Evaluation of community animal health delivery systems in Simanjiro, Tanzania

E S Swai, S Masaaza¹ and C J Daborn²

Veterinary Investigation Centre, PO Box 1068 Arusha, Tanzania
esswai@gmail.com
¹District Veterinary Office, PO Box 13484, Simanjiro, Tanzania
²Tropical Veterinary Services, PO Box 266, Karatu, Tanzania

Abstract

 A survey was carried out to characterise community animal health delivery systems in pastoral communities of Simanjiro, northern Tanzania. This was prompted by the reported high disease challenges, remoteness and long term shortage of formal trained state and private veterinary professional staff. The study was conducted during the period of March 2010 through December 2010. The data were analysed using Statistical Package for Social Sciences (SPSS) version 17. A total of 88 community animal health workers (CAHWs) from 6, 15 and 36 administrative division, wards and villages, respectively, participated in the survey.

The survey revealed that the education level of interviewed CAHWs varied from adult education to certificate (2 years) training in veterinary or animal husbandry and a substantial variation was observed between divisions. Apart from delivering animal / veterinary husbandry services in their respect areas, 83 (95%) of the interviewed CAHWs were reported to be engaged in livestock keeping activities and acknowledged that livestock production (90%) to be their major source of household income. The working relationship and technical link between CAHWs and local government veterinary staff (LFO) was rated to be good. The study established that CAHWs were recognized and respected by the local community for the services they offer. It is, however, seen as an imperative that CAHWs should only operate under the direct supervision of trained and licensed veterinary personnel; receive continuous training and adequate technical support; and require recognition by existing policies, veterinary legislation and laws. Official recognition of CAHWs is long overdue and will be fundamental to facilitate better linkages and information channels between the delivery of community based primary animal health services and government veterinary services and regulatory bodies.

Key words: Africa, CAHWs, livestock, pastoralists

Introduction

 In Tanzania livestock represents on average 13% of the Agricultural Gross Domestic Product (GDP) and about 4.6% of the national GDP and up to 70% of the poor rural population depend on livestock for their income and livelihoods (Bhandari and Wollen 2008; URT 2012). However, the sector is seriously constrained by animal diseases and inadequate investments to enhance its contribution to the development of the country, despite its great leverage potential.

Since mid 1980’s, Tanzanian economy has been undergoing gradual and fundamental transformations towards a market-based economy. The macro-economic policy reforms have required a redefinition of the roles of the public and private sectors in livestock development. These changes have paved the way for the withdrawal of the Government involvement in subsidies and non-participation in private good inputs and services provision, which could be better performed by the private sector (Umali et al 1994). As a consequence of such policies there was a drastic cut back in government field veterinary staff – leaving a large part of the marginal rural areas without adequate animal health service provision.

One widely publicized initiative to re-establish livestock health service delivery in these underserved areas has been the introduction of community-based animal health workers (CAHWs). This initiative involves training community-selected representatives in basic animal health care and livestock production techniques. Community-based livestock services in Tanzania have received increasing attention during the past two decades (Allport et al 2005). This attention has come not only from the communities concerned, but also from international agencies such as Food and Agriculture Organization of the United Nations (FAO), Non-governmental organization such as ‘VET-AID’, ‘World Vision’, ‘Vredeseilanden/VECO’ and Continental organization such as AU-IBAR (FAO 1997; Jackson and Ward 1999; AU-IBAR 2003). Reports from these organization and expert opinions have concluded that community-based approaches for underserved areas offer a viable alternative to the resource-constrained and poorly functioning public veterinary services in developing countries (Daborn et al 1998). The CAHWs are therefore regarded as one approach that can be used in providing animal health services in the vast and remote areas that are not conducive for private practitioners. Services that are expected to be offered by the CAHWs include provision of primary animal health care, extension services on disease control and prevention, distribution of veterinary inputs and, most importantly, surveillance for and reporting of unusual events affecting livestock health and productivity.

Simanjiro, one of the most remotely located districts in Tanzania, is endowed with a large livestock resource base. It’s estimated that the current cattle population totals 358,968 heads distributed unevenly throughout 47 villages, 6 Division and 15 wards (NBS 2012). Other livestock species kept include 26,060 Poultry, 210,058 goats, 78,283 sheep, and 8,651 donkeys. Livestock form the major source of income followed by crop production. However, production remains low due to several reasons. Important among these being inadequate support services for animal care due to remoteness; uneven distribution of household (HHs) and animals; lack of vet input shops; and unwillingness of the official vet and para-vets to work in such remote areas. Therefore the objective of the study was to characterise the CAHWs systems in Simanjiro district, Tanzania, with a view to identifying gaps and ways to improve the impact and value of community animal health services delivered in such remote pastoralist settings.

Materials and Methods

Survey areas

The surveys were carried out in Simanjiro district, one of the five districts of the Manyara Region of Tanzania. Detailed description of the district is elaborated elsewhere (Swai and Masaaza 2012).  The district profiles in terms of area and population at glance are given in table 1 below.

Data collection

A combination of qualitative and quantitative data collection methodologies were employed in this survey. This was achieved through conducting an in-depth discussion with livestock keepers focus discussion groups (FDGs), in depth interviews of key informants such as Livestock Extension officers and other relevant stakeholders such NGO’s etc using semi-structured questionnaires, which was prior tested before administered.

A list of all practicing and non- practicing CAHWs was obtained from the district agriculture and livestock development office, and conveniently 88 were selected and enrolled to the study. The data were collected between March and December 2010. The information sought by questionnaire and FDGs included those related to CAHWs personal characteristics (age, sex, experience); the training, activities (source of daily income, cattle ownership); constraints faced by CAHWs; acceptability; competence (not reported here); the relations between CAHWs and their immediate government officials (VEO, LFO and DVO) and opinions regarding future operation of their duties.

Proportional piling

This tool was used to rank livestock disease by animal species and relative occurrence in their localities. Participants (5 groups of 5-10 livestock keepers, mainly men) were asked to list all the diseases that had affected cattle, goats, sheep and poultry in the past year preceding this study (2009). A circle was drawn on the ground representing each disease. Participants allocated 100 counters (beans or maize seeds) to the circles according to the relative numbers of each disease. Disease classification (i.e. vector and non-vector) and signs were guided by researchers and judged based on individual participant disease knowledge. Proportional piling were further ranked by pair wise ranking.

Plate a: Ranking	Plate b: FDGs and scoring
Plate ab: Participatory tools used during data gathering

Data analysis

The data collected were entered and analyzed using the Statistical Package for Social Sciences SPSS version. Descriptive statistics were used to describe the characteristics and activities of CAHWs and other information collected in the study. The level of agreement between informants score and pair-wise ranking was evaluated by Kendal coefficient of concordance W SPSS version 17 (SPSS Inc., Chicago USA) and were categorized as ‘weak’ ‘moderate’ and ‘good’, according to critical values for W provided by Siegel and Castellan (1994).

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. Out of the 88 interviewed CAHWs, 68 (77%) were males and only 20 (23%) were females, conforming with the gender bias toward male candidates as reported in the literature (Bagnol and Hickler 2010). Working experience varied from one year (n=28; 31.8%) to more than three years (n=46; 52.3%) following graduation from a training course. The results indicated that 70% of the respondents were men and women of 30 years and above, with age ranging from 20 to 59 years. Distribution of the interviewed CAHWs by division was not significant different (P>0.05) (Fig 1). The education level of interviewed CAHWs varied from adult education to certificate (2 years) training in veterinary or animal husbandry. Distribution of CAHWs education status varied significantly between divisions (P<0.05). Ngorika division had a significantly higher number of primary school leaver educated CAHWs compared to other divisions (P<0.05). Consistently, a higher number of adult educated CAHWs were seen in Ruvu Remit compared to other division (P<0.05). Education according to Bonnem (1990) is an intervention on human capital that improves its quality and enables better comprehension of basic animal health concepts and hence improvement on delivery. We consider this is a significant observation because such cadre of animal health delivery may be able to read and understand the information prescribed in veterinary medicinal products and guidelines described in basic veterinary manuals or books. Failure to enroll into primary or tertiary school education programme could be due to a number of factors such as the unaffordable cost, culture barriers or inadequacy of these services.

Figure 1: Location and percentage (%) of the participating CAHWs by division

Livestock keeping and CAHWs source of income

Results from the survey indicated that CAHWs owned a variety of livestock species. Apart from delivering animal / veterinary husbandry services, 83 (95%) of the interviewed CAHWs were reported to be engaged in livestock keeping activities and only 4 (4.5%) were not keeping livestock. The main livestock species kept were cattle alone (n=32; 36%), goats alone (n=2; 2.4%), sheep alone (n=1; 1.2%), cattle, sheep and goats combined (n=40; 47.6%) and cattle, goats, sheep, chicken combined (n=35; 41.7%). The major source of income was livestock production (n=80; 90.9%) followed by crop farming (n=69; 78.4%), operating a veterinary input shop (n=14; 15.9%) and wage paid salaries (n=2; 2.2%). Details are shown in figure 2. Experience in stock raising and ownership, measured as years of stock-keeping experience, appear to be an obvious criterion for enrollment as a community animal health worker. In this survey, there was, however, no evidence that limited experience with livestock would preclude an individual from becoming a successful CAHW.

Figure 2: Main source of income as reported by study participants (n=88)

Disease challenges

The study revealed that vector and vector borne diseases, namely East Coast fever (ECF), anaplasmosis, babesiosis, ormillo and trypanosomosis, to be common livestock disease conditions in all surveyed villages. The second group of diseases in the order of occurrence included contagious bovine pleuropneumonia (CBPP) and contagious caprine pleuropneumonia (CCPP) for cattle and goats, respectively. Others were black quarter and anthrax. Viral diseases included foot and mouth Disease (FMD), lumpy skin disease (LSD) and pox. Poultry diseases reported at higher frequencies were New Castle disease (NCD), fowl pox and infectious coryza. Consistent to these infectious and contagious diseases, various forms of helminthosis were also reported to be a common problem to all livestock species. Given the reiteration of the multitude of diseases recorded as has been previously reported (Shoo et al 1993), it is imperative that animal health service providers require adequate and continuous training on disease diagnosis, treatment and control skills. The livestock keepers perceptions and ranking diseases prevalence are shown in Table 2- 4.

Education background of CAHWs and service offered

Ideally, a CAHW is defined as an individual from the community who is elected by the community to provide animal health services for the community. Training duration of interviewed CAHWs ranged from intensive residential of < 2 weeks to up to 6 months. The majority (50%) were exposed to a training programme of 2 week - 2 month, at livestock farmer centre based at Emboret, Simanjiro. The main sponsoring (Fig 3) agents or institutions were non-governmental organizations (NGO’s) (n=57; 64.8%) such as ‘Vet Aid’ and ‘World Vision’. Others included local government authority (LGA) (n=19; 21.6%), LGA/NGO’s (n=9; 10.3%) and development projects (n=2; 2.3%) mainly Land Management Programme (LAMP). Subjects covered during training were diagnosis and treatments (n=29; 33%), diagnosis, treatment and animal husbandry related topics (n=56; 63.6%) and diagnosis, records keeping, pasture husbandry (n=3; 3.4%). 

Figure 3: CAHWs training agencies in Simanjiro (%)

Adequacy of training

All interviewed CAHWs admit that the training was an eye opener as it has enabled them carry out basic animal health services. However, they raised a concern that they would wish to attend and upgrade their knowledge and skills through additional training. Future areas of training are shown in Table 5.

Importantly, the CAHWs commented that, the training duration was too short to be able to comprehend difficult subjects such taking specimens for diagnosis, dosage computation according to body weight. All these point to the fact that skill building is a time–bound process and thus continuing training is essential. Post-training career development opportunities such as seminar and workshop participation was perceived to be low. Information on refresher training was collected because available literature indicates that refresher courses provide a forum for the continued competence development of these workers (Holden 1997). To remain in business, these workers need to remain more knowledgeable than ordinary farmers on animal health matters. Given the limited initial training offered to these workers, it could only be a matter of time before livestock keepers in the surrounding area acquired equivalent animal health knowledge and having done so then dispense with their services. The level of competence development should have a positive effect on likelihood of success as a CAHW. Thirty-two (36.2%) of these workers had attended refresher training, ranging from one to nine times. It can be further argued that for CAHWs to continue to provide services, they must be able to price their products competitively so as to run their services profitably. In order to remain financially viable and become successful workers, CAHWs must possess business skills; possession of these skills is postulated to have a positive effect on success. To capture this factor, researchers asked the workers whether they had undertaken any training in business skills. The results showed that just 20.5 % of the workers had undertaken such training.

Regarding ways of improving the training, all CAHWs agreed that the subjects were quite relevant for beginners; however, the time allocated was not adequate. They therefore suggested that such training should take 16 weeks instead of 2 to 8 weeks. Other views for improving the training include subject coverage and more practical sessions.

Service offered

Animal health services in all surveyed village/wards were reported to be offered by the following cadres: CAHWs (n=67; 78.82), government trained Livestock Field Officer (LFO) (n=15; 17.6%) and jointly CAHWs/LFO (n=3; 3.5%). Most of such services were operating from LGA owned vet centre, or dip tank point (n=58; 67.42%) or at a small vet input shops owned by LFO (n=19; 32.2%), NGOs office (n=2; 3.4%) and village government office (n=34; 57.6%). Working tools/equipment were either outsourced from NGOs (n=49; 55%), Project such LAMP (n=4; 4.5%), LGA (n=14; 15.9%) or CAHWs themselves (n=65; 73.8%). Major or routine activities performed and their frequencies are shown in Figure 4. Eighty four (n=84; 95.4%), (n =14; 15.9%) and (n=2; 2.2%) reported referring complicated cases to LFO, DVO and nearby Veterinary Investigation Centre (VIC), respectively for additional professional/laboratory diagnosis. Some (n=18; 20.4%) share the problem on occasions with local leaders.

{Notes: BC = blood less castration, WT = wound treatment, HT = hoof trimming, DR = drenching, DEH = dehorning, VAC = vaccination; AD = attend dystocia} Figure 4: Types and frequency of operation/ services offered /performed by CAHWs

Record keeping

Forty-six (52.3%) of the respondents claim to keep records related to their day to day animal health delivery tasks. Forty-two (47.3%) do not keep records. These records include disease cases handled, drugs used, and the prices of the drugs. Furthermore, 43 (48.9%) write regular reports pertaining to their work. Of the 43 respondents, only 5 (11.4%) and 39 (88.7%) were submitting their reports to DVO and LFO, respectively. The majority (n=33; 76.7%) raised concern of not getting feed-back from their supervisors.

CAHWs relationship with other extension agents in the district

Field disease diagnostic or control operations require close collaboration between key players. Village administrative, extension officers are key people at village level with respect to animal health interventions. Relationship (work or personal) between CAHWs and Village Extension Officer (VEO) and District Veterinary Officer (DVO) were sought and the response is as shown in Fig. 5. 

Figure 5: CAHWs relationship with VEO and DVO

With respect to support or supervision, only 57 (64.8%) reported to have received regular support (advice) or supervision from their DVOs. They also shared knowledge, skills and a bi- directional case referral system depending on case complexity. When asked to suggest how they would further enhance the existing positive collaboration, CAHWs and LFO gave suggestions, as summarized in Table 6.

Conclusion

In common with many other rural areas in Tanzania and elsewhere, the delivery, in most areas of Simanjiro district, of formal clinical veterinary-laboratory supported veterinary service is practically not feasible. The remoteness, poor physical infrastructure, transhumance and high transport cost will not justify private animal health delivery service operation in the area, however the study revealed that:

• CAHWs constitute a key source of animal health services for the rural communities of Simanjiro district

  
  

• More than 50% of CAHWs have been in practice for more than 3 years and offer a variety of animal husbandry services

  
  

• The working relationship of CAHWs and link with their immediate supervisors were rated to be good suggesting that under minimal supervision CAHWs may be co-opted into other animals health activities such as disease surveillance and mass scale animal vaccination.

Recommendation

• Our study underscores the fact that given the current scenario the role of CAHWs as a primary animal health service provider remains a viable solution to addressing the needs of livestock keepers in underserved, remote pastoralist livestock production areas.

  
  

• There is an urgent need for the veterinary hierarchy to re-appraise its view and policies as directed at this essential and grossly under-supported third tier of the veterinary service in Tanzania and give due recognition to the value added they can bring to addressing the primary animal health care needs of livestock keepers. Critically the Veterinary Council of Tanzania (VCT) should provide for enabling legislation that supports, defines and properly regulates the duties of primary animal health care  workers, putting their day to day supervision clearly under the professional direction of a veterinarian [1^st tier] and technical direction of a subordinate veterinary para-professional [2^nd tier].

  
  

• A key component of this responsibility must be a VCT directive for the continuing education of CAHWs by their supervising veterinary superiors and the requirement for the establishment of an efficient reporting chain inclusive of regular feedback and response to events being reported by frontline staff. Such in-service training should be recognized by the VCT as an approved activity for the veterinarian / veterinary para-professional meeting his /her continuing professional development (CPD) obligations. Under such proper and effective supervision by licensed veterinarians and veterinary para-professionals, – frontline service delivery would experience a significant and quantum improvement. To achieve this goal we urgently need a focused and time bound dialogue with all concerned stakeholders in the pastoralist livestock sector, leading to the development of facilitating policies, legal instruments and evidence based interventions. These interventions should be designed to progressively enhance the sustainability, quality and value of frontline community based, primary animal health care services with the targeted and readily achievable objective of increasing the contribution made by the pastoralist livestock sector to national GDP.

Conflict of interest statement

• None of the authors of this paper has a financial or personal relationship with other people or organization that could inappropriately influence or bias the content of the paper.

Acknowledgements

Northern Zone Agriculture Research Development Fund (NZARDEF Project No LP/10/01) for financial support to undertake the study and Simanjiro district council, livestock department staff and CAHWs for help and assistance. This paper is published with the permission from the Director of veterinary services in Tanzania.

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Received 11 April 2014; Accepted 9 May 2014; Published 1 August 2014

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