Bornean orangutan in West Kalimantan, Indonesia.

Saving Forests with a Stethoscope

By Climatelinks

There is a growing body of evidence that climate change can impact human health through numerous pathways, such as by expanding geographic ranges of climate-sensitive diseases and improving conditions for disease vectors to flourish. Likewise, forest cover is positively linked with child health and nutrition. But can human health affect climate change? Can good healthcare protect a forest?

Dr. Kinari Webb believes it can. Her work, as founder of the NGO Health in Harmony and co-founder with dentist Hotlin Ompusunggu of Indonesia's Alam Sehat Lestari (ASRI, "Healthy Nature Everlasting"), suggests she is right.  By providing innovative health services to communities around Gunung Palung, a national park in West Kalimantan, Indonesia, Dr. Webb and colleagues have seen rapid and dramatic improvements in public health indicators while reducing the number of families involved in illegal logging by 90 percent.

How did ASRI and Health in Harmony realize that health care might help conserve a peat-rich, high-carbon forest of global importance for the Bornean orangutan and other endangered species? This unconventional conservation strategy is the result of “radical listening” sessions in communities around the park, to better understand what drives deforestation and invite local people to share their ideas for solutions.

The listening sessions crystallized two key messages: (1) medical care is too costly, of low quality and hard to access; and (2) illegal logging is one of the only ways to make money. Together, with modest support from USAID’s Indonesia Forest and Climate Support project and others, Health in Harmony and ASRI have been able to test whether convenient, affordable and quality health care might be the key to ending illegal logging.  

ASRI started by building a clinic, then mobile clinics, and more recently a hospital and training center. They also received donated time and materials from American doctors to train and equip Indonesian health professionals. Today, ASRI clinics provide affordable health care, even allowing patients to pay using tree seedlings and native handicrafts (the latter are sold in the United States to defray clinic costs). With community monitors in place to verify compliance, ASRI is also able to offer an incentive-based discount: patients in villages not involved in illegal logging receive up to 70 percent off their bill.

During the radical listening process, farming communities around the park overwhelmingly asked for training in organic agriculture. Health in Harmony found the expertise needed in nearby Java, and through training helped turn farmers away from traditional, land-hungry shifting cultivation to more intensive organic agriculture. Farmers in communities served by ASRI now produce more food on less land using inexpensive local inputs, including organic manure accepted by clinics as payment for health services.

After just five years of improved healthcare and organic agriculture training in 32 villages around the park, rates of infant mortality, fever, diarrhea and other public health indicators decreased dramatically. In the same period, the number of families involved in logging declined by two-thirds, from an estimated 1,350 in 2007 to about 450 in 2012. Half of those ex-loggers now make a living by farming, often applying ASRI’s sustainable approaches. Today, fewer than 150 families still log trees—a nearly 90 percent decline from when the program began. ASRI, now comprised of over one hundred staff, nearly all of whom are Indonesian, hopes to reach these remaining loggers through a chainsaw buy-back program and continued organic agriculture training.
Can this approach--and its impressive results--be replicated? Dr. Webb was among the environmental innovators and thought leaders at Smithsonian’s Earth Optimism Summit in Washington, DC in April, and stopped by USAID to discuss plans to test the model in other places with forests under threat. We identified some of the enabling conditions that seem key to success, like clear land tenure and existing local support for conservation among Gunung Palung communities. The discussion also highlighted that drivers of resource degradation vary by place, along with capacity and willingness to change unsustainable practices. A clear theory of change, rigorous monitoring, and possibly even elements of experimental design could all be useful for detecting the effectiveness of the approach in new contexts.

Health in Harmony likes to describe their healthcare-as-conservation approach as “saving forests with a stethoscope.” This metaphor also describes “radical listening,” since stethoscopes help us hear what we otherwise cannot. Wherever Kinari Webb takes this model next, radical listening will be critical to devising effective and sustainable solutions that address the root causes of forest loss.


Learn more:
Strategic Objective
Biodiversity, Forestry, Health, Land Use, Sustainable Landscapes



Climatelinks is a global knowledge portal for USAID staff, implementing partners, and the broader community working at the intersection of climate change and international development. The portal curates and archives technical guidance and knowledge related to USAID’s work to help countries mitigate and adapt to climate change. 

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