Financing intersectoral action for health: a systematic review of co-financing models.

BACKGROUND: Addressing the social and other non-biological determinants of health largely depends on policies and programmes implemented outside the health sector. While there is growing evidence on the effectiveness of interventions that tackle these upstream determinants, the health sector does not typically prioritise them. From a health perspective, they may not be cost-effective because their non-health outcomes tend to be ignored. Non-health sectors may, in turn, undervalue interventions with important co-benefits for population health, given their focus on their own sectoral objectives. The societal value of win-win interventions with impacts on multiple development goals may, therefore, be under-valued and under-resourced, as a result of siloed resource allocation mechanisms. Pooling budgets across sectors could ensure the total multi-sectoral value of these interventions is captured, and sectors' shared goals are achieved more efficiently. Under such a co-financing approach, the cost of interventions with multi-sectoral outcomes would be shared by benefiting sectors, stimulating mutually beneficial cross-sectoral investments. Leveraging funding in other sectors could off-set flat-lining global development assistance for health and optimise public spending. Although there have been experiments with such cross-sectoral co-financing in several settings, there has been limited analysis to examine these models, their performance and their institutional feasibility. AIM: This study aimed to identify and characterise cross-sectoral co-financing models, their operational modalities, effectiveness, and institutional enablers and barriers. METHODS: We conducted a systematic review of peer-reviewed and grey literature, following PRISMA guidelines. Studies were included if data was provided on interventions funded across two or more sectors, or multiple budgets. Extracted data were categorised and qualitatively coded. RESULTS: Of 2751 publications screened, 81 cases of co-financing were identified. Most were from high-income countries (93%), but six innovative models were found in Uganda, Brazil, El Salvador, Mozambique, Zambia, and Kenya that also included non-public and international payers. The highest number of cases involved the health (93%), social care (64%) and education (22%) sectors. Co-financing models were most often implemented with the intention of integrating services across sectors for defined target populations, although models were also found aimed at health promotion activities outside the health sector and cross-sectoral financial rewards. Interventions were either implemented and governed by a single sector or delivered in an integrated manner with cross-sectoral accountability. Resource constraints and political relevance emerged as key enablers of co-financing, while lack of clarity around the roles of different sectoral players and the objectives of the pooling were found to be barriers to success. Although rigorous impact or economic evaluations were scarce, positive process measures were frequently reported with some evidence suggesting co-financing contributed to improved outcomes. CONCLUSION: Co-financing remains in an exploratory phase, with diverse models having been implemented across sectors and settings. By incentivising intersectoral action on structural inequities and barriers to health interventions, such a novel financing mechanism could contribute to more effective engagement of non-health sectors; to efficiency gains in the financing of universal health coverage; and to simultaneously achieving health and other well-being related sustainable development goals

Key criteria for developing ecosystem service indicators to inform decision making

Decision makers are increasingly interested in information from ecosystem services (ES) assessments. Scientists have for long recognised the importance of selecting appropriate indicators. Yet, while the amount and variety of indicators developed by scientists seems to increase continuously, the extent to which the indicators truly inform decision makers is often unknown and questioned. In this viewpoint paper, we reflect and provide guidance on how to develop appropriate ES indicators for informing decision making, building on scientific literature and practical experience collected from researchers involved in seven case studies. We synthesized 16 criteria for ES indicator selection and organized them according to the widely used categories of credibility, salience, legitimacy (CSL). We propose to consider additional criteria related to feasibility (F), as CSL criteria alone often seem to produce indicators which are unachievable in practice. Considering CSL & F together requires a combination of scientific knowledge, communication skills, policy and governance insights and on-field experience. We present a checklist to evaluate CSL & F of your ES indicators. This checklist helps to detect and mitigate critical shortcomings in an early phase of the development process, and aids the development of effective indicators to inform actual policy decisions

Trees enhance soil carbon sequestration and nutrient cycling in a silvopastoral system in south-western Nicaragua

Tree occurrence in silvopastoral systems of Central America has been under pressure for various reasons including attempts to improve grassland productivity and the need for wood. However, scattered isolated trees are also recognized to provide ecosystem services like shade, fodder and fruits that are important to cattle in the dry season. In addition, trees may enhance the climate change mitigation potential of silvopastoral systems through increased carbon (C) uptake and subsequent soil carbon sequestration. Through differences in plant traits like nutrient uptake, canopy structure and litter quality, tree species may have an effect on C and nutrient cycling. Due to a prevailing north-easterly wind in the study area, three distinct areas associated with the impact of tree litter deposition were identified: (1) open pasture—no tree litter deposition; (2) tree canopy—above and belowground tree litter; and (3) leaf litter cone—aboveground tree litter deposition. Furthermore, the effect of tree species, Guazuma ulmifolia and Crescentia alata, were considered. The presence of trees, as compared to pasture, caused larger topsoil C, N and P contents. In the subsoil, C content was also larger due to tree presence. Soil fractionation showed that tree-induced larger litter input subsequently increased free and occluded OM fractions and ultimately increased stabilized SOM fractions. Therefore, trees were found to enhance soil C sequestration in these silvopastoral systems. This is also supported by the soil respiration data. Although the respiration rates in the pasture subplots were lower than in the leaf litter subplots, the difference was not significant, which suggests that part of the extra C input to the leaf litter subplots stayed in the soil. Nutrient cycling was also enhanced by tree presence, but with a clear differentiation between species. C. alata (Jı´caro) enhanced available and stabilized forms of organic N, while G. ulmifolia (Gua´cimo) enhanced available soil P and stabilized organic P

Effects of budget constraints on conservation network design for biodiversity and ecosystem services

Limited budgets and budget cuts hamper the development of effective biodiversity conservation networks. Optimizing the spatial configuration of conservation networks given such budget constraints remains challenging. Systematic conservation planning addresses this challenge. Systematic conservation planning can integrate both biodiversity and ecosystem services as conservation targets, and hence address the challenge to operationalize ecosystem services as an anthropocentric argument for conservation. We create two conservation scenarios to expand the current conservation network in the Dutch province of Limburg. One scenario focuses on biodiversity only and the other integrates biodiversity and ecosystem services. We varied conservation budgets in these scenarios and used the software Marxan to assess differences in the resulting network configurations. In addition, we tested the network's cost-effectiveness by allocating a conservation budget either in one or in multiple steps. We included twenty-nine biodiversity surrogates and five ecosystem services. The inclusion of ecosystem services to expand Limburg's conservation network only moderately changed prioritized areas, compared to only conserving biodiversity. Network expansion in a single time-step is more efficient in terms of compactness and cost-effectiveness than implementing it in multiple time-steps. Therefore, to cost-effectively plan conservation networks, the full budget should ideally be available before the plans are implemented. We show that including ecosystem services to cost-effectively expand conservation networks can simultaneously encourage biodiversity conservation and stimulate the protection of conservation-compatible ecosystem services

Spatial prioritisation for conserving ecosystem services : comparing hotspots with heuristic optimisation

Context: The variation in spatial distribution between ecosystem services can be high. Hence, there is a need to spatially identify important sites for conservation planning. The term ‘ecosystem service hotspot’ has often been used for this purpose, but definitions of this term are ambiguous. Objectives: We review and classify methods to spatially delineate hotspots. We test how spatial configuration of hotspots for a set of ecosystem services differs depending on the applied method. We compare the outcomes to a heuristic site prioritisation approach (Marxan). Methods: The four tested hotspot methods are top richest cells, spatial clustering, intensity, and richness. In a conservation scenario we set a target of conserving 10 % of the quantity of five regulating and cultural services for the forest area of Telemark county, Norway. Results: Spatial configuration of selected areas as retrieved by the four hotspots and Marxan differed considerably. Pairwise comparisons were at the lower end of the scale of the Kappa statistic (0.11–0.27). The outcomes also differed considerably in mean target achievement, cost-effectiveness in terms of land-area needed per unit target achievement and compactness in terms of edge-to-area ratio. Conclusions: An ecosystem service hotspot can refer to either areas containing high values of one service or areas with multiple services. Differences in spatial configuration among hotspot methods can lead to uncertainties for decision-making. This also has consequences for analysing the spatial co-occurrence of hotspots of multiple services and of services and biodiversity

Trees enhance soil carbon sequestration and nutrient cycling in a silvopastoral system in south-western Nicaragua

Tree occurrence in silvopastoral systems of Central America has been under pressure for various reasons including attempts to improve grassland productivity and the need for wood. However, scattered isolated trees are also recognized to provide ecosystem services like shade, fodder and fruits that are important to cattle in the dry season. In addition, trees may enhance the climate change mitigation potential of silvopastoral systems through increased carbon (C) uptake and subsequent soil carbon sequestration. Through differences in plant traits like nutrient uptake, canopy structure and litter quality, tree species may have an effect on C and nutrient cycling. Due to a prevailing north-easterly wind in the study area, three distinct areas associated with the impact of tree litter deposition were identified: (1) open pasture—no tree litter deposition; (2) tree canopy—above and belowground tree litter; and (3) leaf litter cone—aboveground tree litter deposition. Furthermore, the effect of tree species, Guazuma ulmifolia and Crescentia alata, were considered. The presence of trees, as compared to pasture, caused larger topsoil C, N and P contents. In the subsoil, C content was also larger due to tree presence. Soil fractionation showed that tree-induced larger litter input subsequently increased free and occluded OM fractions and ultimately increased stabilized SOM fractions. Therefore, trees were found to enhance soil C sequestration in these silvopastoral systems. This is also supported by the soil respiration data. Although the respiration rates in the pasture subplots were lower than in the leaf litter subplots, the difference was not significant, which suggests that part of the extra C input to the leaf litter subplots stayed in the soil. Nutrient cycling was also enhanced by tree presence, but with a clear differentiation between species. C. alata (Jícaro) enhanced available and stabilized forms of organic N, while G. ulmifolia (Guácimo) enhanced available soil P and stabilized organic P

Distant regions underpin interregional flows of cultural ecosystem services provided by birds and mammals.

Ecosystem service assessments rarely consider flows between distant regions. Hence, telecoupling effects such as conservation burdens in distant ecosystems are ignored. We identified service-providing species for two cultural ecosystem services (existence and bequest, and birdwatching) and two receiving, i.e. benefitting, regions (Germany, the Netherlands). We delineated and analysed sending, i.e. service-providing, regions on a global scale. The proportion of service-providing species with distant habitats was higher for birdwatching (Germany: 58.6%, Netherlands: 59.4%), than for existence and bequest (Germany: 49.3%, Netherlands: 57.1%). Hotspots of sending regions were predominantly situated in tropical and subtropical grasslands, savannas and shrublands and were significantly more threatened and poorer than the global mean. Hotspot protection levels for flows to Germany were higher than the global mean, and lower for the Dutch hotspots. Our findings increase understanding on how distant regions underpin ecosystem services and necessitate interregional assessment as well as conservation efforts.Environmental Biolog