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Community-Based Animal Health Workers (CAHWs): Guardians for quality, localized animal health services in hard to reach livestock production systems.
Introduction

In conflict-ridden South Sudan more than half of the population depends on livestock for survival. Public veterinary services infrastructure is dilapidated, access to animal health services severely constrained and endemic diseases of economic importance cause heavy losses to livestock producers. Vétérinaires Sans Frontières (VSF) promotes the Community-based Animal Health Workers (CAHW) model as a cost-efficient and locally available option to offer access to quality animal health services. The practice contributes to protect key livelihood assets and to grant access to food of animal origin, hence improving food, nutrition and income security of vulnerable populations.

Objective of the practice

In remote areas underserved by public or private qualified veterinarians, VSF trains members of hard to reach and at-risk communities in good husbandry practices and basic animal health care. These trained CAHWs are able to perform a limited range of veterinary tasks and popularize husbandry methods in order to optimize animal production, which is particularly important as the crisis has significantly compromised crop production and vulnerable populations have been relying more than before on livestock.
To reach a large number of conflict-affected people (internally displaced populations – IDPs –, host communities and returnees) and their livestock, VSF facilitates mass livestock vaccination and treatment campaigns using CAHWs teams that are equipped with basis service kits. Based on past experiences, these emergency veterinary interventions have focused on diseases with a quick impact on the reduction of livestock losses and thus food and nutrition security.

Livestock does not only provide highly nutritious food, it is also a source of income, savings and employment throughout various sectors, which links the practice to SDG 1.

The animal health extension services through the CAHW system also focus on awareness creation on the prevention and control of zoonotic diseases (anthrax, brucellosis, rabies etc) and other Neglected Tropical Diseases (NTDs), whose prevalence constitute a major disease burden among agro-pastoral communities. VSF trains the mobile and versatile CAHWs on public health and facilitates linkages with health service providers under the “One Health” approach for further basic instructions, case reporting and promotional activities to tackle concerns such as cholera epidemics in cattle camp settings. Addressing diseases of public health importance contribute to better health outcomes among communities and directly links the practice to SDG 3 (targets 3.2 and 3.3).

The CAHW approach is built within a One Health focus and its positive impacts are measurable on the animals, on the people that depend on them, and on the environment, through better use and management of natural resources. Due in part to contacts between domestic livestock and wildlife and the high prevalence of vector-borne infectious diseases, health security also helps to preserve several ecosystem services provided by natural resources.

Key challenges that confront the practice include poor infrastructure that constrain access to mobile livestock communities, maintaining reliable cold chain system for livestock vaccines in the absence of reliable energy sources, access to quality drugs, policy dimensions on the integration of the CAHWs system into the national veterinary service structures and limited resources to maintain service delivery.

To ensure sustained access to services, CAHWs are selected from among the livestock keeping communities, equipped with basic kits and operate as mobile teams. The use of solar powered vaccine fridges and thermo-stable livestock vaccines have overcome vaccine integrity challenges. Cost recovery mechanisms in service delivery have been introduced as a strategy to achieve sustainability of the system while VSF actively promotes the development of the private veterinary service delivery to bridge gaps in access to quality inputs and field-based services.

Key stakeholders and partnerships

ILRI and ICARDA developed the CC structure through the CGIAR research program on Livestock. For animal welfare aspects, the project partnered with University of Melbourne to target transformation in practices on animal welfare and livestock. Both groups are part of the Global Agenda for Sustainable Livestock’s animal welfare Action Network.

The success of CCs depends on engagement of stakeholders. Regional technical expertise from Government district offices of Agriculture and Livestock Development and inputs from the National Agricultural Research System has been key. Community stakeholders include livestock farmers, community leaders, community elders, women’s affairs representatives, religious representatives and industry cooperative representatives.

Implementation of the Project/Activity

The CAHW system is implemented as an integral part of emergency livestock intervention projects funded by donors on short to medium term basis in the country. The training of CAHWs has been an ongoing practice since mid-1990s. Standard training curriculum provides for an initial two weeks training followed by bi-annual refresher trainings to update skills and incorporate new knowledge and techniques. Supervisory cadres are trained for 4-5 months and undergo annual refresher trainings. Trained CAHWs are equipped with basic service kits and deployed to delivery service under the supervision and monitoring by the project veterinarians. In more stable states, public veterinary service technocrats monitor the delivery of services. Communities also play a major role in monitoring, evaluating and reporting on the activities of CAHWs. Functions of CAHWs heavily rely on external support by the humanitarian actors who facilitate input supplies and equipment. The system constantly faces the risk of redundancy in the absence of sustained project funding, a situation compounded by under-resourced public veterinary services.

Results/Outputs/Impacts

A research carried out by FAO in 2016 found that CAHWs were the preferred animal health service providers in South Sudan due to the superior accessibility, availability, affordability and quality of their services . In many places and not least due to the ongoing crisis, CAHWs are even the only available form of animal health service.

Their proven impacts include:
 reduced number of disease outbreaks,
 reduced mortality of sick animals and mortality during crises,
 increased productivity, milk production and fertility of animals,
 secured income of farmers through the sale of milk and animals in good health,
 Improved food security and nutrition of livestock keeping communities
 better management of animal health, animal welfare and safety/hygiene of animal-sourced food.

In South Sudan, one of the most outstanding achievements of the CAHW system was the eradication of Rinderpest which was major cattle plague in Africa, with South Sudan being one of the few foci countries in the early 2000. The eradication of the disease from South Sudan has contributed to a major livestock based economic boom in the Greater Horn of Africa, with significance contribution to the GDPs of the regional countries. The success of the Rinderpest eradication through the CAHW system has provided the impetus to initiate the Global PPR Eradication program by 2030 which is currently a major focus of the countries of the region with CAHWs being at the centre of the eradication campaigns.

Enabling factors and constraints

The establishment of a network of CAHWs cannot be limited to providing technical training. In order to ensure the delivery of quality services and the sustainability of the intervention, CAHWs have to be part of a broader institutional set up, which involves all different animal health actors at national and local levels and takes into account their interactions. In order to assure quality control, they have to be linked to private and/or public vet services (depending on the national systems in place). The fact that the national veterinary services embraced the CAHW system in the country (contrary to the policy position of some neighboring countries) has been a key enabling environment for the success of the system. Sustained funding to livestock interventions by the key donors have also contributed to its success, although gaps still exist.

Delivery of animal healthcare services in conflict situations however presented immense challenges. Livestock keepers are frequently displaced by conflict, making it hard to make follow up monitoring with vaccinated herds. CAHWs too have been victims of the conflict and some were displaced while others lost their lives in the line of duty thus creating gaps in service delivery. To overcome these challenges, training programmes have been continuous, to fill gaps based on assessed needs. In parallel, sustained advocacy with donors on contribution of livestock to household food and nutrition security has succeeded to attract interest and funding and to promote public private partnerships on livestock infrastructure investments.

Sustainability and replicability

CAHWs are selected in a participatory manner within communities according to pre-identified criteria – such as level of education, time and dedication, a good reputation, etc. – to ensure that community members recognize them as legitimate actors. Thanks to this clear link with their communities, the sustainability of CAHWs can be ensured so that they remain active after having received a training.

Especially in South Sudan, however, CAHWs’ access to quality drugs and equipment remains challenging. A recent project evaluation has found that providing business advisory services, including income accumulation/savings, organizational development, veterinary drugs sourcing, etc., are key to the success of privatization of animal health services. Customized support through private-sector mentors may also be explored as a way of enhancing the sustainability of incentive-based or cost-recovery CAHWs services as a step in the development of sustainable private veterinary pharmacies within the targeted areas. The sustainability of the system requires therefore stronger public-private engagements and frameworks for incentives to promote investments in the system and practice.

Regarding replicability, the VSF network is active in strengthening animal health services in over 25 countries, often through the training of CAHWs, combined with support to the local public or private veterinary services. The contexts in which VSF works are very diverse, and the different national legislations may facilitate or hinder the recognition of CAHWs as actors of the animal health services. The model is therefore contextualized and adapted to the different local settings. The common guiding principle, in any case is that CAHWs shall not substitute the veterinary services, but rather complement them, allowing to reach the more remote or underserved communities of livestock keepers.

The CC local partners have indicated that, due to the successes of the breeding and sheep fattening programs, and the community conversations, other communities in the area are asking for the same. The partners therefore envisage expanding the model further by adding new modules covering topics to breeding and feeding and to extend the scope to more communities with continued technical support from ILRI/ICARDA. Experience sharing session with other members ad communities that did not take part in the CC will foster scaling of the good practice locally. To ensure sustainability of the practice, a training module for service providers, such as development agents, local researchers and veterinarians, has been developed and rolled out.

Conclusions

The CAHW system has proven to be a viable model for animal health services delivery, especially in fragile or remote areas with no stable public services delivery systems. Its implementation entails a very robust community participation that enhances its acceptance, usability and replicability. The practice registered a major breakthrough when it was deployed in the successful Rinderpest eradication program in South Sudan.

Since the territorial coverage of animal health services remains insufficient in many countries of the global South, there seems to be a clear need to invest in (i) training veterinarians and veterinary para-professionals and in (ii) the spreading of qualified CAHWs to ensure quality animal health services, adapted to the needs of smallholder livestock keepers. However, several challenges still exist for CAHWs to be fully recognized as true guardians for quality, community-based animal health services. Efforts should be made (both internationally and country-by-country) to integrate CAHWs in the national veterinary legislation, so to facilitate their training, follow-up and service delivery; to clarify the roles and responsibilities of each of the actors involved in the local animal health system, to assure the sustainability; and to promote stronger public-private engagements and frameworks to incentivize investments in the system.

Other sources of information

VSF International (2018). Community-Based Animal Health Workers (CAHWs). Guardians for Quality, localised Animal Health Services in the Global South.
http://vsf-international.org/wp-content/uploads/2018/08/Policy-Brief-n.5-web.pdf

VSF Belgium (2016). Quality animal health services adapted to pastoralism in Western Africa. https://dierenartsenzondergrenzen.be/wp-content/uploads/2017/08/VSF-PB4-en.pdf

AVSF (2010). Dispositifs de santé animale de proximité et de qualité: synthèse d’expériences, analyse, leçons apprises, recommandations. https://www.avsf.org/fr/posts/644/full/dispositifs-de-sante-animale-de-proximite-et-de-qualite-les-enseignements-de-l-experience-d-avsf

Y. A. Gebreyes et al., 2016, The Impact of Conflict on the Livestock Sector in South Sudan. FAO.

Leyland T., Lotira R., Abebe D., Bekele G. and Catley A. (2014). Community-based Animal Health Workers in the Horn of Africa: An Evaluation for the US Office for Foreign Disaster Assistance. Feinstein International Center, Tufts University Africa Regional Office, Addis Ababa and Vetwork UK, Great Holland.

Galière, M. (2017). Réalisation d’une enquête sur les dispositifs de santé animale de proximité dans les pays d’intervention des ONG du réseau VSF-International. Thèse pour obtenir le grade de Docteur Vétérinaire. Université de Toulouse. http://vsf-international.org/project/enquete-dispositifs-sap/

Guidelines on the Community Conversation structure and results have been published by the ILRI. Some examples: https://cgspace.cgiar.org/handle/10568/99264
https://cgspace.cgiar.org/handle/10568/99378
https://cgspace.cgiar.org/handle/10568/99316
https://cgspace.cgiar.org/handle/10568/106206
https://cgspace.cgiar.org/handle/10568/106552
https://cgspace.cgiar.org/handle/10568/107025

Goal 1
Goal 2
Goal 3
Financing (in USD)
2,000,000 USD
Basic information
Start: 01 August, 2018
Completion: 01 May, 2022
Ongoing? yes
Region
Africa
Countries
Geographical Coverage
The VSFs coverage of the CAHW system is limited to 6 out of 10 states: Unity, Northern Bhar el Ghazal, Warrap, Lakes, Jonglei and Upper Nile States. Other states are covered by other humanitarian actors in the livestock sub-sector, including UN FAO
Entity
Global Agenda for Sustainable Lviestock, hosted at FAO
Type: Other Multistakeholder partnership
Contact information
Anna Grun, Associate Professional Officer, anna.grun@fao.org, +39 06570 50210
Photos


United Nations