LIVESTOCK-BASED INTERVENTIONS TO BUILD RESILIENCE IN PASTORAL AREAS.Lunchtime Conference, ECHO ERC, 23rd February 2018

DELIVERY OF A MIXED SERVICE OF HUMAN AND ANIMAL HEALTH IN PASTORAL AREAS OF NORTHERN MALI Stefano Mason, AVSF

NORTHERN MALI: PASTORAL VASTNESS WHERE HEALTH IS OUT-OF REACH

Area inhabited by nomadic and transhumant pastoralists, with mobile and very-spread population (about 0.5 inhabitants/km2)

Difficult physical access (tracks) and lack of means of communication for vast zones (no GSM, no vehicles)

A difficult access to water : during the dry season, families travel up to 10 km (often 2 daysjourney) to find water in pastoral wells or temporary ponds

A way of life with strong socio-cultural traditions, low school enrolment and a great proximity between humans and animals

Near absence of basic state services (human health, education, animal health) due to a lack of means by the State

Absence of private operators : the veterinarians who could settle down in these zones did not stay: the activity is extremely difficult and non-profit making due to long distances

Public health problems (hygiene, malnutritions, pre- and post-delivery pathologies, parasitic desease), higt risk for zoonoticdiseases (Rift Valley fever, anthrax, rabies, parasitic deseases, TBC, brucellosis)

Strong self-medication with sometimes small knowledge of animal health or human health; very low quality drugs (counterfeit)

NORTHERN MALI: PASTORAL VASTNESS WHERE HEALTH IS OUT-OF REACH

Mixed Health Mobile service: a proven approach to pastoral areas in Mali

§ Action started in 2005 in Mali as implementing partner§ Composition of a Mobile Team: a doctor or state nurse, an obstetrician nurse, a

livestock technician and a facilitator - translator§ Equipment: a vehicle (rental since the outbreak of the crisis); a cold chain; drugs for

humans and animals, camp kit, satellite phone, (no money)

§ Preventive, curative and awareness activities: actually 5 MT makes 2 tours/month in 68 sites with (7 days of field activities and 7 days of rest in town) and 5 fixed health centres (25 activity days and 5 days for reporting)

§ Network with CAHWs and midwifes, actors in the community, trained in the concept of basic health and participatory epidemiological surveillance. 68 ER and 68 matrones / relays

§ Monthly debriefing with Malian technical services

§ The 4 MT and 4 fixed health centres have an official status of a mobile ASACO (AlfarhatTalawit)

§ Mobile team and fixed health center in Gao are attached to Almusharat CSCOM for management and supervision

CHALLENGE OF RECOGNITION AT NATIONAL LEVEL AND REGISTRATION IN PUBLIC HEALTH POLICIES

Institutionalization of the service

Animal health

57409

123686

2015 2016

Treated animals

25%

36%

2015 2016

Prevalence of sick animals in the herd

36%

29%

7%2%

42%

35%

8%11%

Parasitosesexternes

Parasitosesinternes

infectionsrespiratoires

Carencesminérales

Dominant pathologies

2015 2016

Delivery of the minimum standard’s activity in human health

• Human health :

21151

2860032524 34209

2013 2014 2015 2016

Curative consultations

4225963

917

1291

Vaccination of children against measles

2013 2014 2015 2016

• Nutrition :

691 616

1610 1566

2013 2014 2015 2016

Management of moderatemalnourished children

71

121

242

415

2013 2014 2015 2016

Pregnant and lactating women with a malnourished child under 6 months

64% 65%

96% 98%

2013 2014 2015 2016

Coverage rate for the management of malnourished children

313356

429

564

2013 2014 2015 2016

Management of severelymalnourished children

Delivery of the minimum standard’s activity in human health

Comparison of data from a mobile team and a fixed Cscom in pastoral zone

301287

126145

2015 2016

Children vaccinated against measles

Enfant vaccinés contre la rougele équipe Mobile Tomb ouctou

Enfant vaccinés contre la rougele Cscom zone pastorale

552

439

306

127

2015 2016

Management of severely malnourishedchildren

Enfants Malnutris PEC équipe Mobile Tomb ouctou

Enfants Malnutris PEC Cscom zone pastorale

5066

6146

2516

3229

2015 2016

Curative consultation

Consultation Curative équipe Mobile Tomb ouctou

Consultation Curative Cscom zone pastorale

Comparison between mobile and fixed CSCOM

ItemAnnual costs

CSCOM (EUROS)

Annual costsmobile mixed

CSCOM(EUROS)

Human resources 10,610 18,020

Equipment costs(annual values) 21,330 15,690

Other expenses 3,000 1,830

TOTAL / Year 34,940 35,540

10,610

21,330

3,000

34,940

18,020 15,690

1,830

35,540

-

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

Charges RH ChargesEquipement

(Valeursannuelles)

Autres charges TOTAL ANNUEL

COUT ANNUELCSCOM FiXE(EUROS)

COUT ANNUELCSCOM MobileMixte (EUROS)

Annual cost are almost identical, but:• With Fixed CSCOM: only human health access, coverage radius of 15 km;• Mixed and mobile CSCOM Mobile: simultaneous access to Human and animal health, maximum

8 km to reach a mobile CSCOM.

SWOT Analysis of a mixed health service in pastoral zone

Significant contribution to vaccination and curative coverage in human and animal health

Adaptation to the lifestyle of populations, to climatic hazards and to the security context

Local epidemiological surveillance device based on institutional tools

Involvement of all stakeholders: technical services, elected representatives, communities

Experience of more than 10 years with social, economic and technical references

Acceptance / Appropriation of service by pastoral communities: CPN and vaccination

One of the answers to the challenge of a "One health“ approach

Registration of the device in the Algiers Agreements signed in May 2015

Included in the recommendations of the colloquies of N'Djamena and Nouackchott

Funding available for resilience and development

STERENGHTS OPPORTUNITIES

Currently funding of the scheme by humanitarian aid (EU - ECHO, PAM, Aura ...)

The security situation remains a major challenge

Few local HR

Very few actors (national governments, TFPs, NGOs, research ...) have been interested and have studied and financed this approach (apart ECHO and French decentralized cooperation)

Non-recovery of costs since the start of the crisis (according avec national politics on health)

Turnover of significant staff because of difficult working conditions

ASACO management capacity reduced due to the security crisis

Time interval between 2 visits and relatively long follow-ups (14 days) ... but offset by the presence of community relays

Referencing at the regional hospital of Timbuktu and Gao

Research is very little interested in this type of action

SWOT Analysis of a mixed health service in pastoral zone

WEAKNESSES THREATS

Some reflection on the sustainability of the Mobile Health Mixed Service

• State subsidy at 50% of cost (mainly agent salaries andmajor vehicle repairs, drugs)

• The operation (fuel and maintenance of the vehicle) atthe expense are in charge of the intercommunality.

• The daily operation (drugs, the salary of the guide) atthe expense of the ASACO: the population, in “normaltimes”, can take in charge of cost of consultation anddrugs and pay back the money to the ASACO

• In prospective: installation of a private veterinarianwithin the mobile team?

Thank you!www.vsf-international.org www.avsf.org