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Focus on the Public Sector
A common feature — in some cases, an identifiable flaw — of many of IFAD's earlier projects with animal health components has been their emphasis on the strengthening of government veterinary services. Typically, new buildings, diagnostic and office equipment, drug and vaccine supplies, technical assistance and staff training were provided. Staff salaries were sometimes also financed, for example, in the Second Village Livestock and Rural Development Project in Madagascar. Some of these projects, such as the Livestock and Pasture Development in the Eastern Region in Morocco, have been successful, albeit on their own terms. More frequently, as with the Central Rangelands Development Project in Somalia in the early 1980s, they have fallen short of their aims and components have had to be scaled down or cancelled. According to the mid-term evaluation (MTE) report on the Badulla Integrated Rural Development Project in Sri Lanka, implementation of the livestock health component was limited and did little to benefit the target group, and money was spent inefficiently on the construction of new buildings. However, even the successful projects have not always had a beneficial impact on IFAD's target group — the rural poor.
Certain capacity-strengthening projects have, in addition, attempted to ensure that rural poverty will be alleviated. The provision of vehicles or mobile clinics, as in the improved Second Badulla Integrated Rural Development Project in Sri Lanka and the Mewat Area Development Project in India, is intended to improve the coverage of the veterinary services. In the Second Village Livestock and Rural Development Project in Madagascar, new veterinary centres apparently facilitated staff access to remote areas. Project financing of comprehensive government vaccination or dipping campaigns may also have a measurable positive effect on the rural poor. The Mewat Area Development Project dewormed 26 000 head of cattle; the Wadi Beihan Agricultural Development Project in Yemen vaccinated 12 000 small ruminants and a few hundred camels. Projects focusing on small ruminants have an added advantage in that the poorest people traditionally own such animals. The Small Ruminants Project in Togo, which vaccinated 270 000 animals against Small Ruminant Pest (SRP) in 1996 alone, was successful in this respect.
Nevertheless, even in the case of Togo, government involvement had its disadvantages. More vaccinations might have been performed had the restrictions on private veterinarians’ use of vaccines not been so stringent. Moreover, there have been many unsuccessful national vaccination campaigns. For example, according to the completion evaluation report on the Second Integrated Agricultural Development Project in Kenya, the campaigns were not fully implemented (although figures were not available due to poor monitoring), they failed to introduce cost recovery as had been intended, and apparently resulted in no improvement in productivity. The Animal Health Services Rehabilitation Programme in the same country, seven years later, was equally unsuccessful, as the completion evaluation report on Animal Health Services Rehabilitation Programme in Kenya (188-KE) shows.
In short, IFAD's experience with projects focusing only on the improvement of government animal health departments has been largely negative. In too many instances, national governments and public veterinary services have been uncooperative or inefficient. Even when this was not the case, the impact on the rural poor was indirect and limited.
Focus on Communities
As a consequence of the foregoing, many of IFAD's more recent animal health-related interventions have included community-level components. These are intended to benefit the rural poor more directly, besides conforming to the new strategy of a participatory, bottom-up approach to development. They raise an entirely new range of issues.
Community targeting. If a project concentrates on communities rather than on national veterinary services or disease-control campaigns, the question of how these communities are to be selected becomes much more important. Ideally, communities should be chosen so as to give the most benefit to the target group — the rural poor. However, poverty itself is a difficult concept. For example, absolute poverty is defined as an income level below basic subsistence, while the definition of relative poverty involves comparisons with the average national income. But neither of these measures has a qualitative aspect (Heffernan and Sidahmed, 1998). IFAD has used concepts including those of ‘food insecurity’ (Southern Province Household Food Security Programme in Zambia) and ‘poverty line’ (as in the Mewat Area Development Project in India). Even so, targeting is difficult when all a country’s people are in need. The appraisal report for the Northern Areas Development Project in Pakistan states that "While priority should be given to the poorest and the poor, given the low income levels overall, there is no justification for excluding the less poor."
Among the rural poor, IFAD tends to give priority to three groups: the landless, marginal farmers and poor women.
Strategies for reaching these groups have varied. Some projects, such as the Smallholder Livestock Development Project in Bangladesh, have had women beneficiaries only, or have included special programmes for women. Others — in Cameroon and the Central African Republic, for example — have targeted pastoralists and herder associations on the grounds that the food insecurity of this group is typically very high. Projects aiming at smallholders often include a maximum allowable acreage, although the figures vary. In Ghana, for the Upper-East Region Land Conservation and Smallholder Rehabilitation Project, almost all smallholders had less than 2.4 ha of land and were therefore defined as being ‘at risk’. The focus was on those who had less than 2 ha and inadequate alternative employment. The Small Ruminants Project in Togo was aimed at farmers with less than 2 ha and about seven sheep or goats: animals that tended to be owned by the poorest and raised by women.
Communities are therefore targeted largely according to the concentration of poor households, defined in these ways. Specific criteria used include:
- distance from markets, schools, health facilities and social services;
- poor infrastructure and road access;
- recurrent food shortages and poor storage facilities;
- insufficient water and susceptibility to drought;
- lack of alternative income sources; and
- number and disease status of livestock.
Approaches vary, however. Some projects, such as the Smallholder Livestock Development Project in Bangladesh, have actually given priority to areas that have better market access and institutional support and can thus make more use of project aid. Others also take account of community enthusiasm. For example, the Southern Province Household Food Security Programme in Zambia considered the following criteria, in addition to those related to food insecurity:
- ability to live up to commitments (in defining an action plan, etc.);
- economic growth potential;
- willingness to contribute labour and pay for services; and
- willingness to accept training and select paraveterinarians.
At this point, however, community selection goes beyond the relatively simple techniques of observation visits coupled with a sample survey of key household data. The process used in Zambia proved too cumbersome: it was delayed and never implemented fully.
Community animal health workers. Given that the target communities are too poor to pay much for animal health care and tend to be remote or inaccessible, the delivery of veterinary services raises particular problems. Especially in extensive areas, it is usually uneconomic for them to use professional veterinarians on a routine basis. Professionals are unwilling to establish themselves in such unlucrative practices, and travel expenses are often too high for them to make regular visits.
One solution used in a number of IFAD projects has been to train local people to operate as CAHWs. These are sometimes called by other names, including animal health auxiliaries (AHAs), paraveterinarians and village vets (VVs). Occasionally the animal health aspect is combined with training in animal husbandry or marketing to produce community livestock workers (CLWs) or village livestock auxiliaries (VLAs). In other projects, the training may specify a particular animal species or function. For example, the Smallholder Livestock Development Project in Bangladesh had trained 7 819 women poultry workers by 1997, while the auxiliaries trained by the Second Atacora Province Rural Development Project in Benin had vaccination as their principal function.
IFAD has used this approach in a wide variety of projects, ranging from Ghana and Togo to India and Nepal, and seems to intend continuing to do so. Paraveterinarian training has been included in several projects approved since 1997, including the Southern Governorates Rural Development Project in Yemen and the Ha Tinh Rural Development Project in Viet Nam. However, that approach raises a number of important questions.
1) How should CAHWs be selected?
This issue is important in terms of both equity and sustainability. Attempts to include more women have had varying results. The Agriculture Productivity Improvement Project in Cambodia had to impose a quota of 30% women paraveterinarian trainees in order to ensure their selection. However, under the Production Credit for Rural Women Project in Nepal, attempts to enrol several women from credit groups came to a standstill after some initial success.
Selection procedures have almost always tried to include a significant degree of community participation. One exception was the first Livestock Development Project in the Central African Republic, approved in 1979, which simply trained herder chiefs and their sons. Later projects have shied away from this approach, but the amount of participation certainly varies. For example, trainees in the Southern Province Household Food Security Programme in Zambia were simply appointed by their communities. In the Agriculture Productivity Improvement Project in Cambodia, this was done at a project-organized meeting, with reference to certain predetermined criteria, as follows:
- literacy;
- establishment and intention to remain in the village;
- skill in working with animals;
- desire to learn new skills to help the community and earn extra income;
- willingness to learn;
- age (between 23 and 35); and
- time to devote to training and work
In the ongoing Northern Areas Development Project in Pakistan, however, community organizations will merely nominate candidates (unemployed youth, preferably holders of secondary school certificates); for the Mewat Area Development Project in India it was simply specified that the advice of village groups should be sought.
2) How long should the training course be, and what should it involve?
Because of the many different types of CAHWs, the variation in training courses is predictably wide. The shortest courses are of only one week (the Livestock Development Project in the Central African Republic changed from a planned three-month course), or a fortnight (the Southern Province Household Food Security Programme in Zambia). Courses of three or four weeks seem more typical. The Agriculture Productivity Improvement Project in Cambodia began with 25 days’ intensive training, but also included 11 days of one-to-one field monitoring, and included the possibility of additional meetings and refresher courses spread over a 12-month period.
The location of the training is also important. In Cambodia, it was divided between classes in the commune and fieldwork in the village, and in Central African Republic it took place in the herder compound. For logistical reasons, however, training centres appear to be the routine, and were used in Zambia and in the Northern Areas Development Project in Pakistan.
As far as the curriculum is concerned, the training for such specific functions as vaccinator or poultry worker is equally specific. Conversely, for the more generalist CLW trainees, the animal health component of the training is quite limited. In the Northern Areas Development Project in Pakistan, it is intended to cover routine vaccinations, first aid, deworming and delousing, but in the Upper-East Region Land Conservation and Smallholder Rehabilitation Project in Ghana it was so basic that CLWs could earn little money from their work and felt they required more training even to perform vaccinations. The more successful courses (in the Cambodian Agriculture Productivity Improvement Project and the Xieng Khouang Agricultural Development Project in Laos, for example) seem to involve some very basic theory, treatment and prevention of common diseases, vaccination, castration and obstetrics, followed by field training and experience. An interesting additional feature of the project in Cambodia is the existence of contracts between the trainers and trainees, setting out a code of conduct for each.
3) What sort of follow-up and impact monitoring should be performed?
One problem that has affected several paraveterinarian training programmes is that of unsustainability. McCorkle (1997) lists some conditions that make it more likely that a trainee will continue working after the end of a project. These include:
- acceptability to the community,
- refresher training and follow-up during the project; and
- access to professional support and drugs after the project.
The first of these, insofar as it depends upon local origin, participatory selection and local training, has already been discussed. But the other two are equally important. The general procedure is that the CAHW is given a basic veterinary kit. In the project in Cambodia, the value of the kit was set at USD 60. For the Northern Areas Development Project in Pakistan, it was specified that it should contain: "Vaccination, dressing and castration equipment and supplies in a durable leather bag with a wide mouthed thermo flask for vaccines."
Limited drugs are usually supplied, but the CAHW is expected to replenish them him/herself, buying more with the money he/she earns. Sometimes, as in Ghana and Zambia, he/she is also provided with a bicycle. In Pakistan, a lump sum subsistence allowance for the first 12 months is also included. In the project in Ghana, however, only 200 of the 400 CLW trainees were trained in animal health; only 160 of these were issued with veterinary kits; and even fewer actually received bicycles.
This particular paraveterinarian programme (included in the Upper-East Region Land Conservation and Smallholder Rehabilitation Project in Ghana) had further problems with sustainability. CLWs were part of small, ten-member groups on whom they focused most of their efforts, and had only weak links with the wider community. Consequently, it was difficult for them to earn enough money. In Bawku East District, by the time of the interim evaluation mission, 25% of trainees were not operating — having left the district, used the drug money for private purposes, or supplied drugs on credit.
However, drop-out rates have been high in other projects, too. This was the case in the otherwise successful Smallholder Livestock Development Project in Bangladesh, where no provision was made for replacement. The Agriculture Productivity Improvement Project in Cambodia allowed for a 10% drop-out rate.
Follow-up and refresher training are not mentioned by many projects. The case of Cambodia is an exception: it allows for one year's routine monitoring and mentions refresher courses, the content of which is still to be decided. The Xieng Khouang Agricultural Development Project in Laos also included classroom follow-up training for 600 (project and non-project) village veterinary workers (VVWs), and plans for the Pakistan project specify three one-week refresher courses as well as continuing project assistance — for example, in charging farmers.
Most CAHW projects have provided for at least minimal monitoring — for instance, of numbers trained and sometimes of numbers operating. In the Livestock Development Project in Central African Republic, monitoring of herder auxiliaries was used to show that they were working according to recommended scientific standards. The training of AHAs in the Mewat Area Development Project in India apparently led to increased vaccination of buffaloes (Shyam Khadka, pers. comm.). In the Southern Province Household Food Security Programme in Zambia, calf mortality was monitored as a proxy for VLA efficiency, since the reduction of such mortality was supposed to be their main purpose. Similarly, in Bangladesh, declining poultry mortality rates were recorded, and the use in Laos of VVWs to vaccinate cattle is recorded as having reduced the mortality rate to some extent.
In Cambodia, other indicators were also monitored, including the number of VV clients. In Pakistan, the plans for monitoring and supervision of routine activities are even more ambitious, including a daily work register for each CLW to be summarized in a prescribed reporting form each quarter, which is crosschecked and certified by a veterinary officer. Indicators should therefore also include the numbers of various routine activities performed by CLWs.
The issues of sustainable drug supply and good relations with the professional veterinary services are closely related. There appears to have been some success in Togo, where, according to the supervision mission report, VLAs provided care "in most cases in relation with eight private vets established outside the capital".
The project in Cambodia intended that VVs should be registered and licensed yearly by the Government, thus entitling them to support and permitting them to buy vaccines. It was also intended that an independent VV association should be established to provide further supervision and training. However, the study of the potential functions of such a body was not scheduled until the third year of the project. In Bangladesh, arrangements were made for the supply of vaccines, but these were not always successful. Occasional high mortality rates were attributed by project staff to inappropriate storage and incorrect timing of vaccinations. In the completion evaluation report, concern was expressed that poultry workers depended on non-governmental organizations (NGOs) and the Government for the supply of inputs. By contrast, in Laos, VVWs were supplied with vaccine through RDFs and did not rely on the Government for procurement.
Community access to drugs. The move towards projects focusing on community animal health care raises more general issues regarding access to veterinary drugs. There are two types of supply problem. One is where the government imposes strict controls on the legal handling and use of such drugs. For example, in the Small Ruminants Project in Togo, the effect of vaccination campaigns was reduced by the fact that private veterinarians could only vaccinate at certain times, and auxiliaries could not do so at all. Likewise, in Cameroon, intended legislation allowing the private use of veterinary drugs was not enacted during the project period. In the Second Village Livestock and Rural Development Project in Madagascar, veterinary imports arranged by the project (even though they were at first delivered to the Government's central pharmacy) were fewer and slower than planned owing to lengthy bureaucratic procedures. In India, there is a strict law controlling veterinary drugs, but the Government has neither the will nor the capacity to enforce it and paraveterinarians can be supplied efficiently by the private sector, although there are some problems with low-grade drugs in rural areas (Shyam Khadka, pers. comm.).
The second type of problem is purely logistical, and can be combated by development projects with much greater chances of success. In the Kwale and Kilifi District Development Project in Kenya, IFAD merely attempted to help the veterinary service make non-prescriptive drugs more available at strategic points at the divisional and locational levels, to be sold at the recommended, non-subsidized, government retail price. However, especially in recent years, it has instead generally tried to improve private-sector supply mechanisms.
One means has been the provision of credit to establish drug-importing companies or for private pharmacies. The Livestock Sector Development Project in Cameroon intended to do both, but no credit for either purpose had been disbursed by the time of the MTE. Credit for small livestock pharmacies was also available under the Western Kenya District-based Agricultural Development Project in Kenya. However, the Small Ruminants Project in Togo took a slightly different approach, and provided 160 VV pharmacies (run by local committees) to farmers' associations under a matching grant scheme. According to the supervision mission reports, these were much appreciated and averaged sales of about USD 2 per day by the end of the project.
The Agriculture Productivity Improvement Project in Cambodia aimed to encourage private pharmacies in a more general way, including the provision of training in vaccine use and small business management for pharmacists. By contrast, the Andhra Pradesh Participatory Tribal Development Project in India simply intended to provide USD 31 100 worth of veterinary drugs to be held by individual communities. However, the most common means of improving the supply of veterinary medicines and vaccines has been RDFs.
Revolving drug funds. Revolving funds for veterinary products were pioneered as a means of improving supply to government veterinary departments. For example, in the Southern Province Household Food Security Programme in Zambia, it was a condition of loan effectiveness that RDFs (charging at cost plus a commission) should be set up in each district veterinary office. In Ghana, a large fund for bulk purchases was established. Drugs were sold at cost to livestock owners, the fund was audited, the revenues were deposited in a central account in Bolgatanga, and the recovery rate was about 70%. A fund set up by the Kasungu Agricultural Development Project in Malawi was quite successful. Supply was maintained, barring some temporary shortages, and farmers were prepared to pay cost plus 25%. The MTE concluded that the fund was sustainable and a possible candidate for privatization.
Other national RDFs have functioned less well, however. For example, the fund in the Western Savannah Project — Phase II in The Sudan started promisingly in 1984, but subsequently encountered severe administrative and technical problems. Orders were eventually limited to trypanocidal drugs and Veterinary Department trypanosomiasis treatments, but numbers continued to fall. This was attributed to the strength of the black market for such drugs, understaffing and the complexity of the receipt system. In Saint Vincent and the Grenadines, a planned RDF had still not been implemented by the time of the MTE in 1995, although the management procedures had been almost finalized. A revolving fund for veterinary products in the Central African Republic began slowly under ANDE, but was transferred to the National Livestock Producers’ Association in the third year of the project. Herders used and administered it well and sales surpassed the appraisal objective by 500%, reaching 80% of the target population.
The Xieng Khouang Agricultural Development Project in Laos took a somewhat different approach, having by 1997 set up small revolving funds for vaccine and medicine procurement in every village where there was a cattle bank. In response to supply problems caused by the lengthy bureaucratic process of obtaining vaccine through official channels from district offices, it also established similar, larger funds at district level to facilitate procurement from the provincial centres. More RDFs are planned in a new initiative in Laos, the Northern Sayabouri Rural Development Project, and in the Sustainable Agricultural Development Programme for the Mountain Areas in Lesotho.
