Allocating group-level payments for ecosystem services: experiences from a REDD+ pilot in Tanzania

Payments for ecosystem services (PES) typically reward landowners for managing their land to provide ecosystem services that would not otherwise be provided. REDD+—Reduced Emissions from Deforestation and Forest Degradation—is a form of PES aimed at decreasing carbon emissions from forest conversion and extraction in lower-income countries. A key challenge for REDD+ occurs when it is implemented at a group, rather than an individual landowner, level. Whilst achieving a group-level reduction relies on individuals changing their interaction with the forest, incentives are not aligned explicitly at the individual level. Rather, payments are made to a defined group as a single entity in exchange for verified reduced forest loss, as per a PES scheme. In this paper, we explore how REDD+ has been implemented in one multiple-village pilot in Tanzania with the village defining the group. Our findings suggest that considerable attention has been paid towards monitoring, reporting, verification (MRV), and equity. No explicit mechanism ensures individual compliance with the village-level PES, and few villages allocate funds for explicit enforcement efforts to protect the forest from illegal activities undertaken by individual group members or by outsiders. However, the development of village-level institutions, “social fencing,” and a shared future through equal REDD+ payments, factor into decisions that influence the level of compliance at the village level that the program will eventually achieve

Causes of HIV-related CNS infection in Cameroon, Malawi, and Tanzania: epidemiological findings from the DREAMM HIV-related CNS implementation study

Background CNS infections cause approximately a third of HIV-related deaths. The Driving Reduced AIDS-Associated Meningo-encephalitis Mortality DREAMM study aimed to prospectively diagnose the aetiology of HIV-related CNS infection in five public hospitals in Cameroon, Malawi, and Tanzania. Methods DREAMM was a multicentre, hybrid type-2 implementation science project. Adults (aged ≥18 years) presenting with a first episode of suspected CNS infection, who were HIV seropositive or willing to have an HIV test, were eligible for recruitment. Following implementation of the DREAMM model of care, we measured the prevalence of cryptococcal meningitis, tuberculous meningitis, bacterial meningitis, and cerebral toxoplasmosis and did a χ2 test to assess whether prevalence differed between countries. We also reported disease-specific mortality and Toxoplasma gondii seroprevalence. Findings Of 356 participants with suspected CNS infection analysed at baseline, 269 (76%) were diagnosed as having a CNS infection. Of these, 202 (75%) had a confirmed diagnosis. Between Cameroon, Malawi, and Tanzania, the prevalence of the four main types of CNS infection differed (cryptococcal meningitis p=0·0014, bacterial meningitis p=0·0043, CNS tuberculosis p<0·0001, and toxoplasmosis p<0·0001). Cryptococcal meningitis (148 [55%] of 269) was the leading cause overall. The next most common causes were CNS tuberculosis in Tanzania (29 [29%] of 99) and bacterial meningitis in Malawi (15 [19%] of 80). In Cameroon, cerebral toxoplasmosis (39 [43%] of 90) was the leading cause followed by cryptococcal meningitis (36 [40%] of 90). For cryptococcal meningitis, all-cause 2-week mortality was 23% (34 of 147) and all-cause 10-week mortality was 45% (66 of 146). Interpretation Within the study population, the aetiology of HIV-related CNS infection varied substantially between Malawi, Cameroon, and Tanzania. Additional prospective epidemiological data are needed to inform HIV programmes. 2-week cryptococcal meningitis mortality outcomes were similar to those of clinical trials. However, new interventions are urgently needed to sustain mortality reductions following hospital discharge. Funding European and Developing Countries Clinical Trials Partnership and French Agency for Research on AIDS and Viral Hepatitis. Translations For the French and Portuguese translations of the abstract see Supplementary Materials section

Reduction in mortality from HIV-related CNS infections in routine care in Africa (DREAMM): a before-and-after, implementation study.

BACKGROUND: Four decades into the HIV epidemic, CNS infection remains a leading cause of preventable HIV-related deaths in routine care. The Driving Reduced AIDS-associated Meningo-encephalitis Mortality (DREAMM) project aimed to develop, implement, and evaluate pragmatic implementation interventions and strategies to reduce mortality from HIV-related CNS infection. METHODS: DREAMM took place in five public hospitals in Cameroon, Malawi, and Tanzania. The main intervention was a stepwise algorithm for HIV-related CNS infections including bedside rapid diagnostic testing and implementation of WHO cryptococcal meningitis guidelines. A health system strengthening approach for hospitals was adopted to deliver quality care through a co-designed education programme, optimised clinical and laboratory pathways, and communities of practice. DREAMM was led and driven by local leadership and divided into three phases: observation (including situational analyses of routine care), training, and implementation. Consecutive adults (aged ≥18 years) living with HIV presenting with a first episode of suspected CNS infection were eligible for recruitment. The primary endpoint was the comparison of 2-week all-cause mortality between observation and implementation phases. This study completed follow-up in September, 2021. The project was registered on ClinicalTrials.gov, NCT03226379. FINDINGS: From November, 2016 to April, 2019, 139 eligible participants were enrolled in the observation phase. From Jan 9, 2018, to March 25, 2021, 362 participants were enrolled into the implementation phase. 216 (76%) of 286 participants had advanced HIV disease (209 participants had missing CD4 cell count), and 340 (69%) of 494 participants had exposure to antiretroviral therapy (ART; one participant had missing ART data). In the implementation phase 269 (76%) of 356 participants had a probable CNS infection, 203 (76%) of whom received a confirmed microbiological or radiological diagnosis of CNS infection using existing diagnostic tests and medicines. 63 (49%) of 129 participants died at 2 weeks in the observation phase compared with 63 (24%) of 266 in the implementation phase; and all-cause mortality was lower in the implementation phase when adjusted for site, sex, age, ART exposure (adjusted risk difference -23%, 95% CI -33 to -13; p<0·001). At 10 weeks, 71 (55%) died in the observation phase compared with 103 (39%) in the implementation phase (-13%, -24 to -3; p=0·01). INTERPRETATION: DREAMM substantially reduced mortality from HIV-associated CNS infection in resource-limited settings in Africa. DREAMM scale-up is urgently required to reduce deaths in public hospitals and help meet Sustainable Development Goals. FUNDING: European and Developing Countries Clinical Trials Partnership, French Agency for Research on AIDS and Viral Hepatitis. TRANSLATIONS: For the French and Portuguese translations of the abstract see Supplementary Materials section

Diagnosing scaling bottlenecks in 10 community conservation initiatives in southern and eastern Africa

Scaling area‐based conservation, including initiatives led or comanaged by Indigenous Peoples and local communities, is a flagship goal of the Kunming‐Montreal Global Biodiversity Framework. Conservationists often aspire to scale initiatives, but this is rarely achieved in practice. Identifying and addressing factors that limit initiative adoption (i.e., bottlenecks) could improve scaling strategies. We used insightsfrom 84 expert surveys to identify potential risk factors and bottlenecks to scaling 10 community, area‐based initiatives in southern and eastern Africa. The number of reported potential risk factors and bottlenecks varied among initiatives. However, unfair benefit sharing, unequal decision‐making, inflexible rules, and top‐down leadership were frequently identified as bottlenecks. Although adopting initiatives had costs (e.g., increased local conflicts, reduced local access to natural resources and cropland), most experts believed these costs were offset by other benefits and thus did not constitute bottlenecks. Our results did not capture local perspectives, but they suggest scaling strategies that strengthen environmental governance may support more socially just and durable approaches to meeting area‐based conservation goals

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance.

Investment in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing in Africa over the past year has led to a major increase in the number of sequences that have been generated and used to track the pandemic on the continent, a number that now exceeds 100,000 genomes. Our results show an increase in the number of African countries that are able to sequence domestically and highlight that local sequencing enables faster turnaround times and more-regular routine surveillance. Despite limitations of low testing proportions, findings from this genomic surveillance study underscore the heterogeneous nature of the pandemic and illuminate the distinct dispersal dynamics of variants of concern-particularly Alpha, Beta, Delta, and Omicron-on the continent. Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve while the continent faces many emerging and reemerging infectious disease threats. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

The Marginalization of Sustainable Charcoal Production in the Policies of a Modernizing African Nation

Charcoal is the main cooking fuel for urban populations in many African countries. Urbanization and population growth are driving an increase in demand for charcoal, whilst deforestation reduces biomass stocks. Given increasing demand for charcoal, and decreasing availability of biomass, policies are urgently needed that ensure secure energy supplies for urban households and reduce deforestation. There is potential for charcoal to be produced sustainably in natural woodlands, but this requires supportive policies. Previous research has identified policy issues that have contributed to the charcoal sector remaining informal and environmentally destructive. In this paper, we describe how national policies in Tanzania on energy, forests, agriculture, land, and water, consider charcoal, and the degree to which they do, and do not, support sustainable charcoal production. The paper identifies policy gaps and a cross-sector tendency to marginalize natural forest management. By adopting a nexus approach, the paper highlights the inter-connections between sustainable charcoal production, ecosystem services, and trade-offs in the allocation of land, labor, and net primary production. In conclusion, sustainable charcoal production has been marginalized in multiple national policies. As a result, potential benefits of sustainable charcoal production are lost to multiple sectors

A triple win? The impact of Tanzania’s Joint Forest Management programme on livelihoods, governance and forests

Only data used in the analysis published in the Final Report to 3ie on the project, "“The impact of Tanzania’s Joint Forest Management programme on livelihoods, governance and forests" (project code OW3.1109). This project was funded as part of the Open Window Round 3. The data and analysis have not been verified by 3ie as the authors have not submitted the statistical code files to 3ie

A triple win? The impact of Tanzania’s Joint Forest Management programme on livelihoods, governance and forests

Only data used in the analysis published in the Final Report to 3ie on the project, "“The impact of Tanzania’s Joint Forest Management programme on livelihoods, governance and forests" (project code OW3.1109). This project was funded as part of the Open Window Round 3. The data and analysis have not been verified by 3ie as the authors have not submitted the statistical code files to 3ie