Developing a Community Animal Health Worker Programme Best Practice Guide Contents Consistent use of livestock ass or c-operatives 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. It is our experience that up to 50 percent mortality in kids happens Also high mortality in chickens and eg also cattle Also high parasite load and cycles Production compared to commereial examples is very low –give percentages Also infrastructure of vet support services and effeccint medicine availability limited to non existent 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. 1 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. Per community if it appears that livestock power groups are separate from women and small livestock keepers 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 followed 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. Case study- 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 2 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. Embedded gender based power structures need to be understood and not supported to the detriment of more vulnerable members of the society. 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 3 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-if there are more than one party supporting the cAHWS it would be usefull to have a co-ordinating committee so as to mitigate conflicting intrests and positions towards the cahws 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. 4 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 their time. Control diseases and zoo-onic 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. Look at govt ideas and add here for Rauri 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. 5 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. 6 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 7 k. l. m. n. o. p. Cost recovery and business management Extension messages/services Field practical’s Trainee assessment and “certification” Refresher courses 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 sulphur based Dewormer Wound spray Tick grease De-ticking medicines Vitamins 8 11. Samples of Animal Health and Treatment Records, Attendance Register, Assessment, Certificate, Job Description, baseline documents 9