Livestock and livestock products play a key role in raising incomes of households and providing a source of protein to many families. Majority of Elbarde communities live in the agro-pastoral and pastoral areas and their livelihoods depend primarily on livestock rearing, in recent years the arid and drought-prone nature of much of Elbarde has deteriorated the food security situation and group survival often difficult and precarious. Camel are highly valued, not only as a means of providing sustenance but also as bride wealth, social status, and a ceremonial centerpiece.
An evaluation exercise was carried out to assess the performance of Community Animal Health Workers (CAHWs) in the delivery of animal health care services in Elbarde district, identify capacity gaps and recommend remedial measures. This activity has been implemented by ACF and supported by SomReP through funding from DFAT since March 2015 up to the time of the assessment in March 2018. The system involved the supply of veterinary medicines to 20 CAHWs from 15 target villages. ACF established the initial training for the CAHWs and provided them with training certificates and start-up kits.
The support from DFAT / SomReP project included:
- Refresher training to CAHWs in animal health care.
- Training pharmacy owners and their assistants in small business planning and management.
- Assistance with renovation of pharmacies.
- Facilitation of linkages between the Veterinary suppliers, local pharmacies in Elbarde district and to the lining ministry of the federal Somali government.
- Support to a disease surveillance system linked to local government ministry.
The assessment focused on the financial performance and sustainability of the CAH system, and the quality of CAHW treatments. It was recognized that both financial performance and clinical competence/quality relate to overall sustainability.
The villages visited during this assessment were (Ato,Buq,Dhabaribi,Eldhere,Eleheley,Bulashidle,Wargarweyne,Emilow,Halul,Harcad,Hiray,Qabsey,Salkudoble,Halane1,Lawarerg,Sayid1,Salkudoble,Sayid2,Halane2,Biyo-fadh)i. The assessment was conducted over a period of three days, and aimed to provide information on CAHW performance approximately one year after their initial training in September 2014. The assessment was based on questionnaires administered by direct interview to CAHWs. From the 20 CAHWs trained, 20 out of 20 CAHWs were met and interviewed at the time of the assessment.
Findings of the assessment
Overall functions of project CAHWs were identified and assessed in this evaluation. The functions were; Treatment, Disease surveillance, control of external parasites, Animal production, vaccination, reporting, animal identification, and performing minor surgeries such as dehorning and castration.
The main livestock health problems reported in the 15 evaluation sites included; Trypanosomiasis (camels), Helminthiasis, Mange, Tick-borne diseases (Babesiosis), Pneumonia, Lymphadenitis (camels), Foot rot, infected wounds, CCPP, Pox and mastitis. 20 CAHWs handled a wide range of livestock health problems across the 15 evaluation sites, but with variations in the problems covered. An assessment of livelihoods impacts on a disease-by-disease basis was not feasible given the complexity of the impacts from different diseases, and uncertainties over the level of impact that can be expected from some treatments. Overall disease impacts included:
- Livestock mortality—either acute deaths due to diseases such as anthrax or blackleg, or deaths after chronic disease such as trypanosomosis;
- Production losses—milk losses are particularly important in pastoralist herds with immediate food security implications, especially for children and if disease occurs at times of year when children are particularly dependent on milk. Poor growth and body condition reduces the sale value of livestock;
- Herd growth—is affected by mortality, and diseases that reduce fertility or milk supply to offspring; herd growth is the key strategy for building financial assets in pastoralist herds;
- Social transfers—gifts and loans of livestock, and sharing of products such as milk, are critical in pastoralist communities; traditional social support systems depend on livestock transfers to poorer households, and marriage involves bride wealth payments in livestock.
All CAHWs were often involved in livestock treatment and vaccination campaigns of livestock supported by ACF and received payments for this work also other livestock interventions that were carried out by MoLAH in their respective villages and surrounding area. Although this was an important aspect of CAHW income and incentives to practice, from a wider perspective of disease control and economics, government services still lack the resources and strategies to conduct effective, preventive vaccination for many diseases.
All CAHWs interviewed confirmed that they value the knowledge they have gained and use this to pass key messages of animal health care promotion awareness and treat their own livestock and provide advice to neighbors. Indeed, one key benefit of being a CAHW was the respect gained from the community.
The evaluation found that training of CAHWs in public health issues was variable, and depended on the issue in question. For example, most CAHW trainings covered milk and meat withdrawal periods for veterinary drugs, and this has public health implications, as does correct disease diagnosis and drug administration. Although CAHWs are trained on topics such as withdrawals periods and can advise livestock keepers accordingly, it falls to the livestock keeper to adhere to this advice or not. Various zoonosis were reported in the evaluation sites, such as mange, and lice or flea problems were also handled in some locations. For anthrax, CAHWs could be involved in vaccination programs, or advise on the safe disposal of carcasses.
All trained CAHWs are active except Biyo addo village who shifted with his camels to Hawd area soon after the first training as he finished the training.
Sources of Income of CAHWs
Although ACF had been running the SomRep resilience project funded by DFAT since the year of 2014 up to the time of this assessment, the more commercially‐minded approach taken by the project was showing good results. For example, 20 CAHWs secured veterinary drugs with loan from two private veterinary shops and generated good income and the two private veterinary shops had injected a substantial amount of stock into their businesses by using their own capital. On average, these independent investments amounted to between (US$3230) and (US$6107). Some CAHWs had collected a stock of value (US$70) to (US$140) from the two private veterinary shops on a loan basis. The SomRep project contributed to the renovation costs of the pharmacies. In terms of CAHW monthly income derived from veterinary activities, a limited analysis of CAHW records showed an average profit of (US$35) per month. Although a more comprehensive review is important, which takes account of seasonal variations in income and drought.
Supply of veterinary drugs
ACF provided start up veterinary drug kit to the CAHWs at the end of initial training and immediately each CAHW began to treat animals at a fee jointly set by both private vet-shop owners and the CAHWs. This system allowed the CAHWs to make a profit of 10% above the cost of drug as motivating factor
Quality of CAHW treatments
Selling quality drugs is one of the main activities of CAHWs perform that is readily subject to the agency relationship. Given that CAHWs’ income heavily relies on selling drugs, they may be inclined to increase their income by selling more quality drugs, thus undermining their own integrity. Furthermore livestock keepers tend to choose drugs on the basis of cost and do not generally value intangible services. However during the assessment it was found out that communities recognize that drugs sold by the CAHWs are of better quality than those available at the market.
The CAHW service quality which included (knowledge, competence and ethical behavior assessment) was assessed according to their knowledge of clinical signs of disease, identification and reporting of notifiable diseases, aspects of veterinary public health namely zoonotic diseases, drug dosage, storage, and disposal of drug containers.
The main constraints listed by the CAHWs interviewed was:
- Lack of an adequate drug and equipment supply Reduced income driving CAHWs to look for alternative sources of income.
- CAHWs losing respect when the community comes to them for help but they have no drugs
- Vast areas to cover and lack of transport, restricting access Most CAHWs move by foot and range 20–40 km.
- Many communities still expect CAHW services to be subsidized or free.
For them to improve the services they are providing to their communities the CAHWs suggested the following;
Regular vaccination campaigns
Transportation Resource like Motorcycles To simplify the long transportation
Regular supply of veterinary drugs at competitive prices.
Refresher training courses to be organized.
To sustain the chain of CAHWs, ministry of veterinary and NGOs