Acknowledgements First, my deepest appreciation goes to all community members who participated, for their patience and active participation in the impact assessment exercise that took more than 3 hours per informant group.

I would also like to thank Dr Berhanu Admassu for his technical contribution during the preparation and planning of the work. I am grateful to Dr. Tarekegne Tolla and Jateni (SC/US staff) for the technical and logistical support during the month of field work. Without Dr. Tarekegne’s presence the coordination and management of the logistical aspects of the mission would have not been possible.

I would also like to thank all field staff of (SC/US, CARE & LVIA) for their major contributions to the implementation of the review and impact assessment. I also appreciate Abdullahi Sandoll (Area Manager, SC/US Somali) for logistical support provided in Dollo Ado, Hargelle, and particularly in Moyale. Finally, I would like to thank Dr. Andy Catley and Mr. Adrian Cullis for reading the draft report and commenting on it.

Table of Contents

Executive Summary ...... I

Section 1. Introduction ...... 1

Section 2. Methodology ...... 3

Section 3. Relevance of the Community-based Animal Health program ...... 5

Section 4. Review of the Programs' approach ...... 8 4.1 Designing and planning if CAHWs system ...... 8 4.2 Selection if CAHWs ...... 10 4.3 CAHWs training and technical support ...... 11 4.4 CAHWs performance ...... 17 4.5 CAHWs Cooperatives ...... 22 4.6 Monitoring and Evaluation of the CBAHWs Program ...... 25 4.7. Sustainability and exit strategy if the CBAHWs Program ...... 27 4.7.1 Policy issues ...... 27 4.7.2 Stakeholders' participation ...... 27 4.7.3 Social sustainability ...... 31 4.7.4 Technical sustainability ...... 31 4.7.5 Financial sustainability ...... 33 4.7.6. Conflict ...... 34

Section 5. SWOT analysis ...... 35

Section 6: Impact of the CAHWs Program ...... 39 6.1 Changes in the livestock health status ...... 39 6.1.1 Change in general livestock health status 'Before' and 'After' the project ...... 39 6.1.2 Change in specific disease incidence and mortality after the CAHWs activity ...... 41 6.1.3 Attributes to the observed changes in livestock health ...... 53 6.2 Impact on the animal health service delivery system ...... 55 6.3 Impact on livestock herders' welfare ...... 61

Section 7. Conclusion and Recommendations ...... 69

Annexes Annex 1. Terms of Reference for an Animal Health Review and Impact assessment as part of the LEAP Mid-Term Review ...... 71 Annex 2. Itinerary for field visit and persons met ...... 74 Annex 3. List of Kebele (PAs) included in the assessment ...... 75 Annex 4. CAHWs Performance Evaluation form ...... 76 Annex 5. Stakeholders' participation analysis form ...... 77 Annex 6. Results of Livelihood and vulnerability analysis ...... 79 Annex 7. Case study on the impact of conflict ...... 81 Annex 8. List of documents consulted ...... 83

List of figures Figure 1 Sustainable livelihood framework...... 5 Figure 2. Relative technical competence of CAHWs in Dollo Ado and Hargelle impact area ...... 18 Figure 3. Relative technical competence of CAHWs in Liben impact area ...... 18 Figure 4. Relative technical competence of CAHWs in CARE impact area ...... 19 Figure 5. Ranges of services provided by CAHWs in Dollo Ado & Hargelle impact areas ...... 20

Figure 6. Ranges of services provided by CAHWs in Liben impact area ...... 21 Figure 7. Ranges of services provided by CAHWs in LVIA impact area ...... 21 Figure 8. Ranges of services provided by CAHWs in CARE impact area ...... 22 Figure 9. Level of community participation at different stages of the CBAHWs project in Dollo Ado, Hargelle, Moyale and Liben impact area ...... 28 Figure 10. Level of community participation at different stages of the CBAHWs project in CARE impact area ...... 30 Figure 11. An example of community based privatized animal health network ...... 33 Figure 12 Change in the disease impact score for all livestock disease in Dollo & Hargelle impact areas...... 39 Figure 13 Change in the disease impact score for all livestock disease in Liben impact area ...... 40 Figure 14 Change in the disease impact score for all livestock disease in LVIA impact area ...... 40 Figure 15 Change in the disease impact score for all livestock disease in CARE impact area ...... 41 Figure 16 Community perceptions of changes in cattle disease impact after CAHWs Program in Dollo Ado & Hargelle impact areas ...... 42 Figure 17. Community perceptions of changes in sheep & goat diseases impact after CAHWs Program in Dollo Ado & Hargelle impact areas ...... 43 Figure 18. Community perception of changes in camel disease impact after CAHWs Program in Dollo Ado & Hargelle impact areas ...... 43 Figure 19. Community perceptions of changes in cattle disease ...... 45 Figure 20. Community perceptions of changes in sheep & goat diseases impact after CAHWs Program in Liben impact area ...... 46 Figure 21. Community perceptions of changes in camel diseases impact after CAHWs Program in Liben impact area ...... 47 Figure 22 Community perceptions of changes in cattle disease impact after CAHWs Program in LVIA impact area ...... 48 Figure 23 Community perceptions of changes in sheep & goat...... 49 Figure 24 Community perceptions of changes in camel disease impact after CAHWs Program in LVIA impact area ...... 49 Figure 25 Community perceptions of changes in cattle disease impact after CAHWs Program in CARE impact area ...... 51 Figure 26 Community perceptions of changes in sheep & goat disease impact after CAHWs Program in CARE impact area ...... 52 Figure 27 Community perceptions of changes in camel disease impact after CAHWs Program in CARE impact area ...... 52 Figure 28. Matrix scoring of animal health service providers in Fiko PA in Dollo Ado Woreda ...... 55 Figure 29. Benefits derived from improved animal health ...... 61 Figure 30. Household milk distribution 'before' and 'after' project in Dollo Ado & Hargelle impact areas ...... 62 Figure 31 A pick up transporting milk for sale to Mandera (Kenya) ...... 62 Figure 32 Livestock ownership 'before' and 'after' the project in Dollo Ado & Hargelle impact areas...... 63 Figure 33 Benefits derived from improved animal health during the CAHWs Program in Liben impact areas ...... 63 Figure 34. Household milk distribution 'before' and 'after' project in Liben impact areas ...... 64 Figure 35. Livestock ownership 'before' and 'after' the project in Liben impact area ...... 64 Figure 36. Benefits derived from improved animal health during the CAHW Program in LVIA impact area ...... 65 Figure 37 Household milk distribution 'before' and 'after' project in LVIA impact area...... 65 Figure 38 Livestock ownership 'before' and 'after' the project in LVIA impact area...... 66 Figure 39 Benefits derived from improved animal health during the CAHWs Program in CARE impact area ...... 67 Figure 40 Household milk distributions 'before' and 'after' project in CARE impact area...... 67 Figure 41. Livestock ownership 'before' and 'after' the project in CARE impact area ...... 67

List of tables Table 1. Contribution of Livestock to household assets among pastoral and agro-pastoral communities in Somali and Oromia low lands ...... 7 Table 2. Summarized number and type of CAHWs trainings in Dollo and Hargelle impact area ...... 11 Table 3. Summarized number and type of CAHWs trainings in LVIA impact area ...... 14 Table 4. Summary of SWOT analysis carried out in SC/US Dollo Ado & Hargelle impact areas ...... 35 Table 5. Summary of SWOT analysis carried out in SC/US Liben impact areas ...... 36 Table 6. Summary of SWOT analysis carried out in LVIA impact areas ...... 36 Table 7. Summary of SWOT analysis carried out in CARE impact areas ...... 37 Table 8. Disease handled and not handled by CAHWs in Dollo Ado and Hargelle impact area ...... 44 Table 9. Disease handled and not handled by CAHWs in Liben impact area ...... 47 Table 10. Disease handled and not handled by CAHWs in LVIA impact area ...... 50 Table 11 Disease handled and not handled by CAHWs in CARE impact area ...... 53 Table 12 Factors attributed to changes in livestock disease pattern during the project period in Dollo Ado & Hargelle impact area ...... 54 Table 13 Factors attributed to changes in livestock disease pattern during the project period in Liben impact area ...... 54 Table 14 Factors attributed to changes in livestock disease pattern during the project period in LVIA impact area ...... 54 Table 15 Factors attributed to changes in livestock disease pattern during the project period in CARE impact area ...... 55 Table 16 Summarized matrix scoring of animal health service providers in Dollo Ado and Hargelle impact areas ...... 56 Table 17 Summarized matrix scoring of animal health service providers in Liben impact areas ...... 57 Table 18 Summarized matrix scoring of animal health service providers in LVIA impact areas ...... 58 Table 19 Summarized matrix scoring of animal health service providers in CARE impact areas ...... 59

Abbreviations used in the report AFD Action For Development AHO Animal Health Officer AHT Animal Health Technician AU/IBAR African Union – International Bureau for Animal Resource BDRP Borana Drought Recovery Project BVRI Borana Vulnerability Reduction Initiative CAHW Community-Based animal Health Worker CAPE Community-Based Participatory Epidemiology CBAH Community-Based Animal Health CBAHP Community-Based Animal Health Project CBPP Contagious Bovine Pluro Pneumonia CCPP Contagious Caprine Plure Pneumonia DAP Development Activity Program FMD Foot and Mouth Disease HAC Health Action Committee IA Impact Assessment LSD Lumpy Skin Disease LT Laboratory Technician LVIA Lay Voluntary International Association M&E Monitoring and Evaluation MCF Malignanet Catteral Fever MoA Ministry of Agriculture NGO Non Governmental Organization PACE Pan African Control of Epizootics PCAE Pastoralist Concern Association for Ethiopia PCM Project Cycle Management PPR Pest di Petitius Ruminantus PTT Participatory Training Technique SC-US Save the Children – United States SL Sustainable Livelihood SORDU Southern Range lands Development Unit SSI Semi Structured Interview STI LEAP Southern Tier Initiative Livelihood Enhancement for Agro-Pastoralists and Pastoralists SWOT Strength, Weakens, Opportunity and Threats TOR Terms of Reference TOT Training of Trainers VSC Veterinary Supervising Committee W Kendall coefficient of concordance

Executive Summary Background In pastoral areas of Ethiopia, livestock is the most important component of rural livelihoods, contributing to the five asset bases of rural households (human, physical, social, financial, and natural capital). Despite the centrality of livestock to rural livelihoods (contributing 50-63% of livelihoods in the impact areas in southern Oromia and Somali regions), pastoralists often have difficulty accessing animal health care. Traditional medicine and black market drugs may be ineffective, while private veterinary services and government services, while effective, are often not available. In an effort to improve animal health services and boost rural livelihoods, Save the Children/US, working with two partner organizations (Lay Volunteers International Association and CARE), has implemented a variety of Community-Based Animal Health Projects, beginning as early as 1995. Impact areas included Dollo Ado/Hargelle (SC/US), Liben (SC/US), Moyale (LVIA), and Yabello, Dire, and Teltele (CARE). This study aimed to review the decentralized animal health approaches and methodologies in the various impact areas, to assess the impacts or likely impacts of the interventions, to identify strengths and weaknesses of the respective approaches, and to make recommendations for improvement.

Methods Used A review of each impact area was conducted through a review of project documents; semi-structured interviews and discussions with field project staff, government partner departments, and private animal health workers; performance assessment of CAHW’s, and personal observations. In addition, communities’ feedback was gathered from an extensive group semi-structured interview that used participatory methodologies such as ‘before’ and ‘after’ proportional piling, disease ranking, and matrix scoring, and community-identified indicators. Data from community sessions was analyzed using Excel to calculate median values, and by assessing the degree of agreement between informant groups using the Kendall coefficient of concordance (W) (SPSS Version 13.0). Finally, a SWOT analysis was conducted to review the strengths (S), weaknesses (W), opportunities (O), and threats (T) of each program.

Findings and Recommendations

Baseline Surveys and Participatory Dialogues: In the CARE impact area, needs identification with extensive community dialogues were carried out by project staff in each of the communities prior to project implementation. These dialogues helped to ensure that local priorities, opportunities, and constraints were taken into account, and incorporated local disease descriptions and knowledge into the training. Dialogues also enhanced community understanding of and commitment to the project objectives and activities.

In the SC/US Dollo Ado and Hargelle impact area, preliminary assessments evaluated common livestock diseases, treatments (traditional or modern), drug availability, and general livestock conditions. However, there was only very limited pre-program dialogue that informed local communities of project activities but did not solicit their input. In the SC/US Liben and the LVIA impact areas, there was no baseline survey, and limited-pre program dialogue was used only to inform the community of project activities. In these cases, the communities should have been engaged as partners in identifying the number of CAHW’s to be trained, the criteria for selecting CAHWs and Veterninary Supervising Committees, and program staff should have clearly defined the specific role and benefits that CAHW individuals could expect (that they are part time, private operators).

Training: Trainings were standardized under STI LEAP to have two phases and were generally thorough. Evaluation of individual CAHW performance showed that in impact areas where trainers used were both well-qualified (veterinarians or Animal Health Assistants rather than Animal Health Technicians or previously-trained CAHW’s) and received sufficient training in participatory methods, more CAHW’s were rated as ‘good’ or ‘very good.’ For example, in the CARE area, where veterinarians and Animal Health Assistants conducted the training of new CAHW’s after being trained in participatory methods for two weeks, 93% of CAHW’s were rated as ‘good’ or ‘very good’ in their technical skills. In contrast, only

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70% of CAHW’s in SC/US Dollo Ado and Hargelle, and 80% in SC/US Liben impact areas were rated as above average.

All impact areas used a standardized manual that included basic knowledge on animal husbandry and diseases, their treatments, and vaccinations. This was one of the strengths of the program, though the manual could be further strengthened with illustrations. In the CARE impact area, the manual was adapted to include local descriptions, seasonal occurrence patterns, and other indigenous knowledge. Other impact areas would have strengthened their CAHWP by using this same approach.

The training of women CAHWs deserves specific attention. Women were only trained as CAHWs in the CARE impact area, where there was a significant positive impact of their participation. Women were evaluated to be as effective as their male counterparts, and in some cases, were perceived by the community as more responsible and committed than male CAHWs. In Somali region, religious and traditional beliefs were cited as constraints limiting women’s participation, but no specific accommodations were made to allow their participation in the project. For example, the importance of their participation could have been discussed as part of pre-training community dialogues, and trainings could have been carried out in rural areas to specifically facilitate their attendance. In addition to facilitating women’s participation, holding the trainings in rural areas could have provided additional opportunities for communities’ participation. Communities could have contributed the location, animal cases for practical learning, and would have been more familiar with the program from the outset.

Monitoring: Ongoing field monitoring of CAHW performance and a regular schedule of refresher trainings are critical to the success of a CAHW program. CARE was most successful at implementing on-the-job field monitoring and technical support, which provided systematic strengthening of CAHW capacity and confidence, and identified problems that were addressed at regularly scheduled refresher trainings. In other areas, some problems noted in the field (some CAHWs don’t have enough drugs in their kits, are doing insufficient and incomplete record-keeping, are loosing motivation and not providing services, and are not providing disease reporting functions), are exacerbated by poor monitoring, which could identify and address these issues.

In any CAHW program, ongoing training, as well as training of replacement CAHW’s (as some CAHW’s inevitably move or stop for other reasons), needs to be planned for. However, in the one impact area where the project had ended (LVIA), no ongoing monitoring or technical support was planned for, indicating a poor exit strategy.

Services Provided: In all impact areas, most CAHW’s are providing a comprehensive range of services, including treatment of external and internal parasites, infectious diseases, Trypanosomis, vaccination, hoof trimming, and dehorning. Communities said that CAHWs also mobilize the community for vaccination activities, create awareness about drug quality, inform pastoralists about disease prevention, and provide links to the larger development community. The proportion of individual CAHWs providing comprehensive services ranges from 73% (LVIA) to 93% (CARE), with the major constraints limiting service provision being drug supply. Drug supply is limited in some cases because of a misuse of cost-recovery money (CARE and SC/US Dollo Ado and Hargelle), and because of logistical constraints (SC/US Liben).

Cooperatives: CAHW cooperatives have been established in all impact areas, with the goals of supplying the necessary animal health drugs in sufficient quantity and quality in a consistent manner, liasing with NGO’s and other government organizations (especially for disease reporting), and providing ongoing training, technical assistance, and information sharing for members. Many of these cooperatives are too new to be evaluated. However, the older cooperatives (the Dollo Ado Cooperative, and to a lesser extent, the Moyale-Somali Cooperative) are having issues with providing an inconsistent drug supply, and with failing to meet their non-drug objectives. Generally, cooperative members have limited business knowledge and poor accountability and transparency. In addition, these cooperatives are operating in violation of the 176/91

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Drug Administration and Control Proclamation, which allows only veterinarians, Animal Health Assistants, and Animal Health Technicians to be involved in opening and running veterinary drug shops.

To address this issue and increase the long-term sustainability of the CAHW systems, it is recommended that the programs develop a relationship with private animal health care providers who will act as a single source to provide sustainable technical support, drug supply, and CAHWs disease and activity reporting. This private animal health care provider could be supervised by the government veterinary department, and would forward disease reports to the government. Meanwhile, the currently established CAHW cooperatives could be involved in livestock and livestock product marketing, for which there is a huge potential in all impact areas.

Impact On Animal Health and Pastoralist Livelihoods: All informant groups in all areas agreed that there has been a significant increase in the proportion of healthy versus unhealthy animals since the CAHWP was implemented. The change was attributed mostly to the availability of medicines, vaccines, CAHW training and knowledge, and other project inputs. The change in incidence of specific diseases was also analyzed, and with two exceptions where disease pressure had risen significantly for non-project reasons, or where drug quality was poor, there was strong agreement that the incidence of diseases handled by CAHWs had fallen.

There was overwhelming support from communities for CBAHP, with a significant positive attitude change by local communities towards the use of modern medicine, and a high willingness to pay for services and drugs. When compared with other service providers (government veterinary services, black market drug dealers, traditional medicine, and others), CAHWs were ranked as the most trusted in all impact areas. The use of CAHWs was higher than all other services, with other services less important than they used to be, and in some cases not used at all at present. CAHWs are ranked as highly accessible, even to the poorest members of the community, because they provide medicines to these families on a credit basis. They are said to provide high quality drugs and advice. Black market drugs were cheaper in some cases, but are of low quality. Government drugs and advice are judged to be of good quality in some areas, and may be cheaper that CAHWs, but are not consistently available.

In SC/US Dollo Ado and Hargelle impact area, there was an increase in milk production, meat, income, and livestock numbers (camels, cattle, and especially shoats). Increased milk production has resulted in some additional household consumption, but most is sold as milk or butter, locally or in Kenya. In other impact areas, there has been increased income and livestock numbers, but a decrease in milk production. However, communities agreed that the decrease in milk production had been caused mostly by a reduction in pasture (from drought, bush encroachment, and ethnic conflict and ethnic-based regionalization), and not by the impact of diseases.

Increased income from the sale of livestock and livestock products has significantly increased in all impact areas during the project, due to improved livestock markets and increased prices. The money has been used for restocking, buying consumer items such as clothes and food staples, paying for medical and veterinary services, for weddings and other social purposes, and for contributions to local development initiatives such as roads or school and clinic construction. The numbers of livestock have risen overall, but herd composition has also changed in the SC/US Liben, LVIA, and CARE impact areas, because of changed market conditions favoring selling cattle, and (in Borana lowlands) the growing preference for camels because of their drought-resistance.

Participation of Other Stakeholders: In all impact areas, government participation and support is high. The project should take advantage of this enabling policy environment to press for further support in two areas: the government should be discouraged from providing occasional services at a subsidized rate, because this provides unfair competition; and the government should support the distribution of legal drugs by cracking down on the illegal drug trade.

One weakness in community participation was the Veterinary Supervising Committees, made up of community members. In all impact areas, VSC’s were not effectively carrying out their duties. For

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example, they were not overseeing CAHW performance, addressing issues such as drug shortages, or questioning why inactive CAHWs were inactive.

One stakeholder group that should be more fully engaged, in impact areas where they are present, is private animal health workers. In many cases, they were not involved in the projects as stakeholders, and they view the CAHWs as competitors. Impact areas could engage these private animal health providers, particularly in addressing drug supply and disease reporting weaknesses in the current project.

Conclusion Despite some variability in the quality of implementation of the CBAHW program, the program has been highly successful in meeting its goal of providing higher quality animal health services at a price that is affordable to communities. CAHWs have improved the health of livestock in the pastoral areas where they work, and have also in many cases improved livelihoods. Improvement to make the programs more participatory would strengthen their sustainability. Attention also needs to be paid to designing and implementing sustainable support systems for CAHWs, particularly for ongoing training and drug supply.

The following are recommended to improve the program: • Include an ethno-veterinary approach, gathering information from communities including community identification of diseases, ranking of most important diseases, and season of occurrence for each species of livestock. • Strengthen the participatory structure of programs to include adequate pre-program and ongoing dialogue (including communities identifying their own criteria for selecting CAHWs), and community participation in monitoring and evaluation. • An annual assessment should be conducted to determine the number and distribution of active CAHWs in each area, and this assessment should be used to plan for further CAHW training to fill in gaps or increase coverage where needed • Trainings should be conducted by veterinarians or animal health assistants who have attended a participatory training techniques workshop • During this evaluation, some diseases were identified as priorities by communities, but not handled by CAHWs. A participatory study should be conducted to learn more about these diseases and come up with control strategies • On-the-job monitoring and refresher trainings of CAHWs should be more regularly carried out, with community participation in monitoring. • Trainings should be carried out in rural areas, under pastoralist setting, to facilitate the training of woman CAHWs and community participation • Drug supply should be moved from CAHW cooperatives to private animal health providers (supervised by the government), who should also take on technical support and disease reporting roles. • Government should be discouraged from providing services at a subsidized rate, because this provides unfair competition; and the government should support the distribution of legal drugs by cracking down on the illegal drug trade. • The projects should continue awareness-raising activities about the dangers of using black-market poor quality drugs

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Section 1 Introduction

1.1 The content of the report This report describes findings regarding the effectiveness of the methodologies and approaches used by SC/US and its partner organizations (LVIA & CARE) in the design and establishment of a sustainable community-based animal health workers system and a concurrent privatization of animal health services. The effect of the community-based animal health workers project on the impact of the various livestock diseases and on overall animal welfare is also discussed.

Section 1 gives a brief introduction to the assessment including: 1.1 the content of the evaluation report; 1.2 General background information and Geographical scope of the program areas; and 1.3 Consultant’s TOR.

Section 2 discusses the methodologies used.

Section 3 looks at the relevance of the program in the respective impact areas.

Section 4 presents and discusses findings regarding the various methodologies and approaches employed by the implementing organizations to establish sustainable community-based animal health workers systems and private systems of animal health services in their respective impact areas.

Section 5 summarizes the results of SWOT analyses carried out in all impact areas.

Section 6 depicts the influence of community-based animal health workers on disease impact and incidence, on animal health service provider use, and on the welfare of pastoralists.

Section 7 summarizes the major conclusions and recommendations made under the previous sections.

1.2 General background information and context Livestock plays a major role in the livelihood of the majority of those who live in Somali and Borana lowland areas, contributing significantly to the five household capital assets (Finance, Human, Social, Natural and Physical). However, pastoral and agro-pastoral communities in these areas are highly vulnerable to various shocks, which can lead to the loss of their sustainable means of livelihood (their livestock), and consequently to destitution.

SC/US, CARE and LVIA have been operating in these pastoral areas to ensure food security and strengthen livelihoods through livestock development activities. To this end, they have been implementing a community-based animal health workers system to improve animal health services, and ultimately, to increase households’ supply of livestock products for home consumption and marketing. In order to enhance their impact, the three implementing organizations are working in partnership under the Southern Tier Initiative Livelihood Enhancement for Agro-Pastoralists and Pastoralists (STI LEAP) program funded by USAID for the project period September 2002 to August 2007.

1.3 Geographical scope and duration of the program.

Save the Children/US:
Began implementing animal health activities in Guji zone of Oromia Region through providing direct financial and material support to the government veterinary department under its Development Activity Program (DAP1). The implementation of community-based animal health workers was continued under DAP2 following the phase-out of DAP1. DAP2 was initially planned as a 5-year project beginning in 2002; however, it was discontinued after the third year of implementation because of a change in government strategy and policy towards supporting development interventions. There is no currently funded CBAHP in this area, because STI LEAP is not implemented in this zone.

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began working on animal health interventions in Liben and Afder zones as early as 1995 and has trained and supported several CAHWs since then. Currently, STI LEAP is an active program in this area.

CARE : has been working in Borana zone since 1984, focusing mainly on various emergency interventions. In October 2001 they launched a community-based animal health system which was implemented for one year in Yabello and Dire Woredas through their Borana Drought Recovery Project (BDRP). The intervention continued from October 2002 to September 2005 in the same Woredas through another project called Borana Vulnerability Reduction Initiative (BVRI). Additional work under STI LEAP was started in September 2002, providing support to already established CAHWs, expanding to new Kebeles (PAs) within Yabello and Dire Woredas, and covering the whole of Teltele Woreda.

LVIA : has been present in Moyale Woreda since 1995. They started an animal health support program by training 10 CAHWs (through Debre Zeit University) from the Somali side of Moyale in 1998. The program was further strengthened and expanded to other 10 Kebeles (PAs) on the Somali side of Moyale and 8 Kebeles (PAs) on the Oromia side of Moyale through the STI LEAP. But unlike in SC/US and CARE impact areas, implementation under STI LEAP was continued in LVIA areas for just 2 years (from September 2002 – August 2004).

1.4 Terms of Reference (TOR) The overall objectives and aim of this mission was to review the decentralized animal health approaches in SC/US supported projects, to assess the impacts or likely impacts of the interventions, to identify strengths and weakness of the respective approaches, and to make recommendations where necessary. See Annex 1 for the detailed TOR.

1.5 Constraints faced during the assessment mission
There was miscommunication between the SC/US Addis Office, field offices and partner organizations on the schedule of this mission. Some of the partner organizations were unaware of the mission and said they had not been informed (LVIA & PCAE). In addition, relevant staff from some of the SC/US field offices could not be met for discussion. It was not possible to undertake the review and impact assessment in Filtu (PCAE impact area), because no one was available to facilitate this. In Moyale (LVIA impact area), with support from SC/US field office, it was possible to undertake the field visit and impact assessment, though most of the staff were interviewed in Addis Ababa afterwards.

The amount of time needed for the fieldwork was underestimated in light of the extensive and in- depth assessment desired; the participatory methodology used; the inaccessible and dispersed geographical locations of impact areas; and the bad condition of the roads and uncomfortable vehicle.

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Section 2 Methodology

2.1 Review of methods and approaches employed to achieve the objective of the Program Methodologies and approaches followed by each of the implementing organizations to achieve a sustainable community-based animal health workers system and the privatization of veterinary services were reviewed. This review was carried out through:
Review of documents such as project proposals, reports (project progress reports, CAHWs training reports, and workshop reports), and previous reviews and evaluations (see Annex 8 for documents consulted).
Semi-structured interviews and discussions were conducted with field project staff, government partner departments, private animal health workers (Dollo Ado & Moyale) and community members (See Annex 2 for lists of persons met with).
Performance assessment of CAHWs (Annex 4)
Personal observations made during visits to the program areas

2.2 Assessment sites Four impact areas were defined based on the implementing organization, geographical location and community involved. These impact areas were: 1. SC/US Dollo Ado and Hargelle impact area 2. SC/US Liben impact area 3. LVIA Moyale impact area 4. CARE Yabello, Dire & Teltele impact area

For the purposes of the assessment, each of the impact areas was considered as one project area. In each impact area, 10 sites having CAHWs were selected, for a total of 40 sites (see Annex 3). The sites were first categorized according to their proximity to the district town as ‘close’ (maximum 20km), ‘moderate’ (maximum 45 km) and ‘distant’ (more than 50km), and then sites were randomly selected within each category.

2.3 Impact assessment methodologies Participatory methodologies such as semi-structured interviews (SSI), ‘Before’ and ‘After’ proportional piling, disease ranking, and matrix scoring were used . A total of 683 community informants (602 men and 81 women) participated in the impact assessment exercises. Simple drawings on cards and locally available materials (stones) were used for the proportional pilling exercise. The facilitator first explained each exercise to the informants, and asked the community to identify locally relevant indicators. The indicators were represented pictorially on cards, and the facilitator confirmed that all community participants understood what each picture represented. Each group of informants was then asked to select representative individuals from among the group to place the counters (stones) during the proportional pilling, ranking and scoring activities. Using brainstorming and probing questions, explanation and additional information was generated out of the proportion of stones placed on the different indicators. Afterwards, the other informants were asked whether they agreed with the placement of the counters and justifications given by their representative. Informants who did not agree on the distribution of the counters were given a chance to redistribute the counters and explain their reasoning. The process continued until a consensus has been reached by all informants. Each impact assessment exercise with a given informant group took a minimum of 3 hours.

2.4 Data analysis Data derived from proportional pilling (including means of livelihood, factors affecting livelihood activities, changes in the impact of animal diseases, and matrix scoring of service providers) were first analyzed using Excel spread sheet to calculate median values. Second, the amount of agreement between informant groups was assessed using the Kendall coefficient of concordance (W) (SPSS Version 13.0).

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2.5 SWOT analysis In addition to the methodologies described above, a SWOT analysis was conducted to review of the strengths (S), weakness (W), opportunities (O) and threats (T) of each of the programs. This analysis was carried out through discussions with the various stakeholders in the project areas, project staff, CAHWs, and through the personal observations of the consultant.

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Section 3 Relevance of the Community-based Animal Health program

3.1 Community livelihoods and vulnerability in the assessment areas Livestock-keeping in arid and semi-arid areas is a rational approach to utilizing scarce vegetation, as livestock are efficient at converting this vegetation into highly nutritious foodstuffs for people. When effectively managed, livestock represents the only ecologically and economically sustainable domestic land use of arid lands. In these areas, livestock and livestock-related activities contribute to over 50 percent of household gross revenue, and livestock contribute 20 percent or more of overall household food energy (Otte and Chilonda, 2002 quoted by Knips, 2004).

The Sustainable Livelihoods (SL) Framework approach is used to understand and highlight the role of livestock in Somali and Oromia pastoral and agro-pastoral areas (see Figure 1).

Transforming Livelihood Structures and Outcomes Vulnerability Livelihood Assets Process Structures: Income Context H Levels of •Shocks well being S N government Livelihood food security •Trends Influence Private sector Strategies and Access vulnerability •Seasonalities P F Process: •Animal Diseases sustainability Laws •Conflict Policies Culture Figure 1. Sustainable livelihood framework Institutions

(adapted from Carney, 1998) A household depends on five capital assets: human capital, physical capital, social capital, financial capital and natural capital, portrayed in the shape of a five-axis graph (pentagon). Access to all five types of capital is required for a sustainable livelihood.

Communities in all impact areas have identified several different livelihood activities, including livestock keeping, crop cultivation, petty trade, casual labour, and the selling of firewood & charcoal or incense. The proportion of each livelihood activity occurring in all impact areas has been identified using the proportional pilling score for each activity (Annex 6). Livestock ranked as the most important source of livelihood in all areas, accounting for 50% in Dollo & Hargelle; 63% in Liben; 52% in Moyale; and 52% in Yabello, Teltel & Dire impact areas.

Livestock are central to the Somali and Oromo pastoral communities. Their role is defined by the various ways they contribute to a poor household’s capital assets, as represented by the pentagon. They serve as subsistence food (milk, meat & blood), as a food reserve, and as a key source of cash, which is used to pay for veterinary & medical costs and for other non-pastoral consumer items. Livestock also play a significant role in individuals’ and households’ social activities, through determining marriage chances and as a means to correct or prevent wrong doings. The various contributions of livestock species to household assets among Somali and Oromo pastoralists and agro-pastoralists are detailed in Table 1.

The same SL approach was used to review the vulnerability context in which people seek to build the different kinds of capital assets available to them. Informants in all impact areas identified a number of vulnerabilities which are affecting their livelihood activities. These include drought, animal diseases, conflict, bush encroachment, seasonal floods, pests, and predators. The proportional importance of each

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vulnerability factor has been identified by the community in all target areas through the proportional pilling score (Annex 6). It is beyond the TOR of this work to discuss and present the status of the target communities as regards each of the vulnerability factors. Rather, the basic interest of this work is to assess the extent to which animal disease is a threat to a sustainable livelihood. The results in all impact areas revealed that animal disease was the second most important threat after drought.

Poverty can be reduced through sustainable improvements in people’s livelihoods, amongst other strategies.

“…where sustainable livelihood is defined as “capabilities, assets (including both material and social resources) and activities required for a means of living. A livelihood is sustainable when it can cope with and recover from stress and shocks and maintain or enhance its capabilities and assets both now and in the future, while not undermining the natural resource base.” (Carney, 1998 1).

As described by Carney (1998) sustainable livelihoods are derived from access to five types of assets: natural, physical, financial, human and social capital. The greater the access to these five types of assets, the more secure the livelihoods. Thus, an approach that aims to improve pastoral livelihoods should focus on increasing the production of livestock, as this is pastoralists’ key asset base. In terms of livelihood outcomes, improvements in livestock production have the potential to generate more income, increase social well being, reduce vulnerability, improve food security and encourage more sustainable use of natural resources.

In light of this fact, SC-US and its partners are tackling the right issues through improving animal health services.

1 Carney, D., (Ed.) 1998 Sustainable Rural Livelihoods: What contribution can we make? DFID, London.

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Table 1. Contribution of Livestock to household assets among pastoral and agro-pastoral communities in Somali and Oromia low lands.

The five capital assets Species Human Financial Social Physical Natural

Cattle • Source of food (milk, • Form of savings • Gifts for relatives, friends, etc. • Used as draught power • Manure for butter & meat) • Source of income • Dowry and bride wealth payment (3-10 for ploughing crop fields maintaining soil • Hides used to make through sale of milk, cattle depending on the wealth status of (mentioned only in one fertility (only household implements & butter, hides and live the bridegroom) PA: Suftu) mentioned in one in the construction of animals • Compensation for blood: when a man is PA: Suftu). Tukuls killed the payment would be 44 –100 cattle, and when a woman is killed the payment would be 22 – 50 cattle, as agreed upon

• Source of food (milk & • Form of savings • Gifts for relatives, friends, etc. Sheep & meat) • Source of income • Dowry and bride wealth payment (20-100 Goats through sale of milk, shoats depending on the wealth status of skin and live animals the bridegroom) • Used as in-kind payment for Koran teachers and labourers.

Camels • Source of food (milk & • Form of savings • Loans for relatives • Draught power for meat) • Source of income • Dowry and bride wealth payment (up to transportation of water, • Skins used to construct through renting for 1-5 camels depending on the wealth status goods & humans from Tukuls transport purposes and of the bridegroom) place to place sale of milk and live animals

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Section 4 Review of the Projects’ Approaches

In this section, the projects’ achievements and the quality of the fieldwork will be reviewed. Under each sub-heading, qualitative and quantitative information gathered during the review process is presented and discussed. This review is focused on assessing the quality of the design and establishment of the CAHWs program. The national minimum standards and guidelines for design and establishment of Community- based Animal Health Workers Systems have been used as the basis for this assessment.

4.1 Designing and planning of the CAHWs system Participatory baseline surveys and community dialogues are important components of the design and establishment of a CHAWs system. Therefore, under this section of the report, the designing and planning process followed by each respective organization is assessed and discussed.

4.1.1 SC/US Dollo Ado and Hargelle impact area SC/US started the CBAHP in Dollo Ado and Hargelle Woredas in 1997, and it continued implementation through various projects. There was no evidence as to how the previous programs were initiated, and therefore, it was impossible to determine whether proper baseline surveys and community dialogues were carried out. The STI LEAP animal health program has continued to work in the same areas with the same CAHWs, but has also expanded CAHWs into new PAs. It has been noted that preliminary assessments were carried out in all target PAs where new CAHWs were to be trained. These preliminary assessments evaluated common livestock diseases, treatments (traditional and modern), veterinary drug availability, and general livestock conditions, but did not include any pre-project dialogue with the community.

There are currently 40 CAHWs in Dollo Ado & Hargelle, out of which 20 in Dollo Ado and 10 in Hargelle were trained in previous programs, and only 10 (5 from each Woreda) were trained under the current program (STI LEAP). There were no records of community dialogues carried out in the process of training of the previous CAHWs. Under the STI LEAP program, only one pre-training community dialogue was carried out in areas where new CAHWs were trained. Community discussions and evaluation of CAHWs activity were carried out in other areas, but after CAHWs had been active for quite some time, in response to poor performance.

4.1.2 SC/US Liben & LVIA Moyale impact areas In the SC/US Liben and LVIA Moyale impact areas, no baseline survey was done. Thus, identification of local problems, descriptions of important diseases, and disease rankings were not carried out. Three communities, namely Borana, Guji, and Arsi and Geri, were covered during this mission in the two impact areas, and it was found that each of them have different local vernacular for describing diseases. Under such circumstances, a participatory baseline survey would have been critical to identify locally important problems, to understand local indigenous knowledge, and to prepare training based on the specific local descriptions of diseases. However, in Liben and Moyale, in most cases, English names of diseases were used during the training.

With regard to community dialogues, only one pre-training community dialogue was carried out to inform local communities about the program and select candidates for CAHW training. Neither post-training nor subsequent dialogues were conducted as part of the ongoing CAHWs performance monitoring.

4.1.3 CARE impact area In addition to the conventional baseline survey carried out by STI LEAP in all its impact areas, CARE conducted a community needs identification and prioritization workshop in each target PA. The workshop occurred over three consecutive days and was carried out jointly with teams from other components of STI LEAP. Government counterparts were also involved in the exercises. Following general awareness-raising activities covering all components of the STI LEAP, the following activities were accomplished regarding the more specific animal health component during the 3-day workshops in each PA:
Community needs identification and prioritization of animal health problems
Identification of appropriate solutions to address animal health constraints

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Community identification of selection criteria for community committees (VSC and HAC) and CAHW candidates
Community identification of animal diseases for each species of livestock, ranked according to their importance and with season of occurrence described

In addition to this, minutes of community dialogues carried out in each target PA were properly compiled and documented for reference.

Generally speaking, the information gathering, the community dialogues and the time spent in each PA as a part of the CAHW project design and establishment was very satisfactory. However, besides the ranking done for each disease identified, it would have been good to identify the disease’s impact on the animal health and production. The status of existing animal health service delivery in terms of accessibility, availability, quality etc. should also have been assessed.

Discussion Participatory baseline surveys and community dialogues are important aspects in the design and establishment of a Community-Based Animal Health Program. However, this has not been carried out to the level required for meeting the national minimum standards in the cases of the Somali, Liben and Moyale impact areas.

STI LEAP conducted a baseline survey for all sectors, including livestock, to assist in developing indicators and establishing performance targets for project monitoring and evaluation. However, the baseline survey was conducted using the conventional approach of a structured questionnaire, rather than a more participatory approach. Pastoralists are usually suspicious about questions asked by outsiders, particularly when it comes to asking about how many livestock they own and how much income they get, as this is associated with tax collection and / or a traditional belief that counting animals is bad. Thus, it is common to face non-cooperation or to get erroneous information, leading to unreliable results. An additional constraint of the conventional survey is that it only explores pre-defined variables, and important variations or details can be missed. It also hinders community participation because of its inflexible nature.

Participatory baseline surveys have multiple advantages: they ensure that local problems, prioritizations, opportunities and constraints are taken into account; they enhance community understanding of project objectives and activities and so create increased commitment to the project; and they are useful for identifying locally relevant indicators.

In the design of a CAHW program a participatory (ethno-veterinary) baseline survey is an important component, serving the following purposes: • Gathering information on existing indigenous veterinary knowledge such as ethno description of disease, symptoms, and seasonal occurrences; and on the existing use and knowledge of conventional veterinary services and medicines • Identifying and prioritizing common animal diseases that should be included in the CAHWs training manual • Identifying and documenting community indicators that can be used as milestones to measure the impact of the CAHW program.

It has been determined that the required level of community dialogues were not facilitated, particularly in Somali and Liben impact areas. At the beginning of the program, communities were simply told to select one person for the CAHW training. Community dialogues should be a continuous process through which the community and development agents interact, discuss, exchange ideas, and form opinions, so that they can agree on the necessary modalities required for community development. In this case, dialogues have not been facilitated to this level.

The demand for more CAHW training (in Dollo Ado & Hargelle, Liben and Moyale impact areas), and the issues of salary / employment raised by some CAHWs (in Hargelle) likely reflect the poor pre-training

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community dialogues, where communities were not involved in deciding the number of CAHWs to be trained per PA, and the role and benefits of the CAHWs were not communicated clearly.

Therefore, considerable time should be devoted to pre-training community dialogues, to make sure that the communities are fully aware of the expected roles of CAHWs and what incentives they might receive. If it is not made clear during the selection process that the CAHWs are part-time, private operators, they easily develop mistaken expectations and may even demand salary from or employment with the project. In fact, this is one of the reasons that a CAHW dropped out of service in Hargelle Woreda.

4.2 Selection of CAHWs All partners identified standard criteria for selection of CAHWs. However, the process used to facilitate selection was different for each partner. In the case of Dollo, Hargelle, Liben & Moyale impact areas, communities were asked to select candidates based on pre-defined criteria, rather than being given an opportunity to identify locally-relevant criteria. In contrast, in the case of CARE, a process was used in which the communities and staff were each asked to identify what they perceived to be good criteria.

In some of the PAs in Dollo Ado and Hargelle, politicians and local administrators interfered to influence the selection process, and therefore, some of the CAHWs were selected without community support.

Discussion The success of a community-based animal health program depends on the careful selection of the candidates to be trained as community animal health workers. The strategy that the STI LEAP partners used was to come up with standard criteria for selecting all training candidates. These selection criteria were used in all impact areas, whether or not the community was consulted. Unfortunately, this approach does not allow the community to determine the criteria for selecting CAHWs. Project staff may have their own opinions about what criteria should be used to select successful CAHWs, based on standard criteria they have developed, or on successful experiences with CAHWs elsewhere. However, their views should not dominate the communities’ opinions in determining the selection process. It was only in CARE impact area that communities were facilitated to identify their own selection criteria, with the project staff opinions being incorporated. This approach enhances community participation and commitment to the project, and gives the community greater influence over development work that affects their lives.

Ability to read and write and good educational background was one of the criteria included in the list of CAHWs selection criteria. Although being literate is an advantage in some respects, field experience showed that literate CAHWs may use their training as a stepping stone to obtaining better employment, and therefore are more likely to leave the community when they get a job opportunity. A good example of this is the case of a CAHW from El Gof PA (Moyale-Somali) who joined a political party and is now based in Addis Ababa.

Another issue that could be addressed more fully is equal gender representation. It is believed that training women as CAHWs will raise their profile within the society. However, it was only in the CARE impact area that women were trained as CAHWs. In Somali impact area, religion was mentioned as a constraint making it difficult or impossible to take women away from their home areas for training. The fact that the training in all impact areas was carried out in towns could have discouraged the community from selecting women. Performance evaluation of the CAHWs in the CARE impact area revealed that women are as competent as men. In fact, in some cases they are more competent than the male CAHWs, and are perceived to be more responsible and committed than the male CAHWs. Therefore, training of women as CAHWs should be encouraged through enhancing community awareness about gender issues and, more practically, through conducting training in venues that are chosen by the community and that facilitate women’s involvement.

There is a need to revisit the selection procedures of the CAHWs, and to involve the community in this process. Community-based approaches, where the initiation, planning, implementation and evaluation are controlled by the local communities, should be emphasized. If the communities are well-informed about the negative consequences of making wrong selections, they will do all they can to select the right person through a participatory system.

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4.3 CAHWs training and technical support

4.3.1 SC/US Dollo Ado and Hargelle impact area SC/US began implementing Community-Based Animal Health services in the region in 1997. In Dollo Ado and Hargelle Woredas, 25 CAHWs (20 CAHWs trained during the previous programs and 5 through STI LEAP) and 15 CAHWs (10 CAHWs trained during previous programs and 5 through STI LEAP) were trained, respectively.

The total duration of CAHW training has been standardized and accepted by all STI LEAP partners. Initially, the training of CAHWs was to be given in three phases. After completing one phase, CAHWs were required to deliver services at least for 2-3 months, and successful performance (evaluated with a job performance assessment) was required in order to be allowed for the following training phase . At the end of the cycle, those who successfully completed all three phases of training were to be given a certificate. However, based on suggestions from the MOA/PACE this approach has recently been reduced to two phases. The trainings carried out during the LEAP period are summarized in Table 2.

Table 2. Summarized number and type of CAHW trainings in Dollo and Hargelle impact area Woreda Type of training Dates Days No. of Remark CAHWs Dollo Ado Basic training STI LEAP trained CAHWs Phase I & II ???? 60 5

Phase III ???? ?? ?? Refresher training August 15 – 21, 2003 Previously trained CAHWs 7 18 2005 (Dates not All CAHWs (Dollo Ado-21 mentioned) 3 38 & Dollo Bay-17) Hargelle Basic training STI LEAP trained CAHWs Phase I March 11 – 30, 2004 20 20 (Hargelle-5, El Kare-4, Cherati-5 & Bare –6) STI LEAP trained CAHWs Phase II May 3 – 22, 2004 20 20 (Hargelle-5, El Kare-4, Cherati-5 & Bare –6) STI LEAP trained CAHWs Phase II July 4 – 23, 2004 20 20 Previously trained CAHWs Refresher training August 15 – 24, 2003 10 38 (10- Hargelle, 9-Cherati, 10- El Kare & 9-Bare) All CAHWs (Charati-12, January 10 – 19, 2005 10 50 Elkari 12, Bare-13 & Hargelle-13 All CAHWs (Hargelle 15, April 2 – 8, 2005 6 52 Bare 13, Charati- 12 & Elkari 12)

Issues that arose from the training and technical support assessment:

No. of active CAHWs and dropouts: Out of the total trained CAHWs, two individuals from Dollo Ado and one individual from Hargelle dropped out due to: • Misuse of the cost recovery money and veterinary drugs • Demand for employment and salary from the project • Lack of motivation

Duration of training, no. & frequency of refresher trainings, & no. of participants : There is variation within the impact area in terms of number of days required to complete basic training, and

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also the number of days for refresher courses (from 3 – 10 days). From Table 2 above it seems refresher trainings were not planned properly and were carried out haphazardly. In some cases, no refresher was given for over a year, and in one situation (Hargelle), two refresher courses were conducted over a very short time period for the same group. The number of CAHWs participating in the various refresher courses also varies, meaning that not all CAHWs attended all refresher courses. Consistency in the training duration and the methods for ensuring CAHW attendance should be given more consideration in the future. In addition, the number of participants per training session, particularly in refresher courses, was too large. Large numbers do not allow for participatory training to be conducted, and therefore the maximum recommended number of CAHWs per training session is 20.

Training content and its relevance: Most of diseases mentioned as important by the community during the impact assessment were included in the training curriculum, and therefore, the training content was relevant to the problems of the livestock producers in the impact area. However, there were some additional diseases identified as important by the community which should be included in the training in the future.

The training approach and quality of the trainer: It seems that the trainings used lecture-based methods much more than hands-on-experiences. Most of the CAHWs interviewed had their lecture notes and referred to their notes periodically when asked questions. Although the trainers- SC Animal Health Officers (AHO) and staff from the Department of Agriculture (DOA)- were trained as trainers (TOT) of CAHWs before conducting the trainings, the level of skill, particularly that of the Animal Health Technicians (AHT), is not sufficient for them to conduct quality training.

Training manual: STI LEAP partners have developed a standard training manual providing basic knowledge about animal husbandry and diseases, their treatments, and about vaccinations. This was one of the strengths of the program; however, the manual was not adapted to take local descriptions, seasonal occurrence patterns, and other local indigenous knowledge into consideration. The training manual was not also supported by illustrations where needed.

Supply of starter kit after training: In Dollo Ado new CAHWs trained under STI LEAP program were not issued with starter kits following the completion of their training. Because of this, they had to wait for long time to start delivering services. This wait may have contributed in some cases to poor technical performance of the CAHWs. In addition, it certainly delayed their ability to begin addressing the animal health demands of their communities.

4.3.2 SC/US Liben impact area SC-US started its animal health programme initially through providing direct financial and material support to government veterinary department during its Development Activity Program (DAP1). Direct implementation of animal health activities through training and support of Community-based animal health workers was started under DAP2 after DAP1 phased out. Nineteen CAHWs selected from Borona, Guji and Arsi communities have been trained under this programme. The assessment of the overall training and support provided to the CAHWs is summarized as follows:

No. of active CAHWs and dropouts: all CAHWs are operational although some as in the case of the CAHW from Bul Bul Kebele /PA who is not available most of the time. This CAHW has his second family leaving in Negele town and consequently he was not available to provide services for livestock keepers regularly. The selection of this CAHW is against the selection principle for successful CAHWs.

Duration of training, no. & frequency of refresher trainings & no of participants: Duration of the initially training and the number of participants were in line with the recommended standard. This review was conducted shortly after the CAHWs have completed their second phase of the training to complete their CAHWs training, and refresher training is planned to be conducted with in the next couple of months.

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Training content and its relevance: Most of the diseases identified by the community during the impact assessment exercise of this mission have been included in the training of the CAHWs curriculum, and thus relevant to the animal health needs of the community.

The training approach and quality of the trainer: the training approach was participatory by large although the use of training aids were limited. The trainers were Veterinarians who have been trained themselves on Participatory Training Techniques.

Training manual: training manual that was standardized and implemented by STI LEAP partners have been used in this case. The training manual was prepared based on the local names and description of diseases used among Borana community and English. However, the adoption of the manual did not take in to consideration the differences in local disease vernacular and description of the three communities from which the CAHWs have been selected and trained. Basically the three communities in the project (Borana, Guji and Arsi) speak the same language (Oromiffa), however, it has been noticed during this review that they use different local name and description for some of the diseases.
Supply of starter kit after training: it was found that all CAHWs were issued with starter kit following the completion of each phase of the training, except that supply of accaricides have been delayed for long time due to logistical reasons. It has been also found that some equipment supplied to the CAHWs (e.g. Burdizzo) were not of good quality and not functional.

Training venue: the trainings were conducted in Negele town and this is not in line with the recommended approach.

4.3.3 LVIA impact area LVIA started implementing an animal health program in Moyale Woreda in 1998. Since then, 28 CAHWs (20 on the Somali side and 8 on the Oromia side of the Woreda) have been trained. Out of the 20 CAHWs from the Somali side, 7 were trained in the Faculty of Veterinary Medicine of Addis Ababa University under a previous program. The remaining 13 on the Somali side and the 8 CAHWs on the Oromia side were trained locally under STI LEAP funding, based on the three phase training approach adopted by STI leap partners. An inventory of the number of CAHWs trained and the duration of the trainings is shown in Table 3 below.

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Table 3. Summarized number and type of CAHW trainings in LVIA impact area. Woreda Type of training Dates Days No. of Remark CAHWs Moyale - S Basic training 1998 90 days 7 Previously trained CAHWs Refresher 2002 15 days 7 Mar.22-2 Apr. 2004 12 days 7 Previously trained CAHWs TOT March 9-11, 2003 3 days (21h) 4 participants (2 vets & 2 previously trained CAHWs) Phase I Feb 12 – Mar. 3, 20days (160h) 13 STI LEAP Program 2003 Phase II June 22 – July 7, 15 days 13 STI LEAP Program 2003 Phase III Feb 5 – 14, 2004 10 days (96h) 13 STI LEAP Program Moyale -O Basic training Phase I Dice. 12-26, 2003 15 days (120h) 8 STI LEAP Program Phase II Feb 27 – Mar. 15, 17 days 8 STI LEAP Program 2004 Phase III May 24 – June 8, 16 days 8 STI LEAP Program 2004

Issues that rose from the training and technical support assessment:
No. of active CAHWs and dropouts: The LVIA record shows that only 3 CAHWs out of the 10 previously trained in Debre Zeit (Faculty of Veterinary Medicine, Addis Ababa University) have dropped out. Seven PAs out of 20 in Moyale-Somali and 3 PAs out of 8 in Moyale-Oromia have been included in this assessment. Unfortunatley, only 3 CAHWs from Moyale-Somali side, two of them working in the CAHWs association drug shop in Moyale & El lay, and the third running a personal veterinary drug business in El lay, were reached during this assessment. The remaining 4 CAHWs were not in their PA. Through community discussions it was discovered that one CAHW (from Bede PA) left the community and settled in another PA, leaving all his veterinary equipment and drugs behind. Another CAHW (from El Gof) joined a political party and during this assessment he was in Addis Ababa. The community in both affected PAs noted that there has been no veterinary service delivery for over a year. In the other 3 PAs, although the CAHWs were said to live within their respective areas, they were said to be inactive because they did not have the needed drug supply. In Moyale-Oromia side all 3 CAHWs visited seemed to be active.

Duration of training, no. & frequency of refresher trainings & no. of participants: The first CAHWs (7) from Somali side were trained continuously for 3 months. Later, following the initiatives taken by STI LEAP partners to standardize CAHW training, LVIA also adopted the three-phase approach of training. In this case, the number of training days covered for basic trainings seems to be within the agreed-upon range (15-20 days), except for one occasion in which the 3 rd Phase for Moyale-Somali training was conducted in only 10 days. All participants attended all consecutive training phases.

It seems that there was no refresher course organized for the CAHWs trained under STI LEAP program. This has definitely contributed to the poor performance of these CAHWs.

Training content and its relevance: Most of the diseases identified by the community during the impact assessment exercise of this mission were included in the training curriculum, and thus the training was relevant to the animal health needs of the community.

The training approach and quality of the trainer: The training of the first 7 CAHWs (trained under the previous program) was carried out by professors from the Faculty of Veterinary Medicine in Addis Ababa University for three months. In the awareness of the consultant, this is

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the first training of this kind (within the University) in the history of CAHW training. It is obvious that training methodology and approaches are excellent in such institutions, but participatory training approaches cannot be expected.

Training of the following CAHWs (13 CAHWs in Somali and 8 in Oromia side) was carried out locally by the LVIA Animal health officer and by the previously trained CAHWs. It has been noted that a 3-day TOT was given to the trainers before they conducted the CAHW training. However, in consultant’s experience, there is no effective TOT for CAHW trainers that can be given in 3 days, and the minimum number of days required to conduct TOT for a CAHW trainer is 7 days. Therefore, it is impossible to say that the trainers acquired the skills, knowledge and attitudinal change required to implement a participatory approach. Moreover, it has been uncovered through discussion with one of the previously trained CAHWs who attended the 3 day TOT (Ali Shi Kero from Dokio PA) that most of the training sessions during the later training of the 13 Moyale-Somali CAHWs were taught by the previous CAHWs rather than by the veterinarians. Therefore, the training approach and the quality of the trainer did not meet the minimum standards.

Training manual: LVIA has adopted training manual that was standardized and used by STI LEAP partners to train all CAHWs except those trained in the University.

Supply of starter kit after training: All CAHWs were issued with starter kits following the completion of each phase of training.

Training venue: Some CAHWs were trained in the University and others in Moyale and pre-urban towns such as El Lay and Tuka .

4.3.4 CARE impact area One hundred and four CAHWs (Dire –44, Yabello- 38 and Teltele – 22) have been trained and supported by CARE. In Dire, out of the 44 CAHWs, 16 were trained under CARE-BVRI Program, 11 by GTZ, and 17 by STI LEAP; in Teltele all 22 CAHWs were trained under STI LEAP; and in Yabello, out of the 38 CAHWs 12 were trained under AFD operation area, 14 under CARE-BVRI program and 12 under STI LEAP. All CAHWs had completed all phases of the training except in Teltele Woreda, where phase III training of 15 CAHWs was about to start when this assessment was undertaken (see further discussion below).

The recommendation from AU/IBAR and the National Veterinary Department to reduce the number of training phases to 2 has not been accepted by the government counterpart in Oromia Region until recently. Therefore, all CAHWs completed all three phases of the training except in Teltele where training of 15 CAHWs was delayed due to the government requirement that a CAHW be able to read and write before he/she continues on to the next phases of the training. CARE has been giving adult literacy training to illiterate CAHWs in order to qualify them to complete the trainings. Training of the remaining 15 CAHWs in Teltele Woreda was underway during this mission to complete the 2 nd and last phase of the training (based on the recent change made to require only two phases).

Issues that arose from the training and technical support assessment:

No. of active CAHWs and dropouts: Out of the total of 104 CAHWs trained and supported by CARE, 2 CAHWs dropped out. One dropped out due to poor performance, and the other was forbidden to work and expelled from the PA by the community because of his involvement in a traditionally forbidden pre-marital sexual affair. In addition, one female CAHW passed away due to a natural illness. All of these cases were in Dire Woreda.

Duration of training, no. & frequency of refresher trainings & no. of participants: It was found that all CAHWs except those in Teltele completed all phases of the basic training and the training duration was 15-20 days.

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Training content and its relevance: Most of the diseases identified by the community during the impact assessment exercise of this mission were included in the training of the CAHWs curriculum, and thus training was relevant to the animal health needs of the community.

The training approach and quality of the trainer : The training used in the CARE implementation area was fully based on a participatory approach. Training aids such as illustrative pictures /drawings, photos, live animals, etc., were used. Trainers from the government and CARE, including Veterinarians and Animal Health Assistants, attended a 2-week TOT prior to conducting the CAHW training. The training was organized and facilitated by the Pan-African Campaign for the Control of Epizootic and Ministry of Agriculture (PACE/MOA) and AU/IBAR/CAPE. The training of the CAHWs was therefore facilitated by trainers experienced with participatory training techniques (PTT).

Training manual: The standard training manual developed by STI LEAP partners and government counterpart in Oromia region was adapted to take into account local animal health needs and problems, indigenous knowledge, and commonly-used disease vernacular and descriptions.

Supply of starter kit after training: All CAHWs interviewed during this mission noted that they were issued starter kit following the completion of each of the training phases and were able to immediately begin delivering services to their respective communities.

Training venue: In all cases, the CAHW trainings were carried out in towns (Dubuluk, Yabello- SORDU meeting hall, Teltele town etc…). Communities were not consulted or involved in the venue selection. The advantages and disadvantages of holding CAHWs training in town were discussed with CARE STI LEAP staff during this mission, and as a result all have agreed that the disadvantages outweigh the advantages. Absences and latenesses for the training sessions, getting drunk and chewing chat, poor participation, and a lack of sufficient animal disease cases for practical purposes were some of the problems observed during the trainings held in town. Proximity to the office and other facilities was mentioned as a logistical advantage of the town venues.

Discussion A certain number of drop-outs is inevitable and as the program learns more about the areas in which it is working, gaps in coverage will emerge. It is necessary for each program area to reassess the number and distribution of active animal health workers on an annual basis. Gaps should be verified through community dialogue, inactive CAHWs formally dismissed, and additional individuals selected for CAHW training as appropriate. A balance needs to be reached between meeting the community’s demand for new personnel and the practical and efficiency needs of the program.

In Dollo Ado, Hargelle and Moyale, communities and CAHWs have both expressed the need for more training and refresher courses of CAHWs in all PAs. Currently, there is only one CAHW per PA, and most of the PAs are too vast to be covered by one CAHW. Thus, most CAHWs are not able to provide services throughout their respective communities. Therefore, there appears to be a need to train additional CAHWs, particularly in areas where the CAHWs have dropped out and service provision has stopped completely, as in the case of Bergel PA (Hargelle Woreda) and Bede PA (Moyale Woreda) where the CAHWs are not living with their respective communities any more.

Although all STI LEAP partners have agreed to standardize the duration of training, it seems there is still a lack of consistency. It is also clear that in most cases, there has been a limited number of refresher trainings, and in the case of LVIA, there has been none. On-the-job support and capacity-building at the field level were insufficiently carried out in all impact areas except CARE. Personal experiences of CAHWs show that it is not necessary to have training that is divided into 2 or 3 phases. CAHW training should be given for 15-20 days, focusing on the 5 most important animal diseases for each species according to previously completed community rankings. It is essential that refresher trainings be planned and conducted in a timely fashion, based on findings and problems observed during the regular field monitoring. Regular on-the-job monitoring and technical support in the field is a key strategy that needs to be used to build the technical capacity and confidence of the CAHWs, and provide immediate solutions to any problems encountered by CAHWs. Field monitoring also enables staff to identify CAHW training

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gaps, problems, and additional diseases, which can be addressed in the refresher training. Overall, well- planned regular field monitoring and refresher trainings need to be given more attention in the future.

It is recommended that a veterinarian, or at least an animal health assistant, should facilitate CAHW training, and it is essential that these individuals be well-trained and experienced in participatory training techniques. Contrary to this recommendation, in Somali impact areas, animal health technicians (Dollo & Hargelle), and even CAHWs (Moyale), have been given major roles in carrying out the training. Their contribution as support providers should not be undermined or discouraged, but they should not take part in facilitating key portions of the training.

The initiative taken by STI LEAP partners to standardize the CAHW training manual is commendable. However, some of the partners have adopted the manual without adapting it to include the specific local disease situation, the indigenous knowledge, and the local disease vernacular and descriptions. In general, the manual is of good standard, though the introductions to each topic could be improved, and the manual should include easy-to-understand illustrations and drawings where possible.

Failure to supply starter kits at the end of the CAHWs training session has been a problem in Dollo Ado. If CAHWs are not able to start delivering services immediately following their training they forget some knowledge and lose some of the techniques and skills they have learned. Thus, their confidence and competence is reduced, and they can lose respect and support from the community. Such problems were directly observed in the field during this mission. In future, attention should be given to these logistical issues so that CAHWs go back to their communities with starter kits after their training.

It is highly recommended that CAHW training be carried out in an area close to the community and in their natural environment and traditional settings, rather than in towns or universities. The disadvantage of bringing trainees to town was clearly observed in CARE’s experience, and their experience was similar to that of other partners. In addition to avoiding the problems mentioned above, conducting the training in a location close to the community and the livestock grazing areas provides an opportunity for the community to participate in the training process through lending their animals for practical use. When trainings are conducted within the community, the community will contribute towards training costs in- kind and will be able to see the training process. This will enhance communities’ confidence in the CAHWs’ skills and will help develop community ownership of the program.

4.4 CAHW performance Technical competence, the extent of CAHW coverage, and the range of services provided by CAHWs were assessed during this mission. Drug kits and CAHW records were also inspected. At least one CAHW was interviewed in each PA visited, and their performance was assessed on the basis of pre-prepared checklists (Annex 4). Secondary information was collected from the clients, from a review of records of services provided, and from soliciting the views of project staff.

4.4.1 Technical competence

4.4.1.1 SC/US Dollo Ado and Hargelle impact area 30% of the interviewed CAHWs rated below average (poor or very poor) in their capacity to demonstrate skills and knowledge taught during their training (Figure 2). The fact that the training was mainly lecture- based is a likely reason for such poor technical performance, given that skills and knowledge acquired through a participatory and practical training approach are not as easily forgotten. The poor participatory training skill of the trainers is therefore an important factor. Most of the training was conducted by Animal Health Technicians (6 month Agarfa-trained professionals). Although they attended a TOT course (facilitated by a SC/US animal health officer), they are not skilled enough to train CAHWs. A second problem that contributed to poor technical competence was the long delay in starter kit supply, particularly to the CAHWs in Dollo Ado Woreda, a delay that likely further reduced the confidence and competence in some of the techniques learned. A third factor contributing to the reduced skill level of the CAHWs was the lack of planned and regular monitoring and refresher training. Despite these constraints, 70% of the CAHWs were found to be fully competent (good or very good) in the skills and techniques taught.

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Very poor Poor Good

Assessment level Assessment Very good

0 1 2 3 4 5 6

No. of CAHWs

Figure 2. Relative technical competence of CAHWs in Dollo Ado and Hargelle impact area.

4.4.1.2 SC/US Liben impact area 20% of the interviewed CAHWs rated below average (poor or very poor) in their capacity to demonstrate skills and knowledge taught during their training (Figure 3). The CAHWs in this impact area were selected from three different ethnic groups, namely the Borana, Guji and Arsi, and were trained together. Although the three communities basically speak the same language, they have different local vernacular and description of diseases. The training manual did not take into consideration these variations; instead, all CAHWs were forced to learn the names of diseases and their descriptions using the Borana dialect or English. There is no question that major differences in local naming of disease would lead to confusion and ultimately, to poor understanding. In such cases, it is advisable to conduct the training locally. Limited refresher courses and on-the-job technical support were additional factors resulting in poor performance. However, 80% of the interviewed CAHWs were found to be competent (good or very good).

Very poor Poor Good Assessment level Assessment Very Good

0 1 2 3 4 5 6 7

No. of CAHWs

Figure 3. Relative technical competence of CAHWs in Liben impact area.

4.4.1.3 LVIA impact area Out of the 10 PAs (7 in Moyale-Somali & 3 in Moyale-Oromia) visited only 6 CAHWs (3 from each side) were reached during this mission. The 3 CAHWs interviewed from Moyale –Somali side were all working in drug shops (2 of them in CAHW cooperative drug shops in Moyale and El lay, and the third working in his own drug shop in El lay town). Most of the CAHWs from Moyale-Somali side were not reached for the interview. Therefore, a representative sample size was not obtained, and it is therefore impossible to

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generalize about the technical competence of CAHWs in the impact area. However, the technical competence of those contacted CAHWs varied from poor (as in the case of the CAHW in Mudhiambo PA, Oromia side, who was not able to explain dosages of antibiotics properly), to very good (as in the case of the two CAHWs working in the cooperative drug shops in Moyale & El Lay).

4.4.1.4 CARE impact area Fifteen CAHWs were interviewed in the CARE impact area because there are 3 CAHWs trained per PA and all CAHWs who were present in their PA during the visit were contacted. 93% of the interviewed CAHWs rated above average (good or very good) in their technical competence (Figure 4). No CAHW in this impact area was evaluated as very poor in his/her technical skills. All interviewed CAHWs were able to answer questions asked from memory, without the need to refer to notes. For that matter, no CAHW was seen to be carrying lecture notes. This indicates that the training approach, monitoring and technical support in the field was carried out properly.

Very poor Poor Good

Assessment level Assessment Very good

0 2 4 6 8 10

No. of CAHWs

Figure 4. Relative technical competence of CAHWs in CARE impact area.

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4.4.2 Ranges of services provided by CAHWs CAHWs are having a significant impact on the level of treatment and vaccination services used by livestock herders in their respective communities. In all impact areas most CAHWs are providing a comprehensive ranges of services that includes treatment of internal and external parasites, infectious diseases, Trypanosomosis, vaccination against various diseases, hoof trimming, and de-horning.

4.4.2.1 SC/US Dollo Ado and Hargelle impact area 80% of CAHWs were perceived to offer most of the services covered in their training curriculum, whereas the remaining 20% were offering a more limited range of services (see Figure 5). The main constraint, mentioned by both the CAHWs and the communities, was the supply of veterinary drugs; this was particularly a problem in Dollo Ado Woreda, either because drugs were not supplied as a starter kit, or because CAHWs have failed to restock their kit. The drug kits were inspected during the visit, and most of them did not have sufficient drugs. From interviews, it seems that some CAHWs do not have the cost recovery money needed to buy more drugs. In spite of their limited drug supply, CAHW activities are not limited to treatment and vaccination. They also provide advice and create awareness and community mobilization for vaccination campaigns.

With regard to coverage, the CAHWs provide services to all species of animals except donkeys and poultry, because both the community and the CAHWs have only very limited knowledge of donkey and poultry diseases. All members of the community, irrespective of their wealth, location, gender or ethnicity, use the services provided by the CAHWs.

Very poor Poor Good Very good Assessment level Assessment

0 1 2 3 4 5 6

No. of CAHWs

Figure 5. Range of services provided by CAHWs in Dollo Ado & Hargelle impact areas.

4.4.2.2 SC/US Liben impact area 80% of CAHWs were perceived to offer most of the services covered in their training curriculum, while the remaining 20% were offering a more limited range (see Figure 6). Shortage of drug supply was mentioned overwhelmingly as a major constraint. Most of the CAHWs have very few drugs, both in quantity and type. All CAHWs have been supplied with starter kits and almost all were ready to restock their kits, but there was no drug source, either through the project or through other means.

During this mission, it was learned that SC/US had established a revolving fund for drugs managed by the government veterinary department (through DAP 1). However, it seems, according to a discussion with the government veterinarian (animal health section head), that the amount of money in the revolving fund has diminished from the initial capital due to mismanagement of the fund. Moreover, procurement of drugs was usually constrained by government bureaucracy. Occasionally, even when drugs were available, animal health officers working in the government dispensaries were not willing to sell drugs to CAHWs.

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Very poor Poor Good Very Good Assessment level Assessment

0 1 2 3 4 5 6

No. of CAHWs

Figure 6. Range of services provided by CAHWs in Liben impact area.

4.4.2.3 LVIA impact area In the case of LVIA, the range of services provided by the CAHWs was assessed on the basis of information given by the community since CAHWs in most of the PAs visited were not reached and could not be interviewed. According to the community, 70% of the CAHWs were offering most of the services covered in their training curriculum, while the remaining 30% were offering more limited services (Figure 7). Shortage of drugs was mentioned as the major problem limiting the activity of CAHWs, while other issues mentioned included poor quality drugs (for example acaricide) and faulty equipment (for example large animal burdizzo)

Very poor Poor Good Very good Assessment level Assessment

0 1 2 3 4 5 6

No. of CAHWs

Figure 7. Range of services provided by CAHWs in LVIA impact area.

4.4.2.4 CARE impact area More than 93% of the CAHWs were perceived as offering most of the activities covered in their training, including disease reporting, providing advice, and creating community awareness about disease prevention (Figure 8), while the remaining 7% offered a more limited range of services. The reason given for offering more limited services was that some of the CAHWs failed to buy more drugs upon finishing their initial supply.

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Very poor Poor Good Very good Assessmentlevel

0 2 4 6 8 10 12

No. of CAHWs

Figure 8. Range of services provided by CAHWs in CARE impact area.

4.5 CAHWs Cooperatives Establishment of CAHW cooperatives has been used as a strategy to ensure continuity of the community animal health activity. SC/US and its partners have facilitated the establishment of CAHW cooperatives in all target Woredas and provided start up capital (both in-kind and in-cash), including veterinary drugs and equipment, office furniture and other minor costs. Cooperatives visited during this mission included Dollo Ado, Hargelle, Moyale-Somali, Dire and Yabello. All of these cooperatives have been registered and issued certificates by their respective government departments to operate to support community- based animal health activities. Capacity-building training (covering business and cooperative management) has been given to members of executive committees. It has been noted that a CAHW cooperative in the rest of Somali impact area (outside of Moyale) has been established, and two cooperatives, one in Moyale – Oromia side and one in Teltele Woreda, in LVIA and CARE impact areas respectively, are in the process of being established.

The cooperatives were established to undertake the following main activities: • Consistently supply necessary animal health drugs, in sufficient quantity and quality • Liaise with NGOs and other government organizations • Provide technical assistance to members, and upgrade the capacity of members through training and information sharing • Serve as a discussion forum for members • Identify and solve members’ problems

Each cooperative was assessed in light of these objectives, and the results are presented as follows:

4.5.1 SC/US Dollo Ado and Hargelle impact area The Dollo Ado Cooperative is the oldest cooperative (more than 5 years of age), and yet it still isn’t operating independently. Despite the strong technical, financial and material inputs provided by SC/US, this cooperative seems behind in development. It is too early to comment conclusively about the Hargelle Cooperative because it was very recently established. But generally speaking, it seems that it is not undertaking, even partially, the activities it was established to carry out. Some of the observed constraints of the two cooperatives include:

• Drug supply: The cooperatives still depend on SC/US to identify drug sources from Addis Ababa or Gode, to buy the drugs, and to transport them to the area. The cooperatives are not paying any portion of the cost of transporting the drugs, and thus they are receiving a hidden subsidy. This hinders future financial sustainability of the system and the cooperative will certainly disintegrate upon withdrawal of the implementing organization’s support. Meanwhile, a drug supply shortage by CAHWs cooperative has created a serious drug shortage in the field, most critically in Dollo Ado Woreda.

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• Technical support: The cooperatives are established by CAHWs and all have basically the same limited level of technical skills and knowledge. Therefore, they still depend on SC/US for technical advice and support. The DOA is incapable of taking on this responsibility because of structural instability, and a lack of logistical and financial inputs.

• Accountability: Despite several cooperative management trainings given to the executive committees, this mission found that the two cooperatives lack transparency: there were no meetings of the members, and members of the executive committee were usually not available in their office to support the CAHWs. By-laws are not strictly followed and several issues were mentioned as critical problems, including a lack of trust among members, a lack of regular financial auditing, and poor communication between members and executive members. These were more serious problems in Dollo Ado. The Hargelle cooperative is very new and it is therefore too early to comment on issues of accountability.

4.5.2 SC/US Liben impact area In the Liben impact area, the CAHWs are in the process of establishing their cooperatives, and therefore, there is nothing to report.

4.5.3 LVIA impact area LVIA supported the establishment of two CAHW cooperatives, one for CAHWs in Moyale-Somali side and one for Moyale-Oromia side. The Oromia CAHWs’ cooperative was in the process of being established and registered during this mission. Therefore, there is nothing to report except that they have received training on various aspects of cooperative management.

The Moyale – Somali CAHW Cooperative was established in June 2004. The cooperative is well-organized and financial management systems are in place and functioning properly. The cooperative has opened two drug shops, in Moyale and El lay towns, both purchasing drugs from Addis Ababa. It is clearly independent of LVIA and other institutions in terms of drug sourcing, and there are no hidden cost subsidies. The fact that they are working effectively on a free market basis is an indicator of strength. The CAHWs are linked to the cooperatives for activity and disease reporting, although this was very irregular and decreasing over time as a result of reduced CAHW activity in the field (see concerns, below).

Despite their overall strength, there are some internal and external concerns constraining the achievements of the Moyale-Somali cooperative. These are as follows:

Both drug shops in Moyale and El lay town were well-equipped with the necessary drugs and had a consistent supply; however, the CAHWs were not restocking upon finishing their stock of drugs. Instead, many CAHWs had used the cost recovery money from their initial starter kit for personal use. The major clients of the cooperative are individuals from the communities who buy drugs directly from the cooperative drug shops. The cooperative’s prices are the same for the community and the CAHWs. Thus, for the community, it is more expensive to purchase drugs from the CAHWs (with a profit margin for the CAHW added on the top of the cooperative price), and the community refuses to buy from the CAHWs. With no business, the CAHWs have become less motivated, and many have gradually stopped working.

The second concern is that the handling and use of drugs by untrained community members poses unwanted risks such as misuse and mishandling of drugs, which could lead to drug resistance, among other problems. It seems that the CAHW cooperative is focused on buying and selling drugs for profit, at the expense of supporting service delivery through CAHWs. Obviously, this conflicts with the objectives of the project.

The two drug shops are currently managed by members who rotate in turn for one month each, receiving a paid allowance of 10 Birr per day for their efforts. The problem with this structure is that animal health services are interrupted for one month in a given community while the CAHW is managing the shop. During this mission, for example, the community in Dokiso PA complained about the absence of their CAHW, who was in Moyale drug shop on duty. There is only one trained

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CAHW per PA, and particularly in larger PAs, there is little chance of the service being covered by a CAHW in a neighboring PA.

The CAHWs have not had any technical support for over a year, since the LEAP program implemented by LVIA was phased out. There has been no system created to provide ongoing technical support and supervision, and therefore, there is no technical sustainability within the CAHW group. Unfortunately, the cooperative has not tried to address the problem of inactive CAHWs who are neither buying drugs nor providing services to their communities.

Circulation of cheap and illegal drugs, lack of transport facilities for distributing drugs, and lack of capital for expanding the business were mentioned by members as major constraints affecting their business.

There has been no general meeting of the members to date, and consequently, members do not have information about the financial status or progress made by the cooperative. This leads to similar problems as in the case of Dollo Ado and Hargelle.

4.5.4 CARE impact area Two CAHW cooperatives in Dire and Yabello have been established and are operational. In addition to providing each cooperative with start-up capital in the form of in-kind drugs and equipment, CARE built and provided a drug store. Both the Yabello and Dire cooperatives started to operate relatively recently, within the past 6 months. Thus, the cooperatives are still in the process of setting up operational systems such as financial procedures and record keeping, among other structures.

Initially, members agreed that the drug shops would be managed by members of the executive committees on a monthly rotation, with an allowance of 30 Birr per day for the 2 days per week which are market days. After considering the work load on the executive members, and in order to avoid their absence from their villages and ensure continuous availability of veterinary services, they later agreed to employ an outsider to manage each drug shop for a salary of 200 Birr per month.

The CAHW cooperatives have made a contractual agreement with a locally operating private animal health worker to ensure a drug supply. Under this agreement, they order their drugs through the private business establishment, and in turn sell to the CAHWs. The cooperative and the private business worker agreed that drugs would be supplied to the cooperative at a lower price when they were bought in bulk. The cooperative then sells the drugs to CAHWs with a small profit margin added for the cooperative. Even with this profit margin added, the unit price is lower that the price of the private business owner. This discourages the livestock producers from buying directly from the private business worker. It therefore maintains the CAHWs’ business incentives and motivates them to continue their services.

Technical support is still linked with the project and veterinary department (SORDU). The CAHWs also still submit activity reports to the project unlike in the case of the Somali impact areas, where CAHWs report to their respective cooperatives.

Discussion

The CAHW cooperatives visited at the three impact areas are at different stages of development. Given that the Dollo Ado cooperative is the oldest, it is surprising that it hasn’t achieved the objectives for which it was established: to provide sustainable community based animal health services (including a consistent drug supply) to the community. On the contrary, besides its inability to ensure sustainable drug supply, it is facing many of the challenges which contribute to cooperatives’ failure. These include poor accountability, lack of transparency and poor communication about financial issues between members, lack of trust, and a prioritization of individual interest over group interest. Currently, these problems were not observed in the other cooperatives, but this is likely because all of the rest were established less than a year ago, and have only just started operating. However, sooner or later, it is inevitable that all cooperatives will experience similar problems, and these issues may cause a total failure in meeting overall program objectives. An approach based on the involvement of the private sector is recommended (see section 5.4)

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4.6 Monitoring and Evaluation of the CBAHWs Program SC/US and its partners have standardized the CAHW performance monitoring format. The content of the format largely satisfies the information needs of the various stakeholders of the community-based animal health projects. However, it was prepared based on structured questionnaire leading to a ‘yes’ or ‘no’ response, and therefore does not encourage the participation of the person being interviewed. Consequently, important details may be missed. Veterinary Supervising Committees (VSCs) have been established and trained to monitor and assist the CAHW activities in all impact areas.

In this assessment, whether monitoring was carried out, the number and frequency of monitoring visits, who was involved in the monitoring and evaluation, and the performance of the VSCs have been assessed. Assessment was carried out through discussion with the community and CAHWs, through examination of the technical competence of CAHWs’ skills, and through a review of record keeping and reporting, including completed CAHW monitoring forms. The findings are outlined below.

4.6.1 SC/US Dollo and Hargelle, and Liben impact areas In general, there was no clear monitoring and evaluation system designed or implemented as part of the project management system. Although participants said that the standardized CAHW performance monitoring form was being used, there was no indication that this had been done. Monitoring visits had been planned on a monthly basis initially following the training of CAHWs, and on a quarterly basis afterwards. Monitoring sheets for individual CAHWs were supposed to be completed during each of these monitoring visits and kept for future follow-up and tracking of improvements. However, during this mission, it was not possible to see a completed record for any of the CAHWs, suggesting that monitoring had not been done (or had not been done consistently). Treatment and financial records of most of the CAHWs visited in the field were not up to date or consistent. In addition, most of them did not have drugs and their equipment (Burdizzo) is not functioning. Monitoring and evaluation of CAHWs is carried out haphazardly in response to problems observed in a workshop setting, rather than being done regularly through observations of CAHWs who are on-the-job.

The community was not aware of their role within the monitoring of the project. Although VSCs had been selected and given a mandate to monitor CAHWs, in most places they were not undertaking their responsibilities properly. They had never questioned why CAHWs were not active. Community participation in the monitoring of the project scored very low (see section 4.7.2.1.1), indicating a level of monitoring that is insufficient. This remains a great concern and a weakness of the program.

4.6.2 LVIA impact area Monitoring of CAHWs was carried out through occasional visits to the CAHWs in their respective areas and through discussions with the community. The standardized monitoring format developed by partners had not been introduced at all. There was no clearly defined M&E system designed or established. In fact, following the completion of the STI LEAP-funded project there was no monitoring and technical support provided to the CAHWs in the field. The fact that sustainability of monitoring and technical support after the project period was not ensured is an indication of a poor exit strategy.

Final evaluations and impact assessments were carried out from 15-25 of June 2004. The impact assessment was carried out in only 3 PAs (Kebeles); namely Lagasurie (Ormia side), El Gof and Arda-ola (both Somali side) out of the total 28 PAs (8 in Oromia and 20 in Somali Region) covered under the program. Because the number of PAs was so small, it may not be a representative sample. A minimum of 10 PAs (informant groups) should be covered in a specified project area to reach any valid conclusions. The current participatory impact assessment was carried out in 10 PAs (3 in Oromia and 7 in Somali side), and communities and CAHWs were appreciative that they were being asked about the project and the problems they were having.

Lack of veterinary drugs in the field, personal use of cost recovery money by almost all CAHWs, and inconsistent and incomplete record keeping by CAHWs all indicate insufficient ongoing monitoring. In the case of one CAHW (Guyo Godo – in Mudhiambo PA, Moyale –Oromia), drugs issued as a starter kit

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had not been used and were found expired, indicating that monitoring even during the life of the project was not strong enough.

4.6.3 CARE impact area A monitoring and evaluation structure for the Community-based Animal Health System, along with a CAHW performance monitoring sheet, has been developed and implemented by CARE. The monitoring and evaluation system and CAHW performance monitoring form have been annexed in the “Community- based Animal Health Workers (CAHWs) Training Manual for Borana and Guji Lowlands,” reviewed in December 2004. While the system of M&E used was good compared to the other STI LEAP partners (where M&E didn’t exist at all) some limitations were observed, including:
The various information needed by each of the range of stakeholders was not included in “what to monitor & evaluate”;
It seems as though the community & private animal health workers were not included in the M&E, despite the fact that they were identified as stakeholders by the project. As an indication of this, in the stakeholders’ participation analysis, community and private animal health workers’ participation in monitoring was rated as moderate and low, respectively.
The M&E method does not indicate the use of participatory methodologies.

Similarly, the CAHWs’ performance monitoring format included the major indicators for assessing whether or not CAHWs were successful; however, issues or information needs for each of the indicators, the sources of information, the methodologies to be used to collect the information, and how and who was to analyze and use the information were not clearly defined.

Despite the limitations, there was evidence that monitoring was undertaken in the project. CAHW performance monitoring was carried out every month for three months following the completion of each phase of the training and on quarterly basis thereafter. Each monitoring visit was carried out jointly with the veterinary department, the performance monitoring form for each CAHW was completed, and records were kept in the project office.

Discussion In the STI LEAP proposal it says that “The M&E officer will be responsible for the design and implementation of the monitoring and evaluation system that is consistent with SC/US Ethiopia’s overall M&E system.” However, there was no clear M&E system designed and implemented in Somali and Liben impact areas for the CBAHP. Reduced performance of CAHWs, failure of the CAHWs to replenish their drug kits, inconsistent record-keeping and poor reporting of CAHWs, and weakening of CAHW cooperatives have been noted as some of the consequences of a lack of regular monitoring and field supervision in some of the impact areas. In contrast, in the CARE impact area, there has been an initiative to design and implement an M&E system, although it needs some improvement.

Participatory M&E and impact assessment is part and parcel of the Project Management Cycle (PCM) in community-based projects. Project M&E is part of the learning process, in which the lessons learned feed back into improvement and development of the project. Therefore, in the future, an M&E system that addresses the following issues should be designed and implemented:
Who should be involved in M&E (all stakeholders)?
What information should be collected to address the needs of the various stakeholders?
What methods should be used to collect the information?
How frequently should the information be collected?
Who should analyze the information, and when?
Who will use the information?

Skills and knowledge of staff and partner organizations regarding M&E seems to be poor in some of the impact areas, and unsatisfactory in others. Therefore, attention should be given to enhance this capacity in the future.

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4.7. Sustainability and exit strategy of the CBAHWs Program In this section, factors that affect the sustainability of the Community-Based Animal Health Workers system have been assessed, including the appropriateness of the exit strategy. Policy environment, community participation, CAHWs’ technical competence, financial sustainability and other factors have been identified and examined extensively.

4.7.1 Policy issues There has been a significant improvement in government policy at both the Federal and Regional levels regarding CAHWs and veterinary privatization. At the Federal level a community-based animal health workers and participatory epidemiology unit has been established with the aim to standardize, monitor, and provide support to community-based animal health programs in the country.

The same approach has been adopted in Somali National Regional State, and therefore, CAHWs have been recognized as part of the veterinary service delivery system in the region. The government has realized that it is incapable of reaching livestock herders in remote areas, and therefore has started using CAHWs to bring veterinary drugs and vaccines closer to these communities. The fact that the government sells drugs to CAHWs in Dollo Ado & Hargelle Woredas is one indicator of their acceptance of the CAHW system.

Similarly, in Oromia National Regional State, CAHWs have been accepted in principle as the lowest animal health service providers. However, there is still a lot to be done to ensure their integration at the grassroots level. The fact that the government veterinary service is still involved in direct service delivery at a subsidized rate creates unfair competition and discourages the CAHWs and the private animal health workers. The government needs to clarify the roles and responsibilities of the different actors to ensure a sustainable animal health delivery system in the region.

With regard to drug retailing and distribution, the 176/91 Drug Administration and Control Proclamation allows only Veterinarians, Animal Health Assistants and Animal Health Technicians to be involved in opening and running veterinary drug shops. There is no provision made in any form (individually or as a group) for CAHWs to run drug shop businesses. Therefore, the currently envisaged approach to ensuring drug supply through the CAHW cooperatives contradicts the proclamation, and should be reviewed.

4.7.2 Stakeholders’ participation The lack of community and other stakeholder (such as government and private animal health worker) participation in the design and establishment of CAHWs services has a negative implication for the sustainability of services. Thus, measuring the level of the stakeholders’ participation has been given due consideration in this assessment. A Project Management Cycle (PCM) framework has been used (Annex 5) to assess participation levels at different stage of the project cycle.

Community, government and private animal health service providers have been identified as the main stakeholders by project implementers. Consequently, the level of participation of these stakeholders in the program has been assessed in the respective impact areas through a review of documents and discussions with the communities, government counterparts, CAHWs, and project staff.

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4.7.2.1. Community participation 4.7.2.1.1 Dollo Ado, Hargelle, Moyale and Liben impact areas The community involvement in the projects was found to be low to medium (Figure 9). The community involvement in need identification was ranked low since the communities should have been asked to identify and prioritize locally important diseases to be included in the training content. Community participation in selection of the CAHWs was ranked medium, because in some of the PAs (Dollo and Hargelle) local politicians influenced the communities to select an unsuitable candidate. In all cases, selection criteria were developed by outsiders (project staff & government counterparts), and communities were only asked to select their chosen candidates based on these pre-defined criteria. This is in contrast to a more participatory approach, whereby communities would have been given an opportunity to identify their own criteria (with input from others).

There is a huge demand for the training of more CAHWs in all the PAs visited (there is currently one CAHW per PA in all of these impact areas). This demand indicates that communities were not consulted on the number of CAHWs to be trained. One main challenge of consulting the community is that they may propose more CAHWs than necessary for training. However, by referencing the geographical area to be covered by each CAHW and the number of animals located in that area, it would be possible to arrive at an acceptable estimate for the number of CAHWs needed .

CAHW trainings were carried out in town in all impact areas. Communities were not consulted or involved in the venue selection. Therefore, besides the negative consequences noted previously for CAHWs, an opportunity for community participation in the implementation of training was missed.

Community participation in CAHW monitoring was low in all cases. The role of the community was not clear in the M&E of the CBAH Program. Only PA chairmen or vice-chairmen and a few elders were involved in monitoring. In Dollo Ado, Hargelle and Liben impact areas Veterinary Supervising Committees (VSC) have been established in all PAs and trained to monitor activities of CAHWs, mobilize the community for vaccinations and support CAHWs activities; however, most of them were not undertaking their roles and responsibilities properly. Need Assessment

Preliminary assessment carried out by project staff, livestock disease ranking was not carried out by the community Low participation Design and planning Impact assessment Community agreed on

In the past participatory CAHWs selection criteria;

impact has been carried out in community dialogues on Dollo Ado & thus community CAHWs operational system participated; in the current IA PROJECT & no. of CAHWs decided by community participation was MANAGEMEN project staff High in all target areas T CYCLE Moderate participation

Monitoring Impl ementation Monitoring framework designed by Community selection of project staff, information collected & CAHWs, cost recovery analyzed by project staff, no feedback implemented & training venue to the community, VSC involved in in town. some PAs. Moderate participation Low participation

Figure 9. Level of community participation at different stages of the CBAHWs project in Dollo Ado, Hargelle, Moyale and Liben impact area.

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4.7.2.1.2 CARE impact area The community participation in the project ranged from low to high (Figure 10). Community involvement in monitoring was perceived to be low by both the project staff and community members. The role of community was not clear in the M&E of the CBAH program. Although VSCs have been trained and are operational in most of the PAs, their role is limited.

In the implementation phase of the project community participation was rated as moderate. The fact that the training venues were selected by the project and the trainings were carried out in towns limited community participation. Missed opportunities included that the community could have provided the training venue, offered their livestock to supply sufficient practical cases, and made other contributions.

Community participation in the needs assessment, design and planning was perceived as high by the project staff and the community.

Impact assessment had not been carried out in this impact area before; however, in the current impact assessment, the community and the project staff rated community participation as high.

4.7.2.2 Government counterpart participation Project staff in Dollo Ado, Hargelle and Liben impact areas rated the participation of government counterparts such as the veterinary department and the local administration as high at all level of the project. This was confirmed through discussions and interviews with government staff in both areas. Similarly, in CARE and LVIA impact areas, the participation of government counterparts was rated as high at all level of the project except in the current impact assessment, where participation was rated as very poor. All agricultural development staff in Moyale, Yabello, Dire and Teltele were completing an awareness-raising training on the current political environment in the country at the time of this mission, and therefore, they were not available to participate in the impact assessment exercise.

Generally speaking, participation of the government counterparts was rated as very high despite the continuous restructuring process and re-location of staff, which constrained the continuity of their involvement.

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Need Assessment Community identified & prioritized

local needs; livestock disease ranking

was carried out by the community

High participation Design and planning Impact assessment

Pre-training community dialogues No impact assessment on CAHWs system carried out, carried out before, during PROJECT Community identified CAHWs this mission MANAGEMENT selection criteria; no. of CAHWs High participation CYCLE decided by the community High participation Monitoring

Implementation Monitoring framework designed by project staff, information collected Community selection of CAHWs, & analyzed by project staff, no cost recovery implemented &

feedback to the community, VSC training in town. Moderate participation involved in some PAs. Low participation Figure 10. Level of community participation at different stages of the CBAHWs project in CARE impact area.

4.7.2.3 Private animal health workers’ participation Private animal health workers were identified as a stakeholder group only in the CARE impact area. There are two drug shops (in Yabello and Dire) owned by one private animal health worker, and a strong linkage was established with the CAHWs in the area. Due to his unavailability, the private animal health worker did not participate in the stakeholders’ participation analysis session organized at the CARE office; however, CARE staff rated his involvement as very low in assessing initial need, very low in monitoring and impact assessment, moderate in the design & planning, and high in the implementation phase. The private animal health worker was not involved in the current impact assessment because he was unavailable.

Although there were legalized private animal health workers running veterinary drug businesses in Dollo Ado and Moyale impact areas, they were not considered as stakeholders by the respective projects, and consequently were not involved in the projects. Two private animal health workers (one in Dollo Ado and the second in Moyale) were interviewed to find out their perceptions and understanding about CAHWs system. They said that they have perceived CAHWs as opponents, competing with them for business. The person interviewed in Moyale felt particularly strongly, describing the CBAH system as “inappropriate and dangerous.” There were also negative perceptions between the CAHW program implementers and the private animal health workers.

There are no private animal health workers operating in Hargelle and Liben impact areas and therefore, there is nothing to report from this area.

Discussion Several community-based animal health projects have failed to meet their objectives because of lack of participation of relevant stakeholders. Low participation of community members in decisions that affect their lives has a major implication for the sustainability of a project such as this. Livestock owners’ participation could have added considerably in terms of reducing unnecessary costs. Generally, if community participation is high the cost of the project will be low. It is more likely that a project will be sustainable if the community participates in joint problem identification and analysis, development and implementation of action plans, and finally, monitoring and evaluation of the program. It is important that in the future great emphasis be placed upon involving local people fully in the decision-making and the management of the program. This is an expression of the mainstreaming of a ‘rights based approach’ and

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‘entitlement’ concept. In simplest terms, these concepts say that people are entitled to participate fully in things that concern them.

The various stakeholder groups may have different interests at different stages of the project cycle. Therefore, all stakeholders should be involved fully in the project cycle as necessary.

The ultimate objective of all animal health service providers is to improve animal health service delivery. Therefore, in future, proper stakeholder analysis should be facilitated. Through this process, the roles and responsibilities of each of the stakeholders should be identified and all should agree to work together to achieve common objectives.

4.7.3 Social sustainability The level of community support for CAHWs is another indication of the sustainability and impact of the CAHWs within their respective communities. The level of community support to CAHWs varies from one PA to another, but generally speaking it is rated as average. Although VSCs have been established in all the PAs and trained to support CAHWs, most of the committees are not carrying out their roles and responsibilities. Consequently, most of the CAHWs, particularly in Dollo Ado Woreda, are not delivering services because of shortage of drugs. In Liben, Yabello, Dire and Teltele impact areas the CAHWs are enjoying relatively higher levels of community support. In some of the PAs the community members have constructed drug stores and have supported the CAHW’s family in farming activities and looking after livestock when the CAHW was on training or away delivering services outside his PA.

There is a significant attitudinal change among community members towards the use of modern medicine, with a high willingness to pay for services and dugs used, and CAHWs have generally been accepted and cherished by their respective communities.

The use of cheap, illegal, and poor quality drugs in some of the impact areas has indicated that there are some community members who still have not changed their behavior. Therefore, there is a need to continue community awareness activities about the consequences of using poor quality drugs. To support awareness-raising, government controls of the illegal drug trade should be put in place.

4.7.4 Technical sustainability Drawing on the experiences of similar CAHW systems in other countries, it appears that technical monitoring and drug re-supply of CAHWs are the most significant constraints to the sustainability of the programs. The CAHWs need to maintain high levels of technical competence to ensure sustainability of the animal health program after the withdrawal of the implementing organization. The current technical competence has been assessed (section 4.4.1) and the majority of the CAHWs are above average in their level of skills and knowledge. They are offering appropriate services based on the community demand (section 4.4.2) and provide service to their communities irrespective of the wealth status, gender, ethnicity and location.

However, technical support such as training of new CAHWs to replace dropouts, refresher courses for existing CAHWs, and ongoing support and supervision should continue after the termination of the project. The inability of the project to consistently maintain a regular supply of veterinary drugs of sufficient quality and quantity and the current insufficient field supervision both have negative implications for the long-term sustainability of CAHWs. To this end, the approaches followed by SC/US and its partners to ensure future sustainability of technical support, drug supply, and activity and disease reporting have been specifically assessed.

Drug supply : It was hoped that drug supply would be ensured through CAHW cooperatives. Therefore, CAHWs have been linked to their respective cooperatives in all impact areas (except in Liben where they are linked to government). The relative failure of cooperatives to ensure drug supply has been reviewed under section 4.5, and generally, the current approach does not seem likely to ensure a stable and sustainable drug supply. Furthermore, the current government proclamation for drug administration and control (Proclamation 176/91) allows only Veterinarians, Animal Health Assistants and Animal Health

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Technicians to open and run drug shops. Therefore, CAHWs do not have the legal grounds to act as drug vendors, either individually or in groups/cooperatives, unless they employ eligible professionals.

Technical support : In SC/US Dollo Ado, Hargelle, Liben and CARE the projects have been providing technical support to CAHWs through regular monitoring and refresher courses in collaboration with their government counterparts. In the future, it is envisaged that the government will continue offering technical support by itself. In Moyale, however, the project phased out a year ago, and although it was hoped that the government counterpart would take on the responsibility for providing continued monitoring and field technical support to CAHWs, this has not happened.

All implementers have provided sufficient training to government staff to refresh their technical skills and knowledge of animal health, and their understanding of the Community-based Animal Health Workers approach, in order to enhance their capacity to provide technical support and monitoring of CAHWs in the long term.

However, past experiences have shown that in other locations the government has not continued providing technical support and monitoring of CAHWs after withdrawal of the implementing NGO. This situation has been observed in Moyale, where monitoring and follow up did not continue after phasing out of the LVIA project. As usual, lack of transport, lack of operational funds and lack of commitment were mentioned as the major hindrances preventing them from undertaking this role. This is by no means an unusual finding, and it is one that has been observed commonly in the past.

CAHWs activity and disease reporting: CAHWs report their activities to their respective cooperatives in Moyale, Dollo and Hargelle impact areas; while in the case of CARE they report to the project with a future plan to report to the government. In SC/US Liben, the report is occasionally forwarded to the government.

In the case of Dollo Ado where cooperatives were not supplying drugs in a sustainable way, it is not possible to expect reports from CAHWs. Even where there is sufficient drug supply through the cooperative, as in Moyale-Somali side, CAHWs are not restocking themselves and have decreased their level of service delivery due to lack of monitoring. Thus it is unreasonable to expect activity reports from CAHWs.

Some of the problems observed in the field because of insufficient technical support & monitoring and drug supply are summarized as follows: • Most CAHWs do not have enough drugs in their kits • CAHWs are losing their credibility because without drugs there are few services offered, and thus the community looses trust in the service. • There are no reports coming from CAHWs in some areas • CAHW’s are doing insufficient and incomplete record-keeping • CAHWs and community members are sometimes sourcing drugs from the black market • CAHWs losing motivation in some of the areas

The fact that CAHWs are linked to different institutions for different purposes hinders the sustainability of the Community-Based Animal Health Program. To address this issue, a system that ensures accountability and provides strong linkage between the three elements of sustainable technical support, drug supply, and CAHW disease and activity reporting should be established.

The best strategy for ensuring sustainable technical support, drug supply and CAHW disease and activity reporting would be through a linkage established with a private animal health worker in each area who is supervised by the government veterinary department. See Figure 11 for this suggested model of sustainable community-based animal health delivery.

Currently, there is a favorable policy environment (section 4.7.1) in both Somali and Oromia national regional states in support of a privatized CAHW network. SC/US and its partners should use this opportunity to support Veterinarians or other animal health workers (such as Animal Health Assistants) to

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set up private veterinary businesses and establish a privatized network of CAHWs. The private animal health worker could provide technical monitoring and ensure sufficient drug supply, collect reports of treatments and vaccination from CAHWs, compile the reports on regular basis and distribute them to stakeholders. He/She could also assume other responsibilities for the CAHWs under his/her direction. This approach would provide better sustainability in terms of technical monitoring, drug supply and reporting than either government or CAHW cooperatives. Two private animal health workers interviewed (from Dollo Ado and Moyale) expressed an interest in creating such a linkage with CAHWs in their areas.

Meanwhile, CAHW cooperatives should be strengthened and involved in other marketing opportunities besides the resale of drugs. There is a huge potential for livestock and livestock products marketing in all impact areas. For example, in the case of Dollo & Hargelle, cooperatives could be organized for the collection and marketing of milk and small stock as there is high demand in Mandera (Kenya).

Training * Government NGOs

Credit to set up •Quality control business •Compile monthly report & send to the •Initial training of CAHWs; Private Animal woreda Vet. Office •CAHWs status •Supply starter kit Health worker • report Link with PAHW (PAHW)

•Drug & Vaccine supply •Technical support & advice •Monthly activity reports •Control quality of •Disease outbreak reports services provided •Technical support when possible CAHWs

•Monitor CAHWs activity Service delivery •Facilitate marketing CAHWs Cooperatives •Report disease outbreaks •Monitor CAHWs activity •Community participation & awareness raising •Illegal drug control Livestock keepers

Figure 11. An example of community based privatized animal health network

4.7.5 Financial sustainability There is high level of understanding and awareness among the community and stakeholders on how the financial system of CAHWs functions. They have clear understanding about CAHW incentives and they are willing to pay for drugs, vaccines and services. CAHWs in all impact areas were provided with starter kits, although this was delayed in some impact areas (Dollo Ado). The initial drug supply was used as start- up capital. Therefore, upon finishing the drugs in the startup kit CAHWs were supposed to buy replacement drugs with the cost recovered, utilizing only the profit margin for personal use.

As described previously, CAHW cooperatives were established with start-up capital donated from projects and they have opened drug shops. However, some concerns have been identified related to financial sustainability, in the cases of both the individual CAHWs and the cooperatives. These concerns are described below:
In most of the impact areas (Dollo Ado, Hargelle and Moyale) the initial principle money given as a starter kit for CAHWs is declining. In some of the areas, CAHWs have stopped buying drugs and have completely used the start-up money.
The quantity of drugs initially issued to CAHWs was insufficient.
Cheap, inefficient and illegal drugs are available and are still used by some community members.

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The government is opening some drug shops at the PA-level (Oromia side)
In the case of Moyale – Somali, the CAHW cooperative sells drugs to the community at the same price it sells drugs to CAHWs. This pushes the CAHWs out of the business.
CAHW cooperatives in Dollo Ado & Hargelle still depend on SC/US for drug sourcing, buying and transporting from Addis or Gode to the sites, and the associated costs are still covered by SC/US. A system has not been put in place for the cooperatives to cope with full cost recovery and running costs, which puts the cooperatives’ sustainability in jeopardy.
Cooperatives have limited working capital.

Poor understanding about private business and financial management contributes to poor financial performance and poor financial sustainability of individual CAHWs.

Therefore, in the future, CAHWs should be trained in small business skills and attention should be given to the scaling-up of the business and financial management capacity of the cooperatives. Due to an improved market for animals and animal products, the involvement of the CAHWs and cooperatives in this activity as an additional income source is highly realistic and could be facilitated to secure the long- term financial sustainability of the system.

4.7.6. Conflict Conflict and insecurity have a significant negative impact on the sustainability of community-based animal health worker systems. The community animal health worker system in Borana lowlands has suffered from the sporadic conflict that has occurred between different ethnic groups in the area. CAHWs have lost their drug kits and cost recovery money and consequently, have been forced to limit or stop their services in most PAs. See Annex 7 for a case study of a CAHW who lost her drugs, cost recovery money and livestock due to the recent conflict between the Guji and Gebra communities in Yabello Woreda.

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Section 5: SWOT analysis

The projects’ Strengths (S), Weakness (W), Opportunities (O) and Threats (T) were analyzed as a part of the review. This analysis was carried out based on the discussions held with the various stakeholders in each impact area, the impact assessment exercises, and the consultant’s own perceptions. The results are summarized below:

5.1 SC/US Dollo Ado and Hargelle impact area

Table 4. Summary of SWOT analysis carried out in SC/US Dollo Ado & Hargelle impact areas. Strengths Weaknesses • CAHWs system established and operational in areas • Insufficient community dialogue where there was no service before. • Lack of participatory baseline survey • Previously trained 30 CAHWs (20 in Dollo Ado & 10 • Poor CAHW selection process followed in Hargelle) received refresher training and were made • Conventional training approach used instead of operational participative and hands-on practical training

• 10 new CAHWs (5 in Dollo Ado & 5 in Hargelle) • Duration of training not consistent trained and made operational • No regularly planned refresher training

• New CAHW cooperative in Hargelle established, & • Irregular and poor CAHW monitoring system the existing cooperative in Dollo Ado strengthened • CAHW cooperatives are not independent of • TOT conducted for trainers SC/US

• All treatments and vaccinations were given at full cost. • CAHWs’ services declining

• Government sold drugs to CAHW cooperatives when • Shortage of drug supply available. • CAHWs dropped out demanding salary and due • Active participation of DAO in the Program to lack of motivation.

• Community awareness on the use of appropriate • Poor CAHW reporting veterinary drugs & vaccines enhanced • VSC and community support to CAHWs was not • VSCs established and trained in each PA satisfactory

• CAHW cooperatives trained in business management • Amount of CAHWs’ cost recovery money

• Donkey cart distributed to CAHWs to support their declining, and in some cases totally used for means of living. purposes other than refilling the drug kits • Insufficient involvement of all stakeholders at all level of the project. Opportunities Threats • Privatized CAHW network system accepted and • Drought supported by the region • Subsidized government veterinary drug supply • Community willing to pay full cost for veterinary (when available) services, including vaccination and minor surgery • Poor quality drugs of unknown source circulating • The presence of privately operating veterinary drug in the area vendor (Dollo Ado) • Absence of sustainable drug supply sources for • Availability of markets for livestock and livestock CAHWs products • Poor accountability and transparency among • Willingness and interest of the community to CAHW cooperatives participate in project activities

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5.2 SC/US Liben impact area

Table 5. Summary of SWOT analysis carried out in SC/US Liben impact areas. Strengths Weaknesses • CAHW system established and operational in areas • Shortage of drugs in all PAs where there was no service before • Insufficient monitoring and supervision of • 20 CAHWs trained and functional CAHWs • All CAHWs were issued with starter kit following • No CAHW cooperative established the completion of each training phase • No baseline data collected • Government veterinary staff received TOT and • Poor CAHW selection process followed participated in CAHW training • Limited community participation at all levels of the • 83, 310 animals received treatment against various project diseases in 2004 & 2005. • Lack of clearly defined exit strategy

• Community awareness about the appropriate use • Insufficient support from government veterinary of veterinary drugs and vaccines enhanced department

• Drug cost recovery system established • Insufficient community dialogue

• Used standard CAHW training manual that is • Limited refresher courses conducted suitable to the local situation • Limited veterinary services for some diseases

• Limited re-supply of equipment Opportunities Threats • Government animal health technicians posted in • Government animal health officers (AHO) not most cases in the rural areas willing to support the work of CAHWs • Appropriate policy environment for privatized • Drought CAHW network system in the regions • Insecurity (conflict) • Community willingness to pay full costs for • Unfair competition from illegal drug dealers veterinary services, including vaccination and • Insufficient attitudinal change towards the use of minor surgery illegal drugs • Government policy hindering the use of trypanocidal drugs by CAHWs.

5.3 LVIA impact area

Table 6. Summary of SWOT analysis carried out in LVIA impact areas. Strengths Weaknesses • CAHWs system established and operational in area • Insufficient community dialogue where there was no service before. • Insufficient monitoring and supervision • 20 CAHWs in Moyale-Somali and 8 CAHWs trained • Lack of participatory baseline survey and made operational • Poor CAHW selection process followed

• All CAHWs were issued with starter kits following • Conventional training approach used instead of the completion of each training phase participatory and hands-on practical training

• Government veterinary staff (AHAs, AHTs & LTs) • CAHWs trained at the University were given refresher trainings. • Government veterinary department staff were not

• More than 830,317 animals have been treated and trained as trainers of CAHWs (TOT) 99,410 vaccinated • CAHWs participated in direct training of other

• Cost recovery was applied on all treatment & CAHWs vaccinations • Limited refresher courses conducted

• Active government participation • 4 CAHWs trained in Debre Zeit (Addis Ababa

• Strong CAHW cooperatives established University) dropped out

• Business and financial management training given to • Most of the CAHWs are not active due to shortage cooperatives of drugs • Amount of CAHWs cost recovery money declining, & in some cases totally used for other purposes • Insufficient involvement of all stakeholders all

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levels of the project • CAHW cooperatives not meeting the objectives they were established for • Some equipment provided for CAHWs were faulty (example Burdizzo) • Acaricide was not of good quality • CAHW cooperative was not established on Oromia side Opportunities Threats • Appropriate policy environment for privatized • Insufficient attitudinal change towards the use of CAHW network system in both Somali & Oromia illegal drugs regions • Drought • Community willingness to pay full cost for • Insecurity (conflict) veterinary services, including vaccination and minor • Drug subsidies by government surgery • Illegal drug business

• The presence of private animal health workers in • Lack of drug control regulation at Woreda level Moyale town • Availability of markets for livestock and livestock products • Willingness and interest of the community to participate in project activities • Establishment of CAHW cooperatives

5.4 CARE impact area

Table 7. Summary of SWOT analysis carried out in CARE impact areas. Strengths Weaknesses • Trained and equipped 60 CAHWs and covered • USAID policy on veterinary drug procurement for animal health services in all target areas (50% of CAHWs PAs) • Lack of vet kit maintenance or replenishment • CAHWs treated more than 835,663 and vaccinated • CAHWs failed to replace mules when they died more than 1,116,095 animals • Lack of direct reporting communication between • High community participation at all levels of the CAHWs and Government Animal Health project Department. • Facilitated establishment of 2 CAHW cooperatives • Government policy hindering the handling and use • Strong collaboration and working relations of trypanocidal drugs by CAHWs established with line departments • Limited veterinary service for some diseases • Trained women as CAHWs • Vaccination limited to list “B” diseases • Strong support for and acceptance of CAHWs by • Limited re-supply of equipment the community • Established strong linkages of CAHWs with Government veterinary department and private veterinarians • Strong coordination and collaboration with other NGOs (AFD & GTZ) and other CARE projects (BVRI) • Established drug cost recovery system • Developed standard CAHW training manual that is suitable for the local situation • CAHWs also provided extension services on Drought, Early Warning Systems, HIV/AIDS and Family Planning • Training duration reduced from 3 phases to 2 phases, and treatment of Trypanosomosis added to CAHW training curriculum through strong lobby for policy change with government

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• Access to animal health services provided to Gebra and Wata minority pastoral and agro-pastoral communities • Maintained correct balance between professional ethics and service delivery Opportunities Threats • Presence of line departments • Drug subsidy by government • Increased community acceptance of CAHWs • Illegal drug business • Improved CAHW skills through additional • Lack of drug control regulation at Woreda level trainings • Poor implementation of government policy • Enhanced CAHW cooperatives, both in terms of • Conflict institutional capacity and expanded services • Drought

• CAHW cooperatives enhance community • Outbreak of unknown diseases awareness • Vaccine production and supply constraints

• Enforcement of roles and responsibilities of • Lack of spare parts for veterinary equipment in stakeholders Yabello

• Decentralization of Oromia Pastoral Development • Lack of technical support from government Commission to Woreda level counterparts

• Enabling policy environment • Training of new CAHWs and refresher training for

• Possibility to re-organize (expand) CAHW existing CAHWs after the project not planned for cooperatives to MPC or secondary cooperatives • Absence of local private veterinary drug supplier • Acceptance of CAHWs by government as the lowest veterinary service providers

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Section 6: Impact of the CAHWs Program

6.1 Changes in livestock health status A primary objective of the CBAHP is to improve animal health services to pastoral and agro-pastoral communities, and thus an obvious indicator of impact is the effect on animal health and production status. The absence of accurate baseline data for various species poses a significant constraint to quantification. Nevertheless, livestock herders are constantly exposed to the dynamics of animal health and production, and are very aware of any changes. Participatory methodologies such as ‘Semi-structured interviews’, and ‘Before and after’ proportional piling were used to determine communities’ perceptions of changes in the general health status of all livestock species, and changes in the incidence and mortality caused by specific diseases. Findings are outlined below:

6.1.1 Change in general livestock health status ‘Before’ and ‘After’ the project. All informant groups were first asked to score the proportion of healthy and unhealthy animals (cattle, sheep & goats, and camels) ‘before’ the CAHW program started in their area using 10 stones. Then, they were asked to score changes in the proportion of healthy and unhealthy animals ‘after’ the project (now) by increasing or decreasing the number of stones (or leaving it as it was if there were no changes).

All informant groups in all areas agreed that there has been a significant increase in the proportion of healthy animals since the CHAW project was implemented, and that the change is dues mostly to the increased availability of medicines, vaccines and other project inputs. Results for specific impact areas are shown below:

6.1.1.1 SC/US Dollo Ado and Hargelle impact area

8 7

6 5

4

3 2

1

0 Healthy Unhealthy Healthy Unhealthy Healthy Unhealthy Median livestock health impact score impact health score livestock Median Cattle Sheep & Goat Camel

Before the project After the project

Figure 12. Changes in the disease impact scores for all livestock disease in Dollo & Hargelle impact areas.

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6.1.1.2 SC/US Liben impact area

8

7 6

5

4 3

2 1

0 Healthy Unhealthy Healthy Unhealthy Healthy Unhealthy

impact score health livestock Median Cattle Sheep & Goat Camel

Before the project After the project

Figure 13. Changes in the disease impact scores for all livestock disease in Liben impact area.

6.1.1.3 LVIA impact area

9

8 7 6

5 4 3

2 1 0

Healthy Unhealthy Healthy Unhealthy Healthy Unhealthy

Medianlivestockscore health impact Cattle Sheep & Goat Camel

Before the project After the project

Figure 14. Changes in the disease impact scores for all livestock disease in LVIA impact area.

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6.1.1.4 CARE impact area

9 8

7

6 5

4 3

2

1 0

Median livestock healthimpact score Healthy Unhealthy Healthy Unhealthy Healthy Unhealthy

Cattle Sheep & Goat Camel

Before the project After the project Figure 15. Changes in the disease impact scores for all livestock disease in CARE impact area.

6.1.2 Change in specific disease incidence and mortality after the CAHWs activity Semi-structured interviews were used to identify the most important diseases for each species of animals (cattle, sheep & goat and camel). More than 12 diseases were mentioned by each of the informant groups; however, for the purposes of statistical analysis only the diseases which were mentioned by all 10 informant groups were selected, and the incidence and mortality impact for each disease was assessed using the ‘Before and After’ proportional piling method with 10 stones. At the same time, the informants were asked whether each of these diseases was handled by CAHWs, and asked to explain the reason for any change in disease incidence. The findings in each impact area for each species of animal are presented below:

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6.1.2.1 SC/US Dollo Ado and Hargelle impact area a) Change in Cattle disease incidence ‘Before and After’ the project

Nine of the most important diseases affecting cattle, and the community perception of changes in disease incidence after the CAHW project was implemented are illustrated in Figure 16. The diseases handled and not handled by CAHWs are shown in Table 8. There is strong agreement between informant groups that the incidence of diseases handled by CAHWs has been significantly reduced. Garabgoye (Black leg), Goryan (Internal parasite) and Kud (Anthrax) were among the diseases significantly reduced.

Handled by CAHWs Not handled by CAHWs 3 2 1 0 -1 -2 -3 -4 -5 -6

e n b o a t ye Kud y idig a

Change in medianin Change disease impact score goy b Sillin or Abe u b G Dooqe udid ra G K a Kadh G Diseases

Figure 16. Community perceptions of changes in cattle disease impacts after CAHW Program implementation in Dollo Ado & Hargelle impact areas. Number of informants =10; W = 0.25 (p < 0.001). b) Change in sheep and goats disease incidence ‘Before’ and ‘After’ the project

The ten most important diseases affecting sheep & goats mentioned by all informant groups, and the perception of changes in disease incidence after CAHW project implementation are illustrated in Figure 17.

Diseases handled and not handled by CAHWs are shown in Table 8. There is strong agreement between all informant groups that the incidence of diseases handled by CAHWs has been significantly reduced. Rii wayne (CCPP), Dabrahan / Shuan (Diarrhoeaa), Cadho ( Mange), Gorian (Internal parasite) and Shilin (Tick infestation) were among the diseases reduced significantly.

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Handled by CAHWs Not handled by CAHWs

6 4 2 0 -2 -4 -6

o n d ne a y dh a hu qara Injir C Shillin gudu Karaf f f bog i wa /S Goryan Hergeboo Ri uf/A gos/Ra D Change in median disease scoreimpact ruq/S u u L Dabrahan F

Disease

Figure 17. Community perceptions of changes in sheep & goat disease impacts after CAHW Program implementation in Dollo Ado & Hargelle impact areas. Number of informants = 10; W = 0.35 (p < 0.001).

c) Change in Camel disease incidence ‘Before and After’ project Informant groups identified eleven diseases affecting camels, out of which 6 were handled by CAHWs (Table 8). The perception of changes in disease incidence after CAHW project implementation is shown in Figure 18. Kud (Anthrax), Dhukan (Trypanosomosis), Goryan (Internal parasites) and Caadho (Mange ) were among the diseases significantly reduced.

Handled by CAHWs Not handled by CAHWs

2 1 0 -1 -2 -3 score -4 -5 -6 -7

n o o e ja Changemedian in diseaseimpact a t lin uq bir n k a Kud il ur a hu ug adh F K D Sh El qot D / Ca Shim yan/Sok r Madhabrar Kufa Go Diseases

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Figure 18. Community perception of changes in camel disease impacts after CAHW Program implementation in Dollo Ado & Hargelle impact areas. Number of informants = 10; W = 0.30 (p < 0.001).

Table 8. Diseases handled and not handled by CAHWs in Dollo Ado and Hargelle impact area Disease handled by CAHWs Diseases not handled by CAHWs Species Oromifa name English name Oromifa name English name Cattle Shillin Tick infestation Cabeeb FMD acute form Jomo FMD chronic form Garabgoye Black leg Gubato Undiagnosed skin disease Kud / Habat Anthrax Kududuye Three day sickness Goryan Internal parasite Kadhidig Red Urine Do’oqe Trypanosomosis Sheep & Rii wayne CCPP Furuq / Soogudud Sheep & goat pox goats Cadho Mange Lugos / Raf qurar Foot rot Dabrahan / Shuan Diarrhoea Injir Lice Goryan Internal parasite Duf / Af bog Orf Shillin Tick infestation Hergeb Pasteurellosis Camels Dhukan Trypanosomosis Furuq Camel pox Kufa / Coughing Madhabrar/ Swelling of the head & Dugato (Respiratory problem) Anabarar neck Kud Anthrax Shimbirki Twisted neck syndrome Caadho Mange Kanja Not identified Shillin Tick infestation El qot Eye disease Goryan / Soke Internal parasites

6.1.2.2 SC/US Liben impact area

a) Change in Cattle disease incidence ‘Before and After’ the project There is a significant reduction in the impact of the various disease handled by CAHWs (Figure 19). However, the impact of Tuma (MCF) & Shilmi (Tick infestation) didn’t reduce very much, although these diseases were handled by CAHWs. This was because of insufficient knowledge about the disease in the case of Tuma , and reduced mobility and a ban on bush burning resulting in an increased tick population and therefore increased disease pressure in the case of Shilmi . The list of diseases and their English equivalents is shown in Table 9 below.

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Handled by CAHWs Not handled by CAHWs 12 10 8 6 4 2 score 0 -2 -4 -6 Changemedian diseasein impact -8

i n a a a o a u e g it m m ir lo C u / T arssa Birte ucha e Hark Shillmia T w Gadel Butala el e/Ra A / a M m ux / bessaSuki/Be ukub sa m ir im h an o C S irra S D B M / / Tabarii/Tarabii le Dhukub ta Huda/Kelete/Silisa u Disease L Oya

Figure 19. Community perceptions of changes in cattle disease impacts after CAHW Program implementation in Liben impact area. Number of informants =10; W = 0.56 (p < 0.001). b) Change in Sheep and Goats disease incidence ‘Before and After’ the project.

Since the implementation of the CAHW project, there was a significant reduction in the impact of the various sheep and goat diseases handled by CAHWs (Figure 20). The impact of Kenxo/Cito (Mange) and Ramo (Internal helminthosis) was among those highly reduced. However, in the case of Shilmi (Tick infestation ), disease impact reduction was not significant although it was handled by CAHWs. This was because of higher tick populations, as explained in the Cattle section. The list of diseases and their English names were shown in Table 9 below.

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Handled by CAHWs Not handled by CAHWs

3

2

1

0

score score -1

-2

-3

Change in median disease impact disease median in Change -4

a ii i r a to mi r k i s ga uf ulla il 'laa u ala e Ci a F hita t B Q Sh E C uden Dh / Bu / a Dhukana Shimb la hechebs e C M Gudan Diseases

Figure 20 . Community perceptions of changes in sheep & goat disease impacts after CAHW Program implementation in Liben impact area. Number of informants = 10; W = 0.53 (p < 0.001 ). c) Change in Camel disease incidence ‘Before and After’ project Informant groups identified thirteen major diseases affecting camels. Of the 7 diseases handled by CAHWs (Table 9), only the impact of 4 diseases such as Qufa (Coughing –Pneumonia), Cito (Mange ), Furri (Nasal discharge due to Upper Respiratory infection) and Chita (Anthrax) was reduced since the CBAHP implementation. The impact of the other three diseases was not reduced. Of those three, Shilmi (Tick infestation ) didn’t reduce due higher tick populations, as explained in the Cattle section. Among diseases not handled by CAHWs, Dhukana (Trypanosomosis ) was reduced significantly due to increased availability of medicines from black market. Although Dhukana was included in the training of the CAHWs, the medicine to treat the disease was not included in the drug kit, because the Oromia regional government policy did not allow the use of trypanocidal drugs by CAHWs.

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Handled by CAHWs Not handled by CAHWs

3

2

1

0

score -1

-2

-3

-4 Change Change in median disease impact i i a o a a la a a fa lm a ta n nk Cit 'l urii Qu F ka Beg Dhull Shi Ea Chi Buta de ebss hu /u h a/ D Shimbir la Chec Me Gudan

Diseases

Figure 21 . Community perceptions of changes in camel disease impacts after CAHW Program implementation in Liben impact area. Number of informants = 10; W = 0.24(p < 0.001) .

Table 9. Diseases handled and not handled by CAHWs in Liben impact area. Disease handled by CAHWs Diseases not handled by CAHWs Species Oromifa name English name Oromifa name English name Cattle Sombessa Loni CBPP Luta / Birra / Trypanosomosis Awarssa

Suki / Bega LSD Birte Babesiosis/Anaplasmosis

Cirmele / Cita Anthrax 1) Oyale / Mansa 1) FMD, acute form 2) Gadele 1) FMD, chronic form Huda / Kelete / Pasturellosis Dhukuba Mucha Silisa / Necerssa Mastitis

Harka Black leg Tabarii Toxic plant Simuxe / Ramo Gera Internal Helminthosis Butala Bovine Ephemeral fever Tuma MCF Shillmi Tick infestation Dhukuba Tiru Cowderiosis Sheep & goats Kenxo / Cito Mange Tefki Flees Sombessa Re’ee CCPP Merereb PPR Albati Dhiga Bloody Diarrhoea Jonjo /Metamere Cenerosis Dhooqa Undiagnosed Disease Habara /Humburur Orf Qando Undiagnosed Disease causing shivering Bergow /Okola Foot root Simuxe / Ramo gera Internal Helminthosis Shilmi Tick infestation Camels Qufa Chronic coughing Dhukan Trypanosomosis (Pneumonia) Dhulla Lymphadenitis Butala Ephemeral Fever Cito /Chito Mange Gudan / Hudenki Undiagnosed Tick born disease

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Disease handled by CAHWs Diseases not handled by CAHWs Species Oromifa name English name Oromifa name English name Shilmi Tick infestation Shimbirki Twisted neck syndrome Melaa Skin Abscess Chechebssa Undiagnosed Furii Upper Respiratory Bega Camel pox Infection Chita Anthrax

6.1.2.3 LVIA impact area a) Change in Cattle disease incidence ‘Before and After’ the project Informant groups identified 15 major cattle diseases, 10 of which were handled by CAHWs (Table 10). There was a significant reduction in the impact of all diseases handled by CAHWs except in the case of Nekersa / Jikawo (Mastitis) (Figure 22). The impact of this disease wasn’t reduced due to the shortage of drugs in some of the PAs and the high cost of the medicine in others. One CAHW had not used the medicine (Intera -mammary injection) that was supplied as starter drug, and it had expired.

Handled by CAHWs Not handled by CAHWs 10 8 6 4 2 score 0 -2 -4 -6 Change in median disease impact a n o e a s ni ra le a t ita rk o w a C a uma L Buta Begaa Shili Oy Bir H uk sa Gadal s /Jikamo ge e a m b rs ido/Gubeto Huda/Sili b Awarsa/Luxake I Tuma/TSom Ne orian/Ra G Diseases

Figure 22. Community perceptions of changes in cattle disease impacts after CBAHP implementation in LVIA impact area. Number of informants = 10; W = 0.52(p < 0.0001).

b) Change in Sheep and Goats disease incidence ‘Before and After’ the project. Fifteen major sheep and goat diseases were identified, out of which 8 were handled by CAHWs and the rest were not handled by CAHWs (Table 10). There was a significant reduction in the impact of most of the diseases handled by CAHWs after the project was implemented (Figure 23). Chito (Mange), Ramo gera / Goryan and Marared were among those highly reduced, the last due to a vaccination campaign carried out jointly with government veterinary department. On the other hand Shilmi / Chini (Tick infestation ) did not reduce because of the poor quality of the acaricide supplied and used. CAHWs in all PAs complained about the ineffectiveness of the acaricide supplied.

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Handled by CAHWs Not handled by CAHWs 6

4

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r o Change in median disease impact lla reb e ru e'ee bati bale d ote Chito ryan tb Sirg R Al a/Furiio tu o Sirido f QandhoGa B Marailmi/Chini /G Ku Umbu/ Qu o bessa Sh wo/Bekektuera m g skus So erga B Ku ammo R Diseases

Figure 23. Community perceptions of changes in sheep & goat disease impacts after CAHWs Program implementation in LVIA impact area. Number of informants = 10; W = 0.34(p < 0.0001).

c) Change in Camel disease incidence ‘Before and After’ project Eighteen camel diseases were identified, out of which 11 were handled by CAHWs (Table 10). For those diseases handled by CAHWs, a significant reduction in the impact of the most important diseases was observed (Figure 24). Shilmi (Tick infestation) was not reduced because of the poor quality of acaricide used, as explained in the Sheep and Goats section.

Handled by CAHWs Not handled by CAHWs 5 4 3 2 1 0 -1

score -2 -3 -4 -5 -6

i a i r Changemedianin disease impact sa to d la n u s ala ga bsa Cita hi ka t enki m C Furr u d Be birkca Malaa DhulShilmih Bu m c n/Le Dhugu a Luk a D Umburur C ri Shi o nki/U G uda G Diseases Figure 24. Community perceptions of changes in camel disease impacts after CAHWs Program implementation in LVIA impact area. Number of informants = 10; W = 0.45 (p < 0.0001).

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Table 10. Diseases handled and not handled by CAHWs in LVIA impact area. Disease handled by CAHWs Diseases not handled by CAHWs Species Oromifa name English name Oromifa name English name Cattle Sombessa Loni CBPP Oyale FMD, acute form Gadele FMD, chronic form Bega LSD Birte Babesiosis/ Anaplasmosis Chirmele / Cita Anthrax Ibido/Gubeto Undiagnosed skin disease, probably photosintesization Huda /Silisa Pasteurellosis Gadela Toxic plant Harka Black leg Buta Ephemeral Fever Gorian / Ramo Gera Internal Helminthosis Tuma / Tukuma MCF Shilln Tick infestation Nekerssa / Jikawo Mastitis Awarssa / Luxa Trypanosomosis

Sheep & goats Chito Mange Kutubale Pox Sombessa Re’ee CCPP Qandho Undiagnosed disease Albati Diarrhoea Sirgo Cenerosis Merereb PPR Humburur Orf Shilmi Tick infestation Gadella Toxic plant Bergow /Bekektu Foot root Kuskuso/Botbota Undiagnosed disease Goryan / Ramo gera Internal Helminthosis Sirido Oestrsovis Qufa / Furri Pasteurellosis

Camels Gorian / Lessa Internal Helminthosis Umburur Camel Orf Dhulla Lymphadenitis Butala Ephemeral Fever Cito /Chito Mange Gudan / Hudenki Undiagnosed Tick born disease Shilmi Tick infestation Shimbirki Twisted neck syndrome Melaa Skin Abscess Caechebssa Undiagnosed Furii Upper Respiratory Bega Camel pox infection Chita Anthrax Luk mure/Mil mure Lameness of the hind leg Dhugud Chronic coughing Dhukan Trypanosomosis

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6.1.2.4 CARE impact area a) Change in Cattle disease incidence ‘Before and After’ the project

Informant groups identified fourteen major cattle diseases, out of which nine were handled by CAHWs (Table 11). Significant reduction in the impact of all diseases handled by CAHWs was observed (Figure 25). Gendi (Trypanosomosis ) was included in the training but medicine was not included in the drug kit for more than 2 years due to the regional government’s policy of not allowing CAHWs to handle and use trypanocidal drugs.

Handled by CAHWs Not handled by CAHWs

10

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2 score 0

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-6 Change in median disease impact median in Change i a ni e k it o im ndi iga ma aga urru M Birt Tu Buta HarkaSilisa Shil G Ge Oyale ele/Ch essa lo ita m Bega/Su lbati Dh ir Dhi A Ch Somb Diseases Figure 25 . Community perceptions of changes in cattle disease impacts after CBAHP implementation in CARE impact area. Number of informants = 10; W = 0.45 (p < 0.0001). b) Change in Sheep and Goats disease incidence ‘Before and After’ the project. Informant groups identified 14 major sheep and goat diseases, out of which 7 were handled by CAHWs (Table 11). There was a significant decrease in the impact of all diseases handled by CAHWs (Figure 26), particularly for Chito (Mange ) and Shilmi ( Tick infestation ).

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Handled by CAHWs Not handled by CAHWs 10 8 6 4 2 0 score score -2 -4 -6 -8 Change in median disease impact disease median in Change -10

e b a a a o u e o e e ho mi t g r l ito ' il i id ma kol nd h ir T ir a Ch rer O Mag S uba S Re e Ke S a M ekeno ub Kut ssa R Qurt uk h D ombe Bergewo/ S Umburur/Adarra Diseases

Figure 26. Community perceptions of changes in sheep & goat disease impacts after CBAHP implementation in CARE impact area . Number of informants = 10; W = 0.45 (p < 0.0001). c) Change in Camel disease incidence ‘Before and After’ the project

Informant groups identified 14 major camel diseases, out of which 6 were handled by CAHWs (Table 11). The impact of all diseases handled by CAHWs was significantly reduced (Figure 27), particularly Chito (Mange ).

Handled by CAHWs Not handled by CAHWs 4

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-6 Change in median disease impact disease inChange median -8

a i a da lla k ur s ki u ito ch a ana r g h k bi u C hi M Furri u den km Baga h d Dhulla h U Butala im h D D r/Lu hmburur u U S Qan Chachabs ilm M Diseases

Figure 27. Community perceptions of changes in camel disease impacts after CBAHP implementation in CARE impact area. Number of informants = 10; W = 0.54 (p < 0.0001).

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Table 11. Diseases handled and not handled by CAHWs in the CARE impact area Disease handled by CAHWs Diseases not handled by CAHWs Species Oromifa name English name Oromifa name English name Cattle Sombessa Loni CBPP Oyale FMD, acute form Bega / Suki LSD Albati Diga Bloody Diarrhoea Chirmele / Cita Anthrax Gendi Trypanosomosis Silisa Pasteurellosis Buta Bovine Ephemeral Fever Harka Black leg Tuma MCF Maga Internal Helminthosis Birte Babesiosis / Anaplasmosis Shilln Tick infestation Ditta Guru Mastitis

Sheep & goats Chito Mange Kutubale Pox Sombessa Re’ee CCPP Rekenota Undiagnosed Qandho Heart water Sirgo Cenerosis Merereb PPR Humburur/Adarra Orf Shilmi Tick infestation Dhukuba Tiru Bergow /Okola Foot root Sirido Oestrsovis Maga Internal Helminthosis Qurtama Undiagnosed Camels Dhulla Lymphadenitis Dhukan Trypanosomosis Chito Mange Umburur Camel Orf Qendhicha Undiagnosed Butala Undiagnosed Melaa Skin Abscess Udenki Undiagnosed Furii Upper Respiratory Shimbirki Twisted neck Infection Syndrome Chita Anthrax Caechebssa Undiagnosed Dhugud Chronic coughing Bega Camel pox Milmure/Lukmure Lameness of the hind leg

6.1.3 Attributes to the observed changes in livestock health Several factors other than the project inputs and activities could have caused the changes in disease impact observed during the project period. Other contributing factors could include the quality of government veterinary services, good rainfall and better availability of pasture during the project period, as well as other factors. It was, therefore, important to determine the importance of the project inputs and activities relative to other non-project factors in reducing disease impact. Semi-structured interviews were conducted with the same informant groups that conducted disease impact scoring to identify factors that had contributed towards the change in livestock disease impact during the project period. Identified contributing factors were ranked by the community in order of their importance. The degree of agreement between the 10 informant groups within each respective impact area was assessed using the Kendal coefficient of concordance (W). The results of the assessment are described below:

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6.1.3.1 SC/US Dollo Ado and Hargelle impact area Table 12. Causal factors identified as impacting changes in livestock disease patterns during the project period in Dollo Ado & Hargelle impact area. Factors Median rank (Value) Increased usage of modern veterinary medicine 1st (9)

Training and increased knowledge of CAHWs 2nd (6)

Annual and biannual vaccination by CAHWs. 3rd (6)

Good rain and better availability of pasture 4th (3)

Reduced heard mobility 5th (3) Informant groups number (N) = 10 W = 0.54; p < 0.001

6.1.3.2 SC/US Liben impact area

Table 13. Causal factors identified as impacting changes in livestock disease patterns during the project period in Liben impact area. Factors Median rank (Value) Training and increased knowledge of CAHWs 1st (9)

Annual and biannual vaccination by CAHWs & government veterinary department. 2nd (7)

Increased usage of modern veterinary medicine 3rd (6) Improved community awareness on disease prevention and usage of modern veterinary drugs and vaccines 4th (4) Good rain and better availability of pasture 5th (3) Informant groups number (N) = 10 W = 0.46; p < 0.001

6.1.3.3 LVIA impact area

Table 14. Causal factors identified as impacting changes in livestock disease patterns during the project period in LVIA impact area. Factors Median rank (Value) Annual and biannual vaccination by CAHWs in collaboration with government 1st (10) veterinary department.

Increased usage of modern veterinary medicine 2nd (8)

Training and increased knowledge of CAHWs 3rd (6)

Improved community awareness on disease prevention and usage of modern veterinary drugs and vaccines 4th (4)

Good rain and better availability of pasture 5th (3) Informant groups number (N) = 10 W = 0.56; p < 0.001

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6.1.3.4 CARE impact area

Table 15. Causal factors identified as impacting changes in livestock disease patterns during the project period in CARE impact area. Factors Median rank (Value) Training and increased knowledge of CAHWs 1st (9)

Increased supply and usage of modern veterinary drugs 2nd (7)

Annual and biannual vaccination by CAHWs in collaboration with government 3rd (6) veterinary department.

Improved community awareness on disease prevention and usage of modern veterinary 4th (5) drugs and vaccines

th Good rain and better availability of pasture 5 (2) Informant groups number (N) = 10, W = 0.58; p < 0.001 In all impact areas, project inputs such as training of CAHWs, drug supply, vaccination and community awareness-raising activities scored the highest rank as major factors contributing to the changed patterns of livestock disease before and after the project period.

6.2 Impact on the animal health service delivery system. In this section, the relative strengths and weakness of CAHWs as a group are assessed and compared to other service providers based on indicators including service accessibility and availability, quality of services provided, quality of advice provided, range of services covered, affordability, and community trust in service provider. Changes in community service usage since the CAHW project started was also assessed.

Semi-structured interviews with the 10 informant groups were used to identify the different service providers. These were: • Government veterinary services, which occasionally undertake vaccination campaigns and bring drugs. • Kiosk (black market), and drug shops in Dollo Ado town and across the border in Mandera town (Kenya), which supply veterinary drugs • Religious and traditional healers who are available • CAHWs trained by the project, who provide services when they have the necessary drugs. • Some livestock herders treat their own animals and also assist others when requested.

After animal health service providers were categorized into the five groups described above, the 10 informant groups were asked to measure the relative strength of each service provider against each indicator using 30 stones. The level of agreement between the 10 informant groups was then assessed using the Kendal coefficient of concordance (W).

Figure 28. Matrix scoring of animal health service providers in Fiko PA in Dollo Ado Woreda. The service providers and indicators were represented with simple drawings on pieces of card.

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The findings of the matrix scoring for each impact area are presented below:

6.2.1 SC/US Dollo Ado and Hargelle impact area

Table 16. Summarized matrix scoring of animal health service providers in Dollo Ado and Hargelle impact areas. Median score (range) for animal health service provider Government Drug dealers Traditional CAHWs Others Indicator veterinary services (Black market) medicine 1. ‘Service is near to us, so our animals are treated quickly’ 6(0-8) 2(0-11) 3(2-9) 14(9-19) 2(0-7) (W = 0.59, p < 0.001) 2. ‘Service always has medicines available’ (W = 0.58, p <0.001) 3(0-10) 5(0-17) 5(2-7) 14(8-21) 0(0-11) 3. ‘The quality of medicine is good’ 9(2-14) 1(0-6) 4(2-7) 15(9-18) 0(0-10) (W = 0.73, p < 0.001) 4. ‘Our animals usually recover if we use this service’ 5(1-8) 1(0-6) 5(0-10) 19(9-23) 0(0-6) (W = 0.83, p < 0.001) 5. ‘We get good advice from the service provider’ (W = 0.84, p < 0.001) 4(0-11) 0(0-1) 1(0-7) 24(12-30) 0(0-3) 6. ‘This service can treat all our animal health problems’ 5(2-11) 2(0-4) 4(0-8) 19(12-24) 0(0-4) (W = 0.80, p < 0.001) 7. ‘This service is affordable’ 5(2-7) 10(3-18) 8(0-10) 7(2-12) 0(0-4) (W = 0.54, p < 0.001) 8. ‘This service is affordable to the poorest people’ 4(0-7) 11(0-17) 9(0-15) 6(0-12) 1(0-3) (W = 0.55, p < 0.001) 9. ‘We trust this service provider’ 6(0-12) 0(0-4) 5(0-9) 18(11-28) 0(0-12) (W = 0.62, p < 0.001) 10. ‘The community supports this service’ 7(0-11) 0(0-1) 0(0-10) 21(19-26) 0(0-7) (W = 0.75, p < 0.001) 11. ‘Change in service usage’ -6(-18-0) -15(-24 - 6) -18(-24-9) 30 (24-30) -17(-27 –2) (W = 0.75, p < 0.001) Number of informant groups (N) = 10; W = Kendal coefficient of concordance. Value of W varies from 0 to 1; the closer the value to 1 the higher the level of agreement between informants.

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6.2.2 SC/US Liben impact area

Table 17. Summarized matrix scoring of animal health service providers in Liben impact areas. Median score (range) for animal health service provider Government Drug dealers (Black Traditional medicine CAHWs Others veterinary services market) Indicator 1. ‘Service is near to us, so our animals are treated quickly’ 6(3-8) 5(0-9) 3(2-7) 13(8-21) 3(0-6) (W = 0.56, p < 0.001) 2. ‘Service always has medicines available’ 8(0-18) 9(2-15) 3(0-9) 7(3-10) 1(0-4) (W = 0.42, p <0.001) 3. ‘The quality of medicine is good’ 14(8-15) 2(0-6) 1(0-5) 14(8-17) 0(0-3) (W = 0.86, p < 0.001) 4. ‘Our animals usually recover if we use this service’ 14(0-17) 0(0-2) 2(0-6) 14(9-20) 0(0-1) (W = 0.82, p < 0.001) 5. ‘We get good advice from the service provider’ (W = 0.94, p < 0.001) 14(10-22) 0(0-1) 1(0-2) 24(8-20) 0(0-0) 6. ‘This service can treat all our animal health problems’ 13(8-16) 0(0-2) 1(0-6) 15(6-20) 0(0-2) (W = 0.90, p < 0.001) 7. ‘This service is affordable’ 10(6-16) 1(0-12) 1(0-15) 14(9-20) 0(0-2) (W = 0.71, p < 0.001) 8. ‘This service is affordable to the poorest people’ 9(4-16) 2(0-8) 5(0-12) 11(4-20) 0(0-2) (W = 0.63, p < 0.001) 9. ‘We trust this service provider’ 14(8-21) 0(0-2) 2(0-4) 15(5-20) 0(0-0) (W = 0.92, p < 0.001) 10. ‘The community supports this service’ 11(4-16) 0(0-3) 2(0-8) 17(8-26) 0(0-0) (W = 0.91, p < 0.001) 11. ‘Increase in service usage’ -6(-18 - 15) -15(-18 - -6) -12(-21- -6) 24(9-30) -17(-24 – -9) (W = 0.75, p < 0.001) Number of informant groups (N) = 10; W = Kendal coefficient of concordance. Value of W varies from 0 to 1; the closer the value to 1 the higher the level of agreement between informants.

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6.2.3 LVIA impact area

Table 18. Summarized matrix scoring of animal health service providers in LVIA impact areas. Median score (range) for animal health service provider Government Drug dealers Traditional CAHWs Others veterinary (Black market) medicine Indicator services 1. ‘Service is near to us, so our animals are treated quickly’ 1(0-12) 4(0-17) 4(1-11) 13(9-13) 2(0-6) (W = 0.53, p < 0.001) 2. ‘Service always has medicines available’ (W = 0.56, p <0.001) 1(0-8) 11(5-18) 5(2-12) 10(3-13) 1(0-7) 3. ‘The quality of medicine is good’ 3(0-13) 2(0-4) 5(0-10) 18(11-26) 0(0-2) (W = 0.68, p < 0.001) 4. ‘Our animals usually recover if we use this service’ 2(0-13) 3(0-6) 4(2-9) 16(11-26) 0(0-3) (W = 0.64, p < 0.001) 5. ‘We get good advice from the service provider’ (W = 0.84, p < 0.001) 3(0-13) 0(0-2) 5(0-13) 19(10-28) 0(0-3) 6. ‘This service can treat all our animal health problems’ (W = 0.54, p < 0.001) 6(0-12) 1(0-12) 4(0-9) 17(9-28) 0(0-4) 7. ‘This service is affordable’ (W = 0.51, p < 0.001) 0(0-16) 2(0-13) 6(2-12) 16(5-24) 0(0-5) 8. ‘This service is affordable to the poorest people’ (W = 0.62, p < 0.001) 0(0-9) 2(0-9) 10(3-20) 14(4-26) 1(0-4) 9. ‘We trust this service provider’ 4(0-15) 0(0-4) 4(0-9) 21(11-26) 0(0-1) (W = 0.67, p < 0.001) 10. ‘The community supports this service’ 0(0-12) 0(0-4) 2(0-9) 25(14-30) 0(0-4) (W = 0.74, p < 0.001) 11. ‘Increase in service usage’ 0[(-24) – (0)] -15[(-24) – (-6)] -21[(-24)-(-6)] 18 (0-24) -12[(-30) – (W = 0.52, p < 0.001) (-6) Number of informant groups (N) = 10; W = Kendal coefficient of concordance. Value of W varies from 0 to 1; the closer the value to 1 the higher the level of agreement between informants.

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6.2.4 CARE impact area

Table 19. Summarized matrix scoring of animal health service providers in CARE impact areas. Median score (range) for animal health service provider Government Drug dealers (Black Traditional CAHWs Others veterinary market) medicine Indicator services 1. ‘Service is near to us, so our animals are treated quickly’ 5(0-10) 3(0-5) 7(3-14) 13(9-16) 3(0-6) (W = 0.62, p < 0.001) 2. ‘Service always has medicines available’ (W = 0.53, p <0.001) 8(2-12) 4(0-12) 5(2-8) 10(7-18) 3(0-7) 3. ‘The quality of medicine is good’ 11(0-15) 0(0-3) 4(0-16) 14(9-16) 0(0-5) (W = 0.79, p < 0.001) 4. ‘Our animals usually recover if we use this service’ 8(0-11) 1(0-4) 3(3-16) 14(9-18) 1(0-4) (W = 0.83, p < 0.001) 5. ‘We get good advice from the service provider’ (W = 0.82, p < 0.001) 10(0-14) 0(0-0) 4(0-10) 16(14-23) 0(0-0) 6. ‘This service can treat all our animal health problems’ 10(0-15) 0(0-2) 5(0-15) 16(12-22) 0(0-1) (W = 0.82, p < 0.001) 7. ‘This service is affordable’ 12(4-19) 0(0-14) 3(0-21) 9(3-18) 0(0-1) (W = 0.60, p < 0.001) 8. ‘This service is affordable to the poorest people’ (W = 0.42, p < 0.001) 9(0-11) 0(0-8) 7(0-12) 11(2-21) 0(0-9) 9. ‘We trust this service provider’ 12(0-16) 0(0-2) 4(2-16) 13(9-19) 0(0-4) (W = 0.79, p < 0.001) 10. ‘The community supports this service’ 9(0-16) 0(0-2) 6(0-15) 16(14-20) 0(0-1) (W = 0.83, p < 0.001) 11. ‘Increase in service usage’ -6[(-24) – (6)] -12[(-30) – (-6)] -18[(-21)-(-6)] 21 (9-30) -18[(-30) –(- (W = 0.61, p < 0.001) 3) Number of informant groups (N) = 10; W = Kendal coefficient of concordance. Value of W varies from 0 to 1; the closer the value to 1 the higher the level of agreement between informants.

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Following matrix scoring, probing questions were asked and brainstorming discussions were carried out about the advantages and problems of each of the service providers in all impact areas. The findings from the discussions in all the impact areas are summarized below:

Accessibility: Whether the livestock herders can reach the service or not is measured by accessibility of the service in terms of distance and other geographical barriers. On the basis of this measure, community- based animal health workers were considered to be highly accessible compared to other service providers by all informant groups in all impact areas.

“Nure (the CAHW of the PA) lives with us so that we can reach him always; he is willing to travel for more than 5 hours to help the community and he does not need transport.” (Muktar Mohammed from Godbokol PA Dollo Ado)

Beyond the service that the CAHWs are providing directly to their respective communities, their close contact with the livestock herders has facilitated communities’ access and linkage with wider development service providers.

Availability: This measures whether the service exists or not. All informant groups in all impact areas confirmed that there is a community animal health worker in their respective area. With regard to medicine availability in Dollo Ado & Borana, informant groups were in agreement that medicines were more often available from CAHWs than from other service providers, although shortages were reported in Dollo & Hargelle. In the case of Liben and LVIA impact areas, however, medicines were more available through drug dealers (on the black market) than through the CAHWs.

Quality of medicine and services : The informants were in agreement that better quality medicines were available from the CAHWs than from other service providers, and that their animals usually recovered when they used CAHWs. They mentioned that the quality of medicine and services provided by government is also good, when they are available. There are a lot of cheap medicines of unknown source and brand circulating in all impact areas, some coming from Somalia and others from Kenya. The informants indicated these drugs are not of good quality although they are cheaper in price; therefore, they do not use these drugs unless they cannot get drugs from the CAHWs.

Advice: Informants agreed that the best advice comes from the CAHWs and the government. However, CAHWs are better in providing advice regularly as they are closer to the community, whereas the government comes only when there is a disease outbreak. The informants noted that besides providing treatment and vaccination activities, CAHWs also mobilize the community for vaccination campaigns, create awareness on the use of quality drugs, and inform the community about disease prevention methods.

Range of activities : all informants were in agreement that the CAHWs handle most of the animal health problems they encounter. This finding was confirmed by the interviews with the respective CAHWs (section 5.4.2).

The community identified the activities of CAHWs as: 1) Treatment of internal parasites, external parasites and major infectious diseases, 2) Vaccination, 3) Advice on quality drug use, disease prevention and reporting 4) Castration and hoof trimming

Affordability: The CAHWs’ services are less affordable than the drug dealers and traditional healers in Dollo Ado & Hargelle. However, all informants agreed that the quality of medicines from the drug dealers is not good. Because their animals do not recover when they use drugs from the drug dealers, informants do not use drugs from this source. There is agreement among informant groups in Liben & LVIA impact areas that the CAHW service is more affordable than other service providers. In the CARE impact area, government medicine is cheaper than that of the CAHWs, and therefore the medicine from CAHWs is

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seen as less affordable. However, the community said that they use medicines from CAHWs because drugs are not normally available from the government. They also pointed out that drugs from CAHWs are more accessible because the poorest of the poor in the community can get medicines from CAHW on a credit basis.

Trustworthy and community support : All informant groups in all impact areas agreed that CAHWs are the most trusted and supported of all service providers.

Service usage: All informants agreed that the use of CAHWs services is higher than that of the rest of the service providers. Since the CAHW system was introduced, the use of services from other service providers has been significantly reduced, and in some cases some service providers are not being used at all at present.

6.3 Impact on livestock herders’ welfare

As with any other animal health service delivery project, the ultimate objective of the CAHW program is to bring a sustainable livelihood to the livestock producer’s household through improving income and welfare. Therefore, it is important to assess how the change in disease impact has affected the lives of the livestock producers in the project area.

Considering disease reduction as a project benefit, the communities were asked how this benefit had affected their livelihoods. Informant groups were asked to identify specific benefits resulting from improved animal health, selecting from among the various benefits derived from livestock (Section 3.1). The relative importance of these benefits was then assessed using ‘before’ and ‘after’ proportional pilling, similar to the method used to assess changes in disease incidence and impact.

6.3.1 SC/US Dollo Ado and Hargelle impact area

In the SC/US Dollo Ado and Hargelle impact area, the perception of the informant groups was that milk, meat, income and livestock number are the most important benefits derived from livestock, and their relative importance ‘before’ and ‘after’ the project is illustrated in Figure 28. There was significant increase in milk and meat production as well as an increase in livestock number. The income derived from livestock and livestock product sales has also more than doubled.

Before After Figure 29. Benefits derived from improved animal health 10 during the CAHW Program in Dollo Ado & Hargelle impact areas. 8 6

4

2 Median benefit Median score 0 Milk Meat Income Increased livestock Benefits number

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Increase in livestock number and increase in milk consumption creates a direct benefit to household food security, and are important indicators of the project’s impact. Therefore, the use of milk within household (Figure 30) and livestock ownership ‘before and after the project’ (Figure 32) were more closely examined using the proportional pilling method.

All informant groups in this impact area agreed that in some cases there was an increase in the amount of milk consumed by members of household after the project. The amount of excess milk left after household consumption has increased significantly since implementation of the project. This coincides with community perception of an increased milk benefit from the CAHW project.

Before After 12

10

8

6

4

2

0 Median household milk usage score Children Girls & Husband Elderly Excess boys & Wife

Figure 30. Household milk distribution ‘before’ and ‘after’ project implementation in Dollo Ado & Hargelle impact areas.

All informant groups were asked what they do with the excess milk, and they responded that they sell all excess milk in the form of milk or butter. In fact, during the five day stay in Dollo Ado & Hargelle the team saw a pick-up truck carrying milk to Mandera town (Kenya) every day (Figure 31 below). Milk was also sold locally in Dollo and Hargelle towns.

Women were said to be responsible for collecting and selling milk. The proceeds from the sale of milk are also managed by women.

Figure 31. A pick up transporting milk for sale to Mandera (Kenya ).

Livestock ownership was assessed to triangulate the finding that livestock population had increased as a positive consequence of the project. All informant groups agreed that the proportion of the population owning livestock increased after the project

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implementation (Figure 32). In particular, the increase in the number of people owning cattle and shoats is very high.

9 8 7 6 5 4 score 3 2 1 0 Medianownership livestock Population Population Population Population with witout with witout livestock livestock livestock livestock

Before the project After the project

Figure 32. Livestock ownership Cattle Sheep & Goat Camel ‘before’ and ‘after’ the project in Dollo Ado & Hargelle impact areas.

6.3.2 SC/US Liben impact area

In the SC/US Liben impact area, milk, income from the sale of livestock and livestock products, and an increased livestock population were identified as important benefits derived from livestock. In spite of the reduced impact of the major livestock diseases as a result of the CAHWs’ activity, there has been no improvement in the production of milk. There has, however, been a significant increase in the level of income and an increase in the number of livestock (Figure 33). Reasons for these changes are discussed later in this section.

Before After 9 8 7 6 5 4 3 2 Median benefit Median score 1 0 Milk Income Livestock number Benefits

Figure 33. Benefits derived from improved animal health during the CAHW Program in Liben impact areas.

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The change in milk production was further investigated by assessing the relative milk consumption within a household ‘before’ and ‘after’ the project. There was a significant reduction in the amount of milk consumed by members of the household during the project period (Figure 34). This coincides with the findings of changes in benefits above. ’Before’ the project was implemented, excess milk was kept as a reserve food for the family and given to guests. Currently, excess milk is being sold in the form of either milk or butter.

10 9 8 7 6 5 4 3 2 1 0 Median husehold milk usage score Children Girls & Husband Elderly Excess Boys & Wife Milk Before After

Figure 34 . Household milk distribution ‘before’ and ‘after’ project implementation in Liben impact area.

Increased livestock number was mentioned as a benefit of the animal health program due to control of diseases that used to cause high mortality of animals. This was further triangulated by assessing livestock ownership ‘before’ and ‘after’ the project. The proportion of people keeping more cattle has decreased ‘after’ compared to ‘before’. On the other hand the number of people owning more sheep, goats and camel has increased ‘after’ compared to ‘before’ (Figure 35).

Cattle Sheep & Goat Camel 9 8 7 6 5 4

score score 3 2 1 0 Population Population Population Population

Changeownershiplivestock in median with witout with witout livestock livestock livestock livestock

Before the project After the project

Figure 35. Livestock ownership ‘before’ and ‘after’ the project in Liben impact area

6.3.3 LVIA impact area

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Before After Before After 8 9 7 8 6 7 5 6 4 5 3 4 2 3 1

score benefit Median 0 2 1 Milk Income Livestock 0 number Median household usagemilk score Children Girl & Husband Elderly Excess Benefits Boys & Wife Figu re 37 . Benefits derived from improved Figure 36 . Household milk distribution ‘before’ and animal health during the CAHW Program in ‘after’ project implementation in LVIA impact area. LVIA impact area

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Analysis of benefits derived from livestock in LVIA impact area shows the same result as in the case of Liben impact area. Milk production has reduced since project implementation compared to ‘before’ the project, while income derived from sale of livestock and livestock products and livestock number has increased ‘after’ compared to ‘before’ (Figure 36).

These findings were confirmed by the results of further investigation into ‘before’ and ‘after’ household milk consumption (Figure 37) and community perception of change in livestock ownership (Figure 38). All informant groups agreed that the proportion of milk consumed by all members of a household is reduced compared to what it was before the CAHW project implementation. On the other hand, the proportion of people keeping cattle and camel has been slightly increased, while proportion of people keeping sheep & goats has been reduced.

8 7 6 5 4 3 2 1 0 with with witout with out with livestock livestock livestock livestock Median livestock ownership Median score livestock Population Population Population Population

Before the project After the project

Cattle Sheep & Goat Camel

Figure 38. Livestock ownership ‘before’ and ‘after’ the project in LVIA impact area.

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6.3.4 CARE impact area

Before After Before After 12 8 7 10

6 8 5 6 4 3 4 2 2 1 Median benefit score Median 0 0 Milk Income Livestock Children Girl & Husband Elderly Excess

Production number Median household milk usage score Boys & Wife Benefits Figure 40 . Household milk distributions ‘before’ and ‘afte r’ Figure 39 . Benefits deriv ed from improved project implementation in CARE impact area animal health during the CAHW Program in CARE impact area.

Community perceptions of changes in the benefits derived from livestock since project implementation in CARE impact area was the same as with that of LVIA and Liben impact areas. There has been a drop in milk production compared to before the project, while income derived from sale of livestock and livestock products, and livestock number has increased (Figure 39).

The findings of further investigation into household milk distribution (Figure 40) and community perception of change in livestock ownership (Figure 41) confirmed this. All informant groups agreed that the amount of milk consumed by all members of household has been reduced since implementation of the project. On other hand, the proportion of people with large numbers of cattle is slightly reduced. The proportion of people with and without sheep and goats has not changed, while the proportion of people keeping camels has increased significantly.

7

6

5

4

3

2

1

0 Population Population Population Population with livestock witout with livestock with out livestock livestock Median Median livestock ownershipscore Before the project After the project

Cattle Sheep & Goat Camel

Figure 41. Livestock ownership ‘before’ and ‘after’ the project in CARE impact area.

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There is agreement between informant groups in Liben, LVIA and CARE impact areas that there has been a drop in the amount of milk benefits derived from livestock, despite the significant reduction in major livestock diseases which has been achieved as a result of the CAHW project. Through probing questions and discussion with the community, it was uncovered that the community attributes the reduction in milk production to a lack of pasture, and not generally to the effects of diseases. One exception to this finding is that severe Tick challenge (Shilmi ) was also mentioned as a factor contributing to reduced milk production (in Liben and LVIA impact areas). This latter coincides with the earlier finding that there was no change observed in the impact of Tick (Shilmi ) in Liben and LVIA impact areas. Frequent drought and reduced access to seasonal grazing areas due to intra-ethnic conflict were mentioned by all informant groups as major constraints creating the shortage of pasture. They also stated that loss of grazing land to neighboring ethnic groups as a consequence of ethnic based regionalization, and bush encroachments were major factors. This coincides with the findings of the vulnerability analysis (Section 3.1).

Income from the sale of livestock and livestock products has significantly increased during the project period in all impact areas and informants attributed this change to the improvement in livestock markets and increased prices. The informant groups in all impact areas were asked what they do with the proceeds from the sale of livestock and livestock products, and responded that they use the money for:
Restocking (they sell camel and buy oxen for farming in Dollo & Hargelle; while they sell cattle and buy camels in Borana and Moyale)
Buying consumer items such as clothes, sugar, coffee, rice, etc.
Paying for their medical and veterinary services
Use for weddings (to buy clothes and other gifts for the bride) and other social purposes
Contributions for local development initiatives (road, school and clinic construction).

With regard to livestock number, in Borana and Moyale impact areas the informant groups agreed that there has been a slight reduction in the number of cattle since project implementation. They attributed this change to improved market situation for cattle, which means that more cattle are sold ‘now’ than ‘before’. This coincides with the increased income level from sale of livestock and livestock products. It was also uncovered that people sell cattle to buy camels, and therefore, the proportion of people keeping camel is increasing ‘now’ compared to ‘before’, while that of people keeping cattle is decreasing. The preference for camel over other livestock is increasing in Borana lowlands due to the camel’s tolerance to the effects of drought.

Overall, the community-based animal health program has contributed to the welfare of the pastoralists through reducing the livestock mortality and morbidity, and thus securing household milk supply and income from sale of livestock and livestock products.

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Section 7: Conclusion and Recommendations

I strongly believe that the findings in this report will provide relevant feedback for the implementers of the program, particularly for field based-staff, and that the feedback will help to advance their efforts to improve animal health delivery and ultimately, to ensure food security in the program target areas.

Livestock-keeping remains the major livelihood strategy contributing to households’ capital assets in this area. Animal disease is on the top of the list of major problems affecting the livelihood activities of the livestock owners in all impact areas, and therefore, the project is highly relevant because it addresses animal health issues to reduce poverty through livestock development. Within this framework, significant results have been achieved in reducing the impact of the various diseases, particularly through annual and biannual vaccination interventions.

SC/US and its partners have laid a good foundation for the community-based animal health worker programs in their respective operational areas, although one organization has been better than the others at implementing a strong CBAHP. All organizations should strengthen the components of their programs to meet the national minimum standards set for design and establishment of community-based animal health programs. Specific suggestions for addressing identified weaknesses have been made in the previous sections.

The summary of the major suggestions of the consultant is as follows: • The participatory methodology used in this review and impact assessment was a positive experience for the project staff, the community and the consultant. It facilitated experience sharing, the identification and learning from the communities’ indigenous knowledge, and the ability of pastoralists to identify specific diseases and to describe trends in disease patterns over a 3-year period. Therefore, this approach should be used in the regular and periodic monitoring and evaluation of the program. • Participatory baseline surveys should be conducted in the future to identify community priority needs and issues, to increase understanding of indigenous knowledge, and to identify diseases that should be included in the CAHW training curriculum. • Community dialogue should be facilitated regularly to review performance of CAHWs and enhance community participation in the monitoring of the program. • The community should identify its own selection criteria for successful CAHW candidates. Staff can give their views, based on standardized criteria, but they should not dictate that the community use pre-defined criteria that might not be relevant. • An annual assessment should be conducted to determine the number and distribution of active CAHWs in each program area, and this assessment should be used to plan for further CAHW training to fill in the gaps or increase coverage when required. • The standardized training manual should be strengthened by including easy-to- understand illustrations and drawings where necessary. The standardized manual should also be adapted to address specific local needs based on the findings of the baseline survey, and should include local disease vernacular and descriptions. • Veterinarians or animal health assistants who have attended a participatory training technique (TOT) workshop and who have a positive attitude, behavior and knowledge towards pastoralism and towards the participatory approach should facilitate CAHW trainings. CAHWs should not be trained by animal health technicians or previously trained CAHWs. • Basic CAHW training should be completed in one phase of 15 – 20 days. At a minimum, the training curriculum should cover the 5 top animal diseases per species, as identified and ranked by the community. The other less important diseases should be included during refresher trainings.

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• During impact assessment, some diseases were prioritized by the livestock herders but not handled by CAHWs, and thus it was not possible to offer solutions through the project. A participatory study should be conducted to learn more about these diseases and to come up with control strategies. • The number of CAHWs trained during one session should not be more than 20, to allow enough participation and one-on-one interaction with the trainer. • The training venue should be in an area close to the community and to livestock grazing areas, under the pastoral set up. • CAHWs should be supplied with starter drug kits immediately after the training is completed. • Refresher training should be planned and carried out in a regular fashion, rather than in the irregular way it is currently being carried out. • A community-based monitoring and evaluation system that ensures the participation of all stakeholders and defines the role and responsibilities of each should be established and implemented. • Project staff and stakeholders should be trained in establishing and implementing community based monitoring and evaluation approaches. • The CAHW monitoring format should be properly designed, taking into consideration the information needs of all stakeholders. The methods of data collection, who will collect the information, frequency, analysis and use of the information should all be clearly determined. • The project should seek to facilitate veterinary privatization through support to private animal health workers, who could link with CAHWs to establish a privatized community-based animal health network in order to ensure drug supply, technical support and reporting. • Lobbying and influence on government should be strengthened, with a goal of having government withdraw from direct dispensing of subsidized drugs and competing with the private animal health workers (including CAHWs). The government should also be motivated to increase control of illegal drug dealers. • CAHW cooperatives should be encouraged to participate in livestock and livestock products marketing, to monitor the activity of CAHWs and to enhance community participation in the program, rather than running drug shops, which will not be sustainable. • Community awareness and sensitization on the negative consequences of the use of poor quality drugs should continue.

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Annexes

Annex 1. Terms of Reference for an Animal Health Review and Impact assessment as part of the LEAP Mid-Term Review

General SC/US wants to conduct a review of its animal health interventions in pastoral areas in order to document the lessons learned and to start a process of harmonization. SC/US will use the review as a basis for re-orientating as necessary its own decentralized animal health work and that of the partner organizations with which it is working.

To this effect SC/US is looking for a consultant to carry out a review and impact assessment of SC/US’s animal health interventions and those of its partner organizations, based on the following TOR.

The projects to be reviewed are the animal health component of LEAP and DAP projects in selected districts of Somali (4 districts) and Oromiya (5 districts) Regional States.

Overview of SC US Pastoral Program SC/US has a long history of working in both pastoral areas to improve pastoral livelihoods and improving animal health which it is recognized can result in significant improvements in pastoral livestock production – more milk, faster weight gain and reduced vulnerability from drought.

It is perhaps not surprising that the upsurge of interest in animal health has resulted in both Government and NGOs initiating community animal health programs, though not all adopt the same approach. The result has been confusing and wasteful of scarce resources. It is for this reason that the MoARD has produced a National Minimum Standards and Guideline for Design and Establishment of Community-Based Animal Health Workers System publication, 2004 to begin the process of harmonizing approaches.

SC/US welcomes this initiative and seeks to support efforts by bringing its own animal health portfolio under external review, with the view to harmonizing its own approaches.

Project areas to be covered during the review During the review the team will visit each of SC/US’s target districts in pastoral areas in Somali and Oromiya regional states. Cluster representative woreda could be selected from the target districts in:

Somali State Oromiya State Hargelle Yabello Doll Ado Taltalle Filtu Dirre Moyale Liban

Overall Objectives and aim of the review:  To undertake a review of the decentralized animal health approaches in SC/US supported projects.  To identify strengths and weaknesses of the respective approaches.  To make recommendations resulting in a phased harmonization of approaches to decentralized animal health based on the MoARD’s Minimum Standards  To document the findings and recommendations in a detailed report, which can be shared with partner NGOs and relevant Government departments.

Specific Objectives:

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 To analyze how effective the different strategies and approaches adopted in achieving improved and sustainable animal health service are at the herding household level  Assess the realistic prospect for future sustainability of project concepts and practices by partner organizations as well as by herding communities after termination of the various projects.  To evaluate the impact or likely impacts of the projects in reducing vulnerability amongst the respective pastoral community.  Assess the process applied in project implementation and identify strong and weak points.  Finally to identify problems that are constraining project implementation and suggest ways and means to alleviate them.

Methods  Review methodology and sample site selection In addition to reviewing project documents in Addis it is anticipated that the reviewer will visit each of the target woreda to meet project staff, CAHWs, beneficiaries and woreda administrative and animal health staff. Randomly selected PAs in each woreda will be used as sample sites, where more detailed information regarding the impact of the animal health intervention on local livelihoods will be sought.

 Information collection and data analysis The review will be carried out by one consultant involving SC/US veterinarian, key partners at various levels, project staff, and target communities. The generated data should be analyzed using spread sheet and Statistical Package for Social Scientists (SPSS) latest version.

 Participatory assessment methodologies The Review should employ a set of participatory assessment methodologies such as semi structured interviews with key stake holders, focus group discussions and key informants discussions, etc.

Presenting the results  The consultant will produce and submit the first draft of the finding within 15 days of completion of the field work for comment to SC/US. Food security COP and SC/US veterinarian will comment on the draft document and submit back to the consultant to produce finished document. It is anticipated that the final report will be ready by 10 days after receiving comment on the draft report. As per the requirement from SC/US, the consultant and SC/US veterinarian will present the findings and transfer the experience to other NGOs and GOs.

Organization and Logistics  One consultant from AU/IBAR will join the SC/US veterinarian to lead the whole review process. The consultant will be responsible to facilitate, coordinate, and write the review reports to the required level and standard. The consultant should have demonstrated understanding of pastoralist livelihood and demonstrated commitment to participatory processes. SC/US anticipates that the field work will be carried out in a period of 21 days in the field, with an additional 10 days for report writing.  SC/US will arrange one vehicle to and from the project sites and in the field during the review exercise.

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Contact person at the project site  Regional Pastoral Program Managers will ensure the reviewers receive every possible support from SC /US and its program partners.

Professional fees and logistics  SC/US pays professional fees to undertake the review based on the current market situation and negotiation made with the consultant. There will be no additional per diems and accommodation expenses for the consultant. Per diems for GO staffs that are anticipated to join the review team will be covered by the regional pastoral program offices as required.

Specific duties and responsibilities of the consultant After official agreement with SC/US the responsibility of the consultant will be:  Reviewing project documents and setting time table to conduct the field work.  Developing detailed animal health interventions review methodology such as:
Defining the project in terms of its geographical coverage and period of operation through time line, participatory mapping, before and after proportional piling of disease incidence, mortality and morbidity rates.
Participatory ranking methodologies of factors influencing livestock health during the project interventions
Develop methods to assess impacts of CAHWs on veterinary service in terms of accessibility, availability, quality and other indicators  Based on the review methodology developed the consultant will work to meet all the pre set overall objectives and specific objectives of the review.  Generate representative report of target districts from the representative woredas  Forward professional recommendations and suggest better intervention strategies for pastoral development in future to promote decentralized animal health service in pastoral areas.  Submit the findings of the review in a timely manner to SC/US for comment and then produce the final document to the required level of quality and standard.  Present the finding to GO partners and SC/US staff as required.

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Annex 2. Itinerary for field visit and persons met

Date Name of people met Organization Responsibility 13/9/05 Addis Ababa AU/IBAR IPST Coordinator Berhanu Admassu 14/9/05 Travel to Awassa 15/9/05 Travel to Negele Borena 16/9/05 Travel to Dollo Ado and met • Abdullahi Sandoll SC/US Area Manager • Abdulkader Ahmed SC/US Operation Manager • Abdulrashid Sheki Mohammed SC/US • Hussien VOCA Trainer 17/9/05 Aden Guliye Gov. Vet. Dept. AHT 17 –19/9/05 Field visit See annex 3 20/9/05 Abdullahi Farah Private Drug Vendor 20/9/05 Travel to Hargelle and met • Abdi • Abdi Umer SC/US Finance officer 21 – 23/9/05 Field visit See annex 3 23/9/05 Ahmmed Buno Abdi CAHWs cooperative Chairman 23/9/05 Ahmmed Rage Abdi Gov. Vet. Dept. AHO 24/9/05 Travel to Liben 25/9/05 Dr. Bekele Gov. Vet. Dept. Head veterinary unit 25 – 29/9/05 Field visit See annex 3 29/9/05 Worku Chibssa SC/US Admin Head 30/9/05 Travel to Moyale and met • Getachew LVIA Administrator • Ibrahim LVIA Social promoter • Amanuale LVIA Social promoter 01-04/10/05 Field visit See annex 3 04/10/05 Mesfen Alemayhu Moyale-Oromia Pastoral Cooperative dept. Development Office 04/10/05 Waganee H/Iyasus Moyale-Oromia Pastoral Office Head Development Office 04/10/05 Alishek Kero Moyale-Somali side CAHWs CAHW & Shopkeeper cooperative 04/10/05 Dr. Kimiya Mohammed Gov. vet employee & private drug business owner 05/10/05 Travel to Dire 05/10/05 Dr. Molu CARE-Dire Animal Health Officer 05-06/10/05 Field visit in Dire woreda See annex 3 06/10/05 Travel to Yabello 07/10/05 Dr. Kider CARE- Yabello Animal Health Officer 07 –09/10/05 Field visit in Yabello & Teltel See annex 3 08/10/05 Dr. Abay CARE STI-LEAP 08/10/05 Abubeker CARE Teltele Animal Health Officer 10/10/05 Fekadu Terefe VOCA Trainer 10/10/05 Travel to Awassa 11/10/05 Travel to Nazareth visit to OPDC & met • Ato Habtamu Teka OPDC Head • Dr. Genene Regassa OPDC Animal Health Unit 11/10/05 Travel back to Addis Ababa 21/10/05 Mr. Adrian C. SC/US Chief of Party, Food Security Unit 1/11/05 Italo Rizzi LVIA Country Rep. 1/11/05 Dr. Shimeles Ollana LVIA Veterinarian (Resigned) 1/11/05 Linda Pescini LVIA Moyale Project Coor.

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Annex 3. List of Kebele (PAs) included in the assessment

Region Implemen Woreda Kebeles (PAs) Distance from Number of Date of ter the Woreda participants Community center (Km) Dialogue Male Female Somali SC-US Dollo Ado 1. Suftu 45 9 1 17/9/05 2. Woldehube 70 19 0 18/9/05 3. Fiko 58 19 2 18/9/05 4. Godbokol 45 11 3 19/9/05 5. Galomey 30 12 4 19/9/05 Hargelle 1. Daresellam 75 20 5 21/9/05 2. Bergel 45 18 2 21/9/05 3. SokSok 50 16 5 22/9/05 4. Yo’oo 20 12 3 22/9/05 5. Melkadur 30 23 5 23/9/05 LVIA Moyale 1. E-Lay 42 20 3 02/10/05 2. Bede 27 25 8 02/10/05 3. El-Gof 64 15 6 02/10/05 4. Kadaduma 100 11 4 02/10/05 5. Sororo 113 20 4 03/10/05 6. El-Qur 84 15 3 03/10/05 7. Hardure 117 14 4 03/10/05 Oromia SC-US Liben 1. Buradhera 18 9 0 25/9/05 2. Siminto 25 13 0 25/9/05 3. Bul Bul 60 10 0 26/9/05 4. Melka Guba 90 31 1 26/9/05 5.Dilelassa 55 13 2 27/9/05 6. Madhadunwey 65 14 0 27/9/05 7. Nurahumba 30 20 0 28/9/05 8. Adadi 25 9 0 28/9/05 9. Keraro 50 28 0 28/9/05 10. Sokora 43 16 0 29/9/05 LVIA Moyale 1. Lagasure 35 18 3 01/10/05 2. Mudhiambo 40 10 0 01/10/05 3. Mado 35 15 1 04/10/05 CARE Dire 1. Tesso 63 9 2 05/10/05 2. Gorile 49 11 1 05/10/05 3. Arbale 61 14 6 06/10/05 4. Higo 45 15 1 06/10/05 Yabello 1. Ariri 26 10 1 07/10/05 2. Haro Bake 57 12 0 07/10/05 3. Harawayou 32 14 1 09/10/05 Teltele 1. Sarite 70 9 0 08/10/05 2. Dida Lencha 8 8 0 08/10/05 3. Gandhile 25 15 0 08/10/05

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Annex 4. CAHWs Performance Evaluation form

Name of CAHWs ------Kebele (PA) ------Woreda------Region

1) CAHWs Success indicators

Grading Very Good- Poor- Very Good Average Average Poor Technical competence Ranges of activities / services General level of motivation Level of community support Scoring system: 1 = Very good; 2 = Good to Average; 3 = Poor to Average, and 4 = Very Poor. Total scoring: 3 = excellent; 16 = poor

Tools: Semi Structured Interview used A success ‘grade’ should be derived for each CAHWs, based on responses to the questions / issues outlined under each of the indicators below and evaluator’s perception of their effectiveness relative to other CAHWs.

Technical competence: Q: Ask questions about specific diseases (clinical signs, treatments: drug, dosage, rout of administration etc.) Q: Advices to livestock herders related to disease prevention, animal husbandry etc Q: Awareness on disease reporting to veterinary dept. Q: Record keeping and reporting Ranges of activities / services provided by CAHWs Q: Does the skill level of the CAHWs, in light of training, meet communities’ service demand? Q: Is there sufficient drug supply to the CAHWs? Q: What services do you provide? Q: Clients based on wealth, ethnicity, gender & location? Level of CAHWs motivation: Q: What are there expectations? Q: Reasons why are they working as CAHWs? Q: What income and benefits do they receive for being CAHWs? Level of Community Support: Q: What support the CAHWs receive from their respective community? Q: Have the community accepted CAHWs? Q: How do the CAHWs be considered with in the community? (are they considered and cherished as social capital?)

2) COMMENTS: Note down all those key factors during the various interviews that have led you to award this CAHW the above ‘scoring’. Make a note of any critical issues that have had an impact in the assessment of this CAHWs. ------

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Annex 5. Stakeholders’ participation analysis form

ANALYSES OF STAKEHOLDERS’ PARTICIPATION AT ALL LEVEL OF PROJECT CYCLE

Implementing organization (SC-USA /CARE/LVIA)------

Method: Project staff will be asked to identify main project stakeholders, and then followed by half-day session on evaluation of the participation level of each of the stakeholders after short briefing and understanding has been created on Project Cycle by the consultant. The evaluation will follow the following framework:

1. Community Participation

Project Cycle High Moderate Low participation Very low participation participation participation Need assessment Design and planning Implementation Monitoring Impact assessment

2. Private Vet. Participation (if available)

Project Cycle High Moderate Low participation Very low participation participation participation Need assessment Design and planning Implementation Monitoring Impact assessment

3. Government Vet. Department Participation

Project Cycle High Moderate Low participation Very low participation participation participation Need assessment Design and planning Implementation Monitoring Impact assessment Scoring system: 1 =High participation; 2 = Moderate participation; 3 = Low participation, and 4 = Very low participation. Total scoring: 5 = excellent; 20 = poor The score of each participation level will be decided based on assessment of the questions / issues under each of the project cycle stages outlined below:

Project Cycle Questions/Issues of Participation Need assessment Who was involved in need identification? If survey were conducted, who designed and conducted the survey What was the role of the community in analyzing the needs? Who identified and rank local animal health problem

Design and planning Community dialogue carried out? Who selected the CAHWs training venue? Who prioritized and decided diseases to be included in the training course? Who formulated the CAHWs selection criteria

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Implementation Use of community livestock for practical sessions? Community contribution towards CAHWs training course Community contribution towards starter kit? Drugs and services are paid for by the community (cost recovery)?

Monitoring Who involved in monitoring? Who decided on information to be collected? What methods used to collect the information? Who collected the information? Who involved in the analysis of the information? Who owns and use the result?

Impact assessment Who involved in impact assessment? Who identified impact indicators? What methods used to measure the impact indicators?

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Annex 6. Results of Livelihood and vulnerability analysis

1. Dollo Ado and Hargelle impact areas

1.1. Means of livelihood in Dollo Ado and Hargelle impact area

No. of informants = 10 W = 0.53, p<0.001

10% 2% Livestock

Crop 50% Trade* 38% Labour

* Trade includes petty trade, firewood &charcoal selling

1.2 Factors affecting livelihood activities in Dollo Ado & Hargelle impact areas

No. of informants = 10 W = 0.93, 0.001

19%

40% 6% Drought Animal Disease

Flood

Pest & Predators 35% 2. Liben impact area

2.1. Means of livelihood in Liben impact area No. of informants = 10, W = 0.77, p<0.0001

Livestock Crop Trade 5% Trade Crop 32% Livestock

63%

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2.2 Factors affecting livelihood activities in Liben impact area

No. of informants =10 17% W = 0.40, p<0.001 30% Drought

14% Animal disease

Bush encrochment

Pest & Predators

17% 22% Conflict

3. LVIA impact are

3.1 Means of livelihood in LVIA impact area.

Number of informants = 10; W=0.57; p < 0.001 Petty trade 24%

Livestock 52% Crop

24%

Livestock Crop Petty trade 3.2 Factors affecting the livelihood activities in LVIA impact area.

N0. of informants = 10;W=0.63; p<0.001

Conflict 19% Drought 39% Drought

Animal disease

Pest & Predators Pest & Predators 19% Conflict

Animal disease 23%

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4. CARE impact area

4.1 Means of livelihood in CARE impact area.

Number of informants = 10; W=0.73; p < 0.001 Petty trade 16%

Livestock Crop 52% 32%

Livestock 4.2 Factors affecting the Crop livelihood activities in LVIA Petty trade impact area.

10% 16% 35% Drought Animal disease

Pest & Predators

Conflict 13% Bush encrochment N0. of 26% informants = 10; W=0.63; p<0.001

Annex 7. Case study: Impact of conflict on CAHW system

Adijo Dima is a CAHW working in Surupa Kebele, Yabello, Borana Zone of Oromia Region. She was trained by CARE and has been providing animal health service to her community and neighboring areas. She was one of the CAHWs evaluated to be very good in her technical competence. She was also covering a wide range of animal health activities in the area.

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Nevertheless, during the period of this assessment, she was found to be inactive because of the recent conflict between the Guji and Gebra ethnic groups. The conflict destabilized the situation of the area and she couldn’t continue to effectively undertake her role as a CAHW. During the conflict she was looted, and drugs costing more than 800 Birr and basic materials that she was using to treat animals were taken from her. The invaders have also raided her 10 cattle, 21 sheep and goats and more than 25 camels of her community.

Adijo has been working efficiently and was also acknowledged by the community as a CAHW. Nevertheless, the conflict changed this situation and she has suffered from a major economic and morale loss.

During vulnerability context analysis informant groups have identified conflict as one of the major problems affecting their livelihood activities in these areas (see annex 6 above). Therefore, CARE should continue its conflict resolution and peace building activities using a more extensive and participatory approach. Otherwise, there is a strong fear that conflict will erupt and this continues to be a major factor affecting the sustainability of the community-based animal health workers system.

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Annex 8. List of documents consulted

1. National Minimum Standards and Guideline for Design and Establishment of Community – based Animal Health Workers system, Ministry of Agriculture and Rural Development, Federal Democratic Republic of Ethiopia, 2004.

2. Community-based Animal Healthcare: A practical Guide to Improving Primary Veterinary Services. Andy Catley, Stephen Blackeway and Tim Leyland. ITDG Publishing, 2002.

3. The Herd Instinct. Children and Livestock in the Horn of Africa. Andy Catley, Save the Children, 1999.

4. Participatory Diagnosis of a Chronic Wasting Disease in Cattle in Southern Sudan. A. Cately, S. Okoth, J. Osman, T. Fison, Z. Njiru, J. Mwangi, B.A. Jones, T.J. Leyland. Preventive Veterinary Medicine, 1634 (2001) 1-21.

5. Assessment of the Existing Animal Health Service Delivery in Borena Lowlands. Animal Health team of Oromia Pastoralist Development Commission, July 2004.

6. Contribution of Livestock Development to Poverty Reduction in Pastoral Areas of the Horn of Africa. Dawit Abebe, Tropicultura, ISSN-0771-3312, April 2004.

7. Community-based Primary Animal Health Care. In: Proceedings of the 11th Conference of Ethiopian Veterinary Association, Dawit Abebe, June 1997.

8. Community-based Animal Health Workers Training Report. Dawit Abebe, EU/AFAR Pastoral Development Project, May 1996.

9. Participatory Impact Assessment of the Save the Children USA Community-based Animal Health Project in Dollo Ado and Dollo Bay, Somali National Regional State, Ethiopia. National PMIA Core Team, December 2002.

10. The Impact of Community Animal Health Services on Farmers in Low-Income Countries: A Literature Review, Marina Martin, VETAID, 2001.

11. Southern Tier Initiative Livelihood Enhancement for Agro-Pastoralists and Pastoralists (STI LEAP), Project proposal.

12. Southern Tier Initiative Livelihood Enhancement for Agro-Pastoralists and Pastoralists (STI LEAP), Annual Report, October 2003 – September 2004.

13. Southern Tier Initiative Livelihood Enhancement for Agro-Pastoralists and Pastoralists (STI LEAP), Annual Report, October 2004 – September 2005.

14. LAY Volunteers International Ethiopia, Report of the Participatory Assessment of Animal Health Situation in Moyale Woreda, Borena Zone, Oromia Region, February 2003.

15. Final Evaluation and Impact Assessment, Food Security Project in Pastoral Areas, Moyale and Dire Woredas, LVIA, October 2004.

16. Strategies for Improving DFID’s Impact on Poverty Reduction: A Review of Best Practice in the Livestock Sector, DFID, June 1998.

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