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After 42 years of international trade in wild harvested medicinal bark from Africa and Madagascar, the example of Prunus africana holds several lessons for both policy and practice in forestry, conservation and rural development. Due to recent CITES restrictions on P. africana exports from Burundi, Kenya and Madagascar, coupled with the lifting of the 2007 EU ban in 2011, Cameroon’s share of the global P. africana bark trade has risen from an average of 38% between 1995 and 2004, to 72.6% (658.6 (metric tons or t)) in 2012. Cameroon is therefore at the center of this international policy arena. First, despite the need to conserve genetically and chemically diverse P. africana, there are no populations in Cameroon that are completely protected. Commercial harvesting is allowed in Mount Cameroon National Park (MCNP) and enforcement within forest reserves such as Nkom-Wum Forest Reserve, Mount Manengouba is limited. Second, hopes of decentralized governance of this forest product are misplaced due to elite capture, concentration of power and “informal taxation” (bribery). Although shifts away from an export monopoly did occur, this resulted in “resource mining” rather than the intended sustainable resource management after 1987, when 50 Cameroonian entrepreneurs entered the bark trade. In 2004, this halved to 25 companies. In 2007, just nine companies received quotas, only one of which (Afrimed) actually exported bark. Afrimed continues to dominate the export trade to date. As one of four companies under the umbrella of a privately owned Cameroonian bank, Afrimed is different to other exporters in terms of power and influence. At the current European price for P. africana bark (USD 6 per kg), the 2012 bark quota (658.675 t) was worth over USD 3.9 million, most of it accruing to Afrimed. Third, in contrast to lucrative bark exports, livelihood benefits to local harvesters from wild harvests are low. For example, the 48 harvesters working within MCNP receive less than USD 1 per day from bark harvests, due to a net bark price of just USD 0.33 per kg (or 43% of the farm-gate price for wild harvested bark). The costs of maintaining an inventory, monitoring and managing sustainable wild harvests are far greater than the benefits to harvesters. Without the current substantial international donor subsidies, sustainable harvest cannot be sustained. To supply the current and future market, we must develop separate, traceable P. africana bark supply chains based on cultivated stocks. More Cameroonian small-scale farmers cultivate P. africana than farmers in any other country. This change requires CITES and EU support and would catalyze P. africana cultivation in Cameroon, doubling farm-gate prices to harvesters – from the current FCFA 150 per kg (USD 0.33) received by wild bark harvesters to FCFA 294 per kg (USD 0.66 ) – that could be paid to farmers after a 15% traceability cost was deducted.