Transcript Slide 1

Primary Animal Healthcare in Pastoralist
Areas: experiences with evidence-based
policy reform
Berhanu Admassu
FIC/Tufts University
Animal health services in pastoral areas of developing
countries
•
Delivering animal health services in pastoral and marginalized
areas of developing countries has been and remains of great
concern in the development arena.
•
In the late 1980’s several NGOs began to apply the principles of
community participation and rural development to initiate an
alternative model of delivering animal health services.
Animal health services
Cont’
Delivering animal health services in pastoral and marginalized
areas of developing countries has been and remains of great
concern in the development arena
•
•
•
the physical remoteness and size of pastoralist areas,
the mobility of pastoralism (as an economically sound means of
livestock production), and
relatively weak infrastructure and communications.
85% human population
80% cattle
75% sheep
90% equines
15% human population
20% cattle
25% sheep
Close to 100% goats
Entire camel population
Lowlan
d
63%
Highlan
d
37%
Animal Health Services Delivery
40-50% coverage
Poor mobility
Fixed point animal health
services delivery
•Health Services
Community-based Animal Health Workers (CAHWs) for
the provision of primary animal health care in remote and
marginalized areas
• Despite the complex
problems of service
provision in pastoral areas,
in the late 1980’s several
NGOs began to apply the
principles of community
participation and rural
development to initiate an
alternative model of
delivering animal health
services.
The common underlying philosophy was:
– recognition of indigenous knowledge and skills, and
building on the existing know-how of livestock keepers,
– the involvement of communities in project design and
implementation, and the need to address community
concerns.
– The use training methods which were suitable for both
illiterate and literate trainees.
Final points
Growing interest in CAHW systems is largely related to the high
impact on animal health and human livelihoods resulting from
improved basic veterinary care in rural communities.
Is their any evidence of
impact?
Yes!
Impact on human livelihoods
•
It has been shown in S. Sudan that a well co-ordinated large-scale Communitybased system can form the basis of improved service delivery in conflict zones.
•
A review of CAH project in north-east Kenya in 1998 compared livestock
mortality in project and non project areas. The reduced loss of livestock as a
result of CAHWs treatment was valued at Kenya Shillings 22,853 (approximately
USD 350.00) for each household and this sum was sufficient to buy grain to feed
2 adults and 4 children for 250 days (Odhiambo et al., 1998).
•
A CAHW project in Simanjiro District, Tanzania, was assessed in May 2001. The
Maasai pastoralists associated the CAHW service with reductions in calf
mortality of between 59 and 93%. This led to increased sizes of milking herds
and more cows milked per household. For example, the average number of
cows milked per household increased from 5.3 to 24.2 cows. Communities
concluded that the increased milk availability had a huge impact on local food
security (Nalitolela et al., 2001).
Impact on epizootic disease control
1.
Considerable success with using CAHWs in rinderpest
eradication in Ethiopia /Afar region – higher vaccination
coverage, more cost effective, better sero-conversion
(PARC/FAO, 1996)
2.
In Somaliland CAHWs achieved 95% vaccination efficiency using
heat stable rinderpest vaccine – the highest efficiency reported in
Africa since the Pan African Rinderpest Campaign (PARC) began
(Mariner et al 1994)
Impact of disease reporting and surveillance
• A study of the activities of over 1000 CAHWs in Ghana found over
half were having good to excellent impact on animal health
service delivery. CAHWs provide a regular flow of information to
veterinary professionals including reporting disease outbreaks
and the referral of difficult cases (Hanks et al 1999).
• CAHWs in pastoralist areas have good diagnostic skills. e.g. 1998
Rinderpest outbreak in S. Sudan information rapidly went from
Livestock owner → CAHW → Supervisor → radio message to
the UNICEF veterinary programme. The outbreak was dealt with
quickly using CAHWs. (Jones et al 1998).
Policy & legislative change to support community-based
animal health workers in pastoral areas
•
Despite the innovation and progress of community-based
approaches to animal healthcare, and support from international
agencies such as AU/IBAR and FAO, policy makers in many
countries remained unconvinced.
•
The AU/IBAR /CAPE Unit worked in east Africa and used a variety
of learning, research and lobbying methods to engage national
policy makers.
Methods and Tactics used for Policy Change
Seeing is believing
• Some policy-makers have never experienced the isolation,
harsh environment and limited services in pastoralists
areas. Nor had they worked with pastoralists or appreciated
their knowledge on livestock health and management.
• The simple act of witnessing CAHWs in action and taking to
them was sufficient to convince many skeptics and remove
their fears about community-based approaches
Publicize and communicate
People cannot support good ideas if they don’t know about them.
Different policy actors require different levels and details of
information.
National guideline developed for
establishing CAH delivery in
Ethiopia
Methods of establishing such
systems are well documented
Catley, A.C., Blakeway, S. and
Leyland, T. (eds.), 2002.
Community-based Animal
Healthcare: A Practical Guide to
Improving Primary Veterinary
Services.
Impact Assessment
• AU/IBAR/CAPE supported the creation of multi-stakeholder teams
comprising pro and anti CAHW actors and with represenation
from policy making agencies. These teams conducted
participatory impact assessments of CAHW projects.
• Learning arose not only from the interaction with communities,
but also from conversations and debate between team members.
Results were fed directly back to government departments
(Hopkins and Short 2002)
National Participatory Impact Assessment Team
Ethiopian National PIA Team to examine CAHW issues, comprising:
• Federal government
• Faculty of Veterinary Medicine, University of Addis Ababa
• Veterinarians from NGOs working in pastoral areas
• National Animal Health Research Center
• Ethiopian Veterinary Association
• Facilitation by FIC/Tufts
• The team received training in PIA
and assessed NGO CAHW projects
in pastoral Somali and Afar
regions.
Change in median disease impact score
• Field-level assessments focused on
key questions such as:
– What was the impact of CAHWs
on important livestock
diseases?
– How did the services of CAHWs
compare with other service
providers?
8
6
4
2
0
-2
-4
Handled by CAHWs
-6
Not handled by
-8
CAHWs
Garabgoye
Kud
Goriyan
Cabeeb
Shillin
Diseases
Gubato
Jommo
Tuunyo
Results and process written-up in formal and informal publications
Regional and International perspectives
• Regional and International bodies have a strong influence on
national-level policy makers. New policies are less likely to appear
at country level unless they “fit” the international frameworks
particularly if these new policies relate to international issues.
– September 2002 CAPE presented a paper at an OIE seminar which used the
principles and structure of the OIE Code to show how CAHWs could
strengthen what the OIE defined as “quality” national veterinary services
(Leyland and Catley 2002)
– October 2002 CAPE organized an international conference to bring together
the OIE, FAO and senior policy makers from around the world to discuss
policy and institutional constraints to primary animal health delivery care
(Sones and Catley, 2002)
– 2003 OIE established an ad hoc group to examine how the code could better
address privatization and the role of veterinary para professionals .
– May 2004 the OIE General Assembly endorsed changes to the OIE code the
defined veterinary para-professionals and guided national veterinary services
on their use.
The process proved to be very successful for influencing
CAH services delivery policy
• Ethiopia has had some very notable achievements in veterinary
service delivery since the mid 1990s, with a clear trend both
towards privatization of clinical veterinary services in pastoralist
areas plus related policy and legislative support. Successes
include:
– The eradication of rinderpest from pastoralist areas and Ethiopia as a
whole, including the innovative use of CAHWs in Afar which achieved
international recognition;
– Drawing on support from the Ethiopian Veterinary Association, Addis
Ababa University (Faculty of Veterinary Medicine), NGOs and others, the
MoARD publication Minimum Standards and Guidelines for CAHW
System in Ethiopia, published in 2002 and revised in 2009, which
legitimised the role of CAHWs as private sector actors rather than
government employees;
– Similarly, the issue of Proclamation No.267/2002 noting: the
need for a veterinary statutory body in Ethiopia for the
registration and quality control of veterinary professionals
and para-professionals, including CAHWs; the role of the
MoARD in creating favourable conditions for the promotion
of private animal health services;
– In line with these federal initiatives, the creation of private
veterinary pharmacies and CAHW networks in pastoral
regions with some improvements in service provision albeit,
still inadequate;
Policy options and recommendations
• Ethiopia has made great progress in terms of policy and
institutional support for veterinary services in pastoral areas
relative to other countries in the region, as evident from the
positive events listed earlier.
• However, not only has progress been slow but policy and
legislative gains have been offset by weak implementation, and at
times, contradictory strategies.
• The economic theory and evidence from the ground shows that
support to private clinical veterinary service delivery under
government regulation should be continued, but also accelerated.
This process would be further assisted by:
Policy options and recommendations
• the creation of an independent veterinary statutory body in
Ethiopia for licensing of professional and para-professional
workers (including CAHWs), and for assisting the federal and
regional MoARD to focus more of core public good functions; both
a statutory body and private sector support are already stated in
Proclamation 267/2002, but to date, implementation has been
limited;
• a comprehensive economic review of strategies which require
further construction of fixed point government veterinary facilities
in pastoral areas, including an examination of the long-term
viability of these strategies and options for better harmonization
with the private sector;
Conclusions
• In our experience, combined approaches work best –
address both the emotive/attitudinal and technical
constraints and issues.
• Engage policy makers – address the technical
questions which they want answered (cf. the
questions which researchers want to answer).
Conclusions
• Use local multi-stakeholder assessment teams (not external
consultants); bring the detractors into these teams.
• Use assessment methods which everyone understands.
• Systematic PIA is useful – it combines the benefits of participatory
enquiry with conventional research approaches .
• In terms of policy process, experiences from CAPE will be
modified and applied to other policy areas. Encouraging direct
communication between policy makers and communities will
continue to be a key aspect of policy and institutional change.
The End
Thank You