore species for the benefit of the planet as a whole.

Roadmap to incorporating group A Streptococcus molecular point-of-care testing for remote Australia: a key activity to eliminate rheumatic heart disease.

Roadmap to incorporating group A Streptococcus molecular point-of-care testing for remote Australia: a key activity to eliminate rheumatic heart disease.

Estimating residents' WTP for ecosystem services improvement in a payments for ecosystem services (PES) program: A choice experiment approach

Conservation programs help mitigate the detrimental effects on ecosystems and ecosystem services (ES). However, continuous financial support is essential for their sustainability. Therefore, sustainable financing mechanisms such as Payments for Ecosystem Services (PES) are developed. Nevertheless, assessing whether substantial support could be obtained from stakeholders is critical in establishing a PES. This study evaluated the feasibility of establishing a PES by estimating the potential community benefits from ES improvement using a choice modeling approach.The study surveyed 1560 residents of South Carolina to elicit their monthly willingness-to-pay (WTP) for ES improvement. The findings revealed varying WTP estimates depending on the type of intervention, regional location of the residences, and priority ES for improvement. In terms of water quality improvement, the estimated mean WTP ranged from $0 to $3.00. On the other hand, for wildlife habitat improvement, the mean WTP ranged from $0 to $6.39. Finally, for an increase in water supply, only residents from the Upstate region indicated that they are willing with a mean WTP of $0.31. Overall, the community benefits are estimated to reach $4.6 million to $6.2 million monthly, showing that PES is a promising program that could provide a substantial source to support conservation programs.

Estimating the Recreational Value and Setting Entrance Fees during Early Development of Ecotourism Sites: the Case of Bataan Natural Park

Ecotourism sites are established to provide “sustainable tourism,” bring economic opportunities to the local communities, and can potentially augment funding for conserving protected areas by charging entrance fees. A dilemma, however, faced by managers during the early stages of the development of ecotourism sites is the uncertain effect of increasing entrance fees on demand. This creates an apprehension to use entrance fees as a sustainable financing mechanism for conservation. This study used a combination of revealed and stated preference approaches to provide information on the recreational benefits and empirical guidance in setting entrance fee surcharges for proposed improvements in two eco-tourism sites of Bataan Natural Park – specifically, Ambon-Ambon and Lumutan Eco-trail and Tala River. Count data regression models were used to estimate the consumer surplus of visitors for the current conditions. In contrast, the contingent behavior method was used to measure the visitors’ willingness to pay (WTP) for improvements in the site attributes. Results of the count data models indicate the total consumer surplus from the ecotourism sites in their current state is significantly higher than the site's cost of improvement and maintenance. Furthermore, tourists are willing to pay more than the currently charged entrance fees. Protest and uncertainty corrected mean WTP for the improved condition are approximately PHP 130.90 for a visit to the eco-trail and PHP 108.50 for a visit to the river. The optimal and revenue-increasing entrance surcharge is estimated to be within PHP 15–76 for the Tala River and PHP 15–114 for the Falls. The results may have implications on providing alternative financing for protecting and conserving other natural parks and protected areas in their early stages of development in the Philippines.