With 70% of emerging infectious diseases estimated by the World Health Organisation to be zoonotic in nature, livestock and wildlife often fall ill from these pathogens before they spread to people. As a result, veterinarians and other animal health workers (AHWs) can play a crucial role in early detection of emerging zoonotic diseases, especially in remote areas of poorer countries where human health care infrastructure is sparse or absent.
Yet, despite significant numbers of livestock in rural areas of developing countries, AHWs are few and far between, unable to generate sufficient income to make a living. Well-intentioned policies from national and international organizations in some cases end up driving AHWs away, or into more lucrative pursuits. As a result, animal disease outbreaks, many with public health impacts, may run their course for weeks before being detected and addressed by the authorities.
Populations in remote areas of Africa and Asia in particular often inhabit marginal land unsuitable for anything but subsistence livestock rearing of sheep, goats, camels, or cattle. Veterinarians, accustomed to urban life after years of veterinary schooling, rarely want to work in such places. Life is tough there, family is far away, and income potential is lower for them than in urban areas.
CAHWs to the Rescue
Partly in response to this shortage, as well as to a general privatization of animal health care services in the face of worsening government finances, the late 1980s and 1990s witnessed the training of community-based animal health workers (CAHWs), notably in East Africa. CAHWs were recruited directly from livestock-keeping communities, trained in basic diagnosis and treatment of common animal diseases, then encouraged to return to their communities to work.
With more modest income aspirations than veterinarians, the trust of their local communities, and a vested interest in the health of their communities’ animals, the CAHW programs proved largely successful, despite some resistance from national veterinary interests.
CAHWs were used heavily in the effort to rid the world of rinderpest during the 1990s and 2000s, sending them to implement cattle vaccination campaigns in war-torn communities of southern Sudan, for example, where outsiders could not easily go. The success of this project (Rinderpest was declared eradicated by the World Organisation for Animal Health in 2011) would likely have been impossible without the work of these people.
Today CAHWs act as the eyes and ears of animal health ministries in many countries, reporting outbreaks or suspicious deaths in herds that allow veterinarians or human health officials to investigate and initiate control measures sooner rather than later.
Because the inhabitants frequently live at subsistence level in the best of times, it is common to find national and international non-profit groups (NGOs) active in these marginal areas, engaged in development or humanitarian (emergency) activities. In my own work in South Sudan with the German branch of the NGO Veterinarians Without Borders, we used a group of 40 CAHWs to treat livestock around the refugee camp where they lived. From May to October, they followed larger herds to their grazing areas up to 100 km away, traveling on foot in hot, extremely humid conditions.
Many NGOs have trained, supplied, and funded CAHWs over the years, facilitating their acceptance by and cooperation with veterinarians and government authorities. But in other ways, policies have inhibited the long-term potential of CAHWs. The most conspicuous is the laudable, but detrimental, provision of free or heavily subsidized medications, vaccines, and animal health services to livestock owners.
Such activities offer employment to animal health workers. However, the resulting distortion of prices eliminates the profit motive for any veterinarian, CAHW, pharmacist, or trader in these products. These projects are often short-term. Once the funding ends and the NGO has packed its bags, the vaccines and medications, which comprise the major source of income for any successful animal health worker, dry up.
For long afterwards, local livestock owners may mistrust anyone charging money for livestock medicines, suspecting they continue to obtain them for free from the NGOs. At best, locals are reluctant to purchase any drugs or services, hopeful that the NGO will return with another project soon.
And this same prospect prevents animal health workers from investing in an inventory of drugs, fearful that the arrival of another NGO project will ruin their business. In the meantime, cheap counterfeit or diluted drugs often fill the gap, further weakening trust in the animal health system.
To Pay or Not to Pay?
Habits are hard to change. For one, it feels good to give things for free.
Another consideration is humanitarian projects vs. development projects. The latter are typically longer term efforts to improve incomes and resources through sustainable mechanisms. The negative impacts of free animal health services in this environment are usually obvious.
Humanitarian projects, on the other hand, respond to natural disasters and wars and involve large numbers of often destitute people who have lost nearly everything. The costs and benefits of charging for animal health services in these circumstances is often less clear cut.
In South Sudan, many of the refugees I worked with had fled their villages in neighboring Sudan with no time to pack anything, taking only the clothes on their backs. Others had time to plan their journey and were able to drive significant herds of cattle, sheep, and goats ahead of them. We found the latter able and willing to pay for veterinary work (sometimes in cash, more often by handing over a sheep or goat for every so many animals vaccinated or treated). But an elderly woman with a chicken she carried with her across the border, for example, obviously cannot pay to treat or vaccinate her bird.
There is no easy answer for how to deal with such situations:
Charge no one?
Charge only those who can pay (such as through issuing vouchers to those deemed unable to pay, and with the inevitable abuse this spawns).
Fortunately governments, NGOs, and international donors who fund the NGOs are increasingly aware of the distortions that free services and materials cause in such settings. Those with experience in the livestock sector tend to charge something for the materials they provide, if nothing more than simple cost-recovery that reminds beneficiaries of the intrinsic value of the items and services. In many cases, any income is later returned to the CAHWs, who are encouraged to use it to purchase medicines once the NGO is gone.
Aid projects run for set lengths of time and one of the worst outcomes for an NGO is to not spend the money earmarked by a donor for the project. As their activities wind down, NGOs feel pressure to use up any remaining balance of funds. One relatively easy way to achieve this is to provide blanket vaccination or deworming to livestock. Fees are not collected because the objective is to spend the money, not take it in. The tedious paperwork required by donors when money is paid to NGOs by beneficiaries just slows things down.
And who can argue with free animal health services, right? But unless there is a serious parasite problem, blanket deworming of all animals in a herd is not necessary or even recommended. And even a vaccine campaign is not always benign, potentially causing more long-term damage than good if there are no follow-up vaccinations.
Carefully planned agreements on cost-recovery pricing of livestock medicines between NGOs, international, and government agencies can collapse when an outside NGO decides to give medications away free, without discussing with others working in the area. It creates mistrust of the NGOs and even of the local animal health workers, both of whom are then suspected by the community of profiting from the sale of medicines. They reason, quite logically, that the drugs obviously don’t cost anything since the other NGO is giving them away. This adds one more to an already large number of obstacles for any animal health worker hopeful of making a living once the NGOs are gone.
Prerequisites for Success
Creating an environment that allows animal health workers to survive in rural areas of developing countries requires many things. Not least is a stable environment that encourages someone to build an inventory of equipment and medicines to serve the community. In war-torn South Sudan, Somalia, and Afghanistan, this is but a dream for now. CAHWs operating in these countries are still heavily subsidized by international donors, for better or for worse.
Harmonization and enforcement of pricing practices between governments, international donors, and NGOs working in rural areas can complement rather than undermine animal health workers.
Better training and frequent refresher courses will increase trust in animal health workers’ skills and calls for their services. Business management should be an integral part of this training as most CAHWs have little or no prior business experience, a major impediment to their success in the past.
Keeping animal health workers in rural areas is in everyone’s best interest, but it is not an easy task to achieve sustainably. Their ability to recognize outbreaks of emerging diseases of public health and economic concern can be critical in halting their spread to cities, neighboring countries, and even to other continents. We need to encourage, not stifle, their efforts.
Holden S. The economics of the delivery of veterinary services. Rev. sci. tech. Off. Int. Epiz. 1999, 18(2), 425-439.
Koma LM. Can Private Veterinarians Survive in Uganda? UCIAS. 2003; 5.
Mugunieri LG, Omiti JM, Irungu P. Animal Health Service Delivery Systems in Kenya’s Marginal Areas Under Market Liberalization: A Case for Community-Based Animal Health Workers. IPAR and IFPRI. 2002.
Wang LF and Crameri G. Emerging zoonotic viral diseases. Rev. sci. tech. Off. Int. Epiz. 2014, 33(2), 569-581.