Abstract
Background
Community animal health services in low‐income countries aim to improve the health of animals and directly improve the wealth and health or livelihood of their owners. These services have been promoted by aid organizations since the 1970s.
Objectives
To summarize reliable research of community animal health services on indicators for household wealth and health.
Search methods
We searched the Cochrane Infectious Diseases Group Specialized Register (January 2011), CENTRAL (The Cochrane Library 2010, Issue 4), MEDLINE (1966 to January 2011), AGRIS (1975 to January 2011), Science Citation Index (2000 to January 2011), STN SIGLE database (1976 to 2011), and AGRICOLA (January 2011). We contacted relevant researchers and organizations, and also checked the reference lists of articles.
Selection criteria
Randomized controlled trials and controlled before‐and‐after studies comparing community animal health services with no community animal health services or with an alternative animal health service.
Data collection and analysis
We independently assessed studies for inclusion in the review.
Main results
No studies met the inclusion criteria.
Authors' conclusions
Well‐designed randomized controlled trials or controlled before‐and‐after studies that use standard pragmatic outcomes are needed to evaluate the positive results reported by observational studies.
23 April 2019
Update pending
Studies awaiting assessment
The CIDG is currently examining a new search conducted in April 2019 for potentially relevant studies. These studies have not yet been incorporated into this Cochrane Review.
Keywords: Animals; Humans; Animals, Domestic; ; Animal Husbandry; Animal Husbandry/organization & administration; Community Health Services; Community Health Services/organization & administration
Plain language summary
Community animal health services for improving household wealth and health status of low‐income farmers
Livestock are central to the household economy for some communities in low‐income and middle‐income countries. The availability of basic veterinary services could contribute to the wealth and health of households by preventing animal illness or death. In most low‐income countries in Africa, Asia, and Latin America, the state provided free veterinary services during the years in which countries were colonized, and for some time after their independence. However, since the 1960s privately (or self) employed veterinarians are slowly replacing government veterinary services. Privatized veterinary services, modelled on European or North American systems, have had mixed success in that they seem to have worked well in urban areas, but not in remote arid and semi‐arid areas of the world, where livestock herding is very extensive and people do not have money to pay for the services. While the provision of community animal health services seems common sense, very no well‐designed randomized controlled trials nor any controlled before‐and‐after studies have evaluated its impact. Such studies are needed to substantiate the positive results reported it several observational studies.
Background
Livestock are central to the household economy for some communities in low‐income and middle‐income countries. The availability of basic veterinary services could contribute to the wealth and health of households by preventing animal illness or death. Since the 1970s, governmental and nongovernmental organizations have provided resources for low‐income countries to implement community animal health services. Low‐income farmers are defined as farmers earning less than 755 USD per year.
History of community animal health services
In most low‐income countries in Africa, Asia, and Latin America, the state provided free veterinary services during the years in which countries were colonized and for some time after their independence (Schillhorn 1995). However, since the 1960s there has been a decrease in public sector funding, which also affected veterinary services (Odeyemi 1994). In the 1980s and 1990s, the World Bank and International Monetary Fund encouraged national governments to privatize a large proportion of state services, including the veterinary services (Leonard 1993). Privately (or self) employed veterinarians replaced the government veterinary services.
Privatized veterinary services, modelled on European or North American systems, have been established in some parts of the world with more or less success (Malabar Regional Cooperative Milk Production Union, personal communication, 1999). They have worked especially well in urban areas (Mpelumbe 1994). They have not worked well in remote arid and semi‐arid areas of the world, where livestock herding is very extensive and people do not have money to pay for the services (Odeyemi 1994). Before privatization, the state run service and governments trained a hierarchy of locally recruited veterinary auxiliaries or veterinary scouts, the original community animal health service. These were people who received up to three years training in animal health and disease surveillance, and were responsible for dispensing animal health care and for notifying the veterinary authorities of disease outbreaks. As the funding decreased, many of these veterinary auxiliaries and scouts were made redundant and turned to other employment.
The benefits of these community animal health services have since been recognized. Governmental and nongovernmental organizations, working in collaboration with national government livestock and veterinary departments, have revived the concept of the community animal health worker as deliverer of community animal health services in remote rural areas (Huttner 2000). Typically in these community animal health services, the community animal health worker does not receive a salary from the state but is given money through the programme for a limited time. The aims are for the community animal health worker to make a living by selling his or her livestock services, and the programmes to become self‐sustaining. These community animal health workers go by many different names, such as 'community (based) animal health workers', 'paravets', 'barefoot vets', or 'animal health auxiliaries'. Their skills vary according to their training but generally include correct administration of vaccines, antibiotics, anthelmintic drugs, acaricidal drugs, and trypanocidal drugs in addition to husbandry, nutrition, and management knowledge (Hadrill 1982). The community animal health worker is usually provided with a start‐up kit of veterinary drugs and equipment and is supported by the establishment of a rural pharmacy to replenish stocks (Muir 1999).
Community animal health workers have been delivering community animal health services in Africa, Asia, and Latin America since the 1970s. While the provision of community animal health services seems common sense, very little work has evaluated its impact. The organizations that train and support the community animal health workers have been monitoring their work and attempting to evaluate the extent of their impact on the health of livestock and on the welfare of farmers (Matti 2000). Until this Cochrane Review there was no systematic analysis of the evaluation and impact assessment reports of community animal health services. This means we did not know the extent of the impact of the community animal health workers on farmers and their livestock.
Benefits and harms
Community animal health services can help farmers who rely heavily or exclusively on livestock for their income by keeping the animals healthy and productive. For example, community animal health workers can treat livestock for chronic conditions such as worms or tick infestations that decrease the animals' productivity. They can also vaccinate herds against diseases that can kill entire herds, such as rinderpest.
Community animal health services could also be harmful to vulnerable farmers. The community animal health workers must attempt to make a living from selling their services, which include veterinary drugs. They may attempt to sell the farmer drugs that he does not need, increase the cost of the drugs, or dilute the drugs in order to make or save money. The community animal health service may draw farmers away from using traditional medicines (ethnoveterinary medicines) in order to make money from encouraging the use of conventional medicines. The loss of indigenous knowledge is culturally harmful. This review summarizes the available evidence on the effects of community animal health services from randomized controlled trials and controlled before‐and‐after studies. We have summarized relevant information from other study designs in a separate article (Martin Curran 2002b).
Objectives
To summarize reliable research of community animal health services on indicators for household wealth and health.
Methods
Criteria for considering studies for this review
Types of studies
Individual, cluster, and quasi‐randomized controlled trials; controlled before and after studies.
Types of participants
Communities in low‐income countries that keep livestock (includes cattle, sheep, goats, camels, llama, pigs, poultry). Low‐income countries have a gross national income (GNI) per capita of 755 USD or less (World Bank 2002).
Livestock keepers can include settled farmers, nomadic and semi‐nomadic herders, pastoralists, and agro‐pastoralists. Livestock keepers include the head of the household, his or her family, and the community or extended family amongst whom they live.
Types of interventions
Intervention
Content: Basic preventive and curative animal health services provided by a community animal health worker. This includes all paravet practices, such as vaccination, castration, and drug administration, with or without extension (health, nutrition, and husbandry messages).
Provider: Community animal health services may be delivered by government or nongovernmental organizations with or without the support of multilateral or bilateral donors.
Other characteristics: These services may be initiated as projects or programmes of finite time. Services may be provided free or for a charge.
We exclude animal health services provided by qualified veterinarians (public or private), traditional animal health services provided by a healer or other person, and extensions where it is provided by an extension worker who is salaried and not expected to recover cost of veterinary drugs.
Control
No community animal health services or alternative animal health services.
Types of outcome measures
Primary
1. Livelihood indicators
Number of children sent to school.
Monthly household expenditure.
Monthly household income.
Possession of consumer goods such as radio, bicycle, or vehicle.
2. Health indicators
Nutritional status of children under five years old.
Infant mortality rate.
Secondary
3. Productivity indicators
Livestock productivity (products sold, such as animals, milk, eggs).
4. Animal health indicators
Livestock mortality.
Livestock fertility (interbirth intervals).
Livestock illness episodes (morbidity).
5. Implementation indicators
Number of animals seen.
Number of visits.
Workers active two years after programme started.
Quantity of drugs sold.
Number of community animal health workers trained.
6. Adverse events
Search methods for identification of studies
We attempted to identify all relevant studies regardless of language or publication status (published, unpublished, in press, and in progress).
Databases
We searched the following databases using the search terms and strategy described in Appendix 1: Cochrane Infectious Diseases Group Specialized Register (January 2011); Cochrane Central Register of Controlled Trials (CENTRAL), published in The Cochrane Library (2010, Issue 4); MEDLINE (1966 to January 2011); AGRIS (1975 to January 2011); Science Citation Index (2000 to January 2011); STN SIGLE (1976 to 2011); and AGRICOLA (US National Agricultural Library; accessed January 2011).
Researchers and organizations
We searched the websites listed in Appendix 2 between July and September 2000. For unpublished and ongoing studies, we contacted individual researchers working in the field and organizations including those listed in Appendix 3 during August and September 2000.
Reference lists
We also checked the reference lists of all studies identified by the above methods.
Data collection and analysis
The first author scanned the results of the literature search for potentially relevant studies. Both authors independently assessed eligibility of these studies using the full articles and an eligibility form based on the inclusion criteria. Paul Garner (Co‐ordinating Editor of the Cochrane Infectious Diseases Group) assisted us where there were uncertainties.
No studies met the inclusion criteria. Should we identify any eligible studies we will use the methods outlined in our protocol to assess their methodological quality, extract data, and analyse the data.
Results
Description of studies
We identified 19 potentially relevant studies (14 from the search for the original review (Martin Curran 2002a) and the rest from search updates), but none met the inclusion criteria (see 'Characteristics of excluded studies'). The 14 studies excluded in the original version of the review have been summarized elsewhere (Martin Curran 2002b).
Risk of bias in included studies
No studies met the inclusion criteria.
Effects of interventions
No studies met the inclusion criteria.
Discussion
Although no studies met the inclusion criteria, we summarized the available evidence from the 14 studies excluded in the original version of this review in Martin Curran 2002b. These studies generally reported that community animal health services can have a positive impact on human health and wealth, and animal health and productivity, but they were generally of low methodological quality and used a range of outcomes and study designs. Given the amount of money and time invested in this area, and the potential benefits for low‐income communities, funders and implementing agencies should insist that future studies should be well designed and use common pragmatic outcomes. The studies should also use a framework to determine whether community animal health services are a cost effective way of improving health in low‐income communities dependent on livestock.
Authors' conclusions
Implications for practice.
The use of community animal health services for improving human health and wealth has not been evaluated in a well‐designed randomized controlled trial or before‐and‐after study, and therefore, is not supported by reliable evidence.
Implications for research.
Well‐designed randomized controlled trials or controlled before‐and‐after studies that use standard pragmatic outcomes are needed to evaluate the positive results reported by observational studies.
What's new
| Date | Event | Description |
|---|---|---|
| 13 April 2011 | New search has been performed | New search conducted; one study found and excluded |
History
Protocol first published: Issue 4, 2001 Review first published: Issue 4, 2002
| Date | Event | Description |
|---|---|---|
| 5 August 2008 | Amended | Converted to new review format with minor editing. |
| 6 February 2006 | New citation required but conclusions have not changed | 2006, Issue 2: update following a comprehensive search for new studies. |
Acknowledgements
VETAID, UK for providing the administrative support for this project. Animal Health Programme, UK Department for International Development UK, for providing the financial support for this project. Diane Donaldson of the Moredun Research Institute for helping with the database searches for the original version of the review (Martin Curran 2002a).
Appendices
Appendix 1. Search methods: detailed search strategies for databases
| Search set | CIDG SRa | CENTRAL | MEDLINE | AGRIS | AGRICOLA | Science Citation Index |
| 1 | veterinary | veterinary | animal health | animal health | animal health | animal health |
| 2 | animal* | animal* | animal disease* | animal disease* | animal disease* | animal disease* |
| 3 | — | — | animal husbandry | animal husbandry | animal husbandry | animal husbandry |
| 4 | — | — | livestock | livestock | livestock | livestock |
| 5 | — | — | draught animal* | draught animal* | draught animal* | draught animal* |
| 6 | — | — | working animal* | working animal* | working animal* | working animal* |
| 7 | — | — | cattle | cattle | cattle | cattle |
| 8 | — | — | poultry | poultry | poultry | poultry |
| 9 | — | — | ruminant* | ruminant* | ruminant* | ruminant* |
| 10 | — | — | 1‐9/OR | 1‐9/OR | 1‐9/OR | 1‐9/OR |
| 11 | — | — | vet* | vet* | vet* | vet* |
| 12 | — | — | paravet* | paravet* | paravet* | paravet* |
| 13 | — | — | animal technician* | animal technician* | animal technician* | animal technician* |
| 14 | — | — | paraprofessional* | paraprofessional* | paraprofessional* | paraprofessional* |
| 15 | — | — | barefoot worker* | barefoot worker* | barefoot worker* | barefoot worker* |
| 16 | — | — | 11‐15/OR | 11‐15/OR | 11‐15/OR | 11‐15/OR |
| 17 | — | — | village | village | village | village |
| 18 | — | — | community | community | community | community |
| 19 | — | — | cooperative extension service | cooperative extension service | cooperative extension service | cooperative extension service |
| 20 | — | — | intermediate service | intermediate service | intermediate service | intermediate service |
| 21 | — | — | pastoral* | pastoral* | pastoral* | pastoral* |
| 22 | — | — | rural development | rural development | rural development | rural development |
| 23 | — | — | farm* | farm* | farm* | farm* |
| 24 | — | — | 17‐23/OR | 17‐23/OR | 17‐23/OR | 17‐23/OR |
| 25 | — | — | livelihood | livelihood | livelihood | livelihood |
| 26 | — | — | income | income | income | income |
| 27 | — | — | returns | returns | returns | returns |
| 28 | — | — | socio‐economic* | socio‐economic* | socio‐economic* | socio‐economic* |
| 29 | — | — | social security | social security | social security | social security |
| 31 | — | — | evaluation | evaluation | evaluation | evaluation |
| 32 | — | — | profitability | profitability | profitability | profitability |
| 33 | — | — | poverty | poverty | poverty | poverty |
| 34 | — | — | 25‐33/OR | 25‐33/OR | 25‐33/OR | 25‐33/OR |
| 35 | — | — | 10 AND 16 AND 24 AND 34 | 10 AND 16 AND 24 AND 34 | 10 AND 16 AND 24 AND 34 | 10 AND 16 AND 24 AND 34 |
aCochrane Infectious Diseases Group Specialized Register.
Appendix 2. Search methods: websites
| Name | Website address |
| Africa Online | www.africaonline.com |
| African Development Bank Group | www.afdb.org |
| Canadian Hunger Foundation ‐ Partners in Rural Development | www.partners.ca |
| Care | www.care.org |
| Centre for Information on Low External Input Sustainable Agriculture (ILEIA) | www.ileia.org |
| Centro de Estudios Uruguayo de Tecnologias Apropiadas (CEUTA) | fp.chasque.apc.org:8081/ceuta |
| Decentralised Livestock Services in Eastern Indonesia (DELIVERI) | www.deliveri.org |
| ELDIS (Gateway to Information Sources on Development and the Environment) | www.eldis.org/index.htm |
| Food and Agriculture Organization of the United Nations | www.fao.org |
| Ford Foundation | www.fordfound.org |
| Global Forum on Agricultural Research (GFAR) | www.egfar.org |
| International Development Research Centre (IDRC) | www.idrc.ca |
| International Fund for Agricultural Development (IFAD) | www.ifad.org |
| International Livestock Research Institute | www.cgiar.org/ilri |
| Kenyaweb Agriculture | www.kenyaweb.com/agriculture |
| New Agriculturalist | www.new‐agri.co.uk |
| One World.net | www.oneworld.net |
| Overseas Development Institute (ODI) | www.odi.org.uk |
| Pan Asia Networking (The Asian E‐Development Community) | www.panasia.org.sg |
| Sustainable Rural Development Information System (SRDIS) | srdis.ciesin.columbia.edu |
| Technical Centre for Agricultural and Rural Co‐operation | www.agricta.org |
| US Department of Agriculture | www.usda.gov |
| World Bank | www.worldbank.org |
Appendix 3. Search methods: organizations
| Organization |
| Action Against Hunger |
| ActionAid |
| Adventist Development and Relief Agency |
| African Muslim Agency |
| Africare |
| Agency for Development Cooperation and Research |
| Care International |
| Catholic Relief Services |
| Development Aid from People to People; |
| German Agro Action |
| Institut d'Elevage et de Médecine Vétérinaire des Pays Tropicaux (IEMVT) |
| Lutheran World Federation |
| Norwegian Peoples Aid |
| Oxfam |
| Società Italiana di Veterinaria e Zootecnica Tropicale per la Cooperazione Internazionale ‐ VSF Italia (SivTro) |
| Vetaid |
| Vétérinaires Sans Frontières, Belgium |
| Vétérinaires Sans Frontières, France |
| Vétérinaires Sans Frontières, Switzerland |
| Vetermon |
| Vetwork, UK |
| War on Want |
| World Vision International |
Characteristics of studies
Characteristics of excluded studies [ordered by study ID]
| Study | Reason for exclusion |
|---|---|
| Admassu 2005 | Study design |
| Allport 2005 | Incorrect outcomes |
| Catley 1996 | Study designa |
| Dupont 2003 | Study design |
| Grandin 1991 | Study designa |
| Hadrill 1982 | Study designa |
| Huttner 2000 | Study designa |
| Jones 1999 | Study designa |
| Lohr 1986 | Study designa |
| Mariner 1994 | Study designa |
| Moktan 1990 | Study designa |
| Morris 1989 | Study designa |
| Mugunieri 2004 | Study design |
| Odhiambo 1998 | Study designa |
| Sanaag CBO 1999 | Study designa |
| Schreuder 1996 | Study designa |
| Schreuder 1998 | Study designa |
| Tibbo 1998 | Study designa |
| Young 1994 | Study designa |
*See Martin Curran 2002b for further information.
Differences between protocol and review
2002, Issue 4 (original review): HG MacLehose joined the review team; rephrased the objectives; cohort studies no longer included; slight revision of the wording of the 'Types of participants'; extended and updated the search dates; modified methods to take into account new Cochrane Infectious Diseases Group guidelines.
Contributions of authors
Marina Martin Curran searched the internet and contacted relevant persons in the field to try and elicit new studies. Harriet G MacLehose helped assess the studies and prepared the update of the review.
Sources of support
Internal sources
Liverpool School of Tropical Medicine, UK.
External sources
Department for International Development, UK.
Declarations of interest
Between 1997 and 2001, Marina Martin Curran was employed by VETAID, an organization that trains and supports community animal health workers in low income countries.
Harriet G MacLehose: none known.
Unchanged
References
References to studies excluded from this review
Admassu 2005 {published data only}
- Admassu B, Nega S, Haile T, Abera B, Hussein A, Catley A. Impact assessment of a community‐based animal health project in Dollo Ado and Dollo Bay districts, southern Ethiopia. Tropical Animal Health and Production 2005;37(1):33‐48. [DOI] [PubMed] [Google Scholar]
Allport 2005 {published data only}
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Dupont 2003 {published data only}
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Grandin 1991 {published data only}
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Hadrill 1982 {published data only}
- Hadrill D. Training of community animal health workers: a review. ITDG Agriculture Animal Health Working Group 1982.
Huttner 2000 {unpublished data only}
- Huttner K. Impact assessment of a community‐based animal health service program in Northern Malawi [MSc thesis]. New Zealand: Massey University, 2000. [Google Scholar]
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Lohr 1986 {unpublished data only}
- Lohr KF, Bhannasiri T, Aranyakamanda P, Meemark N, Choochandra T, Leidl K. Farmers' self‐help basic animal health service in north‐east Thailand. Proceedings of the Fifth International Conference on Livestock Production and Diseases in the Tropics. 1986 Aug 18‐22; Kuala Lumpur. 1986:235‐9.
Mariner 1994 {published data only}
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Moktan 1990 {unpublished data only}
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Morris 1989 {unpublished data only}
- Morris RS, Meemark N. Factors influencing adoption of the basic animal health service. Proceedings of the International Seminar on Animal Health and Production Services for Village Livestock. 1989 Aug 2‐9; Khon Kaen, Thailand. 1989:383‐98.
Mugunieri 2004 {published data only}
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Sanaag CBO 1999 {unpublished data only}
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Schreuder 1996 {published data only}
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- Tibbo K. Dairy goat and animal healthcare project: Meru and Tharaka‐Nithi Districts, Kenya. FARM Africa, UK 1998.
Young 1994 {published data only}
- Young J, Stoufer K, Ojha N, Dijkema HP. Case study: animal healthcare training, Nepal's animal health improvement training programme. London: Intermediate Technology, 1994. [Google Scholar]
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Leonard 1993
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Muir 1999
- Muir A. The Participatory Animal Health Project, Simanjiro District, Tanzania: Review. Vetaid UK 1999.
Odeyemi 1994
- Odeyemi IA. A review of the policy to privatise animal health delivery services in Nigeria. University of Edinburgh 1994.
Schillhorn 1995
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References to other published versions of this review
Martin Curran 2002a
- Martin Curran M, MacLehose HG. Community animal health services for improving household wealth and health status of low income farmers. Cochrane Database of Systematic Reviews 2002, Issue 4. [DOI: 10.1002/14651858.CD003049.pub2] [DOI] [PMC free article] [PubMed] [Google Scholar]
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