Annexe 7 SESSION 4: TECHNICAL STRATEGIES FOR GREP

THE WORLD WITHOUT RINDERPEST: THE SOCIO-ECONOMIC JUSTIFICATION

Andrew James¹²

Rinderpest can be a devastating disease of cattle, buffaloes and wildlife species. It has caused pandemics that killed a high proportion of the host populations in many countries. However, due to the availability of an excellent vaccine, and concerted national and international effort, the disease has been confined to a few foci of residual infection in Africa and Asia. Nevertheless, rinderpest remains a serious cause of economic loss arising from:

1. Direct losses due to the disease itself. These are at present relatively small in global terms. However, serious outbreaks do occur from time to time, and these kill a high proportion of the cattle and buffalo population in areas where vaccination programmes have not been effective. All too often, the people most affected are the among the most economically vulnerable groups in remote areas. The losses are not confined to cattle owners and livestock production. Cattle have important roles in farming systems, through draught power and acting as the capital reserve for the farm. Even where cattle production is not the dominant economic activity, typically many poorer people depend on cattle owners for their livelihood. Rinderpest also kills large numbers of wild animals, which cannot be protected by vaccination, but which are of great importance to the economy of some the remote areas where rinderpest is most likely to occur. The disease is a serious threat to restricted populations of endangered wildlife and income from tourism.

2. Cost of control. Rinderpest vaccine is inexpensive, costing from US$ 3.00 to US$ 16.00 per hundred doses. However, the cost of delivering the vaccine from store to animal is generally very much higher. The vaccine must be stored in a deep-freeze and kept refrigerated until it is reconstituted, which requires a “cold chain” network from store to vaccination point. Teams of vaccinators have to be supervised and supported by transport, subsistence allowances and other logistics. Serological monitoring should also be carried out to ensure that vaccinated animals are being immunised. Cattle owners face costs in bringing their animals to vaccination sites, which can have a high opportunity cost in terms of other farming activities, and through production loss caused by the disturbance to the animals. Gathering animals at vaccination sites also creates ideal conditions for the transmission of diseases such as rinderpest itself, CBPP, FMD and others. The overall cost of vaccination varies according to the situation, but the national average cost would rarely be less than US$ 0.50 per animal vaccinated. It is estimated that there are about 500 million bovines in the area subject to rinderpest control. Even if only 20% of these were vaccinated each year, the most conservative estimate of total annual costs would be US$ 50 million per year.

3. Effects on trade. While most of the countries affected by rinderpest would be excluded from world markets by other zoosanitary restrictions, there is important regional and within-country cattle trading, and this is periodically disrupted by rinderpest. Other trading opportunities, e.g. from India to the Middle East, are permanently restricted. This results in loss of economic welfare to both potential sellers and buyers. Moreover, the cost of enforcing movement control and quarantine procedures is significant, even where they are only partly effective.

¹² Director, PAN Livestock Services/VEERU, University of Reading, PO Box 236, Earley Gate, Reading RG6 2AT.

In addition to these actual losses resulting from the continued existence of rinderpest, there remains a risk of major epidemics, which would result in much greater costs. In countries that have not experienced rinderpest for some time, there is constant pressure to reduce expenditures on vaccination. This trend was responsible for the major rinderpest epidemic in Africa in the early 1980s, which killed at least one million cattle. Until rinderpest is eradicated from the world, these costs will continue. It has been shown that the cost of completing eradication for most countries would be less than the costs of continuing vaccination and other control measures. When any individual country eradicates rinderpest from its own territory, it is in a position to replace mass-vaccination strategies with reliance on emergency preparedness, through ensured early-warning and early-reaction, applicable to all epidemic diseases. However, the tendency is to continue vaccination as long as the threat of re-introduction remains, and the potential cost-saving therefore fails to materialise. When such vaccination programmes fail to generate a sufficiently high level of herd immunity, experience has shown that it is nearly impossible to prevent the spread of rinderpest in susceptible cattle populations in most of the affected area. In the face of an outbreak, livestock owners either try to move their animals away from the threat, or sell cattle to reduce their exposure to loss. This results in the rapid distribution of infected animals through the area, and can cause epidemics.

GREP is designed to provide a mechanism by which countries can eradicate rinderpest in a concerted and co-ordinated programme, and thereafter benefit by saving the very considerable recurrent cost of present control programmes.

The importance of adherence to the OIE pathway is much more than symbolic. Countries will only have the confidence to stop vaccination if there is international verification of neighbouring countries' freedom from disease and infection. The OIE pathway, which requires the cessation of vaccination combined with disease surveillance, provides the only practical approach to the disclosure and elimination of hidden foci of infection.

THE WORLD WITHOUT RINDERPEST: OUTREACH TO MARGINALISED COMMUNITIES

Jeffrey C. Mariner ¹³

Introduction

Rinderpest control professionals tend to refer to remote areas as inaccessible or as “no-go areas”. These terms seem to mean in practice that the areas are not accessible to conventional methods of service delivery implemented by government personnel. There are a variety of methods for delivering services to most of these areas. Rather than categorise areas as inaccessible, a negative and absolute term, it is perhaps more useful to talk about remote, marginalised areas or communities. Marginalisation simply means that the areas or communities have been excluded from the mainstream political, sociological and economic systems of their country. They are at the margins of society and have been left out by development. Insecurity often arises hand-in-hand with marginalisation. In a sense, the few truly inaccessible areas with severe security concerns are just extreme cases of marginalisation. Marginalisation is a relative term which immediately calls attention to the fact that there are special social, economic, cultural or political concerns which make the area unique. This recognition facilitates the design of development programmes adapted to local conditions.

This paper will provide examples of some solutions for animal health service delivery to marginalised communities. The paper makes the fundamental assumption that rinderpest eradication is a complex socio-economic development activity rather than a simple technical intervention. There are no quick technical or funding fixes that will lead to rinderpest eradication from remote, marginalised communities. It is not a question of more transport, fuel or per diem for the same old systems. On the other hand, if the basic methods and approaches are rethought, medium-term efforts to establish appropriate service delivery will lead to the sustainable eradication of rinderpest. This requires courage on the part of decision makers as well as a willingness to test new ideas and accept change.

As the author's experience is mainly in Central and East Africa, this region will be used to illustrate the ideas introduced in the paper. In recent years, it has become apparent that the endemic reservoirs of rinderpest (RP) in East Africa are remote, marginalised pastoral communities. This situation has come about as a result of the reality that these communities lack access to veterinary services adapted to the specialised conditions of pastoral life. This lack of access to services is simply another symptom of marginalisation and is not necessarily a fact of life for pastoral societies. It is perhaps noteworthy that no rinderpest has been reported from West Africa since 1988 where pastoralism is more a part of the main stream socio-economic system. The success of the present rinderpest eradication effort in East Africa depends upon frank recognition of all remote endemic foci and the implementation of more appropriate disease surveillance and vaccine delivery programmes in these specialised environments.

The first step in designing a programme for a marginalised area is to identify what are the specialised constraints and why the more conventional methods for service delivery have failed. Why are the communities marginalised? Sometimes this requires national and international planners to overcome a few stereotypical ideas and take a fresh look.

¹³ RDP Livestock Services, PO Box 523, 3700 AM Zeist, The Netherlands; currently EC Technical Adviser, PARC Ethiopia.

Methodologies and strategies now exist for reaching remote pastoral communities with preventive and curative animal health services in a highly effective manner. In many ways, these development approaches were pioneered in West Africa and Asia, however, important contributions have come from East Africa as well. Some methods that are relevant to rinderpest eradication include:

• community dialogue and contracts in conventional vaccination programmes

• participatory service delivery (Community Animal Health Workers)

• sanitary mandates and cost-recovery

• community-based veterinary practice

• participatory epidemiology

Each of these topics will be discussed separately, however it is important to point out that the best solution is usually a combination of several approaches implemented simultaneously. It is also important to understand that more comprehensive solutions that offer service delivery for a number of priority animal health problems will probably be more successful than a simplistic intervention against rinderpest alone. Often in rinderpest endemic areas, the socio-economic impact of rinderpest ranks well behind other diseases such as contagious bovine pleuropneumonia, trypanosomiasis and even anaplasmosis. To be well accepted, the service delivery programme must meet the community's priority needs in addition to the needs of the rinderpest eradication campaign.

Community Dialogue and Community Contracts

There are two main reasons for vaccination campaign failure in pastoral areas. The first is that the organisation of the campaign does not take into account the basic constraints facing the local population. The result is that vaccination is offered at inappropriate times, in inappropriate places or in another manner that does not allow the cattle owners to participate. The second cause of poor vaccination campaign results is a failure to install confidence in the beneficiaries as to the value of the campaign (i.e. that the campaign responds to the cattle owner's needs).

Both of these shortcomings can be overcome through a process of consultation that has been termed community dialogue. In the case of conventional vaccination campaigns, this means that campaign planners and implementors should conduct a series of meetings with the beneficiaries in the context of their local decision-making bodies. It is important that these meetings are conducted with the actual cattle owners and their traditional representatives. Government appointed chiefs do not always have the full support of the cattle owners and should sometimes be de-emphasised in this process. The meetings should be conducted in the local community's language with translation for any visitors. In these meetings, the groups sit down, frankly express their concerns and try to reach a common understanding about what is needed.

Once a common understanding is reached, an agreement that is termed a ‘community contract’ can be made. This is an active agreement where each side clearly states in their own words what is to be done by them. Often, the agreement includes components other than rinderpest vaccination. It is important that both sides are realistic and only agree to steps that they can actually fulfil. One of the most common mistakes made by inexperienced community development professionals is the creation of ‘false expectations’. Marginalised communities have experienced many disappointments and a visit by outsiders raises hopes. A simple suggestion or off-the-cuff statement can easily become a promise in the community's eyes. The community will long remember broke promises, intended or not, and the veterinary team may not get a second chance.

Participatory Service Delivery (Community Animal Health Workers)

The marginalised areas of East Africa are characterised by mobile, extensive production systems and sometimes lack roads or have security concerns that limit access to outsiders. This makes service delivery by conventional methods, even after community dialogue, difficult. In order to reach a sufficiently high percentage of the population for disease eradication, conventional methods should be augmented with participatory service delivery.

The term participatory service delivery refers to trained local community representatives implementing services in the field under the guidance of, or in collaboration with, professional service delivery institutions. Over the years, many different variations of this approach have been tried. There is no one ideal approach that can be recommended as each community is characterised by unique traditional institutions, customs and experiences. One general model that has worked well for animal health care in a broad spectrum of cultures is the Community Animal Health Worker (CAHW). Although there are no absolute rules in how to go about setting-up a community animal health worker network, there are several general principals that should be followed to ensure success and sustainability.

The first principal is to get help from experienced community developers and trainers at the outset. Although many of the activities and concepts may seem simple, self-evident or even trite, community development is a deceptively complex undertaking. Community development is largely dependent on specialised interpersonal skills, and these skills are learned by experience.

Community Animal Health Workers are elder-supervised, community employees. They are selected by their communities and trained by the veterinary authorities through a process of participatory dialogue. The veterinary establishment does not pay them, they are supported through their own activities. The veterinary establishment exercises its authority through its right to set standards for training and to revoke a CAHW's status. The key factors in insuring that CAHWs work properly are that:

• they are cattle owners themselves;

• they are not paid a salary;

• they are supervised by the community elders (e.g. parents, uncles, cousins);

• they are treating their own clans cattle;

• they are under the technical supervision of a veterinary professional.

In this family situation purposive misbehaviour (over-charging, under-dosing, use of false drugs) is extremely rare.

The Thermostable Rinderpest Vaccine Transfer of Technology Project (TRVTT Project) implemented a number of pilot field programmes to deliver heat stable rinderpest vaccination through CAHWs to remote, pastoral communities. The communities included the Fulani of Cameroon, the Karamojong of Uganda, the Afar of Ethiopia and the Arab and Fulani pastoralists of Salamat, Chad. The Project also provided support for the establishment of the UNICEF de-centralised animal health care programme in Southern Sudan.

In each of the communities, the TRVTT Project began by conducting participatory rural appraisals to gather existing veterinary knowledge and to establish an information base for the design of a locally-adapted community animal health programme. The design was agreed upon in discussion with the participating communities and implementing partners. No two programmes were exactly alike. The implementing partners varied by location and included government veterinary and extension services, non-governmental organisations and in the case of Chad, a private veterinarian. Initially, governments proved to be extremely difficult to convince as to the appropriateness and effectiveness of community-based rinderpest vaccination, however their opinions rapidly changed once they saw the programmes in action.

During the TRVTT Project's five years of operation, the Project found that the more time that was invested in dialogue with the communities and implementing partners, the better the programme performed. The key to smooth operation was a clear and active community contract that defined each party's contribution at the outset. Often, it was very difficult to convince implementing partners of the importance of firmly stating the conditions for participation in an open manner. They feared that the communities would refuse. Actually, experience proved that the tougher the negotiations were made, the more quickly the communities responded in a responsible manner. The communities always tested the resolve of the facilitators. It was essential to listen patiently and respectfully, but to be fair, firm and clear in the conditions for participation. The conditions for participating in the programme evolved over the years and at the end of the Project they were:

• no credit for drugs in any form;

• market prices for curative treatment and non-compulsory vaccination;

• partial cost recovery for rinderpest vaccination;

• an initial contribution towards the cost of training and equipping the CAHW.

The community was required to state all the conditions in their own words before they were asked to select a candidate. The community contribution towards training and equipping the CAHW ranged between US$ 20 and 50. Alternatively, the equipment kit did not include drugs, these had to be purchased, and the CAHW trainee was advised to bring cash for this purpose. If the trainee came to the training without the initial contribution, or was unable to purchase drugs, he was trained but was not given his kit until he had raised the money. In most cases, the few CAHWs that did not have their contribution on the registration day of the training course were able to raise sufficient funds by graduation day.

The trainings lasted seven to 10 days. The course emphasised a few basic concepts and practical skills. The last three days of the course focused on rinderpest vaccination and culminated in a full scale vaccination session organised and implemented by the trainees. After the training, it was important to continue to meet with the CAHWs and their communities to reinforce the community contract. Often these meetings included ad hoc negotiations for cost-recovery on rinderpest vaccination in countries that did not have national cost-recovery policies. Even the most notorious communities in Karamoja agreed to pay reasonable vaccination labour charges to their CAHWs after a single face to face meeting.

Community-based rinderpest vaccination proved to be a success. In the three countries where the government was an active implementation partner (Uganda, Ethiopia and Chad), there were immediate calls to expand the programmes within the remote pastoral areas after only the first season of operation. In the case of Cameroon and Ethiopia, the national sero-monitoring programmes were particularly active in following the vaccination efficiency of the programme. The data is presented in Table 1. Please note that the CAHWs were at least as effective as the best national veterinary services.

The real advantage of community-based vaccination programmes is that they cover the key cattle populations for rinderpest virus maintenance at a low cost. For example, the Ethiopian Veterinary Service allocated one vehicle and two staff to follow the CAHW programme in Afar and in the first season of operation, the CAHWs vaccinated 70,000 cattle. In the same period, the veterinary services allocated 14 vehicles with 4 staff each to cover southern portion of Afar and only achieved about 140,000 vaccinations. More importantly, the CAHWs stopped rinderpest virus circulation in their community after only a single campaign despite major outbreaks in the immediately adjacent area to the North. At present, the CAHW programme in Afar is being replicated to these northern areas.

Although all the CAHW vaccination programmes were immediate successes, there remains concerns regarding the sustainability of the monitoring and follow-up of the CAHWs in the two countries where the government services were entrusted with this responsibility (Uganda and Ethiopia). In Uganda, there proved to be difficulty in providing sufficient funds for fuel and per diem for the monitors. The programme in Ethiopia has not experienced this difficulty to date, however it is feared that monitoring constraints will arise as the approach becomes more routine.

Table 1: Vaccination efficiency is the percentage of sero-negative vaccinates which mount a protective immune response as a result of vaccination. For the CAHWs at Sabga, the efficiency was measured by pre-vaccination and post-vaccination serology on ear-tagged cattle. For the national campaigns and the CAHWs in Afar, efficiency was taken as the percentage of ear-marked cattle which actually possessed protective antibody levels. The data for non-Thermovax-based national campaigns is extracted from the seromonitoring report for 1993 of the Pan African Rinderpest Campaign which included detailed data from 22 countries. In the Sabga trial program, a total of 24,000 cattle were vaccinated and a charge of 80 CFA (0.29 USD) was instituted after the first 14,000 vaccinations. This is approximately equivalent to 2 Ethiopian Birr, 300 Ugandan Shillings or 15 Kenya Shillings at rates of exchange in effect at the time of the trial. The Afar group of 22 CAHWs vaccinated 70,000 cattle in their first season or slightly more than the population estimate for their community.

As a solution to the sustainability of monitoring, the TRVTT Project has recommended that monitoring and re-supply of the CAHWs be privatised. In Uganda, this was partially accomplished through allowing the veterinary service personnel to trade drugs with the CAHWs on a commercial basis. This improved follow-up and re-supply, but total privatisation of the CAHW network by bringing in private veterinarians with vaccination contracts would further enhance the long-term sustainability.

The programme in Chad was implemented at the outset in the context of a private veterinary practice with a rinderpest sanitary mandate. Problems with sustainability are not anticipated. This programme is discussed in detail below in the section of community-based veterinary practice.

Sanitary Mandates (Vaccination Contracts)

Assigning rinderpest vaccination contracts for defined regions and cattle populations to private veterinarians has been shown to result in herd immunity levels consistent with rinderpest eradication. In addition to providing good vaccination coverage, vaccination contracts assist with the establishment of private veterinary practice in extensive animal husbandry systems. Contract vaccination is now underway in several Sahelian countries including the remote areas of Chad. Some of these environments bear many similarities to the rinderpest endemic areas of eastern Africa including an element of insecurity. Contract vaccination programmes should be encouraged on a trial basis in eastern Africa and Asia.

Systems of verification such as ear-marking, receipts and serological surveillance must be put in place as part of the contract vaccination programme. The veterinarians are paid partly on the basis of the number of head of cattle they vaccinate - a quantity incentive. The remainder of their remuneration is based on bonus payments for 80% ear-marking and 80% herd immunity levels in vaccinated herds - a quality incentive. A sero-surveillance team inspects all contract vaccination at the end of each season. A contract veterinarian can generally cover his costs on the basic per head payment, but his profits really come from the bonuses for good ear-marking and serological results. Thus, both the quantity and quality of work are rewarded in a verifiable system. Experience has shown that more cattle can be properly vaccinated at less cost using contract vaccination.

An important element of privatised rinderpest control is cost-recovery. Initially, the Pan African Rinderpest Campaign feared that cost-recovery would depress vaccination coverage. However when cost-recovery is used to generate quantity-based incentives for vaccinators (community-based, government or private veterinary teams), vaccination coverage improves considerable. The reason for this is that the vaccinators are motivated to do their utmost to convince the majority of cattle owners to vaccinate their herds. After all, every cow the vaccinators miss is money lost from their pocket. Thus, one finds quantity-based incentives from cost-recovery charges result in proper communication and community dialogue leading to more effective vaccination coverage. It is not unusual to find contract veterinarians who visit reluctant herders 4 or 5 times or simply until they agree to purchase vaccination.

Problems of low vaccination coverage in many, but not all, marginalised areas could be solved by well thought-out contract vaccination programmes. The limiting factor would be the level of security risk relative to the amount of private investment required and the potential profitability. Key elements for success are:

1. Selection of contract holders who can cope with local constraints and who can be accepted by the target communities.

2. Appropriate systems of verification such as:

   • a progressive cost recovery programme

   • receipt systems

   • vaccination cards

   • field monitoring and sero-monitoring

The next section will suggest methods for integrating contract vaccination into communitybased animal health programmes. This approach reduces the amount of veterinary practice investment required in transportation and reduces operating costs. The resulting community-based veterinary practice is less vulnerable in insecure areas since it works through local community representatives who can travel safely where outsiders cannot.

Community-Based or Pastoral Veterinary Practice

The term community-based veterinary practice refers to private veterinary practice integrated within the community through participatory service delivery schemes. In this approach, the veterinarian uses participatory methods to work towards becoming a respected member of the community. He invites members of the community to work with him in designing and implementing the practice.

The integration of CAHW networks within private veterinary practices offers tremendous potential for expanding the market for private veterinary practice in remote areas and increasing practice profitability in other regions as well. This increased profitability will result from increased sales volumes and reduction of operating and investment costs for transportation. The final outcome is a local veterinary practice delivering its services through a CAHW network or to organised community associations which the veterinarian himself has helped to create. The individuals assisting their community and veterinarian are not paid a salary by the practice. They are remunerated by the community at the time they actually provide their service. Thus, one should consider them as employees of the community working under the technical supervision of the veterinarian. From a business perspective, these CAHWs are acting as commission men carrying veterinarian's services to areas where it would not be economical for the veterinarian to establish a formal, permanent presence.

Currently, the concept of a community-based veterinary practice forms the basis of a pilot project in one of the remotest regions of Chad, Salamat, along the border with the Central African Republic and Sudan. The programme has two objectives. The first is to provide adequate vaccination coverage to generate sufficient herd immunity to protect the cattle population against the introduction of rinderpest from Sudan. The second objective is to create a private pastoral veterinary practice that is integrated within the local transhumant Arab and Fulani community. The clients of the practice are highly mobile and only spend 5 to 6 months of the year in the practice area. The veterinarian has received a rinderpest vaccination contract to be implemented through the CAHW network and a stock of heat stable vaccine.

In Salamat, the community-based veterinary practice works through CAHWs trained jointly by the private veterinarian and the extension services. The private veterinarian was prominent in the community dialogue and training process in order to build a strong relationship and sense of loyalty between the veterinarian, the CAHWs and the community. The CAHWs are highly successful in generating good vaccination campaign participation and collect the equivalent of US$ 0.15 per vaccination from the cattle owner. They are allowed to retain approximately US$ 0.02 of this fee. The rest (US$ 0.13) is passed on to the veterinarian. The veterinarian receives the heat stable rinderpest vaccine, vaccination cards, and official receipt books from the government free of charge. In addition to the US$ 0.13 per vaccination that the veterinarian receives from the herd owner, he receives a payment of about US$ 0.08 per head vaccinated from the government. This second payment is made after evaluation of the work using seromonitoring to measure vaccination efficiency and spot inspections to verify proper documentation and marking of vaccinates. In the coming campaign, 1996–97, the herders' contribution will increase to US$ 0.20 and the government's contribution will be reduced accordingly. This programme has met with excellent initial success and should prove to be a sustainable solution. Some profit projections based on actual sales margins, loan and depreciation charges as well as estimates of operating costs are presented in Table 2. Market research indicates that these sales volumes are reasonable targets.

Originally, the programme was to be evaluated from both a technical and financial stand point at the end of its first season of operation in May/June, 1996. Regrettably, the veterinarian was killed in a car accident in April, 1996. Although the Veterinary Services of Chad were initially reluctant to permit the pilot programme, they were very impressed with the preliminary results and are committed to continuing the proogramme.

The single greatest investment cost for veterinarians going private is transport. If one reviews the balance sheets in loan proposals to privatisation programmes one realises that in general, the loss of the vehicle through accident or theft is the single greatest business risk facing a veterinarian who establishes a mobile practice. The community-based approach reduces transport needs with one or two used motorcycles being sufficient. This in turn reduces risk and should make contract vaccination feasible in moderately insecure environments where theft is common.

Participatory Epidemiology

In remote, marginalised areas, it is frequently difficult to carry out classical laboratory-based epidemiology. Serological data from remote pastoral cattle populations is often difficult, if not impossible, to interpret due to the partial vaccination coverage and incomplete marking of vaccinates practised in the past. Sample collection infrastructure for both serology and antigen detection is usually poor. Thus, an over-dependence on laboratory methods often to an underestimation or negation of the prevalence of rinderpest in remote areas.

Table 2: At the current rate of exchange 500 CFA equals US$ 1. Projections include all operating and finance costs for the practice. The vaccinations column covers both rinderpest and non-compulsory vaccinations. Except for Case No. 4 where income from RP vaccination is not included, it is assumed that about 80% of the vaccinations will be rinderpest vaccinations. The medicine sales column represents the sales figures for the entire practice. A 27% margin over cost, as calculated from actual sales figures, is assumed for the projections. PROMEVET, a large drug wholesaler, reported that individual traders sell up to 1,000,000 CFA in medicines per week in Salamat during the height of the season. This practice has the veterinarian two veterinary assistants and a CAHW network as marketing structure. Thus, sales projections are conservative. The last two cases represent break even calculations: Case No. 3 gives the sales volumes necessary to break even with a rinderpest sanitary mandate whereas Case No. 4 indicates the amounts on non-compulsory vaccination and medicine sale necessary to break even without a vaccination mandate.

The techniques of participatory rural appraisal offer key adjuncts to laboratory-based epidemiology. Normally, pastoralists have a very well developed knowledge of clinical diagosis based on symptomatology and patterns of transmission, particularly in regard to major epidemic diseases such as rinderpest. They can very accurately recount the local history regarding rinderpest and often are the first to recognise and report the disease. The problem is that all too frequently nobody listens.

Participatory techniques have been developed specifically for rinderpest epidemiology. The most notable is participatory disease searches where herders and other key informnts are interviewed as to the incidence of major animal disease at present and in the past. The investigation is conducted with an attitude of both respect and scepticism. The technique uses open-ended questions which do not suggest any disease names. If the respondent volunteers information about rinderpest, he is then asked to describe the disease in detail and probed to establish his knowledge and the internal consistency of his report. All reports are cross-checked and major trends in the data noted. This information can be used to elucidate the mechanisms of virus survival in a region, construct a rinderpest time line or history, and is essential to making accurate interpretations of serological data. It is also a powerful tool for the trace back of suspected outbreaks of rinderpest to pockets of active disease for laboratory investigatin.

Laboratory confirmation of outbreaks and genetic analysis of viral isolates are powerful tools in rinderpest epidemiology. Unfortunately in extensive settings, they can only prvide snap-shots of rinderpest activity. Laboratory confirmation of isolated outreaks is comparable to the sighting of icebergs; ninety percent of the danger lurks below the surface. Participatory epidemiology allows rinderpest control authorities to fully delineate the danger and provides and accurate information base for rinderpest eradication. It is also a valuable and cost-effective tool for the verification of vaccination campaign impact and freedom from rinderpest disease.

Sustainability of Participatory Service Delivery and Privatisation

Community-based programmes overcome many of the problems associated with the sustainability of service delivery in remote areas by making the communities responsible for supporting the costs of sservice delivery. The main concern which remains to be addressed is the sustainability of the monitoring and re-supply of community based programmes. It is important to note that the non-governmental organisations (NGOs) have been leaders in the field of community development and participatory approaches. Perhaps this is a result of their smaller size, flexibility and willingness to experiment with new approaches. At any rate, adoption of participatory approaches by government institutions has been a slow process. Support for CAHW programmes is good in some countries, however, this is usually associated with a major project input. True sustainability implies that the activity can stand on its own in the absence of donor or NGO intervention. In the present economic climate in Africa, sustainabillity for community programmes probably implies their ability to function in the absence of government intervention as well.

This was what led to the experiment of privatised and community-based service delivery in Salamat, chad. This is a new initiative and the author believes that the future of both privatised service delivery in remote, extensive areas and the sustainability of the CAHW approach in Africa depends on an appropriate belending of privatisation and participation.

It is essentilally impossible to conceive of profitable private veterinary practices in remote areas without local intermediaries. In traditional veterinary circles, concerns have been voiced that CAHWs pose a competitive risk to the privatisation of the veterinary profession, that they fill market niches which the veterinarian will need to survive. Our experience has suggested just the opposite.

CAHWs:

• create new, high-quality self-employment opportunities for veterinarians;

• organise and mobilise market demand for veterinary services;]

• assist in further monetising the pastoral economies;

• promote the image of the veterinary profession.

Far from being competitors, CAHWs are essential allies for the veterinary profession and are the bridge to successful ‘private pastoral veterinary practice’.

Some individuals have questioned the susttainability of rinderpest sanitary mandates due to the fact that they are a donor funded programme. Just as with all other service provision, cost-recovery is essential for the long-term sustainability of compulsory disease control whether implemented by the government or the private sector - this was the lesson of JP-15. Others have raised the issue that rinderpest vaccination will cease in many areas and that the veterinary practices in remote areas will become non-viable. The experience in salamat indicated that the rinderpest mandate greatly facilitated establishment of the practice, but was not essentially to the long-term sustainability of a communitybased veterinary practice (see Table 2). It is also foreseen that when vaccination against rinderpest is withdrawn, sanitary mandates for other diseases such as contagious bovine pleuropneumonia will be put in place.

Suggestion for Project Preparation

The following points have been stressed in regard to sustainable solution to rinderpest eradication in marginalised areas:

• the need for guidance from experienced community development professionals,

• the over-riding importance of intensive community dialogue,

• the importance of self-sufficiency and sustainability,

• the necessity of full cost-recovery or privatisation where ever possible.

One should note that this combination stresses experienced technical assistance (local, NGO, or commercial) and calls for very little in the way of infrastructure or inputs. Thus, appropriate projects proposals are heavy on personnel and light in the way of equipment, buildings, or material. This runs counter to many donors' preferences at present but does make for better, more sustainable projects. The objective is to develop self-sufficient community institutions to facilitate access to inputs (including rinderpest vaccine) and to make available skilled veterinary labour at real market prices. The limiting factor in most participartory projects is the availability of trained and experienced facilitators to conduct communtiy dialogue, to monitor implementation in the field, and to train and guide counterpart staff who are new to the participatory approach. One of the key factor for the success of veterinary privatisation programmes is also guidance and clos follow-up in the field of loan programme participants by skilled experts who understand private enterprise. Donors need to recognise that the poicy reforms of privatisation and participation necessitate not only reform of national budget, but project budgets as well.

Policy Reform and Legislation

In many countries where CAHW and community-based vaccination programmes opeate, they do so without specific legal provisions and protection. Often they operate at the discretion of the Director of Veterinary Services or the local district authorities. This situation is not conductive to good sustainability and presents an investment risk to private veterinarians who wish to incorporate community-based approaches in their practices.

Governments need to formally recognise th nuique requirements of veterinary service delivery to remote and marginalised communities in their veterinary legislation and regulation. Two reforms are key:

• First, the pivotal role of the CAHW in providing services under the supervision of veterinary professionals against major compulsory any noncompulsory diseases should be recognised, defined and protected at the national level. These provisions should include the application of injectable antibiotics, trypanocidal drugs, and vaccines.

• Secondly, the ability of public veterinary services to contract or mandate the private and community-based sectors to provide compulsory vaccinations and veterinary inspections should be recognised and facilitated.

Progress Towards the World Without Rinderpest - Results in Remote Areas

Since 1988, RP in Africa has been confined to eastern Africa. Since that time, the areas or communities generally recognised to be affected endemically have been southern Sudan, the Iteso-Karamojong peoples of Kenya and Uganda, north-eastern Ethiopia (Afar), and the areas bordering Sudan to the West of Lake Tana and in the south-west of Ethiopia. More recently, outbreak recognition and genetic analysis of isolates indicates that north-eastern Kenya is endemically infected with a separate lineage of rinderpest virus. This is probably not new endemic territory, just newly recognised endemic territory. As the first step in eradication is frank recognition of endemic areas, the news from Kenya represents progress. All of these areas are of course remote, marginalised pastoral communities.

Significant progress has been made in Ethiopia. Rinderpest has not been detected in the areas to the West of Lake Tana or in most of the Afar region of Ethiopia despite extensive participatory disease searches. This is partly the result of a sound eradication strategy based on open rinderpest reporting, epidemiological risk classification and a rational use of resources. Also in southern Sudan, rinderpest is controlled in many areas and we can now talk about specific pockets of viral activity rather than broadly affected areas. This is largely due to the implementation of de-centralised animal health care by UNICEF and the NGOs with rinderpest control based on CAHWs vaccinating with heat stable vaccine. The most prominent pocket in southern Sudan is the Toposa region, a community of the Iteso-Karamojong cluster. The situation in the rest of the Iteso-Karamojong area remains murky as active or participatory disease searches are not practised.

The success in the Afar region is perhaps the most striking example of the impact of participatory techniques in remote, marginalised communities. Here, participatory approaches were integrated into the conventional vaccination campaign and participatory service delivery by CAHWs was established in some sub-communities. The first step was to identify a regional co-ordinator who had the necessary sensitivity and concern for local constraints, as well as the interest to take up the challenge of rinderpest eradication from the area. Next participatory rural appraisals were conducted in conjunction with the regional co-ordinator to identify local needs and constraints. Thereafter, appropriate programmes of communication and community dialogue, as well as training of community members as CAHWs were implemented. All conventional vaccination activities were conducted in close consultation with the participants. The results are that in only three years since the first participatory rural appraisals, rinderpest is close to eradication from this once ‘inaccessible’ region. The first year of this three year period was almost entirely dedicated to study, strategy formulation and preparation. At present, only 5 of 29 weredas are considered as infected and it is anticipated that after the next campaign year these areas will be cleared.

Conclusion

This paper has attempted to suggest appropriate veterinary service delivery solutions for remote, marginalised communities that will lead to sustainable rinderpest eradication. The processes of privatisation and participation are both feasible and essential to service delivery in extensive areas. Privatisation is the sustainable solution to supervision of community animal health programmes while at the same time, private veterinary practice could not hope to be economically viable in extensive environments without trained and loyal local intermediaries. To obtain fully effective programmes, progressive cost-recovery for rinderpest vaccination starting with charges to at least cover field labour costs should be implemented without delay. Far from discouraging good vaccination coverage, costrecovery enhances participation. The programmes implemented to date have shown that these approaches are realistic, practical and effective.

Implementation of these approaches on a wide scale will require intensive dialogue between community development specialists, decision makers and field veterinary professionals to achieve a common understanding and effect the necessary policy reforms at both the national and international level.

THE WORLD WITHOUT RINDERPEST OUTREACH TO THE INACCESSIBLE AREAS

THE CASE FOR A COMMUNITY-BASED APPROACH, WITH REFERENCE TO SOUTHERN SUDAN

Tim Leyland ¹⁴

Abstract

The Pan African Rinderpest Campaign has restricted the rinderpest virus to endemic foci in East and Sub Saharan Africa. These foci are all located in remote, marginalised and risk prone areas. These areas have been termed special action areas for rinderpest control and eradication. The characteristics of these areas tend to preclude the successful implementation of conventional vaccination projects. It is now realised that approaches which use local participation and are community-based are more likely to succeed in these areas. Participatory rural appraisal tools are designed to facilitate such an approach.

The UNICEF / Tufts University livestock project working with Operation Lifeline Sudan in southern Sudan has taken a participatory approach to the elimination of rinderpest and the provision of animal health services. This process has been greatly assisted by the development of thermostable rinderpest vaccine. The paper gives a brief description of the project, records some of the successes achieved and highlights the major lessons learnt from the process.

The paper argues that participatory and community-based approaches should be used more widely in special action areas within Africa and globally in order to ensure eradication of the rinderpest virus.

1. Introduction

Since the introduction of rinderpest into Africa in the 1880s and the resulting pan African epidemic, there have been two programs organised to control and eradicate the disease from the continent. Joint project 15 (JP15) was the first, started in 1962 by the Organisation of African Unity (OAU) and the bilateral donor agencies. At it's close fifteen years later, rinderpest had been confined to the Sudan Ethiopia border and the Niger river delta in Mali. JP15 failed to remove these remaining endemic foci for several complex reasons outlined by Mariner et al 1994. Two of the reasons were as follows :-

• many of the endemic sites were inaccessible, marginalised, insecure areas inhabited by relatively independent transhumant and nomadic pastoral populations

• methods of vaccine delivery using heat-labile vaccine and centralised vaccination teams were inappropriate for such areas.

¹⁴ Tufts University School of Veterinary Medicine, International Programs Section, 200 Westboro Road, North Grafton, MA 01536, USA. Currently seconded to UNICEF OLS, PO Box 44145, Nairobi, Kenya.

JP15 recognised this and chose to wall off these difficult areas with a cordon sanitaire and wait until conditions improved (Atang and Plowright, 1969). Unfortunately these remaining endemic areas acted as a source of an expensive epidemic of rinderpest which spread across West, Central and East Africa in the early 1980's. The on going Pan African Rinderpest Campaign (PARC) started in 1986¹⁵ and is based upon lessons learnt from JP15. PARC is geared toward eradication of rinderpest through not only conventional vaccination services but a policy reform program which includes privatisation of veterinary services and the use of relatively novel initiatives such as community-based vaccinators and contract vaccinator services. PARC has now reached a stage similar to the end stage of JP15. Rinderpest has not been reported in West and Central Africa since 1988 and the remaining endemic foci are thought to be confined to southern Sudan, areas of western Ethiopia bordering Sudan, the Awash valley in NE Ethiopia and the Karamajong area on the Kenyan Ugandan border. These areas have been designated “Special Action Areas” by PARC and rather than try to contain them PARC is actively promoting new approaches to control and finally eradicate rinderpest from these areas. The approaches being taken by PARC use Participatory Rural Appraisal (PRA) and community participation of the affected populations. These new approaches promote decentralised, community-based and privatised vaccination and animal health services.

This paper aims to show that these novel approaches formulated for the special action areas, when viewed in the wider context of the evolution of development strategies over the past 30 years, are a natural choice for use in such areas. They are likely to become more accepted and the methodology stronger with time. The participatory rural appraisal and community-based approach is still being developed in terms of rinderpest control. One of the special action areas where this is most advanced is southern Sudan. This paper uses southern Sudan as a briefcase study to outline some of the methods being used and some of the lessons so far learnt (Leyland, forthcoming).

2. Characteristics of Special Action Areas

In developing an appropriate rinderpest vaccination program for these special action areas, it is worth looking more closely at the particular characteristics of these areas. They tend to have many of the following characteristics:-

• They are areas where the limitations such as climate (rainfall and temperature) or topography restrict the use of land to extensive grazing of natural pastures rather than cultivated pastures or crops;

• They are remote, often inaccessible by road and distant from centralised services; They are inhabited by transhumant agro-pastoral people who generally see their agricultural work as a supplement to their livestock-raising activities and/or are inhabited by nomadic pastoral people;

• The inhabitants decision making processes are complex as they take into account climate, economic considerations (both monetary and non-monetary), social concerns, political factors, legal constraints or incentives and other ecosystem variables (Prior 1994).

• They have recently been or are experiencing civil conflict, resulting in insecurity, displacement of people, loss of assets, greater need to remain mobile and to varying degrees breakdown or stress to traditional social structures.

• They are marginalised in that the inhabitants have had relatively little development contact in terms of education, outside trade and government services including veterinary services.

• The inhabitants may have already experienced top down or poorly planned development projects - which did not consult them.

• The inhabitants have a well established traditional way of life which they are disinclined to change.

¹⁵ PARC is coordinated by the Inter-African Bureau for Animal Resources of the OAU and implemented by the national veterinary services of the 34 member states.

These characteristics have often precluded the successful implementation of conventional vaccination projects. These projects tend to have a ‘top-down’ approach with pre-determined targets for vaccination coverage and sero-surveillance results, a tight time schedule for pre-defined activities and contact with communities is primarily only through local officials. Such a model fails to accommodate the dynamics of special action areas and lacks the inherent flexibility required to work in such areas. A typical example is of centrally organised mobile teams of non-local vaccinators who do not know or fully understand the complexities affecting the local inhabitants because they only visit an area once or twice a year and who are likewise not known well enough by the locals to be trusted and listened to.

This paper argues that to carry out a successful rinderpest eradication program, in a special action area, a strong understanding of the complexities of the area and positive interaction and dialogue with a substantial cross-section of the local communities is required. In addition, given the logistics and expense of mounting a conventional vaccination program, it can be more cost-effectively done by relying on community-based vaccinators and local resources rather than on outside teams. It the case of South Sudan, a participatory approach using “Participatory Rural Appraisal” (PRA) tools and community-based vaccinators is leading to significant widespread vaccinations of cattle and far fewer outbreaks of rinderpest, even though the area is riven by civil strife. The next section details the development and value of the “Participatory Rural Appraisal” approach.

3. The evolution of Participatory Rural Appraisal

In the early 1970s the green revolution in India was considered a success because it had increased yields of wheat and rice over large areas. However it soon became apparent that `green revolutions' in other areas and sectors were not occurring. Many innovations proposed by agricultural research were not being adopted by farmers in the complex, diverse and risk-prone environments of resource-poor people. The reason for non-adoption was that generally the innovations were unsuitable for the local agro-climatic and socio-economic circumstances (Kearl 1976). The doctrine grew that research should be determined by explicit farmers' needs rather than by the preconceptions of researchers (Simmonds 1985). This new doctrine was to develop into farming systems research (FSR) in the late 1970s. FSR is primarily a diagnostic tool, providing a better understanding of the strengths and weaknesses of existing production systems, which multi-disciplinary specialists can use to design packages of improved agricultural inputs (Richards 1986). The packages aim to be farmer-centred, holistic, on-farm, iterative and continuous (Maxwell 1986) and generally consist of four main phases: a description of the problem; design of alternative technologies; validation of technologies and recommendations on use of validated technologies.

According to Rhoades (1985), the euphoria among international development agencies for FSR has unfortunately grown more rapidly than the appropriateness of its methods. The short comings of FSR have been described by many authors (Harwood 1982; Biggs and Gibbon 1986; Rhoades 1985; Biggs and Farrington 1990). Most of these centre on the initial systems survey and descriptive phase eg. it consists of researchers' descriptions and not the farmers' own perceived way of doing things. It tended to be “top down” and not “bottom up”, a bias which is considered a serious flaw in any rural development strategy by many authors (Chambers, Pacey and Thrupp 1989, Farrington and Martin 1988, Bunch 1987, Bernsten, Fitzhugh, and Knipscheer 1983, Scoones and Thompson 1994). FSR projects tended also to be slow and expensive.

Improved information gathering with greater participation of farmers was introduced through use of practical social science tools to carry out what is now generally known as a “Rapid Rural Appraisal” (RRA). The basic RRA consisted of the following components:-

• interview and question-design techniques for individual, household, and key informant interviews;

• methods of cross-checking information from different sources;

• sampling techniques that can be adapted to a particular objective;

• methods of obtaining quantitative data in a short time frame;

• group interview techniques, including focus-group inter-viewing;

• methods of direct observation at site level;

• use of secondary data sources.

RRA has also been criticised (Beebe 1987) for the quality of information it gathers. However the main criticism against RRA was that is does not necessarily increase the level of participation of farmers in the projects RRA leads onto.

The growing recognition that participation by communities in development projects is required for projects to succeed combined with the lessons learnt from the use of RRA in FSR led to the development of interactive data gathering and planning tools which have become known as Participatory Rural Appraisal (PRA) tools (McCracken Pretty and Conway, 1988).

Participatory rural appraisal tools are designed for use with standard RRA tools. They should be used by the farmers themselves, either in dialogue with outsiders or among their communities. The object is to permit them to better record, count, measure, problem pose, discuss and analyse their existing situation with the aim of:-

• building on what people already know;

• using and developing people's abilities and skills to analyse and evaluate their surroundings;

• reveal whether human and material resources are being used efficiently and effectively;

• help people to analyse their individual situations and see how their activities may be altered in a beneficial manner, thus setting local priority needs;

• enable people to study their own methods of organisation and management;

• provide good information for making decisions about planning and programme direction;

• increase the sense of collective responsibility for programme development, implementation, monitoring and evaluation;

• identify indicators for monitoring and evaluation to be recorded.

• concluding with a community action plan also sometimes called a social contract, which sets action priority order, identifies materials and labour required for implementation, assigns responsibilities to groups during implementation. The plan is a focal point for all the data gathering and ranking. The plan will focus community discussion in its preparation, mobilises community groups during implementation, and helps communities to measure their own progress toward achievement.

  The commonly used tools are the following:-

• Informal interviewing

• Diagrams and mapping

• Wealth ranking

• Matrix ranking and scoring

• Progeny histories

• Creative Expression

(See Appendix 1 for very brief details on each tool)

All the above mentioned tools are powerful, relatively simple to use and can be (and have been) taught to all types of project staff. The tools have recently started to be modified for specific use in various sectors from urban welfare to pastoral livestock. For more detailed information on the livestock techniques refer to RRA notes No. 20, special issue on Livestock ¹⁶.

One danger in using such tools is to forget or not understand that the reason for using these tools is not for the facilitator to gather excellent information, but for the tools to be used to promote participation by all groups which might be involved in any future project. This mistake is commonly made. Training facilitators in the use of PRA tools must involve instruction on why greater participation can lead to more success in project implementation.

4. Rinderpest control in Southern Sudan using a participatory approach

Southern Sudan is the most significant endemic rinderpest focus currently in Africa. It neighbours pastoral areas of Uganda, Kenya, Chad and Ethiopia. It is the closest endemic foci to the east west stock routes of the Fulani and Baggara tribes which start in Darfur province of Sudan and Chad. It therefore poses the greatest risk to rinderpest spreading back to West Africa.

Southern Sudan is a war zone, the current war started in 1983. There has been only 11 years of peace since independence was gained in 1956. It is the longest ongoing civil conflict in Africa with over a million people killed and 2.5 million displaced, most of them civilians. Southern Sudan is what is known in current development jargon as a “complex emergency”. The infrastructure of the area has broken down, mechanised internal transport is almost impossible, the cash economy is often not present, schools and hospitals barely function, abuses of human rights have been experienced by the civil population, animal health services lack trained personnel and resources. Southern Sudan is one of PARC's Special Action Areas.

¹⁶ Available from IIED, 3 Endsliegh Street, London, WC1H ODD, UK.

UNICEF as the lead agency of Operation Lifeline Sudan, began to facilitate rinderpest vaccination in southern Sudan in 1989. The majority of the livestock project sites were and still are in rebel controlled areas because that is where most of the livestock are located. One of UNICEF's roles is to ensure the rights of the child to “adequate nutritious foods” (article 24, 2, (C) UN Convention on the rights of the child). Livestock and particularly cattle provide households with 25-40% of their total food needs and this could rise to as high as 60%, depending on the number of cattle and the season. Cattle also fulfil important social economic roles, such as the provision of status to the owner, mobility, and wealth for marriage and bartering, which assists in stabilising war torn communities.

The estimated cattle population for southern Sudan is 3.5-4 million. The UNICEF livestock project vaccinated 1,135,000 cattle against rinderpest over the four years from 1989 to 1992. During this time the project was vaccinating against 4 diseases using full cold chain and teams of vaccinators. The project virtually came to a standstill in 1992 due to disruption of teams and cold chain from insecurity. Only 140,000 cattle were vaccinated in that year.

4.1 The UNICEF / Tufts University Livestock Progam

In 1993 with technical assistance from Tufts University's Section of International Veterinary medicine, UNICEF started a project of developing vaccination projects through community-based, decentralised and privatised animal health services. An integral part of this service development was the participation of local communities. In this year the program confirmed 11 outbreaks of rinderpest and vaccinated 1,489,706 head of cattle, an increase of 10.6 times the 1992 figure and 244,706 over target (Mariner, Akabwai, Leyland, Lefevre and Masiga 1994). In 1994, 4 outbreaks of rinderpest were reported and 1,743,033 cattle were vaccinated, 343,033 over target. 1,070,927 cattle were vaccinated against rinderpest in 1995, as per target, with 2 unconfirmed outbreaks of the disease. The reduced 1995 figure compared to 1994, reflects poor security in certain key pastoral areas and a greater emphasis on community dialogue and training to broaden the scope of the program to include control of other major diseases. The target for 1996 is one million cattle vaccinated and there has been one unconfirmed outbreak of rinderpest. The perception by the cattle owners and the local authorities in southern Sudan is that the program has been successful in controlling rinderpest in those areas vaccinated.

The 1993 program in southern Sudan started on the premise that the veterinary services had broken down in the war affected areas. It accepted the rationale that by soliciting the participation of the pastoral peoples an economically viable and socially acceptable animal health service could be developed (Sollod and Stem 1991). It adopted a participatory approach.

The first contact with pastoral communities by the UNICEF vet in 1993 was by conducting a Participatory Rural Appraisal. The PRA was carried out against a back-ground of severe malnutrition. In March 1993 a nutrition survey of 3 distinct areas revealed that the percentage of children less than five years old who were critically undernourished was on average 80% (Centres for Disease Control and Prevention {CDC} 1993). This was caused by displacement, crop failure and livestock disease. In such times the pastoral people rely on their cattle's milk to keep the children and old people alive.

The particularly useful PRA tools used were informal interview, disease problem ranking with disease descriptions, mapping on the ground with sticks and stones, seasonal calendars and group discussion. Rinderpest was ranked by the cattle owners as the biggest problem disease in every location visited. The population was therefore extremely enthusiastic to participate in control of rinderpest, as can be seen from the following quotes:-

Head chief, Leek, Western Upper Nile Province.

Cattle and human diseases are related. Our lives revolve around our cattle. If our cattle die then we start to think about the future of our children and we cry. Sometimes if our cattle die we have to move away from our areas for example to Khartoum…. We like the idea of training people from our communities {to help keep the cattle alive}….

Head chief, Ganyiel, Western Upper Nile Province.

The cow is considered to be our grand mother. You see me now, I am alive because of the cow. I do not take beer and the best drink is milk. I have 38 wives, these wives where not enslaved but bought with cows in good times. The idea of training people in our communities is a very good one…. The cow is like a human. If our wife is infertile we struggle to take her to the hospital. It is the same for our cows because without our cows our children will die. We must particularly fight the diseases which kill our young cows.

Head chief, Ler, Western Upper Nile Province.

If you want to write you look for a pen. If you want to live you look for a cow. The issue we have been discussing is as important as the Lau / Jikany conflict. We agree with the ideas suggested. When the committees are formed they must include more people, not just the chiefs and the vet staff.

A community action plan was drawn up in each area. UNICEF's main contribution was training and equipping vaccination teams. The local authorities, chiefs and cattle owners organised the selection of vaccinators and the movement of vaccination teams around the local areas. The vaccinators were paid by both the cattle owners in terms of milk, goats and bulls and by UNICEF in terms of soap and salt. Because of the severe malnutrition the 1993 the community action plans were necessarily done fast and mistakes were made. The major mistakes were in terms of not spending enough time contacting all the cattle owners' representatives and agreeing the community action plan with them, of allowing the selection of vaccinators to be dominated by local authorities and of not having vaccination guidelines particularly suited to southern Sudanese conditions eg. uniform ear notching policy.

The community-based approach adopted could not have been possible without the introduction of thermostable Vero cell-adapted rinderpest vaccine by UNICEF in 1993. This vaccine has not only had a significant impact on the control of rinderpest in southern Sudan but is also now being used effectively in Ethiopia, Somalia and Chad as described by Mariner et al 1994. The value of the vaccine is immediately apparent to cattle owners.

Head chief, Mogok, Jonglei Province.

Greetings to you. We are very interested in the issues you have raised. Today's meeting is one of the most important that we have had during our time in Akobo and we will take great care to report it to our communities. Any talk about saving the lives of cattle will concern the saving of the lives of our children and the livelihood of future generations. The new ideas you have mentioned will improve the vet services in our areas. One of the biggest achievements of this meeting is our learning that we will abandon the use of fridges. Last year our cattle could not be vaccinated because they are 5-6 days walk from Ayod, indeed vaccines that were brought to us could not be used because they spoiled in the cold box. Overcoming this problem is very important for us. We will have no problem in recruiting people to do this work.

Since 1993, UNICEF, the local authorities and the communities learnt a lot from their mistakes. This learning process is one of the strengths of participation. Participation can allow the on going dialogue, monitoring and feedback for the projects to be flexible and responsive enough to meet the needs of all parties. For example, the UNICEF livestock program now encourages continued community dialogue through PRA after the development of the initial community action plan and the first training of Community Animal Health Workers (CAHW). This was in response to the fact that all parties learn a lot in the two months after the initial implementation of health services, and a revision of the community action plan is often called for if the animal health service is the remain workable.

The UNICEF/Tufts livestock program had one veterinarian working for it in 1993. In 1994 and 1995 there was change in policy for the program to not just work for rinderpest control but to broaden the scope of the animal health service to include the other major diseases occurring in southern Sudan. The service has remained community-based, decentralised and privatised. The main implementors are a cadre of CAHWs selected by and working for their communities. The CAHWs are paid a proportion of the revenue they collect from the sale of their treatment and vaccination services. It is the CAHWs who carry out rinderpest vaccination using thermostable vaccine. This can be done as individuals within their communities or the CAHWs may be coordinated by the local authorities to come together as a team to vaccinate against rinderpest or other diseases such as anthrax or CBPP. To help expand the program Non Government Organisations (NGOs) with their greater staff capacity were invited to participate in the Operation Lifeline Sudan (OLS) livestock program.

The process of establishing the initial and subsequent community action plans involves a significant amount of staff time in the field. UNICEF therefore provides, as well as its own implementing role, a coordination and advisory role for the NGOs and counterparts. UNICEF also purchases vaccine, equipment and medicines. In effect UNICEF acts on behalf of its Sudanese counterparts rather like a veterinary authority. The process of attracting Sudanese veterinary doctors back to southern Sudan to take over from UNICEF is on going.

At present there are currently 10 NGOs working in southern Sudan under the OLS livestock program, covering approximately 70% of the pastoral areas. It is hoped that security permitting the other 30% of the pastoral areas can be reached in the next few years. UNICEF has seven livestock officers. In May 1996 UNICEF and Tufts University started a similar livestock project in Khartoum also working with NGOs and the government veterinary services.

4.2 Major Lessons Learnt

The UNICEF/Tufts livestock program for southern Sudan has remained participatory in approach and continues to learn lessons. By broad themes, some of the major ones are as follows:-

Community Dialogue:

• Do not under estimate the time needed in carrying out the community dialogue, using PRA tools, which is necessary to gain a working community action plan. On average this process takes 2 months and has taken up to one year. The period required depends upon the demography of the area and the amount of time the facilitators can spend in the location.

• It is vital that all the representatives of the cattle owners are aware of the plan or social contract. It is not good enough to deal with Chiefs alone.

• The respect for and influence of the chiefs should not be underestimated.

• Do not expect anyone to work for nothing.

• Continue community dialogue to make adjustments to the community action plan once the project has trained the first CAHWs and has started implementing health services.

• Reach consensus with cattle owners on difficult policy issues such as, cost of vaccination, which animals should be vaccinated, ear notching and how long vaccination should continue for, who should accommodate CAHWs when they visit.

• Do not be tempted to start implementing animal health activities before a social contract or community action plan between the outside organisation eg. NGO, the local authorities, and the cattle owner's has been agreed.

Training:

• Do not underestimate the ability of pastoral people to grasp new concepts and be trained to implement novel activities. eg. the training of illiterate livestock owners as Community-based Animal Health Workers (CAHWs), who record their activities pictorially, charge for their services and mobilise stock owners.

• Use local perceptions of what causes disease to build cattle owners understanding of how vaccine works and why vaccination must continue after the disease in no longer seen in the area.

• Do not neglect to build CAHW refresher training into projects.

• To speed up the process of establishing community-based animal health services - develop guidelines for a model which can be used by local veterinary authorities and NGOs. The guidelines should include training curricula for courses, topic reminders for community dialogue and extension tools which can be used.

Capacity Building:

• Build on existing social structures.

• Accept that the process of establishing community-based services is a learning process for all parties in order to keep the projects flexible and responsive.

• Be constantly aware of capacity building work required for the local authorities to continue to operate the privatised and community-based approach. The local veterinary authorities in southern Sudan have fully accepted the approach and are being trained to continue with it.

• Establish training institutions for the next generation of local veterinary authorities, with curricula targeted to develop privatised veterinary services.

Privatisation:

• Build drug supply, cold chain management, coordination of vaccination using non heat stable vaccines and monitoring activities such as sero-surveillance into the local veterinary authorities role.

• Ensure regular supply of drugs through local suppliers.

• Link the incentives that the CAHWs and the veterinary coordinators receive to the amount of work carried out, through payment for services.

• Keep book keeping and monitoring as simple as possible.

• Do not provide rinderpest vaccine free of charge.

• Do not subsidise.

• Allow CAHWs to become more mobile by encouraging them to purchase bicycles.

• Combine rinderpest vaccination services within a broader privatised animal health service.

• Target locally perceived disease problems which can be practically controlled or treated.

Guidelines for the Operation Lifeline Sudan animal health service model are currently being collated as a working document. (UNICEF OLS 1996, ongoing).

5. Conclusion

PARC and its partner organisations are developing new approaches to working in the special action areas which are the remaining endemic foci of rinderpest in Africa.

Given the characterstics and challenges posed by these areas it is suggested that a community-based participatory approach is an approach is an appropriate one for such complex, remote and risk prone areas.

A participatory approach to developing vaccination and animal health services is being started in some of these special action areas. This process has been given impetus by the development of a thermostable vaccine which can be used without a cold chain for one month and which maintains the safety and efficacy of traditional tissue culture rinderpest vaccine (Mariner et al, 1990a, Mariner et al 1990b).

Southern Sudan is one area where, despite the severe logistical problems of working in a war zone, such an approach has proven successful in controlling rinderpest. The participation of communities is facilitated using simple Participatory Rural Appraisal (PRA) tools. Community action plans which reflect local conditions are being developed on an area by area basis to evolve community-based, decentralised and privatised animal health services. This is a continuing learning process for all the parties involved. Acceptance that this is a continuing learning process gives strength to the projects. It allows them to remain flexible and responsive enough to find success in areas which are considered to be marginalised and have seen little development. The lessons so far learnt in southern Sudan are already being used within that area but can also be used to assist projects starting in other special action areas. The resulting community-based animal health services are cost effective and sustainable. They could be used to finally eradicate rinderpest from Africa and also go on to assist in similar inaccessible areas as part of the Global Rinderpest Eradication Programme.

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Appendix 1 PARTICIPATORY RURAL APPRAISAL TOOLS

INFORMAL INTERVIEWING

Interviewing is the oldest and most respected manner of information gathering and the foundation for many other tools. It is a skill that should not be taken for granted and training is often required. It is useful to use check lists for when interviewing and ensuring the interviewers are aware of local cultural sensitivities. Mitchel and Slim (1991 and 1992)

DIAGRAMS AND MAPPING

Diagrams are any simple schematic device which presents information in a readily understandable form. In rural communities they capture and present information which would be less precise, less clear, and much less succinct if expressed in words. Diagrams and maps are constructed using shared information which can be checked, discussed, and amended and thus creates a consensus and facilitates communication between different people. They include:-

• maps

• farm profiles and sketches

• transects

• models and seasonal calendars

• flow diagrams

• decision trees

• venn diagrams

• time lines

WEALTH RANKING

This tool uses the perceptions of informants to rank ‘household’s within a village or part of a village (community) according to overall wealth. This is a very useful and powerful tool. It allows outsiders to gain an in-depth understanding of community structure. It is easily used to promote discussion on problems the community faces. I promotes culturally sensitive targeting of interventions.

MATRIX RANKING AND SCORING

Matrix ranking and scoring is used to discover local attitudes to and perceptions of a topic of interest. This may be ranking of diseases, ethnic treatments, worst case scenario plans etc. The exercise is valuable to promote discussion within groups.

PROGENY HISTORIES

These are individual animal case studies. They rely on the pastoralist's intimate knowledge of the pedigree and fate of every animal in his or her herd. Progeny histories are very useful for building up an accurate quantitative view of mortality rates, reasons for death, offtake rates, reasons for offtake etc.

CREATIVE EXPRESSION

Creative expression involves the use of art forms as a means for individuals and groups to represent their ideas and/or feelings. Artistic forms that are commonly used include drawing, drama, role plays, music, and collages. It is important that the participants use the art form with which they are familiar. Role play is particularly powerful in pastoral societies.

REFERENCES

Scoones, I. and Thomson, J. (Ed.) (1994). Beyond Farmer First – Rural People's knowledge, Agricultural Research and Extension Practice. Intermediate Techmology Publications Ltd., UK.

Simmonds, N.W. (1985). Farming Systems Research: A Review. World Bank Technical Paper No 43. The World Bank, Washington D.C., USA.

Sollod, A.E. and Stem, C. (1991). Appropriate animal health information systems for nomadic and transhumant livestock populations in Africa. Revue Scientifique et Technique de l'Office International des Epizooties, 10, 89-101.

UNICEF Operation Lifeline Sudan (ongoing) (1996). Guidelines for the establishment of community-based animal health services in Southern Sudan.