Kenya: the development of private services and the role of the Kenya Veterinary Association

Private veterinary practice has existed in Kenya for more than half a century. Between the early 1930s and the mid-1960s, provision of clinical and advisory services almost entirely involved servicing commercial ranches and dairy farms. The Department of Veterinary Services (VSD) was mainly responsible for providing regulatory services in these areas. Until the mid-1960s, public sector veterinary responsibilities were predominantly associated with the prevention of notifiable diseases outside the commercial farming areas. In a major agrarian reform programme initiated in 1954, Kenya initiated an aggressive campaign promoting the dairy industry in the wetter areas of the country among small-scale farmers. In an effort to encourage dairy development, the VSD decided to provide some services, mainly tick control and subsidised artificial insemination. This support had a great positive impact on the 'smallholder' dairy industry. After the end of the colonial administration in 1963, most private practitioners left the country. A decision was therefore taken to transfer the responsibility of providing services of a 'private goods' nature, such as clinical services, temporarily to the public sector through the VSD. This was accompanied by significant expansion of training and the deployment of both professional veterinarians and para-professionals. By 1988, personnel costs had escalated to over 80% of the recurrent budget, leaving little for operational costs. This necessitated a policy change, which led to decreased government involvement in the delivery of animal health services. The private sector, as expected, responded appropriately to the change in policy. The Kenya Veterinary Association (KVA) launched a privatisation scheme (the Kenya Veterinary Association Privatisation Scheme) in 1994 to provide members with credit to set up private practices. The first phase of the scheme (1994-1996) was rated a success, with 100% loan repayments. The second phase of the project (from 1997) was characterised by a low number of loan applications, which increased the cost of loan administration per unit. There was some defaulting in loan repayments during this phase. While private veterinary practice took root in the high rainfall, intensive farming areas, this was not the case in the arid and semi-arid lands (ASAL), where community-based animal health workers (CAHWs) played a prominent role in providing animal health services. The lack of uniformity in the training of these workers denied them recognition by the Kenya Veterinary Board (KVB). An agreement has now been reached between the KVB, the Director of Veterinary Services and the KVA to discontinue the training of CAHWs and to retain and retrain existing workers for disease surveillance and reporting in ASAL areas. In conclusion, private veterinary practice has been successful in areas of high agricultural potential. Expansion to more marginal areas, however, would require incentives or subsidies.     

Introduction: The provision of animal health services in a changing world

In the future, animal health services in developing countries will need to operate in a continuously changing policy, institutional and commercial environment. Firstly, the changing policies and priorities of national policy-makers regarding public and private sector roles, reinforced in Africa by the donors, have reduced funding and support for the large number of tasks that animal health services have traditionally performed, and there is continuing pressure from policy-makers to focus on what the public sector can do best. Secondly, poverty reduction has become one of the main criteria guiding the allocation of official development assistance, which has major implications for the main target clientele of veterinary services. Thirdly, population growth, increasing income and urbanisation are causing a marked increase in demand for livestock products in the developing world. As a result, the entire livestock commodity chain is undergoing major structural changes, which has significant implications for the definition and control of food safety standards. Fourthly, globalisation, and increasing trade and travel have greatly increased the risk of disease transmission between different countries and continents. Veterinary institutions in the developing world need to adapt to these challenges. They will have to be able to focus on the essential public sector roles. At the same time they must deliver those essential services to the poor, and provide the policy framework to ensure that the inevitable structural changes in the commodity chain take place in an equitable and sustainable fashion, with an acceptable level of health risk for the consumer. According to the weight given to these different objectives, changes in the institutional set-up need to be considered. This issue of the Scientific and Technical Review addresses these challenges. It begins by reviewing the basic economic characteristics underlying the provision of animal health services, and then examines the alternative delivery systems that are emerging in the developing world and their strengths and weaknesses. The implications for food safety and trade are specifically highlighted. Also included are the practical experiences of countries, from all along the development continuum, that have introduced alternative systems. This paper deals with implications for the future, and while the growing importance of veterinary care for companion animals is acknowledged, the focus is on veterinary services for food animals.     

An assessment of the strengths and weaknesses of current veterinary systems in the developing world

The changes that veterinary services have undergone in the developing world over the last two decades are expected to continue and result in the further privatisation of selected tasks, the decentralisation of decision-making and a move towards more focus on public goods service delivery by State veterinary units. At the same time, global food consumption patterns are changing in numerous ways, which will certainly affect veterinary services delivery systems. These changes include a trend towards increasing globalisation, rapidly escalating consumer demand for animal protein, intensification of livestock production into larger units and growth of the trade of livestock and livestock products. Intensification of livestock production into larger units and global trade will increase the challenges resulting from the resurgence of serious animal diseases, food safety hazards and veterinary public health-related problems. Facing and managing these challenges raises issues related to animal health delivery systems and national policies that will have to be addressed. Strengthening the capacity of State veterinary units to respond to regulatory responsibilities dictated by national laws and international World Trade Organization and OIE (World organisation for animal health) health standards will be at the centre of animal health policies in most developing countries. Creating an environment which facilitates privatised service delivery and supports subcontracting is likely to contribute to improving economic efficiency and providing wider access to veterinary services. Equally important is the issue of professional development, which must be addressed by refocusing veterinary curricula and improving professional standards. The profession will then be in a better position to serve the needs of increasing numbers of consumers.     

The economic rationale of public and private sector roles in the provision of animal health services

In the changing market environment of livestock products, the delivery of animal health services is emerging as an important priority area for enhancing the competitiveness of poor livestock producers. At the same time, governments are continuing to face serious budgetary difficulties and are finding it difficult to expand the reach of these services or improve service quality. In this context of a changing environment and dwindling public resources, this paper revisits the economic framework that has thus far guided thinking about public and private sector roles in the provision of animal health services and examines the ongoing debate on livestock service delivery for the poor. The paper highlights the importance of strong institutions and appropriate legislation for regulating behaviour and enforcing contracts and re-emphasises the idea, which is supported by economic theory, that there is a need for task sharing between the public and private sectors. The paper further emphasizes the need for: a) integrating the debate on livestock service delivery with the larger debate on political economy and institutional development, and b) ensuring service access in poor marginal areas by working through membership organisations, self-help groups and civil society organisations, and by promoting the use of para-professionals and community-based animal health delivery systems.     

A conceptual framework for the economic analysis of factors influencing decision-making of small-scale farmers in animal health management.

The delivery of veterinary services in most of sub-Saharan Africa has undergone substantial changes, with the private sector gaining increasing recognition as an alternative to state provision. Given this policy shift, the authors argue that a better understanding of the behaviour and decision-making processes of small-scale farmers in animal health management is urgently required, to guide policy decisions regarding the delivery of animal health services. Whether the involvement of the private sector will improve overall efficiency in the delivery of veterinary services will depend greatly on the demand response of livestock producers who must make decisions about the health of livestock. The authors briefly review the decision-making process in small-scale farming systems, the economic nature of animal diseases and disease control and the models that have been used to guide resource allocation for disease control. To gain an improved understanding of the behaviour and decision-making processes of small-scale farmers, the authors propose a conceptual model including variables that relate to characteristics specific to small-scale farmers and farms, economic factors, institutional setting and biophysical factors. Two possible approaches are proposed for the economic analysis. Agricultural household modelling allows the derivation and testing of hypotheses regarding the demand elasticities for veterinary services, while qualitative choice models are better suited to the analysis of determinants behind the choices of farmers. The authors conclude that an urgent need exists for empirical research in this area.     

Para-veterinary professionals and the development of quality, self-sustaining community-based services

Livestock are a major asset for rural households throughout the developing world and are increasingly regarded as a means of reducing poverty. However, many rural areas are characterised by limited or no accessibility to veterinary services. Economic theory indicates that primary level services can be provided by para-veterinary professionals working as private operators and as an outreach component of veterinary clinics and pharmacies in small urban centres. Experience from the development of community-based animal health worker (CAHW) systems indicates that these workers can have a substantial impact on livestock morbidity and mortality through the treatment or prevention of a limited range of animal health problems. Factors for success include community involvement in the design and implementation of these systems, and involvement of the private sector to supply and supervise CAHWs. Examples of privatised and veterinary supervised CAHW networks are cited to show the considerable potential of this simple model to improve primary animal health services in marginalised areas. An analysis of constraints indicates that inappropriate policies and legislation are a major concern. By referring to the section on the evaluation of Veterinary Services in the OIE (World organisation for animal health) Terrestrial Animal Health Code, the paper proposes guidelines to assist governments in improving the regulation, quality, and co-ordination of privatised, veterinary supervised CAHW systems.     

Eastern Europe and the former Union of Soviet Socialist Republics: animal health systems in transition

The economic transition in Eastern Europe and the former Union of Soviet Socialist Republics (USSR) during the last decade has profoundly changed the agricultural sector and the well-being of people in rural areas. Farm ownership changed; selected farm assets, including livestock, were transferred to farm workers or others, and the social and service structures of rural society are in a state of uncertainty. The transition has, in general, led to the deterioration of rural services. Animal health services have also deteriorated. This decline is associated with the contraction of the livestock inventory, the fragmentation of farms, higher transaction costs for service providers, and the overall decline of the rural economy which has, so far, lowered the demand for animal health services. There are considerable differences in the way that these countries are coping with the economic transition and its aftermath. Among the determining factors in the former USSR are, as follows: the speed of recovery from the legacies of large State-controlled farming and a centrally planned animal health system, the efforts made to address poverty reduction, the choice on whether to become a Member of the World Trade Organization and the requirements of such membership, the ability to provide low-cost services to a fragmented and unskilled livestock production sector. In Eastern Europe, the requirements for joining the European Union (EU) are an additional and important determining factor. In the short term, the choice of a veterinary system to serve the livestock sector may differ from country to country, depending on the legacies of the past, the status of reforms and the proximity of Western markets. Lower-income countries with an oversupply of veterinarians may support labour-intensive, low-cost systems which focus on food security and public health. The better-endowed EU accession countries may focus rather on improved disease surveillance, production enhancement, quality assurance and increased food safety. Such choices may also determine the investment made by these countries in upgrading their State system, laboratories and veterinary education facilities.     

The emerging animal health delivery system in the People's Republic of China

Livestock production in the People's Republic of China has expanded at an unprecedented rate over the last decade and this trend is expected to continue into the foreseeable future. Government and private sector investment supports this growth, and the fact that small farmers are incorporating more animal husbandry into their work is expected to mitigate some of the concerns over recent World Trade Organization accession, particularly in the more precarious grain growing regions. Modernisation and intensification of the livestock industry in the People's Republic of China is subject to significant risks as regards both infectious and production-related diseases and within the framework of food safety and public health challenges. Although historically, the veterinary service system in the People's Republic of China has been successful in the eradication and control of major disease outbreaks, domestic and international market concerns are providing the catalyst for significant reforms in the animal health delivery system in the country. This paper provides an overview of the existing veterinary system in terms of the education and qualifications of veterinary personnel, delivery mechanisms, and future approaches to reforming the system in the context of a dynamic livestock industry in transition.     

Relations between official and private veterinary services in epidemiology and the control of contagious diseases

Growing budget restrictions in many countries have meant that official Veterinary Services cannot assume responsibility for any new activities. The natural reaction is to turn to private veterinary services to provide the support needed to strengthen the control and surveillance of priority diseases and thereby support the development of the livestock sector and the establishment of safe international trade. In this context, official Veterinary Services must work together with private veterinarians, delegating various technical animal health activities, so that they may focus their efforts on those tasks that cannot be delegated: standardisation, control, auditing, general system co-ordination, epidemiological surveillance, etc., as well as organising veterinary policy in order to make best use of budget resources. For these relations to be efficient, a dynamic, two-way epidemiological information mechanism must be created, whereby private veterinarians periodically keep governments informed, on the basis of an agreed methodology. Moreover, the official Veterinary Services must systematically transmit information on List A and B diseases of the OIE (World organisation for animal health), and perform detailed analyses of epidemiologically significant events. The article proposes the establishment of relations between public and private veterinary services as a way in which to provide the livestock sector with the health and hygiene conditions that are necessary for effective disease control, which in turn provides greater security for international trade and increased consumer protection.     

The economics of the delivery of veterinary services.

Low livestock productivity in many developing countries is commonly considered to reflect, among other factors, the inadequate supply of services to control disease. Veterinary services have traditionally been provided by the state, but public finance constraints have limited the availability and effectiveness of public services. The author explains how economic theory can be used to identify alternative delivery systems (beyond the state) for providing animal health care and proposes new roles for the state and private sector in service delivery. The author highlights a number of barriers that currently limit the potential contribution of the private sector to service delivery, and describes a variety of approaches that have been used by the state to create an enabling environment for the private sector.     

The new institutional economics of privatising veterinary services in Africa.

The authors review a number of critical issues in the structural reform of animal health services for both small and non-commercial livestock producers in Africa and highlight several problems that others concerned with the privatisation of this service area have tended to neglect. Most notably, attention is called to the following: a) the need to retain a central role for paraprofessionals in the new delivery system b) the important and problematic relationship between the veterinary and paraveterinary professions c) the importance of developing state contracting procedures for assisting the private delivery of animal health services that will avoid the problems of local monopoly d) the central role that professionalism will have to play in this area, if collective goods and the public interest are to be served.     

Privatisation of veterinary services in Jamaica: a case study

Clinical veterinary services were privatised in Jamaica in September 1992. Using the limited official data, the authors briefly examine the premise and logistics behind transferring the responsibility for clinical services, which may be regarded as 'a private good', to private veterinary practitioners. There are indications that this privatisation model can work for farmers, despite financial problems in the livestock industry and a decline in production, caused by trade liberalisation policies and the substitution of cheaper imports. In addition, other national fiscal problems, such as a downturn in the economy, have left veterinarians attempting to boost production in a livestock industry which lacks adequate financial structuring and resources. The authors express concern that various unpublished projections since the last official agricultural survey in 1996 indicate that the livestock industry in Jamaica is diminishing. It is possible that valuable genetic breeding stock may never recover. A comprehensive study of the future of the livestock industry and its associated services is strongly urged. Ten years after the event, the authors reflect on the privatisation of clinical veterinary services in Jamaica and offer some suggestions to improve on the quality of the services offered by private veterinary practitioners.     

Economic impact of animal diseases on production systems in South America: case studies]

The authors discuss the relative importance of the livestock sector in South America, in developing countries and in countries world-wide. The development of animal health services is highlighted and the new challenges which these services must meet, with respect to the restructuring of international trade, are described. The economic impact of animal diseases and of disease control is evaluated by taking a regional approach and by analysing production systems. A classification of production systems is accompanied by case studies on the economics of animal health. Emphasis is placed on national control programmes, diseases which affect reproduction, parasitic diseases and mastitis, with particular reference to the livestock sector of Colombia. The authors suggest that integrated livestock development programmes include the management of animal health and production information. A change of attitude is also recommended with greater participation of those involved. The need to co-ordinate sustained research initiatives is stressed.     

The inception and development of basic animal health systems: examples of German development co-operation

About thirty years ago the financial, logistic and manpower resources of veterinary and animal production services in the developing world were stretched to the limit. Epizootic disease control was their main and often only field activity, which left livestock owners to manage their daily production and health problems alone. To meet their requirements, Veterinary Services in these countries came under increasing public and political pressure to modify and adjust their approaches. This gave rise to a series of workshops in Africa (e.g. Bujumbura in Burundi and Blantyre in Malawi) and South-East Asia (e.g. Singapore, and Khon Kaen in Thailand), most of which were organised and facilitated by the German Agency for Technical Co-operation (GTZ) in close collaboration with French and British development co-operation agencies and universities. These workshops stimulated discussion with the key stakeholders and, thus, were most beneficial in supporting the process of developing alternative approaches. This paper reports in particular on the outcomes of the regional workshops held in Bujumbura, Burundi, in 1984, Blantyre, Malawi, in 1985, Bangui, Central African Republic, in 1988, Khon Kaen, Thailand, in 1989, Schmitten, Germany, in 1991, and Mzuzu, Malawi, in 1996 and 2000. For more than two decades, concepts of community-based livestock services in general, and primary animal health activities (PAHAs) in particular, have been developed and established in various developing countries. Over the years the PAHA concept has proved to be effective and has shown that livestock-keeping communities clearly benefit from such programmes. In presenting key features from some prominent and successful project examples (GTZ-supported projects in Thailand, Malawi and Somalia) it can be demonstrated that such approaches are not static but rather dynamic, requiring open minded innovative partners on both sides. Over the last few years, the delivery of PAHA has become the domain of non-governmental organisations. The propagation and application of this approach in various developing countries with limited veterinary infrastructure is supporting a privatisation process within the existing governmental veterinary structures, thus, allowing veterinary departments more freedom to focus on their core functions.     

Human and animal vaccination delivery to remote nomadic families, Chad

Vaccination services for people and livestock often fail to achieve sufficient coverages in Africa's remote rural settings because of financial, logistic, and service delivery constraints. In Chad from 2000 through 2005, we demonstrated the feasibility of combining vaccination programs for nomadic pastoralists and their livestock. Sharing of transport logistics and equipment between physicians and veterinarians reduced total costs. Joint delivery of human and animal health services is adapted to and highly valued by hard-to-reach pastoralists. In intervention zones, for the first time approximately 10% of nomadic children (> 1-11 months of age) were fully immunized annually and more children and women were vaccinated per day during joint vaccination rounds than during vaccination of persons only and not their livestock (130 vs. 100, p < 0.001). By optimizing use of limited logistical and human resources, public health and veterinary services both become more effective, especially at the district level.     

The National Order of Veterinary Doctors of Madagascar and the quality control of private veterinarians

Veterinary medicine was introduced into Madagascar with the arrival of French settlers in the early 1900s. At first, veterinary practitioners were all French, and they trained Madagascan veterinary auxiliaries. The first Madagascan veterinarians were trained in French veterinary schools. The idea of organising the profession dates back to the 1970s, but only in 1991 was the Animal Health Law, covering the veterinary profession, adopted by the National Assembly; it was promulgated by President Ratsiraka on July 25 of that same year. Thus, the National Order of Veterinary Doctors of Madagascar (ONDVM: Ordre national des docteurs vétérinaires malagasy) was instituted by a decree in February 1992. All veterinarians and paraprofessionals were employed in the public sector at the time and this new structure proved vital for the private exercise of the veterinary profession. With the adoption of a new national livestock policy, vaccination against major cattle and swine diseases became a profitable activity. One of the objectives of the sectoral livestock programme was that a total of 90 new posts for veterinarians should be created and located throughout the different regions and rural townships of the country. The Centre de promotion vétérinaire (Centre for Veterinary Promotion), which was created in 1992, was the organisation charged with carrying out this task. In 1998, once the private veterinarians were installed, a survey was undertaken with the aim of making an exhaustive assessment of all private veterinarians, collecting data from the public veterinary stations in zones covered by private veterinarians, and establishing a programme of disengagement and withdrawal of the decentralised services, particularly the public veterinary stations. More recently, the Administration and the ONDVM have been facing various organisational problems, notably with regard to the different levels of animal health staff working in the field. Thus, the Order is currently waging a mobilisation and awareness campaign for the adoption of a new animal health law. All new measures would be aimed at strengthening the management of artificial insemination centres and border protection and improving the work of all those involved in animal health: official and private veterinarians and members of the Order of Veterinary Doctors and the Order of Veterinary Paraprofessionals.     

Challenges and options for animal and public health services in the next two decades

Trade in livestock and livestock products makes up approximately one sixth of global agriculture trade. This trade is demand driven, primarily by growing human populations, changing economies, and consumer preferences in developing countries. Different rates of population growth, economic growth, urbanisation, environmental sustainability, and technology transfer will determine which countries will reap the greatest benefits. Global trends in demand and supply for food, not terrorism, will drive the future of animal and public health service delivery. To benefit the greatest number of people and countries, animal and public health services should support policies that temper growing disparities among rich and poor countries, city and rural populations, and the sexes. Economic growth is critical to overcoming disparities between countries and best supported by integrated animal health, public health, labour, and foreign policies. Opportunities for job growth will be the greatest along the value added chain of food production and will require significant investments in science- (risk-) based education.     

The need for research to support the emergence of alternative animal health systems

Animal diseases remain one of the main problems for livestock production in terms of trade development, poverty reduction and public health. Animal health systems are complex because of the diversity of the parties involved and because of various changes in the delivery of veterinary services, such as the redefinition of the roles of the public and private sectors. It is, therefore, often difficult to assess the global performance of animal health systems and sub-systems in terms of their medical, economic and social effectiveness. In addition, the necessary reliability of the health information obtained leads to certification of the status of regions and countries with regard to epizootics, which requires a high degree of standardisation and conformity with international norms. An assessment therefore needs to be made of the advantages of alternative systems compared with conventional systems. An animal health system should be seen as a whole, and when assessing its overall performance several things must be taken into account, e.g. the markets for products and the sometimes contradictory interests of all the different parties involved. There are, therefore, many research needs and avenues to be pursued, including: the methods, data and tools required for assessing the effectiveness of systems, including a definition of what constitutes a reliable indicator; the factors that determine the health of a herd; having a clearer idea of what will affect herd health will make it possible to map risk indicators and animal health care needs; the design and management of realistic and harmonised animal health information systems whose indicators provide reliable measurements of health; the function, organisation and effectiveness of participative surveillance approaches; the definition and effectiveness of animal health contracts, such as health mandates between the State and private veterinarians; the function and role of livestock auxiliaries; the establishment of assessment methods and standards that take into account the specific situation of southern countries that could lead to the certification and accreditation of alternative systems. The efficiency of these systems must then be tested (direct impact, cost-benefit studies) using the above-mentioned indicators, and an implementation 'toolkit' can then be assembled, taking into account the local differences which will affect the suitability of each system for different locations. Research into the assessment of animal health systems is a long-term investment, but it ensures that quality certification is reliable and allows for the safe development of animal product markets.     

The livestock vaccine supply chain: Why it matters and how it can help eradicate peste des petits Ruminants,based on findings in Karamoja,Uganda

Understanding factors that hinder vaccination, including logistical and social constraints, is critical to finding the most effective approach for the global eradication of peste des petits ruminants (PPR). Vaccination projects should analyze the supply chain and take it into consideration when planning and creating a vaccination strategy. Adequate supply chain management of the PPR vaccine could lead to reduced cost, increased availability, and the construction of a data platform for other livestock vaccines. Integrating the supply chain of PPR vaccine with other veterinary or health commodities could reduce cost, as well as increase uptake. The use of a thermostable vaccine could potentially have a positive impact on the eradication of PPR in remote areas, such as the Karamoja subregion in Uganda, as it did with rinderpest across Sub Saharan Africa. In terms of vaccine delivery, the use of community animal health workers (CAHWs) could be beneficial in certain areas, such as the Karamoja subregion of Uganda, by alleviating supply chain constraints in the last-mile delivery, as well as increasing coverage and uptake. A gendered approach to livestock vaccines should also be considered, as decision-making power regarding livestock vaccination is gendered in many various contexts. The PPR eradication strategy—as well as other livestock vaccination programs—would be more effective and efficient if the supply chain management were considered as a key component in the process and efforts tailored, accordingly.     

The challenges for surveillance and control of zoonotic diseases in urban areas

The world is rapidly changing in many aspects concerning veterinary medicine, and man-animal relationships in urban areas represents a real challenge for the profession. Unlike the vertical approach of the academic teaching tradition, veterinary urban hygiene needs a strong holistic-epidemiologic support. Year by year, new animals, new animal uses, new fashions, new zoonoses, and new problems appeared amplified by media with the duty of the public veterinary services to solve them. The practical experience of many years of these continuous challenges is now concentrated on a new health sector: urban veterinary hygiene that now calls for a multidisciplinary and intersectoral collaboration with other professional categories to guarantee human, animal and environment health.