Integration of Ecological and Socioeconomic Factors in Securing Wildlife Dispersal Corridors in the Kavango-Zambezi Transfrontier Conservation Area, Southern Africa

Transfrontier conservation areas (TFCAs) are being established throughout southern Africa to integrating biodiversity conservation and rural development at the transboundary landscape scale. Among the nine TFCAs that have been established over the past 20 years, the Kavango-Zambezi (KAZA) TFCA) is the most grandiose in terms of size (≈ 520,000 Km2), number of partner countries involved (five), elephant (Loxodonta africana) population (≈ 199,031, which is the largest on the African continent), and encompasses 36 protected areas of various categories, interspaced by communal and private lands. The TFCA concept aims to ensure that key ecological processes continue to function where borders have divided ecosystems, and wildlife migration corridors. Attainment of this ecological objective is however being constrained by the anthropogenic threats, mostly poaching, and habitat fragmentation. These threats are being aggravated by the increasing human population, climate variability and underdeveloped rural livelihoods. To restore ecological processes, the following tactics have been recommended: (a) strengthening of transboundary law enforcement to effectively reduce poaching, and illegal offtake of timber; (b) establishment of “Stepping Stones” in the form of conservancies and fishing protected zones at wildlife crossing point on the major river systems; (c) reducing dependence on wood-fuel, and ensuring sustainable provision of affordable and reliable modern sources of energy; (d) adoption of the commodity-based trade standards in the production of beef for the export market to reduce the impact of veterinary fences on the dispersing wildlife; (e) implementation of early-season burning around all the sensitive biomes to protect them from the destructive late dry season fires; (f) adoption of conservation agriculture as a tool for improving land husbandry, intensification of agriculture, and decreasing the likelihood of cutting down forested areas to plant new agriculture fields; and (g) reducing the impact of climate variability on wildlife by providing artificial water – guided by environmental impact assessments. To enhance the socioeconomic development of the local communities and win them as allies in securing the wildlife dispersal corridors, the following actions should be adopted: (a) promotion of community-private partnerships in ecotourism development – alongside the establishment of a revolving loan fund to enable local communities’ access flexible source of capital for investment in ecotourism and auxiliary business opportunities; (b) promotion of biodiversity stewardship as an incentive for the local communities to commit their land to the sustenance of the wildlife dispersal corridors; (c) reducing human wildlife conflicts, through macro, meso and micro-level land-use planning to spatially delineate land committed to various categories, including protected areas, wildlife dispersal areas, and developed and communal areas; and (d) promotion of harmonised enabling policies and legislation to facilitate slowing down of human population growth, which is one of the prime triggers of habitat fragmentation in the KAZA TFCA

Community Collective Land Stewardship Contributions to Sustainable Rural Development: Lessons from Cubo, Mozambique

This chapter offers lessons on the ineffectiveness of community collective land stewardship as an enabling tool for local communities in semi-arid Africa to adopt biodiversity conservation to diversify their income and contribute to sustainable local-level rural development. While collective community stewardship of land could have transformed local land from an open accessed commodity into a collectively managed resource for community prosperity, and ensuring democratic decision-making, and permanent community benefits for generations, the Mozambique government’s inability to effectively implement the statutes of its land law thwarted the Cubo community’s dream to contribute to local sustainable development, due to competing land use. In the case of Mozambique, a number of factors contributed to the community’s loss of its land to alternative use/agrofuel production, including the government’s inadequate political will to enforce the land law’s statutes; ineffective civil society to protect communities against the booming private interest in land for investment in agro-based businesses; blind loyalty of community members to their traditional leaders who are susceptible to corruption and manipulation by the private sector; illiteracy among community members, which renders them incapable of fully understanding their legal rights to land; and lack of financial capacity for the community to take legal recourse against the government’s violation of its land law. We recommend that the new discourse on land tenure reform in Mozambique should: critically examine the effectiveness of how the government is enforcing its land tenure legislation; consolidate processes of accountable governance, transparency, and promotion of the rule of law. Additionally, Mozambique’s civil society should: (a) proactively influence the government to prioritize implementation of existing laws and policies that promote devolved natural resources management to the local communities, and work on harmonizing cross-sectoral policies and legislation that improve management effectiveness of land and natural resources; (b) strongly advocate for implementation of Community-based Natural Resources Management models that strengthen locally accountable institutions for natural resource management and use—enabling local communities to protect their land and associated resources against foreign acquisitions; (c) improve transparency and effectiveness in enforcing the land law—to ensure that all its statutes are adequately implemented and enforced. The Cubo community’s experience of losing its collectively secured land to alternative uses exemplifies one of the challenges faced in integrating local communities in biodiversity conservation and rural development programs in southern Africa, wherein some situations, power and money could easily trump laws and rules

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Topics, Skills, and Cases for an Undergraduate Musculoskeletal Curriculum in Southern Africa

Background: Most patients with orthopaedic pathology in low to middle-income countries are treated by nonspecialists. A curriculum to prepare undergraduate medical students for this duty should reflect the local pathology and skills that are required to manage patients in a resource-restricted environment. The aim of this study was to establish and prioritize a list of core orthopaedic-related knowledge topics, clinical cases, and skills that are relevant to medical students in southern Africa and areas with a similar clinical context. Methods: A modified Delphi consensus study was conducted with 3 interactive iterative rounds of communication and prioritization of items by experts from Africa, Europe, and North America. Preferred priorities were selected but were limited to 50% of all of the possible items. Percent agreement of ≥75% was defined as consensus on each of these items. Results: Most of the 43 experts who participated were orthopaedic surgeons from 7 different countries in southern Africa, but 28% were general practitioners or doctors working in primary or secondary-level facilities. Experts prioritized cases such as patients with multiple injuries, a limping child, and orthopaedic emergencies. Prioritized skills were manipulation and immobilization of dislocations and fractures. The most important knowledge topics included orthopaedic infections, the treatment of common fractures and dislocations, any red flags alerting to specialist referral, and back pain. Surgical skills for the treatment of urgent care conditions were included by some experts who saw a specific need in their clinical practice, but these were ranked lower. Conclusions: A wide geographic, academic, and expertise-specific footprint of experts informed this international consensus through their various clinical and academic circumstances. Knowledge topics, skills, and cases concerning orthopaedic trauma and infection were prioritized by the highest percent agreement. Acute primary care for fractures and dislocations ranked high. Furthermore, the diagnosis and the treatment of conditions not requiring specialist referral were prioritized. This study can inform national curricula in southern Africa and assist in the allocation of student clinical rotations