How does protected area governance affect access to ecosystem services and local livelihoods? Insights from Madagascar

A global shift towards local community involvement in protected area (PA) governance and co-management has aimed to improve conservation-related equity by reducing costs and their uneven distribution, alongside meeting conservation aims. Co-managed PAs are more likely to achieve socio-economic and biological goals than other governance-types, yet this is not always the case. In order to improve PA-related equity, we need to understand why involvement of local communities in PA governance may not always meet its aims. This thesis explores the links between PA governance processes, access to ecosystem services and livelihood impacts. Integrating The Theory of Planned Behaviour model, IPBES framework, theory of access and Sustainable Livelihoods Framework, it takes a mixed methods approach, drawing on village focus groups, semi-structured interviews and household questionnaires. The case study is a PA in Eastern Madagascar, co-managed by a national NGO and 10 local community associations. Local community participation in governance associations was limited by miscommunication, perceived to have limited benefits and high costs, and these were unevenly distributed within and between communities. Respondents considered provisioning ecosystem services most important, but access was unevenly distributed and shaped by institutions and social identity. Perceived livelihood impacts were also distributed unevenly and the main drivers of this were restricting forest access and establishment of local community associations. This research demonstrates that involvement of local communities in co-managed protected areas does not necessarily reduce local costs, or improve their distribution. Findings from this study have useful and important implications for PA-related equity and meeting Aichi Target 11: (1) incorporating local cultural and social values; (2) ensuring meaningful local participation in decision making; (3) recognition of short-term costs and (4) mixed-methods approaches are vital in order to obtain a better picture of who is winning and losing out from conservation interventions and to inform solutions towards improved equity

Impact of mineral and bone disorder on healthcare resource use and associated costs in the European Fresenius medical care dialysis population: a retrospective cohort study

BACKGROUND: Secondary hyperparathyroidism (SHPT) is associated with mortality in patients with chronic kidney disease (CKD), but the economic consequences of SHPT have not been adequately studied in the European population. We assessed the relationship between SHPT parameters (intact parathyroid hormone [iPTH], calcium, and phosphate) and hospitalisations, medication use, and associated costs among CKD patients in Europe. METHODS: The analysis of this retrospective cohort study used records of randomly selected patients who underwent haemodialysis between January 1, 2005 and December 31, 2006 at participating European Fresenius Medical Care facilities in 10 countries. Patients had ≥ 1 iPTH value recorded, and ≥ 1 month of follow-up after a 3-month baseline period during which SHPT parameters were assessed. Time at risk was post-baseline until death, successful renal transplantation, loss to follow-up, or the end of follow-up. Outcomes included cost per patient-month, rates of hospitalisations (cardiovascular disease [CVD], fractures, and parathyroidectomy [PTX]), and use of SHPT-, diabetes-, and CVD-related medications. National costs were applied to hospitalisations and medication use. Generalised linear models compared costs across strata of iPTH, total calcium, and phosphate, adjusting for baseline covariates. RESULTS: There were 6369 patients included in the analysis. Mean ± SD person-time at risk was 13.1 ± 6.4 months. Patients with iPTH > 600 pg/mL had a higher hospitalisation rate than those with lower iPTH. Hospitalisation rates varied little across calcium and phosphate levels. SHPT-related medication use varied with iPTH, calcium, and phosphate. After adjusting for demographic and clinical variables, patients with baseline iPTH > 600 pg/mL had 41% (95% CI: 25%, 59%) higher monthly total healthcare costs compared with those with iPTH in the K/DOQI target range (150–300 pg/mL). Patients with baseline phosphate and total calcium levels above target ranges (1.13–1.78 mmol/L and 2.10–2.37 mmol/L, respectively) had 38% (95% CI: 27%, 50%) and 8% (95% CI: 0%, 17%) higher adjusted monthly costs, respectively. Adjusted costs were 25% (95% CI: 18%, 32%) lower among patients with baseline phosphate levels below the target range. Results were consistent in sensitivity analyses. CONCLUSIONS: These data suggest that elevated SHPT parameters increase the economic burden of CKD in Europe

Understanding the Implications of Alternative Bioenergy Crops to Support Smallholder Farmers in Brazil

Smallholders constitute more than three quarters of the world’s farmers, and despite their numbers, they commonly lack opportunities to advance their development status. Bioenergy production and consumption can help sustain smallholders’ energy needs and generate employment and income, but it also raises concerns over social justice and equity, especially where crops used for bioenergy could also be used for food. This perspective paper is grounded in a literature review related to three different crops in Brazil: sugarcane, landrace maize and sweet potato. It seeks to determine if these crops offer the potential to support smallholder farmers’ development in a more equitable way, focusing on opportunities for their use in bioenergy. We review the literature to identify policies shaping the smallholder development context in relation to these crops, assessing whose knowledge informs policy and institutional decision making, and highlighting the policy attention afforded to the different crops from different sectors. We further evaluate the literature on each crop in relation to water use and calorific value (i.e., food and energy). Our review indicates that while sugarcane has received the most policy and institutional attention, its development is largely anchored in research and development investments that support large-scale commercial farms and agri-businesses. Smallholders have not benefited or had the opportunity to engage in relevant policy decision making for sugarcane cultivation. At the same time, smallholders hold valuable untapped knowledge on the cultivation of sweet potato and landrace maize, both of which have the potential to generate development opportunities for smallholders. Our review suggests that the environmental impact of landrace maize and sweet potato in terms of water use is significantly lower than sugarcane, while they can generate more calories for energy or food consumption and offer diversification opportunities. Despite that these alternative crops offer considerable untapped potential to support rural development, more research is still needed to harness these benefits. Changes are needed to address inequities in policies, institutions and the types of knowledge informing decision making. Such changes need to afford smallholder farmers greater recognition and participation in decision making, so that the distribution of benefits from the three study crops can reach them to support their development better