COM M E N T A R Y

A Conservation Health Program

in Indonesian Borneo:
Lessons Learned
Lorraine B. Shamalla-Hannah,
Sonja M. Likumahuwa, Robbie Ali

This commentary provides a synopsis and evaluation of the

Kelay Conservation Health Program (KCHP) and lessons
learned through the program that may be applicable to
other conservation projects. The KCHP is an example of a
collaboration of multiple stakeholders (university, non-

cept encompassing lack of income, ill health, and the lack

of access to basic social services ~World Health Organization, 1998!. Remote areas are often underserved by both
government and non-governmental programs and may lack
basic infrastructure such as electricity, clean water, and
sanitation services. Poverty impacts conservation outcomes because it influences how people value the protection of natural resources. When it threatens their basic
livelihoods, the conservation of natural resources and biodiversity is often a low priority for populations in remote
areas. In the developing world, many conservation organizations struggle to find a balance between development
interests, policy makers, local communities, and activist
groups. To be effective in the long term, though, conservation activities must change peoples knowledge, attitudes, and beliefs about natural resource management.

governmental organization, and local government) that uses

medicine in the service of conservation. The program site in
Indonesian Borneo (Kalimantan) is noted for its exceptionally high biodiversity value, with a human population whose
health and well-being are deeply linked to the rainforest
ecosystem. The KCHP has a dual agenda: (1) to improve
health for local people, and (2) to allow more effective
conservation of critical rainforest habitat. As such, it is a
unique example of a conservation agency collaborating
with a government health department to improve health
and healthcare for people living in a conservation target
area. A comprehensive evaluation indicated that the program has had significant positive impacts on both health
and conservation in the area it serves, at a total cost of
about $62,500 (USD). The KCHP has allowed an international conservation organization to further its orangutan

The Nature Conservancy ~TNC! creatively and effectively

addressed the needs of human populations while strengthening its orangutan conservation program through its Kelay
Conservation Health Program ~KCHP!. The KCHP used a
broad-based, multi-stakeholder approach that worked within
the existing public health system to support the provision
of primary healthcare to the tribal villages that inhabit the
periphery of the targeted orangutan conservation area in
Indonesian Borneo. This method not only addressed a
basic human right of the people ~health!, but also built
goodwill for the conservation program. Key decision makers, such as the district and provincial governments, as well
as the villagers themselves, saw the health program as a
tangible product that made them more willing to negotiate
environmental conservation targets. The KCHP can serve
as a model for other conservation organizations that are
working in contexts where there is human need alongside
environmental need. This commentary discusses the KCHP,

conservation goals while addressing human needs in the

conservation area.
Environmental Practice 10: 2028 (2008)

any international environmental organizations work

in conservation target areas where there are impoverished, isolated, and/or marginalized human populations
living nearby. Human poverty is a multi-dimensional con-

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Environmental Practice 10 (1) March 2008

Affiliation of authors: Lorraine B. Shamalla-Hannah, University of

Pittsburgh, Pittsburgh, Pennsylvania; Sonja M. Likumahuwa, University
of Pittsburgh, Pittsburgh, Pennsylvania; Robbie Ali, Center for Healthy
Environments and Communities, University of Pittsburgh Graduate School
of Public Health, Pittsburgh, Pennsylvania
Address correspondence to: Robbie Ali, Director, Center for Healthy
Environments and Communities, University of Pittsburgh Graduate School
of Public Health, A226A Crabtree Hall, 130 DeSoto St., Pittsburgh, PA
15261; ~e-mail! rali@pitt.edu.
2008 National Association of Environmental Professionals

doi:10.10170S1466046608080010

Figure 1. Remaining forest cover and orangutan distribution in Kalimantan ~Indonesian Borneo! based
on 2002 data ~source: Conservation Breeding Specialist Group, 2004; used with permission!. Location
of project site is marked.

including the program background, components, and

evaluation.
Country Background: Indonesia is an archipelago of about
17,000 islands in Southeast Asia, home to approximately
245.5 million inhabitants with a diversity of culture, indigenous beliefs, religions, and ethnicities that spread across
the islands ~Information Please, 2007!. The island of Borneo is divided between Indonesia, Malaysia, and Brunei
Darussalam, and the Indonesian region of Borneo is called
Kalimantan. The population of Kalimantan is 70% rural
~Brookfield, Potter, and Byron, 1995!. Out of a total population of 9 million inhabitants, its forests are home to 3
million indigenous Punan Dayak people ~Brundtland, 1999!.
The forests that cover approximately 60% of Indonesia
support the worlds second highest level of biodiversity,
including many large animals found nowhere else ~Information Please, 2007!. One major environmental problem
Indonesia faces is the endangering of local animal species
due to deforestation activities such as logging, mining, and
the replacement of rain forests with palm oil plantations.

Challenges to the protection of Indonesias forests include

financial constraints, logging, corruption, political instability, and local poverty ~Brack and Hayman, 2001!.
Orangutan: The orangutan, found only in the rainforests
of Borneo and Sumatra in Indonesia, is one victim of
deforestation. The number of orangutans left in the world
is estimated to have decreased from 200,000 or more a
century ago to about 20,000 today ~van Schaik and van
Duijnhoven, 2004!. In 2002, an unexpectedly large population of orangutans ~some 1,5002,000, representing perhaps 10% of their total world population! was reported in
one of the last large tracts of lowland rain forest in Indonesia, a remote part of the Berau District of East Kalimantan ~Marshall, 2002!.
TNC made this area a conservation priority, with the goal
of making the district an appropriate model of sustainable
natural resource management suitable for replication at
the East Kalimantan provincial level and at other locations
throughout Indonesia. Village farmer education projects

Conservation Health Program in Borneo

21

and other community, commercial, and policy level forest

resource management programs were begun by TNC. Discussions in April 2002 between one of the authors and
TNCs East Kalimantan Program Director suggested that
the Punan villages along the Kelay River in the Berau
District would be an appropriate location for a conservation health program to complement and augment TNCs
orangutan conservation work.
The approximately 1,000 Kelay Punan villagers were moved
to their present location in the early 1980s through government and church settlement schemes. Prior to that, the
villagers had lived farther upriver within the rainforest,
where they led a semi-nomadic, hunter-gatherer existence
~Abe et al., 1995!. The Punan thus represent an indigenous
group with close economic and cultural ties to the rainforest. They have an intrinsic interest in conservation, as
they are in many ways a part of the ecosystem TNC is
trying to protect. Staff at TNC indicated that local healthcare standards among the Punan were very rudimentary, in
part because the seven Punan villages are accessible only by
river. Human population density in the district was low,
and logging in the area had not yet expanded to levels seen
in other parts of the island.

Aim of the Program

The KCHP is a collaboration of TNC, Community Outreach Initiatives ~an Indonesian non-governmental organization specializing in health education!, and the Berau
District Health Department. The programs primary objective was effective conservation of critical rainforest habitat. A secondary objective was to improve the healthcare
of the local people who live in the conservation target area.
The project worked to understand the basic needs of the
population and then educated TNC staff about the local
communitys heath care needs. Healthcare programs were
implemented to improve the basic needs of the community, resulting in improved community understanding of
the environment and increasing acceptance of conservation. TNCs image among local decision makers was dramatically improved, enabling key short-, medium-, and
long-term conservation targets to be achieved.

Methods
Funding of $50,000 ~USD! was identified through TNC
that would support a health component for the first two
years. In order to implement the program, identification of

22

Environmental Practice 10 (1) March 2008

local stakeholders was determined, health and demographic data were collected from the local government,
two baseline surveys of target villages were conducted, a
conservation health assessment was conducted, and a conceptual framework was developed and implemented.

Stakeholders
District-level support for local projects became critical after
the decentralization of government in Indonesia, beginning in 1999. As part of the strategy to protect the Berau
forests, TNC had to establish strong relationships with the
Berau District government officials. On a visit to the United
States in 2002, TNC staff and Berau District government
officials met with one of the authors of this article and
pledged support for the health program. That meeting laid
out a plan, which was later approved by the national and
provincial health ministries, to improve healthcare delivery
to the remote villages in the Kelay sub-district.
The next step was to identify additional stakeholders for
the health program. A partnership was established with
Mulawarman University Medical College, the only medical
college in East Kalimantan. An additional partnership was
established with Community Outreach Initiatives, an Indonesian non-governmental organization that has extensive experience in community health assessments, village
health worker training, and project monitoring. A TNC
staff person was assigned to manage the health program,
which was contracted to Community Outreach Initiatives
as the implementing agency.

Preliminary ResearchData Collection

Before village-level field assessments could be conducted,
data were collected from the district government on health
and healthcare issues in the target region and on the local
demographics, transportation system, and any additional
information that could be relevant to the program. Staff
members at TNC prepared current reports on the conservation situation ~ecology and conservation priorities, forest cover, logging activity, etc.! and the socioeconomic
conditions in the project locale. In addition, key informant
interviews were conducted with government officials at the
national, provincial, district, and sub-district levels, and
with other stakeholders, including healthcare providers,
TNC, and non-governmental organization staff.
Following the data collection, a preliminary assessment of
health and healthcare at the village level was conducted to
allow the survey team to make direct observations of the

local conditions. The team also examined health facility

records and held structured and unstructured interviews
with village leaders, residents, and local health workers.

What threats and assets impact conservation?

Can these actions assist in conservation?

Baseline Study
An initial baseline study was conducted, and the results
indicated that a more detailed baseline survey of target
villages needed to be planned and designeda plan that
was adapted from Community Outreach Initiatives existing repertoire of methods. The second, more detailed baseline study involved 286 adults from seven program target
villages in Kelay and 120 adults from three comparison
villages in Segah. Questionnaires consisted of demographic
questions followed by a series of questions regarding knowledge, attitudes, and practices related to priority topics in
health, the environment, and economic development. Also
included were questions designed to gauge access to healthcare and the burden of disease in these communities from
tuberculosis, malaria, and childhood diarrhea. For mothers
of children under five years old, additional questions were
asked about numbers of children born and still living,
numbers of additional children wanted, and knowledge,
attitudes, and practices about family planning, nutrition,
and diseases, as well as about prenatal healthcare received,
immunizations, well-baby care, and child growth monitoring.

Assessment PlanData Collection

Staff members from TNC and Community Outreach Initiatives, along with one of the authors, met in East Kalimantan to plan an assessment of the targeted area in order
to obtain more information for the creation of the program. This assessment would be a conservation-health assessment, which consists of a broader scope than a typical
health assessment. The conservation-health assessment would
examine community health status, healthcare needs, healthcare assets, and service gaps. This information would help
identify:

What links exist between health and the environment?

What actions can be taken to improve the local health of
community members?

The data collected through the conservation-health assessment helped formulate a conservation-health agenda, wherein:

The health and conservation agendas had overlapping

goals and strategies;

When health and conservation goals coincided, the program could determine a focus point;

When health and conservation goals did not coincide,

strategies were devised to bring them together when
possible;

Consideration was given to actions that were likely to

affect both health and conservation goals; and

The program was planned and executed with the aim

that both its processes and its outcomes would have
maximum positive impact on both health and conservation.

Conceptual Framework
After all data were collected and analyzed, the programs
collaborators and village leaders worked to form the conceptual framework of the village-focused conservationhealth program. The conceptual framework was based in
the hierarchical Indonesian public healthcare system ~see
Table 1!. The Posyandu is the first level of village healthcare
delivery, providing basic elements of maternal and child
healthcare, including family planning, immunizations,
nutrition, and diarrheal disease control. Puskesmas are
second-level health clinics, staffed by nurses or doctors.
The Posyandu is staffed by volunteer health workers ~kaders! who receive three to six days of initial training from
Puskesmas nurses. During monthly visits, Puskesmas nurses

Table 1. The Indonesian public health system at and below the district level
Administrative unit
District
Sub-district
Sub-district ~as needed for larger
sub-districts!
Village
Village

Type of health center

Staff

Hospital
Puskesmas ~community health center!
Puskesmas Pembantu ~Pustu!~community health
sub-center!
Polindes ~village health post!
Posyandu ~integrated service post!

Doctors and nurses

Staffed by at least one doctor
Nurse on staff
Village midwife
Kaders ~community health volunteers!

Conservation Health Program in Borneo

23

monthly visits included immunizations of children and

pregnant mothers, weighing of children, provision of
supplemental food for children from six months to five
years of age who were below normal weight, and education of both kaders and mothers. As the program
progressed, TNC employed a physician to attend the
visits on a bimonthly basis.

supervise the Posyandu volunteers and hold prenatal and

well-child sessions in the village ~Peterson, 2000!. In the
isolated Punan villages in the Berau District, though,
the public healthcare system was no longer functioning:
the villages had no trained health workers and only sporadic visits by nurses.
The framework intended to improve both conservation
outcomes and human health, with the main focus on maternal and child health. This was achieved in two ways: by
augmenting and supporting the local government health
system at the Puskesmas and Posyandu levels, and by training volunteer village health workers and villagers in a range
of disease prevention and primary care measures. According to the 2000 census, the program planned to reach out
to 1,072 persons, including all seven program villages in
Kelay.
In the first half of the program, planning meetings for
project implementation were held with District Ministry of
Health staff and sub-district Puskesmas staff. The meetings
revealed that the most critical needs were for additional
nursing staff and the re-establishment of monthly Posyandu in the program area villages. District officials were
already attempting to address the nursing shortage issue by
training local high school students as nurses in a special
program. The KCHP was able to include these new nurses
in the program training modules and provide the following services:

24

Health worker and kader training: The initial KCHP

training by Community Outreach Initiatives staff took
place in three modules, each approximately one week in
length. The first module was a training of trainers that
included TNC and health center staff and aimed at developing effective agents for mobilizing community health.
The second module trained Puskesmas nurses in the
diagnosis and management of common clinical conditions. The third module concentrated on the village
level, providing training for the Posyandus and kaders.
The kaders were literate, enthusiastic village residents,
identified by local government and project staff along
with local village heads, who were thought to be suitable
for the role.
Mobile health clinic: A monthly mobile health clinic
consisting of TNC and Kelay Puskesmas staff began
operating in five program villages and eventually included all seven program villages, with boat transportation for the program provided by TNC. Activities at

Environmental Practice 10 (1) March 2008

Water projects and medicinal gardens: With the assistance of village residents, a pipe system providing clean
water from a mountain spring was installed in Long
Sului. A few months later, an additional piped water
system was installed at Long Boi. The villages established committees to monitor the water pipes. In addition, demonstration garden plots growing forest medicinal
plants were started in program villages.

Liaison between villages and district government: Since

the creation of KCHP, TNC coordinated program activities with a group of representatives from the Family
Welfare Bureau, a politically influential governmental
organization that includes wives of high-ranking officials like the District Chief. This collaboration has improved local support for KCHPs activities and programs
in health and conservation. Also, TNC was able to support a meeting of kaders from all program villages with
government officials in the district capital, Tanjung Redeb.

Results
Evaluation Methods
A team comprised of representatives from TNC, the Berau
Health Department, the Medical College at Mulawarman
University, and the Graduate School of Public Health at the
University of Pittsburgh conducted a comprehensive evaluation of the KCHP project. The evaluation covered total
costs ~determined from TNC records! and program processes and activities ~through interviews with program staff
and a review of KCHP records!.
The program outcomes evaluation consisted of qualitative
components such as interviews, focus groups, and direct
observations of program activities. A quantitative assessment compared baseline data and follow-up household
surveys. For some portions of the questionnaire-based assessments, 120 residents from three villages in the adjacent
Segah River and sub-district served as a comparison population for the intervention villages in Kelay.

A quasi-experimental study was conducted to measure program impacts while attempting to control for factors besides the intervention ~such as regional socioeconomic trends,
changes in the physical environment, etc.! that may have a
confounding effect on the programs impact. In the quasiexperimental design, program impacts are assessed by using
a difference in differences approach, wherein, in the present
case, the differences in selected indicators between baseline
and follow-up assessments in Kelay are compared with the
differences between baseline and follow-up assessments in
Segah. Significant differences from baseline to follow-up
for these indicators were tested for using Chi-square analysis, while the Breslow-Day Test was used to test for difference in differences.

Results of Evaluation
TNCs conservation efforts in East Kalimantan during the
three-year KCHP were remarkably successful. The program succeeded in creating goodwill among local village
communities and strong partnerships among the groups
involved, as well as in providing medicine in the service of
conservation to improve the healthcare needs of the people
living in the targeted area.
The question of whether KCHP has impacted conservation
beyond improving health is critical; however, conservation
impacts are more difficult to detect than health impacts,
especially within a short time frame. Therefore, it is difficult to attribute a given outcome to a single intervention.
Also, TNCs conservation effort in Berau is affected by
both a political and social process involving multiple strategies and actions that may be influenced by political, economic, organizational, and individual factors, many of which

are simply beyond the programs control. The following

results were determined by the program evaluation:

Program costs: The total cost for the KCHP over a

two-year period was $62,500. TNC has estimated that it
will cost the KCHP an additional $20,000 per year, or
approximately $20 per person in the villages served, in
order to run the program.

Health impacts: There was a general consensus among

individuals being interviewed that the KCHP is an important and valuable program and addressed the need
for basic healthcare in program villages. The individuals
interviewed felt that KCHP had contributed significantly to improving the health of their children. User
satisfaction of the Posyandu and health services supported by TNC was also high. The results of a survey
indicated that satisfaction with village healthcare in Kelay
was 92%, while satisfaction with Posyandu was 100%
among participants. The perceived value of the health
program among residents of these villages was also high,
with 63% of respondents stating they had heard of TNC
~see Table 2!, further affirming that the health program
was the most useful thing that TNC was doing in their
villages.
In the quasi-experimental component of the programs
evaluation ~see Table 3!, clear program impact in Kelay
was demonstrated in the areas of maternal smoking
reduction and improved prenatal and well-child care,
with increased immunization rates among pregnant
women and children. Smoking was significantly reduced
among young mothers in program villages as compared
to non-program villages. The immunization of children
increased dramatically from 0% to 85% within two years.
There was also an increase in the number of children
who had health card records, as well as an increased rate

Table 2. Conservation survey results for all respondents

% who had heard of TNC

% who knew of at least some
aspects of TNCs activities
% who felt TNC had been helpful
or very helpful to their community
% who participated in land-use
decisions in their community
% who were active in a community
group deciding about forest use

Kelay 2003
(N = 286)

Kelay 2005
(N = 280)

Chi 2
p-value

Segah 2003
(N = 120)

Segah 2005
(N = 128)

Chi 2
p-value

41%
15%

51%
39%

0.015
,0.001

36%
11%

36%
28%

0.986
0.001

0.196
0.784

19%

35%

,0.001

8%

23%

0.002

0.756

33%

61%

,0.001

23%

55%

,0.001

0.518

28%

45%

,0.001

18%

41%

,0.001

0.286

Breslow-Day
p-value

Conservation Health Program in Borneo

25

Table 3. Health survey results for mothers with children under five years old

% surviving children born to mothers

with children under five years
of age*
% mothers who were smokers
% mothers who had received no
immunizations during their last
pregnancy**
% eligible children who had received
standard childhood immunizations**
% eligible children who had received
vitamin A**
% children who had a recorded visit
to a health provider within the
past six months**
% mothers unable to identify any
food sources of vitamin A
from a list
% mothers unable to identify any
foods that can prevent anemia
from a list
% mothers unable to identify danger
signs of severe diarrhea

Kelay 2003
(N = 73)

Kelay 2005
(N = 89)

80.6%

86.3%

41%
32%

19%
15%

0%

Chi 2
p-value

Chi 2
p-value

Segah 2003
(N = 32)

Segah 2005
(N = 29)

90.9%

92.3%

0.702

0.636

,0.001
,0.001

13%
31%

17%
36%

0.400
0.395

,0.001
,0.001

85%

,0.001

3%

39%

,0.001

,0.001

0%

36%

,0.001

0%

0%

,0.001

0%

85%

,0.001

3%

15%

0.002

,0.001

74%

65%

0.018

75%

60%

0.013

0.447

60%

43%

,0.001

74%

57%

0.005

0.823

56%

27%

,0.001

56%

37%

,0.001

0.156

0.069

Breslow-Day
p-value

*The survival rate among children born to mothers of children less than five years old was determined as the total number of respondents surviving children
divided by the total number of children born to respondents. That is,
number of surviving children
total number of children born.
**For 2005, N includes only children born after the program began in May 2004 and their mothers, since that is the only sub-population potentially affected by
the program.

of visits to a health provider within the past six months.

Additional data indicated that the survival rate of children under five years of age increased in program villages, from 80.6% to 86.3%, with a Chi-square p-value
of 0.069; however, this increase could not be demonstrated as significantly larger than that seen in nonprogram villages, where survival rates also increased.

26

Health education: Knowledge of health and nutrition

did improve among mothers in program villages, but
not significantly when compared to non-program villages. The program had a slower impact on health education versus health provider services. This limitation
could have been a direct result of not always being able
to reach the village people due to their nomadic tendencies. Therefore, in order to reach a broader audience,
the program decided to increase public awareness during the monthly mobile clinic schedule as well as coordinate clinic times to coincide with other community
activities and events.

Environmental Practice 10 (1) March 2008

Conservation impacts: The conservancy has facilitated

the establishment of two locally managed protected areas:
the Wahea Conservation Area ~38,000 hectares! in the
East Kutai District and the Lesan River area ~12,000
hectares core area! in the Berau District. In addition,
TNC is negotiating with the shareholders of the Gunung
Gajah timber concession to set aside approximately 20,000
hectares from further logging. In the Upper Kelay Punan
communities specifically, TNC conservation successes
include ~1! negotiated and signed conservation agreements with a commitment from the villages to not hunt
orangutans and ~2! the formation of an inter-village
forum that meets monthly to discuss health, clean water,
relations with private timber concessions, alternative livelihoods, and development.
These forum members have been involved in most TNC
activities on the Kelay, including participatory mapping
of village borders and village land use planning. TNC
has also trained forum members in communications,

financial record keeping, small grants proposal writing,

and drafting village legislation. TNC and forum members are also assisting four of the villages in creating laws
related to natural resource use and the prohibition of
logging without permits ~The Nature Conservancy, 2005!.

Water project: TNCs water project in Long Sului and

Long Boi was also a success that created strong healthconservation links through KCHPs participatory style
of management. Data collected after two years of the
program in the Long Sului region indicated that 95% of
the respondents ~58/61! reported using the new water
system provided by the TNC project, whereas two years
prior, the survey indicated that 100% of respondents
were getting their water from the river. Moreover, the
residents of Long Sului have a strong sense of ownership
of their water system. This is evident from the regulations that the village has drafted to care for and manage
the system, which includes the establishment of a village
fund to be used for system repairs and a two-weekrotation shared duty among all residents to keep the
water basin clean.

Collaboration and sustainability: Planning and implementation of the various components of the program
were done with the participation and input of all involved parties. Initial meetings and training were critical
for the establishment and coordination of the program,
team spirit building, and government support. For example, planning and building of water systems in Long
Sului and Long Boi were done with TNC providing
technical assistance and village residents providing the
labor and local materials needed for its construction and
maintenance. Also, joint planning with the Berau Health
Department allowed TNC to avoid duplication of services. During the course of the program, however, TNCs
collaborators did sometimes fail to meet their responsibilities as per their cooperative agreements. This left
TNC, at times, to assume more responsibility and costs
for certain aspects of the program than originally planned.

Creation of an enabling environment: An additional

goal of TNCs conservation strategy in East Kalimantan
is to engage communities and local government to work
together through collaborative management. One of
TNCs aims was to use the United States Agency for
International Developments approach of creating an
enabling environment at the village level. To succeed at
this, TNC used the KCHP as a component of its overall
project goal. TNCs Program Director observed that the
program was successful in creating an enabling environment at the local government level, where KCHP was

able to establish TNCs reputation among government

leaders as an agency that assists and works well with
local communities.

Discussion
This commentary has demonstrated how collaborative programs such the KCHP can contribute to the promotion of
conservation and goodwill while improving the basic needs
of marginalized communities. When organizations take
into account the lack of social services, such as healthcare,
of marginalized populations close to conservation areas,
they can influence the value these communities place on
the environment. The KCHP was successful in not only
promoting conservation, but the data have also demonstrated that it was effective in offering better healthcare
than what is available in most remote rural areas of Kalimantan. Therefore, the KCHP has the potential to serve as
a model for both Indonesian and other developing nations
rural health services.
The KCHP also demonstrated that, by developing a multistakeholder collaboration, the program was able to work
with existing organizations, which has led to continuous
improvement in targeted areas. For example, collaboration
with the medical school at Mulawarman University has led
to increased improvements in the linkage between conservation and health and to the importance of good rural
health delivery in Kalimantan. Mulawarmans medical school
is now working towards establishing the KCHP as a formal
clinical training site for its students. As a result, these
spillover effects are broadening the health impact beyond
the program villages to rural and remote areas in Kalimantan. The collaboration with the university and with the
public health system also increased the sustainability of the
project and ensured that TNC can reduce its involvement
over time as local capacity is improved.
Challenges faced by the KCHP were similar to those faced
by all organizations. The Punan villages are extremely isolated, and their semi-nomadic lifestyle presented challenges to health programming. It is very important to
understand and involve the target area and population.
Through the extensive needs assessment process, it became
clear that health was the most prioritized need of the
human population; this may be different in other settings,
so a strong participatory needs assessment process is critical. Conservation organizations are not development organizations and typically do not have the expertise or
funding to carry out long-term development work. The

Conservation Health Program in Borneo

27

KCHP, however, shows that even a small project that addresses human needs can yield significant results for
conservation.
The KCHP has opened the door for TNC to have a stronger
entry point into development programs within communities. One of TNCs conservation strategies in Indonesia is
to train local governments in eco-regional planning for
economic development that provides for human needs while
also protecting the most critical natural areas. Because the
provision of healthcare services is one of the major responsibilities of governments, conservation health programs such as the KCHP may be useful components of
such planning. Even though conservation efforts in Indonesia remain somewhat fragmented, it may be possible to
conduct eco-regional planning at the provincial and national levels. For example, given the orangutans status as
highly threatened ~Conservation Breeding Specialist Group,
2004; Yeager, 1999!, areas of orangutan habitat in Kalimantan and Sumatra can become the geographic focus of a
comprehensive plan for conservation. To increase the likelihood of acceptance and success, the plan should include
strategies for economic development and the provision of
government services, such as healthcare and education, to
the remote and underserved human populations in these
areas. The KCHP is a model that can be replicated in
developing nations where conservation organizations can
work to determine the right balance between local community needs, policy, and conservation agendas.

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