40. Privatization of veterinary services has been at the forefront of all recent discussions on animal health policies. There are a number of compelling reasons for such a move. Economically, veterinary activities like clinical interventions and voluntary vaccinations are exclusively private in nature and have a clientele that is willing to pay for the services, as has amply been demonstrated. Financially, public services cannot maintain a full scale of services, and need to concentrate on those services, which government has to fulfill, i.e. the services with a high "public good" element. The large number of veterinarians and livestock technicians graduating in SSA each year who cannot be absorbed by the public sector creates social problems. Privatization is a high-profile component of most recent Bank-funded livestock operations. In most of these projects, privatization is not restricted to the development of professional veterinary practices, but more importantly, involves the transfer of public sector tasks to other levels (middle-level technicians, veterinary auxiliaries, and producers). The approaches used to date in these different categories are outlined in the following paragraphs.
(i) Professional veterinarians
41. Self-employed veterinary professionals, common in other parts of the world, are still rare in SSA. At present, they are operating only in the main urban centers, in the commercial livestock industries, and in some high potential areas. Private veterinary care has been - and in many instances still is - stifled by (a) unfair competition from public services which dispense subsidized treatments and often use paraveterinary staff to compete with would-be professional private veterinarians; (b) a preference for - and sometimes an obligation to employ -new graduates in the civil service; (c) the uncertain availability of drugs and equipment; and (d) the perceived poor financial prospects for private veterinarians, especially in the pastoral and smallholder areas.
42. These disincentives are now being addressed in the context of macro-economic adjustment programs and recently approved macro-economic adjustment programs and recently approved livestock projects, and special incentives are being established to improve profitability. Income projections for private veterinarians in Bank staff appraisal reports vary from US$ 4,000 to US$ 35,000 per year. Such projections seem to be somewhat optimistic, and earnings from a private practice are likely to be below the income earned by a government veterinarian in many parts of Africa. This should not, however, deter professional veterinarians from considering self-employment, as it will be impossible to fully absorb veterinary graduates (the numbers of graduate veterinarians in SSA increases by 10-20% per year) in government posts (which, applying average public sector requirements, would have already about 2,000 professional veterinarians available for self employment). Privatization can provide the impetus needed to improve the quality of veterinary services. The marginal profitability does mean, however, that in the professional practices preference needs to be given to areas with higher potential, such as those in which dairy production is more intensive, those around urban centers with a growing poultry industry, and those with some commercial ranching. In addition, private professional veterinarians could - in some countries, they already do - play a central role in the import and wholesale distribution of drugs. In the lower potential areas, veterinary care needs to be delegated to middle- and lower-level technicians or to producers themselves, ideally under the supervision of private professional veterinarians. Although basic animal health care has been successfully introduced at the middle and lower levels, the basic animal health care system in SSA has not yet been adequately linked up with private professional veterinarians. This is a critical issue that needs more attention in future project design.
43. Although some issues still need to be resolved, interest in privatization is rising in the changing policy climate in SSA, and in the face of frozen recruitment and retrenchments of public servants in many countries. In a number of surveys carried out for the preparation of the project for Bank funding, most veterinarians were positive about getting into private practice. Another encouraging development is the creation and rehabilitation of national associations of veterinarians (NAV). Such professional associations are nongovernmental organizations that represent the interests of the veterinary profession and can be highly effective interlocutors in these discussions. NAVs, however, are not yet sufficiently strong to give business management training and administrative support to private veterinarians and would require technical assistance until their membership fees can support such activities.
44. Special incentives to encourage the establishment of private veterinary practices included in externally funded projects cover:
(a) financial support in the form of credit, sometimes supplemented by grants in kind, for those leaving government service;(b) partial salary payment for a limited period in those areas where livestock density is too low to provide an adequate income;
(c) subcontracting of public sector services at remunerative rates to self-employed veterinarians;
(d) transfer of facilities and transport equipment to the private operator who would then pay only for their maintenance and operation: government employees to test the feasibility of private practice; and
(e) the free or subsidized provision of office and laboratory facilities combined with part-time employment, which combines (c) and (d) above. Introduction of one or a combination of these incentives started in mid-1987, and it is too early to tell whether the incentives are strong enough to encourage the development of private veterinary practices.
45. Experience thus far suggests that the following two issues merit specific attention when designing a privatization program:
Balance between the Public and Private sector
. This balance is of concern in almost all externally funded projects as they seek to stimulate privatization, and at the same time to improve the performance of public sector tasks. The latter is necessary in part because the tasks are important in themselves and need to be strengthened, but also because it is vital to interest the government in the overall project. However, the investment in equipment, the financing of allowances, and the funding of clinical services gives government veterinarians strong advantages over any newly established private ones and discourages government veterinarians from leaving the public sector.
Full cost recovery by government services. There is an innate resistance in the public sector to charge real costs for the services it provides, still, it is essential to do so if the private practitioner is to be assured of an adequate income. Arguments are frequently put forward that cost recovery can only be gradually introduced, because of the necessity to improve services first to a level where producers would be willing to pay for them. However, where producers would be willing to pay for them. However, where farmers are quite willing to pay for veterinary service, valuable opportunities to develop sustainable services were missed. Therefore, a comprehensive approach, which will eliminate all unfair competition from the public service seems to be a prerequisite for the success of professional private veterinary practice.
(ii) Other groups
46. While progress in self employment of professional veterinarians has been minimal, considerable progress has been gained with lower-level skills, notably (a) private middle-level technicians with one to four years of technical training after primary training for the sedentary production systems; and (b) producer representatives (auxiliaries) with varying educational backgrounds specially trained for the pastoral production systems. These nonprofessionals are better equipped to serve the extensive production systems in particular, because:
· their income aspirations are below the level a professional expects and can be met in most production systems;· communication between the non-professional animal health worker and the producer - frequently from the same ethnic group - is generally better than between the professional veterinarian and the producer, who are frequently from different backgrounds; and
· a large proportion (80-90%) of the veterinary interventions required in the extensive production systems are simple and can be done by less qualified persons, especially if they are properly supervised.
47. Although private non-professional animal health care is a fairly recent phenomenon in SSA, it is now being tested in at least 10 countries involving 8 million head of livestock; it is also expected to be introduced in much broader scope in another 10 countries. Non-professional systems seem to be providing a viable alternative to the poorly functioning public services. Middle-level technicians have been successfully employed in nonprofessional animal health care in sedentary livestock production systems in West and Central Africa (see Annex 2), while satisfactorily operating veterinary auxiliaries are a feature of pastoral production systems in the Sahel and East Africa.
48. Empirical data on the quality of the service provided by nonprofessional agents are scarce. Surveys in the Central African Republic indicated that in pastoral systems about 90% of the herders-auxiliaries there used drugs against internal parasites correctly, 85% of the producers diagnosed trypanosomiasis correctly, and 75% of the herders calculated the dosage within 10% of the recommended amounts. Vaccinations against anthrax and blackleg were carried out properly as well. These figures compare favorably with surveys on the level of expertise of government field staff in some countries, which frequently show lower scores for the proper disease diagnosis and correct dosage administration. Experience in other countries corroborate the auxiliaries' expertise in diagnosing disease and judging dosage. However, more research and monitoring will obviously be required to adequately assess levels of expertise, especially with auxiliaries recruited from populations relatively new to livestock raising. Experience with veterinary services for the work-oxen of crop farmers suggests that the farming population involved is much less skilled in diagnosing and treating animal disease and that it was difficult to recruit auxiliaries sufficiently familiar with livestock raising. This difference in skills between pastoral and mixed farmers suggests a two-pronged approach, following a rather liberal drug distribution policy for pastoral producer, using their representatives as the main channel, and a more restricted policy with mixed farmers new to livestock raising, using higher-qualified technicians as the main agents.
49. Lessons drawn from past experience in the organization of non-professional animal health care are:
Organization
. Non-professional animal health care is not sustainable unless the auxiliary is integrated into a group or association at the grass roots level and there is a reliable supply system for equipment and drugs at the national level. The integration in producers groups is recommendable also in a broader context, as many groups now go beyond animal health care and take responsibility in other tasks such as water point maintenance and range management. Animal health care then becomes the catalyst for group formation in better management of communal resources. The input supply side seems to be the weakest link. Input supply for the auxiliaries is generally handled by the project or is left to a parastatal company, thus seriously endangering post-project sustainability. Fully self-financing and independent input supply institutions need to be developed to respond adequately to otherwise well-established nonprofessional animal health care.
Selection and training. It is important for the veterinary auxiliary to come from the community he or she is to serve, particularly in the pastoral production systems, and to maintain close ties with his community during the training period. Selection on the basis of literacy rather than origin and representation, as frequently done, means that the auxiliary does not have the basis to fall back on later and results in disappointing performance. Maintaining contact with the home front is also important when deciding on the course format. Short (3-6 days), frequently repeated (every 6 months) programs, involving not only the auxiliary, but also the traditional hierarchy is much more successful than long, continuous training periods without any contact with their group of origin.
Remuneration. Although it is important to integrate the auxiliary into an association, experience shows that there is a danger that the auxiliary will become a poorly remunerated social worker. When that happens, the interest of the auxiliaries dies quickly. Consequently, a combination of a small retainer paid by the association and a margin on the sale of drugs seems to be essential to maintain the auxiliaries' interest.
Government involvement. Non-professional animal health care should develop as a private activity, and the government's role should be restricted to technical support/training and ex-post control and should exclude day-to-day management. Day-to-day supervision should be entrusted to private veterinarians, although this is one of the key links still missing in the system.
Funding and assistance. Establishing a non-professional animal health care system is a location-specific, protracted, and incremental task without a high funding requirement. Most external donors (including the World Bank) and national governments are not as well equipped to handle such a task as NGOs, which therefore should be encouraged to assist in the development of pastoral associations and basic animal health care systems.
(iii) Groups and special animal health tasks
50. Group responsibility for animal health tasks ranges from the management of all health tasks and artificial insemination, to the simpler tasks of managing dips and the veterinary stores. Experience with group management of dips has been mixed. The turnover in group-managed dips was in most projects higher than in government-managed ones, although access to the dip sometimes becomes an inequitable political tool in the hands of the president of the group. Experience in Kenya showed that communities performed rather poorly in maintaining the required acaricide level of the dipping fluid, resulting in a much higher incidence of tick borne diseases in areas of community controlled dips than in areas with government controlled dips (Leonard 1984). The present approach in Bank-funded projects is to transfer the dips to the community but to improve government capability in monitoring the dip operation.
51. Success in managing veterinary stores also depends on the control and quality of management. The overall financial management of these seems better in the more hierarchically structured and more tightly controlled pastoral societies than in crop farmers' groups. Group veterinary pharmacies appear to be operating satisfactorily in a number of Bank-funded projects, and the associations' revolving funds are now also used for additional functions besides the veterinary pharmacy. Post-project sustainability has been disappointing, however, and considerable efforts are necessary to establish improved internal control systems and to strengthen the role of the auxiliary in directly managing the revolving fund.
52. In summary, while the initial experiences with private nonprofessional animal health care have been positive, especially when integrated into producers' groups, some important steps still need to be taken. The countries of SSA should now focus on establishing a reliable input supply system, involve private veterinarians in the management of private non-professional health care, clarify the relationship between the official livestock service and the non-professional animal health care system, and ensure quality control and financial sustainability.
