BUILDING AN INVESTMENT CASE FOR CO- MANAGEMENT OF ECOSYSTEMS, FOOD SYSTEMS & PUBLIC HEALTH IN AFRICA A REPORT OF THE ECOSYSTEMS, FINANCE & HEALTH INCEPTION WORKSHOP MARCH 19-22, NAMUNYAK CONSERVANCY, SAMBURU, KENYA Ecosystems, Finance & Health Inception Workshop Acknowledgments The organizers of the Ecosystems, Finance & Lead organizers Health Inception Workshop thank all participants, and offer special thanks to the government of James Hassell (Smithsonian’s Global Health Program, USA Kenya, partners and funders. The ideas behind and Yale School of Public Health, USA) this workshop were sown over more than a Joseph Kamau (Global Health Program, Institute of Primate decade’s worth of collaboration between the Research, State Department of Public Health, Ministry of Health, Kenya) Smithsonian’s Global Health Program and peer institutions in Africa. Steering Committee The organizers would like to extend special Serap Aksoy (Vector-borne disease ecology & epidemiology, appreciation to the community of Namunyak Yale School of Public Health, USA) Wildlife Conservancy in Samburu who hosted the Vanessa Ezenwa (Ecology & evolution of infectious disease, workshop on their land, and whose in-depth Yale University, USA) knowledge sparked open and constructive Francesco Fava (Remote sensing, agroecology & risk dialogue between international participants and management, University of Milan, Italy) Eli Fenichel (Natural resource economics, Yale School of the members of local communities throughout the Environment, USA) four-day workshop. Eric Fèvre (Epidemiology & veterinary public health, University of Liverpool, UK and International Livestock Finally, the organizers wish to thank the teams Research Institute, Kenya) from SenseTribe and Sarara for the huge effort Lydia Franklinos (Wildlife health & vector-borne disease epidemiology, University College London, UK) made in the effective organization of the event. Michael Von Fricken (Ecology & evolution of infectious disease, University of Florida, USA) Sponsored by Gretchen Gettel (Aquatic biogeochemistry & hydrology, Aarhus University, Denmark) Albert Ko (Physician and Epidemiologist, Yale School of Public Health, USA) Dino Martins (Ecology & evolutionary biology, Turkana Basin Institute, Kenya) Lutz Merbold (Biogeochemistry, climate change & agroecology, Agroscope, Switzerland) Misheck Mulumba (Epidemiology, ARC- Onderstepoort Veterinary Research, South Africa) Suzan Murray (Wildlife health, Smithsonian’s Global Health Program, USA) Judy Omumbo (Capacity development & vector-borne disease epidemiology, Science for Africa Foundation, Kenya) Geoffrey Siwo (Computer sciences, AI and global health, University of Michigan, USA) Participants In-kind support Pierre Comizzoli (Conservation biology & physiology, Smithsonian Institution, USA) Benis Egoh (Biodiversity & ecosystem services, University of California Irvine, USA) Jaclyn Eng (Climate finance & nature based solutions, Singapore) Christina Faust (Ecology & evolution of infectious disease, University of Glasgow, UK) Sonia Fèvre (Capacity building & workforce development, World Organisation for Animal Health, Kenya (Facilitator)) Facilitation Sagan Friant (Social anthropology & epidemiology, Penn State University, USA) Danny Govender (Wildlife health & disease ecology, SAN www.sensetribe.com Parks, South Africa) Barbara Han (Computing, disease ecology & global health, Cary Institute of Ecosystem Studies, USA) 2 Ecosystems, Finance & Health Inception Workshop Rubina James (Biodiversity conservation & institutional Felix Ngetich (Soil science & food security, Jaramogi Oginga program development, African Biodiversity Collaborative Odinga University of Science and Technology, Kenya) Group, Kenya) Mary Njuguna (Capital markets in Africa, regulation and law, Gladys Ketuyo (Sarara guide and member of Namunyak FSD Africa, Kenya) community) Peter Ogwang (Finance & public health, Africa Development Tilas Lekango (Sarara guide and member of Namunyak Bank, Kenya) community) David Redding (Global environmental change and public Robert Lemayian (Sarara general manager and member of health, Natural History Museum, UK) Namunyak community) Marina Roa (Participatory facilitation & visual thinking, Daniel Losieku (Sarara guide and member of Namunyak SenseTribe, Spain (facilitator)) community) Ivan Selin (Business management & policy, USA) Maria Lorente-Perez (Participatory facilitation & leadership Eliane Ubalijoro (Agroforestry, sustainable development & development, SenseTribe, Spain (facilitator)) biotechnology, Center for International Forestry Research, Christine Magu (Statistics & ecosystem accounting, Kenya Kenya) National Bureau of Statistics, Kenya) Nicola Urbani (Finance & business management, Center for Sibusisiwe Makhanya (Computing at the interface with International Forestry Research, Kenya) climate science, sustainability, and health Neil Vora (Epidemiology & planetary health, Conservation IBM Research Africa, South Africa) International, USA) Michelle Mashonganyika (Participatory facilitation & James Wabacha (Veterinary public health & livestock psychotherapy, Kenya (facilitator)) development, African Union - InterAfrican Bureau for Animal Mary Mbole (Data integration & agricultural food systems Resources, Kenya) development, African Union - InterAfrican Bureau for Animal Resources, Kenya) Anne Mottet (Natural resource use efficiency, climate change & agroecology, International Fund for Agricultural Development, Italy) Kris Murray (Ecology, public health & conservation, MRC Unit The Gambia at LSHTM, Gambia) Mathew Muturi (Veterinary and human public health, & epidemiology, Government of Kenya Zoonotic Disease Unit, Kenya) Fiona Napier (Finance & environmental sustainability, Nature Finance, Kenya) Isaac Ngere (Medical epidemiology, Global Health Program, Washington State University, Kenya) Contents Acknowledgements ……………………………2 Executive Summary ……………………………5 WORKSHOP HIGHLIGHTS Day 1: 18 March 2024 - Opening Welcome remarks .…………………………..8 Review of workshop design ….………………………..8 Day 2: 19 March 2024 Conceptual model review ….………………………12 Case studies ….………………………14 Day 3: 20 March 2024 Making an investment case for integrated interventions ….………………………17 Bush dinner and storytelling ….………………………18 Day 4: 21 March 2024 Open space ….………………………19 Way forward ….………………………21 Road map ….………………………22 4 Ecosystems, Finance & Health Inception Workshop Executive Summary A significant proportion of human increases human and animal and animal disease is mediated productivity, reduces the cost of health by the environment. This is care to families and governments, and especially, but not only, the case in has the potential to reallocate risks 21st century African landscapes, where associated with investments. hazards posed by climate and other Considering the health impacts of forms of environmental change environment focussed interventions converge with food systems, social and that have proved successful in economic conditions to determine generating finance (e.g. carbon credit where people fall sick. Managing these schemes) could also add significant risks preemptively costs significantly value to these investments. less than the cost of response. This workshop gathered 40 leading Framing management of experts from science, finance, communicable and non-communicable governments, NGOs and communities“This workshop gathered 40 leading scientists, practitioners and financing experts to disease as a socioecological challenge to explore the feasibility of building explore the has important implications for an investment case and de-risking feasibility of building allocation of public health spending. mechanisms for co-management of The African health care sector is ecosystems and public health in an investment case estimated to be worth US$ 259 billion Africa. The goal was to co-create a for co-management by 2030, with a financing gap of at road map outlining steps that could be of public health and least US $66 billion annually. Increasing taken towards achieving this. emphasis is being placed on human Participants, whose work examines ecosystems in Africa and animal health as a preventative environmental change and public expenditure. However, health financing health from different perspectives, were tends to focus narrowly on individual drawn from 29 organizations from diseases at the expense of more Africa and further afield. integrated solutions that place disease threats within the context of a broader The workshop’s activities were framed environment-health nexus. around the following questions: Opportunities to counter these 1. How is public health currently threats by financing preemptive financed on the African continent? health system improvements jointly with ecosystem management and 2. Would joint financing of health sustainable food production have yet systems, food production and to be explored using traditional or sustainable ecosystem management more innovative financial structures be an attractive proposition to such as blended finance. Targeting financing organizations? interventions along pathways connecting ecosystem function to food 3. Can a framework that captures the systems, social systems and the health linkages between changing of rural and urban populations not only environmental and social systems, has the potential to allow for more disease and economics be used to effective and sustainable approaches identify interventions that most to reducing disease risk, but also has effectively deliver health and societal impacts on ecosystem integrity sustainability benefits and financial (e.g. biodiversity), food and water returns on investment, within a given security, equity and poverty alleviation landscape? that extend far beyond the diseases in question. Structuring health financing 4. What value proposition do these in this way is also economically and interventions hold for local financially beneficial; in principle it stakeholders? 5 Ecosystems, Finance & Health Inception Workshop 5. What are the data gaps and other unknowns that social, and epidemiological pathways that give rise need to be addressed in order for investors and to human disease risk across landscapes (presented decision makers to direct resources towards co- on page 12). This model was developed through a financing public health, ecosystem management, process of virtual pre-workshop participant and sustainable food production? engagement. Diverse perspectives strengthened this model and framed the economic impacts of The meeting was held on Namunyak Conservancy in managing disease risk alongside other ecosystem Samburu, Kenya (1°00'34.3"N 37°23'05.3"E outputs (such as food and water security, as well as ), from March 19th to 22nd, 2024. Namunyak, which climate co-benefits, and equitable community is managed by local communities and the Sarara benefits). Foundation, is a model for community conservation and landscape management. By holding the To test the conceptual model’s suitability for workshop here, the aim was to immerse participants identifying preemptive interventions linking in a landscape where co-management of health and ecosystems, food systems, and public health the environment in African rangelands is already systems, groups were assigned one of three different being put into practice, and to emphasize the landscape-disease systems. These were: importance of equity and community partnership. We also sought to foster genuine interactions and A. Rodent-borne diseases in forested landscapes learning experiences between workshop participants supporting small-holder agriculture, and members of the local Samburu community B. Mosquito-borne diseases in pastoral rangeland during the workshop. systems, C. Heat in rural, peri-urban and urban landscapes. The workshop began with an open discussion around the broader meaning of health, and an Anchored to these systems, each group spent one opportunity for participants to review and provide full day identifying integrated interventions, and feedback on the workshop’s goals, objectives, and considering the evidence that would be required to hypotheses. Participants were also encouraged to measure their impact, and understand the value share their expectations and the tangible outcomes proposition for local stakeholders. Ideas were they would like to see generated from the workshop. exchanged with members of the local Samburu community, who were active participants in this On day 2, participants worked in groups to evaluate exercise and shared insight from their own and refine a conceptual model for the ecological, resilience-building strategies. A fourth group consisting of experts in natural resource economics, nature-based solution investments, development Hon. Pauline Lenguris MP - the Women’s finance, and capital markets met separately to Representative for Samburu and member of the discuss how the financial risks, returns, and impacts Kenyan Government’s Parliamentary Committee on Health, addresses workshop participants Ecosystems, Finance & Health Inception Workshop of interventions could be measured, and to (particularly women who are agents of map how public health & ecosystem change) as custodians of the environment. management is currently financed in Africa. She also offered the Government’s full Each group’s co-management plans were support to the outcomes of this workshop. then ‘pitched’ to the group of financing experts, which created awareness about Participants then came together to create different financing mechanisms and the work streams through which a community of extent to which these could be leveraged to practice dedicated to building an investment A one-year blend financial support for interventions. case for co-management of ecosystems, roadmap towards food systems and public health systems in the development of In the evening, participants were treated to Africa could be developed. These included: a show of traditional Samburu song and synthesizing evidence gaps and mapping a pan-African dance, and a briefing on the constellations, these to tangible workshop outputs (e.g., initiative called first from the point of view of the Samburu scientific papers, policy briefs and “Ecosystems, and then of the ancient Greeks. Our hosts communication materials); identifying and explained the environmental challenges engaging key stakeholders and financing Finance & Health” they face, and their need to be included as mechanisms; and defining an adaptive was discussed, full participants in solutions. The Samburu structure, guiding principles, and timeline to drawing women also provided context on the carry these activities forward. important role played in an otherwise unanimous support traditionally male dominated society, and A one-year roadmap towards the from participants the importance of gender sensitivity was development of a pan-African initiative later infused into workshop discussions. called “Ecosystems, Finance & Health” was discussed, drawing unanimous support The final day was opened by Hon. Pauline from participants. It was agreed that the Lenguris Member of Parliament, the lead organizers will be responsible for Woman’s Representative for Samburu and a spearheading co-creation of this initiative, Member of the Kenyan Government’s with the buy-in of workshop participants. Parliamentary Committee on Health. Her excellency stressed the health challenges faced by her constituents, and the importance of empowering communities Samburu residents of Namunyak Conservancy, who played an integral role in the workshop’s discussions, listen to proceedings Ecosystems, Finance & Health Inception Workshop Workshop highlights Day 1: 18 March 2024 - Opening T he first day was dedicated to welcoming participants and developing a shared understanding of workshop’s goals, objectives and outputs. Welcome Remarks Welcoming participants to the forum, James Hassell and Joseph Kamau, the workshop’s lead organizers, noted that there is limited investment in measures to address the upstream drivers of ill health in humans and animals. This is despite an increasing appreciation for the role that changing climate, pressures on agricultural systems and social systems play in generating burdens of disease. They noted that on the one-hand, such complexity can render conventional medical and veterinary interventions less effective for controlling disease. However, if key epidemiological processes can be identified and disrupted along pathways linking climate, ecosystems, food systems and health, then a The Sarara wider array of possible preemptive interventions could be unlocked. Foundation’s healthcare program Hassell outlined the potential investment case for operationalizing more holistic approaches to disease control; financing of ecosystem, food system and provides mobile public health system improvements could generate economic returns through“ healthcare to healthcare cost savings, taxable economic output, and other ecosystem mothers and service outputs, whilst also de-risking these investments. For investors to direct resources in this way, they would need to identify interventions with the children across the greatest potential to improve human health, advance sustainable development 850,000 acre goals, and have a risk profile that matches their goals/tolerance. conservancy, and The workshop was formally opened by Mathew Muturi from the Kenyan has established a Government’s Zoonotic Disease Unit. Participants were then welcomed by Nomadic Montessori Robert Lemayian and Nurse Dorcas on behalf of the Namunyak Wildlife Education system to Conservancy, it’s inhabitants, and the Sarara Foundation. They expressed how appreciative the community were that Namunyak was chosen as a destination access difficult to for the workshop, and drew parallels between the workshop’s focus on health reach communities and the environment which are also core values of Samburu culture. Dorcas explained how the Sarara Foundation’s nomadic healthcare program provides mobile healthcare to mothers and children across the 850,000 acre conservancy, and has established a Nomadic Montessori Education system to access difficult to reach communities. Conservation has also benefited through this model, with Namunyak now being home to Kenya’s 2nd largest elephant population and Kenya’s largest population of Reticulated giraffe. This, she said, showed the interdependency between responsible environmental stewardship, healthcare and education. Review of the Workshop Design Participants split into groups to refine the workshop’s vision, objectives, hypotheses and outputs/outcomes. Important points raised in these discussions are summarized in Figure 1, below. The workshop was framed around three major problems/barriers to achieving our proposed vision of an investment case for co-management of public health and ecosystems in Africa. These were discussed with participants in a series of pre- workshop webinars, giving rise to three hypotheses that were carried forward to the workshop. 8 Figure 1: Feedback received from participants on the workshop’s vision, objectives, Suggested goal: To hypotheses & outputs build an investment case for co- management of public health and ecosystems in Africa to catalyze innovative financial instruments that de-risk financing Participants felt this statement reflected an objective as opposed to a vision. The following vision was suggested: “A world in which co- management of ecosystems 1. Are these the correct problems? and public health, through How do we know that addressing embracing diverse knowledge them will lead to success? systems, enables people to 2. Are we talking about well-being more than freedom from disease? thrive” 3. Integrated data systems are weak-to-non existent. Targeted investments need to be made in This will require a One Health data platforms that lot of education for allow sharing of data across investors, many of disciplines. whom are currently 4. Why Africa? Do we think there is unaware more leverage here? Sustainable food systems are a key piece of this What does Interventions must “managing be developed with ecosystems” communities and mean? other actors Managing for There is a social who/what? dimension linked to poverty and conflict underlying this Needs a regulatory structure that Combined can be enforced Need evidence of metrics/ actionable data is Must link to contribution of critical indigenous environmental knowledge & animal driversproductivity Must be able to demonstrate value of integrated 8 financing Climate also impacts social and behavioral systems What about non- communicable diseases? Many of these drive communicable disease burdens (e.g. diabetes and How do you turn malaria) research outcomes into political will/ budget allocation? Being able to How do you scale measure & up from case quantify health, studies to identify social and natural generalizable capital is crucial principles across landscapes? Telling the How to make narrative/story change? Embrace behind this is disruptive thinking, crucial positive deviance How will the strategy be structured? Communications Who will do outreach is also what? crucial Issues are felt across the Global South - could connect South South Policy paper should have a narrow focus, and be about interventions more broadly than 8 complementary cases Dr Éliane Ubalijoro, Director General of CIFOR- Using a conceptual model and series of case studies, we sought to explore these ICRAF discusses the hypotheses with participants, thereby generating the information required to create a workshop’s hypotheses roadmap with which they could be tested. The conceptual model essentially served with other participants as a general framework to capture the linkages between changing environmental and social systems, disease and economics within a given landscape, in such a way that interventions with the greatest potential to deliver health and sustainability benefits and financial returns on investment can identified. Three case studies, each representing a different landscape-disease system of relevance to different localities in Africa, were used to test and refine the conceptual model and address the following questions: 1. How is public health currently financed on the African continent, and would joint financing of health systems, food production & sustainable ecosystem management be an attractive proposition to financing organizations? 2. Can a framework that captures the linkages between changing environmental and social systems, disease and economics be used to identify interventions that most effectively deliver health and sustainability benefits and financial returns on investment, within a given landscape? What value proposition do these interventions hold to local stakeholders? 3. What are the data gaps and other unknowns that need to be addressed for investors and decision makers to direct resources towards co-financing public health, ecosystem management and sustainable food production? 11 Ecosystems, Finance & Health Inception Workshop Day 2: 19 March 2024 T he workshop’s second day was dedicated to refining and testing a framework (the ‘conceptual model’) for identifying entry points for co- managing ecosystems, food systems and public health systems. Conceptual Model Review Participants began by reviewing the conceptual model for the ecological, social and epidemiological pathways that mediate human disease risk in a given landscape. In this framework (Figure 2), disease risk is expressed as a Participants refined factor of hazard, exposure and vulnerability. James Hassell explained that this was conceived from a disease ecology perspective, where and tested a epidemiological processes (occurring in the environment) feed in from the framework for boxes in green to influence the hazard to which humans are exposed at a identifying entry given point in time and space. Disease hazards may be non-communicable “ (e.g. heat) or communicable (pathogens borne by vectors, livestock, wildlife points for co- etc). Social and behavioral factors feed in from boxes in blue to determine managing where and when people are exposed to hazards, and their level of ecosystems, food vulnerability. systems and public Considering hazard, exposure and vulnerability in this way enables disease health systems risk to be estimated for a population of individuals at any given point in time and space. It is assumed that disease risk could be extended to a measure of the economic costs imposed by disease (i.e., morbidity and mortality), represented here as ‘productivity’. Figure 2: The conceptual model, that participants reviewed and refined on day two Ecosystems, Finance & Health Inception Workshop Working in three groups, participants reviewed the framework, considering it’s main assumptions, and the key pathways and variables that were missing. The following themes emerged through these interactive discussions: • The framework assumes that disease risk and productivity are the primary outcomes of interest. Is this a suitable measure of human well-being? How can the broader sustainability and economic benefits of intervening in the processes outlined in this framework be captured (e.g., food security, biodiversity conservation, carbon sequestration, natural capital etc.)? In economic terms, how should productivity be defined? • As key components of epidemiological pathways, the management of agricultural and livestock systems needs to be further defined. Local stakeholder involvement including indigenous knowledge needs to be more explicitly captured. • A more explicit breakdown of the social and behavioral pathways is required. E.g., social factors that influence behavioral choices, how to capture that human behavior is dynamic and not static, whether behavior and culture should be framed as of the environment, and how to capture behavioral responses to changes in disease risk and productivity. • As depicted in this framework, the pathways are linear. Is this a necessary simplification or should more bi-directionality and feedback loops be included? • The framework represents processes occurring at many different scales. How can the scales at which specific investment (as interventions) are made be matched with the scales at which outcomes are measured? • Although not necessarily required as part of the framework, the availability and accessibility of data and how a diversity of data streams are being merged will have a huge impact on operability. “ Protection of Participants reviewed Critical the framework, Biodiversity considering it’s main Areasassumptions, and the key pathways and variables that were missing 13 g nt een in e r lop m G eveD Ecosystems, Finance & Health Inception Workshop Case Studies Following review of the conceptual model, the workshop moved to focus on whether this framework is suitable for identifying entry points for co-management of ecosystems, food systems and public health when applied to ‘real-world’ landscape-disease systems. Participants were assigned to one of three case studies; • Rodent-borne disease in a lowland forest ecosystem, supporting forest and rural smallholder agriculture. This is characteristic of emerging infectious diseases in humid and sub-humid tropical areas of Central and West Africa. • Mosquito-borne disease in a rangeland ecosystem, supporting grasslands, extensive pastoral agriculture and growing urban centers. This is characteristic of emerging and endemic vector-borne diseases in semi-arid and arid (Above) Participants brainstorm landscapes across much of the Sahel and Southern Africa. interventions for mosquito-borne disease. • The impacts of heat on ecosystem health across an urban to (Below) The group working on heat mapped rural gradient in Africa. interventions onto a framework representing their landscape-disease system, and then Using the conceptual model as a point of reference, groups began by used a multi-criteria decision analysis mapping out the pathways linking ecological, social and behavioral approach to compare interventions processes to disease outcomes. Notably, the model was used in different ways to achieve a shared understanding of each case study; for instance, the group working on heat reframed the model from the perspective of “drivers”, “pressures” and “impacts”. Equipped with a shared understanding of their landscape-disease system, groups were encouraged to brainstorm interventions focused on management of ecosystems, food systems or public health systems. For each intervention, participants explored evidence gaps, risks and the value proposition to key stakeholders. Groups were joined by members of the Samburu community to get their perspective on the suitability of interventions, as experts in living with environmental variability and local stakeholders. Different approaches to identifying and prioritizing interventions emerged. For example, the group working on rodent-borne disease developed interventions targeting agroforestry and green waste management at the rural and urban ends of the land-use gradient respectively. Participants working on mosquito-borne disease split into subgroups, with one identifying interventions in a rural pastoral grassland setting, and the other identifying interventions in peri- urban and urban environments where a mosaic of pastoral, agropastoral and urban livelihood strategies coexist. Participants subsequently reconvened to integrate and prioritize interventions across this rural-urban gradient. The group working on heat adopted a different approach; once identified, interventions were compared against a set of criteria with which their value to different stakeholders (e.g. resource requirements for implementation and impacts on environmental and social development goals) could be evaluated. Prioritized interventions for each case study are outlined in Table 1. There was consensus across the groups that, when paired with ‘real- world’ landscapes, the model helped contextualize complex processes and enabled people with differing expertise to identify landscape-level interventions with combined impacts on health and 12 other key sustainability indicators. Ecosystems, Finance & Health Inception Workshop Table 1. Interventions prioritized by each group Landscape -disease Intervention Evidence gaps & risks Key Stakeholders & value proposition system Agroecological practices that reduce rodent-borne disease risk, while increasing biodiversity, food safety • The availability of data to measure The local community (who are at risk of disease) and food security. impact across the system Food producers & consumers Specifically: Agroforestry to disincentivize deforestation, • Surveillance of rodent-borne diseases, Healthcare workers leading to increased soil health and biodiversity, a and rodent abundance estimates Local & national government (e.g. human & animal health services, environmental reduction in rodent populations (due to increase in • Identification of the most important protection services) Rodent- predation and competition), and increased income to variables that could be leversfarmers from food production. Development organizations borne disease • Availability of health data on Community living in informal settlements at direct risk of disease Green waste management in permanent informal inhabitants of informal settelements Surrounding (i.e. in-contact) communities settlements to reduce rodent and vector-borne • Surveillance of rodent-borne diseases, Local government (e.g. human & animal health services, environmental protection disease risk. and rodent abundance estimates services) Specifically: vegetation to filter organic waste, latrines & • The impact of green waste National government solid waste management management practices on other Local politicians hazards (AMR, pharmaceuticals) Development organizations Investing in ecosystem services that allow function of • The ability to demonstrate that Rural pastoral communities - resilience, risk avoidance, economic improvements. ecosystems at times of stress, to avoid forced landscape-level environmental Urban pastoral communities - risk avoidance (less pressure on public health and migration. interventions have a measurable social systems due to lower migration). Specifically: reduction of environmentally induced impact on health and economic Local government - governance plans for greater social & environment impact migration (rural -> urban) by implementing measures that productivity Politicians - recognition, social impact make the environmental resource base more resilient to • Mis-match between the scale at which change; such as water management, grazing the intervention is taking place, and Private enterprise - business through implementation management (see “herding for health” below) and land indicators of success are being Private equity financial institutions - carbon market impacts of grassland restoration tenure. measured. Development organizations - social & environmental key performance indicators Herding for health - improve livestock management • How should success be measured? practices, to address degraded rangelands and Metrics could include health: livestock improve human and animal health. Including best body condition, disease burden; practices and capacity building for reduced herd sizes, environment forage quality, % bare As above livestock species/breeds, mixed herd foraging, rotational ground, soil organic carbon, economic: Mosquito- grazing systems etc market price, household income security borne • Accuracy and resolution of the disease Prediction/early warning of disease risk to best model(s) - restricted by gaps in our knowledge of the system. Rural pastoral communities - risk avoidance, better human & animal health, lower allocate resources at relevant spatial scales. This is treatment costs, jobs, telecoms access, less forced migration. built on a model of integrated participatory surveillance, in • How to integrate participatory which community members collect data on environmental environmental, ecological and social Local government (e.g. human & animal health services) - quicker, more effective conditions, vector populations, and syndromic data on data in probabilistic models. decision-making. animal and human health. This is supported by • How to make sure that the model Politicians - recognition, social impact. investments in telecommunications. outputs are informative to different Development organizations - social development key performance indications. decision-makers? • Measuring the cumulative impact of Rural & urban pastoral communities (producers) - risk avoidance, household improvements along a value chain on economic improvements. human health and economic Rural & urban pastoral communities (producers) - risk avoidance. Value chain interventions that ensure a low risk of productivity disease introduction from farm to fork. Local and national government - civil servants & politicians - recognition, social • Introduction of environmental stress impact elsewhere in the system (e.g. new markets for animal-sourced foods Private enterprise - better food safety, more revenue drives increased livestock populations) Development organizations - social development key performance indications Installation of solar-powered boreholes for non- irrigation purposes (drinking water) & related • Quantifiable metrics/indicators to Multiple co-benefits spread across rural & urban communities, local and national infrastructure like reticulated pipelines, animal measure impact on human health and government, NGOs & development funders in the realms of clean energy, water watering points etc. economic productivity security, equity and health. Also easily scalable. • Causal pathways Landscape rehabilitation and sustainable • Quantifiable metrics/indicators to Multiple co-benefits spread across rural & urban communities, governance management. Specifically: rehabilitation and restoration measure impact on human health and institutions, NGOs & development funders, private equity financial institutions and of trees and other vegetation types to counteract the economic productivity entrepreneurs. Tree planting in heat exposed areas leads to disease prevention, and Heat effects of degradation and deforestation. • How do co-benefits accrue away from water and biodiversity conservation. Approach also provides leverage for other the location targeted for intervention/ ecosystem-health initiatives. investment? Integrated heat-health behavioral change education • Lack of heat-health early warning program from communities. Specifically: an education systems program for behavioral change required in response to Multiple co-benefits spread across rural & urban communities, local government heat exposure and for managing health complications. • Lack of evidence-based best practice (e.g. community health workers), national government institutions and NGOs & Including; promotion of health work practices in the guidelines on heat-health public development funders. Education is scalable and provides synergies with structural context of heat stress, promotion of WASH, health-health education intervention programs to address the impacts of heat. Education also underpins the early warning triage for vulnerable population with • Lack of incorporating indigenous effectiveness of all other interventions, but is individually ineffective. community health workers, and water intake guidelines. knowledge into education programs 15 Ecosystems, Finance & Health Inception Workshop Participants with a background in economics and finance met to map out the incentives and instruments for financing public health or ecosystem management in Africa. This group also discussed the types of information and measurements that matter to financing organizations when they are deciding whether to invest in projects. Take-home messages from this discussion include: • There are an incredibly diverse range of financing organizations with differing incentives to provide financial support. These range from impact and influence on sustainable development goals, foreign policy and political process, to economic financial returns and managing long-term risk. Some of these incentives align with the interests of scientists. • An equally diverse array of investment vehicles could be leveraged to finance joint improvements in ecosystems, sustainable food systems and public health systems. These include grants to support research and government interventions (e.g. surveillance programs), subsidies and tax incentives to support trade, public goods, and biodiversity conservation, and bonds, equity, loans, debt swaps, blended finance and grants to support sustainable infrastructure, climate resilience and sustainable ecosystem management. • To be attractive to investors, interventions must i) address an unmet need/solution, and be simple to describe, ii) have a clear timeline for completion, iii) demonstrate a quantifiable change, and clearly identify how this will be measured, and iv) fulfill the investor’s mandate - whether for impact, financial returns or both. • Examples of appropriate measurements for an intervention targeting rodent-borne disease through agriculture production systems include change in grain production or profit, change in % organic matter in the soil, change in population of rodent predators and change in health clinic cases or spending on human health. “A diverse array of investment vehicles could be leveraged to finance joint improvements in ecosystems, sustainable food systems and public health systems Members of the finance group, representing Africa Development Bank, CIFOR-ICRAF, FSD Africa, Nature Finance, International Fund for Agricultural Development (IFAD), Kenya National Bureau of Statistics, 12 University of California Irvine & Yale School of the Environment. Ecosystems, Finance & Health Inception Workshop Day 3: 20 March 2024 On day three, participants continued working on case studies before reconvening as a whole group to share their findings. Making an investment case for integrated interventions Adopting a format reminiscent of the popular US TV show "Shark Tank" - where entrepreneurs pitch their ventures for investment - participants from each of the three case studies presented a high-impact intervention to the finance group. Each of these interventions operated at a scale that was spread across the management of ecosystems, food systems and public health, in their respective landscape-disease systems. “ The finance panel evaluated each group’s ‘pitch’, to see whether it could meet the criteria required to be considered an investment opportunity. Given the panel’s Adopting a format diverse background, each interventions was evaluated from the perspective of reminiscent of the investors interested in different types of ‘returns’; profits, value being assigned to assets (such as climate change mitigation), and social and environmental key popular US TV show performance indicators. "Shark Tank”, participants from Insights from this session include: each of the three • Science and finance (particularly in the public sector) often share an end goal case studies of sustainable development impact, but divergent views on implementation presented a high- and measurements of success limit collaboration across these sectors. impact intervention to • There exist significant untapped financial opportunities to support research the finance group. and implementation efforts at the interface between ecosystems, food systems and health. However, for scientists to capitalize on this, perspectives on data collection and types and accuracy of measurements need to be more closely aligned with public and private sector investors. E.g. • Investors are interested in change - so to be interested in an intervention, changes that result from this intervention on the system must be measured. 12 Ecosystems, Finance & Health Inception Workshop • Investors would need to know the effect size of this change, but prioritize a range of certainty over absolute accuracy. • Strengthening financial acumen and knowledge of financing instruments among scientists would also facilitate more effective communication and engagement with the financial sector. Many scientists are unaware of the returns on investment that investors are interested in, even when these overlap with their goals (e.g., social or environmental key performance indicators). • Standard operating protocols for evaluating interventions collect quantitative data that could be translated into economic cost models with relatively little effort. • Blended financial vehicles, with support from development banks like the African Development Bank, can make integration of interventions across landscapes more commercially attractive to investors, by de-risking transactions. “ Bush dinner and storytelling That evening, participants were driven to a large open area of dry river bed at the Robert welcomed the centre of Namunyak Conservancy where they gathered in a large circle for dinner. Before food was served, Samburu warriors entertained everyone with traditional group, gathering song and, for which audience participation was strongly encouraged! After dinner, them around the fire Tilas Lekango (a Samburu elder and workshop participant) presented a charming to speak about the and interactive briefing - complete with laser pointer - on the constellations, first from the point of view of the Samburu and then of the ancient greeks. current Samburu world view and how Robert Lemayian, a Samburu elder and general manager for Sarara, then they are handling the welcomed the group, gathering them around the fire to speak about the current Samburu world view and how they are handling the severe environmental severe environmental challenges facing their ancestral lands. Robert eloquently described how the challenges facing Samburu know their needs and their land and are quite competent to be included their ancestral lands as full participants in planning for land use, grazing and water management. He took questions from the audience, playing the crowd like a master with wit and a clear idea of his message. Many in the group were struck by how comfortable the workshop’s Samburu hosts are with their cultural identities, while embracing the modern world with their deep and insightful knowledge of the challenges we face as a planet. 12 Ecosystems, Finance & Health Inception Workshop Day 4: 21 March 2024 On the workshop’s fourth and final day, participants came together to consolidate views and discuss next steps in developing an investment case for co- management of ecosystems, foods systems and public health. Proceedings were opened by Hon. Pauline Lenguris MP, the Women’s Representative for Samburu and member of the Kenyan Government’s Parliamentary Committee on Health. She expressed her gratitude that Samburu County was chosen as the venue for this workshop. She explained that her role is to represent the Samburu community and spoke very eloquently about the impacts of prolonged drought and emerging healthcare challenges (such as malnutrition and cancer) facing her constituents. She also spoke about the work being done to address these challenges, noting nomadic healthcare programs which are seeking to achieve universal health coverage, biodiversity conservation, and the importance of empowering women as agents of change. Hon. Lenguris finished by pledging the Government’s support to the outcome’s of this workshop, and encouraging participants to work with the Samburu community in Hon. Pauline Lenguris MP - the Women’s Representative for designing projects and interventions. Samburu, addresses workshop participants Open space The rest of the morning was spent identifying gaps and forward actions through a series of small group activities. This visioning exercise was built around the following six questions; • What is the vision, and how can it remain rooted in the origin (Namunyak Conservancy)? • What organizational structures could bring the vision to life? • How do we engage stakeholders who could align with our vision? • What are the key scientific evidence gaps that need to be overcome to design landscape-level ecosystem-food system-health interventions, and measure their impact? • How should we frame the workshop’s scientific and policy outputs, and communicate this to broad audiences? • How do we bridge the gap between science and finance? These conversations were open, allowing participants the freedom to move between groups, reviewing outputs and seeding new ideas. Outcomes from these discussions included: • A vision statement, designed around the future that members of the Namunyak community who participated in the workshop would like to see in 2050, was termed the “Namunyak Declaration”. This vision and guiding principles would serve to anchor EFH to Namunyak, and ensure that future work is guided by the needs and knowledge of local communities. There was also a strong sense that interventions designed with the people of Namunyak could serve as an initial case study for the initiative, with a view towards translation and impact at a much broader scale. Climate Change Adaptation and Mitigation 19 Ecosystems, Finance & Health Inception Workshop “A vision statement, designed around the future that members of the Namunyak community who participated in the workshop would like to see in 2050, was termed the “Namunyak Declaration”. • A series of guiding principles for how EFH should be structured, including the need to: • be anchored on the African continent, • commit to working closely with local communities, embracing diverse knowledge systems and ensuring that they are participants in and beneficiaries of our work, • operate at the interface between science, policy and practice, • have a mission-oriented thematic structure, that is guided by a theory of change and strategic plan • make independent decisions (unconstrained by institutional bureaucracy), • be financially sustainable over the long-term, • have a clear time commitment from team members. • The need to conduct a comprehensive stakeholder mapping process, and use a framework such as RACI (responsible, accountable, consulted and informed) to clarify and define roles and responsibilities when engaging key stakeholders. The “Big 5” - government, communities, academia, NGOs, and financing organizations must be engaged early in the inception process. • Key scientific evidence gaps, which include: • prioritization of diseases that are impacted by global environmental change, based on risk and morbidity/mortality, • can tipping points/thresholds at which degraded ecosystems pose a disease hazard be identified? • generating sufficient causal evidence to simulate the future impacts of multiple interventions on complex environment-food-health systems over time, • collection and harmonization of sufficient data across disciplines, with which the impact of interventions targeting ecosystems, food systems and health could be measured, • understanding how land-use change affects hydrological processes and water security, and what the key indicators of disease associated with this are, • understanding feedback loops between disease risk, health interventions and ‘risky’ behavior, • understanding the environmentally-mediated causal pathways of co-infections/co-morbidities, and their impact on health, 20 Ecosystems, Finance & Health Inception Workshop • how can ecosystem services and infrastructural health system input be connected to outputs that accurately reflect human disease transmission (if infectious), recovery (i.e., morbidity and mortality) and economic productivity? • how does financial risk scale with project size and scope (in terms of interventions)? • Identification of potential outputs targeted at the financing and scientific communities, and outreach materials, which included: • a high-impact position paper presenting the conceptual model and explaining how suitable interventions targeting ecosystems, food systems and public health systems could be identified within a landscape, based on the case studies discussed in this workshop, • a policy brief looking at how science can inform finance architectures, policies and practices, and how finance can be made more accessible to transform science, • policy briefs/finance papers explaining how health and finance measurements could be connected, and making the case for integrating interventions across landscapes as a de- risking mechanism, • scientific papers - e.g. a deep dive into one of the case studies developing during this workshop (such as agroecology and health), evidence gaps, indicators that could be used to measure and extrapolate the impacts of interventions across landscapes, • synthesis of data gaps, a data inventory and data release, framed within the types of landscape-disease systems (and points of intervention) identified in this workshop, • communications materials for the general public (e.g. a workshop report, coordinated press release, an animated YouTube video), and the support of a communications expert, • activities dedicated to highlighting the bi-directional impact of the Namunyak community’s involvement in the workshop, and mechanisms to maintain this engagement moving forward. Way forward In the workshop’s final session, participants reconvened to map these gaps and forward actions against a one-year timeframe. From this, emerged a roadmap for implementation (Figure 2). Participants expressed their willingness to move this agenda forward, and roles and responsibilities were assigned to specific tasks. It was agreed that the workshop co-leads (James and Joseph) would take responsibility for coordinating these forward actions, and spearheading development of the EFH initiative. The group also agreed that participation should be broadened beyond those who were able to attend the workshop, and therefore agreed to find ways in which the broader community of scientists and practitioners working in Africa could be engaged. 12 EFroHad map Phasedapproach PHASE I OBJECTIVES 2024-2025 • Inception workshop • A community of practice to collaborate on workshop outputs • An organizational structure • A 10-year strategic plan, and donor engagement • Core funding to execute the strategic plan PHASE II OBJECTIVES 2025-2035 • Launch EFH’s mission-oriented approach through a ten-year program of activities that allow the initiative to meet its goals & objectives