Given that VPH is essentially a "public good" activity defined as "the contributions to the physical, mental and social well-being of humans through an understanding and application of veterinary science"
12. How can governments that are actively privatizing their veterinary services be persuaded to retain a basic service to ensure that communities are protected from zoonotic disease, food and water-borne infections and other environmental problems that may be associated with animals or livestock production?
Public goods are those from which everyone stands to benefit and from which no one can be denied access. These would include activities such as quarantine, disease surveillance and meat and food inspection that are best provided by the State. Private goods on the other hand are those for which benefits only accrue to individuals or groups and are not experienced by the wider community. Clinical services are an example because the only beneficiary is the owner of the animal receiving attention. Not all services to society can be clearly categorized as exclusively public or private goods. For example vaccination of dogs against rabies not only protects the dog, but also other animals and humans. Therefore this spillover effect is described as public good with externalities (Sherman, 2002).
Functions which provide the necessary tools and means for the protection of the health of a country people and domestic and wild animal herds should not be privatized. (Dr D. Allard et al., Contribution 38). However there seemed to be general agreement that veterinary clinical services, especially for livestock in DC, will continue to be either privatized or be provided by farmer-owned cooperatives. The savings in financial and human resources should be used to strengthen the regulatory and service delivery infrastructure (i.e. public good activities). These would include programmes for disease control, epidemiological and surveillance services, quality control and registration of biologics etc. There were also opinions expressed that extension and research services should be carried by government institutions, preferably in collaboration with Universities (especially those with Veterinary Schools) and also NGOs.
The World Veterinary Association (Contributions 21 and #25) has adopted a policy on veterinary involvement in the restructuring of public health services. This policy recognizes the vital contribution that veterinarians can make to public health especially in the whole area of food safety. It also recognizes that the control of transboundary diseases and food safety are public "goods", because they are multidimensional in scope and in DC, cannot be delegated to the private sector for profit. Nevertheless private veterinarians and also veterinary associations can play very important roles in transboundary disease control programmes especially in coordinated disease reporting, information distribution and continuing professional development.
Basic services such as tuberculosis and brucellosis testing, meat inspection and quarantine should not be privatized (Dr. J. Calder, Contribution 19).
Dr H. Schneider (Contribution 14) emphasized that because many African countries shift non-core government functions to private veterinarians, there is the opportunity to employ these individuals on a part time basis in food/meat inspection or other VPH activities and thus broaden their income base.
For governments in DC, the publication "Guiding Principles for Planning, Organization and Management of VPH Programmes" was recommended (FAO, 1990).
13. How can active collaboration at national, provincial and local levels between ministries of health and agriculture, including physicians and veterinarians, become more proactive and beneficial?
There was general support for the proposal that zoonotic disease control committees should be formed at all levels and be multidisciplinary to include physicians, veterinarians, epidemiologists, social scientists and other professionals as required from both government as well as NGOs. Community representation is also very desirable. The importance of Health Systems Research and inter-sectoral collaboration in VPH is stressed in a WHO Consultation report (WHO, 1989).
By introducing legislation or regulation for the control of zoonotic diseases, animal owners, animal product manufacturers, veterinarians and medical practitioners could be made more responsible and accountable in DC. By creating task forces and working groups with representatives from central, provincial and local governments who have a stake in VPH and zoonoses, the expectation would be that they all work in a productive and collaborative manner (Dr G.K. Sharma, Contribution 24). Where difficulties are encountered in setting up VPH programmes either within a Ministry of Health or Agriculture, the suggestion was made to conduct a 'pilot experiment' with technical cooperation from an international organization such as WHO or FAO. (Dr G. Togo, Contribution 27).
Dr B. Gummow (Contribution 4) drew attention to the situation in South Africa where the Departments of Health and Agriculture rarely appear to work together. He also cites the example of a recent Medical Research Council report showing that an estimated 40 percent of reproductively active persons are HIV positive. Yet there does not appear to be any clear plan to ensure that VPH policies are incorporated into HIV control and prevention programmes. There is also minimal training of medical students to recognize common zoonoses such as brucellosis, Q fever, tick-bite fever, leptospirosis and psittacosis, all of which can be misdiagnosed as malaria. To compound the situation, autopsies are rarely carried out. It is also likely that there will be many more zoonotic infections in the future. This is because almost 50 percent of populations in DC live in rural areas, where they can be expected to come in contact with animals on a regular basis, they live under poor socio-economic conditions and are immunocompromised from HIV infections.
Another example of failure of the Departments of Health and Agriculture to communicate is the not infrequent situation where persons receive the full schedule of post-exposure rabies prophylaxis, despite quarantined dogs remaining healthy after 10 days of observation. These are just two examples of the urgent need for greater cooperation between the medical and veterinary professions.
Ministries of Health in DC tend to focus on disease prevention and care, for example, childhood vaccinations and HIV/AIDS. Zoonoses often do not warrant attention unless there is a major epidemic. Building effective partnerships with individuals in different ministries and disciplines that can address specific diseases (such as plague, rabies or hydatidosis) is recommended as an excellent start (Dr D. Waltner-Toews, Contribution 31). Later these initiatives can be expanded and built upon to ensure that effort is not restricted to a specific disease and that they are used to leverage broader support for VPH. Effective use of the media by professionals working in VPH is also strongly recommended.
Dr A. Benkirane (Contribution 34) suggested that the most immediate action to be developed in DC (where the priorities tend to prevent both physicians and veterinarians from concentrating their efforts on VPH issues) is to create a synergy among all concerned. A well-identified interface ought to be established in each DC to deal specifically with these problems within its particular administrative infrastructure. Such an interface should also exist physically, and either be hosted by the Ministry of Health or Agriculture, or exist as an independent entity. Other Ministries such as Education may also be involved if school children were a group targeted for a VPH programme. Both FAO and WHO, as well as other international organizations involved in VPH, should work in close collaboration to assist DC governments. They should help them set up relevant VPH units and possibly network these units on a sub-regional or regional basis. The Regional Animal Disease Surveillance and Control Network for North Africa and the Near East (RADISCON) was cited as a fairly successful example of an organization for surveillance in the area. Pilot diseases may be investigated at the launching of national VPH units, using say rabies and hydatidosis as representative models. These diseases are also more likely to motivate physicians. To reach a fully operational VPH unit, funds will have to be raised and these will only be released if decision-makers respond at the highest levels.
A suggestion was made that communication and information sharing between human and veterinary medicine would be encouraged by having a focal zoonotic disease information centre, as well as a file server and a web page (Dr K. Sato, Contribution 10). Dr D. Allard et al., (Contribution 38) suggested that courses on zoonoses and food-borne illness be taught jointly by physicians and veterinarians, and lectures attended by both medical and veterinary students together. The expectation would be a strengthening of working relationships between the two professional groups. In DC, it was also suggested that cooperation between the two groups could be encouraged in rural areas by having joint veterinary and human vaccination campaigns.
The current controversy regarding the prudent use of antibiotics by both professions was cited as another example of where more active collaboration is urgently needed. While the evidence in developed countries for antibiotic resistance of micro-organisms of animal origin infecting humans is becoming clearer, the situation in most DC is unknown. The World Veterinary Association (WVA) has taken a lead in this area (Dr J. Edwards, Contribution 21) by advocating that therapeutic antibiotics should be used under supervision of a veterinarian, and only in those situations where an infectious agent susceptible to therapy is likely to be present.
14. Identify resources in industrialized countries that might be able to better assist VPH capacity and institution building in developing countries
An innovative example of bilateral governmental and non-governmental cooperation was described in Contribution 29 from Dr N. Neils-Ole Bjerregaard. The Danish Veterinary Association assisted the veterinary profession in Latvia, following their regaining of independence in 1991, by support and contributions for a Latvian Veterinary Journal, an annual veterinary conference and training of Latvian veterinarians in Denmark. The latter included training in VPH. In virtually all developed countries there are well organized veterinary associations and they have the resources to cooperate with colleagues in developing countries by helping to structure the profession and improve it where necessary. This is especially critical in countries where food safety is often problematical, yet it is a precondition for international trade in both food and feed.
It was also suggested several times that companies producing vaccines, pharmaceuticals and diagnostics for use in zoonotic disease control programmes should be approached to determine whether they would be able to develop a VPH capacity in DC where they can also market their products. These companies have already played a major role, especially in sponsoring extension campaigns. Organizations with expertise in communication and the production of educational materials are also potential resources.
Given that many veterinary schools in developing countries are inadequately funded, staffed and equipped to teach VPH at both undergraduate and graduate levels and also participate in community extension programmes
15. Suggest how this situation could be improved especially to include the basic principles of food safety, zoonoses control and environmental/community health
While the curriculum of veterinary schools is increasingly under pressure to include more material, concern was expressed that VPH was not being given a high enough priority, especially in DC. Guest lectureships by experienced veterinarians in the various fields of VPH should be encouraged to assist in broadening the professional perspective of students. There is increasing acceptance that not all veterinary students need identical education. 'Tracking' of students into health disciplines of particular interest to them helps to solve the problem of information overload. It allows students to tailor their education to their career aspirations and the expectations of the communities in which they work.
A number of contributors indicated that faculty exchange programmes between Universities of developed and DC countries should be started, or existing programmes expanded. Programmes like these have been undertaken informally over many years using a variety of funding sources such as Fullbright grants to and from the USA.
It was suggested that curricula for VPH education at the undergraduate level be reviewed and developed on a regional basis because it is recognized that emphasis may vary depending on the geographical region (Dr G. Nasinyama, Contribution 18).
A difficulty cited by one Contributor (Dr B. Gummow, Contribution 4) was that veterinary students often fail to grasp the importance of their role in controlling zoonotic diseases. While they see clinical animal disease, they do not routinely see the associated human cases. Perhaps therefore when opportunities arise, students should be exposed to say a child with rabies or an adult with tuberculosis. Medical and veterinary infectious disease faculties should consider giving lectures in each other's disciplines.
Dr C. Wilks (Contribution 22) described an innovative approach being used in the teaching of VPH in Australia. On the assumption that VPH was "the application of veterinary science to the protection and promotion of human health and well being", the decision was made to present an expanded VPH course over the whole four-year curriculum. Traditionally the VPH course was primarily focussed on meat inspection, but now it has been expanded to include:
quality assurance of animal-based products to meet consumer expectations;
knowledge of the causes, epidemiology and control of food borne zoonotic and emerging diseases;
adverse effects of agricultural and other human activities on food quality, animal welfare, human health and the environment.
The mode of delivery has shifted to a small number of formal lectures, tutorials and field visits, which are used to guide the students rather than instruct them. Specific learning objectives are set for each year and links into other courses that are already providing core material are identified. Students are also encouraged to use identified Web sites. Under this new approach, students are required to assemble an electronic portfolio that draws together, analyses and discusses the information needed to meet the annual learning objectives. At a set time these portfolios are accessed and assessed by the responsible faculty member. The portfolios are developed and enlarged over the four years and on graduation, provide a dynamic document that can continue to be updated and expanded according to the student's/veterinarian's interests and professional needs. In summary, VPH should be seen by students as an integral part of every veterinarian's responsibility and education. It is also considered vital that students develop skills in locating, identifying, assessing and collating information.
Dr B. Miller (Contribution 37) made the point that a critical component of VPH is interacting and understanding human populations and their relationships with animals. A frequently overlooked part of this population is women, as livestock producers, as mothers and as professionals, i.e. veterinarians. It is well established that educational messages given to men regarding women's work are rarely successful, so VPH personnel need policies, strategies and training to help reach both rural and urban women in DC. In DC over 40 percent of the agricultural work force is female. This means a VPH educational programme that includes an understanding of the social context and an examination of "gender neutral" thinking, in which the farmer is assumed to be male, literate and has the authority to make decisions. VPH is the branch of veterinary medicine most related to sociology, yet veterinary graduates, both those with and without explicit VPH training, often shy away from thinking about the internal dynamics within the family and community, fearing to incite controversy. Yet clearly VPH personnel are agents for change in DC, and must act responsibly in that role.
Awareness of men and women's different roles in livestock production and food handling can increase the effectiveness of VPH educational campaigns. For example, the echinococcosis campaign in Morocco targeted existing women's groups for training in offal handling and sanitation. Heifer Project's technical training in dairy production in Uganda is designed for whole families, so that women as well as men can attend. Messages on sanitation and pasteurization can be directly transmitted to women who can implement them.
Worldwide the percentage of women entering the veterinary profession has been increasing over the last decade. Women professionals have a great deal to contribute to VPH not only as veterinarians, but also as researchers, paravets, and technicians. They can provide new perspectives and increase outreach to women farmers. However many women find it difficult to work in institutions designed for men, so policies regarding dependent care, flexible hours, security and harassment can help VPH institutions and organizations find and retain women professionals. In summary, although the challenge of VPH in DC is great, inclusion, awareness and outreach to women is a 'low tech' and affordable way to increase the effectiveness of programmes.
An example of a VPH course entitled "Introduction to Community Health" used in Nigeria was described by Dr B. Olugasa in Contribution 30. This was given in the fourth year of a six-year programme and placed emphasis on the VPH systems of that country. Topics included definition of VPH and discussions on zoonoses, the role of the abattoir, small clinics, livestock and poultry farms and of human households for data collection and epidemiological studies, etc.
Moderator's comments: A successful exercise that has been used for many years in the VPH clinical rotation at the College of Veterinary Medicine, University of Minnesota in the United States is for all studies to be presented with a 'real' problem These are based on circumstances where a faculty has been asked to provide advice on a situation involving human health or exposure from an animal source. Students are expected to prepare a written response in the form of a letter, and defend their advice in an oral presentation to faculty and their peers. These case-based exercises tend to engender more interest and participation by students than is customary with formal lectures.
A model of a VPH/Preventive Medicine curriculum for United States' Colleges of Veterinary Medicine based on a 1974 PAHO publication "A Competency Based Curriculum for VPH and Preventive Medicine" has recently been developed ( Association of Teachers of Veterinary Public Health and Preventive Medicine, 1999). However Veterinary Schools in DC are encouraged to develop the VPH curriculum for their students that reflects the current and future needs in their own countries.
16. How can veterinarians, either wishing to be or currently employed in vph programmes, expand their knowledge and skills by formal graduate or continuing education?
Whatever type of course is developed, it is critical that it is not only well planned, but also designed with a set of learning objectives that are appropriate to the needs of the individual as well as those of his/her current or future employer. Other principles needed to maximize the effectiveness of any education/training should include:
Provision of adequate financial assistance based on ability, commitment and financial need.
A commitment to continuous learning by the candidate, educational institution and supporting institution.
A requirement to demonstrate a focused need and a plan to address it at a basic level before advancing to a more technical level.
An obligation for the candidate to be a catalyst for community change and improvement from the perspective of VPH.
An outcomes assessment to measure performance of the individual.
That participants should critique any courses or programmes to ensure their ongoing relevance.
Wherever possible online/Internet based programmes should be developed to ensure the widest coverage.
Traditionally veterinarians with an interest in VPH and Zoonoses have gone to North America, Europe or Australasia for either Diploma or graduate level education. A list of educational institutions offering these educational opportunities will be posted on the conference Web site (FAO, 2001).
One example is a three-month course on Animal Production and Veterinary Public Health offered by the Faculty of Veterinary Medicine of Utrecht University in the Netherlands (Utrecht University, 2001) as described by Dr K. Balogh (Contribution 33).
Participants have come from DC and also Europe. The emphasis is on providing a broad and intensive overview of many different aspects of VPH, primarily by way of problem solving case studies, presentation of group assignments and round-table discussions. In addition, and to encourage greater harmonization of veterinary curricula, a number of case studies compiled in a European Module on VPH has been developed with six other European faculties using EU funding. These cases follow a specific format and include both a student and teachers guide. A complete two week course on VPH has also been developed jointly by three European and three East African faculties primarily in a 'train the trainers' format. Curricula on VPH should ideally have the flexibility to make use of material/modules already available and introduce new topics as they arise. The WebCT programme (WebCT.com, 2001) enables the creation of a virtual classroom. Following the 2000 outbreak of West Nile virus (WNV) infection in the United States, a group of Dutch students were put in touch with the Veterinary faculty at the University of Florida to develop a Web site for WNV in Northern Europe. Other contacts have been made with Faculties in South Africa, Brazil, Italy and Portugal by e-mail and WebCT. Even live chat sessions via WebCT have been organized. These types of cross-border educational experiences can be developed without large resources and depend on cooperation between the various institutions.
While there are numerous excellent publications in the general areas of VPH and zoonoses, many are inaccessible to veterinarians in DC, primarily because of cost. Comments were made that in the past FAO, WHO and OIE publications were readily available to Universities in DC gratis, but this appears to have lapsed. A bibliography of current publications, sources and availability will be appended to the conference Web site (FAO, 2001).
Dr M. Abo-Shehada (Contribution 15) described how a successful one-week course was held in Jordan training veterinarians and biomedical scientists on the use of polymerase chain reaction (PCR) techniques in diagnosis. This is a very useful low cost technique for diagnosing zoonoses in DC with modest laboratory equipment.
The development of a National Zoonosis Centre with associated laboratories, besides acting as a valuable country resource, could also serve as a learning and skills development centre for veterinarians in VPH programmes (Dr B. Olugasa, Contribution 30). Regular seminars and workshops focussing on epidemiological findings and control measures in both rural and urban situations could be organized.
17. How can distance learning or similar techniques be applied in developing countries?
Many contributors commented that electronic teaching aids are very useful and versatile and providing that needs are clearly defined, can be matched by even the most modest of facilities. A wide range of software and online resources in VPH is now available. Examples include the epidemiology "Supercourse" ( Computer-aided Learning In Veterinary Education, 2001 ) and "Emerging Infections of International Public Health Importance" (Pitt.edu, 2001) described earlier. The United States' based Association of Teachers of VPH and Preventive Medicine (ATVPHPM) also list many educational resources on their Web site (ATVPHPM, 2001).
Where Internet connections are uneven or absent, scarce materials can be stored on moveable discs such as CD's and can be distributed or exchanged.
Dr M. Abo-Shehada in Contribution 15 suggested that the means of producing VPH course materials on CD's should be made available to educational institutions in DC with the assistance of international organizations. Some institutions already use such interactive teaching aids as a complete course. Students or veterinarians are asked to access the materials for set hours and only see the tutors for evaluation. This methodology would allow participation of experts worldwide in the production of accredited courses in VPH and zoonoses. Such courses could be stored on an Internet site such as FAO or WHO as a public domain to be downloaded as required. Translation versions would also be needed in the long term.
Other suggestions included setting up focal Internet sites where VPH related questions could be directed and using the Internet to hold conferences, continuing education programmes etc.
18. Given that the primary need in most developing countries is for village level basic human and animal health care, how can trained lay persons be better utilized to provide these services?
In many DC, NGO's and cooperative organizations have established good infrastructures and have also won the confidence of poor and illiterate animal owners in their areas. Involvement of these organizations in VPH programmes is likely to include many extension and education initiatives to create awareness at grass roots level. Ultimately this would facilitate the participation of farmers in these programmes. These organizations have developed a new class of paraprofessional; the community-based animal health worker (Sherman, 2002). These individuals, with appropriate training, could play a significant role in VPH extension at the local level. The emphasis should be on a 'train the trainers' approach, taking into account the socio-cultural habits and customs of the area.
Dr G. Sharma (Contribution 24) suggested that the services of lay workers could be better utilized for providing village level basic human and animal care. This could be done through their education and training in vaccination, presumptive diagnosis and subsequent reporting to veterinary or medical officers. Data collection could also be achieved and above all, educating animal owners about the importance of VPH, the risks involved and what steps can be taken to avoid them. Education of animal owners and animal product producers is of critical importance, because without a change in their attitude and practices, nothing substantial can be attained.
Dr D. Allard et al. (Contribution 38) suggested village 'health workers' could be given additional knowledge and skills for basic diagnosis and control of the most prevalent zoonoses in DC. These workers would already have the biological knowledge necessary to grasp such information, and their access to village populations could be an asset in the early identification and control of zoonoses, not just in humans but also in domestic animals.
Dr E. Rapoport (Contribution 43) recommended that farmer community training in DC would be better if it were carried out slowly in order that recipients can more easily assimilate the principles and other concepts of modern management. Often the changes needed are relatively simple and do not need sophisticated electronic equipment or techniques. They are better carried out by watching the instructor at model sites such as farms, abattoirs, dairies, butcheries, homes etc. Generally at least one whole breeding season (more or less a full year) is necessary before new methods are well assimilated on livestock farms.
19. Give examples of innovative community based VPH programmes, especially those involving grass roots approaches
Dr B. Olugasa (Contribution 30) described a VPH programme developed specifically to identify zoonotic infections and risks for children (9-16 years of age) working as apprentices in abattoirs in Nigeria. They may constitute up to 12 percent of the total workforce. Abattoir waste water quality assessment was also included as a measure of environmental pollution.
Moderator's comment: Dr David Sherman in his recently published book "Tending Animals in the Global Village - A guide to International Veterinary Medicine"(Sherman, 2002) describes the critical elements of community-based animal health programmes. The importance of ethnoveterinary medicine, defined as 'local people's knowledge pertaining to animal health and production', derived over long periods of time from the close association of people and their animals, is emphasized. Human health knowledge and attitudes regarding zoonoses and other animal-related risks should be included in these types of programmes.
20. If you wish to raise other topics or issues related to VPH and zoonoses control in developing countries that are not covered in the above topics, please do so under this item
Contribution 39 from Drs A. Mantovani and R. Borrini raised the issue of VPH preparedness for disaster situations. The major disasters which can and have occurred in DC countries include: war and civil instability, epidemics and natural disasters such as droughts, floods and earthquakes. All may result in massive loss of livestock and other animals with resulting famine. In some instances the risks of zoonotic disease, for example rift valley fever, are exacerbated by a geophysical event such as flooding. DC are especially at risk because livestock are essential for both human and economic survival. The involvement of the veterinary profession in preparing for such events is emphasized and details exampled through the planning measures undertaken by the Italian official veterinary services.
For a review and recommendations see the OIE publication: "Emergency management of disasters involving livestock in developing countries" (Heath et al., 1999).
Dr G.K. Sharma (Contribution 24) suggested that certain VPH problems present in developed countries, including zoonoses, may not be present in DC. The vast majority of DC are ill equipped to diagnose and prevent the entry of such VPH problems. Developed countries, as a social obligation, should not knowingly supply items that could introduce new VPH problems to DC. International agencies like FAO/WHO/OIE could play a very important role in preventing the spread of VPH problems between countries.
There appeared to be general agreement that the current needs and future challenges for the delivery of effective VPH programmes in developing countries will be very different from those in developed countries. The latter generally have public infrastructures in place, which will be better able to cope with challenges faced from emerging or re-emerging zoonotic infections and also bioterrorist threats from zoonotic agents.
VPH initiatives in DC should focus at community levels and also choose programmes prioritized on the basis of disease burdens; they should also be epidemiologically defensible, risk based and have a reasonable probability of success and sustainability. Success is more likely if veterinarians take their place as a member of the health team rather than try and go it alone.
While international assistance was available and examples of cooperative projects were described by several contributors, there were obviously many unmet needs for technical help as well as financial assistance. International agencies need to make their numerous publications more readily available and also consider expanding their staff, particularly at regional level so that more support can be provided. Electronic access to information for those with a 'need to know' can and should be greatly expanded.
A number of deficiencies in surveillance programmes in DC was noted, and coordinated human/animal health databases for zoonotic infections were supported. Again these would require extensive training and commitment, especially at local level if they were to be successful.
While there was a wealth of knowledge and experience on how to control and prevent zoonotic diseases in developed countries, it was hazardous to transfer this directly to DC unless participatory field research had identified local knowledge and attitudes which might present major barriers for implementation. Food safety in DC is a good example. New quality control systems being adopted in meat hygiene in developed countries, where virtually all animals are slaughtered and inspected at abattoirs, are of very limited value where the majority of meat is derived from animals killed at a local butcher or at home. As globalization of trade in products of animal origin increases, DC should benefit from a need to meet export standards.
While there was a perceived need for DC to develop sound risk-based economic justification for zoonoses control programmes, it was also noted by several contributors that attention should be paid to ecological, ethological, social, ethical and psychological issues.
A number of examples of community based involvement in VPH programmes were presented. These ranged from improving surveillance, delivery of a combined animal and human health programme, especially to isolated communities, and the involvement of women and young people in prevention based education. In DC, human and animal health are interrelated especially as the majority of food is still produced and consumed locally.
A number of suggestions were made to ensure that 'public good' VPH services were not eliminated as more DC veterinary administrations transfer clinical services to the private sector. While in some cases NGO's and farmer cooperatives could provide some VPH services, ultimately the State must retain responsibility for disease surveillance, control of transboundary and zoonotic diseases and meat and other food safety.
Several contributors gave examples of very limited collaboration between Ministries of Health and Agriculture at all administrative levels. Unfortunately this problem is not only confined to DC. One solution favoured was that a well identified interface should be established in all DC either within an existing Ministry or as an independent entity. The problems facing DC were too important to be hampered by interprofessional rivalry or non-communication.
A number of innovative trends to improve both instruction in teaching VPH in veterinary schools and the 'student friendliness' of the subject were reported. These included reducing the number of formal lectures and increasing tutorials and field visits. More use of real life problems for teaching was also advocated. Specific learning issues were identified for each year and students were encouraged to use identified Web sites and to develop their own electronic portfolios.
The increase in women veterinary students presents many opportunities in DC, as women are still the major caregivers for livestock in many rural areas. Education on basic hygiene and other preventive measures can often be more effective if given by women to women directly rather than via men.
Opportunities for graduate and continuing education in VPH in DC are limited unless funding is available from North America, Europe or Australasia. However, several initiatives were described involving both inter-University linkages and distance learning via the Internet. Given the difficulties and also cost of access to the Internet in DC, a greater use of multilingual CD's was recommended, but unfortunately there is only limited material available at present.
If preventive VPH information especially on zoonoses was to be delivered at village level, greater use of community based animal and human health workers was advocated. These individuals could be taught the basic skills needed to advise on the common zoonoses. This material should be seen as a supplement to local people's knowledge relating to animal health and production rather than as a replacement.
Finally the importance of dealing with livestock emergencies following natural disasters was advocated and based on experiences, specific recommendations were made.
The assistance of staff in the Animal Health Service of the Animal Production and Health Division of FAO, Drs C. Eddi, W. Amanfu and D. Ward is acknowledged. Also Dr Scott McEwen, University of Guelph, Ontario, Canada, Dr David Hird, University of California, Davis, California, United States and Dr D. Cordes, New Zealand, for kindly reviewing the summary document.
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I he scope of veterinary public health (VPH) is clearly multidisciplinary, involving not only veterinarians in both government and non-government sectors, but other health professionals and scientists as well as paraprofessionals who treat, control or prevent diseases of animal origin. The VPH group in FAO contributes to research, consulting and training on veterinary public health and feed/food safety issues. In 1999, the World Health Organization (WHO) with FAO and the World Organisation for Animal Health (OIE) convened a conference of invited experts in Teramo, Italy, to consider the contributions of VPH programmes to human health on a global basis, with particular emphasis on the future contributions that VPH could make in developing countries. To publicize the discussions and recommendations of the Teramo meeting to a wider audience, FAO sponsored an electronic conference in collaboration with WHO and OIE, focusing primarily on the situation in both countries in transition and developing countries. This publication, presented in English, French and Spanish, highlights the growing need for a greater understanding of veterinary public health activities and summarizes the outcome of the electronic conference.