Background

Rainforest communities have a wealth of knowledge on living in balance with ecosystems and stopping forest loss. Health in Harmony uses a grounded methodology called Radical Listening to position these communities as climate and conservation experts and address the root causes of rainforest degradation. Instead of designing siloed, sector-based solutions, the communities develop exchange systems based on interdependent elements: healthcare, conservation, livelihoods, and education. Health in Harmony is currently implementing these solutions with rainforest communities in Indonesia, Brazil, and Madagascar. In Indonesian Borneo, a $5.2 million investment over 10 years protected $65 million in carbon, led to a 90% drop in illegal logging households, and a 67% drop in infant mortality. The program costs in Madagascar average $450,000 per year.

The Challenge

Despite being legally protected, the Manombo Rainforest is rapidly shrinking due to slash-and-burn agriculture and uncontrolled anthropogenic wildfires. These activities are rooted in the nutritional and economic poverty of the 7,885 community members living around the Manombo Special Reserve. The local communities suffer from extreme poverty, widespread malnutrition, and inadequate healthcare. Climate change exacerbates these issues, with extended droughts, frequent cyclones, and an unpredictable growing season. Climate-stressed people then resort to degrading forests through slash-and-burn agriculture and logging.

Solutions

To identify solutions to the degradation of the Manombo Rainforest, the experts — the communities living in and around the rainforest — were consulted. The communities identified the need for access to healthcare, alternative livelihoods, and education.

Access to High-Quality and Affordable Healthcare:

The medical team provides healthcare by organizing mobile clinics at locations selected by the communities and accessible to all villages. Patients can pay for healthcare with non-cash means such as seedlings used in our reforestation and agroforestry programs. Communities receive a discount for their healthcare based on how much their communities are extracting from, logging, and hunting in the rainforest monitored by community members referred to as Forest Guardians. This incentive system motivates communities to protect the forest. Healthcare services are coordinated with the national and regional Ministry of Health and directly support the health system’s capacity and resources.

Regenerative Livelihoods:

Communities seek to shift away from slash-and-burn (tavy) agriculture to enhance land use and minimize deforestation and forest fires. Community-designed training in regenerative agriculture covers fast-growing rice varieties that allow three harvests per year, composting to regenerate soil fertility, and vegetable gardening to support diverse diets.

A focus on maintaining and enhancing crop variety to support diversified diets and integrating climate-resilient crops and crop management will lead to higher yield agriculture and nutrient-dense diets.

Education:

Communities have asked for support in primary and secondary education for their children. We will invest in strengthening the public school system by renovating community school buildings and hiring primary and secondary teachers.

Progress Achieved:

Since the programs were implemented in October 2020, over 8,000 patients have been treated at the mobile clinic sites, providing primary care, family planning, and vaccination services.

Training for community health workers was supported, along with close collaboration with four local health centers and the local hospital in the region. Health in Harmony’s Agricultural Technicians have trained 2,000 community members (60% women) in organic farming and rice cultivation techniques. Nine seedling nurseries were built with a capacity of 45,000 seedlings total. 9.44 hectares inside the Manombo National Park were reforested, and communities are about to start implementing agroforestry programs.

Sixty-two Forest Guardians were hired from the community who monitor illegal forest degradation to apply the incentive system to healthcare services.

Infrastructure for 10 out of 13 schools in the region was supported, and close collaboration is ongoing with partners and the Ministry of Education to further support teachers and infrastructure needs for primary and secondary schools.

Lessons Learned:

• COVID-19 has exacerbated the need for a systems-oriented planetary health approach.
• Intersectional funding that supports multiple Sustainable Development Goals (SDGs) simultaneously is scarce.
• With just nine years to significantly address the climate and nature crisis, progress needs to be scaled up.
• This project was replicated in four rainforest sites in three countries: Indonesia, Brazil, and Madagascar.

Next Steps

The goal of this project is to influence government, development, and climate initiatives to listen to and invest in community-designed solutions with our proof of concept site in Indonesia and data from the replication sites in Brazil and Madagascar.

More data should be collected at the replication sites to understand the impact of stabilization on forest loss. Health in Harmony continues to seek and secure intersectional funding that supports human and environmental well-being to ensure the quality of programs at all the sites.

Ultimately, this model can be scaled up through partnerships, a virtual platform, and advocacy.