Offer high-quality, affordable health care incentives to communities living near high-value conservation areas

June 15, 2017

Indonesia Placeholder
Indonesia

Offer high-quality, affordable health care incentives to communities living near high-value conservation areas

About the Implementing organization

Name: Alam Sehat Lestari (ASRI)

Country: Indonesia

Year of establishment: 2007

Type of organization: Community-based association or organization / Legally recognized non-profit status

Description

ASRI is innovative in that they use health services as a delivery system for conservation outcomes. The traditional "siloed" approach of health care and conservation initiatives misses the critical links between the two. When it is necessary to cut down 60 enormous rain forest trees to pay for one C-section, and then that child does not have clean water to drink because the forest has been too heavily logged, everyone loses. But if it is recognized how interconnected these problems are, a destruction cycle can be reversed and become a virtuous cycle. In general, rural health care services are either unavailable or of extremely low quality, but ASRI is changing that. ASRI provides high-quality and affordable health care to over 103,000 people in the area surrounding Gunung Palung National Park in Indonesian Borneo. The Park is home to 5 - 10% of the world's remaining orangutan population, and is a vital watershed to over 60,000 people living on its borders. ASRI has been operating a medical clinic but will be able to provide an even greater range of services with their Community Hospital and Training Centre opening this year. To ensure the care is of high quality, over hundreds of medical residents and attending physicians from the US and around the world have spent time at ASRI building the capacity of Indonesian doctors. The standard of care is world-class, and ASRI has a great reputation in the area, allowing for greater influence in the conservation realm.

Nature Element

Forests / Wildlife

Type of Action

Protection / Awareness and education

Sustainable Development Element

Water security / Health / Climate action

Related Sustainable Development Goal(s)

    

Environmental Impacts

Born out of hundreds of hours of community meetings, ASRI's health clinic offers tiered discounts to sub-villages that stop or reduce logging in the national park. Discounts are based on logging indicators that are frequently monitored. Meetings with community members also resulted in conservation-focused training programs that help improve household economic stability. ASRI has seen a dramatic drop in illegal logging from a baseline of over 1,350 logging households down to 450 after five years. Their current estimate is only 180 individuals still log now, 8 years after starting the program. In 2016, ASRI completed construction on Indonesia’s first conservation hospital. ASRI’s Community Hospital & Training Centre serves as an environmental education centre in addition to being a first-class medical facility that will offer even more powerful incentives for biodiversity conservation.

Sustainable Development Impacts

When this work began, local health care was poor. In 2007, a baseline survey of over 1,500 households revealed a very high 3.4 infant deaths per 100 households. Health facilities were either unavailable or of extremely low quality, and the nearest hospital was 2-12 hours from the villages bordering the park (if roads or rivers were passable). The same survey showed that the average cost of an emergency visit to the district or regional hospital was $227, more than the average annual income, and that 13% of surveyed households had experienced such an emergency over the last year. One third of the interviewees reported previously having to choose between health care and food. In a 2012 follow-up survey, we found decreases in infant mortality (to 1.1 births per 100 households), as well as decreases in instances of fever, diarrhoea, and cough. There was also a drop-in birth per mother. Simultaneously every measure of human well-being increased.

Scalability

Although ASRI has not yet expanded nationally, there are many opportunities to do so. This model functions in locations of high conservation value but weak governance and a desire by the communities to protect the ecosystem (ASRI has yet to encounter a place in Indonesia that does not meet these criteria). Indonesia has been called by National Geographic, the most critical area for conservation on the planet but sadly it has the highest deforestation rate in the world and more than 80 percent of deforestation occurred in Indonesian Borneo and Sumatra. ASRI is implementing the Wheel model of replication, which looks at project sites from the perspective of a hub site (ASRI), where investment is high and infrastructure developed to support satellite projects throughout the region. These satellite projects are the spokes to that hub, creating a Wheel of positive change programs happening throughout one region.

Replicability

ASRI is one of few organizations improving access to health services as the "payment" for environmental services. This is a PA + PES (PA= Protected Area and PES= Payment for Environmental Services) model, which provides payments (incentives) in exchange for communities providing the environmental service of protecting a high-conservation-value area. ASRI will franchise, implementing the Wheel Model of Replication. This model incorporates project hubs, and program spokes which are managed from those hubs. Research is ongoing to identify locations for new hubs that have the potential of lots of spokes, where the PA + PES model might work. This year, ASRI will also begin curriculum and program development of a training academy, which will operate out of ASRI’s new Community Hospital and Training Center. This will allow doctors from around Indonesia and around the world to come learn about the model and be able to implement these principles in other locations.

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