REVIEW OF CURRENT STATUS OF DECENTRALIZED COMMUNITY BASED ANIMAL HEALTH SERVICES IN KENYA

Transcription

1 REVIEW OF CURRENT STATUS OF DECENTRALIZED COMMUNITY BASED ANIMAL HEALTH SERVICES IN KENYA Policy Workshop on Review of Current Status of Decentralized Community- Based Health Services in Kenya Workshop Report Held at Holiday Inn July 28, 2009, Facilitators and presenters: Mike Wekesa, Dr. Mosoti Mogoa, Irene Karani Rapporteur: Tom Ombogo

2 TABLE OF CONTENTS ACRONYMS WORKSHOP OVERVIEW WORKSHOP OVERVIEW Report Format THE WORKSHOP Opening Session FAO Opening Remarks The Minister s Opening Remarks PRESENTATIONS Policy Brief 2: An Exclusionist Policy and Legal Framework on Delivery of Veterinary Services Hurts Kenya s Livestock Industry Policy Brief 1: Technical, Operational and Sustainability Implications of the Legal Operationalisation of Community Animal Health Care Systems Policy Brief 3: The case for Policy and Legislative Reform in Order to Improve Animal Healthcare Delivery Systems in Kenya: WAY FORWARD CLOSING CEREMONY...12 Annex 1: List of Participants in the Policy Workshop Holiday Inn...13 Annex 2: Workshop Agenda...15 ANNEX 3: Opening Speech...16 Annex 4: Policy Brief Annex 5: Policy Brief Annex 6: Policy Brief Annex 7: Closing Speech

3 ACRONYMS AHS AHTs AU-IBAR ASAL CAHC CAHWs CAHC DVOs DVS EU FAO IGAD KALT KVA KVB MOH MOU NGO OIE PRSP UON Animal Health Services Animal Health Technicians African Union-Interafrican Bureau for Animal Resources Arid and Semi-arid Lands Community Animal Health Care Community Animal Health Workers Community Animal Health Services District Veterinary Officers Department of Veterinary Services European Union Food and Agriculture Organization of the United Nations Inter Governmental Agency for Development Kenya Association of Livestock Technicians Kenya Veterinary Association Kenya Veterinary Board Ministry of Health Memorandum of Understanding Non Governmental Organisations Office International des Epizooties (World Organization for Animal Health) Poverty Reduction Strategy Paper University of Nairobi 3

4 1.0 WORKSHOP OVERVIEW One of the fundamental cogs that drive the wheel of provision of Community Animal Health Services (CAHS) in Kenya is the existence of Community Animal Health Workers (CAHWs). The CAHWs have been very instrumental in ensuring accessibility to Animal Health Services (AHS) in the remotest parts of the country especially in the Arid and Semi-Arid Lands (ASALs). They have played roles in diseases surveillance, reporting, treatment and vaccination of animals. The debate on CAHS has been on the agenda since the 80s yet no progress has been made so far in terms of policy and legislative arrangements institutionalizing the operations of CAHWs. There is need to take the debate to a higher level and enact new policies in animal disease control and surveillance. The National Livestock Policy (May 2008), Section 3.4, Article recognises the need to review the different Acts that govern the provision of CAHS in Kenya. It recognises that the existing legal and regulatory framework is inadequate to address these challenges. The Act also recognises that the Veterinary Surgeons Act does not accommodate the operations of paraveterinarians. This policy workshop was convened by the Food and Agriculture Organisation (FAO) and was facilitated by Kesarine and Associates. The workshop targeted policy makers and other institutions that were interested in seeing the debate on Community Animal Health Care (CAHC) taken to the next level. The workshop brought together policy makers, regulatory bodies, implementing institutions and interested individuals in CAHC. There were 37 participants in total (See Annex 1). This was a high level workshop with policy makers. The policy briefs that the consultants had prepared were tabled for discussion. The workshop objectives were the following: Presentation of three policy briefs and input into them. Carrying the CAHS debate with policy makers at a higher level of engagement with the Ministry of Livestock Development and the Ministry of Northern Kenya and other Arid Areas. Additional input into policy direction based on the current situation on the ground by practitioners. The policy way forward for CAHS and the CAHWs concerns. 1.1 Report Format The report is a summary of the workshop presentations and reactions from workshop participants. More detailed information on the reports that informed the presentations on the policy briefs are available from FAO. The report is structured by agenda item as per the workshop programme (See Agenda in Annex 2). 2.0 THE WORKSHOP The Policy Workshop on the Review of Current Status of Decentralized Community Based Animal Health services in Kenya hosted by FAO took place at Holiday Inn, Nairobi on the 28 th July, It was facilitated by Kesarine & Associates. 4

5 The event brought together 37 participants from different stakeholders groups representing policy makers in the Government of Kenya, international agencies, professional organizations, practitioners and scientists. During the Workshop, participants heard presentations by the consultants and high-level officials from the Kenya government and engaged in discussion sessions on the policy implications of the current legislative arrangements in the provision of CAHS in Kenya. 2.1 Opening Session The Workshop was called to order at 9.15 AM. The participants introduced themselves to the Guest of Honour (Assistant Minister for Livestock Development). The session moderator then gave a brief introduction on the objectives of the Workshop FAO Opening Remarks The FAO international livestock consultant Rob Allport introduced and welcomed Dr. Abate who spoke on behalf of the FAO Representative in Kenya and underscored the importance of the workshop in Community Animal Health Services. Dr Abate highlighted the importance of the contribution that the workshop would have in policy development for CAHS in Kenya and especially the ASALs. She urged the participants on the need to have an open mind on the debate and she wished the participants a fruitful discussion. The Chairman of Kenya Veterinary Association (KVA), talked about the implementation of the National Livestock Policy, the need for better service delivery and affirmative action in the provision of CAHS in the country through the Department of Veterinary Services (DVS). The Director of Livestock Production accentuated the critical role played by Community Animal Health Workers in the delivery of CAHS. He then welcomed the Assistant Minister, Ministry of Livestock Development to officially open the workshop The Minister s Opening Remarks The Assistant Minister for Livestock Development, Hon. Aden Duale, gave an overview of the country s livestock figures but stressed the need for factual and authenticated figures since the current figures may not be accurate given the fact that the last animal population census was conducted in The Minister then gave a brief history of CAHS in Kenya and the need for a new era in policy orientation to support the livestock sector especially in ASALs. This, he noted would help retain staff in ASALs and in some cases even push for signing of contracts between the vet staff and constituencies for better service delivery. He talked about the need for objectivity in CAHS debate, the appropriateness of a localised Animal Health Services provision in ASALs and the importance of policy evolution that would target specific areas given the fact that Kenya has varied socio-economic systems. The Assistant Minister further stressed the need for an investment the livestock sector in line with the meeting of the goals of Vision He noted that other international conventions which Kenya is a signatory of (OIE) recognise the existence of CAHWs while Kenya does not. He cited the cases of AU/IBAR and OIE and he went ahead to recommend the amendment of the Veterinary Surgeons Act to conform to international standards. In finalising his speech, the Assistant Minister reiterated his Ministry s commitment to support a policy that would improve CAHS and livelihood support systems of ASAL communities. The Workshop was then declared officially opened (See full speech in Annex 3). 5

6 3.0 PRESENTATIONS 3.1 Policy Brief 2: An Exclusionist Policy and Legal Framework on Delivery of Veterinary Services Hurts Kenya s Livestock Industry This policy brief was introduced by Dr. Eddy Mogoa of Kesarine and Associates. The brief highlighted the issues surrounding livestock population data in Kenya, the importance of livestock and its position in the National strategies for development. There was an emphasis on the importance of livestock to livelihood support of communities in the ASALs and the Kenyan economy. This was evidenced in the sector recognition in the National development strategies such as the Poverty Reduction Strategy Paper (PRSP 2003), Strategy for Revitalization of Agriculture and the National Livestock Policy. It was quite clear that these strategies addressed the same issues and that the realization of the strategies calls for the effective provision of AHS to ASAL communities. An analysis of the historical perspective into the CAHS in Kenya revealed that policy changes drove the emergence of CAHWs. These changes through the SAPs, created disparities in the delivery of CAHS and the CAHWs came in to fill in the gap created. The presentation also focussed on the definition, objectives and successes of CAHWs in other parts of the world. The presenter outlined the importance of the CAHWs role in disease reporting and the strengths of CAHWs in ensuring the timely and affordable delivery of AHS to livestock keepers in marginalised areas. Major challenges facing CAHS were noted as opposition to programmes by government statutory bodies and lack of information on programme effectiveness in animal health service delivery. The basis of the opposition was that the programmes did not fit within the existing technical, legal, and policy framework in the countries concerned. The presentation highlighted on the sections of the Law that touches on the provision of CAHS. The implication of the Veterinary Surgeons Act and the Pharmacy and Poisons Act was also examined in great detail in this presentation. The following were some of the options, suggested in this presentation as the way forward; Exploring the possibility of going the AU/IBAR way or OIE way in terms of definitions. Evolving a policy through reviewing of the current legislation on the delivery of AHS. Defining the cadres of AHS and clearly defining their roles to minimise conflict. Developing the capacity of statutory body to effectively regulate and monitor the operations of CAHS practitioners. Developing supportive structures to facilitate delivery of AHS in marginalized regions. Developing other statutory requirement for training the CAHWs to Certificate, Diploma and other higher levels for those with qualifications. Addressing concerns of other stakeholders in CAHS provision. Conclusively, from this presentation it emerged that there was a need to use policy and legislative reforms to address disparities in delivery of Animal Health Services in the country especially in marginalised areas (See full policy brief in Annex 4). 6

7 Reactions to this Presentation Responses from the participants can be summarised as follows: There was concern that the availability of counterfeit drugs in the pastoral areas has not been addressed in the emergent policy options. The state system has not been able to absorb trainees and that s why there is no way we can do without them (CAHWs) as stated in the National Livestock Policy Sessional Paper #2 of There were concerns that 40% of animals in the World are in the Sub Saharan Africa yet it appeared that the government was not doing enough to encourage and boost the livestock industry. Kenya failed the risk analysis in Israel because Kenya could not relay how it controls the animal drug chain. The Director of Veterinary Services is the custodian of Animal Health Services and the CAHWs are not recognised in the current reviewed Policy. The case where the CAHWs programme has worked was because they were under the DVS with proper supervision and monitoring. The participants were in agreement that CAHWs programmes have succeeded elsewhere and that it would be good to recognize them within the provisions of the law. There was need to recognise CAHWs, train them continuously using the KVB curriculum and regulate them by the policy provisions. The current KVB curriculum for training CAHWs needs to be upgraded in order to conform with the CAHW trainers guide for Kenya 3.2 Policy Brief 1: Technical, Operational and Sustainability Implications of the Legal Operationalisation of Community Animal Health Care Systems This policy brief was presented by Irene Karani of Kesarine and Associates. She discussed: technical support and training of CAHWs, CAHS operation, management and sustainability and 10 points for a new policy on animal health service delivery. On the characteristics of CAHS, she outlined that: one, the individuals are selected for training by the communities within which they work; two, the technical training in animal health is short, usually less than a month; three, the low-cost strategies concentrate mainly on important livestock health and management issues of the farming community and four, that the payment for services provided comes directly from clients. In this policy brief discussion, it emerged that: There is need for delineation of operational areas in terms of spatial extents to mitigate conflicts of overlaps. In this regard the department of vet services should map the areas in which CAHS should operate only within the ASALs. There should be collaboration between NGOs involved in CAHC and DVS through MOUs this will ensure that operational areas are well defined and monitoring and supervision mechanisms as well as exit strategies are well set. 7

8 Planning for logistics (transport and subsistence) by supporting organizations is necessary for improved supervision; this should be well spelt within the MOU. The use of supervision guidelines/checklists in the standard curriculum should be enforced by the DVOs. Standardized disease reporting formats and the use of the CAHWs trainers guide should also be enforced by the DVOs. It is necessary for CAHW trainer to undergo a TOT (Training of trainers) training on how to train CAHWs using participatory techniques and adult learning skills. This calls for the KVB and DVS to have accredited trainers for CAH that will be used for training CAHWs when need arises. Sustainability of the CAHS is necessary if effective animal health service delivery is to continue having impact in the ASAL areas, in this regards there is the need to link CAH Systems to private practitioners, drug stores or pharmaceuticals. The FACT is that CBAHWs are no longer a stop gap measure and hence the need to create a law to regulate them and For the purposes of enhancing sustainability there was need to: Form linkages between private vets, AHAs and CAHWs. Contract CAHWs during branding and vaccination. Upgrade CAHWs so as to employ them as they are a cheaper option. The presentation further illustrated that: the CAHWs treated most of the animals in terms of all main ailments, they were the most accessible to livestock keepers in terms of minimum distance and that they are the most preferred by livestock keepers in the delivery of AHS. In concluding the presentation, there was an outline of 10 key points as a road map to an effective operationalization of technical, operational and sustainability aspects of the CAHS policy being evolved. These 10 key points stressed the need to: Clearly define specific legislation in animal health delivery systems focusing on marginalized parts of the country with special attention to ASALs. Recognize that it is government s responsibility to deliver animal health services in ASALs. Adapt and respond to the changing needs of the livestock sector. Enjoin animal health delivery with the end products as an incentive for marginalised communities by linking the CAHS to value chains which meet OIE standards. Clearly give direction on work ethics and address the fears of professionals. This could be achieved through a subsidiary legislation and not necessarily an Act of Parliament. Bridge the existing gaps in current legislation, define the roles of paraprofessionals (including CAHWs) and recognize them to help deter drug peddlers and quacks. 8

9 Borrow from the concept of Community Health Worker systems in medical services. Revisit privatization of animal health services in order to improve service delivery. Articulate how CAHS and incorporation of CAHWs can provide a platform for community partnership in service delivery. Provide for mandatory upgrading of CAHWs to enhance their professionalism as they provide much needed services to livestock keepers as are the most preferred. Full policy brief is in Annex 5 Reactions to this Presentation The responses could be summarized as: There is need to put CAHWs under a subsidiary legislation if their importance has been outlived. The CAHWs thrive in ASAL areas given the dynamics involved. There is need to give the DVOs the green light to enforce the National Livestock Policy and to incorporate the CAHWs in the delivery of AHS. The best person to be selected for training and must meet the community criteria for the selection of CAHWs. Kenya is lagging behind when it comes to developing new policies and institutions to respond to the needs of the community. There is need to put in place monitoring and supervision mechanisms that looks into the work of the CAHWs and recommend on their licensing each year. There is need for stock taking of the CAHWs in the country for the purposes of establishing their activity status and enlisting them as AHSPs. DVOs can play a crucial role in providing this information. 3.3 Policy Brief 3: The case for Policy and Legislative Reform in Order to Improve Animal Healthcare Delivery Systems in Kenya: Are community-based animal health workers a risk or asset to the livestock industry in Kenya? This policy brief was presented by Mike Wekesa of Kesarine and Associates. The presentation covered: the rationale for CAHWs, veterinary drugs handling by CAHWs, the credibility of services offered by CAHWs and their related economic impact among farmers and pastoralists. The discussion explored policy options for future legislation with particular reference to AHTs and CAHWs. The justification for the incorporation of CAHWs in the policy for delivery of AHS stated that: An institutional vacuum exists in animal health delivery in the ASALs. The ASALs are peculiar in their livelihood systems mobility, poor infrastructure, vast terrain, cultural and traditional norms; 9

10 Even if we posted one Veterinary Officer per location, infrastructure, transport and communication would be stumbling blocks; Government resources are not adequate to employ professionals in large numbers to meet the demand in ASALs; Changing landscape of livestock diseases: Recently animal diseases are simpler i.e. mostly parasite and nutrition related, something that does not require the intervention of professionals but which can be handled by CAHWs. The world over, there is a move to use paraprofessionals e.g. UK; the doctor nurse relationships; MoH in Kenya with Community health workers.; OIE has recognized the role CAHWs play in animal health On the farmers ability and willingness to pay for the services, the presentation based on the field studies, outlined that: without subsidized drugs during the drought or other emergencies, evidence showed that pastoralists are willing to pay for drugs and that a decentralized and privatized animal health services system in Meru and West Pokot are an example of this. In view of economic impacts of CAHWs, the presentation showed how CAHWs in Kathekani in Kenya reduced cattle and shoat mortality from 19% to 11% and 22% to 7% respectively. Further from the presentation, it emerged that losses to diseases can be high, particularly in the ASALs where access to animal health services is still extremely low. Pastoralists without ready access to veterinary services could expect to lose up to 25% of their herds and flocks each year through disease. This was the main cause of poverty for pastoralists. In concluding the presentation, this study proposed that: one, policy and legislative reform should allow all stakeholders to participate in the provision of animal healthcare; two, veterinarians be allowed to handle drugs because drug sales are one of the main income sources for veterinarians, AHTs and CAHWs and three that there is need to recognize the role of AHTs and CAHWs in policy and law so that they can provide the vital link between professionals and the communities. The full policy brief is in Annex 6. Reactions to this Presentation A summary of participants input into the process was as follows: There was need to bring on board all stakeholders into the provision of CAHS from the grassroots to the national level. This would create coherence in policy direction by all stakeholders. The cross border aspect of pastoralist lifestyle and thus the added value of CAHWs need to be considered in the debate. There was need to agree on how address regional imbalances in the country. The curriculum and the certification of CAHWs are to be provided for in the resultant policy document. KVB needs to formulate a monitoring and accreditation mechanism for CAHWs as this will ensure better organization of CAHS delivery. 10

11 There was need to think of an exit strategy for CAHWs through enhanced training. This will help in upgrading CAHWs for better delivery of AHS to farmers. There was need to designate specific areas where CAHWs would work to ensure mitigation of conflicts of spatial overlaps. Plenary Issues from the Presentations The plenary session discussions raised the following issues that: There is need to plug into the EU market since the Arab states do not pay well and the pastoralist suffers. The drug distribution chain in Kenya is still not clear and is hard to trace. This makes Kenya loose international trade opportunities e.g. in Israel recently. The revised Veterinary Surgeons Act accommodates Certificate, Diploma and Degree holders but has no place for CAHWs. The first thing to do would be for the KVB to agree on CAHWs and give the DVOs the green light to monitor them effectively. Kenya is poor in embracing reforms as compared to other countries and there is a serious discontent in key institutions in the provision of CAHS. The Ministry of Northern Kenya and other arid lands and the Ministry of Livestock development are under Agenda 4 to address regional imbalance especially in ASALs. The achievement of Vision 2030 would require posting of more professionals to ASALs. The case of Botswana was cited, where the Government of Botswana invested heavily on the livestock sector. Revisit the recommendations of 1999 and 2000 KVA meetings, which proposed the recognition of CAHWs to offer limited AHS in designated areas under supervision from a Veterinary surgeon. 4.0 WAY FORWARD The following were the recommendations suggested by the participants for the way forward: 1. There is need for KVB, KVA and DVS to come up with a practical strategy to achieve Vision 2030 and sell the ideas to NGOs and the private sector. 2. The directorate of veterinary services should come up with clear guidelines on the implementation of CAHS and ensure these are well enforced. 3. There is need for stock taking of all the CAHWs in the country to determine their status for enlisting and identification purposes. The DVS and KVB can play a good role in this. 4. There is need to efficiently and effectively monitor CAHWs, this it was argued, would help eliminate quacks and strengthen the delivery of CAHS. 11

12 5. There is need to designate difficult areas for CAHWs to operate in by naming them and producing spatial maps for these same areas. 6. There is a need for a few people to follow the Kenya Association of Livestock Technicians (KALT) bill currently in parliament so that we avoid having parallel systems of conflicting pieces of legislation. 7. In as much as the CAHWs are meant to be a stop gap measure may not be incorporated in the existing law, there was a need to develop strategies to address AHS in the ASAL areas for the time being. 8. There is need to sponsor policy makers to other countries to see how CAHWs fit in the provision of AHS. These best practices could then be replicated here in Kenya. 9. There is need to implement an action plan for the ASALs from stop gap measure stage to the era of professionalism. 10. There is need to move forward in a manner acceptable to OIE and countries willing to buy livestock from Kenya. 11. There is need to develop a strong constituency of stakeholders to push the CAHWs agenda forward and stakeholders need to invest in dialogue and lobbying the relevant government institutions. 12. Defining roles, responsibilities, creating linkages, giving incentives and creating an enabling environment for the operation would help improve the delivery of AHS. 13. Refresher training would upgrade CAHWs and programmes should be started to sponsor them to certificate level for those who qualify. 14. There is need to develop a specific Action Plan for the livestock sector which is reviewed regularly to make it more adaptive to changes in the sector. 15. Since Kenya is a signatory to the IGAD Policy on livestock, its implementation needs to be prioritized as this would improve AHS provision. 16. The livestock policy forum should be revived as a multi stakeholder forum with clearly defined TORs and a specific timeline to come up with a practical programme which can easily be executed. Membership should be drawn from KVA, KVB, UON, Ministry of Trade (MOT), DVS, KALT, NGOs and the private sector. 5.0 CLOSING CEREMONY The Ministry of Northern Kenya and other Arid Lands closed the workshop. In a speech read by an Undersecretary from the Ministry the Minister acknowledged FAO and the Consultants; Kesarine & Associates for putting the policy workshop together. The speech stressed the importance of evolving an all inclusive policy that would ensure timely delivery of AHS to the residents of ASALs who are often marginalised. He reiterated the government s commitment to fostering sustainable development of community livelihoods through policy formulation that is adaptive and responsive to the needs of the society. The full speech is in Annex 7. 12

13 ANNEXES Annex 1: List of Participants in the Policy Workshop Holiday Inn Deleted: Page Break No. NAME ORGANIZATION POSITION CONTACT 1 TOM O. OMBOGO Kesarine & Associates Rapporteur t.odero@yahoo.com 2 DR. KISA J. NGEIYWA VEDAMAN Consultant kisajuma@yahoo.com 3 ADAN HAJI YUSSUF Practical Action Area coordinator Hajiadan2003@gmail.com 4 ABDUL E. HARO Practical Action E.A Abdul.haro@gmail.com 5 DR. LANYASUNYA R.P Practical Action E.A Livestock livelihoods P.O lanyasunya@gmail.com 6 CHRISTINA SULLIVAN ASCU Administration Officer csullivan@ascu.go.ke 7 WINNIE MAILU SNV Development advisor wmailu@snvworld.org 8 DR. WAMWELE NJOROGE G.J ACCPRO/NOLD Community Development Officer or gwnjoroge@yahoo.com 9 ACHOCHORO BECKY W. ACTED Programme manager or +256l achobew07@yahoo.com or becky.achochoro@acted.org 10. HARUN K. KIRIGIA KUB EXECUTIVE OFFICER hkkirigia@yahoo.com 11 DICKENS M. CHIBEU AU-IBAR Project Coordinator Dickens.chibeu@au-ibar.org 12 SAM O. OKUTHE FAO-ECTAD Epidemiologist Sam.okuthe@fao.org 13 MAKEDA TSEGAYE USAID Snr.pastoral livelihoods advisor mtsegaye@usaid.gov 14 DARLINGTON AKABWAI Tufts University Researcher dakabwai@iconnect.co.ke 15 ANNE NJUGUNA CARE Kenya Emergency Prog. Manager anne@care.or.ke 16 PAUL M. MUTUNGI FAOKE Pastoral Field adv or Paul.mutungi@fao.org 17 JECHONIAH KITALA SNV Kenya Econ. Devt Advisor jkitala@snvworld.org 18 JOSEPH NJUGUNA FAOKE Livestock consultant joseph.njuguna@fao.org 19 B.O GODIA Kenya Vet Board Inspector Diagoh08@yahoo.com 13

14 20 SIMON KIHU Vetworks Eastern Africa Program officer JULIUS KAJUME Private Consultant GRACE KAMAU Kesarine & Associates Admin Officer TABITHA KIMANI FAO-ECTAD Socio-Economist ILONA GLUECKS VSF-Suisse Prog. Coord. Kenya ABASS A.M Arid lands project SIDC ROBERT ALLPORT FAO Kenya Livestock & pastoralism consultant VICTORIA KYALLO VSF-Germany Programmes officer ABDI NUR ELMI CARE Kenya Project Manager FRANCIS CHABARI PACAPS/RELPA Chief of Party or JOSEPHINE MUGABI CAHNET/FARM-Africa Regional coordinator of CAHNET & GALVMed partnership manager EDDY MOSOTI MOGOA UON/Kesarine & associates Trainer.consultant IRENE KARANI Kesarine & Associates Consultant MIKE WEKESA Kesarine & Associates Consultant WILLIE TUIMISING Practical Action Team Leader n.or.ke 35 DR. ANDREW G. THAIYAH UoN Participant rep. vet. Faculty. 36 STEPHEN N. KINIIYA KVAPS TRUST CEO DR. WANJALA C.H.O Kenya Vet Association KVA

15 Annex 2: Workshop Agenda am am Registration Introduction, workshop objectives Opening Remarks (FAO) am am Opening by Minister Livestock Development (Hon Dr. M. Kuti) Presentation of Policy Brief titled: an Exclusionist Policy and Legal Framework on Delivery of Veterinary Services Hurts Kenya s Livestock Industry (Dr. Eddy Mogoa) Tea Break Presentation of Policy Brief 2 titled: Technical, Operational and Sustainability Implications of the legal operationalisation of Community Animal Health Care Systems (Irene Karani) pm pm pm pm Presentation of Policy Brief 3 titled: Are Community based workers a risk or an asset to the Livestock Industry in Kenya (Mike Wekesa). Discussion on the Way Forward Closing remarks by Ministry of Northern Kenya and other Arid Lands (Hon. Sasura) Lunch and departure 15

16 ANNEX 3: Opening Speech SPEECH FOR HON MOHAMMED KUTI, MP MINISTER FOR LIVESTOCK AND FISHERIES ON COMMUNITY ANIMAL HEALTH SERVICE DELIVERY TECHNICAL AND POLICY ISSUES, HOLIDAY INN NAIROBI 28 TH JUNE 2009 Ladies and gentlemen, Livestock production contributes significantly to food security of this country. Current statistics show that livestock contributes up o 10% of the Gross Domestic Product and 30% of the farm gate value of agricultural commodities of which a substantial portion of the income arises from trade both local and international. The livestock sub-sector also provides raw materials for the local dairy, meat, hides and skins wool and hair processing industries. Livestock production is carried out in the high and medium potential lands (HMPL) and in the arid and semi arid lands (ASALs). Livestock population in Kenya is estimated at just over 60 million which includes 27 million chicken, 13million cattle, 10.4 million goats, 7.9 million sheep, 1 million camels, 600,000 donkeys and 300,000 pigs. The ASALs of Kenya constitute 80% of the land surface and hold 75% of the livestock population, of which the livestock sub-sector accounts for 90% employment and more that 95% of the family income. In the high and medium potential lands which occupy 20% of the country, livestock provides employment to more than 50% of the agricultural labour force. Up till 1989, the government was providing animal health services either free of charge or at a highly subsidized level. This venture was extremely successful in controlling livestock diseases resulting in the growth of the livestock sector with most veterinarians working for the Ministry of Livestock Development (MoLD). Veterinarians manned districts and divisions while the Animal Health Technicians (AHTs) provided clinical and extension services at the locational level. However the number of veterinarians serving in the Ministry has greatly reduced over the last decade due to the government s decision to suspend recruitment of new veterinarians. The changes in policy were in tandem with economic and institutional reforms initiated by the government due to the World Bank initiated Structural Adjustment Programme 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. 16

17 This scenario had a disproportionate impact on the ASAL areas and the period 1990 to 2000 witnessed the flight of veterinary personnel in ASALs to less remote areas. The problem of provision of veterinary services was further compounded by collapsed infrastructure, lack of essential, veterinary equipment and serviceable vehicles and low budgetary allocations to carter for the vast and remote ASAL areas. Currently Kenya has more than 2,000 veterinarians serving in the public and private sector and the ASAL areas comprise of less than 10% of the veterinary personnel force, for example in a sample of 10 ASAL districts covering 332,859 sq kilometres only 40 vets were available against a livestock population of over 12.5 million. The last two decades have seen a number of changes take place in delivery systems for animal health inputs and services in much of Africa. These changes are attributed to liberalization and privatization owing to budgetary constraints in providing these services to the public. In order to bridge the gap that has been left by the declining animal health services veterinary service privatization programmes have emerged and have had varied impacts in different regions, with marginal / ASAL areas receiving minimal attention. One initiative undertaken to respond to disparity in delivery of animal health services in marginal /ASAL areas has been the introduction of community-based animal health services (CAHS) that are associated with community animal health workers (CAHWs) This initiative was spearheaded by nongovernmental organizations in the early 1990s and involves training community-selected representatives in basic animal health care and livestock production techniques. The primary objective of the community animal health service delivery has been to supplement and support the existing but overstretched professional system for delivering such services to communities in marginal/asal areas of many developing countries including Kenya. According to Africa Union/Inter-African Bureau for Animal Resources (AU/IBAR), a community animal health worker is a person who performs a limited range of veterinary tasks as defined by the statutory body in a given country. This worker is, within the OIE Code, regarded by this authority as a category of para-professional (AU/IBAR, 2003). A community animal health worker can also be defined as one selected by the community and given basic training in animal health and related issues, according to local priorities. These workers are also called Village Animal Health Worker, Community Livestock Worker or other similar names. Although the community animal health service initiatives are credited with substantial impact on community livelihoods in many parts of Africa and ASAL areas of Kenya, they have not been free of obstacles, especially policy and legislative ones. Government statutory bodies in many developing countries have opposed the establishment of the community animal health worker programmes on the basis that these programmes do not fit within the existing technical, legal, and policy framework in the countries concerned. The veterinary department also has not issued clear guidelines on the implementation of community animal health support systems and how they should effectively function within the districts they operate. At a workshop on the veterinary practitioners bill and community based animal health delivery systems in 2002 it was recommended existing community animal health workers should be retained and not be included in the law, should act as a stop gap measure, no training of new ones and they should be phased out in 5 to 10 years. Seven years down the line, the situation on animal health service delivery in ASALs has not improved and non- 17

18 governmental organizations still continue to train CAHWs. The KVB also has not issued and implemented clear regulatory guidelines on the operations of the community animal health worker systems. In the last six years, the GOK has accorded the ASALs a high priority especially in the Economic Recovery Strategy (ERS) Paper of where the medium to long term strategies were articulated. This was an amalgamation of the recommended strategies in the Poverty Reduction Paper (PRSP). The ASAL policy also specifically mentioned that investment in ASAL areas in animal health should support Decentralized Animal Health approaches being practiced in the country by communities with support from NGOs. The importance of the ASALs to the attainment of Kenya Vision 2030 is also emphasized with substantial investment targeted in the areas of disease control, livestock marketing and value addition. The first medium term plan ( ) of the vision aims at creating disease free zones near export markets through enhanced vaccinations and diseases control measures, investment in livestock breeding, range improvement and marketing infrastructure. The NARC government Strategy for the Revitalization of Agriculture also mentions the support to strengthen community animal health worker systems. It can therefore be deduced that there has been goodwill on the part of national policies to embrace community animal health service delivery systems. However sectoral polices and laws e.g. the Veterinary Surgeons Act and the Pharmacy and Poisons Act are still in their original form despite the acknowledgement decentralized animal health (DAH) in other national policies. The Kenya Veterinary Board (KVB) is the veterinary statutory body charged with the responsibility of regulating veterinary training and practice in Kenya. This board is a creation of The Veterinary Surgeons Act (Cap 366) of 1953 (GoK, 1993). The Act gives KVB the mandate to: register duly qualified veterinary surgeons; license and supervise private veterinary practices and regulate veterinary education amongst others. The Act that created this Board does not provide for any other category of veterinary service providers other than veterinary surgeons as given in section 4. Thus the current act does not actually recognize community animal health workers as paraveterinarians. However the OIE on the other hand makes provision for them. The OIE Terrestrial Animal Health Code defines veterinary paraprofessional as a person who is authorized by the veterinary statutory body to carry out certain designated tasks (dependent upon the category of veterinary paraprofessional) in a country, and delegated to them under the responsibility and direction of a veterinarian. The tasks authorized for each category of veterinary paraprofessional should be defined by the veterinary statutory body depending on qualifications and training, and according to need (OIE, 2008). Other sources give examples of veterinary paraprofessionals as including veterinary nurses, veterinary technicians, community-based animal health workers, food inspectors, livestock inspectors etc. A number of issues are apparent from the OIE Terrestrial Animal Health Code s definition of veterinary paraprofessional. These include: The categories of veterinary paraprofessionals should be determined by the country s veterinary statutory body; The veterinary paraprofessionals are authorized to operate by the country s veterinary statutory body; 18

19 The tasks undertaken by veterinary paraprofessionals must be designated and also defined by the veterinary statutory body; There must be a supervising veterinarian to oversee the activities of veterinary paraprofessionals; The qualifications and training of veterinary paraprofessionals must be taken into account when determining what tasks they can undertake. It is a reality that the ASAL areas are unique and have special challenges, which include mobility of livestock to inaccessible areas, insecurity, rugged terrain, poor road and telecommunication network and other infrastructure as well as low distribution of veterinary personnel. It is the high time that we re-think our priorities and the possible cost effective means of providing a quality veterinary service delivery that is well supervised and regulated effectively for the good of the ASAL areas that house 75% of the countries livestock. In this regard, it is therefore important that the Veterinary Surgeons Act be amended to reflect OIE standards and the practical reality on the ground as exemplified under section 2.3. It is clear from the OIE that responsibilities of regulation of community animal health workers (CAHWs) must be borne by the Kenya Veterinary Board. With respect to their training, it is crucial that they are properly trained in full cooperation with the veterinary profession in certain, limited, procedures which provides effective treatment for all animals and ensures enhanced public confidence in the production of safe food and in the veterinary profession. It is only in this way that professional animal health service delivery can be professionalized entirely with the added impact of better services for communities who have been marginalized for a long time. With healthier animals especially in the ASAL areas, we expect better animal products, enhanced incomes of pastoralists and needless to say motivation for unemployed youth to venture into animal health delivery services which can earn them a livelihood with the prospects of furthering their education. It is therefore necessary to: Revise the current policy and legislative framework which is not tenable as it marginalizes a big proportion (over 70%) of this country the ASALs. An alternative policy and legal framework is required that clearly addresses the needs of the ASALs with regards to animal health service delivery. Kenya needs to recognize and certify the roles played by community animal health workers, certificate and diploma holders; enact policy and legislative reform to allow veterinary supervised community animal health service systems (CAHSs) to be encouraged and legalized and; formulate and establish start up schemes for private veterinarians wishing to work in ASAL areas. Recognize the community animal health worker and strengthen the role they play in disease reporting and their contribution to national disease surveillance systems may be the way to go particularly now that countries need to demonstrate national disease status to trading partners according to WTO guidelines. It is not enough to recognize community animal health systems (CAHS) in policy but it is equally important to integrate the policy changes in the livestock sector budget for 19

20 sustainability. In this way the government will be compelled to budget for CAHS with additional funding being sort from private sector and other development partners. Incentives for marginalized communities to purchase animal health services and thus create sustainable CAHSs are essential. This can be done through the linking the CAHSs to value chains which meet OIE standards. In this way communities that purchase animal health services from approved CAHS are guaranteed both local and markets for their livestock and livestock products. May I end by urging all the stakeholders in the animal health service delivery to come and reason together, discuss, formulate, revise, and correct defective sectoral policies and laws that hamper the provision of animal health service delivery to marginalized communities. This calls for reasonable, practical, and realistic options that will enhance, reshape and boost animal health service delivery in ASALs while contributing to improved livestock production, food security, secure livelihoods and a strong national economy. I strongly believe that my ministry will not only willingly but strongly support policies that are geared to improve and boost livestock production in the ASALs by exploiting the numerous opportunities that exist in these areas. Thank you. 20

21 Annex 4: Policy Brief 1 An Exclusionist Policy and Legal Framework on Delivery of Veterinary Services Hurts Kenya s Livestock Industry Policy Brief No.1 Kenya Country Office REVIEW OF CURRENT STATUS OF DECENTRALIZED COMMUNITY BASED ANIMAL HEALTH SERVICES IN KENYA Key issues addressed in this policy brief are: 1. Historical perspective 2. Privatisation of Services 3. Emergence of CAHS 4. Strengths of CBAHWs 5. Opposition to CBAHWs and ways of dealing with it. 6. Policy options CONTEXT Arid and semi arid lands constitute about 71 percent of Kenya s total land mass and are home to about 70 percent of Kenya s livestock population. In these marginalized lands, animal health care although a public sector responsibility remains wanting and is mainly provided by GENERAL OVERVIEW Livestock production is carried out in the high and medium potential lands (HMPLs) and the arid and semi arid lands (ASALs). Due to lack of accurate figures of Kenya s livestock population over several decades, conservative estimates put the figure at just over 60 million livestock. More than 70% of the cattle, sheep, goats and almost all camels are found in arid and semi arid lands (MoA&RD, ). Livestock remains pivotal in the quest to attain food security, provide basic raw materials for local agro industries and for local and international trade, create jobs, reduce poverty and sustain development. These are fundamental issues in various Government policy documents including the Poverty Reduction Strategy Paper (PRSP), Economic Recovery Strategy for Wealth and Employment Creation (GoK, 2003) and Strategy for Revitalization of Agriculture (SRA, ). For all these to be realized, the sub sector requires provision of adequate, accessible and guaranteed veterinary services as they play a vital role in sustaining its productivity and viability. These veterinary services include: health services (both curative and preventive services and provision of veterinary pharmaceuticals) and; production services including research and extension related to improved livestock husbandry such as artificial insemination. 1.0 HISTORICAL PERSPECTIVE During the colonial period, the Government was the primary provider of veterinary services and inputs. Following independence, the demand for veterinary services and inputs expanded rapidly with the government meeting the full cost of these services. Until the 1980s, the government had been subsidizing the delivery of veterinary services. However, in the late 1980s and early 1990s, Kenya embraced the implementation of the International Monetary Fund (IMF) and World Bank (WB) sponsored Structural Adjustment Programmes (SAPs). The implementation of the SAPs and other broad based market reforms which were being undertaken, coupled with the scaling down of government expenditure brought into sharp focus the role of the private sector in delivery of animal health services. In light of these developments, the government of Kenya instituted several policy and strategy changes in the livestock sub sector aimed at attaining sustainable and balanced investments as well as reliable provision of services as a responsibility shared between the public, private sector and beneficiaries. These changes included: 1. The transfer of most holding grounds to county councils; 2. Transfer of dip management to community dip committees; 3. Provision of veterinary drugs and chemicals at cost; 4. Liberalization and privatization of delivery of veterinary services including clinical and artificial insemination services and; 5. A freeze on automatic employment in the public sector for professionals graduating from various animal health training institutions (in 1988). 2.0 PRIVATIZATION OF SERVICES Privatization of veterinary services in the HMPLs took off relatively well following liberalization and privatization. However, the same cannot be said to have taken place in the ASALs. With shrinking budgetary allocations, an expanding administrative structure and management problems, the ASALs with more than 70% of the country s livestock population were most affected. The situation was further compounded by a collapsed infrastructure, insecurity, inadequate number of veterinary 21

22 community based animal health workers (CBAHWS) / paraveterinarians / veterinary paraprofessionals, who are not organized in any professional associations and mostly have a weak working relationship with the Department of Veterinary Services or veterinarians. These marginalized lands have not been able to attract the services of a significant number of qualified private veterinary personnel given the cost of establishment and the low demand for these services. This situation obtains not only due to poor infrastructure, harsh climate, low household incomes, and low literacy levels but also because, the existing policy and legal framework on delivery of veterinary (animal health) services is exclusionist as the law as given in the veterinary Surgeons Act, Chapter 366 of the laws of Kenya does not provide for any other category of veterinary / animal health service providers other than veterinary surgeons. The sum total of all these include a demoralized lot of a section of veterinary service providers because the existing laws term their activities illegal; poor / inadequate veterinary services to livestock keepers in ASALs and; production losses owing to increased rates of mortality and indirectly by increased morbidity losses in terms of the impact of diseases on growth, fertility, product quality, and work output. The way forward should be to evolve an all inclusive policy and legal framework on delivery of veterinary services in marginalized lands that embraces all service providers given that CAHS initiatives are credited with substantial impact on community livelihoods in many parts of Africa, Kenya included. The Primary Objective of CAHS has been to supplement and personnel and inputs and recurrent drought, among others (Mogoa and Nyangito, 1999). Owing to this disparity in the establishment of private veterinary practices, the government adopted a policy of providing veterinary clinical services in the ASALs. There are a handful of private veterinary practices in the ASALs, which are mainly confined to agro vet shops. However, these services are inadequate and thinly spread on the ground due to existence of public sector livestock health service activities; low density of livestock population per unit area which does not generate sufficient volume for business to sustain private practice; and a harsh environment which contributes to high transaction costs per animal. ASALs are not attractive to private veterinarians because of Poor infrastructure, Vastness, Pastoralism and transhumance, Insecurity, Harsh environmental conditions High cost of delivery of veterinary services, among others (Mogoa and Nyangito, 1999). 3.0 EMERGENCE OF CAHS Animal health services delivery channels in marginal areas There are a number of distinct animal health delivery channels within Kenya s marginal areas. They include: (i) (ii) (iii) (iv) (v) Traditional public sector system of veterinary professionals and their accompanying paraprofessionals whose numbers keep declining; CBAHWs, largely supported by non governmental organizations (NGOs); Village veterinary drug shops (popularly known as Agrovets) that supply drugs, often with advice, to livestock keepers; Small number of purely private veterinarians and para veterinarians; Ethno veterinary practices undertaken by some community members (Mugunieri et al, 2002). Liberalization and privatization of some veterinary services undertaken in Kenya in the mid 1980s leading to disparity in delivery of animal health services in marginal areas was the main factor that led to introduction of community based animal health services (CAHS) and associated communitybased animal health workers (CBAHWs), also referred to as Contact Herders (Chema and Gathuma, 2004), Village Animal Health Workers or Community Livestock Workers (Catley and Leyland, 2002). These workers have also been variously defined: as persons who perform a limited range of veterinary tasks as defined by the statutory body in a given country (AU/IBAR, 2003); as a category of para professionals (AU/IBAR, 2003) and; as persons selected by the community and given basic training in animal health and related issues, according to local priorities (Catley and Leyland, 2002). There is evidence (Leyland et al. 1998) that a number of CAHS have had a significant and positive impact on pastoral livelihoods and economies in various parts of the world, including Kenya and thus the support for the use of CBAHWs and their integration into for example, the national strategy for disease reporting has gained credence. 3.1 The strengths of CBAHWs The usefulness of CBAHWs stems from several of their desirable attributes (see left): Evidence shows that in some areas, CBAHWs are not only the most utilized but also the most preferred channel of obtaining animal health services, giving credence to the position that CBAHWs have enhanced the capacity to deliver animal health services in marginal areas (Mugunieri et al. 2002). 22

23 support the existing but overstretched professional system for delivering such services to communities in marginal areas Strengths of CBAHWS include: Very good in mobilizing communities; They can be used as extension agents; They can be integrated in surveillance and disease reporting systems and; They can handle minor clinical cases. Their ability to easily access vast areas not accessed by other service providers and being able to migrate with pastoralist farmers. The biggest advantage they probably have is that they are relatively accessible to livestock keepers as they operate within these communities. The current policy and legislative framework is not tenable as it marginalizes a big proportion of this country the ASALs. Therefore there is need to: Enact policy and legislative reform to allow veterinary supervised CAHS to be encouraged and legalized. Formulate and establish start up schemes for private veterinarians wishing to work in ASAL areas. Establish legal CAHS in line with the AU/IBAR model which is in line with that of the OIE with regard to Veterinary Services. It stipulates that competent veterinary services should demonstrate that their human resource component includes an integral core of full time civil service 3.2 The Opposition However, CAHS initiatives although well intended and with their substantial impact on community livelihoods in many developing countries, have not been free of obstacles, especially policy and legislative ones. These CBAHW schemes/programmes have met with strong opposition in many countries from statutory and professional bodies, and Kenya is no exception, on the basis that they do not fit within the existing technical, legal, and policy framework for delivery of veterinary/animal health services. Lack of information on programme effectiveness in animal health service delivery has compounded the problem (Mugunieri et al 2002). Such opposition, coupled with campaigns to stall CAHS development and establishment continue, despite the fact that these remote, underdeveloped parts of the country where poorer livestock keepers live, have not been able to attract veterinarians/veterinary private practices and those opposed to the CAHS programmes have not provided alternative modes of delivery of these vital services other than blaming the government for this failure. The end result is ASALs that have been marginalized in terms of provision of veterinary services, with government turning a blind eye and CAHS programmes operating as illegal entities. The opposition to CAHS programmes by statutory and professional bodies in Kenya (the Kenya Veterinary Board [KVB] and the Kenya Veterinary Association [KVA] and other institutional stakeholders like the Faculty of Veterinary Medicine of the University of Nairobi, will remain legitimate as their arguments are based on the current policy and legal framework. The Veterinary Surgeons Act, Chapter 366 of the laws of Kenya (GoK, 1993), which created the KVB gives the Board the mandate to among others: register duly qualified veterinary surgeons; license and supervise private veterinary practices and regulate veterinary education. The Act does not provide for any other category of veterinary service providers other than veterinary surgeons as given in section 4 of the said Act nor does it allow anybody who is not registered under the Act to practice veterinary surgery. Past efforts to find the place for the emerging CAHS and associated CBAHWs in delivery of veterinary/animal health services, especially in the ASALs have not been able to tame this opposition. 3.3 Dealing with the opposition resistance by stakeholders addressing the problems/fears For any feasible arrangement to be reached with respect to the role CBAHWs can play in delivery of animal health services in Kenya in future, it is important that the fears of the administrators, veterinarians and animal health technicians, whether real or imagined be addressed. The main reason for resistance to change in the mode of delivery of veterinary services (and therefore changes in policy and legal framework) with respect to especially professional associations is that anticipated changes pose a threat to the welfare of membership. Fears of stakeholders in general arise from: insecurity, possible social loss, economic losses, inconvenience, resentment of control, unanticipated repercussions, obsolescence, ego defensiveness, desire to maintain the status quo, resource constraints and peer pressure. Possible ways of overcoming or reducing the level of anticipated resistance include: Providing information in advance giving reasons for change, its nature, timing, impact on the department and various cadres of administrators/service providers (CHANGE MANAGEMENT); Encouraging participation in development and implementation of intended changes (NO AMBUSH, NO ARM TWISTING); Guaranteeing against loss and; providing technical counselling to achieve voluntary adaptation (Munyua et al, 1999). 4.0 POLICY OPTIONS An alternative policy and legal framework is required. Possible policy options include what has been suggested by AU/IBAR (AU/IBAR 2003). Among other things, it proposes: CBAHWs should be regarded as a category of paraprofessionals; CBAHWs activities should be regulated and supervised by the country s statutory body in 23

24 employees. This core must include veterinarians, administrative officials and veterinary paraprofessionals. The human resources may also include part time and private sector veterinarians and veterinary para professionals. charge of animal health service through the veterinarian in whose jurisdiction they operate; Recognition and certification of the roles played by CBAHWs, certificate and diploma holders; Training of CBAHWs should follow a standard curriculum endorsed by the statutory body; Trainers of CBAHWs should be defined by the statutory body; There should be examination of CBAHWs on practical skills and technical knowledge; These workers must be licensed by the statutory body and; overall implementation of quality CBAHWs systems at national level be dependent on; i. There should be a clear policy on veterinary service restructuring ii. Adequate government support to statutory bodies (Kenya Veterinary Board). Other options include that of retaining current CBAHWs, retraining them and using their services for disease surveillance and reporting and their work would be supervised by qualified personnel. One tenable view is that given the level of literacy in Kenya, recruiting people with a certain level of education as animal health technicians should be encouraged. The department of veterinary services encourages training up to certificate level (as for government AHAs) of any qualified individuals sponsored by NGOs, religious groups or co operatives, particularly for the ASALS, in government animal health training institutes. This will ensure that most private field workers will have certified training (Chema and Gathuma, 2004). National recognition of CBAHWs owing to their importance in disease surveillance and reporting has already been proposed in Tanzania (Allport et al., 2005). Recognizing the CBAHW and strengthening the role they play in disease reporting and their contribution to national disease surveillance systems may be the way to go particularly now that countries need to demonstrate national disease status to trading partners according to WTO guidelines (Catley and Leyland, 2002). There is hope on the way forward for CBAHWs in Kenya following the development of a national CBAHW curriculum that includes core skills and knowledge required by all CBAHWs and which also allows for training in animal health problems according to local priorities (Catley and Leyland, 2002). In line with this, there will arise a need for the Kenya Veterinary Board to clearly define not only what a veterinary paraprofessional means in the Kenyan context, but also the categories of veterinary paraprofessionals and tasks authorized for each category depending on qualifications and training, and according to need. With respect to their training, it is important that they are properly trained in full cooperation with the veterinary profession in certain, limited, procedures which provides effective treatment for all animals and ensures enhanced public confidence in the production of safe food and in the veterinary profession (FVE, 2008). CONCLUSIONS There is overwhelming evidence that CBAHWs where they exist, have contributed to improvement of both primary level delivery of veterinary services and disease surveillance in rural areas of developing countries. However, if CBAHWs are to provide livestock health services efficiently, they need to be an integral part of these services (Oakeley 2001). The appropriate roles of CBAHWs must be recognized by law and incorporated into the regulations governing animal health services in Kenya. So should be the roles of other veterinary paraprofessionals. A large number of veterinary paraprofessionals has advantages: a) Their numbers can expand the geographic area covered and the number of farmers serviced; b) Their opportunity costs are lower than those of veterinarians thereby making their services more affordable to farmers; c) Time required for and cost of their training is significantly lower than that required of the veterinarian and thus more veterinary manpower can be generated within a short time and at lower costs; d) They avail more time to veterinarians to treat more serious cases (Umali et al., 1992; Oruko et al., 2000). Therefore, to provide efficient veterinary services to livestock keepers in the marginalized areas of this country, there is need to: 1. Evolve a policy on delivery of animal health services in the country that recognizes the roles of other players besides veterinary graduates. 24

25 2. Evolve a policy on training of CBAHWs to certificate and diploma levels for those with required qualifications. 3. Review current legislation on delivery of animal health services and the practice of the veterinary profession to accommodate certificate and diploma holders. 4. Define the cadres of animal health / veterinary service providers and the roles and responsibilities of each. 5. Develop the capacity of the statutory authority the Kenya Veterinary Board to undertake its responsibilities effectively and efficiently. 6. Promote continuing education for the veterinary professionals 7. Develop other supportive structures to facilitate delivery of animal health services in marginalized regions of this country (to attract and enhance retention of service providers and reduce the cost of doing business in these areas). References and further reading 1. Allport R, R. Mosha, M. Bahari, E. Swai & A. Catley (2005): The use of community based animal health workers to strengthen disease surveillance systems in Tanzania. Rev. sci. tech. Off. int. Epiz., 2005, 24 (3), AU/IBAR (2003): African Union / Interafrican Bureau for Animal Resources: Policy on Community based Animal Health Workers, p Catley A and Leyland T (2002): Overview: Community based animal health workers, policies, and institutions. PLA Notes, Chema, S. and Gathuma J.M. (2004): Kenya: the development of private services and the role of the Kenya Veterinary Association. Rev. sci. tech. Off. int. Epiz., 2004, 23 (1), FVE (2008): Federation of Veterinarians of Europe (FVE): Veterinary Acts. Pp KVB (undated): Minimum standards and guidelines for training of community based animal health workers in Kenya, Kenya Veterinary Board, Uthiru, Kenya. 7. GoK (1993): The Veterinary Surgeons Act, Chapter 366 of The Laws of Kenya. Government Printers, Nairobi, Kenya. 8. Leyland T, Akabwai D, and Mutungi P M (1998): Delivery of private veterinarian supervised community based animal health services to arid and semi arid pastoralist areas are they a viable and sustainable option? Proceedings of a workshop on Delivery of Animal Health Services in Eastern Africa held in Arusha, Tanzania, December VetAid/CTA 9. Mogoa, E.G.M and Nyangito M.M. (1999): Constraints to delivery of animal health services in pastoral areas of Kenya: A Review. Pastoral Information Network Programme: Working Paper Series No. 20. p Mugunieri G.L., Omiti, J.M. and Irungu P. (2002): Animal Health Service Delivery Systems in Kenya's Marginal Areas Under Market Liberalization: A Case for Community Based Animal Health Workers Vision Network for East Africa, Report 3, pp Munyua M.S.J., Farrah, K. and Kahiu, G. (1999): The need and possible modalities of establishment of community based delivery of veterinary services and inputs in the arid and semi arid areas in Kenya: Proceedings of the Tanzania Veterinary Association Scientific Conference, Arusha, Tanzania 30 th November to 2 nd December Oakeley, R. (2001). Community livestock workers: A review of experiences with communitybased animal health care delivery. In OIE (2008): OIE Terrestrial Animal Health Code: Glossary. 14. Oruko, O.L., Upton, M. and McLeod, A: (2000): Restructuring of Animal Health Services in Kenya: Constraints, Prospects and Options. Development Policy Review, 18 (2): Umali, D.L., Feder G., and de Haan C. (1992) The balance between public and private sector activities in the delivery of livestock services, Discussion Paper No. 163, World Bank, Washington DC. This policy brief is part of a Series developed by: Kesarine and Associates for FAO under the Regional Drought Decision Programme, P. O. Box 997, 00517, Nairobi. Tel: / admin@kesarine.com 25

26 Annex 5: Policy Brief 2 TECHNICAL, OPERATIONAL AND SUSTAINABILITY IMPLICATIONS OF THE LEGAL OPERATIONALISATION OF COMMUNITY ANIMAL HEALTH CARE SYSTEMS Policy Brief No TECHNICAL SUPPORT AND TRAINING Kenya Country Office REVIEW OF CURRENT STATUS OF DECENTRALIZED COMMUNITY-BASED ANIMAL HEALTH SERVICES IN KENYA Key issues addressed in this policy brief Technical support and training of CBAHWs. CAHS operation, management and sustainability. 10 points for a new policy on animal health service delivery Different countries have adopted different approaches in the implementation of Community Animal Health Care Systems (CAHS). Experiences from these programmes indicate that, by using existing traditional knowledge, the programmes encourage the participation of local communities in the design and delivery of animal health care services. The CAHS model also empowers the local people to determine the type of animal health services they receive. In some areas conditions may exist that would permit full privatisation using this approach. In addition the approach has shown that pastoralists and agro-pastoralists can organize themselves to select Community Based Animal Health Workers (CBAHWs) for training who then offer reliable and consistent animal health services to their communities. Most CAHS programmes have the following characteristics: Individuals are selected for training by the communities within which they work; Technical training in animal health is short, usually less than a month; Low-cost strategies concentrate mainly on important livestock health and management issues of the farming community; and Payment for services provided comes directly from clients 1. However, the training and operations of CBAHWs have drawbacks because of the following reasons identified by stakeholders 2 : i. Despite the existence of standard training guidelines approved by the Kenya Veterinary Board (KVB), they are not being implemented by trainers. Furthermore a majority of District Veterinary Officers (DVOs) are not aware of the guidelines. ii. Some of the facilitators of the CBAHWs training are not trained. iii. Selection criteria for CBAHWs trainees as stipulated in the guidelines are not being followed. iv. There is lack of standardized certification. v. There is inadequate monitoring and supervision by trainers. vi. Non-Governmental Organisations (NGO) are not aware that they are meant to sign Memorandum of Understanding (MOU) with the Department of Veterinary Services (DVS) and this sometimes results in conflict between the two entities. vii. The CBAHWs are not legally recognized by KVB on the basis of their training despite KVB having approved the training curriculum. viii. Some CBAHWs are incapable of handling basic animal healthcare due to inadequate refreshers. ix. The basic operations kit does not meet the standards stipulated in the 26

27 curriculum. Context It is widely recognized that Community Animal Health Services (CAHS) has been on the agenda in policy formulation cycles in Kenya since the 80s. A review of the current policy environment reveals no recent national comprehensive review amalgamating technical, management and policy issues together. There is a consensus among stakeholders on the need to revive debate and enact new policies in animal disease control and surveillance. The National Livestock Policy (May 2008), section 3.4, article recognizes the need to review the different acts that empower the DVS to control animal diseases and pests in Kenya. It also recognizes that the existing legal and regulatory framework is inadequate to address challenges associated with CAHS. Further the policy recognizes that the Veterinary Surgeons Act does not accommodate the operations of paraveterinarians. A recent ECHO-RDD funded review of community-based animal health work in Kenya commissioned by FAO- Kenya Office and undertaken by Kesarine & Associates (Policy Review) and Vedaman Consultants (Technical Review) shows that In order to streamline the training and technical aspects of CBAHWs the following are suggestions that can inform policy direction i. Sensitize the DVOs on operational CAHS training guidelines. ii. DVOs should have a say in the vetting of trainees. iii. Sensitize all stakeholders and avail the curriculum to them. iv. There is need for a standardized Training of Trainers (TOT). v. DVOs should ensure the set criteria are followed. vi. Certification and accreditation should be standardized. This would be achieved by providing a standardized kit for all. vii. There is need for proper regulatory, enforcement and monitoring system for CAHS. viii. The issues of terminology and definitions should be resolved. ix. There is need to initiate and strengthen the service providers forum to enhance dialogue and better the service delivery across all stakeholders. x. There is need to revise the curriculum and initiate refresher courses for paraprofessionals and the professionals. A study conducted by the Institute of Policy Analysis and Research (IPAR) and International Food Policy Research Institute (IFPRI) showed that the number of refresher courses and the keeping of practice records positively and significantly influenced the likelihood of CBAHWs remaining in active practice. These are the same variables that were found to influence the level of activity. The study further indicated that after attending refresher training three times, a CBAHW is 17.2 times more likely to remain in active practice than one who has attended only once (See table 1). Furthermore, a CBAHW keeping records is 110 times more likely to remain in active practice than the one who keeps none. Table 1. The odds ratio of a CBAHW remaining active by attending repeated refresher courses. Refresher Courses One Two Three Source: Mugunieri et. al (2002). Odds Ratio 2.0 CAHS OPERATION, MANAGEMENT AND SUSTAINABILITY The CAHS has evolved through the support of NGOs working in ASAL areas in a bid to fill the gap left by the DVS. There are 40 CAHSs operating under different models in various parts of the country 3. Different CAHS models have proven to be a success where CBAHWS are linked to Animal Health Assistants (AHAs) or veterinarians. For example the Pastoral Veterinary System (PAVES; Figure 1) was established in 2001 as a Private Pastoral Veterinary Practice (PPVP) that uses a chain of Animal Health Technicians (AHTs) and CBAHWs to provide quality veterinary drugs, products and services to livestock owners of Pokot Districts and beyond. The private veterinarian based at Makutano near 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 AU-IBAR gave him an interest free loan to boost the business. This model has proved to be successful and sustainable as it has stood the test of time. 27

28 community based animal health workers are an asset to the livestock industry in Kenya. Although legal impediments stand in the way of their recognition as animal health care givers, particularly in the Arid and Semi Arid Lands (ASALs) where the government does not have capacity to provide an effective service, it is imperative that policy and legislative frameworks are put in place to support decentralized and privatized animal health services that incorporate the important work that CBAHWs undertake on a regular basis. There are over 40 CAHSs operating under different models in various parts of the country Figure 1: PAVES MODEL Source: Ngeiywa and Masake (2009). Whilst different models have also been documented by Isiaho et.al 2004 there are still operational issues that require clarification with regard to the operation, management and sustainbility of the system as bulleted below: i. There is need for delineation of operational areas in terms of spatial extents to mitigate conflicts of overlaps. ii. There should be collaboration between NGOs involved in CAHC and DVS through MOUs. iii. Planning for logistics (transport and subsistence) by supporting organizations iv. Animal Health Technician District Veterinary Office Private Veterinarian: Drug supplier (Dr. Ririmpoi) Animal Health Technician CAHWS CAHWS CAHWS CAHWS CAHWS CAHWS is necessary for improved supervision. The use of supervision guidelines/checklists in the standard curriculum should be enforced by the DVOs. v. Standardised disease reporting formats should also be enforced by the DVOs. Sustainability of the CAHS is necessary if effective animal health service delivery is to continue having impact in the ASAL areas. The FACT is that CBAHWs are no longer a stop gap measure and hence the need to create a law to regulate them. Sustainability can be enhanced by: i. Forming linkages between private vets, AHAs and CAHWs as shown in figure 1. ii. CBAHWs should also be contracted during major activities like branding and vaccination. iii. The CBAHWs should not be upgraded to Community Based Junior Animal Health Assistants (JAHAs) because of associated costs but instead should be employed by the government after further training- it would be cheaper to employ them and sustainable. iv. The Government phased out JAHAs on paper but they still exist in reality so 28

29 the government needs to revisit their case. So What Next? The suggestions given above need to be anchored within a sound policy and legislative framework. It has already been acknowledged that the current frameworks are inadequate in addressing animal health issues in the ASAL areas and CAHS have been established and are operating outside the law. Needless to say this situation needs to be rectified and stakeholders suggestions are as follows: 10 points for a new policy on animal health service delivery: Table 2: Distances to animal health service Type of Service Mean distance (km) Veterinarian AHA Vet drug shop CBAHW 2.00 Source: Mugunieri et.al (2002) 1. Clearly define specific legislation in animal health delivery systems that focuses on marginalized parts of the country with special attention to ASALs as the livelihoods in these areas is different from the high potential areas. 2. Recognize that it is the government s responsibility to deliver animal health services in ASALs. Thus there needs to be an increase in the fund allocation for the DVS so that more professionals can be posted to these areas. 3. Adapt and respond to the changing needs of the livestock sector. 4. Enjoin animal health delivery with the end products as an incentive for marginalised communities. This can be done through linking the CAHS to value chains which meet OIE standards. In this way communities that purchase animal health services from approved CAHS are guaranteed both local and markets for their livestock and livestock products Bridge the existing gaps in current legislation, define the roles of paraprofessionals (including CBAHWs) and recognize them to help deter drug peddlers and quacks. The inclusion and recognition of CBAHWs by the law would be of great benefit because most cases in the marginalized areas are handled by CBAHWs and not the veterinary professionals (see table 2 left and 3 below). Main ailment % (n = 171) of livestock keepers using CBAHWs a Professionals b Drug shops Trypanosomiasis c Tick-borne diseases Gastro-Intestinal parasites Coughing Stock diarrhea Wounds Source: Mugunieri et.al (2002) a. Professionals in this case refers to formally trained animal health personnel, including veterinarians and para-veterinarians in private and public practice. b. Use of veterinary drug shops entailed purchase of drugs from these outlets to facilitate own treatment. c. Livestock keepers knowledge about trypanosomiasis and tick-borne diseases in the area could stem from the activities of NGOs (like ITDG, GAA) and government institutions (like KETRI, KARI) that have been 29

30 actively involved in creating community awareness on disease and vector identification and control (KETRI 2000). The suggestions in this brief were expressed in a FAO Technical Workshop that was held at Gracia Gardens in July It was attended by District Veterinary Officers, Kenya Veterinary Association, NGOs and individuals who pioneered the CAHS in the ASALs. 6. Clearly give direction on work ethics and address the fears of professionals. This could be achieved through a subsidiary legislation and not necessarily an Act of Parliament. 7. Borrow from the concept of Community Health Worker systems in medical services. 8. Revisit privatisation of animal health services in order to improve service delivery. 9. Articulate how CAHS and incorporation of CBAHWs can provide a platform for community partnership in service delivery. 10. Provide for mandatory upgrading of CBAHWs to enhance their professionalism as they provide much needed services to livestock keepers as are the most preferred as shown in the table below: Animal health delivery channel % of respondents mentioning the channel as the most preferred CBAHWs 40 Public veterinary services 34 Drug shops 21 Private veterinary services 1 Ethnoveterinary 1 References and further reading 1. Isiaho R., Ndungu L and Kajume J. (2004). Viable Practice Units and Promotion of Sustainable Privatised Animal Health Services. A study conducted for the Kenya Veterinary Association Privatization Scheme (KVAPS). FIT Resources Limited. 2. Karani I., Wekesa M., Mogoa E. and Tsuma V. (2009). Review of Current Status of Decentralized Community Based Animal Health Services in Kenya. The case for Policy and Legislative Reform in Order to Improve Animal Healthcare Delivery Systems in Kenya by Kesarine and Associates. FAO Report. 3. Kesarine and Associates (2009). Summary Report of the Technical Workshop on Review of Current Status of Decentralized Community Based Health Services in Kenya. 4. KETRI (Kenya Trypanosomiasis Research Institute) Kenya Trypanosomiasis Research Institute 9th Annual Internal Scientific Review, 19th 23rd June, 2000, Muguga. KETRI, Nairobi, Kenya. 5. Mugunieri, L.G., Omiti, J.M, and Irungu P. (2002): Animal Health Service Delivery Systems in Kenya's Marginal Areas. Under Market Liberalization: A Case for Community Based Animal Health Workers Vision Network for East Africa, Report 3 6. National Livestock Policy (2008). Sessional Paper No.2. Ministry of Livestock Development. Government Printer. 7. Ngeiywa K. & Masake R. (2009). The Status of Community Animal Health in Kenya. FAO report by Vedaman Consultants. This policy brief is part of a Series developed by: Kesarine and Associates for FAO under the Regional Drought Decision Programme, P. O. Box 997, 00517, Nairobi. Tel: / admin@kesarine.com 1 Mugunieri et.al (2002). Animal Health Service Delivery Systems in Kenya's Marginal Areas Under Market Liberalization: A Case for Community Based Animal Health Workers 2 Stakeholders included: DVOs, NGOs and other interested individuals in a workshop held by FAO in July Source: Mugunieri et. al (2002). 4 Karani I, Wekesa M, Mogoa E. and Tsuma V. (2009). Review of Current Status of Decentralized Community Based Animal Health Services in Kenya. The case for Policy and Legislative Reform in Order to Improve Animal Healthcare Delivery Systems in Kenya by Kesarine and Associates. FAO Report. 30

31 Annex 6: Policy Brief 3 Are Community Based Animal Health Workers a Risk or Asset to the Livestock Industry in Kenya? Policy Brief 3 Context The Agricultural sector in Kenya accounts for 30% of the gross domestic product, with livestock contributing 10%. Livestock production in the ASALs, which supports 52% of Kenya s animal population and about 20% of the human population, accounts for 70% of employment and household incomes in these areas. These areas also support over 80% of Kenya s wildlife population in either free range or gazetted areas (GoK Annual Economic Report, 2009). A recent ECHO-RDD funded review of community-based animal health work in Kenya commissioned by FAO-Kenya Office and undertaken by Kesarine & Associates (Policy Review) and Vederman Consultants (Technical Review) shows that Animal Health Technicians and Community Animal Health Workers are an asset to the livestock industry in Kenya. Although legal impediments stand in the way of their recognition as animal healthcare service providers, particularly in the ASALs where veterinarians, both public and private, do not have adequate capacity to provide an effective service, it is imperative that policy and legislative frameworks are put in place to support decentralized and privatized animal health services that incorporate the important work that these paraprofessionals undertake on a regular basis. Key issues tackled in this policy brief 1. Rationale for CAHWs 2. Can CBAHWs be trusted with drugs? 3. Do CBAHWs provide credible services? 4. Are farmers and pastoralists willing to pay? 5. The economics of CBAHWs 6. Options for future legislation with particular reference to AHTs & CBAHWs 31

32 Rationale for CAHWs: There is overwhelming evidence in Kenya and particularly in the ASALs that there is an important role for animal health technicians (AHTs) and Community Animal Health Workers (CAHWs) in providing animal health care. The rationale for recognizing these paraprofessionals, particularly CAHWs includes the following: Of all the animal health service providers at the community level, particularly in the ASALs, research shows that their services are most preferred because they are with the community all the time and their treatment of sick animals is effective; From research, communities that do not have access to a CAHW have lost up to 25% per annum of their herd or flock due to disease. Where CAHWs have treated animals, there have been patient recovery rates of up to 70%. They extend the reach of primary health care and provide a link between the AHT, the Veterinarian and the communities; They are often seen as a relatively low cost means of extending the reach of animal health services into the most remote of the communities and are able to produce measurable improvements in the health status of livestock in those communities; They often take on a much broader role than that of simply treating animals, adopting a holistic approach to health problems by integrating curative, preventive and promotive activities; They are in a position to foster the greater community participation that is essential in tackling animal health issues. CAHWs under instruction from Dr. Lanyasunya in Turkana Those against paraprofessional being allowed to practice Vs those who are for it Reasons for resistance We cannot trust CAHWs with drugs: Many of the drugs that CAHWs use are not without their dangers. As CAHWs have only rudimentary training, it would seem optimistic in the extreme to expect them to be able to administer these drugs safely. Reasons for allowing paraprofessionals Reality on the ground is different: Evidence from the field indicates that their services are the most preferred and that although drug misuse is common, well trained CAHWs make accurate diagnoses and their treatment is largely effective with patient recovery rates of up to 70%. But this a valid concern and the key lies in training and supervision by a professional The inclusion of CAHWs will undermine the credibility of the country s animal health care system: By providing a cheaper service than a private veterinarian would, CAHWs out-compete veterinarians, 32 OIE recognition: The OIE recognized CAHWs as a category of veterinary paraprofessionals five years ago. The OIE sees CAHWs as a means to strengthen veterinary services, if they are properly

33 pushing them out of business. With the loss of vets would go the higher-level professional skills they can bring to public goods, International trade and international credibility both demand demonstrably high standards within a country s animal healthcare systems. We want to ensure quality through regulation and support of professionals: The client of a veterinarian must effectively accept his services on trust, having faith in his integrity to provide the correct treatment. Therefore there is need to maintain the reputation of the profession and limit membership to those with a certain standard of training and expertise.. A system that incorporates CAHWs may not be internationally credible: We know that CAHWs have the potential to improve the provision of public goods, such as disease surveillance and reporting. However, to engage fully in international markets, countries are obliged to demonstrate that they apply rigorous standards within key elements of their animal health services, and may find further elements coming under scrutiny in the near future CAHWs have a low level of training with minimal skills: The skill levels of CAHWs are not high enough for quality to be guaranteed. We can therefore not entrust livestock to them for treatment We must protect our livestock industry from quacks by lobbying the government to employ more veterinarians: In order to protect Kenya s livestock industry from quacks, the government and development partners should employ the already trained veterinarians who are currently unemployed. trained, licensed and supervised. Moreover, the issue of out-competing veterinarians does not arise since they CAHWs undertake their work without supervision from a veterinarian. It is like a nurse one day taking over the duties of a medical doctor. An institutional vacuum exists in service delivery in the ASALs: There is a critical institutional vacuum in veterinary service delivery in the ASALs. This situation has been compounded by ill-advised policy and regulatory constraints, which among other things, blocks true private sector participation and also local level initiatives that could help fill the vacuum. The OIE recognized CAHWs as a category of veterinary paraprofessionals five years ago. The OIE sees CAHWs as a means to strengthen veterinary services, if they are properly trained, licensed and supervised. No untrained CAHWs are being proposed. The training approved by the KVB should be implemented and those who go through the training must meet certain minimum skills and work under supervision or oversight of a qualified veterinarian. Declining government animal health services in the ASALs: Government may not be able to employ as many professionals under prevailing economic circumstances. The use of para-professionals in sectors such as health, law, agriculture, livestock and environment is growing worldwide. We should look at how the Ministries of Health are doing it. 33

34 A study on the impact of CAHWs in 3 countries i.e. Kenya, Philippines & Tanzania in 2003 showed that CAHWs provide an effective service. Table 1: Who do farmers prefer to use? The % of respondents in areas with CAHWs who ranked different types of service providers as their No. 1 choice CBAHWs Drugstore Traditional Gov. Vet/ Other Doctor AHA Kenya 82% 11% 2% 4% 0% Philippines 71% 2% 12% 15% 0% Tanzania 88% 0% 5% 5% 0% Source for data in all tables: IDL Group (2003) Community Animal Health Workers Threat or Opportunity Table 2: Average annual mortality rates on farms with and without access to CAHWs Without CAHWs With CAHWs Cattle Sheep/Goats Cattle Sheep/Goats Kenya 19% 22% 11% 7% Tanzania 15% 25% 9% 17% Philippines 3% 12% 0% 6% Table 3: Impact of CAHWs on annual small-stock mortality rates in richer and poorer groups Richer Poorer Without With CAHWs Without With CAHWs CAHWs CAHWs Kenya 24% 5% 19% 11% Philippines 18% 8% 6% 3% Tanzania 17% 12% 33% 15% Livestock keepers clearly value the services of a CAHW. Over 70% of livestock keepers living in villages with CAHWs ranked them as their preferred source of animal health service provider. The reasons put 34

35 forward by livestock keepers in Tanzania for their preferences of CAHWs were a combination of their close proximity and their ability to treat animals. Although most farmers considered that better-trained animal health assistants and veterinarians provided more professional service, they were often considered to be too far away to be of use (a similar finding was observed in Kenya). The OIE recognized CAHWs as a category of veterinary paraprofessional in around They see CAHWs as a means to strengthen veterinary services, if they are properly trained, licensed and supervised. Losses to diseases can be high, particularly in the ASALs where access to animal health services is still extremely low. Available data suggests that pastoralists without ready access to veterinary services can expect to lose up to 25% of their herds and flocks each year through disease. High animal mortalities and impaired productivity contribute towards pastoralists poverty and increase their vulnerability. It is therefore not surprising that many pastoralists consider better access to veterinary services as a priority area for action if they are able to improve their livelihoods (The IDL group, 2003). Thus while stakeholders are arguing about professionals and paraprofessionals in animal healthcare in this country, pastoralists are losing 25% of their livestock to disease annually because the current system does not provide an effective animal health service in the ASALs. This amounts to a conspiracy against pastoralists. Which way forward in terms of policy and legislative reform? 1. It is clear that state resources are diminishing and it is unlikely that the Government can afford to employ more veterinarians. In fact those veterinarians already in government should have their roles redefined. Their core mandate should be training, supervision and regulation of other service providers. In addition, the departmental policy should allow veterinarians in government to establish quasi-private practices such that they can practice on a part time basis. This would mean changing the KVB s code of ethics to allow for part time practices. Such practices could be called Veterinary Centres to differentiate them from Agro-Vets that are currently operated by non professionals; 2. A review of the law should be made in order to allow AHTs to operate in a private capacity. This cadre of paraprofessionals provides a cheaper, locally available basic animal healthcare service that can lead to major improvements in service delivery, particularly in the ASALs. They would need their own code of practice to be enforced by the KVB or any other Authority 3. The entrance of AHTs and government veterinarians into quasi-private practices in the ASALs will still be hampered by various constraints prevalent in the ASALs e.g. poor road network and communications, insecurity, mobility of pastoralists, etc. In order to overcome these hurdles CAHWs should be carefully selected by the communities so that they are trained using an approved syllabus and by approved trainers so that they can provide the vital link with mobile herders. They would be supervised by veterinarians and AHTs to whom they will be accountable; 4. With regard to the Animal Diseases Act 1972, Revised 1989, cap 364, provision for the control of animal disease is made and bestowed upon the Director of Veterinary Services to regulate important and internal movement of animals. Section 2 of the Act defines Inspectors and notifiable diseases. Section 5 makes it an offense for a service provider or owner of an animal infected with a notifiable disease not to inform a veterinary officer as stipulated in Section 4 (I and II). Section 7 (I) (e) provides that no person shall leave any area where there has been an outbreak of a notifiable disease without having taken such reasonable precautions for preventing the spread of the notifiable disease as may be required by a veterinary officer or inspector. As a recognized service provider, CAHWs would be expected to adhere to such provisions although 35

36 their training would not have equipped them to respond as other more highly trained service providers would. Although it is important for mechanisms to address notifiable diseases are in place, it is suggested that for the purpose of this Act, CAHWs are considered as lay persons. 5. The Pharmacy and Poison s Act 1983, Revised 1989, Cap 244, which established the Pharmacy and Poisons Board, empowers the Board to register duly qualified pharmacists and to regulate the establishment of pharmacies in Kenya. Sections 20 and 23 limit the distribution of veterinary ethical drugs to pharmacists. Sections 26, 27, 28, 29 and 31 limit the quantities of drugs that can be held by medical doctors, dentists and veterinarians. It would be advisable that the supply and distribution of drugs and chemicals used in the livestock industry be in the control of veterinary professionals in order to improve drug supply lines at the field level. Once they become vendors themselves, veterinarians would make these drugs and chemicals more available to the AHTs and CAHWs working under their jurisdiction. 6. Finally, in order to improve the capacities of CAHWs within the system, their training and accreditation of CAHWs trainers who will use authorized syllabus, methods and approaches need to be provided in policy and legislative frameworks. Memoranda of Understanding (MoUs) will be entered between the DVS/KVB and private practitioners and others dealing in any aspect of animal health. These will detail 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. There is also need to strengthen 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 should be explicit and CAHWs can be used as the medium to communicate such messages between livestock keepers and authorized practitioners. 7. Once the relevant agreements have been reached by the appropriate authorities and professional bodies i.e. the DVS, KVB, KVA, KALT and the respective Ministries, drafting of the amendments should proceed speedily for Cabinet Approval and subsequent presentation to Parliament by the Minister for Livestock Development. References 1. Catley A., Leyland T., Admassu, B., Thomson G., Otieno M., and Aklilu Y. (2005) Communities, Commodities and Crazy Ideas: Changing Livestock Policies in Africa An IDS Publication 2. Catley, A, Blakeway, S, and Leyland T. (2002) Community Based Animal Health Care: A Practical Guide 3. DFID (2001) The role of livestock in Rural Livelihoods, Optimal Consultancy Services Ltd., Accra 4. Holden S. (1997) Economic Impact Assessment of Community-based Animal Health Workers in Kathekani, Kenya, Report to the ITDG, Livestock in Development, Crewkerne 5. IDL Group (2003) Community Based Animal Health Workers Threat or Opportunity? 6. Leyland, T., Akabwai D, and Mutungi, P. (1998) Delivery of Private Veterinarian Supervised Community Based Animal Health Services to Arid and Semi Arid Pastoralist Areas Are they a Viable and Sustainable Option? Keynote Paper II in (Daborn, C, Njau, P., Wood S. and Martin, M, eds) 7. McCorkle, M. and Mathias, E (1995) Paraveterinary Health Care Programmes: A Global Overview, paper presented at 8 th International Conference of Institutions of Tropical Veterinary Medicine, Berlin, 36

37 25-29 September Munyua S.J.M. Farrah, K.O and Kahiu, I.G. (2000) Alternative Veterinary Service Delivery Systems in Arid and Semi Arid Areas of Kenya: Suggested Structural, Policy and Legal Amendments, in (Nyariki, D.M. and Farrah, K.O, eds) Proceedings of the pastoral information network programme (PINEP), Redpa-Pinep, Nairobi. 9. Odhiambo, O., Holden, S., & Ackello Ogutu, C. (1998) An Economic Impact Assessment, Oxfam Wajir Pastoral Development Project, Oxfam, Nairobi. 10. Vedaman Consultants Ltd. (July 2009) Technical review of the status of community based animal health services in Kenya. (FAO consultancy funded by ECHO Regional Drought Decision). This policy brief is part of a Series developed by: Kesarine and Associates for FAO under the Regional Drought Decision Programme, P. O. Box 997, 00517, Nairobi. Tel: / admin@kesarine.com 37

38 Annex 7: Closing Speech SPEECH BY HON. MOHAMMED IBRAHIM ELMI MP MINISTER OF STATE FOR DEVELOPMENT OF NORTHERN KENYA AND OTHER ARID LANDS, ON COMMUNITY ANIMAL HEALTH SERVICE DELIVERY TECHNICAL AND POLICY ISSUES, HOLIDAY INN NAIROBI 28 TH July Ladies and gentlemen, Let me first begin by acknowledging FAO (Food and agriculture organization) together with Kesarine and associates for having organized this event that is set to deliberate on policy issues with regards to community based animal health services. It is my sincere hope that the significance of community based animal health service delivery and its contribution to livestock production in the marginalized areas of Kenya will be given due consideration. The Ministry of Northern Kenya and other Arid Lands is tasked with spearheading development in Kenya s arid lands. This Ministry signals the commitment of the Government of Kenya to develop and transform arid and semi arid areas in ways which acknowledge the unique features of their production systems and cultural heritage. The arid pastoral areas of Northern, North West and North eastern Kenya and their peoples have witnessed considerable long term marginalization before and after the country attained independence in During the colonial period, pastoral communities were considered backward, too custom oriented, resistant to change and hence no viable economic activity could be undertaken in these areas. These kinds of attitudes led to the separation of Northern Kenya (The closed districts) and its livestock-based economy from the rest of the country, both physically and psychologically. Different laws and different standards of governance applied in the so called one country. To a very considerable extent these attitudes continued to shape post-independence thinking about pastoral areas and their backwardness. A Sessional Paper of 1965 argued that the countries investment should be directed towards areas with abundant natural resources, whose people were receptive to and active in development. These so-called high potential areas, which cover only 20% of Kenya, framed the approach to development since then, obscuring the potential of the other 80% of the country and relegating it to the periphery of the national vision. 38