Developing a Community Animal Health Worker Programme Best Practice Guide
Contents
Purpose of this guide
This will be a book/manual for facilitators with context, not a paper and to be translated to Zulu
1. Community Animal Health Worker (CAHW) Programme Overview
The need for a Paravet program
Dr Modisane said that of the 2 400 trained veterinarians in South Africa, only 215 were working for
the State, and very few of them were operating in rural areas. Dr Mulder said it cost the state R260
000 per annum to train a veterinarian, which was more expensive than the training required for a
medical doctor. Veterinary and Para-Veterinary Professions Amendment Bill June 2012
Even in this thinly stretched sector the Veterinary Department sees its mandate and thus job, as
dealing with control diseases (Rabies, Foot and Mouth and Anthrax mainly).
In this situation its obvious that farmers cannot expect formal Veterinary support at a home or
village level.
Farmers are often illiterate and thus battle reading labels and working out dosages
Farmers do not have critical mass of livestock as a result they cannot buy medicines appropriate
there livestock numbers so have expired medicines or don’t buy at all as they cant justify the
purchase of a 100 dose bottle for 12 cattle.
The cold chain into rural areas is tenuous at best so much vaccine arrives no longer viable but gets
injected anyhow.
In many African countries there are varied types of state and non state sponsored CAHW’s programs
they work side by side with state veterinary systems with Government sponsoring some parts of the
CAHW’s costs.
2. Community Dialogue and CAHW Selection
CAHWs must be chosen ‘owned’ and managed by the community that they will be servicing
this can often be difficult as the perceived leadership in any particular area will try and
choose family members rather than young people that are known to have interest and
ability and livestock management.
The CAHW also has to be young, literate, trusted and currently unemployed.
A meeting must be called with the community leadership as well as the livestock leadership
systems and at this meeting 2 prospective CAHWs need to be selected.
Experience shows that regardless of societal rules around the livestock, young woman are
often better than young men in these roles so it is worth making sure that at least one of
those selected is a young woman.
It is not unusual to lose CAHWs through various reasons including marriage, finding a job or
realisation of what the job entails. So having a pool of possible CAHWs that the community
can fall back on is quite useful.
3. Baselines as a starting point
very few of the areas that CAHWs will be expected to work in have good data sets on numbers of
farmers or their livestock. It is thus imperative that to start this process the state agencies the local
community fora and the CAHW agree on a baseline survey so as to have a clear idea of the livestock
that are expected to be worked on as well as their owners. This baseline must also cover shops in
the area that do provide medicines, vets in the area as well as government service and staff that will
be operating in this area. Common and notifiable diseases should also be collated and discussed with
the farmers as these will be the starting point of any animal health intervention.
This baseline should be repeated annually so as to also get a sense of how much change there has
been in any particular area but in terms of livestock numbers herd sizes and services that support
the farmers.
Changes in sales of livestock looking at both numbers of livestock sold as well as changes in
marketing systems should also be covered in these ongoing baselines.
4. CAHW Relationships
Assumptions- it is generally assumed that there are structures representing livestock
owners in all the rural areas. These are generally based on the infrastructure of dip
tanks that are doing the have members who use this dip tank and get subsidised
medicines from the state for the dip. In other areas of South Africa they are quite
strong wool and sheep cooperatives and structures. If these are not present in any
way then the use of traditional leadership structures in whatever form they are on
the ground or worth using.
The most successful structure so far in South Africa has been livestock cooperatives
that were set up by the state and are quasi-independent. They meet every month
the farmers pay annual fees and these fees are used to facilitate their meetings and
transport for the EXCO structure that then coordinates with the state and vets
Department on accessing state infrastructure like dams and dip tank rehabilitation
as well as fencing. They also coordinate monthly dip days for their members and
coordinate getting medicine for these dip tanks they also worked closely with the
Vet Department on getting lumpy skin, anthrax and Blackquarter vaccinations. They
are also responsible for coordinating with the livestock theft unit of the SAPS around
the stock theft as well as branding and tattooing. They appoint a person who will be
the only one allowed to provide tattooing and branding for the farmers in that area
they justify this as a way of preventing farmers branding cattle don’t belong to them.
To this end the Department agriculture has provided them with branding irons as
well as registered a dip tank mark for every one of the 1600 dip tanks in KZN.
The only weakness to this dip tank system with livestock cooperatives is that they
are almost exclusively for cattle owners who are dominated by older men. Thus goat
owners who are often largely woman as well as chicken owners are left out of both
communication thinking and support of any type in the structures. The CAHWs will
often be servicing these people who are not part of the livestock Association. Local
solutions need to be found to get through this problem.
a. Livestock owners- the CAHWs are essentially responsible to the livestock owners in
the area they must have been chosen by them and should be held responsible by
them. The CAHW thus needs to be trusted and available and known by the whole
community so that any individual farmer can get hold of the CAHW and get them to
come and work on the livestock. Implicit in this is that as the CAHW does not provide
blanket coverage to the community the members that use the CAHW must pay for
this particular service.
b. Livestock Associations whether formally constituted or not, should be the managers
of the CAHWs who decide the strategy that the particular area will use in both
deploying the CAHW, how the payments for the medicines will be connected, what
the CAHW can charge for its services and making sure that the CAHW has enough
work to sustain them. They also needs to make sure that the CAHW has had
sufficient training and that the CAHW gets refresher courses. If the CAHW is not
working has another job or has become problematic for any reason it is thus
livestock Association that needs to take it on themselves to find a replacement and
replaced this particular CAHW.
c. Department of Agriculture- Vet-the vet Department of the local Department of
agriculture needs to provide training support and oversight of the CAHW
underground as well as use them whenever they go to a particular dip tank to make
sure that there are the and are doing the work in a technically proficient manner.
They should also use the CAHW to take messages to the community support training
initiatives and bring back issues that the CAHW is unable to solve to the local vet.
The CAHW should use the state vet infrastructure to feedback information from the
field support the veterinary departments initiatives and follow-through on any
requests from the field that need to be answered by Department staff. If and where
possible this Department should also use the CAHWs to extend and support the
vaccination campaigns. Lastly this Department needs to provide assurances to the
livestock Association that local shops are carrying medicines and vaccines that are
properly stored and are within the sell by dates.
d. Department of Agriculture- Animal Production- the animal production staff must
support the CAHWs in providing training either themselves or through a third party
in veterinary and production issues around livestock they should work together in
the field meeting farmers and supporting initiatives and programs. Former
production issues should be brought in by the CAHW to the technicians who should
then be able to provide answers that the CAHWs can take back into the field.
e. Private Vets-although there are very few private vets in the rural areas there is
definitely a need to formally link with them on one level so they do not feel
undermined but on another level so that their professional skills are used efficiently
by farmers the CAHW should have a referral system between itself the farmers and
the vet where they are able to take problems that are unsolvable at a state level to
the local vet for support answers or treatment. At a deeper level it would be useful
for the local vet to set at the level of the livestock Association so that they are seen
as part of the community and supported accordingly.
f.
Tribal Authority/local civic bodies/political councillors/NGO’s -the traditional
authority or where it is absent the civil society organisations must represent farmers
that are not part of the livestock Association as it is constituted and be consulted,
informed and invited to processes that involve the community. Often these
structures feel threatened by civil society organisation that does not involve them so
it is well worth the while involving them from a early-stage in the thinking and vision
of the CAHWs. Livestock issues can be volatile and it is also worth it for this reason
to involve structures that one can transfer disputes and the like to.
g. Local Project Leadership
h. Minicipality-the local municipalities are the responsible bodies for initiating and
continuing local economic development initiatives they should thus be involved
from the start. From the very early planning of any CAHW intervention or process
the local municipalities should be aware that these CAHWs would eventually
become small businesses that the municipality must support to spark local economic
development in the area. The municipality also needs to see them as a first step in
creating value chains for that particular area.
i.
Agrivet shops-most small towns have a particular shop or shops that do sell some
veterinary equipment these shops should be involved in discussions with the CAHWs
in agreeing on value chain guarantees efficacy of medicine and support by the local
livestock Association as an incentive. In further discussions they can work closely
together with the CAHWs to make sure that appropriate medicines and vaccines and
the like are kept at local shops and farmers are informed that they are available at
the same.
j.
Animal Health Product Companies (e.g. Intervet) the major veterinary medicine
suppliers need to support the agri-vet shops in the local towns by creating
innovative ways to support the cold chain from the wholesaler to the farmers home
as well as appropriate dose sizes and dosage tools like weight belts.
5. CAHW Primary Role
a. Limitations-a CAHW is not legally allowed to give prognosis of what is wrong with
the animal and cannot charge for dispensing information or diagnosis. Both of these
are bound up inside South African law around veterinary practice and professionals
charging for thier time. Control diseases and zoonic diseases by their very nature are
contagious and should be referred to vets.
b. Referrals-a CAHW identifying or suspecting a controlled disease outbreak or a zoonic
disease must by law informed the state vet and state officials. Where there is an
outbreak of a disease or condition that falls outside of these that the CAHW cannot
identify what does not know how to treat they should initially request support from
the state vet and production officials and if this is not forthcoming should take this
issue to a private vet to try and get help.
6. Sustainability of CAHW Programme
a. CAHWs are not state officials they must be either private small businesses or an
extension of livestock Association support services and as such part of cooperative.
Various models have been tried internationally on how to fund them initially as well
as over the longer term. The most successful of these has been where farmers pay
for them on a dose by dose basis and they essentially run as Micro businesses.
b. An initial kit needs to be acquired to go with the training process this kit should
cover the basics of what the CAHWs expected to do but what should be kept in mind
is that the larger the kit the more likely it is that the CAHW will be able to be selfsustaining. Each intervention needs to think through with the kit is being lent to the
CAHW by the livestock Association or whether it is being donated to the particular
individual. A third option is that the CAHW by the kit over time from the initiating
institution.
c. The ongoing cost of medicines needs to be seen as a separate issue as this will
entirely depend on how much work the CAHWs doing four which farmers and what
type of medicines they will be using.
d. The pricing of their own time and transport needs to be also dealt with separately
and in such a way that they would be able to see this income as enough of an
incentive to stay in the field using both the minimum wage and the amounts
government pays for volunteers is all is a good guide to judge what people expect to
be able to bring home.
e. The state cannot and will not provide medicines like antibiotics or vitamins among
others for the CAHW these need to be seen as monies for the own account of the
farmer.
f. It is very tricky to work with subsidised and and subsidised medicines in their
nontransparent way as this will make farmers believe that they are being taken for a
ride because the medicines already covered by state subsidies. With this issue also
these livestock Association needs to make decisions and rules for itself in its own
CAHW.
7. CAHW model comparison
There are various models that needs to be considered as each livestock Association
farmers group or NGO looks at CAHWs below are the five possible models and some
brief ideas on the respective strengths and weaknesses.
a. Stipends from state or NGO-in this model the state or an NGO would provide
stipends to the CAHW as well as a kit and medicines. The advantages of this are that
it will always be largely successful while it is funded, the vet kits stays the position of
the NGO or Department. The disadvantages are that the ownership of the CAHW
and its management are not in the farmers hands so there is little investment from
the farmers in this person, there is also no long-term thinking into how to transfer
vision this into small business, farmers do not get into the habit of paying for their
own medicines as a result they waste them and don’t learn to invest in the livestock.
In this system there is enough extra time invested to get production records
baselines and the like.
b. Weaning System-and the system they would be in an initial outlay of a vet kit as well
as start-up medicines and stipends that decrease by 20% every year so that the end
of five years this person has either succeeded or moved on. The advantage is that it
gives that a best case opportunity to work and everybody learns about the
possibilities and the markets steadied itself but from the very beginning is paying
something for these medicines and as the habit becomes established learns to pay
more and more to invest in the livestock which should be improving. The
disadvantages are the weaning wharf process or transfer vision needs to be handled
very carefully from even before the planning phase and neither NGOs nor the state
have a very good track record of weaning off people from their processes. The vet
could also needs to be donated to the management body rather than the individual
and as the individuals leave the management body takes control back and handed to
the next person. In this system the records will only be kept for a short while and
also stop being kept once the organisation paying starts the weaning process.
c. Hybrid Government pays for campaigns. Farmers pay for the services-in
international literature this is seen as the best case scenario where the state has no
presence in the field and works exclusively through CAHWs to implement state
campaigns and pays the CAHWs accordingly. The farmers pay for anything other
than campaigns be a treatment deworming de- ticking branding or antibiotics. This
works well as it makes a clear differentiation between what farmers need to pay for
and what is provided for free by the state. This disadvantages are that for a person
to be employed by the state to do controlled disease support they need advanced
training and person by person registration onto a government database that needs
to be regularly updated. The state is weary of handing over control of this process.
d. Farmers paying themselves-in this model the farmers would pay annual fees that
would be pooled and medicines bought and they would agree on a stipend that day
directly paid the CAHW monthly. All the farmers were just pay a straight fee for
services rendered. The advantages of this are that it is totally self-sustaining and
once it gets going it needs no further interventions beyond training and follow-up
training but because the farmers are not supervising it they have no control whether
the particular CAHW is going to follow up trainings or not. Another disadvantage is
that very few farmers have any experience of CAHW processes or indeed paying for
their own treatment from non-vets so there may be an issue here of uptake.
e. Hybrid provide capital (equipment/kit) & then CAHWs runs it themselves-in this
model and organisation or state’s Department would provide seed funding for startup in terms of equipment and the kit they would then give it to theatre to
individuals and set them on their way as small businesses. The advantage of this is
that the big capital outlay to start with that often stops people being able to enter
this sector would be covered and the long-term weaning would be unnecessary. The
disadvantage would be that it would be unclear what happens when this particular
individuals CAHW files that the kit then just get sold off as a private asset or doesn’t
get handed off to someone else.
8. Management of Community Animal Health Workers
a. Training - the training of the CAHW can be done in three sessions of three days each
with the third day of a recession being a practical in the field day with each student
gets tested on the skills that they have learnt. This will cover one livestock group. For
other livestock types the CAHW will then need to go for further training. The
curriculum is based on covering all the topics in the MRDP animal health book which
is available for free from the Department or on the Internet. Refresher training is or
expected quarterly in sessions of three days with the last day again bieng a practical.
b. Quality Assurance-the training must be done by a registered trainer who has the
trust of the state vet of the area. An exam needs to be done at the end of every
three-day session covering both a written exam and the practical exam a
competency book needs to be kept for each CAHW and this needs to be filled in and
signed at each and every training. This book can be presented as proof of training is
done and trainings passed to anyone who wants to see it. It is also imperative that
the CAHWs do not get trained by only one training institution or body but also get
trained by departmental officials and separately veterinary control officers this gives
an opportunity for the trainers to pick up discrepancies in trainees abilities. It also
creates a better trust in these people if they have been trained and have passed
trainings set by different institutions.
c. Reporting-reporting should be to the structure or institution that chose them and
represents the community.
d. Mentoring- mentoring of the CAHWs should be done by either staff from the NGO or
government department that initiated the process and should involve being in the
field with the CAHW and watching them work and giving them a formal feedback
session of what was seen in the field with a follow up of training specific to any
problems that were noticed.
9. CAHW Training Curriculum
a. Role of CAHW
b. Basic anatomy
c. Animal restraint
d. Livestock diseases, prevention and control
e. Parasites prevention and control
f. Animal nutrition and housing
g. Animal breeding
h. General management (castration, tagging, hoof trimming, body condition, etc.)
i. Drug handling and equipment use
j. Conducting baselines, routine monitoring and record keeping
k. Cost recovery and business management
l. Extension messages/services
m. Field practicals
n. Trainee assessment and “certification”
o. Refresher courses
p. Field days/learning exchanges
10. CAHW Kits
Equipment- all relevant to the animals to be worked on
Digital Thermometer
Tattoo machine, ink
Castrator
Vacuum flask for vaccinations
Syringes
Needles
Dosage gun
Gloves
Face mask
Cooler bag for all equipment
Weight belt
scalpel
Medicines
Antibiotic LA and normal –oxytetrocycline –and sulphure based
Dewormer
Wound spray
Tick grease
De-ticking medicines
Vitamins
11. Samples of Animal Health and Treatment Records, Attendance Register, Assessment,
Certificate, Job Description,