The Status of Community Animal Health in Kenya: OSRO RAF 801 EC

Transcription

1 Food and Agriculture Organisation The Status of Community Animal Health in Kenya: OSRO RAF 801 EC Technical Report June 2009 By

2 The Status of Community Animal Health in Kenya: OSRO RAF 801 EC Technical Report June 2009 Undertaken by Dr. Kisa Juma Ngeiywa Dr. Rachael Asike Masake i

3 TABLE OF CONTENTS TABLE OF CONTENTS... ii ACRONYMS AND ABBREVIATIONS... iv LIST OF FIGURES... vii LIST OF TABLES... vii EXECUTIVE SUMMARY... ix 1.0 BACKGROUND INFORMATION AND INTRODUCTION History of Veterinary Services in Kenya History of CAH and the Birth of CAHWs Current Policy/Legal Frameworks The Study Objectives of the Study APPROACHES AND METHODOLOGY Study areas Study methods RESULTS Animal Health Service Providers The key findings The role of Service Providers in CAH The Veterinarians The Animal Health Technicians The Community Drug Suppliers The Community Animal Health Workers CAHW s Overall Responsibilities CAHWs Principle Role CAHWs Minor Clinical Roles Rationale for Training of CAHWs Selection Criteria Trainers Training of Trainers Refresher Courses Training Curriculum/Trainers Guide KVB Training Curriculum and CAHW s Trainers Guide The FARM-Africa Training Model AHSPF CAHW s Training Model Practical Action and ACTED Monitoring and Supervision of CAHWs Monitoring Supervision Facilitating Agents Upgraded AHA Certificate CAHWs THE VALUE OF CAHWs SERVICES Value to the Community ii

4 4.2 Value to the Department of Veterinary Services Value of CAHWs to CAH System Value of CAHWs work Vis as Vis employment of AHTs & Vets by GoK IMPACT OF CAHWs WORK PRIVATISATION PROFITABILITY OF CAHWs BUSINESS CHALLENGES Administrative Structural and Logistical Challenges at the Governmental Level Challenges at the Community Level Need for Recognition of CAHWs SUSTAINABILITY Legal Environment Donor dependency Competition for Elite Community Members Opportunities for Sustainable Animal Health Care RECOMMENDATIONS REFERENCES ANNEXES Terms of Agreement Itinerary for Field Visits Check list CAH Study Check List List of people contacted CAHW s Monthly Monitoring Sheet iii

5 ACRONYMS AND ABBREVIATIONS ACK ACTED ADB AHA AHITI AHSD AHSP AHSPF AHTs AIDS ALDEF ALLPRO ALRMP AMRE F ASAL AU/IBAR BQ CAH CAHNET CAHWs CAP CAPE CARE CBO CBPP CCPP CCS CDCCs CEO CHs CHWs CIFA CODES COOPI CORPs CPA CSD DAH DAO DAs DC DDVO DLPO Anglican Church of Kenya Agency for Technical Cooperation and Development African Development Bank Animal Health Assistant Animal Health and Industry Training Institute Animal Health Service Delivery Animal Health Service Provider Animal Health Service Providers Forum Animal Health Technicians Acquired Immune Deficiency Syndrome Arid Lands Development Focus ASAL Based Livestock and Rural Livelihoods Support Project Arid Lands Resource Management Project African Medical Research Foundation Arid and Semi Arid Land African Union/Interafrican Bureau of Animal Resources Black Quarter Community Animal Health Community Animal Health Network Community Animal Health Workers Community Action Plan Community-Based Animal Health and Participatory Epidemiology Christian American Relief Community Based Organisation Contagious Bovine Pleuropneumonia Contagious Caprine Pleuropneumonia Christian Community Services Community Disease Control Committees Chief Executive Officer Contact Herders Community Health Workers Community Initiatives Facilitation and Assistance Community Development Support Cooperazione Internazionale Community s Own Resource Persons Comprehensive Peace Agreement Camel Sudden Death Decentralised Animal Health District Agriculture Officer Development Agencies District Commissioner Deputy District Veterinary Officer District Livestock Production Officer iv

6 DMI Drought Management Initiative DMO Drought Management Officer DO District Officer DPA District Pastoral Association DPSC District Pastoral Steering Committee DSU District Support Unit DVO District Veterinary Officer DVS Department of Veterinary Services ELCK Evangelical Lutheran Church of Kenya EPAG-K Emergency Pastoralist Assistance Group Kenya EVK Ethno Veterinary Knowledge FA Facilitating Agency FAO Food and Agriculture Organisation of the United Nations FARM-Africa Food Agricultural Research Management Africa FHI Food for the Hungry International FMD Foot and Mouth Disease GB Great Britain GoK Government of Kenya GTDO Garba Tulla Development Office GTZ Germany Development Cooperation Agency HIV Human Immunodeficiency Virus ICRC International Committee of the Red Cross IDP Internally Displaced Person IGA Income Generating Activity ITDG-EA Intermediate Technology Development Group East Africa JAHA Junior Animal Health Assistant KALT Kenya Association of Livestock Technicians KAPP Kenya Agricultural Productivity Project KARI Kenya Agricultural Research Institute KCA Kenya Camel Association KENDAT Kenya Network for Development of Agricultural Technologies KES Kenya Shillings KLIFT Kenya Livestock Finance Trust KLMC Kenya Livestock Marketing Council KMC Kenya Meat Commission KPR Kenya Police Reservists KVA Kenya Veterinary Association KVAPS Kenya Veterinary Association Privatisation Scheme KVB Kenya Veterinary Board KVDA Kerio Valley Development Authority LDUA Livestock Drug Users Association LO Livestock Officer LWF Lutheran World Federation MDP Marsabit Development Programme MoU Memorandum of Understanding MPIDO Mainyoito Pastoralists Integration Development Organization v

7 MRTC Maasai Rural Training Centre NALEP National Agriculture and Livestock Extension Project NEP North Eastern Province NFDs Northern Frontier Districts NGI Non Governmental Institution NGO Non Governmental Organization NIA Neighbourhoods Initiative Alliance NIDRA Nomadic Integrated Development and Research Agency NPHC Nomadic Primary Health Care OIE World Animal Health Organisation OLS Operation Lifeline Sudan Oxfam GB Oxford Committee for Famine Relief in Great Britain PA Pastoral Association PAVES Pastoral Veterinary Services PCM Project Cycle Management PDS Participatory Disease Searching PDVS Provincial Director of Veterinary Services PECOLIDA Pokot Environmental Conservation and Livestock Development Organisation PPR Peste des Petits Ruminants PPVP Private Pastoral Veterinary Practice RPK Resource Project Kenya RVF Rift Valley Fever SALT-LICK Semi Arid & Arid Lands Training & Livestock Improvement Centres Kenya SAPs Structural Adjustment Programmes SIDEP Samburu Integrated Development Programme SLHO Senior Livestock Health Officer SNV Netherlands Development Organisation TBAs Traditional Birth Attendants TLDP Turkana Livestock Development Programme ToT Training of Trainers TP Trained Pastoralist UNICEF United Nations Children Fund VO Veterinary Officer VSF-B Veterinaires sans Frontiers Belgium VSF-G Veterinaires sans Frontiers Germany VSF-Suisse Veterinaires sans Frontiers Switzerland WASDA Wajir South Development Agency WVK World Vision Kenya vi

8 LIST OF FIGURES Figure 1 Map Showing the ASAL Districts of Kenya...5 LIST OF TABLES Table 1 Table 2 Sample of DVO s service delivery challenges in ASALs...9 Inventory of CAHWs/Rate of attrition amongst CAHWs...19 Table 3 Phased Training Model of Marsabit AHSPF...26 Table 4 Facilitating Agents at the Districts...29 Table 5 The number of Veterinarians, AHTs and CAHWs operating in 8 districts...33 Table 6 Viable Practice Units, VPUs (KVAPS 2004)...33 Table 7 Table 8 Annual costs of public AHSPs & CAHWs under the existing circumstances (abstract).34 District with 91 public AHSPs and 80 CAHWs (abstract)...34 Table 9 Estimated costs of service delivery by public AHSPs and CAHWs in selected districts 35 vii

9 ACKNOWLEDGEMENTS VEDAMAN Consultants are grateful to the Food and Agriculture Organisation (FAO) Kenya of the United Nations for the opportunity to undertake the Community Animal Health (CAH) status study in Kenya, a process that has greatly broadened our view on CAH system and approaches to service delivery. Briefs and updates from Dr. Paul Mutungi and Mrs Emmanuella Olesambu provided a good platform for launching the desk and field studies. A number of other FAO Kenya (FAOKE) staff also played a crucial role in logistical support and guiding the situation analysis process. The data contained in this Report was generated through a process of literature review, key informant interviews, focus group discussions and field missions where experiences were shared. Special thanks go to all those who participated for their contributions that have greatly enriched the report. We are indebted to all organisations that shared information either through interviews or by availing literature material. We extend our appreciation to Ms Njeri Kangethe for reviewing the Report and Ms Emily Obayo Mbwaga for providing office support. The Report was written and edited by Drs Kisa Juma Ngeiywa and Rachael Asike Masake (VEDAMAN Consultants Ltd). viii

10 EXECUTIVE SUMMARY The study on the Status of Community Animal Health (CAH) in Kenya was commissioned by the Food and Agriculture Organisation (FAO) of the United Nations to provide a situational analysis of the status of community animal health in the Arid and Semi Arid Lands in Kenya by reviewing the CAH activities to date, implementation modalities of the programmes and the extent of harmonisation including among other aspects, monitoring and supervision mechanisms by the Government and implementing organisations; and carrying out an inventory of the current programmes and their impact on CAH. VEDAMAN Consultants Limited was contracted to carry out the study during the months of February - April The study was implemented through a participatory and consultative process involving a diverse range of stakeholders, right from grassroots pastoralists, community leaders, animal health practitioners, to high level Government functionaries and national/international non Governmental organisations officials. Using participatory tools e.g. rapid rural appraisals, opinions of key stakeholders were sought. Focus group discussions (FGDs) were held with the grassroots communities and their leaders. Indicators/benchmarks for impact by Community Animal Health Workers (CAHWs) and other players, challenges, threats and opportunities were identified and analysed in great detail. Out of these, recommendations for policy and institutional changes were made. Among the many and varied findings, the study established that, although CAH systems using CAHWs started as a stopgap measure to counter deficiencies occasioned by various factors in the provision of animal health care, especially in the ASALs, CAH has evolved from a temporary measure into a movement whose work is no longer complementary of the state, but critical, albeit in an amorphous framework that lacks desirable institutional perimeters of standardisation, regulation, supervision, harmonisation, uniformity and quality control. The study also established that, in light of the ongoing Government s general economic reform agenda, and consequent devolution of resources to the grassroots, the multi-faceted service provision role of CAHWs can no longer sit well in a subservient complementary position. The role played by CAHWs is not only invaluable in terms of socio economic development of the ASAL pastoral communities, but is culturally relevant and subject to requisite supervision, regulation and oversight by relevant Governmental authorities can be easily replicated in other areas of the country. It was also established that although there have been attempts at the Governmental and community levels to recognise the role played by CAHWs, these are at best inadequate and there is need to recognise, promote, support and reward the work of CAHWs in a coordinated and structured manner. Finally, the study does make recommendations, some with far reaching implications and key among these are:- ix

11 Training and accrediting of CAHWs trainers. Use of authorised syllabus, methods and approaches. Memoranda of Understanding (MoU) between the Director of Veterinary Services and organisations dealing in any aspect of animal health detailing activities, scope of operations, qualification of technical staff, resources availed for specified activities including salaries and allowances, entry and exit strategies (definition of roles/responsibilities and consensus on obligation) etc. Strengthening veterinary public health, inspectorate and laboratory services. Elaborate communication to all stakeholders, particularly the livestock keepers, on the need to use quality services and goods delivered professionally by qualified persons i.e. veterinarians and AHTs. x

12 1.0 BACKGROUND INFORMATION AND INTRODUCTION Community-based Animal Health (CAH) system is an innovative approach used to deliver primary animal health care to marginalized and geographically isolated livestock keepers and their communities using selected and trained members of the community. This system was developed by NGOs in the 1980s and is a decentralised, client oriented, participatory system of animal health service provision which aims at empowering communities to deliver primary animal healthcare services. The services include but are not limited to palliative care, chemotherapy and ethno-veterinary medicine. A functional CAH system ensures access to basic and affordable animal healthcare by the pastoral communities. Although it began and in some quarters it is still viewed as a stopgap measure, the system has become a core component of veterinary services delivery in Kenya. 1.1 History of Veterinary Services in Kenya The mainstay of Kenya s economy is agriculture, which accounts for approximately 30% of the country s Gross Domestic Product (GDP). Of this, the livestock sub-sector contributes approximately 10%. Most of the livestock is raised in the Arid and Semi-Arid Lands (ASAL) which represent 80% of the total land mass. The livestock sector in Kenya has had a chequered history. The Department of Veterinary Services (DVS) was established in 1890 to cater for the white settler farmers i.e. during the colonial era. The African livestock owners were totally excluded. During the pre independence era the few and far between veterinary services were mainly provided by the private sector. At independence things changed and provision of veterinary services became an integral part of the public sector. Evolution of veterinary services in post independence Kenya is marked by two distinct phases namely; expansion ( ) and reforms (1986- to date). During the expansion phase, the Government of Kenya (GoK) and its development partners provided highly subsidized clinical services, key among them being Artificial Insemination (AI) and dipping services. To ensure survival of livestock in the ASALs which had been quarantined by the colonial Government in an attempt to stem the spread of Contagious Bovine Pleuropneumonia (CBPP), the Government provided subsidised clinical and extension services. In the early 80s, under the District Focus Strategy for Rural Development Programme, graduate technocrats were posted to divisional offices throughout the country, a thing that enhanced provision of services such as farm visits, herd health and other advice, by the Government to the people. This notwithstanding, there were still gaps in the ASALs. Pastoralists who are highly dependent on livestock for their livelihoods are constantly on the move. Livestock demands efficient, effective and accommodative animal healthcare and extension services focusing on disease surveillance, control of trans-boundary transmission of disease, and marketing services for livestock and their products, all activities that are resource intensive. With the changes in global politics and consequent liberalisation and enhanced implementation of the Structural Adjustment Programmes (SAPs) instigated by the World 1

13 Bank (WB) and International Monetary Fund (IMF), the Government experienced dwindling donor support and had no option but to cut back on spending on many sectors including the livestock sector. Sessional Paper No 1 of 1986 on Economic Management for Renewed Growth was the turning point. Provision of goods and services to the citizenry was no longer purely a Government affair but was relegated to a shared responsibility between the public sector, the private sector and the consumers of the goods and services themselves. The subsequent budgetary reduction led to Decentralised Animal Health (DAH) services i.e. CAH utilising the CAHWs as animal health service providers. Although the reforms brought by this change of policy were well absorbed by the hitherto well resourced livestock keepers who were able to enjoy the diverse benefits of liberalisation of veterinary supplies and services, the historically marginalised, disadvantaged and vulnerable ASALs were impacted negatively. Most of the ASALs in the Northern Frontier Districts (NFDs) were closed for development resulting in high levels of illiteracy, and undeveloped infrastructure that translated to inability to access markets for livestock/livestock products. Harsh climatic conditions, frequent epidemics, and a land tenure system that was not sensitive to the needs of nomadic communities, exacerbated conflicts for natural resources use. These political, social and cultural disablers took their toll on the ASALs and created a gap in delivery of quality veterinary services. 1.2 History of CAH and the Birth of CAHWs In an attempt to improve animal healthcare and mitigate some of the adverse consequences of liberalisation, an alternative system of service delivery involving dispersed, active and accessible network of local service providers at community level was established. These were CAHWs or Trained Livestock Keepers as they were called. The CAHWs were selected from the communities and equipped with skills to enable them provide appropriate, quick, reliable and cost effective extension services. This cadre was expected to enhance disease surveillance, link nomadic communities to public service providers, and act as a conduit to development in the area. CAHWs training and capacity building was undertaken by Non Governmental Organisations (NGOs) working in areas that required enhancement of veterinary services, but because of the ad hoc nature of the undertaking, training was haphazard, uncoordinated, unregulated and not standardised. As stated above, the CAH programmes, using CAHWs to deliver primary animal healthcare, commenced in Kenya two decades ago as a stopgap measure to complement conventional delivery of veterinary services, and were confined to the pastoral and, to some extent, deserving agro pastoral areas of the country. Ideally, the CAHWs were to operate under the watchful eye of the District Veterinary Officer (DVO). Unfortunately, the regulating and nurturing role of the DVO for CAHWs has suffered due to staff shortages and declining budgetary support. In addition, the inadequate supervisory and/or regulatory capacity of DVS and Kenya Veterinary Board (KVB) allowed mushrooming of unprofessional service providers, including quacks, sometimes with disastrous results - death of livestock due to wrong drug or pesticide application. A case in point is that of a Maasai livestock keeper who sprayed his animals with a poisonous concoction of acaricide/insecticides. 2

14 In Sub-Saharan Africa, livestock services were among the first rural services targeted for privatization under the SAPs. The privatisation of some aspects of veterinary services were rushed and not well thought out. Consequently, this denied some livestock keepers, particularly those from the NFDs, access to quality and affordable animal health services, basically because the ASALs were not economically attractive to animal health entrepreneurs and the public sector was stretched to the limit and could no longer meet the demand. This scenario justified and led to mushrooming of other cadres of animal health service providers including quacks. The new models e.g., CAHWs fronted by NGOs were not mainstreamed into the public service (mandated by law to oversee and regulate all animal health and allied services), hence some of the methods and approaches used were different, unsupervised, unregulated, uncoordinated and with no clearly articulated benchmarks for standardisation and quality control. In addition, most of the CAH systems were initially invisible to policy makers and professionals who were few in the marginalised areas. Intermediate Technology Development Group (ITDG) tried to educate the veterinary professionals and other stakeholders on the concept and importance of the DAH approach in disease control and livestock/livestock products market access and the linkage and value of the indigenous/traditional knowledge. Due to the concerns on quality control and sustainability of the CAHWs work, various efforts were undertaken to improve animal health service delivery in the ASALs. These included the development of CAHW curriculum and minimum guidelines for training by KVB, policy briefs on CAHWs by AU/IBAR, introduction and discussion on the Veterinary Surgeons and Para-Professionals Bill, development and distribution of the CAHWs trainers guide for Kenya, and concept of establishment of Community Animal Health Support Unit (CAHSU) within the Directorate of Veterinary Services. 1.3 Current Policy/Legal Frameworks The Veterinary Surgeons Act, Cap 366 of the Laws of Kenya is the statute that governs provision of veterinary services and practice of the veterinary profession in Kenya. Section 24(b) of the Act allows livestock owners to treat their own animals but does not define ownership in the context of nomadic pastoralists, where the tag ownership could cover the whole clan, friends or neighbours. To-date, CAH service delivery continues to be offered through the support of NGOs in marginalised areas. The veterinary authority, veterinary regulatory board and professional body have not adequately addressed the policy, legislative frameworks and administrative issues of CAH system. These policy and legislative gaps have impacted implementation modalities of CAHWs programmes negatively. 1.4 The Study It is against this background that this study was commissioned by FAO, to provide a situational analysis of the status of CAH in the ASALs of Kenya (Fig 1). The study was necessitated by the glaring deterioration in the provision of animal health services and deficiencies in the implementation modalities of CAH programmes. VEDAMAN Consultants 3

15 Limited (the Consultant) was contracted to carry out the study during the months of February - May Objectives of the Study The main objectives of the study were:- To review the community animal health activities in Kenya to date; To review implementation modalities of community health animal workers (CAHWs) programmes generally, and harmonisation, monitoring, evaluation and supervision mechanisms by the Government and implementing organisations in particular; To carry out an inventory of the current CAHWs programmes and their impact on community animal health; To make recommendations and prepare a presentation on the technical aspects of CAH in Kenya; and To present findings to stakeholders with a view to deliberating on a way forward. By and large these objectives were met and will be discussed in depth in the Findings and Recommendations sections of this Report. 2.0 APPROACHES AND METHODOLOGY 2.1 Study areas Field missions to Mandera, Wajir, Kajiado, Turkana, West Pokot, Marsabit, Samburu, Isiolo, Mwingi, Garissa and Tana River districts to meet DVOs, DLPOs, representatives of Facilitating Agencies (FAs) involved in animal health care and allied services e.g. Arid Lands Resource Management Project (ALRMP), NGOs, CBOs, livestock keepers and community members. 4

16 Figure 1 Map Showing the ASAL Districts of Kenya 2.2 Study methods The assignment was accomplished using the following methods: i. Review of literature and relevant documents. This provided the necessary background information on the scope of the CAH and the status of CAHWs. ii. Participatory Rural Appraisal of CAH system was used for in-depth analysis of the identified issues. These techniques employed such methods as interviewing, visualization and ranking or scoring. Pictures of discussants and CAHWs activities were taken as evidence of what was observed. 5

17 iii. Data collection methods included but were not limited to: Use of secondary information (literature, project data sets and project reports). Community interview: using a structured-checklist, stakeholders were interviewed on issues related to Community Animal Health services. Focus group discussions with homogenous groups e.g. CAHWs, elders and pastoralists, proprietors of drugstores, and key informant interviews. Visualization approaches. VEDAMAN Consultants interviewed a. FAO representatives; b. Ministry of Livestock Development personnel c. Private veterinarians and Animal Health Technicians; d) CAHWs; d) Facilitating Agencies (NGOs, CBOs, FBOs); f. local facilitators; g) pastoralists and agropastoralists; h) livestock traders; i) local community leadership; j) local administration and k) proprietors of drugstores using a checklist of questions, Focus Group Discussions with CAHWs, pastoralists and agro-pastoralists. 3.0 RESULTS 3.1 Animal Health Service Providers The CAH status study in the ASALs clearly indicated several service providers. The players so far identified and interviewed in the field include: 1. Veterinarians (VOs). 2. Diploma holders (LOs) and certificate holders (AHAs) in animal health who are collectively referred to as Animal Health Technicians (AHTs). 3. Pharmacists (veterinary drugs are in the chemists and pharmacists dispense at will). 4. CAHWs. 5. Livestock keepers. 3.2 The key findings The Key findings were: The DVS is not facilitated sufficiently to deliver the necessary services to the remote parts of the ASAL. This is primarily due to inadequate resources in terms of financial and human resources, insecurity and infrastructure. AHTs cannot carry out their duties satisfactorily for the same reasons as above. In addition most AHAs have taken up additional responsibilities of Meat Inspection. Where CAHWs have been trained, their competence cannot be guaranteed due to the haphazard and uncoordinated manner in which the training is implemented; lack of proper monitoring and evaluation; lack of properly stipulated referral system; inadequate drug supply lines and quality control. FAs have different approaches to training of CAHWs. Furthermore, some of them have not been transparent with their activities in animal health and have not signed a MoU with the Director of Veterinary Services. 6

18 CAHWs do not fall under the Kenya Veterinary Board (KVB) or any other statutory authority. Therefore there is no specific body that regulates their activities. 3.3 The role of Service Providers in CAH The key findings in this study established the fact that roles played by veterinary service providers are interdependent and must of necessity be looked at in-depth in order to critically assess the implementation modalities of the CAH programmes The Veterinarians Quality community animal healthcare is core to sustainable livestock production generally, and is critical for pastoralist communities especially those found in the ASALs. As the principal duty bearer, the Government plays a pivotal role in the provision of quality animal healthcare. The primary players, popularly known as the engine by the communities they serve, are the employees of the Ministry of Livestock Development i.e. DVS Responsibilities of Veterinarians in ASAL The DVO coordinates all efforts geared towards disease control and eradication of Transboundary Animal Diseases (TADs) to facilitate production of internationally acceptable, marketable, competitively priced, healthy livestock. Veterinarians are charged with the responsibility of overseeing all animal health issues in their areas of jurisdiction. In ASAL areas these include: Clinical services. Extension services e.g. Farmer Field School (FFS) or Pastoral Field School (PFS). Monitoring and control of livestock movements through issuance of No Objection chits and livestock movement permits as well as stock route and livestock markets inspection. Creation of linkages with other arms of Government and partners. Veterinary public health including meat inspection service. Disease control activities e.g. mass treatments and vaccination campaigns. Institution of measures to curb spread or entry of emerging diseases, TADs, including promotion of community and other stakeholder participation in disease control so as to facilitate trade in livestock/livestock products and create wealth. Some of the public sector responsibilities get handed over to the private veterinarians where they operate. Veterinarians perform other tasks as assigned by their superiors from time to time Current Situation As stated earlier, up to 1989, the Government was virtually the sole provider of animal health services, either free of charge or at a highly subsidized level. This venture was extremely successful in controlling epizootic and TADs resulting in the growth of the livestock sector. The upward trend was suddenly brought to a halt by the change in policy 7

19 resulting in profound changes in the delivery systems for animal health inputs and services. This was further exacerbated by the suspension of employment of professionals without taking into consideration attrition rate attributed to death and retirement. Consequently, there was a tremendous reduction in the number of veterinarians serving in the public sector. Prior to this, veterinarians manned districts and divisions while AHTs provided clinical and extension services at the locational level. Kenya has more than 2,000 veterinarians serving in the public and private sectors. The number of veterinarians serving in the DVS has greatly reduced over the last decade. The changes in policy were in tandem with economic and institutional reforms initiated by the Government with the aim of improving economic performance and microeconomic stability of the country. The reforms sought to reduce Government support and its direct involvement in various sectors of the economy culminating in withdrawal of subsidies, and no participation in input and services provision. The Government expected these reforms to permit the forces of supply and demand to determine livestock production, distribution, marketing and provision of veterinary services in order to spur efficiency and economic growth. Currently the majority of veterinarians serve as DVOs who take care of all administrative issues pertaining to livestock health and management and in the process spend minimal time in delivery of animal healthcare. The decline in the number of veterinarians serving in the public sector, coupled with change of policy relegating the Government to supervisory and regulatory role in disease surveillance and control, created a gap in service delivery. This gap should have been filled by privatisation of some of the veterinary services. Unfortunately, conditions in ASAL areas are not conducive to entrepreneurship and private practitioners have not been able to establish the traditional model of veterinary practice amenable in high and medium potential areas. Some of these disadvantages are the non economically viable practice of barter trade where payments are made in kind and not in a timely manner, poor infrastructure Fig 2: A stony, rough road connecting Isiolo to Kulamawe town (Fig 2), low economic returns due to inaccessibility to markets, insecurity, nomadic lifestyle characterised by high mobility of herds/flocks and the livestock keepers, frequent droughts and dependency syndrome that has made people reluctant to pay for goods and services. Ideally, areas without established private practice for livestock services were to be taken care of by the Government continuing to provide clinical and extension services. Unfortunately, the DVS has experienced unprecedented decline in funding to a point where staff are only assured of their salary. In some districts the DVO s do not have reliable means of transport and have to borrow to facilitate their field work. The lack of resources has rendered the public service veterinarians ineffective and incapable of discharging their duties (Table 1). For instance four veterinarians in one of the ASAL district, covering 8

20 approximately 56,000 km 2 with 1.2 million livestock share one reliable vehicle with a total budget of KES 327,000 per quarter (KES 109,000 per month). This amount of money might, with utmost care, take care of fuel, but exclude vehicle maintenance. This makes the public sector veterinarians, operating in ASAL areas, heavily dependent on NGOs and other well wishers to facilitate their work. Even with this level of assistance, the veterinarians are only well placed to carry out vaccination campaigns and gather information on disease occurrence in conjunction with the para-veterinarians. For surveillance they depend heavily on data generated by the livestock owners and para veterinarians on the ground. The table below is a clear indication that not all veterinary officers are supplied with vehicles for use despite the long distances they have to travel to reach pastoralists. For instance, the 5 veterinarians in Turkana are expected to deliver service to pastoralists dispersed over an area of 77,000 km 2 on rough, uncharted terrain. Furthermore, a sizeable part of the land is still experiencing insecurity due to cattle rustling and competition for pasture and water resources. Table 1 Sample of DVO s service delivery challenges in ASALs District No. of Veterinarians Livestock population Land mass (km 2 ) Available means of transport Isiolo 3 778,000 25,605 1 vehicle; 5 motorbikes Kajiado 6 1,394,770 21,903 5 vehicles Mandera 5 1,088,000 26,470 2 vehicles; 1 motorbike Marsabit 4 1,547,900 62,297 1 vehicle, 1 motorbike; other vehicles are unserviceable Pokot 3 1,376,212 9,100 Rely on 1 pickup & 5 motorbikes of ALLPRO Turkana 4 3,200,000 77,000 Rely on borrowed vehicles Wajir 4 1,182,000 55,501 1 vehicle (serviceable) 2 grounded vehicles 2 motorbikes Mwingi 4 545,000 10,031 2 vehicles; Garissa 7 1,300,000 44,952 2 vehicles used in rotation by the 2 districts; 1 motor bikes The Animal Health Technicians Animal Health Technicians refers to persons who have undertaken either a three year diploma or a two year certificate course in animal health and allied. Under the Kenyan civil service they were employed as Livestock Officer (LO) and Animal Health Assistant (AHA) respectively. When the GoK employed all AHTs prior to 1989 straight from colleges they worked under veterinary surgeons as a legal requirement and for mentoring, coaching and counselling. The LO deputized the VO, some were even in charge of Divisions and/or disease control programmes such as tsetse and tick control, disease control activities, Artificial 9

21 Insemination and Livestock Identification. AHTs were deployed to the Divisional and Locational levels to provide veterinary services. The exact nature of services varied according to the district s priorities. It was deemed that these cadres did not require legal recognition as they were invariably supervised directly by the veterinary surgeons. The surgeons work under the provisions of the Veterinary Surgeon Act, Cap 366 of the Laws of Kenya. The AHTs were allocated duties by the officers in charge of stations/sections/units and the majority did not have assigned offices but were allocated space at the chief s or District Officer s offices. In reality, the AHTs are and have been the hands-on people that come directly in contact with the livestock keepers and livestock at their duty stations. Like the VOs they also are not endowed with resources and lack facilitation/support to carry out their tasks. However, one positive contribution of these cadres is being the main source of veterinary drug and equipment to the livestock keepers today. The AHTs also advise livestock keepers and CAHWs whenever they collect drugs from their agrovet outlets and during mass treatment or vaccination campaigns. Some hardworking AHTs (public and private) have established privatised animal health services in the remote ASAL areas and are committed to serving the livestock keepers directly and through the CAHWs. Those doing well have diversified to sustain business and buffer against seasonal changes in demand of veterinary drugs due to animal migrations occasioned by drought and decreased ability of the livestock keepers to purchase during prolonged dry periods. However, the expected role of supervision and follow up of the CAHWs is not done adequately because AHAs cannot migrate with livestock keepers. In the advent of CAH systems and training of CAHWs the AHTs became fully involved in the whole process from the concept, planning, community dialogue, selection, training, monitoring and supervision as well as follow-up and refresher courses for CAHWs. The AHTs work station was nearer to the livestock keepers and many of them understood the local languages and culture. As the Frontline Extensions Workers (FEWs) they were known by the community members and other stakeholders hence accepted. The current position is that there are very few AHTs serving in the districts and most are aged (average age of 50 years). Where their number is large they serve mainly as the Meat Inspectors (MIs) e.g. in Kajiado District but due to shortage of AHSPs they also attend to clinical cases yet it is not advisable to carry out Meat Inspection services and deliver clinical or herd health services as chances of spreading disease causative agents is high. The AHTs attend meetings and forums in the district geared towards improved food security as well. Apart from training the selected livestock keepers, the AHTs are closely linked to the CAHWs in terms of disease reporting, referral system, source of veterinary drugs and information/feedback. They involve and train CAHWs on the job during mass treatments and vaccination campaigns as well as supervise them, albeit with limitations occasioned by lack of resources, support or facilitation are common. At the administrative level, AHTs are from both the private and public sectors and are the immediate supervisors of CAHWs. In the ASAL areas as indicated earlier, both the public servants and private veterinary practitioners do not reach all areas of the district i.e. where the livestock migrate to. It is 10

22 because of this scenario that models linking livestock keepers to the DVO have arisen. Some linkages take a short or long route: i. Livestock keeper DVO; ii. Livestock keeper CAHW DVO; iii. Livestock keeper CAHW AHT DVO; iv. Livestock keeper CAHW AHT private practitioner (Veterinarian) DVO. The AHTs and VOs are almost helpless in terms of resources including finances for operations except during emergencies and vaccination campaigns. From the flow diagram below it is clearly depicted that AHTs and VOs are not usually at the community level but operate at the administrative and policy levels (Chart 1). Chart 1: Information flow between livestock owners, AHSPs and veterinary policy makers DVS PDVS DVOs Veterinarians AHTs CAHWs Livestock keepers 11

23 3.3.3 The Community Pastoralists and agro-pastoralists have a repository of rich and detailed understanding of important animal health problems affecting their animals. This is acquired through life experiences, shared information and oral tradition. The knowledge pertains to clinical, epidemiological and pathological observations which are linked to specific ailments. This knowledge is extremely important in identification and recognition of emerging diseases in an area. This makes livestock owners a crucial informant in disease surveillance. Furthermore, being regular users of veterinary drugs, they are critical in advising Government in the event of drug resistance particularly in the case of acaricide. All livestock keepers deserve quality animal health services. Ideally the services should be delivered by professionals who observe and are bound by their professional code of ethics. However, following the veterinary service reforms of the 1980s, the role of the community members in complementing the formal veterinary service delivery system in Kenya became critical. Hitherto some communities have used Ethno Veterinary Knowledge (EVK) and skills to ensure their livestock remained healthy and productive but these practices, though common knowledge locally, have not been documented. For a common understanding, community refers to a group of persons united by shared or common interests and is viewed as a set of people treated as a unit sharing some attribute e.g. activity based such as football fans, profession such as doctors, or locality based such as slum dwellers, pastoralists. The Community is characterized by personal intimacy, emotional dependence, moral commitment, social cohesion and continuity in time. In order to gain acceptance and subsequent active participation and ownership of a project focus must be on the whole rather than on individuals. Relationship within a community is based on inherent trust and good will. CAHWs are livestock keepers selected by community members for training through intervention of the facilitating agencies. Sustainability of CAH system is largely dependent on correct community entry process, CAHW trainee selection criteria and community support. Although the idea of barefoot veterinarians, paravets or CAHWs was introduced to the communities, its success hinges on the community participation and active involvement. There are numerous roles of the community in CAH system including: Demanding and lobbying for quality veterinary services that are easily accessible and affordable. They preferred the highly subsidized or free GoK services. Enumerating and prioritising the felt needs of animal health and allied services. Custodian of the EVK. Accepting DAH with element of privatisation and stakeholder participation. Willingness and commitment to participate in solving their animal health problems. Selecting CAHW trainees. Supporting the CAHWs by paying for the services and goods supplied. Monitoring and supervising the CAHWs. Disease and outbreak reporting as they occur since they monitor health and disease status constantly. 12

24 Acting as live fence against quacks and use of inferior quality veterinary drugs and products from whichever sources. Assist in disease preventive measures such as presenting animals for vaccination. Articulating the community felt needs on livestock development through all avenues including development and other meetings. Treating their livestock (first aid before competent person is reached) Drug Suppliers Livestock is a cherished asset of livestock keepers and pastoral communities. Disease is one of the most important limiting factors to production and productivity of livestock and livestock keepers spare no effort in prevention, treatment, cure and control of livestock diseases. Initially when EVK was the feasible option, communities shared the expertise and herbal medicines based on traditional norms. There were no fake concoctions or peddlers. Missionaries brought religion, education and governance modelled on alien norms and perception. This worked at the beginning but later, some undesired results were seen e.g. erosion of the EVK and emergence of counterfeits peddled by untrained persons to the detriment of livestock health and loss of livestock commodities markets. Inferior quality veterinary drugs reach the livestock keepers deep in the interior of remote country through the quacks. These drugs are used because of lack of choices, knowledge or alternatives. Majority of the Kenyan livestock are found in places that are not attractive to the animal health entrepreneurs and input suppliers. Associations such as the Livestock Drug Users Associations (LDUAs) in Mandera, Turkana were mismanaged and have closed shop. The management committees were usually handpicked by the local leaders and had no prior training on veterinary drugs and record keeping. Association of CAHWs has been tried in various places e.g. Mandera, Wajir, West Pokot, Turkana, Isiolo with various degrees of success and failure. In Wajir the CAHWs are affiliated to the Pastoral Associations that own the veterinary community drug stores but in Mandera 45 CAHWs, supervised closely by the DVO, own and operate a veterinary drug store. In all instances the drugs are located at town centres far from the concentration of livestock and their keepers. Drug supply and oversight is better exemplified by the innovative models in West Pokot (Pastoral Veterinary Systems PAVES) (Chart 2) and FARM-Africa s Dairy Goat Project (Chart 3) DAH system in Mwingi and Kitui. The DVO supervise private veterinarians who supervise AHTs linked to CAHWs. These models are driven by profits but business within the law. Some FAs have facilitated veterinarians, AHTs and CAHWs to set up veterinary drug stores, in remote marginalised areas, to facilitate access of quality drugs to the CAHWs and livestock keepers PAVES Drug Supply Line PAVES was established in 2001 as a Private Pastoral Veterinary Practice (PPVP) that uses a chain of AHTs and CAHWs to provide quality veterinary drugs, products and services to 13

25 livestock owners of Pokot Districts and beyond. The private veterinarian based at Kapenguria (Dr. Benson Ririmpoi) set up a drugstore at Makutano using his own equity as start-up capital. Subsequently, some pharmaceutical companies advanced him goods. Later on the Community-Based Animal Health and Participatory Epidemiology (CAPE) Unit of African Union/Interafrican Bureau of Animal Resources (AU-IBAR) gave him an interest free loan to boost the business. Chart 2: Pastoral Veterinary Systems - Private Pastoral Veterinary Practice District Veterinary Office Private Veterinarian: Drug supplier Animal Health Animal Health CAHW CAHW CAHW CAHW CAHW CAHW Dr. Ririmpoi, a private Fig 3: PAVES Veterinary Centre Makutano, West Pokot practitioner was connected to CAHWs, the majority of them used to be drug peddlers. The CAHWs were offered refresher courses on management of veterinary drugs, their uses, and routes of administration and equipped with business skills. These CAHWs were linked to AHTs who procure drugs from the PAVES drugstore at a reasonable price. The AHTs sell drugs to CAHWs, supervise and provide professional support. Initially, only 2 AHTs (Juma and Chekeruk) were linked to the PAVES drugstore (Fig 3). 14

26 The number of AHTs had risen to 6 by May In order to improve profitability and sustainability, the AHTs and CAHWs have diversified their businesses and are now stocking agrochemical products and other goods required by pastoralists like Shukas (cloth wraps) and sandals. It is important to take cognisance of the fact that PAVES model is pegged on loyalty of the CAHWs and AHTs. This is determined mainly by product prices and close supervision as well as requirement for legitimacy. Only about 45% of the CAHWs are considered active and associate and purchase goods from PAVES. Other veterinary drugs and products outlets exist and are sometimes cheaper than PAVES. The PAVES business model has done relatively well to the extent that financial institutions are now inviting PAVES to borrow funds without fear. Pharmaceutical companies have funded extension and promotional campaigns and offered free drug samples to livestock keepers. NGOs have sometimes assisted in community mobilization and dialogue meetings and also transport during field supervision. NGOs also contract PAVES for training and to provide business support to AHTs. The DVS has also played a key role in regulating the work of CAHWs and providing professional supervision. The Department has contributed to training and receives monthly progress reports through the private veterinarian (Dr. Ririmpoi). The Department also offers Dr. Ririmpoi contracts for supply of products for example, during vaccination campaigns. PAVES have seen significant impact in animal health service delivery using CAHWs. For example, quacks selling drugs to livestock keepers have been pushed out of business and a professionally supervised system has been put in place instead (fig 4). Figure 4: Drug store run by a CAHW in Nakwijit West Pokot 15

27 Livestock owners prefer services offered by the CAHWs to that of quacks who are selling drugs in the open-air markets. This is because CAHWs belong to the community and are well known and trusted. The presence of CAHWs has also seen dramatic reduction of fake drugs that were common in the community FARM-Africa s Dairy Goat Project DAH system FARM-Africa s Dairy Goat Project DAH system in Mwingi and Kitui has a drug supply line that functions well at the moment. It still has a lot of the NGO support and the CAHWs involved in the system are monitored, supervised and provided with technical back-up. Nevertheless, the set up is such that all the actors in the drug supply line benefit from the venture and all have a back up. For example, the AHTs running drugstores are supported and nurtured by the private veterinarian in his/her line while the private veterinarian receives support from both the FARM-Africa and the DVO. Below is a flow chart that depicts the drug supply line from drug companies to the livestock keepers. Livestock owners in West Pokot and Mwingi benefit from PAVES and FARM-Africa models (Chart 2 and Chart 3 respectively) of DAH. This is a handful of pastoralists requiring service. The majority of livestock keepers that cannot reach the licensed veterinary drugs outlets are at the mercy of quacks who hawk the drugs in open-air markets (fig 5) and/or sell them with other retail shop items including food. Figure 5: Open air vet drug display at Orolwo West Pokot Not all animal health products that are required reach the livestock areas because of poor infrastructure and lack of cold chain for the vaccines. 16

28 Chart 3: Decentralised Community Animal Health System 17

29 3.4 The Community Animal Health Workers CAHWs were established as an alternative system of service delivery involving dispersed, active, and accessible network of local service providers at community level, in an attempt to improve animal healthcare and mitigate some of the adverse consequences of liberalisation. At the beginning, use of CAHWs to deliver primary animal healthcare by the CAH programmes was for all intent and purposes a stopgap measure to complement conventional delivery of veterinary services. A brief history of CAHWs shows that the concept of community participation in animal health services delivery is not novel to Kenya and was mooted by the Chinese and Indians who equipped livestock-keeping communities with basic skills on animal healthcare. This idea was taken up by Darlington Akabwai in 1978 who trained Catechists at Kakuma as Bare Foot Veterinarians to deliver veterinary services to the geographical remote parts of Turkana. This improved the use of Novidium for treatment of Trypanosomosis in cattle by the pastoralists as well as disease diagnosis. The impact of the Bare Foot Veterinarians (initial CAHWs) was pronounced when Contagious Caprine Pleuropneumonia (CCPP) decimated goats in Lokichar and Lokori in 1980 but not in areas served by these trained pastoralists of Kakuma. This experience, coupled with inability of the Government to deliver sustainable veterinary services to mobile communities situated in remote parts of Kenya, led to acceptance of CAHWs and subsequent training of selected community members to enhance vaccination against Rinderpest by OAU-IBAR in Kenya, Ethiopia, and Sudan (PACE 1993). It was noted that when CAHWs vaccinated the livestock keepers had confidence. The CAHWs made impact on vaccination in the Karamoja ecosystem. In Afar regions where the veterinarians could not reach due to the remoteness and prolonged civil war Dr Akabwai trained CAHWs to treat and vaccinate their own animals. Between 1993 and 1994 the CAHWs using a thermostable vaccine were able to vaccinate cattle against Rinderpest even at the foci of Chifra. Ethiopia declared provisional freedom of Rinderpest in 1994 due to the work of CAHWs. During the civil war in Southern Sudan, AU-IBAR under UNICEF led OLS-SS assisted in training of CAHWs trainers who subsequently trained CAHWs that successfully vaccinated 1.1 million cattle against Rinderpest in GTZ designed and conducted a training of 53 selected pastoralists drawn from 14 traditional grazing areas of Central Somalia in The pastoralists were taught basic animal healthcare. The trained pastoralists were called Nomadic Animal Health Auxiliaries (NAHAs). These NAHAs were tested for their effectiveness in surveillance and monitoring of CCPP and the information relayed by the NAHAs had good correlation with laboratory proven data. Subsequent to this GTZ, in collaboration with the Ministry of Livestock Development and other NGOs, equipped 26 Contact Herders (CHs), later referred to as CAHWs who were selected from areas with no veterinary staff, trained and equipped with animal health care knowledge. The CAHWs were incorporated in all veterinary activities and were closely linked to the AHAs as disease reporting points and enhancers of the disease surveillance system. Since then, many NGOs have stepped in to train CAHWs. Some of these are FARM-Africa, VSF Belgium, VSF Germany, VSF Suisse, COOPI, Oxfam GB, Practical Action/ITDG, CARE Kenya, North Eastern Development Programme, Woman Kind, Woman Concern, Kenya Red Cross, SALT LICK etc. In Isiolo Garba Tulla 18

30 Development Office (GTDO) of the Diocese of Isiolo was the first to train community volunteers. Subsequently, COOPI trained more CAHWs in It is instructive to note that although over 5,000 CAHWs have been trained in Kenya to date, records of all the CAHWs are not available both at the DVOs and/or facilitating agencies offices. Even where such records exist, the information is sometimes sketchy or contradictory as shown below for Kajiado and Samburu (Table 2). This deficiency may to a large extent be written off to attitude the resistance to accept operations of the CAHWs, hence the DVO s office has no obligation to maintain records of CAHWs in their districts. This lack of authoritative data notwithstanding, there is ample qualitative evidence of the value attributed to contribution by CAHWs in provision of veterinary services and supplies in the ASALs and its impact. This is discussed in detail in Chapters 4 and 5 of this Report. Analysis of the table below also shows the percentage of CAHWs that drop out of service. The variation in the rate of attrition is closely linked with support offered to the CAHWs in terms of monitoring, backstopping and financial support through provision of subsidised drugs. It is notable that where the NGO is actively monitoring and supporting the CAHWs (e.g. FHI in Marsabit, FARM Africa in Mwingi) the retention of CAHWs in service is 100%. This may also be linked to provision of refresher courses. Table 2 Inventory of CAHWs/Rate of attrition amongst CAHWs Serial Institution Number Number Active Per cent Active # Trained 1. Elwak Garissa Kajiado NGOs DVO Marsabit (FHI) * 5. Marsabit Mwingi (FARM Africa) ** 7. Narok ** 8. Turkana (VSF-Belgium) Turkana (LWF) Samburu (DVO office report) VSF Suisse (Mandera 2000) Wagala Wajir District West Pokot * FHI assisted the CAHWs to start a SACCO which is of monetary value or profitable for the CAHWs. This may explain the 100% active number of CAHWs. 19

31 ** The high percentage of active CAHWs is probably due to the system on the ground for monitoring and drug supply line. FARM Africa is still on the ground for Mwingi and for Narok, ILRI programme is still supporting the CAHWs CAHW s Overall Responsibilities In was noted in the study that there is no clear or documented, standard responsibility given to CAHWs. Nevertheless, they were chosen by the community to meet their needs and fill the gap observed in Community Animal HealthCare. This has taken several shapes depending on the needs of the community. The CAHWs, however, undertake the following activities: Fill the gap on animal health service provision. For instance animal health care services are currently provided in the Nuu Division of Mwingi by 1 Government AHA and 6 CAHWs while in Sereolipi location there has not been an AHA since The AHSD is done by the CAHWs trained in 2000 by COOPI. The CAHWs were refreshed by Samburu Integrated Development Programme (SIDEP) and SNV project. Provide Linkage between DVOs office and herders. Act as the entry point for veterinarians and animal health technicians to the community that selected them. CAHWs serve as frontline veterinary extension workers since they are based at the community. They attend to disease outbreaks immediately without wasting time and are very vital for disease and outbreaks reporting in pastoral areas. Although CAHWs are active, written reports are not submitted especially in North Eastern due to the fact that the Somali residents are basically an oral society dependant on memory and verbal communication. Good community mobilisers especially during vaccination campaigns or any other v eterinary activity needing community cooperation and participation. Create awareness of the community on animal health issues and avail their h erds as m odels on animal health care. The communities observe CAHWs operations in their herds and copy. For example, CAHWs of Garissa have been very in assisting the communities address the issue of Trypanosomosis and have increased awareness on tick infestations to the extent that some herde rs started hand spraying their livestock as a means of controlling tick infestation. Avenues used to train the livestock keepers on drug usage include chief s barazas, women group meetings, ceremonies i.e. whichever opportunity arises. C AHWs migrate with livestock CAHWs take time to pass the knowledge gained to the pastor alists but some of the livestock keepers do not listen to them CAHWs Principle Role CAHWs principle role is reporting occurrence of notifiable diseases and refer unknown cases to the DVO. In 2006 CAHWs were the first people to report PPR (Lomoo) to the DVO Turkana. The CAHWs also facilitated quick tentative diagnosis. CAHWs do community policing effectively because they are found in every location and close to the livestock 20

32 keepers. Being livestock owners themselves, they do direct observation, take elaborate case history using the local language and terminologies; treat simple cases based on tentative diagnosis and report disease outbreaks to the DVOs through various ways such mobile phone s, via public means, send the chief or DO or the CAHWs themselves go to the DVOs office. The reports sent to the DVO capture the following data: Duration of disease occurrence. Type of animals affected. Age groups involved. Similarity to other diseases. Action taken to remedy the situation CAHWs Minor Clinical Roles In addition to this, CAHWs treat all types of diseases but are not allowed to handle vaccines which are primarily the responsibility of the DVS. They routinely: De-worm livestock. Undertake disease diagnosis. Treat diseases and fix minor injuries. Participate in vaccination campaigns e.g. against Lumpy Skin Disease (LSD), Anthrax and Black quarter (Blanthrax-BQ) and Rabies. Report emerging disease outbreaks to the DVO. Facilitate the process of disease quarantine. Refer cases to both public and private AHAs who assist them by handling difficult cases. Sell drugs to farmers in need. Help with difficult calving cases especially in cross breeds Rationale for Training of CAHWs Pastoralists are generally good in disease diagnosis and have fairly good herbal medicine for treatment and one would be hard put to answer the question why train CAHWs who are part of the community? With influx of new diseases and loss of traditional knowledge on EVK and remedies, coupled with introduction of modern medicine, the challenge is to identify the right medicine for specific ailments. Furthermore, conventional Government animal healthcare services have failed to entrench effective and sustainable mechanism for delivery of veterinary services due to limited resources, organisational weaknesses, and lack of appreciation of pastoralism, professional biases and a myriad of logistical problems associated with rendering service to nomadic communities living in harsh terrain and hostile climatic conditions. Hence the need for training CAHWs to: Fill the gap in animal health service delivery. 21

33 Enhance the use of appropriate quality drugs while educating against use of fake drugs at the grassroots. Assist inadequately resourced DVOs extend services to the community. Stem the rise in livestock diseases. Ensure prompt response to infected livestock and other queries from pastoralists. Bring in a cadre of indigenous people who understand the problems of the communities and will discourage creation of new settlement areas resulting in environmental degradation and upsurge of animal diseases Selection Criteria Prior to undertaking training of CAHWs, the DVO and the FAs carry out a needs assessment in the target area. The needs assessment is essential for determining the number of CAHWs required; distribution and the literacy level of the community or to verify whether or not to train CAHWs and whether the area has a high livestock concentration. If CAHW s are needed, then the FA sponsors the training in which only one facilitator from the NGO joins the team from the DVO s office. The process of selecting CAHW trainees applies a variety of participatory approaches that recognise the community governance structures and affords the communities the opportunity to own the selection process. The criteria for choosing CAHWs vary, but there is a general agr eement on the need for community choice and control over candidate selection. DVOs together with NGOs offer basic guidelines for selecting appropriate candidates based on personal characteristics. The selection criteria applied by each FA was discussed, modified and accepted by all the parties involved (NGOs, DVOs and the target community). The first group of CAHWs were selected on the basis of their: Trustworthiness/Honesty Good public and interpersonal relationships; commanding respect from the community; endowed with good communication skills/ Community member resident of the area. Available and hardworking. Tolerant and persevering individual (walks long distances without complaining). Confident person. Owns and migrates with livestock. Active in livestock issues such as disease control activities. Willingness to serve the community regardless of individual members social status. Knowledge of ethno-veterinary medicine was an added advantage. The first lot of CAHWs trained, especially in Marsabit, tended to be old and enjoyed greater respect and trust within the community and they lived with and migrated with the livestock owners, hence were always available to take care of any ailments impacting negatively on the animals. These CAHWs met the needs of the communities but later on it was felt that it was important to incorporate persons who could read and write. This led to the introduction of the following criteria: 22

34 Literate, able to speak, read, write and prepare report sheets in Kiswahili or English or local language. Young, strong, able bodied persons. Possession of collateral to refund public items includes the ability of the parents. Sharp in retaining what is taught (good memory). Business oriented in animal health e.g. a hawker of veterinary drugs. Self-motivated individual. The new selection criteria were set by the FAs, and endorsed by the target community during the chiefs Baraza. CAHWs were then selected by their communities through voting in a public Baraza called by the chief and attended by the FAs and DVO representatives. An example of this is EPAG who target school dropouts and trains them as CAHWs to: Identify diseases and use appropriate drugs. Perform disease reporting and surveillance. The team observed that few women were chosen for training as CAHWs. Reasons given for this were varied. In some cases communities perceived women to be weak, incapable of handling stress of work and walking long distances. Others cited security issues and household chores such as taking care of the children. In Garissa, preference was given to women. In Mwingi, not many women were selected due to the community s fear of the likelihood of women not remaining in the community/group. Fig 6: Dorcas Epusie Lokaale, a A few key informants were dissatisfied with the system applied in the selection of CAHWs. The complainants felt that the majority of the CAHWs were selected among the roadside livestock keeper s i. e. peripheral livestock keeper s who no longer practice pastoralism and were demanding for a mechanism for fishing out true nomads. This could be attained by involving bone fide traditional community leaders in the selection process Trainers All th e CAHWs are trained jointly by the staff of FAs and DV Os. In most cases the participants are issued with certificates bearing the signatures of a DVO and FA as show n below. Some of the FAs entered into agreement with the Director of Veterinary Services e.g. FARM- Africa signed a MoU to facilitate training of CAHWs Training of Trainers Trainers of CAHWs include veterinarians and animal health technicians well versed with participatory 23 CAHW at Kainuk, South Turkana

35 approaches and adult education principles. A small number of the current trainers underwent the course on training of trainers for CAHWs, offered to a few veterinarians in the DVS in December A handful of these trained veterinarians were still involved in the training of CA HWs. Of all the people interviewed by the study team, only one PDVS had gone through the To T training for CAHWs. Some have participated in ToTs for Participatory Approaches. The majority have not undergone any specific training as trainers. FARM-Africa trainers of CAHWs undergo DELTA, a one year course and are exposed to approaches for training adu lts Refresher Courses Refresher courses for CAHWs are offered by FAs. The training gives the CAHWs opportunity to share their experiences with the trainers and this basically shapes the course programme. The majority of agents offering refresher courses are new entrants into the scene. They have the tendency of retraining CAHWs who were trained by different NGOs. Thus their pool of trainees is of different levels of understanding and experience. Nevertheless, CAHWs who have gone through many refresher courses are better equipped to continue with clinical and veterinary extension services. The study team met several CAHWs who have attended more than 2 refresher courses. For example, Dorcas Epusie Lokaale (Fig 6), a CAHW in Kainuk area was first trained by ICRC in 2004 and put through refresher courses by VSF-Belgium and WVK; including refresher for 21 days in Training Curriculum/Trainers Guide It was noted that there is no uniform, standardised training curriculum or trainers guide for CAHWs and different players use different training tools KVB Training Curriculum and CAHW s Trainers Guide The CAHWs training by various FAs has not been harmonised despite the existence of A Guide for Trainers of Community-Based Animal Health Workers in Kenya developed by the Department of Veterinary Services (2005) and the Minimum Standards and Guidelines for Training of Community-Based Animal Health Workers in Kenya (2004). To-date, the DVS has not made specific effort to ensure adherence to these documents. For example VSF Suisse adopted Operation Lifeline Sudan (OLS) curriculum developed for Southern Sudan in 1993 which is in line with KVB minimum standards and guidelines while CIFA uses a Manual developed by Animal Health Service Providers, Forum (AHSPF) under the leadership of MDP-GTZ. On the other hand, Isiolo are using the document produced by Dr. Jacob Wanyama (former employee of ITDG, who developed his own version based on the field experience). Finally, there are NGOs who do not use any known syllabus e.g. SALTLICK. In addition to regular training, some of the CAHWs received training tailored to meet the prevailing situation such as conflict resolution, management of RVF, Rinderpest, FMD and PPR. Practical Action in Mandera trains CAHWs to provide veterinary services specifically on equine disease control (livelihoods and donkey welfare). To-date the organisation has 24

36 retrained 45 CAHWs and 40 new ones along the Somalia and Ethiopia borders. The new trainees are offered 2 blocks of training prior to being provided with drug kits containing relevant drugs and those allowed for their use The FARM-Africa Training Model The FARM-Africa Training Model entails: i. First phase: 7 days of theory plus 1 day of field practice. In this first session the trainees are taught: a. de-worming, b. spraying and c. Administration of antibiotics. ii. The trainees take a six month break to practice in the field. The firm equips them with : a. 1 drug kit b. Simu ya Jamii provided by Safaricom Company to ease communication between CAHWs, DVO and staff and others c. 1 bicycle iii. Second phase: 7 days training focuses on wound management, experience sharing and addressing field challenges. iv. Field practice for 6 months v. Third phase: 7 days final raining. In addition to training on clinical work, the CAHWs were equipped with business skills by staff from trade and cooperative services. Upon completion of the course, the CAHWs went on an exposure/study tours to Wajir and West Pokot. To facilitate the work of CAHWs, FARM-Africa budgets for the training of leaders inclusive of chiefs and assistant chiefs. FARM-Africa also gives each trainee 1 drug kit and Simu ya Jamii facilitated by Safaricom Company to ease communication between CAHWs, DVO and staff and others. All the grandaunts received bicycles as part of the kit AHSPF CAHW s Training Model Animal Health Service Providers Forum (AHSPF) in Marsabit came up with a phased training that ran over a period of one year. Each phase entailed 7 days of training. This strategy used progressive knowledge impartation. 25

37 Table 3 Phased Training Model of Marsabit AHSPF Phase Interval Activity Phase I - 7 days of theory. - Interval I 2-3 months of practical work. The trainees are engaged on their own businesses but CIFA staff monitor how their interaction with the communities. Phase 2-7 days of theory - Interval 2: 2-3 months of practical work. During the training intervals the majority of the trainees were found to be inactive due to lack of resources to deliver the required services Phase 3-7 days training - Interval months of practical work Phase 4-7 days training. On graduation the CAHWs are given kits containing acaricide, de-wormers, antibiotics, trypanocidals and Burdizzo as well as disposable syringes and needles. The kit costing about Kshs , was free The CAHWs are also given disease monitoring forms which are filled and submitted to CIFA and DVO on monthly basis and issued with certificates similar to those shown below. The left certificate shows the court of arms for the GoK while right certificate bears the logo of VSF Belgium and the signature of the FA rep. Thereafter, the CAHWs are linked to drug suppliers, reintroduced to their respective communities on completion of their training as the DVO s Contact Herders (CHs). Some DVOs issued permits allowing CAHWs to possess and use veterinary drugs to treat livestock e.g. Dr Irura and Dr Mbogo. Nevertheless, it is important to note that all FAs give starter kits upon graduation Practical Action and ACTED Practical Action in Turkana and Agency for Technical Cooperation and Development (ACTED) Pokot North training curriculum is based on Kenya s Curriculum Guidelines for training CAHWs (A Guide for Trainers at Community Based Animal Health Workers in Kenya) and the CAHWs trainers manual i.e. 21 days (7 then 14 days respectively). The training based on the Minimum Standards and Guidelines for Training of Community Based Animal Health Workers in Kenya by the KVB encompasses the following: General introduction and clarification of the roles and responsibilities of CAHW. Herd health and livestock production. 26