Evaluation for actionAssessing animal disease surveillance capacities

The Kyrgyz Republic

October 2019

Evaluation for actionAssessing animal disease surveillance capacities

FOOD AND AGRICULTURE ORGANIZATION OF THE UNITED NATIONSRome, 2021

October 2019

The Kyrgyz Republic

Required citation:FAO. 2021. The Kyrgyz Republic – Evaluation for action - Assessing animal disease surveillance capacities (October 2019). Rome.

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Cover photograph: FAO/Ryan Aguanno

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Contents

Acknowledgements ....................................................................................... vi

Abbreviations.................................................................................................vii

Background ..................................................................................................... 1

General context ..................................................................................................... 1

Development of SET .............................................................................................. 1

Context of the SET mission to the Kyrgyz Republic ............................................... 2

Objective of SET missions ...................................................................................... 3

Evaluation methodology ................................................................................. 4

The SET toolkit and expected outputs ................................................................... 4

Phases of SET missions .......................................................................................... 4

The SET mission in the Kyrgyz Republic .......................................................... 6

Local situation and livestock production ............................................................... 6

Composition of the Evaluation Team .................................................................... 8

Mission summary .................................................................................................. 8

Evaluation results ......................................................................................... 11

Description of surveillance system ...................................................................... 11

SET outputs ......................................................................................................... 16

Core results ......................................................................................................... 16

Performance attributes ....................................................................................... 17

Recommendations ........................................................................................ 20

SWOT analysis ..................................................................................................... 20

Strengths ......................................................................................................... 20

Weaknesses ..................................................................................................... 20

Opportunities .................................................................................................. 21

Threats ............................................................................................................ 21

Recommendations and action plan ..................................................................... 22

Action plan ...................................................................................................... 23

References .................................................................................................... 29

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Figures Figure 1. Areas visited during SET evaluation mission in the Kyrgyz Republic, October 2019 (Source: UN). Blue stars denote location of laboratory or veterinary services staff (four) transported to Bishkek for interviews. .................................... 10

Figure 2. Organisation of the State Inspectorate showing number of employees in brackets, Kyrgyz Republic, October 2019 ................................................................ 11

Figure 3. Animal disease reporting lines in the Kyrgyz Republic .............................. 14

Figure 4. Comparative SET graphical outputs for the Kyrgyz Republic by category, October 2019. ......................................................................................................... 16

Figure 5. SET outputs for the Kyrgyz Republic by performance attribute of the system, October 2019. ............................................................................................ 19

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Tables Table 1. Categories and areas evaluated by SET ....................................................... 4

Table 2. Number and type of livestock in the Kyrgyz Republic .................................. 7

Table 3. Evaluation team during the SET mission to the Kyrgyz Republic, October 2019. ......................................................................................................................... 8

Table 4. Notifiable animal diseases in the Kyrgyz Republic ..................................... 11

Table 5. SET outputs for the Kyrgyz Republic October 2019 ................................... 17

Table 6. Performance attributes evaluated by the SET ........................................... 18

Table 7. Prioritized recommendations from SET outputs, Kyrgyz Republic, October 2019 ........................................................................................................................ 22

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Acknowledgements This report is the result of a collaborative effort between Ryan Aguanno (FAOHQ), Dinara Imanbayeva (FAOREU), Marina Kichinebatyrova (FAOKG) and Daniel Beltran-Alcrudo (FAOREU).

The authors of the present evaluation report would like to thank all the stakeholders met, as well as all the people who contributed to the success of this evaluation mission in the Kyrgyz Republic (Kyrgyzstan), including:

In addition, the authors would like to thank those who contributed to the development of SET and its methodology: Gaël Lamielle (Veterinary Epidemiologist, FAOHQ), Subhash Morzaria (FAO Senior Animal Health Adviser), Sophie von Dobschuetz (Veterinary Epidemiologist, FAOHQ), Sibylle Bernard-Stoecklin (Veterinary Epidemiologist, formerly of FAOHQ), Magali Ruiz (Veterinary Epidemiologist, formerly of FAOHQ), Eran Raizman (FAOREU), Ryan Aguanno (Veterinary Epidemiologst, FAOHQ), Madhur Dhingra (Veterinary Epidemiologist, formerly of FAOHQ), Asma Saidouni (Veterinary Epidemiologist, FAOHQ), Béatrice Mouillé (EMPRES Lab Unit Deputy Coordinator, FAOHQ), Pascal Hendrikx (Veterinary epidemiologist ANSES), Aurélie Courcoul (Veterinary epidemiologist ANSES), and Jean-Philippe Amat (Veterinary epidemiologist ANSES).

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Abbreviations

AITS Animal Identification and Traceability System

AHS African Horse Sickness

ANSES Agence nationale de sécurité sanitaire de l’alimentation, de l’environnement et du travail

CDC Centers for Disease Control and Prevention

CVO Chief Veterinary Officer

EAEU Eurasian Economic Union

ELISA Enzyme-Linked Immunosorbent Assay

FAO Food and Agriculture Organisation of the United Nations

GIS Geographic Information Systems

GHSA Global Health Security Agenda

IFAD International Fund for Agricultural Development

IHR International Health Regulations

IO International Organizations

ISELEK Information System “Elek”

IT Information Technology

JEE Joint External Evaluation

Kyrgyzstan Kyrgyz Republic

LSD Lumpy Skin Disease

LIMS Laboratory Information Management System

LMT Laboratory Mapping Tool

MAFIM Ministry of Agriculture, Food Industry, and Melioration

MoEP Ministry of Environmental Protection

MoU Memorandum of Understanding

NADIS National Animal Disease Information System

OIE World Organisation for Animal Health

OASIS Outil d’Analyse des Systèmes de Surveillance

RADIS Raion Animal Disease Information System

REU Food and Agriculture Organisation of the United Nations Regional

Office for Europe and Central Asia

PCR Polymerase Chain Reaction

PH Public Health

PVS Performance of Veterinary Services

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SET Surveillance Evaluation Tool

SIVPS State Inspectorate on Veterinary and Phytosanitary Safety

SOP Standard Operating Procedures

SWOT Strengths Weaknesses Opportunities Threats

USAID United States Agency for International Development

WHO World Health Organisation

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Background

General context

Outbreaks of animal disease can have a devastating impact on people’s livelihoods if not detected in a timely manner. In addition, over 70 percent of emerging infectious diseases are zoonotic in nature (WHO, 2020) and identifying them in animals can prevent their transmission to humans. Good-quality data is therefore essential to better prepare and respond to known and new threats to both livestock and people. Strong surveillance systems represent the cornerstone to provide decision-makers with adequate information to implement disease control programs.

Many assessments exist to help countries develop their animal health capacities, including the Joint External Evaluation (JEE) led by the World Health Organization (WHO) and the Performance of Veterinary Services (PVS) developed by the World Organisation for Animal Health (OIE). Although both JEE and PVS address some aspects of animal disease surveillance, their primary focus is to address general capacities related to One Health and veterinary services, respectively.

African countries working with the Food and Agriculture Organisation of the United Nations (FAO) therefore requested in 2016 a comprehensive evaluation methodology to guide activities aimed at enhancing national animal disease surveillance capacities.

Development of SET

In response to the request received, FAO developed the Surveillance Evaluation Tool (SET) during 2017 to support prevention and control of animal disease threats, including zoonoses. The tool provides veterinary services and ministries with an objective, standardized, comprehensive and systematic evaluation of animal health surveillance systems. The initial development of SET was supported by the United States Agency for International Development (USAID) for use in African nations under the Global Health Security Agenda (GHSA) project.

The basis for SET was the surveillance network assessment tool “Outil d’Analyse des Systèmes de Surveillance” (OASIS) developed by the French “Agence Nationale de Sécurité Sanitaire de l’alimentation, de l’environnement et du travail” (ANSES) (Hendrikx, et al., 2011). Additional assessment criteria from FAO’s Epidemiology Mapping Tool (EMT) were also included for the following indicators: cross-sectoral collaborations, epidemiology workforce capacities, outbreak investigation, and risk assessment. Finally, the tool’s structure, scoring system (1 to 4) and graphical outputs were harmonized with FAO’s Laboratory Mapping Tool (LMT) and EMT.

In past SET missions, JEE indicators for “Real Time Surveillance”, “Workforce Development” (D.4.1 and D.4.3) and “Zoonotic Diseases” (WHO, 2016) were incorporated into SET and assessed in order to further characterise these indicators from the perspective of animal health. Following the publication of the new JEE indicators and guidelines in 2018 by WHO (WHO, 2018), this aspect of the SET assessment was discontinued.

Two piloting sessions were conducted in Tanzania (12–21 June 2017) and Liberia (4–13 September 2017) to test SET in real-time situations in the East and West African

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contexts. Following these missions, outcomes were compiled in final reports that were distributed to key-decision makers of the surveillance system in both countries. The toolkit and evaluation methodology were also updated to reflect feedback and lessons learned during each of those piloting missions. Lastly, the final version of SET was distributed in English and French for implementation in the rest of project countries.

Following the successful implementation of SET in 14 countries in West, Central and East Africa between 2017 and 2019, the tool was made available for use in other regions.

Context of the SET mission to the Kyrgyz Republic

SET was requested by the FAO regional office for Europe and Central Asia (REU) under the Technical Cooperation Programme “Establishing a Network on Priority Livestock Diseases in Central Asia” (TCP/SEC/3702).

FAO, through the REU office, will function as the initial driver of the network that includes Tajikistan, Uzbekistan, Kazakhstan, Kyrgyzstan and Turkmenistan. The network was officially launched In Tashkent, Uzbekistan on 14–15 November 2019 and was named Central Asia Animal Health Network (CAAHN). The agenda, concept note, presentations and recommendations of the meeting are available at http://www.fao.org/europe/events/detail-events/en/c/1238290/.

Animal health networks offer a framework for building strong technical capacity, competency, leadership and a critical mass of regionally networked specialists in veterinary medicine, epidemiology, surveillance and diagnosis – all of which are essential to coordinate actions to manage the risks of transboundary animal diseases and zoonoses.

Experience from regional animal health networks in other regions has already proved to be successful. FAO, in cooperation with other international agencies, has led the establishment and support of several regional animal health networking initiatives in various regions of the world, e.g. RESEPI and RESOLAB in Western and Central Africa, EARLN and EAREN in East Africa, REMESA in Northern Africa, and also in Southeast and South Asia. The examples above are valuable resources to build synergies and efficiency in terms of animal health expertise and to enhance transparency and mutual confidence in disease information exchange.

Regional animal health networks offer a framework for building strong technical capacity, competency, leadership and a critical mass of regionally networked specialists. A regional animal health network will join forces to: 1) exchange information and experience, 2) standardise laboratory, field prevention/control, operating, communication and other procedures, 3) identify gaps, weaknesses and priorities, and 4) fulfil these gaps, e.g. by providing training, capacity building. This can be done by means of specific meetings, exchange of people, training and capacity building, organization of ring trials, joint work plans, etc.

The initial driver of the network will be brucellosis, which is a high priority for all Central Asian countries. Bovine and small ruminant brucellosis can be controlled and, as the primary responsibility of all governments is to protect all people leaving no one behind, it is their duty to give high priority to reducing risks associated with zoonotic diseases. FAO and the U.S. Centers for Disease Control and Prevention have jointly developed a Stepwise Approach for the Progressive Control of Brucellosis (SPCB) to aid countries along the progressive control process.

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This report details the SET mission conducted in the Kyrgyz Republic during October 2019, and highlights outcomes and recommendations for the improvement of the local animal disease surveillance system.

Objective of SET missions

The main objective of the mission was to conduct an external evaluation of the animal health surveillance system in the Kyrgyz Republic using the SET tool, with specific focus on:

• Institutional organization and legal frameworks at central, intermediary, and field levels

• Timeliness and quality of laboratory analyses

• Surveillance activities and methodology

• Epidemiology workforce capacity and management, and epidemiological training

• Outbreak investigation mechanisms and resources

• Data management and analysis

• Communication and reporting of results to internal, local, multi-sectoral and international

stakeholders

• Sensitivity, specificity, representativeness, rapidity, simplicity, flexibility, acceptability, data

quality, stability, and utility of the surveillance system

Examining each of these areas in the Kyrgyz Republic context allowed for the identification of strengths and areas of improvement for the surveillance system. Recommendations on tangible actions were then made in the form of an action plan to reach realistic goals for improvement.

Given the importance of brucellosis for CAAHN and all participating countries, including Kyrgyzstan, particular attention was paid to capture and gather brucellosis-specific information related to surveillance.

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Evaluation methodology

The SET toolkit and expected outputs

SET was developed to provide a comprehensive evaluation of the animal health surveillance system of a country, using a scoring grid composed of 90 indicators. These indicators are grouped into 19 “categories”, which constitute seven “areas” (Table 1).

Using the information gathered during the evaluation mission, a score from 1–4 (or “N/A” if the indicator is not applicable) must be assigned to each one of these 90 indicators. Finally, after the scoring session, outputs are generated to identify the strengths and the gaps of the evaluation system, including:

• Core-results for the operation of the surveillance system, assigning a score for each category and

area evaluated by SET.

• Performance attributes of the surveillance system (sensitivity, specificity, representativeness,

rapidity, flexibility, reliability, stability, acceptability, simplicity and utility). These performance

indicators are calculated using weighted coefficients assigned to the scores obtained for each

indicator. Table 1. Categories and areas evaluated by SET

Area Category Nº of indicators

Institutional

organization

Central institutional organisation 7

Field institutional organisation 8

Intersectoral collaborations 4

Laboratory

Operational aspects 2

Technical aspects 8

Analytical aspects 3

Surveillance

activities

Objectives and context of surveillance 4

Surveillance data collection 14

Surveillance procedures 9

Animal health investigations 2

Risk assessment 2

Epidemiology

workforce

Workforce management 5

Training 4

Data management Information system 2

Data processing and exploiting 5

Communications Internal communication 4

External communication 3

Evaluation Internal evaluation 2

External evaluation 2

Total indicators 90

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Phases of SET missions

SET evaluation missions consist of four main phases:

• Preparation and document review. Preparation of the mission starts at the latest one month

prior to the arrival of the team into the country. During this phase, team members finalise the

mission’s program, stakeholders to interview and logistics in the field. The full SET package is

also shared with each evaluator so that they can familiarise themselves with the toolkit and its

methodology. A number of documents to support the information provided during the

interviews must be shared by the national focal points prior to the mission – these include

standard operating procedures (SOPs), protocols and other written documents describing how

the surveillance system functions.

• Data collection during stakeholder interviews. Detailed information on the country’s animal

surveillance system is elicited through participatory interviews with various stakeholders at

each level of the system (national, subnational and field) and in the field (livestock owners,

traders, abattoirs, markets, public/private sector and more). A structured questionnaire is

available to identify the information required for a complete evaluation. Nevertheless, a key

element of the SET methodology is to embrace dialogue with stakeholders and therefore the

questionnaire may only be utilized as a guideline during the interview process.

• Scoring session. The evaluation team enters the information gathered during interviews into

the SET scoring grid (Excel file), by assigning a score (1–4) to each of the 90 indicators

evaluated, along with a justification.

• Development of country-specific recommendations. Based on the scores entered into the SET

scoring grid, graphs highlighting the system’s strengths and weaknesses are automatically

generated. These outputs become the basis from which recommendations are identified. A

final restitution meeting reports the evaluation’s conclusions and recommendations to key

decision-makers for their feedback, and allows for discussion and amendments to the

recommendations to be made.

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The SET mission in the Kyrgyz Republic

Local situation and livestock production

Livestock play an important role in the Kyrgyz Republic as a source of income for 64 percent of the rural population. They are a source of employment, both at the production and post-harvest/processing stages, accounting for about half of the agricultural contribution to the national gross domestic product while also possessing export potential. In addition, livestock products represent a substantial part of the diet in the Kyrgyz Republic. At the end of 2018, the livestock industry accounted for 6.1 million sheep and goats, 1.6 million cattle (including yaks), 0.5 million horses, and 6.0 million poultry (Table 2). The Kyrgyz Republic has a very particular production environment due to the geographic and climatic conditions, with extensive livestock production expected to continue as the priority system into the future. Animals are kept primarily in smallholder systems. Cattle, sheep, goats and poultry constitute the most economically dynamic and promising species, along with horses which are used in transport and in meat/milk production. There is a significant variation in livestock populations and species composition across the country:

• Osh, Jalal-Abad and Chui lead in cattle population; Jalal-Abad, Osh and Naryn in sheep and

goat populations;

• Naryn, Osh and Issyk-Kul in horse population; and

• Chui in poultry population.

Mainly due to differences in proximity to internal and external produce markets, as well as the transfer of live animals for use / slaughter from other oblasts (provincial level), Chui, Osh and Jalal-Abad oblasts have the highest meat production amongst all oblasts. Chui is also a dynamic leader in egg production, and Osh and Jalal-Abad oblasts in wool production.

The livestock sector is the country’s largest land user, natural mountain pastures with rich grass occupy 83 percent of agricultural land, or 9.3 million hectares. The type of seasonal use divides the pastures into the summer distant pastures (rangelands, 3.9 million hectares), spring and autumn pastures (2.8 million hectares), and winter pastures (near villages/settlements, 2.4 million hectares). In 2009, a the new Pasture Law was adopted which delegated the authority for pasture management and use rights from Aiyl Okmotu to the Pasture Users’ Union and their executive bodies, the Pasture Committees (PC). In total, 456 Pasture User Associations have been established and are operating throughout the country.

The cattle population is comprised of the Alatau brown cattle and the Aulieatanskaya breeds. All animals have been identified (tagged) and entered into the Animal Identification and Traceability System (AITS), as well as undergo strict veterinary records for all preventive measures. In the valley areas of the country, dairy processing factories purchase milk from the rural population. This system is well developed in the Chui Oblast, in the eastern part of the Issyk-Kul Oblast, and in Talas, Osh, and Jalal-Abad oblasts. At the time of this writing, the price of 1 litre of milk was about 17–20 soms/0.29USD.

Yaks are mainly concentrated in high mountain pastures, in the summer altitudes ranging from 3 200–4 200 meters above the sea level, and in the winter at altitudes of

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2 000–2 300 meters above sea level with a small amount of additional fodder in the spring during the calving period. Gourmet yak meat is mainly sold in the domestic market all year round.

Table 2. Number and type of livestock in the Kyrgyz Republic

# KR/regions (oblasts)

Cattle Yaks Horses Sheep and Goats

Poultry

1 Kyrgyz Republic 1 627 296 38 488 498 684 6 167 949 6 009 697

2 Batken 149 012 1469 7774 504 002 281 429

3 Osh 366 327 5950 96 439 1 142 087 638 953

4 Jalal-Abad 329 623 305 71 444 1 305 833 1 114 212

5 Issyk-Kul 237 564 9769 105 606 916 615 950 268

6 Naryn 174 650 18 810 119 367 1 064 767 204 510

7 Chui 289 952 1195 70 074 655 618 2 480 455

8 Talas 67 596 611 26 836 552 706 257 674

9 City Bishkek 589 0 261 1864 18 252

10 City Osh 11 362 0 737 24 328 62 959

11 Special recording*

621 379 146 129 985

* These are animals that belong to the farms of the Ministry of Internal Affairs

The horse industry is traditionally highly profitable due to the low cost of winter feed. Gourmet meat and koumiss (a fermented liquor prepared from mare's milk) are mainly sold at the domestic market. The cost of 1 litre of koumiss ranges from 40–80 soms/1.15 USD, the milking period is 100–120 days with an average of 5–6 litres per day from one mare. Recently, racing breeds are being imported in to the country, such as the English thoroughbred, Russian fine harness horse (trotter), American Standardbred breed, and partially heavy breed.

Sheep are mainly represented by the coarse wool breed and meat–and-fat breed, these are crosses of the Hisar breed and cross of the Edilbaev breed. The remains of the former Kyrgyz fine-fleece breed represent the wool sheep breeds; there are about 300 000 head. Goats are represented by the local breeds for the production of fluff and meat, with many goat farms in the southern regions of the country in areas of rocky steep knolls and with a semi-desert type of pasture. In the valley zones where it is possible to produce abundant feed, intensive animal husbandry is well developed. There are many dairy farms in stall barn housing and farms engaged in year-round fattening of young cattle and horses for meat. With the onset of the warm weather period, animals move to the pastures. The grazing period on average starts from 1 April–25 May before cattle move to the summer pasture until 20 September. After harvesting crops in the field, cattle are grazed on crop residues. From November, some herds move to winter pastures and some to stall barn housing.

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Regarding wild fauna, in the Kyrgyz Republic today, there are 83 specially protected natural areas with a total area of approximately 800 000 hectares, which is four percent of the total area of the country. There are six reserves, eight national parks, and 67 natural parks (subdivided into forests, botanical, geographical, and hunting). In addition, there are two biosphere reserves recognized by the United Nations Educational, Scientific and Cultural Organization (UNESCO). Deer (550 animals), argali (22 000 animals), Rocky-Mountain goat (38 000 animals), roe deer (5 000 animals), and wild boars (1 000 animals) are found in the Kyrgyz Republic.

Composition of the Evaluation Team

The evaluation team consisted of eight members of the Kyrgyz Republic Veterinary Inspectorate, FAO Kyrgyzstan, FAO Regional Office for Europe and Central Asia in Budapest, and FAO Headquarters in Rome (Table 3).

Mission summary

Identification of the stakeholders and areas to visit reflected the need for a representative assessment of the Kyrgyz Republic animal disease surveillance system, balanced with logistical limitations of field work. The mission started on 23 September 2019, when members of the evaluation team met at the FAO Kyrgyzstan office in Bishkek to finalise the agenda and ensure adequate coverage of all identified stakeholders. Immediately afterwards, a launching meeting was held at the Ministry of Agriculture, Food Industry, and Melioration (MAFIM) together with 20 key decision-makers of the animal disease surveillance system in the Kyrgyz Republic, including

Table 3. Evaluation team during the SET mission to the Kyrgyz Republic, October 2019.

Team member Title and organisation

Ryan Aguanno Veterinary epidemiologist, FAO Rome

Dinara Imanbayeva Veterinary epidemiologist, FAOSEC Ankara

Marina Kichinebatyrova Veterinary epidemiologist, FAOKG Bishkek

Larisa Ermakova Center for Veterinary Diagnostics and Expertise in the northern region of the Kyrgyz Republic

Chyngyz Romanov Head of Animal disease monitoring department, State Inspectorate for Veterinary and Phytosanitary Safety under the Government of the Kyrgyz Republic (SIVPS GKR)

Adilet Sotovaldiev Chief Inspector of Animal disease monitoring department, SIVPS GKR

Murat Kenjebaev Inspector of State veterinary surveillance unit, SIVPS GKR

Ozot uluu Erlan Inspector of Internal veterinary surveillance Department, SIVPS GKR

Danyar Januzakov Chief Inspector of State veterinary surveillance unit, SIVPS GKR

Aichurek Baitova Lawyer, SIVPS GKR

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representatives from various departments within the State Inspectorate on Veterinary and Phytosanitary Safety (SIVPS). The launching presentation highlighted the development of the SET, as well as the goals for the mission. Interviews with the Chief Veterinary Officer (CVO), Deputy Director, Head of the Southern Region Central Veterinary Laboratory, and Oblast veterinary services from Batken, Jalal-Abad and Osh, who had been specifically transported to Bishkek for interviews immediately, followed the launching meeting. This allowed for representation from the southern part of the Kyrgyz Republic, which could not be visited during field interviews.

The first two days of interviews allowed the evaluation team to gain a clearer understanding of the structure and function of the system at the central level, as well as the integration between human and animal surveillance systems in place in the Kyrgyz Republic at the time of the mission. Interviews at the central level also included the following: State veterinary surveillance unit, Animal Health Control Department, Internal Veterinary Surveillance Department, Animal Disease Monitoring Department, Food Safety Sector, Identification and Traceability Unit, Border Control Unit, Agency of Environmental Protection, and Public Health, before travelling to the Northern Region Central Veterinary Laboratory.

The evaluation team then commenced the field portion of the mission (Fig.1). Stakeholders selected for interviews originated from various district/raion and city veterinary offices and laboratories, as well as livestock farmers and associations, abattoir workers, and private veterinarians. A total of 104 interviewees were interviewed at all levels of the system to obtain a thorough understanding of the context of surveillance in the Kyrgyz Republic.

Following the data gathering phase, the team reconvened in Bishkek on 30 September

to summarize the information from the interviews and begin scoring the system using

the SET tool. A strengths, weaknesses, opportunities and threats (SWOT) analysis was

done to help identify specific recommendations to improve on the gaps identified.

A closing meeting took place on 3 October 2019 where findings of the mission and

recommendations were presented to key decision-makers, who were then provided

an opportunity to comment on the preliminary findings. Following this meeting, the

evaluation team met one last time to provide feedback on the mission in order to

improve future iterations.

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Figure 1. Areas visited during SET evaluation mission in the Kyrgyz Republic, October 2019 (Source: UN). Blue stars denote location of laboratory or veterinary services staff (four) transported to Bishkek for

interviews.

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Evaluation results

Description of surveillance system

Central and Sub-national Organisation

The State Inspectorate on Veterinary and Phytosanitary Safety is a subordinate organization of the Government of the Kyrgyz Republic, with a clearly identified management structure headed by the CVO. Central level activities are supported by the relevant subordinate divisions (Fig. 2), which play an important role in the animal disease surveillance system.

Figure 2. Organisation of the State Inspectorate showing number of employees in brackets, Kyrgyz Republic, October 2019

Effective national, as well as Eurasian Economic Union (EAEU) regulations are in place. Government decree 81 from 10 February 2014 covers all emergencies involving government representatives (Ministries), as well as establishes the Veterinary Service Steering Committee that is in charge of general issues, including surveillance. The Kyrgyz Republic has prioritised eight diseases (Table 4) that play a key socio-economic and trade role for the country, with strategic plans developed for each disease. Lumpy skin disease (LSD) and African horse sickness (AHS) are in draft legislation to be included as future priority diseases. It was noted during the evaluation that many of these strategic plans need to be revised based on more comprehensive risk assessments.

At the field level, there is zoning based on administrative divisions covering the entire country, with supervision of the private veterinary professionals conducted by raion veterinarians. The number of veterinary epidemiologists is limited at regional and field levels. Private veterinarians operate in each village on a contract basis implementing the vast majority of state activities on disease prevention (e.g. vaccination, animal identification and sampling), and providing other services for farmers. Private veterinarians are responsible for the entire total population in the administrative unit, but difficulty accessing remote pasture areas due to transportation issues and reduced

Table 4. Notifiable animal diseases in the Kyrgyz Republic

Notifiable animal diseases (VSD)

Foot and mouth disease Anthrax

Sheep and goat pox Peste des petits ruminants

Echinococcus Brucellosis

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profitability of these visits was noted. Equipment is often out of date or inadequate for all surveillance capabilities (e.g. it was mentioned that a cold-chain for disease sample submission is often unavailable). These issues continue to impact disease reporting, though overall the provision of supplies by the veterinary services is commendable.

A new animal identification system is in place currently covering every individual cattle, including yaks. The system is planning to begin incorporating horses and donkeys before the end of 2019.

Intersectoral Collaboration

Collaboration with other ministries is governed by a Government decree with guidelines in place. Legislation is also present which defines the role of the private veterinary industry in the delivery of ground-level animal health services. There are no functioning private animal health institutes or laboratories operating within the territory at this time, apart from small private laboratories operating in markets that are capable of performing basic food safety testing. A memorandum of understanding (MoU) related to epidemiological investigation and the exchange of information on zoonotic disease with public health (PH) authorities, the Ministry of Environmental Protection (MoEP), military services, and scientific institutes has been signed. Rapid response teams have also been created under this MoU and cover oblast, raion, and village levels, who are able to respond within 48 hours. Meetings of all stakeholders involved are conducted once yearly or more frequently in the face of emergencies. During interviews, PH authorities demonstrated interest in improving and coordinating joint surveillance activities. Though the MoEP is included in the MoU and collaboration has increased since 2017, there was a noted need for improvement in this area. There are no international organisations such as FAO captured under the MoU.

Laboratory

The Kyrgyz Republic has two central level laboratories (Northern and Southern regions, Bishkek and Osh respectively) that perform standardised and harmonized testing activities. The laboratory system is well structured and fully involved in epidemiological surveillance, implementing diagnostic activities according to the State Plan.

There is an agreement in place with international reference veterinary laboratories for sample shipment and testing. The Federal Centre for Animal Health of the Russian Federation (FGBI ARRIAH) is the most commonly utilised to conduct testing unavailable within the Kyrgyz Republic. Unfortunately, the lack of a proper provider to ship samples limits the laboratory from conducting proficiency testing with internationally recognized reference laboratories in a regular manner.

In cases of emergency events, the central laboratories are able to provide support to the raion level laboratories with respect to staffing, diagnostic testing, or other equipment needs. A mobile team is available to accompany private veterinarians in the field, however the team is not comprised of specific focal points and greater availability of rapid testing kits are warranted.

Currently, accreditation has been received at only the two central level laboratories for 18 tests, however the development of additional tests for priority diseases is planned, as is the accreditation of zonal laboratories. Quality control managers have already begun working to prepare this eventuality. Though the central laboratories are confident in the testing methodologies applied, at the raion level there is a need for the improvement of work standardisation. However, inter-laboratory proficiency testing is conducted for all priority diseases. Varying diagnostic techniques are

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available to differentiate suspect cases versus confirmed cases, but case definitions have not been clearly defined in national regulations (default OIE definitions are most often used). Data management of laboratory samples is organized using a combination of paper and Excel files, covering the process of sample registration to results delivery. This system would benefit from the introduction of a laboratory information management system (LIMS), capable of reducing human error and improving laboratory efficiency across the entire system. Reports from laboratory submissions are communicated separately to the field and central levels.

Surveillance Activities

Though formal surveillance protocols are in place, some of those (which originated before independence in 1991) could benefit from revision. The Programme of Veterinary Service Development for 2018–2023 was approved by Government decree and includes disease-specific surveillance objectives in a basic but not easily measurable format. These objectives have been created in collaboration with identified partners such as FAO. In some instances, objectives lack aspects of disease surveillance such as identifying prevalence or incidence, as well as differentiating between confirmed vs. suspect case definitions. Moreover, field level private veterinarians are not overly familiar with the definitions provided.

Priority diseases are identified based on a variety of factors (including socio-economic) and the list is continually assessed during meetings and discussions with stakeholders. There is a plan to update the list of priority diseases by adding LSD, AHS, and African swine fever.

A draft law on anti-epizootic activities, which dictates the notification and response procedure, is expected to be approved in 2020. At the moment, notification and response are covered by disease-specific legislations where they exist.

Private veterinarians currently submit disease reports monthly, with the central level confirming that over 95 percent of report forms were filled in at the time of the evaluation mission. At the field level, it was stated that the forms, which are reviewed for format annually, are simple to fill out but too high in number. A current pilot project in the Alamudun raion allows private veterinarians to submit disease reports electronically. Reports to the EAEU are required monthly based on the forms. In addition, six-monthly reports and annual reports are submitted to OIE. There are also bilateral agreements with neighbouring countries on disease situation reporting.

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Figure 3. Animal disease reporting lines in the Kyrgyz Republic

Overall, there is a strong understanding of the importance of the surveillance system amongst private veterinarians and farmers. In the case of disease suspicion, a farmer is obligated to notify the private veterinarian or paraveterinarian immediately. There was no indication from farmers or private veterinarians that a disease would not be reported. Private veterinarians are covered by the necessary legislation when they require farm access, with fines permitted if access is not allowed. However, due to the current moratorium on private sector inspection (e.g. farmers, production facilities) to allow for acceptance and uptake of new legislation, few visits are being conducted at this time.

Objectives of the surveillance system are generally met, and active and passive surveillance is planned accordingly. Geographic coverage is taken into consideration to ensure the population is appropriately covered. For brucellosis, all milking cattle are sampled, with calves vaccinated at three months of age. For FMD, random selection is performed based on geographic coverage.

It was reported that nearly all active surveillance plans for the country are completed on an annual basis. For brucellosis, this includes seromonitoring of the entire cattle population. Investigations are conducted systematically based on SOPs. Sampling as well as sample packaging and transport SOPs were developed by FAO based on International standards.

Epidemiology Workforce

Terms of reference are in place for each individual, including private veterinarians, which are reviewed and approved annually. The Deputy Head of the Raion Veterinary Department is in charge of all epidemiological activities, planning, and response. An epidemiology expert is employed at the raion level who is supported by the epidemiological department at the central level. These experts must hold at least five years of experience.

Each veterinarian at the raion level and central level is required to have a veterinary degree, which is considered equivalent to a Masters level. At the central level there are several employees holding PhDs.

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All veterinarians receive continuous on-the-job training and initial support upon entry to the system (e.g. mentorship), however there is no standardised initial training programme. Ongoing trainings are organised by either the central level and/or international organizations (e.g. FAO), with field-level interviewees specifically requesting more surveillance training and a higher frequency of training overall.

Data Management

A variety of databases exist to manage epidemiological data for the veterinary services. The Raion Animal Disease Information System (RADIS) and National Animal Disease Information System (NADIS) are utilised to input animal disease events at the raion and national level, respectively; DOGSKG is used to store information of canine identification; the Animal Identification and Traceability System (AITS) records ear tag data, and; the Elek Information System (ISELEK) is used to monitor veterinary certificates. Where appropriate, there is planned improvement of these systems including interoperability between existing national databases and with the databases of the EAEU.

Entering disease data into RADIS at the field level was viewed by interviewees as time-consuming since currently private veterinarians do not have access to data entry. As a result, all records are entered at the raion office over a period of several days each month. Though this process is not streamlined, it does allow for data verification and is governed by a formalised set of procedures. However, improvements could be made into tracking which users have not submitted monthly reports and allowing for horizontal access to reports across raions. Overall, it was mentioned by multiple field actors that the number of forms to fill in could be reduced and due to separate EAEU record keeping there is duplication in data submission.

Data analysis is currently performed at only a basic level due to unavailability of appropriate software or training. Geographic Information System (GIS) software is not utilised and mapping of disease events is not regularly conducted. Analyses are currently conducted by a team of six people within the Risk Analysis Unit. Analyses are conducted at the central level only and not shared back with the field.

Communication and Evaluation

Monthly meetings are held with private veterinarians within the raions where report submissions are reviewed, data is validated, and missing data is sought. Similarly, the central level holds monthly meetings with raion veterinarians and the veterinary association. Two to three times annually there are also workshops, with quarterly meetings related to surveillance. The central unit makes quarterly visits to the field for supervisory purpose.

Due to financial constraints, there is currently no epidemiological newsletter being regularly released, though leaflets or bulletins do exist. When released, newsletters are available on the veterinary services website, however no example was seen. Communication regulations state that one person for each raion is responsible for horizontal and vertical communication, however this is mostly done through informal WhatsApp groups. Horizontal communication across raions also requires improvement.

There is mandatory communication with the EAEU, OIE, and FAO managed by a unit for international relations and communication. Greater financial and material resources are required for a variety of communication needs including videoconferencing, printing, publishing of scientific articles, improvements to internet

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connectivity, and an information technology (IT) specialist. Currently there is only one person at the central level employed for communications.

Formal performance indicators for the surveillance system are absent, though the central level does perform ad-hoc internal evaluations which may cover aspects of surveillance. Veterinarians are assessed individually on an annual basis against their ToRs. The surveillance system could benefit from complete, regular, and measurable evaluation of activities. Excluding this evaluation, the surveillance system has partially been externally evaluated by the OIE (PVS Gap Analysis Mission Report) and International Fund for Agricultural Development (IFAD), with many recommendations captured in the "Development of the Veterinary Service of the Kyrgyz Republic for 2018–2023" approved by the Government of the Kyrgyz Republic, 17 October 2017.

SET outputs

Two different types of outputs are provided by the evaluation:

• Core results (Table 3, Fig. 4)

• Performance attributes (Table 4, Fig. 5)

Core results

The core results describe the operation and general status of the surveillance system, assigning a score to subcategories within each area evaluated by the SET (Table 1). All scores are expressed as percentages, based on an ideal situation where scores of 4 are given to all indicators (100 percent).

The strongest individual category scores were “Laboratory – Operational aspects” and “Animal health investigation” (100 percent), which scored highly due to a well organised and incorporated laboratory structure, as well as the presence of multi-tiered rapid response teams governed by clearly defined protocols. These were followed by “Internal communication” and “Intersectoral collaboration” (91.7 percent). Categories that received the lowest scores included “Risk assessment” (50 percent), “External communication and resources” (44.4 percent), and “Epidemiology workforce training” (41.7 percent) (Table 5, Fig.4).

Figure 4. Comparative SET graphical outputs for the Kyrgyz Republic by category, October 2019.

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Table 5. SET outputs for the Kyrgyz Republic October 2019

Area Score by area

(%) Category

Score by category (%)

Institutional 36.8

Central institutional organization 85.7

Field institutional organization 79.2

Intersectoral collaborations 91.7

Laboratory 41

Laboratory - Operational aspects 100.0

Laboratory - Technical aspects 62.5

Laboratory - Analytical aspects 77.8

Surveillance activities 48.4

Objectives and context of surveillance 75.0

Surveillance data collection 78.6

Surveillance procedures 83.3

Animal health investigation 100.0

Risk assessment 50.0

Area Score by area

(%) Category

Score by category (%)

Epidemiology workforce

44.4 Workforce management 86.7

Training 41.7

Data management 52.4 Information system 83.3

Data processing and exploitation 73.3

Communications 38.1 Internal communication 91.7

External communication and resources 44.4

Evaluation 50 Internal evaluation 50.0

External evaluation 83.3

Performance attributes

Qualitative attributes have been identified and used by several international organisation to evaluate the general performance of a surveillance system (Table 6) (CDC, 2001; CDC, 2004; Health Canada, 2004; WHO 1997). The SET Excel spreadsheet calculates the progress of the surveillance system relative to these performance attributes and generates visual outputs in the form of a spider graph (Fig. 5). Scores for indicators are weighed according to their importance to a specific attribute and outputs are generated as percentages of an ideal situation (scores of 4 on all indicators). An exhaustive list of the relationship between indicators and attributes is available upon request.

Performance outputs for animal disease surveillance in the Kyrgyz Republic revealed a surveillance system with lower scores for “specificity” (53 percent) and “rapidity” (63 percent). This is in part explained by the need for more specific laboratory testing. Likewise, “rapidity” received a 63 percent score in part from a combination of low numbers of rapid testing kits for the field and poor accessibility to some areas under surveillance. On the other hand, the “representativeness” of the surveillance system received the highest score (100 percent) due to both reliable and evenly distributed reporting across the entire country.

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Table 6. Performance attributes evaluated by the SET

Attribute Definition

Sensitivity The ability of a surveillance system to detect true health events i.e. the ratio of the total number of health events detected by the system over the total number of true health events as determined by an independent and more complete means of ascertainment.

Specificity A measure of how infrequently a system detects false positive health events i.e. the number of individuals identified by the system as not being diseased or not having a risk factor, divided by the total number of all persons who do not have the disease or risk factor of interest. Because of the difficulties in ascertaining the total population at risk in surveillance, determination of the number of misclassified cases (false positives) can be used as a measure of the failure of the system to correctly classify health events.

Representativeness A surveillance system that is representative accurately observes both the occurrence of a health event over time and the distribution by person / animal and place of that event in the population at any point in time.

Rapidity/Timeliness The interval between the occurrence of an adverse health event and (i) the report of the event to the appropriate public health agency, (ii) the identification by that agency of trends or outbreaks, or (iii) the implementation of control measures.

Flexibility The ability of the surveillance system to be easily adapted to new reporting needs in response to changes in the nature or the importance of the health event, the population monitored, or the resources available.

Data quality

(reliability)

Reflection of the completeness and validity of the data recorded in the public health surveillance system.

Stability The surveillance system’s ability to collect, manage, and provide data properly, and its availability (the ability to be operational when it is needed).

Acceptability Assessed by the willingness of persons conducting surveillance and those providing data to generate accurate, consistent and timely data.

Simplicity Refers to both its structure and ease of operation. Surveillance systems should be as simple as possible while still meeting their objectives.

Utility/usefulness The usefulness of a surveillance system is assessed by whether it leads to prevention or control or a better understanding of health events.

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Attribute Score

Flexibility 84%

Utility 88%

Acceptability 78%

Data quality 75%

Sensitivity 83%

Specificity 53%

Stability 74%

Simplicity 77%

Representativeness 100%

Rapidity 63%

Figure 5. SET outputs for the Kyrgyz Republic by performance attribute of the system, October 2019.

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Recommendations

SWOT analysis

A strengths-weaknesses-opportunities-threat (SWOT) analysis was conducted to gain a better understanding of the animal disease surveillance system in place in the Kyrgyz Republic. In this context, the strengths of a surveillance system refer to those aspects that are done well and need to be maintained or reinforced. On the contrary, weaknesses are characterised by areas where the system needs improvement in order to function better. Opportunities and threats refer to external factors that can positively or negatively impact the system, respectively.

Strengths

Network • Multiple stakeholders involved in surveillance planning (e.g. laboratories staff) and

approval of action plans (strategic plans) for disease control.

• Well-developed laboratory network with powerful diagnostic capabilities, especially at the

central level (accredited).

• Movement of livestock to pastures managed through pasture control points and the

Association of Pasture Users allowing for surveillance hot spots.

• Significant number of private veterinarians employed who conscientiously carry out their

work and are supplied with equipment.

• Good communication at all levels in the system (feedback and frequent discussion

among participants in the system).

• Professional staff at all levels who respect importance of surveillance in disease prevention.

Modernisation

• Five electronic information systems (ISELEK, NADIS, RADIS, DOGSKG, AITS), which are

consistently reviewed for improvement (e.g. granting greater access to users).

• Identification system for cattle and pigs implemented, with horses and donkeys in the pipeline,

and sheep and goats planned for the future.

• Several newly built slaughterhouses in accordance with international standards which have

been designed to facilitate surveillance of carcasses.

Administration • Independence for planning and financing activities, including internal control to assess the use

of funds (randomly selected) and internal auditing.

• Strict selection of veterinary candidates entering the government system.

• Legislation updated with some frequency and well respected and enforced.

• Priority diseases are often selected because of social, technical, historical, and political factors.

Weaknesses

Funding • Careers as veterinary services personnel, and to lesser extent private veterinarians, are not

viewed favourably by younger generations due to relatively low pay.

• Field level veterinary services are privatised, which means isolated farms or households may

not be financially profitable to include in surveillance or that private veterinarians may not

have transport means (e.g. vehicle, horses) to enable access.

• MoEP is in charge of wildlife surveillance, but does not have a budget line for veterinary

activities.

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Facilities • Some laboratories at field level are not fully equipped or are not currently functioning (e.g.

Karakol).

• There are no quarantine sites at border checkpoints.

Workforce • Small number of laboratory specialists and assistants.

• Laboratory system requires increase or updated sample processing and operations software

(e.g. LIMS).

Administrative

• The system for entering and validating disease events is outdated and time consuming.

• Several old SOPs and legal acts require review and modification in accordance with

international standards.

• Horizontal access to disease reporting software is not currently available

• The memorandum currently in place covering field level One Health collaboration is limited to

emergency situations

Opportunities

• Membership to the EAEU has had a positive impact on the operation of the surveillance system

(e.g. strengthening the structure of the veterinary services, laboratory, legislation, and

development of electronic systems).

• International organizations fund the training of young professionals in the field.

• Support of international organizations (FAO, OIE, International Fund for Agricultural

Development - IFAD, WHO, USAID) in relation to education, training, improving the material

and technical base.

• Recently stabilised political leadership within the Veterinary

Directorate.

• Internships available to veterinary students with the veterinary services.

Threats

• Poor internet speeds and limited availability in field settings.

• Poor road conditions and general inaccessibility of mountainous areas.

• Migration to pastures resulting in mixing of livestock and potential introduction or spread of

diseases over a large area.

• Natural disasters (landslides, snowdrifts, floods) limit access to rural locations.

• Educational programs in universities require revision;

• Public procurement processes often delayed (e.g. start dates, end dates) resulting in

difficulties for planning time-sensitive surveillance activities.

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Recommendations and action plan

The final product of a SET evaluation is a series of strategies for the improvement of the local animal disease surveillance system. These strategies are presented in the form of an action plan with realistic, measurable, and time-bound recommendations. To design this action plan, the evaluation team discussed and identified major recommendations using the information gathered during interviews. All recommendations are deemed to provide significant positive impact to the animal disease surveillance system. Primary recommendations correspond directly to gaps in the surveillance system as visible in scoring spider graph (Fig. 4), while secondary recommendations are aimed at providing more general system improvements (affecting multiple indicators) or gaps forecasted to occur based on findings during interviews.

Recommendations were then prioritized into short-term (<1 year), mid-term (1–3 years) and long-term (>3 years) based on their estimated feasibility (Table 7).

Table 7. Prioritized recommendations from SET outputs, Kyrgyz Republic, October 2019

Recommendations Short-term <1 year

Mid-term

1–3 years

Long-term >3 years

Pri

mar

y

1. Develop a communication plan for domestic/internal requirements and raising public awareness

2. Improve specific training on disease surveillance at university, upon hiring, and during career

3. Develop advanced epidemiological capabilities at the central level

4. Upgrade laboratory equipment and modernize the laboratory information system

Seco

nd

ary 5. Systematically review administrative aspects of

surveillance and address identified gaps

6. Develop a human resource plan to comprehensively address current and future requirements

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Action plan

1 Develop a communication plan for domestic/internal requirements and raising public awareness

Rationale • External communication was scored at 44.4 percent

• Inadequate stakeholder engagement

• Inadequate awareness of epidemiological surveillance systems currently in place

Objective • Raising awareness of programs implemented by the veterinary service

• Raising public and stakeholders awareness of epidemiological situation in the country

• Capacity and knowledge building on veterinary services leading to improvement of the

epidemiological situation

• Improved communication with stakeholders (public health authorities, associations) with the

possibility of conducting tracing and assessment

• Decreased use of antimicrobials by farmers and private veterinarians

Roles and Responsibilities

Lead: Veterinary Inspectorate (International relations division, public affairs office)

Partners: Veterinary Inspectorate (veterinary experts of the Inspectorate)

Resources • Leaflets, brochures

• Websites

• Media (TV, radio)

• Aiyl Demi (farmer’s newspaper)

• Alma (farmer’s magazine)

Outputs • Monthly and quarterly articles and newsletters posted to the website

• Monthly meetings with partners (Veterinary association, Pasture users association, etc.)

• Possibility of funds raised through greater donor awareness

Outcomes • Public and stakeholders are aware of epidemiological situation in the country and

knowledgeable on where to gain more information

• Public and stakeholders practices changed resulting in improvement to sanitary conditions

• Activities of pprivate veterinarians, Veterinary Association, and Pasture users association

modify their work based on surveillance results

Timeline for completion • Within one year

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2 Improve specific training on disease surveillance at university, upon hiring, and during career

Rationale • Training was the lowest scoring category at 41.7 percent

• Training in international standards and EAEU requirements is limited

• Inadequate student training on animal disease surveillance

Objective • Improving surveillance and epidemiology training at university

• Standardization of knowledge on disease surveillance of newly hired employees and raising

awareness of the surveillance activities and programmes being conducted within the country

• Improving training in surveillance at all levels (disease recognition, outbreak response, proper

sampling)

Roles and Responsibilities

Lead: Ministry of Education (students, during veterinary service)

Partners: Veterinary Inspectorate, Donors (EU, World Bank, OIE, FAO)

Resources • Training Experts and expertise

• External evaluation

• Audio visual technology

• Internet for training material

Outputs • Signing a memorandum of cooperation between Ministry of Education and Veterinary

Inspectorate

• Development of training modules on surveillance for state veterinarians

• Competency programs for new entrants

• Field exercises and training of trainers (ToT)

• Long-term field epidemiology training programs

Outcomes • Raising awareness on veterinary epidemiology monitoring, disease detection, analysis,

outbreak investigation and regulatory guidelines outlining the involvement of all partners in

the surveillance system.

Timeline for completion

• Within one year, sign a Memorandum of Cooperation with the Ministry of Education and

KNAU. A further two years to implement the program of study

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3 Develop advanced epidemiological capabilities at the central level

Rationale • Risk assessment was scored at 50 percent

• No capability to conduct comprehensive risk analysis

Objective • Ability to conduct a preliminary risk analysis (risk assessment, risk management, risk

communication)

• Develop GIS and risk modelling methods for surveillance activities planning

• Training in standardized risk assessment approaches

Roles and Responsibilities

Lead: Epidemiological surveillance division of the Veterinary Inspectorate

Partners: Deputy director of the Veterinary Inspectorate, veterinary inspectors, IOs

Resources • External expert support and training

• Software (with focus on free options such as Q-GIS)

• Guidelines, risk assessment materials

Outputs • Continuing education opportunities for central level departments (universities, PhDs, special

GIS courses, etc.)

• Mapping and modelling of risk zones

• Communicating results to the surveillance partners

• Developed/extended functional responsibilities of the risk analysis department

Outcomes • Budget management improved due to prioritization focused on risk areas, i.e. risk-based

surveillance

• Compliance with international recommendations

• Future surveillance activities guided by comprehensive analysis

Timeline for completion • Training within 1–3 years

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4 Upgrade laboratory equipment and modernize laboratory information system

Rationale • Technical aspects of the laboratory were scored at 62.5 percent

• Analytical aspects of the laboratory were scored at 77.8 percent

• False positive testing results could be improved

• Reliant on paper tracking for following laboratory results

Objective

• Transform of all laboratory activities to be recorded in the electronic information system

(LIMS)

• Improving the methods available at the central level to increase specificity (too high level of

false positives)

• Increasing the number of accredited laboratories in other geographical areas

• Advanced training of laboratory specialists

Roles and Responsibilities

Lead: Heads of the Central laboratories

Partners: Veterinary Inspectorate, IOs, other international partners

Resources • ELISA, PCR, diagnostic kits

• LIMS software

• Guidelines, instructions, SOPs

Outputs • Continuing the accreditation process initiated for zonal and inter-district laboratories

• Starting with LIMS Software introduction at central level laboratories

• Purchasing additional ELISA and PCR kits (reagents and equipment) with associated training

delivered

Outcomes

• Increased laboratory efficiency as a result of effective management of laboratory and related

data

• Simplification of the storage, tracking, and evaluation of data and information

• More effective surveillance due to reduced numbers of false positive results

Timeline for completion • From 2–4 years

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5 Systematically review administrative aspects of surveillance and address identified gaps

Rationale • Case definitions do not readily differentiate confirmed vs. suspect cases

• Surveillance objectives not measurable

• Surveillance system not internally evaluated

Objective • Develop suspect and confirmed case definitions for all notifiable diseases differentiated by

species

• Incorporate epidemiological information such as prevalence and incidence into surveillance

objectives

• Create set of surveillance indicators allowing for internal evaluation of system

Roles and Responsibilities

Lead: Veterinary Inspectorate

Resources • Internal expert meeting incorporating laboratory staff to determine definitions, objectives,

and indicators

• Focal point and funding for annual evaluation of system

Outputs • Revised disease action plans that incorporate new definitions, objectives, and are measureable

Outcomes • Increased efficiency of surveillance system through ability to differentiate confirmed vs.

suspect cases, creation of measurable objectives, and surveillance indicators allowing for

progress of surveillance activities to be evaluated without external aid.

Timeline for completion

• Within one year sign modification of definitions, objectives, and indicators with annual

measurements.

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6 Develop human resource plan to comprehensively address current and future requirements

Rationale • Human resources management was scored at 86.7 percent

• Majority of private veterinarians are close to or at the age of retirement

• Low numbers of employed laboratory specialists

Objective • Attract young professionals and retaining specialists for longer period (staff attrition)

• Plan and forecast personnel management (quantitative and qualitative) for sustainable growth

• Address the shortage of technical assistants (laboratory assistants, para-veterinarians,

technicians, and assistant of farmers)

• Improve working conditions, specifically related to hours worked

• Strengthen the Veterinary Association

Roles and Responsibilities

Lead: Deputy Director General of the Veterinary Inspectorate that is in charge of human

resources

Partners: Veterinary Inspectorate

Resources • Material and technical equipment

• Experience exchange

• Incentives / awards

Outputs • An official personnel management plan has been developed with a forecasting methodology

and future needs for specialists.

• Expanded scope of the Veterinary Association for private veterinarians with the possibility of

attracting new specialists, the independence of the Veterinary Association (advertising,

promoting a business to increase revenue, negotiating group benefits, etc.)

Outcomes • Ability to predict needs for hiring specialists and active adoption of measures to meet needs

before the shortage occurs

• Independent (including financially) private veterinary structures

Timeline for completion Within 2–4 years

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References

CDC. 2004. Framework for evaluating public health surveillance systems for early detection of outbreaks [online]. Morbidity and Mortality Weekly Report, Issue 53. Atlanta, CDC. 11 pp. (also available at https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5305a1.htm). CDC. 2001. Updated Guidelines for Evaluating Public Health Surveillance Systems – Recommendations from the Guidelines Working Group [online]. Morbidity and Mortality Weekly Report, Issue 50. Atlanta, CDC. 51 pp. (also available at https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5013a1.htm). GHSA. 2014. Global Health Security Agenda: Action Packages [online]. [Cited 16 October 2017]. https://www.cdc.gov/globalhealth/healthprotection/ghs/pdf/ghsa-action-packages_24-september-2014.pdf. GHSA. 2016. Advancing the Global Health Security Agenda: Progress and Early Impact from U.S. Investment [online]. [Cited 16 October 2017]. https://www.ghsagenda.org/docs/default-source/default-document-library/ghsa-legacy-report.pdf. Health Canada. 2004. Framework and Tools for Evaluating Health Surveillance Systems. 56 pp. Ottawa, Health Canada. (Also available at http://publications.gc.ca/collections/Collection/H39-4-46-2004E.pdf). Hendrikx, P., Gay, E., Chazel, M., Moutou, F., Danan, C., Boue, F., Souillard, R., Gauchard, F. & Dufour, B. 2011. OASIS: an assessment tool of epidemiological surveillance systems in animal health and food safety. Epidemiol Infect, 139(10):1486-1496. WHO. 1997. Protocol for the evaluation of epidemiological surveillance systems. Geneva, WHO. 48 pp. (also available at http://apps.who.int/iris/handle/10665/63639). WHO. 2016. Joint external evaluation tool: International Health Regulations (2005). Geneva, WHO. 95 pp. (also available at http://apps.who.int/iris/handle/10665/204368). WHO. 2018. IHR (2005) Monitoring and Evaluation framework: Joint External Evaluation tool (JEE tool) second edition. WHO, Geneva. 119 pp. (also available at: http://www.who.int/ihr/publications/WHO_HSE_GCR_2018_2/en/). WHO 2020, Neglected Zoonotic Diseases, World Health Organisation, viewed 11/2/2020. (https://www.who.int/neglected_diseases/diseases/zoonoses/en/)

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