Where there is no conventional veterinary health delivery services what are the capabilities of community animal health workers?

E S Swai and S Masaaza

Veterinary Investigation Centre, PO Box 1068 Arusha, Tanzania
ESswai@gmail.com
* District Vterinary Office, PO Box 13484, Simanjiro, Tanzania

Abstract

Livestock are a major asset for rural households throughout the developing world and are increasingly regarded as a means of reducing poverty. However, many rural areas are characterized by limited or no accessibility to veterinary services. Since the liberalization of animal health services in Tanzania in the early 1990s, community-based animal health workers (CAHWs) have become an important alternative animal health delivery channel in the country's marginal areas. However, professional veterinary practitioners, academicians have questioned the effectiveness of CAHW programmes in animal health service delivery. This article describes an assessment of the technical competence of CAHWs in Simanjiro district, Tanzania, which was conducted during the period of May to October 2010. From 88 listed CAHWs, 60 participated in the study and were individually assessed for 5 key technical competencies. These were ability to keep veterinary related records, knowledge of disease clinical signs, ability to match drugs with suspected disease, drug dosage and acaricide computation.

Evaluation of competence was based on three attributes namely correctness, inconsistencies and not keeping/knowing or doing. Based on this formal assessment, the majority (over 60%) of the CAHWs were judged to be competent in keeping proper drug records, providing correct disease diagnosis and correctly matching the drugs with diagnosis. The main technical weaknesses of the CAHWs were poor and inconsistencies of drugs and acaricide dosage computation. The study revealed that if adequately trained and supervised, CAHWs are capable and may contribute toward delivering animal health services in under served areas. We recommends that training packages for CAHWs be designed in a participatory manner and expanded to include not only the identification, diagnosis, and treatment of common diseases, but also handling and the use of veterinary drugs. Policy attention is also needed to enhance the participation of CAHWs in animal health service delivery and to appropriately integrate their activities into the existing formal animal health delivery system in Tanzania.

Key words: CAHWs, Pastoral community, Simanjiro, Tanzania

Introduction

Livestock farming in Tanzania is an agricultural system that has developed since immemorial, in different parts of the country. Currently more than 85% of the populations of Tanzania live in rural household, out of which about 37% keep livestock (MLDF 2009). Sustaining productivity and survival of this valuable livestock species resource require sound and effective disease diagnostic tools, monitoring and adequately supported animal health delivery service system. In many developing countries establishing and maintaining nation wide animal disease surveillance and animal health service delivery is a major challenge (Bekele and Akuma 2009). Important challenges and constraints include the lack of adequately trained animal health service providers, fragmented coordination between private and public animal health delivery system, uncoordinated deployment of the few existing staff, and the need to access remote and often large areas characterized by poor infrastructure and communication networks(Catley et al 2012). For example, Tanzania has the second largest livestock population in Africa but has only one telephone mainline per 230 people, 44% are cellalur phone user, I km of paved road per 188 km² of land and less than 2% of the population are internet user (CIA 2011). The logistical and resource problem affecting animal health delivery in countries such as Tanzania are compounded by the limited incentive for veterinary workers to cover rural areas.

According to Office Internationale Epizootics (OIE) or World Animal Health Organisation, Terrestrial Animal health code, animal health surveillance, quality animal health service delivery is of fundamental importance for countries wishing to engage in international trade (OIE 2003; Thomson et al 2004). As a consequence of World Bank structural adjustment policies (SAPs) during the period of late 1980’s, which led to a gradual decline in public sector investment and eventual liberalization of animal health services in Tanzania; community-based animal health workers (CAHWs) have become an important alternative animal health delivery channel in the country's marginal areas (De Haan and Bekure 1991; Catley et al 2004; Bett et al 2009). By definition, a CAHW is an individual that is indigenous to his/her community and agrees to be a link between community members and the service delivery system (Iles 2002). Experience from the development of community-based animal health worker systems indicates that these workers can have a substantial impact on livestock morbidity and mortality through the treatment or prevention of a limited range of animal health problems (Catley and Leyland 2001; Ali et al 2006). However, professional veterinary practitioners, regulatory authorities and trainers have questioned the effectiveness of CAHW programmes and institutional working frameworks in animal health service delivery in Tanzania. Besides the above shortfalls, other constraints observed include the legal mandates including recognition of the CAHWs and the mechanism to evaluate their impact in the community they serve. However, no systematic studies have been carried out to asses their technical competence.

This study aimed to determine their competence and generate animal health delivery service information that would guide policy and institutional frame wok modalities modest suit in under served marginalized areas taking Simanjiro district, Tanzania, as an exemplar area. 

Material and Methods

Study area  

Simanjiro is one of the five districts of the Manyara Region of Tanzania. The district lies between longitude 36’30⁰ E and latitude 4 ‘0⁰S covering an area of 18,851 km²(Fig 1). Simanjiro is remote and is inhabited mainly by the Pastoralist Maasai, who depend on livestock for their livelihoods. The district is bordered to the north by Arusha Region, to the northeast by Kilimanjaro Region, to the south east by Tanga Region, to the south by Kiteto district, to the west by Dodoma Region and to the west by Babati district. Administratively, it is divided into 6 divisions, 15 wards and 43 registered villages and sub villages. According to the 2002 population census, the District has a population of 141,136 out of which 54% are males and 46% are females (Anon 2004). The population of Simanjiro was estimated to be growing at the growth rate of 7.2% in the year 2000.

Coverage and spatial pattern of animals 

According to district livestock department report, the population of domesticated rumiminats (cattle, sheep and goats) stands at 600,000 distributed un-evenly due to seasonal availability and fluctuation of water and forages (Anon 2004). The number of official/ formal veterinary personnel (livestock field officers, livestock officers and District Veterinary Officer) is 31 implying that the ratio of veterinary personnel is 1 to 22,000 animals, equivalent to every personnel serving an area of not less than 600 km². These figures are by far higher than the recommended figure of 1: 10,000 and 1 personnel per 200 km² by Veterinary council of Tanzania (URT 2006) 

Study subjects and data collection 

A combination of methods was adopted while conducting this investigation by employing qualitative and quantitative approaches carried out in participatory manner. This was achieved through conducting an in-depth discussion with livestock keepers focus groups (FFDG), in depth interview of key informants such as Livestock Extension officers and other relevant stake holders such as NGOs etc.

A list of all practicing and non- practicing CAHWs was obtained from the district development office. Through random sampling procedures, 88 CAHWs were selected and participated in the study. A sub-set of CAHWs (n=60) chosen randomly were individually assessed for their technical competence. The assessment was conducted using a standardized questionnaire. Competence is defined as the knowledge and skills of doing something well/ or to the required standard. The key technical competencies emphasized were: record keeping, provisional diagnosis, drug choice in relation to diagnosed disease and acaricide dose computation. Drug usage in relation to dosage issue, reading and interpretation of drug labels, estimation of animal weight dosage of antibiotic and other drugs were concurrently explored. Technical competence were based on 3 key attributes namely correctness, inconsistencies and not keeping/knowing or doing.  The study was conducted during the period of May-October 2010. 

Data analysis  

The data collected were entered and analyzed using the Epi Info programme (Epi-Info 1996). Descriptive statistics were used to describe the characteristics and activities of CAHWs and other information collected in the study. 

Results and Discussion

CAHW characteristics 

Overall, 88 CAHWs from 6 division, 15 wards and 36 villages were visited and interviewed during the period May - Oct 2010. As for gender, out of the 88 interviewed CAHWs, 68(77%) were males and only 20(23%) were females, confirming the gender bias toward male candidates as reported in the literature (Bagnol and Hickler 2010). The average age (in years) of the interviewee was 38 ± 8.12 (mean±stdDev) which ranged between 20 and 59 years (Fig 2). Sixty-two (80%) of all interviewed CAHWs were above 30 years old.  The recorded average age of 38 years which is considered as middle age category was preferred by their communities because their social characteristics had been established. This age category is less likely to leave their villages to towns in search of employment unlike the youth in their 20s, who once trained, are vulnerable to leave their villages for employment elsewhere. The education level of interviewed CAHWs varied from adult education to certificate (2 years) training in veterinary or animal husbandry.

Training duration of the interviewed CAHWs ranges from intensive residential of <2 weeks up to 6 months. Over fifty-percent were exposed to a training programme of 2 week - 2 month. Majority were trained at livestock farmer centre based in Emboret, Simanjiro. With respect to post training field experience, 28 (31.8%) of the CAHWS have been in practice for only one year and at least 46 (52.3%) have been in practice for more than 3 years after graduation. Upon probing, 32 (36.4%) responded by saying that they would wish to attend short – course training in order to up scale their knowledge and skills on animal health services (Table 1). 

Technical competence 

Results revealed that all CAHWS were highly competent in record keeping, providing correct provisional diagnosis and matching drugs with diagnosed disease (Fig 3- 7). 

a)      Record keeping: Results of the assessment revealed that 60% kept proper and 40 % showed inconsistencies in their records (Fig 3). Although the majority of CAHWs passed, a few CAHW need to be reminded on this vital aspect of service provision. Enhancing the record keeping and professional development of CAHWs will strengthen their capacity in service delivery.

b)      Knowledge of clinical signs: with respect to the ability of providing provisional diagnosis against common diseases in their localities, 88% could correctly mention at least two silent features of the disease while 11.6% could mention one sign and often the consistencies of the mentioning was improper(Fig 4). Despite their short training and field exposure, CAHWs were found to be competent, suggesting that if properly supervised, they may play a significant role in disease control through regular reporting.     

c)      Matching drugs with disease: the study revealed that 67% of the CAHWs could consistently mention the disease and correctly assign the proper drug whereas 33% showed inconsistencies of matching the drugs with the disease (Fig 5). The study found that the CAHWs knowledge of clinical signs of local livestock diseases and their ability to match clinical signs correctly with appropriate drugs were adequate.

d)     Dosage computation: this part covered knowledge and actual use of veterinary drugs, including estimation of dosages viz a viz animal body weight estimates. Results are summarized in Fig. 6 and show that 26(41.6%) were able to consistently calculate the correct dose for the weight of the animals whereas 55% showed inconsistencies and 1.7% never knew drug dosage computation against animal body weight. Failure to use the drug correctly (over or under dose) may lead to giving animals unnecessary and wasteful treatments. Such malpractices may result in pathogen drug resistance development and excessive residues in animal food products such as meat and beef. Additionally, excessive use of medication can increase selective pressure in a population of pathogens to allow the resistant pathogen to thrive and the susceptible pathogen to die off (Okeke et al 2005). As resistance towards medication becomes more common, a greater need for alternative treatments arises.

e)      Acaricide computation: the study revealed that 17 CAHWs (28.3%) were able to correctly dilute the acaricide dosage based on manufacturer instruction. Thus a large proportion of the CAHWs (55%) were weak in this area (Fig 7). Ten CAHWs (16.6%) had no idea on dosage computation or usage against animal body weight. Upon probing it was evident that CAHWs were assuming all brands of acaricide available in the market to be the same, hence using the dilution figures taught at the training centre. Consistently, low knowledge of veterinary drug usage is partly attributed to a variety of drug brands in the market and absence of regular refresher training on drugs handling and usage. Under such a scenario, the animals will be subjected to under- or overdosing which eventually may lead to the danger of the ticks developing resistance against acaricide. Over usage may cost livestock keepers unnecessary money as well as lead to environmental pollution and possibly damage to CAHWs’ health too.

Conclusions

• Despite their short term training exposure, CAHWs were technically competent disputing the fact that short training duration may not be a useful measure for training quality as often perceived by policy makers and other veterinary professional staff.
  
  
• Refresher training in CAHWs system should be considered as a strategy of maintaining and improving diagnostic capacity and use of veterinary drugs, and thereby limit the emergence of drug resistance. A curriculum which has the provision of upgrading CAHWs into tertiary livestock husbandry training institutes, should be explored as a mechanism of upholding them and improving their professional development in the animal health delivery system.
  
  
• The main technical weaknesses of the CAHWs were poor calculations leading to inconsistencies in the computation of drug and acaricide dosages. Further training and constant follow up is required.
  
  
• If CAHWs are to provide livestock health services efficiently, they need to be an integral part of these services (Oakley 1998). The appropriate roles of CAHWs must be recognized by law and incorporated into the regulations governing animal health services. Further, policy attention is needed in order to enhance their participation as well as integrating their activities into the existing formal animal health delivery system.
  
  
• The continuity of CAHW activities is dependent upon communication, support, and cooperation with the professional veterinary system (De Haan and Bekure 1991).
  
  
• Further, the study concluded that if adequately supervised and monitored, CAHWs may serve as an alternative animal health delivery agents in the rural pastoral marginalized areas where formal veterinary services are not available and feasible.

Acknowledgements

Northern Zone Agriculture Research Development Fund (NZARDEF) for financial support to undertake the study and Simanjiro district council, livestock department staff and CAHWs for help and assistance.

References

Anon 2004 Agriculture and livestock annual report, Simanjiro district, pp.12-25 

Ali S N,  Asif M,  Rehman A, Jat L A, Ali Q and Hussain M 2006 Participatory surveillance of livestock diseases in district Karachi–Pakistan, International Journal of Agriculture and Biology 8:652–656. 

Bagnol B and Hickler B 2010 RESPOND Strategy for Gender Planning and Cultural Sensitivity: East and West Congo Basin Regions. RESPOND Project, USAID Emerging Pandemic Threats Program, Washington, DC 

Bekele G and Akuma J 2009 Impact Assessment of the Community Animal Health System in Mandera West District, Kenya. Feinstein International Center, Tufts University, Addis Ababa, Ethiopia. https://wikis.uit.tufts.edu/confluence/display/ (accessed 25 April 2012). 

Bett B, Jost C, Allport R and Mariner J 2009 Using participatory epidemiological techniques to estimate the relative incidence and impact on livelihoods of livestock diseases amongst nomadic pastoralists in Turkana South District, Kenya, Preventive Veterinary Medicine 90:194–203. 

Catley A and Leyland T 2001 Community participation and the delivery of veterinary services in Africa, Preventive Veterinary Medicine 49:95–113. 

Catley A, Chibunda R T, Ranga E, Makungu S, Magayane F T, Magoma G, Madege J and Vosloo W 2004 Participatory diagnosis of a heat-intolerance syndrome in cattle in Tanzania and association with FMD disease, Preventive Veterinary Medicine 65: 17-30 

Catley A. Alders R G and Wood J L N 2012 Participatory epidemiology: Approaches, methods, experiences, The Veterinary Journal 191:151-160 

CIA (Central Intelligence Agency) 2011 The World Factbook. Available at: www.cia.gov/publications/factbook, accessed March, 2012 

De Haan C and S Bekure 1991 Animal health services in Sub-Saharan Africa: Initial experience with alternative approaches. World Bank Paper No. 134. Washington, D.C.: World Bank. 

Epi-info 1996 Centre for disease control, version 6.04d, Atlanta, USA and Geneva, Switzerland. 

Iles K 2002 Community-based animal health care. A practical guide to improving Primary Veterinary Services. ITDG Publishing, London, UK, pp: 6-16 

MLDF (Ministry of livestock development and Fisheries) 2009 Livestock and Dairy Industry Development in Tanzania. Available at www.mifugo.go.tz. Accessed on April 2012 

Oakley R 1998 Experiences with Community-based Livestock Worker (CLW) Programmes, Methodologies and Impact: A Literature Review. Veterinary Epidemiology and Economics Research Unit, Department of Agriculture, University of Reading, Reading, UK 

OIE (World Organization for Animal Health) 2003 Terrestrial Animal Health code, 12 ed. OIE, Paris 

Okeke I N, Klugman K P, Bhutta Z A, Duse A G, Jenkins P, O'Brien T F, Pablos-Mendez A, Laxminarayan R 2005 Antimicrobial resistance in developing countries. Part II: strategies for containment. The Lancet infectious diseases, 5(9), 568-580 

Taylor D 2003 Antimicrobial resistance and community-based animal health. In: Community- based animal health worker – threat or opportunity. (The IDL group, Crewkerne) pp 56-64 

Thomson G R, Tambi E N, Hargreaves S J, Leyland T J, Catley A P, Van’t Klooster G G M and Penrith M L 2004 International trade in livestock and livestock products: The need for a commodity-based approach, Veterinary Record 155:429–433 

URT (United Republic of Tanzania) 2006 Livestock Policy. Ministry of Livestock and Fisheries Development, Government Printers, Dar-es Salaam, pp : 12-27 

Received 18 May 2012; Accepted 4 June 2012; Published 1 July 2012

Go to top