Behind the paper: Transforming Place-based Management Within Watersheds

We speak with Stacy Jupiter, Aaron Jenkins, Timoci Naivalulevu, Akanisi and Mereia Ravoka, some of the co-authors of the recent PLOS Water publication “Transforming place-based management within watersheds in Fiji: The watershed interventions for systems health project“.

What motivated you to explore the topic and decide on this research question?

The ideas behind the Watershed Interventions for Systems Health (WISH) project and approach were over a decade in the making. They began to percolate when our two lead co-authors, Stacy Jupiter and Aaron Jenkins, were working together on a collaboration to scale implementation of ecosystem-based management in Fiji. Aaron and Stacy began a body of research that examined how human activities within Fiji’s watersheds were affecting downstream freshwater and marine ecosystems and species. The results were fairly conclusive – forest loss, particularly along riparian margins and changes to watershed hydrology was associated with lower freshwater fish diversity and abundance, as well as lower coral cover downstream, with compounding impacts on estuarine and marine fish communities.

We tried many different ways to communicate this information back to Fijian communities to improve watershed management. Indigenous (iTaukei) communities have great agency to act, since they hold tenure over 87% of the land in Fiji and can make decisions about how it is used and managed. But we found that simply telling local people that they were losing fish downstream was not enough to influence behaviour change at the scale required to make a significant difference.

Our watershed moment came after Fiji was hit by a succession of extreme floods in 2009, 2011 and 2012 following tropical cyclones and low-pressure systems. Peaks in waterborne bacterial diseases, such as typhoid fever and leptospirosis, lagged the flooding events by several weeks to months. Because the disease outbreaks seemed to be occurring most frequently downstream from heavily altered watersheds, we started wondering if some of the same upstream activities that we know affect downstream ecosystems also contribute to disease risk.

We spent the better part of eight years trying to raise funds to investigate and then manage environmental drivers of disease risk. After we were turned down by multiple donors who were intrigued by the idea but unsure whether to run a project through their environmental or health divisions, Aaron closed the branch office of the NGO he was managing to try to specifically uncover environmental drivers of typhoid in Fiji. His PhD research indicated multiple environmental drivers of disease risk, operating at different, nested spatial scales within watersheds. Armed with this evidence, the idea for WISH was born – though still not so easily funded. Aaron, with colleagues and co-authors from the University of Sydney, Edith Cowan University and Fiji National University, was able to raise funding from the Australian Government’s Indo-Pacific Centre for Health Security to lead a research-action approach to watershed management to reduce the risk of Fiji’s three plagues (leptospirosis, typhoid and dengue, or “LTDs”). Meanwhile, Stacy simultaneously raised funding with colleagues from the Wildlife Conservation Society from Bloomberg Philanthropies’ Vibrant Oceans Initiative to undertake watershed management to improve downstream freshwater and marine ecosystem condition. Because of the long-term collaboration between Aaron and Stacy, we were able to combine the project teams to work across the same five watersheds in Fiji to bring WISH Fiji to life.

Could you talk us through how you designed your study?

We undertook a participatory, co-design approach. We wanted to make sure that the government and other critical stakeholders were actively involved in site selection as a first step towards mainstreaming a process of reframing how water-related disease and ecosystem health risks could be preventatively managed within the context of watersheds in Fiji. In March 2019, the WISH Fiji partnership facilitated a site-selection workshop, which brought together representatives from: the Fiji Ministry of Health and Medical Services; Ministry of Agriculture; Water Authority of Fiji; Ministry of iTaukei Affairs; provincial governments; UN agencies such as WHO and UNICEF; technical organizations; and NGOs engaged in the environment and water, sanitation and hygiene (WASH) sectors. Prior to the workshop, we established selection criteria, collated both public health and environmental data and then relied on local knowledge of the participants to collectively choose project watersheds. Primary selection criteria included: requirements for sufficient records to demonstrate recent outbreaks of at least two of the three LTS in the prior two years; at least six identifiable communities within watershed boundaries; and known concerns about drinking water quality and/or health related climate vulnerabilities. Short-listed watersheds were then evaluated against further secondary criteria, including ensuring at least some of the watersheds selected were directly connected to downstream coral reef systems. 

We then worked directly with provincial government staff to identify which communities within each watershed would be most suitable to enrol in the project, given histories of disease incidence. Once identified, we worked hand-in-hand with the Ministry of iTaukei Affairs to co-design an extensive process to secure free, prior and informed consent (FPIC) from all participating communities. The FPIC process involved visits to every community to first describe the project objectives, followed by ample time for each community to discuss amongst themselves the potential benefits of engaging in the research before giving their willing consent. This community level FPIC process is unusual in global public health research projects and is now used as a standard approach by iTaukei Affairs for all such development projects.

Our next step was to design the survey instruments to be used to assess disease risks and risks to downstream ecosystem health that could be present within each watershed and community at different scales. We combed the literature to evaluate evidence for different risk factors, while simultaneously evaluating different survey tools that were previously developed by other agencies, such as WHO or UNICEF, to assess specific risks to water and sanitation systems. Once we were happy with our survey design and we received ethics clearance, we prepped and trained our all-Fijian team of local staff from Fiji National University and the Wildlife Conservation Society on administration of the survey instruments, including through use of the data collection app Tupaia developed by Beyond Essentials, and protocols for collection of environmental samples for water quality and microbial analysis. We enrolled 311 households in the project through another phase of FPIC and then embarked on collecting our baseline data, which was no easy feat to organize! Over five months, our tireless team collected over 18,000 measurements of water quality and took over 1,000 DNA samples (many of which are still being analyzed) across the five watersheds. With several hundred of these DNA samples now deep sequenced, this extremely large and complex dataset is the largest (and deepest) repository of metagenomic data in existence on freshwater systems of the Pacific Islands region. The baseline data, combined with the responses from key informant and household surveys, as well as information gleaned from the water and sanitation safety planning process that we facilitated with each of the 29 project communities, enabled us to do an initial assessment of risk for 22 known risks factors for disease and downstream environmental health.

Did you encounter any challenges during your study?

A major challenge that we encountered was our inability to link specific watershed variables and management actions to actual disease incidence because case records in Fiji typically do not include the residence of the affected individuals when they became sick. Consequently, we shifted our focus to estimating disease risk and then measured changes in disease risk following implemented interventions based on risk thresholds that we determined from the literature and our data. A key recommendation from our study is for Fiji, as well as other countries, to improve their health systems surveillance, including by adopting digital technologies, to better record case data to place of residence.

Several of our project communities were severely affected by tropical cyclones Yasa and Ana that hit Fiji respectively in December 2020 and January 2021. Our team had just completed a participatory planning process to co-develop Water and Sanitation Safety Plans (WSSPs) with each project community, from which we drew additional information about baseline risks, particularly related to water and sanitation infrastructure. Following the cyclones, we needed to return to these affected communities to help them update their WSSPs based on damage incurred from the cyclones. We were thus then able to use project funds to prioritize urgent interventions like restoration of clean water supply.

Project implementation was also complicated by travel restrictions, both international and domestic, because of the global coronavirus pandemic. Fiji closed its international borders at the end of March 2020, which required transferring a significant amount of project management and coordination responsibilities to the Fiji-based team to manage the WSSP process and oversee implementation of priority watershed interventions. Even when Fiji-based staff were unable to access community sites for a period of over five months in 2021, they were able to ensure that implementation of priority watershed interventions continued because of direct communications with community leaders and by active coordination with the Fiji government and humanitarian partners engaged in the national WASH cluster.

This unforeseen shock resulted in positive outcomes, in that local team capacity and confidence to oversee planetary health work was significantly strengthened. In addition, the laboratory capacities developed to support the WISH Fiji project meant that the Ministry of Health and Medical Services was well positioned to do in-house testing of samples during the COVID period.

What did you find most striking or surprising about your results?

We were struck that our follow-up monitoring in 2022 indicated reductions in Escherica coli, a bacterial indicator of faecal contamination, from river water and drinking water at some sites. We were pleasantly surprised to see these changes, which might at least be partially attributed to project interventions, such as replacing broken pipes and tethering livestock to keep them out of drinking water sources. In fact, subsequent microbial source tracing of E. coli indicates that the most of this bacteria found from river water originated from livestock, which gives further confidence that keeping animals away from waterways is a good bet to improve downstream health outcomes.

New, forthcoming analyses are also showing that similar patterns of degradation hold at different scales in the landscape. Our gene sequence and microbial data are suggesting that, just as we observed at the landscape scale with fish diversity, in degraded systems, microbial communities also have less diversity and more prominence of weedy and pathogenic species.

How do you think this research will be used and who do you hope might benefit from these new insights?

We are hoping that the outcomes of this study will be used to help transform policy in governance in Fiji away from a pure focus on health service interventions, which are important but reactive in nature, to a more holistic focus on systems health, which has a more proactive and preventative perspective. There are specific ways that this can be done in Fiji. For one thing, the government could advance legislation that has been drafted to improve coordination of land and water resource management, which would actually give legal teeth to committees to implement land and water use plans within high-risk watersheds. Secondly, we were thrilled that the Fiji Cabinet endorsed a National Drinking Water Quality Committee in 2022 to oversee monitoring of rural and urban water supplied to direct action where disease risk is high; the next step is for the Committee to be fully activated. Lastly, we need to collectively work to make sure adequate funding is available to undertake the necessary watershed interventions at the appropriate scale and over the right temporal period to be able to effectively reduce risk. This will require some creative thinking and partnership development, which could include innovations like the development of a fund, such as the Watershed Security Fund which was recently established in British Columbia, Canada.

What further research questions need to be addressed in this area?

There is a lot more investigation that needs to be done to uncover specific disease pathways and drivers of disease incidence at multiple scales. We know, for example, that Salmonella typhi bacteria are present in Fiji river and wastewater drain sediments and soil near latrines. Emerging research is suggesting that these bacteria can have high survivorship rates in the presence of soil amoeba. A better understanding of disturbance ecology in microbial communities in watersheds will better enable us to prioritize the most effective interventions. It is also fascinating to see similar patterns hold at different scales in the landscape. The observation that at a landscape scale, in degraded systems, microbial communities also have less diversity and more potential for species that are weedy and/or cause disease, suggests there may be some universal ordering principles that operate regardless of scale.

Why did you choose PLOS Water as a venue for your article?

We were invited to showcase our WISH approach in PLOS Water as part of a mini collection on Health and Watersheds. The mini-collection highlights through different cases and socio-cultural contexts how watershed boundaries can offer an optimal geographic and political unit within which different interventions can be applied to get win-wins for the environment and human health.