Primary Animal Healthcare in Pastoralist Areas: experiences with evidence-based policy reform

1. Primary Animal Healthcare in Pastoralist Areas: experiences with evidence-based policy reform Berhanu Admassu FIC/Tufts University

2. 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.

3. 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.

4. 85% human population • 80% cattle • 75% sheep • 90% equines • 15% human population • 20% cattle • 25% sheep • Close to 100% goats • Entire camel population

5. Animal Health Services Delivery 40-50% coverage Lack of personnel Shortage of drugs and equipment Poor mobility Fixed point animal health services delivery

6. Health Services

7. 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.

8. Final points 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. 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.

9. Is their any evidence of impact? Yes!

10. Impact on human livelihoods • It has been shown in S. Sudan that a well co-ordinated large-scale Community-based 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).

11. Impact on epizootic disease control • 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)

13. 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).

14. 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.

15. 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

16. 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.

18. 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)

19. 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

20. The team received training in PIA and assessed NGO CAHW projects in pastoral Somali and Afar regions. • 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?

21. Results and process written-up in formal and informal publications

22. 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.

23. 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;

24. 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;

25. 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:

26. 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;

27. 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).

28. 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.

29. The EndThank You