__ _ ~~~~WTP-1 34 Animal Health Services in Sub-Saharan Africa Initial Experiences with Alternative Approaches Comnelis de Haan and Solomon Bekure I C0P PR~IC ONTMENDT 2 ~~~~~~~~ESOU -IS AND TNURE LMNGSTAAU - ~f~J1jI~&NUGYCAG RECENT WORLD BANK TECHNICAL PAPERS No. 70 Falloux and Mukendi, Desertification Control and Renewable Resource Management in the Sahelian and Sudanian Zones of West Africa (also in French, 70F) No. 71 Mahmood, Reservoir Sedimentation: Impact, Extent, and Mitigation No. 72 Jeffcoate and Saravanapavan, The Reduction and Control of Unaccounted-for Water: Working Guidelines (also in Spanish, 72S) No. 73 Palange and Zavala, Water Pollution Control: Guidelines for Project Planning and Financing (also in Spanish, 73S) No. 74 Hoban, Evaluating Traffic Capacity and Improvements to Road Geometry No. 75 Noetstaller, Small-Scale Mining: A Review of the Issues No. 76 Noetstaller, Industrial Minerals: A Technical Review (also in French, 76F) No. 77 Gunnerson, Wastewater Management for Coastal Cities: The Ocean Disposal Option No. 78 Heyneman and Fagerlind, University Examinations and Standardized Testing: Principles, Experience, and Policy Options No. 79 Murphy and Marchant, Monitoring and Evaluation in Extension Agencies (also in French, 79F) No. 80 Cernea, Involuntary Resettlement in Development Projects: Policy Guidelines in World Bank-Financed Projects (also in Spanish, 80S, and French, 80F) No. 81 Barrett, Urban Transport in West Africa No. 82 Vogel, Cost Recovery in the Health Care Sector: Selected Country Studies in West Africa No. 83 Ewing and Chalk, The Forest Industries Sector: An Operational Strategy for Developing Countries No. 84 Vergara and Brown, The New Face of the World Petrochemical Sector: Implications for Developing Countries No. 85 Ernst & Whinney, Proposals for Monitoring the Perfornance of Electric Utilities No. 86 Munasinghe, Integrated National Energy Planning and Management: Methodology and Application to Sri Lanka No. 87 Baxter, Slade, and Howell, Aid and Agricultural Extension: Evidence from the World Bank and Other Donors No. 88 Vuylsteke, Techniques of Privatization of State-Owned Enterprises, vol. 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Copyright a 1991 The International Bank for Reconstruction and Development/THE WORLD BANK 1818 H Street, N.W. Washington, D.C. 20433, U.S.A. All rights reserved Manufactured in the United States of America First printing February 1991 Technical Papers are published to communicate the results of the Bank's work to the development community with the least possible delay. The typescript of this paper therefore has not been prepared in accordance with the procedures appropriate to formal printed texts, and the World Bank accepts no responsibility for errors. The findings, interpretations, and condusions expressed in this paper are entirely those of the author(s) and should not be attributed in any manner to the World Bank, to its affiliated organizations, or to members of its Board of Executive Directors or the countries they represent. The World Bank does not guarantee the accuracy of the data included in this publication and accepts no responsibility whatsoever for any consequence of their use. Any maps that accompany the text have been prepared solely for the convenience of readers; the designations and presentation of material in them do not imply the expression of any opinion whatsoever on the part of the World Bank, its affiliates, or its Board or member countries concening the legal status of any country, territory, city, or area or of the authorities thereof or conceming the delimitation of its boundaries or its national affiliation. The material in this publication is copyrighted. Reqests for permission to reproduce portions of it should be sent to Director, Publications Department, at the address shown in the copyright notice above. The World Bank encourages dissemination of its work and will normally give permission promptly and, when the reproduction is for noncommercial purposes, without asking a fee. Permission to photocopy portions for classroom use is not required, though notification of such use having been made will be appreciated. The complete backlist of publications from the World Bank is shown in the annual Index of Publications, which contains an alphabetical title list (with full ordering information) and indexes of subjects, authors, and countries and regions. The latest edition is available free of charge from the Publications Sales Unit, Department F, The World Bank, 1818 H Street, N.W., Washington, D.C. 20433, U.S.A., or from Publications, The World Bank, 66, avenue d'Iena, 75116 Paris, France. ISSN: 0253-7494 Cornelis de Haan is principal livestock specialist in the Agriculture and Rural Development Department's Agriculture Production and Services Division. Solomon Bekure is an agricultural economist in the Agriculture Division of the Western Africa Department, both at the World Bank. Library of Congress Cataloging-in-Publication Data Haan, C. de. Animal health services in Sub-Saharan Africa: initial experiences with alternative approaches / Comelis de Haan and Solomon Bekure. p. cm. - (World Bank technical paper, ISSN 0253-7494; no. 134) Includes bibliographical references. ISBN 0-8213-1773-3 1. Veterinary medicine-Africa, Sub-Saharan. 2. Veterinary public health-Africa, Sub-Saharan. L Bekure, Solomon. I. Title. m. Series. SF719.S92H34 1991 338.1'4-dc2O 91-7613 CI1? - iii - FOREWORD The 1985 World Bank Technical Paper 0 Animal Health Services in Sub- Saharan Africa; Alternative approaches' identified the deteriorating quality of the animal health delivery systems as a key constraint to the successful development of the livestock sub-sector. The paper recommended increasing cost recovery for services rendered and inputs provided, easing of the monopoly restrictions on many government tasks and encouragement of private sector involvement as promising alternative approaches to improve the quality of the service. This paper "Animal Health Services in Sub-Saharan Africa; Initial Experiences with Alternative Approaches" reviews the initial experiences with these reforms. This document outlines first the type of reforms introduced over the last decade. Second, it summarizes past experiences in each categories of reform, i.e. cost recovery for services rendered, liberalization of drug imports and supplies and privatization of clinical veterinary interventions. Third, it reviews the effect of the institutional changes introduced simultaneously in public animal health services. Finally, it provides a preliminary assessment of the impact of the different measures and draws a number of lessons to be taken into account in future policy adjustments and project investments. It is hoped that this document will provide policy planners from the Ministries of Agriculture and Finance, directors of Livestock Services and representatives of the donor community additional elements on which to base their decisions when planning the necessary structural changes, and that this document will give a new impetus to the discussion on the improvement of the quality of the veterinary and livestock extension services provided for African livestock producers. Michel Petit Director Agricultural Department Policy, Research and External Affairs World Bank - iv - ACKNOWLEDGMENTS This World Bank Technical Paper reviews recent experiences with alternative forms of animal health services in Sub-Saharan Africa. It is for officials and decision makers in regional governments and international agencies concerned with the planning and budgeting of animal health care. It is not a policy paper or a definitive statement on the subject, but is intended as a contribution to the discussion on appropriate strategies for improving animal health care in Sub-Saharan Africa. The paper incorporates valuable comments made during a two-day "brainstorming session' in June 1989 in Washington by a panel of experts consisting of Dr. Samson Chema, Deputy Director, Kenya Agricultural Research Institute; Dr. Michael Creek, FAO/CP, FAO; Prof. David Leonard, Department of Political Science, Institute of International Studies, University of California; Mr. Steven Sandford, Head, Livestock Economics Division, International Livestock Center for Africa; Dr. Amadou Sidibe, Coordinator, OAUIEEC Pan African Rinderpest Campaign for West Africa; and Dr. Georges Tacher, Director General, IEMVT. The authors acknowledge the contributions of Dr. Preben Haugaard (consultant veterinarian), who, with funding from the Danish Trust Fund, reviewed field experiences with alternative animal health care systems in several West African countries, and of Mr. Madani Tall (research assistant), who collected most of the background documentation. However, the respon- sibility for the final content of this report rests with the authors and should not be attributed to the panel, or to the other collaborators, or to the World Bank or its affiliates. - v - ABSTRACT Livestock diseases remain one of the principal causes of the ever widening gap between the supply and demand for meat and milk in Tropical Africa, now estimated to reach 2-5 million tons of meat and 10-15 million tons of milk by the year 2000. Technologies are available to control the main diseases, the key constraint lies in the deteriorating quality of the animal health delivery system. Following a number of consultations between the heads of African veterinary services and donor representatives in the early eighties a set of alternative policies to improve these delivery systems were identified and have-- in varying degrees--been introduced in most Sub-Saharan African countries. This paper reviews initial experiences with the introduction of these alternatives policies in the four main reform categories (i.e. cost recovery for services rendered, institutional changes, liberalization of drug supplies and privatization of clinical veterinary interventions). The paper concludes that, while all reforms have not been met with the same level of enthusiasm, the greatly changed attitude of Africa's heads of veterinary services, who now fully recognize the need to identify alternatives and be innovative in the search for more sustainable systems, is probably the most encouraging result of the ongoing policy dialogue, and augurs well for the future. Experiences with individual reforms include: (a) Cost recovery for curative services is probably the reform most widely introduced. Initial experience shows that such cost recovery improved the total availability of the service, even for the poorer groups. The results with cost recovery for cattle dips and artificial insemination is less encouraging. Cost recovery for preventive interventions (vaccinations) is less wide spread, especially for the highly contagious diseases like rinderpest, which have a strong public good element. Different administrative arrangements for the management of revenues from cost recovery are discussed; (b) The attempt at public sector reform have yet to make their impact. In the last decade, the total number of livestock staff in the 20 countries reviewed, jumped from 13,000 to 25,000, and many countries now approach staffing levels commonly found in highly productive temperate livestock farming. The impact of these staff increases on the operational efficiency of the service are reviewed on a regional and country basis. (c) The liberalization of drug supply seems to improve the availability of the drugs significantly. The transfer of the responsibiLity for the distribution to producers organization is recommended as one of the most attractive alternatives. A significant problem in many countries is posed by currency controls and high inflation, which depletes project revolving funds and severely restricts the availability of drugs. The issue of excess vaccine production capacity in Sub-Saharan Africa is being reviewed; and - vi - (d) Considerable favorable experience has been gained in the privatization of basic animal health care, using para-professionals. On the other hand, self-employed professionals common in other parts of the world are still rare in Sub-Saharan Africa. Linkage between the two groups are still weak. The reasons for this lack of success in the development of private professional veterinary care are analyzed and their project design implications highlighted. Thus while some encouraging results are obtained, especially in cost recovery, drug distribution and the use of para-professionals, any definite claim of success would be premature. However, it seems that if this course is continued and supplemented with other technologies in the area of improved feeding and management the sector should be able to alleviate the huge meat and milk deficit projected for SSA in the twenty-first century. - vii - ACRONYMS ADF African Development Fund AfDB African Development Bank AI Artificial Insemination Bank The World Bank CAR Central African Republic CCCE Caisse Centrale de Cooperation Economique CPBB Contagious Bovine Pleuro-Pneumonia EDF European Development Fund EEC European Economic Commission ERR Economic Rate of Return FAC Fonds d'Aide et de Cooperation (Aid and Cooperation Fund) FAO Food and Agriculture Organization of the United Nations FMD Food and Mouth Disease FNEC Federation Nationale d'Eleveurs Centrafricains GTZ Deutsche Gesellschaft fUr Technische Zusammenarbeit (Technical Cooperation Service) IBAR Inter African Bureau for Animal Resources IBRD International Bank for Reconstruction and Development IDA International Development Association IEMVT Institut d'Elevage et de Medecine Veterinaire des Pays Tropicaux IFAD International Fund for Agricultural Development IFPRI International Food Policy Research Institute LDF Livestock Development Fund NGOs Non-Governmental Organizations ODA Overseas Development Association ODM Overseas Development Ministry of the UK OAU Organization of African Unity PARC Pan African Rinderpest Campaign PPR Peste des Petits Ruminants SSA Sub-Saharan Africa TCR Tissue Culture Rinderpest Vaccine VLU Veterinary Livestock Unit - ix - ANIMAL HEALTH SERVICES IN SUB-SAHARAN AFRICA INITIAL EXPERIENCES WITH ALTERNATIVE APPROACHES TABLE OF CONTENTS Pag,e I. BACKGROUND ........... ...................................... 1 II. REFORM IN SSA LIVESTOCK SERVICES: AN OVERVIEW .... .......... 3 (i) Introduction .................................... 3 (ii) Donor Policies .............................. 4 III. INITIAL EXPERIENCES WITH ANIMAL HEALTH SERVICES REFORM: AN INTRODUCTION ............................................ 8 IV. COST RECOVERY OF SERVICES RENDERED ..... .................... 10 (i) Background .10 (ii) General Impact .10 (iii) Vaccinations .10 (iv) Cattle Dips .11 (v) Artificial Insemination .12 (vi) Administrative Aspects of Cost Recovery .13 V. PUBLIC SECTOR REFORMS IN ANIMAL HEALTH SERVICES . .15 (i) Background .15 (ii) Recent Trends in Staffing .15 (iii) Budget and Finances .16 VI. LIBERALIZATION OF DRUG AND VACCINE IMPORT AND DISTRIBUTION . 19 (i) Drug Imports .19 (ii) Vaccine Production .20 (iii) Drug Distribution .22 VII. PRIVATIZATION OF CLINICAL INTERVENTIONS ........ ............ 25 (i) Introduction ............ .......................... 25 (ii) Professional Veterinarians ...... .................. 25 (iii) Other Groups ............ .......................... 29 VIII. IMPACT AND LESSONS LEARNED ......... ........................ 34 List of Tables 1. Management and Funding of Common Livestock Services . 2. Share of Animal Health Spending in Bank-Funded Livestock Projects. 6 3. Government Professional and Support Staff Ratios (VLU per Staff) in the Different SSA Regions .16 x List of Boxes 1. Drug Supply through Producers' Organizations in the Central African Republic ........................................... 21 2. A Dairy Cooperative Society Organizes Its Own Animal Health Service . ................................................... 26 3. Village Poultry Production in Burkina Faso .... ............. 30 4. Service Cooperatives in Ethiopia Employ Animal Health Auxiliaries ........... ..................................... 32 References Cited .36 Annexes 1. An Estimate of Losses Caused by Diseases in SSA .... ........ 38 2. List of Important Projects Aimed at Private Veterinary Care . ...................................................... 40 3. A Summary of Key Animal Health Care Policies in SSA ........ 43 4. Illustrative Cash Flow Projections of Veterinary Practices ............. ..................................... 44 5. Statistical Data on Veterinary Health Care in a Number of SSA Countries (1985-1988) ............................... 45 6. Staffing and Budgets of Livestock Services in 1975 .... ..... 49 ANIMAL HEALTH SERVICES IN SUB-SAHARAN AFRICA INITIAL EXPERIENCES WITH ALTERNATIVE APPROACHES CHAPTER I BACKGROUND 1. With the population of Sub-Saharan Africa (SSA) growing at the rate of 3.1 percent per year and meat and milk lagging behind at 1.4 and 2.3 percent, by the year 2000 the countries of this region will be importing 2- 5 million tons of meat and 10-15 million tons of milk, at a cost of about US$15 billion in scarce foreign currency reserves (FAO, 1982; IFPRI, 1985). To boost production and ward off this huge deficit, the countries of SSA will have to push further their technical improvements in livestock feeding, management, and animal health services. The economic importance of such efforts is clear. 2. At present, livestock contributes approximately US$14 billion per year to agricultural output in SSA. About US$9 billion of this amount (or about 20 percent of the continent's agricultural GDP) is in the form of meat, milk and other livestock products, and US$5 billion is in the form of natural fertilizer and draft power. In several nations (Botswana, Chad, Mali, Mauritania, Somalia), livestock is a major force in the economy. Experience in other parts of the world has shown that a vigorous livestock sector is an essential ingredient for overall agricultural development. In many areas, livestock is one of the most important sources of employment and cash income, which can be used to purchase inputs for crop production, and provides an outlet for surplus grain. Thus, it is safe to assume that African agriculture needs a healthy livestock industry to achieve optimum growth. 3. Unfortunately, livestock diseases stand in the way of such growth at present. Livestock mortality losses in SSA are approaching US$2 billion per year, and the losses due to decreased growth, fertility, and work output as a result of disease are thought to be about as high (Annex 1). Furthermore, approximately 10 million square kilometers of land in SSA cannot be adequately used by livestock because of the prevalence of disease vectors such as the tsetse fly, which transmits trypanosomiasis (animal sleeping sickness). Also because of certain diseases, lucrative export markets like those of the European Community--which offer preferential prices for developing countries- -remain closed to many countries of SSA. 4. Until recently, animal disease control in SSA was almost exclusively the responsibility of the public sector, but in the past few decades, the quality of its veterinary services has deteriorated. Operational problems have contributed significantly to this decline. In many cases, veterinary staff expanded much faster than the means of support, while escalating operating costs made it necessary to cut back on field services, whereupon staff became office-bound and morale plummeted. At the same time, the traditional leaders who wielded strong powers earlier and imposed on their herders' groups the discipline of vaccination lost some of their authority under new post-independence administrative arrangements, and the level of vaccination coverage declined even further. - 2 - 5. In a related development, the demand for veterinary services has increased sharply. First, traditional herders have become more aware of the benefits of veterinary care, especially since the rinderpest outbreaks of the early 1980s, and are willing to pay for good veterinary services. Second, livestock ownership has become more diversified. Crop farmers, government officials, and traders all see livestock as one of the more profitable investment opportunities available in SSA. These new livestock owners recognize the importance of disease control in reducing the risk to their investment in livestock. However, they have no experience in livestock raising and therefore depend much more on outside assistance for veterinary care than traditional pastoralists do. Third, in the past decade an estimated 10-20 million cattle have moved into the humid disease-infested savannas from the semiarid rangelands, where the disease challenge is relatively low, and thus the demand for veterinary services in those areas has increased. Fourth, livestock prices have kept ahead of the cost of the main drugs used and therefore have made veterinary care more affordable. Demand can be expected to increase as the price of milk and meat continue to rise. This can stimulate further intensification of production, with more valuable cross-bred livestock pushing up the demand for veterinary services and justifying the higher expenditures involved even more. 6. Faced with dwindling resources and a growing demand, public authorities began looking for alternative ways of organizing and financing animal health care. New approaches were discussed in a number of workshops with the heads of SSA livestock services and representatives of donor agencies (Bujumbura and Blantyre 1984, Berlin 1985, Bangui, 1987). These new approaches (cost recovery and privatization of animal health services, liberalization of drug importation and distribution, retrenchment and freezing of staff recruitment) received support in a number of reports on animal health in SSA, which recommended cost recovery and privatization as attractive alternatives vis-a-vis the poorly functioning free public sector system (de Haan and Nissen, 1985; Anteneh, 1983, 1985; Leonard, 1984). Subsequently, several projects with alternative forms of animal health services were initiated in SSA. The preliminary results of these reforms are the subject of this report. 7. The principal concern in this discussion is animal health improvement, both because of its importance to livestock development and the experience that has accumulated in this field over the past five years. Other important trends in SSA livestock development (smallholder dairy development, pastoral associations and resource management, integrated crop/livestock extension services) are being reviewed in other World Bank studies. This report outlines the types of reforms introduced in animal health care over the past decade, summarizes past experiences in each category (cost recovery for services rendered, liberalization of drug supply, privatization of veterinary interventions), provides a preliminary assessment of the impact of the different measures, and indicates what lessons need to be taken into account in future policy adjustments and project investments. The discussion concentrates on Bank-supported initiatives, because of the leading role they have played in the reform effort and the accessibility of the data. This review has been prepared to assist decision makers from SSA governments and the donor community better plan the necessary structural changes and to encourage them to further improve the quality of the veterinary and livestock extension services provided for African livestock producers. CHAPTER II REFORMS IN SSA LIVESTOCK SERVICES: AN OVERVIEW (i) Introduction 8. Animal health care services can be classified as private or public goods, depending on who receives the benefits (Leonard, 1984). At one extreme are purely private goods, which (a) only benefit the animal owner receiving the service; (b) can be enjoyed exclusively by that owner (the exclusion principle); and (c) when provided, exclude somebody else from that service (the rival principle). For example, clinical treatment for a wound or worms would qualify as a pure private good because (i) the treatment benefits only the owner of that animal; (ii) nobody else benefits; and (iii) carrying out the treatment excludes other farmers from the services of the veterinarian at that time. In contrast, services like quarantine and meat inspection are pure public goods as they do not directly benefit the owner of the animal and do not exclude other producers from that service. 9. As a general rule, the higher the private benefit, the more justified it is to have the beneficiary pay for the service directly and to transfer the service to the private sector. Public sector management of private good services is justified if economies of scale are an important consideration or if sophisticated expertise or equipment is needed. In such cases, the services should be financed through direct payment from the beneficiaries and not from general revenue. Pure public good services should be managed by the public sector (although subcontracting to private operators is always possible) and financed by the general public revenue. Activities such as food inspection approximate a purely public service and should therefore be financed and managed by public resources. The principal animal health tasks in SSA and their degree of public/private interest are listed in Table 1. 10. The reforms most widely adopted in animal health care in SSA since the early 1980s fall into the following categories: (a) increase in the degree of cost recovery for veterinary drugs, vaccinations, other inputs, and veterinary interventions; (b) reorganization of public services to correct the imbalance between staff and operating means and to strengthen these services in animal health control, policy planning, and livestock research and extension; (c) liberalization of veterinary drug import and distribution; and (d) transfer of responsibility for animal health care to private veterinarians, middle-level technicians, specially trained herder representatives (auxiliaries), and directly to herders. 11. The basic objective behind all four reforms was -- and still is - - to create, through cost recovery and liberalization, the appropriate - 4 - Table 1. Management and Funding of Common Livestock Services Management Payment Private Public Beneficiaries Treasury Drug distribution ++ - ++ - Clinical interventions ++ - ++ - AI - semen production + ++ ++ _ AI - insemination ++ - ++ - Dips ++ + ++ - Vaccinations Compulsory - ++ + ++ Voluntary ++ + ++ FMD a/- ++ + ++ Tsetse control - ++ ++ + Diagnostic support + ++ + + Veterinary surveillance + ++ ++ Veterinary research + ++ + ++ Quarantine - ++ + ++ Drug quality control - ++ ++ Food hygiene/inspection - ++ ++ Policy/planning - ++ ++ Extension + ++ + ++ ++ Obligatory or highly justified + Possible - Not justified or undesirable because of potential conflict of interest situations. a/ Foot and mouth disease vaccination in meat-exporting countries; in other countries, it is considered mostly private. environment for the private sector to take over some of the veterinary tasks formerly carried out as public services. The concept was that once the government had delegated the "privatizable" veterinary tasks to the private sector, it could concentrate on those tasks that needed to remain in the public domain. To ensure that public agencies would carry out these tasks effectively, the reform package was to include institutional adjustments that would provide for adequate and continuous funding for their operations. (ii) Donor Policies 12. These reforms have been strongly supported by the international donor community (see Annex 2). Since 1985, the total foreign commitment to these projects has amounted to approximately US$600 million. This financing has been provided by the European donors: the European Development Fund (EDF), Technical Cooperation Service of the Federal Republic of Germany (GTZ), Aid and Cooperation Fund of France (FAC), Overseas Development Association of the United Kingdom (ODA), the World Bank and other international lending agencies, such as the International Fund for Agricultural Development (IFAD) and the African Development Bank (ADB). - 5 - 13. Most EDF-financed projects are carried out in the framework of the Pan African Rinderpest Campaign (PARC), a US$50 million Africa-wide campaign to provide support for the control of rinderpest. To be eligible for this support, the SSA government concerned is expected to implement a number of policy reforms to make the vaccination campaigns self-sustaining and alleviate some of the more serious distortions in the sector. To ensure that these campaigns are sustainable, the government is to establish a special fund (Livestock Development Fund) to be built up by revenues transferred directly from (a) import duties on animal products; (b) surcharges on veterinary drugs; (c) vaccination fees on other vaccinations; and/or (d) the payment of a lump sum by the producers, according to the size of the herd. The general policy dialogue is concerned with the size of the sector's budget, the privatization of services and distribution of drugs, the creation of producers' organizations, and the introduction of measures to control desertification. By the end of 1989, five countries had carried out PARC emergency campaigns and ten countries had positively responded to the policy dialogue and were receiving PARC aid to carry out rinderpest vaccinations and to implement an animal health reform program. Financing agreements for another nine countries had been prepared and were awaiting EDF approval. 14. The overall objective of most GTZ-financed projects is to develop a basic animal health care system organized around veterinary auxiliaries, who are trained and equipped to provide simple animal health care. These projects often cover only a part of the country. GTZ finances the necessary equipment, training and revolving funds for the auxiliaries. Typical examples of this type of intervention can be found in Chad and Somalia. In addition, supplementary support is often provided for veterinary diagnostic laboratories and the national veterinary pharmaceutical company may receive free donations of drugs. 15. FAC's assistance is mainly for strengthening livestock research, extension, and planning services at the national level in francophone SSA countries. FAC strongly supports the development of private veterinary services. It (a) provides sector ministries with direct technical assistance in policy and planning; (b) carries out free-standing projects in animal health and production (e.g., village poultry health programs in Burkina Faso; dairy development in Madagascar, Mali, and Senegal; extension in Cote d'Ivoire) and research frequently geared toward small ruminants (Chad, Cote d'Ivoire, Senegal, and Central African Republic (CAR)); and (c) participates with other donors, especially the World Bank, in national livestock projects through the provision of technical assistance. In this last category, FAC provides essential support for Bank-funded livestock projects in the Cameroon, CAR, Chad, Guinea, Niger, and Zaire. 16. The World Bank-funded livestock projects generally combine policy reforms and investments. The policy adjustments in the animal health domain seek to create the environment (through the liberalization of input supply and cost recovery for services provided by the government) that will enable the private sector to take over the majority of the "privatizable" services hitherto provided by the public sector. The purpose of the investment component is to strengthen the remaining public services--in policy planning, research, training, and extension--by providing funds for institution building and the rehabilitation of equipment and other infrastructure. Other types - 6 - of adjustments in Bank-funded livestock operations are reforms in pricing, marketing, and land tenure and resource management. 17. In the past five years, Bank-funded livestock projects have devoted increasing attention to improving animal health. Up to 1983, World Bank support for livestock-only projects in SSA amounted to about US$350 million, of which US$60 million (17 percent) was earmarked for improving animal health. Since then the Bank has approved 11 livestock-only projects (Annex 3) with a total outlay of US$465 million, of which US$185 million (40 percent) was for the improvement of animal health. The increase in the proportion spent on animal health has been greatest in Eastern and Southern Africa, as can be seen in Table 2. Table 2: Share of Animal Health Spending in Bank-Funded Livestock Projects (US$ Million) Region Till 1983 After 1983 Amount in Z in Animal Amount in Z in Livestock Health Livestock Animal Health West Africa 127 25 298 32 Eastern and Southern Africa 220 13 167 55 In addition, the Bank's current (1989) SSA agricultural portfolio contains 43 projects in which livestock is a component of a wider agricultural project.l/ The total cost of this component was estimated at US$176 million, of which US$110 million was earmarked for animal health improvement, bringing the total expenditure for animal health improvement in ongoing Bank-funded projects to about US$300 million 2/. 18. The Bank's future lending programs will continue to emphasize strengthening animal health institutions in both the public and private sector by combining policy reforms with investments. Of the 11 livestock-only projects programmed 3/ for 1990-1993 in SSA, 6 would have a national scope and would emphasize institution building in animal health and livestock extension.4/ In addition, livestock services could get an additional boost 1/ The situation as of end 1989. 2/ The performance of these projects is given in para. 75. 3/ Since mid-May 1989, the number of livestock projects in the pipeline has been reduced. 4/ Sudan (FY90), Madagascar (FY91), Nigeria, Ghana and Somalia (FY92), and Kenya (FY94) - 7 - from the renewed emphasis on agricultural research and extension in the lWorld Bank's Agricultural Services Initiative, which was recently expanded beyond its initial goal of improving crop services to include livestock research and extension activities. - 8 - CHAPTER III INITIAL EXPERIENCE 'WITH ANIMAL HEALTH SERVICES REFORMS: AN INTRODUCTION 19. One of the most encouraging results of the animal health policy reforms of the past decade is the greatly changed attitude of the heads of veterinary services toward cost recovery and the privatization of animal health services. Whereas the first proposals were met with considerable skepticism, now many decision makers are convinced that alternative delivery systems must be identified if veterinary services are to improve. This is a result of a growing realization of the need for adjustment and better appreciation of opportunities for private animal health care. Although the early workshops on this subject (see, e.g., Bujumbura, 1984) recognized that privatization would bring some improvements, they still stressed government control. It was not until later high-level meetings (e.g., OAU/IBAR meeting of SSA Livestock Ministers in Addis Ababa, 1987) that policy makers recommended that the government withdraw from 'privatizable" veterinary tasks. 20. However, not all policy adjustments have been met with the same enthusiasm, nor has the reaction been the same at all staff levels. For example, the policy of cost recovery for drugs and noncompulsory vaccinations was widely accepted, but not cost recovery for compulsory vaccination. Whereas in 1980 about 50 percent of a group of 18 West and Central African countries were providing all vaccinations and treatments free (IEMVT), by 1988 they had all introduced some degree of cost recovery (see Annex 3). Similarly, Sudan and Somalia have changed their policy of free services, and the principle of cost recovery is now also fully accepted in all Eastern and Southern African countries. Chabeuf (1990) reported that of the 31 SSA countries he surveyed in 1990, 25 had a policy of full payment for veterinary drugs, 23 for non- compulsory vaccinations and 15 for clinical interventions. Similarly, drug imports and distribution have been liberalized in many areas. Of the 29 countries surveyed by Chabeuf (1990), only 11 maintained a government monopoly on drug imports, and only 7 maintained a government monopoly for the distribution. (see also Annex 3). 21. In the case of compulsory vaccinations, however, few countries require full cost recovery, although progress has been made over the past decade and eight SSA countries now require beneficiaries to make some direct payment for these vaccinations. But most countries provide the compulsory vaccination free of charge. One of the more sensitive issues in the initial phases of the adjustments was whether to consolidate or even reduce government staff, but many countries have begun to recognize the need for this measure and it has been included in the adjustment operations in eight countries. As for the response to privatization at different staff levels, a subjective assessment seems to indicate that acceptance has been greatest among senior policy makers and at the producer's level. Many middle-level technicians have also demonstrated a keen interest in the possibilities of privatization. The response was more uneven among professional and lower-level support staff, who seem to perceive the package of policy adjustments as a threat to their individual interests. The remainder of the report provides information on individual policy reforms. - 10 - CHAPTER IV COST RECOVERY FOR SERVICES RENDERED (i) Background 22. To protect emerging private initiatives from unfair competition, it is essential for governments to introduce a system of full cost recovery for its services. This is an important step in any effort to privatize animal health care because it will enable the government to reduce its financial burden, make the service sustainable and eventually independent of outside (international) financing, and ensure that the service is efficiently used by the beneficiary and not wasted. The justification for cost recovery becomes stronger as the private benefit of the services increases. 23. Indeed, partial or full cost recovery is probably the reform most widely introduced in SSA veterinary services over the past decade and now figures prominently in the animal health programs of almost all SSA countries. This comes from a growing awareness that the producer is quite willing to pay for good services and that additional income must be found for these services since national budgets throughout SSA are under the pressure of financial austerity. A willingness to pay was apparent in all the Bank-funded projects surveyed for this report. Moreover, after a payment system was introduced, the demand for veterinary services did not decline in these projects. (ii) General Impact 24. On the contrary, the total availability of the services improved markedly and poorer people gained greater access to the services when cost recovery was introduced. A case in point is Kenya, which had free veterinary care in the 1970s and then turned to a more commercially oriented system in the 1980s (Leonard, 1984). When staff began charging for their curative visits, the work output increased significantly, inequality in distribution was reduced by at least one-half, and the more fully commercialized veterinary staff graduated their charges according to the recipient's ability to pay. For example, the wealthier farmers were charged an average of about 40 percent more than the poorer farmers. The positive effect of cost recovery is also evident in the CAR. Household data collected in the framework of CAR's Bank/IFAD/ADF funded First Livestock Project show that once full pricing was introduced, drugs became more available, especially among the poor, who purchased, on average, 50 percent more drugs per animal than the wealthier livestock producers. (iii) Vaccinations 25. The decision whether to charge for vaccinations generally depends on the nature of the disease. Thus the beneficiary is generally required to make some direct contribution in the case of voluntary vaccinations that protect animals against less contagious diseases of little threat to the national herd should an outbreak occur (the theiluric diseases, anthrax, blackleg and pasteurellosis, FMD in non-meat exporting countries, and all - 11 - poultry vaccinations). This contribution is generally on the order of US$0.05- US$0.25 per vaccination, which covers the vaccine and some of the other variable costs (fuel and per diem of vaccinators; see para. 50). But to cover all costs, including staff salaries, the charge per vaccination would have to be about US$0.50. Several Bank-funded projects (e.g., in Cameroon, Chad, and Kenya) have included specific cost-monitoring exercises and annual adjustments of the fee in the respective legal project documents, but no information is yet available on the results or the level of implementation of such cost adjustment programs. 26. Most compulsory vaccinations for rinderpest and CBPP (and FMD in the meat-exporting countries of SSA) are financed fully out of general taxes and provided free 5/. However, the private benefits of these vaccinations seem significant enough to ask for a direct contribution from producers. As a general guideline, the World Bank recommends a 50-50 sharing between beneficiary and the state, which is the agreed upon arrangement in most Bank- funded projects. Although incomplete, initial data on 10 countries seem to corroborate the effectiveness of this approach, as no depressing effect could be found from cost recovery: rinderpest vaccination coverage in the five 6/ countries that had introduced a vaccination fee was 58 percent, and in those countries 7/ that had maintained a free vaccination policy it was 60 percent, which is not much higher. These findings are not too surprising as sociological research in several countries has shown that producers are quite willing to pay for good services and that even where the vaccinations are officially free the producer is (illicitly) made to pay. Although the Bank calls for some degree of cost recovery for compulsory vaccinations, it is also generally acknowledged that other reforms (cost recovery for voluntary vaccinations and all clinical interventions) are of higher priority and should be pursued first. (iv) Cattle Dips 27. Ticks and tick-borne diseases (especially East Coast fever in East Africa) are treated by cattle dips, which produce predominantly private benefits. If participation is low, however, the population of ticks resistant to the acaricide may increase and pose a threat to all farmers, including those participating in the program. There is thus a public element in a dipping program. While dipping is economic and essential in intensive production systems using exotic crosses, its economic justification in extensive production systems is becoming doubtful. Study results in the First Central African Livestock Project indicated that an average investment of US$15 per 5/ This policy, shared by most donors (including PARC) is justified on the grounds that adequate control cannot be maintained unless a high percentage of the cattle population is immunized, which can only be done if the vaccination is provided free of charge. During the 1983- 1985 period, this policy was the object of considerable debate between the Bank, which favored cost recovery and other donors, notably the PARC, which advocated free vaccinations. 6/ Burkina, Cameroon, CAR, Mali, and Mauritania. 71 Benin, Chad, Cote d'Ivoire, Ghana, and Senegal. - 12 - head (which equals the annual revenue per animal) and a recurrent annual charge of US$2 per head would be necessary to recover all costs, including depreciation. But this was more than the herders were willing to pay, and the program was discontinued. In the Bank-financed Ituri Project in Zaire, newly established dips had an ex-post economic rate of return (ERR) of 0 to 15 percent because of the high investment costs, and the treatment produced little change in productivity. Studies undertaken during the preparation of the Kenya Animal Health Project (1986) indicate that an increase of Ksh 0.30 to Ksh 1.50 per animal per dipping would be necessary to make the dips self- financing, and the mortality figures would have to drop from 10 to 8 percent per year to justify this fee increase. This reduction is probably feasible in the heavily infested East Coast areas, but not elsewhere. 28. Cost recovery for dipping services has been disappointing in terms of regularity and numbers dipped, but these results may be due in part to an increase in hand spraying. In Kenya, a dipping fee created a disincentive for regular and widespread dipping, which was not overcome by making the dipping compulsory (Sandford, 1983). Meanwhile, Zimbabwe authorities argue that their strictly enforced compulsory dipping program is a success because it is free. Under the Uasin Gishu Project in Kenya (financed by IFAD and the Danish government), however, farmers are clearly willing to pay for dipping services--especially for crossbred animals--provided these services are guaranteed to be effective. A fixed fee per head to cover all dippings over a longer period seems to produce better revenues and herder participation than a system of payment per dipping. This was the case in the Central Province in Kenya, where revenues doubled after a lump sum for four months per animal was introduced; also, the leakage of funds stopped once dip attendants were no longer required to handle small amounts of money continuously. Therefore, because of these disappointments in profitability and payments, the best strategy seems to be to use simpler means (knapsack sprayers), until more modern control techniques are available. Several promising techniques are being developed such as acaricides with a long residual effect that can be applied directly on the skin or vaccines against the tick-borne diseases. The World Bank has stopped financing the construction of new dips, although several Bank-financed projects are still involved in rehabilitating existing facilities, and the emphasis there is on cost recovery and the privatization of the management (para. 68). (v) Artificial Insemination 29. Although the public good element of artificial insemination (AI) is quite small, cost recovery for this service has not yet reached a reasonable level. This is partly because AI has only recently been introduced in SSA. During the first years, the cost per farmer of a daily AI run, with only a handful of farmers participating, is excessive, and some initial subsidy is unavoidable while demand builds up. However, it has proved difficult to phase out the subsidy after the initial phase. According to calculations in Kenya (1986)--the only SSA country in which the World Bank finances AI--the real cost per insemination varies from Ksh 20 to Ksh 250, depending on the livestock density of the region, but the government charges only Ksh 4 per insemination. Farmers have obviously been willing to pay more than Ksh 4 as private veterinarians were recently charging Ksh 30 per insemination. But in many regions the real cost price through government services was still substantially higher than the farmer was willing to pay. Consequently, a profitable, self- - 13 - standing AI service is not likely to materialize in the medium term, except in areas of high density and intensive production, where transport costs are shared with fixed clinical runs and on some private "elite" farms that are breeding bulls to be sold for natural mating. (vi) Administrative Aspects of Cost Recovery 30. A condition recommended by many external donors is that the government transfer the revenues generated by the cost recovery measures to a special account or revolving fund, frequently called a Livestock Development Fund (LDF), which is to be managed by the livestock service. In this way, livestock services can become independent from the sometimes erratic central budgeting process and cumbersome system of financial control. Thus the flow of funds becomes more stable and this ensures that veterinary services will be sustained over the long term. External donors often invoke the sustain- ability argument when trying to persuade governments to establish such a fund, but finance ministry officials usually respond that it is far more efficient to transfer all revenues to the central treasury, where they can be allocated across all sectors. Although the Bank generally supports the centralized allocation of resources, decentralized LDFs have been included in a number of recently approved Bank-funded projects on the grounds that (a) the revenues for these funds are fees for services rendered and not taxes, which would be the finance ministry's prerogative; (b) there is a direct relationship between expense incurred and revenue collected; and (c) it motivates staff to collect the fee and users to pay the fee, because there is a direct return in the form of more means to operate and better services rendered. 31. The same efficiency arguments could lead to a further decentra- lization of the administration and use of funds generated by cost recovery, for example, to the provincial level. The World Bank's Human Health Policy Paper argues for such a further decentralization as it would (a) help improve the utilization of resources since local staff generally have a better idea of the needs of their unit than some remote planner at headquarters; (b) encourage wider community participation in development activities; and (c) help bring down administrative costs, inasmuch as any shift to a higher level of revenue collection increases the administrative load, and the savings could be used for other productive purposes. 8/ 32. At the same time, the efficiency gains expected from decentralization need to be balanced against the possibility of leakage. Experience has shown that recovery tends to be low and that revolving funds become rapidly depleted under a decentralized system of administration (i.e., at the level of the vaccination yard, dip, or veterinary post). 9/ This is clearly shown in many externally financed projects in the dismal performance of veterinary pharmacies 8/ 'Financing Health Services in Developing Countries; An Agenda for Reform." World Bank Policy Study. Washington, D.C., 1987. 9/ An exception is the cost recovery for rinderpest and CBPP vaccina- tions in the Central African Republic, where all revenues are col- lected by herder representatives under a double accounting system (herder representative/livestock service staff) and 85-95 percent recovery was achieved. - 14 - operated by livestock posts. Therefore it seems prudent to keep administrative functions at an intermediate (i.e., provincial) level, where adequate control can be maintained and ample motivation provided for local participation. As more emphasis is placed on cost recovery, project designers may find it necessary to give increasing attention to the administrative management and control of cost recovery revenues. 33. LDFs now exist in six countries of SSA. 10/ Some have chosen to supplement the income of their LDF with revenue from specially earmarked taxes, such as a market tax (e.g., US$3 per head sold in the CAR); a 7 percent surcharge on drugs and feed, as in Mauritania; or the revenue generated by a tax on imported meat, as in Cameroon (which puts 50 percent of the 65 percent import levy in the LDF and the other 50 percent in the Treasury) and Togo. In this case, there is no longer a direct link between services rendered and revenue generated, and the argument for a decentralized financial management becomes less relevant. Most of the LDFs operate at the national level, except in Cameroon, which has created three provincial LDFs. Thus far, experience with these LDFs has been positive: revenues are in the range of US$100,000- 500,000 per year, and some LDFs have become important operating tools of livestock services in the countries concerned. The accounts have by and large been certified by external audits. However, LDFs have not yet had an opportunity to operate after external financing (and external protection) has ended. Once that happens, the political pressure to reintegrate the revenues in the eternally cash-strapped Treasury will be stronger, but the need for these funds will also be much greater. 10/ Cameroon, Chad, Central African Republic, Guinea, Mauritania, and Togo. - 15 - CHAPTER V PUBLIC SECTOR REFORMS IN ANIMAL HEALTH CARE SERVICES (i) Background 34. One of the main reasons for the declining performance of veterinary services in SSA during the 1960s and 1970s was the rapid increase in personnel costs at the expense of non-salary recurrent funding (de Haan and Nissen, 1985; Anteneh, 1983, 1985). From 1960 to 1976, veterinary service personnel costs in West Africa increased an average of 7 percent per year, whereas non-staff recurrent expenditure increased by only 3 percent per year. As a result, the salary/non-salary ratio, one of the predominant indicators of the efficiency of a livestock service, dropped from 64/36 in 1960 to 75/25 in 1976 in West Africa, and, for example, from an excellent 40/60 in 1974 to a poor 70/30 in 1981 in Kenya. In contrast, in Southern Africa the ratio remained close to the 50/50 optimum over the same period. 35. Since the early eighties, several countries in SSA have began to introduce institutional reforms to address this problem, by (i) stabilizing or reducing staff in government service; (ii) establishing LDFs (para. 30- 33); and (iii) increasing direct government contributions to complement non- salary operating funds. The effect of these programs has been assessed by comparing staffing and budget data from 20 countries 111 (of which 8 had started to implement institutional reform programs during 1985-1989; see Annex 5) 12/ with data on the same countries in earlier studies (Annex 6). (ii) Recent Trends in Staffing 36. The results of this study indicate that, while staff numbers in some countries have levelled off, they have in aggregate continued to grow over the past decade. The total number of livestock service staff in the 20 countries surveyed jumped from just over 13,000 staff in the mid-1970s to more than 25,000 in the second half of the 1980s. As a result, the average number of Veterinary Livestock Units (VLUs) 13/ per veterinarian has declined from almost 90,000 in the mid-1970s to just over 50,000 today, and the number of 11/ These 20 countries were selected mainly because of the availability of recent budget and staffing data; however, they cover the different regions, include countries with high and low livestock/human population ratios, anglophone and francophone countries, and poor and wealthier nations. Together they represent about 60 percent of SSA's total livestock population. 12/ Burkina, Cameroon, CAR, Chad, Ghana, Guinea, Mali, and Senegal in West Africa, and Kenya and Somalia in East Africa. 13/ The Veterinary Livestock Unit (VLU) is an animal unit, introduced to aggregate the work requirements for animal health care of different livestock species. One VLU corresponds to 1 cow or 1 camel or 2 horses or 2 pigs or 2 donkeys or 10 small ruminants or 100 poultry. - 16 - VLUs per middle- and lower-level veterinary assistant has dropped from 10,000 in the mid-1970s to about 7,000 now. Overall growth has been the same in the different regions, although in West Africa growth has been particularly strong in the professional category, whereas in Eastern and Southern Africa staff growth has occurred mainly in the support category (see Table 3). Table 3. Government Professional and Support Staff Ratios (VLU per staff) in the Different SSA Regions Thousands of VLUs per Person REGION Professional Staff Support Staff mid-1970s mid-1980s mid-1970s mid-1980s Western Africa 95 30 7 4 Eastern & Southern Africa 120 80 14 6 37. These staff levels exceed the 200,000 VLUs per professional staff and 12,000 per support staff recommended (SEDES/GTZ 1980; Sandford, 1983) for the preventive tasks to be carried out by the public sector in extensive production systems. Similarly, the overall professional/support staff ratio, although it has remained at about 1:9 for the past 10 years, exceeds the generally accepted standards of about 1:20 for very extensive systems and 1:10 for more intensive systems. The higher share of professional veterinarians and zoo-technicians is especially pronounced in some of the West African countries and exceeds normal efficiency levels. 38. Nonetheless, substantial differences persist between countries. At the one extreme are some of the East African countries (Ethiopia and Somalia), which have more than 300,000 VLUs per professional staff and thus do not even meet the minimum requirements for extensive systems; at the other extreme are some West African countries (C6te d'Ivoire, Ghana, and Senegal) with very dense coverage of 20,000 VLUs, or less, per professional staff. The number of VLUs per support staff varies between countries from a high of 13,000 to a low of 900. 39. No correlation was found between the number of VLUs per staff member and the importance of livestock to the economy; countries with a high share of livestock in the agricultural GDP had the same coverage as countries with a less important livestock sector. The status of the economy seems to have had some effect on staff resources allocated to the sector; countries with a per capita GDP of more than US$800 (IBRD countries) had denser coverage in professional and support staff than the countries below the US$800 per capita income level (IDA countries). (iii) Budget and Finances 40. Budgetary trends of the veterinary services look favorable on an aggregate basis. From 1975 to 1985-88, the recurrent budget of the 16 - 17 - livestock services for which data were available (Annexes 5 and 6) increased from US$47 million to US$98 million (in current prices) which represents growth of 110 percent, while staff members grew by 100 percent. The growth was relatively strong in West Africa, where the total budget increased from US$15 million in 1975 to US$47 million in the second half of the 1980s, but was less pronounced in East and Southern Africa, where the budget increased from US$32 million to US$52 million. The lower growth in East Africa is due in large part to exchange rate adjustments as budget figures were calculated in U.S. dollars using in the 1970s the overvalued official exchange rates, viz a viz more realistic rates in the 1980s. The budgets of the West African veterinary services of the--exclusively CFAF--countries in the review were less affected by exchange rate adjustments. In West Africa, total salary expenditure increased from US$11 million to US$29 million, or about 10 percent per year, whereas non-salary operating costs increased from US$4 million to US$15 million, or about 15 percent per year. This trend shows the reverse of the growth pattern in 1961-75, the period in which salary costs in West Africa increased by 7 percent and non-salary operating costs by only 3 percent. Thus, the serious deterioration in the salary/non-salary ratio of the 1970s appears to have been checked. In East and Southern Africa the salary and non-salary budgets (never a major issue) continued to grow about at a rate of 6 and 7 percent, respectively. However, the salary growth rate of 6-10 percent per year is not enough to keep up with inflation and staff growth together, and points to a salary reduction in real terms. 41. In any case, these aggregates must be treated with caution as the rather high figures are almost exclusively from countries with the strongest economies (per capita GDP of more than US$800 14/), whose livestock service budgets increased by an average of 16 percent from 1975 to 1985. The livestock service budgets in the poorer countries increased by only 1 percent. Although part of this stagnation might again be due to exchange rate movements, it does point to the serious financial position of many services in the poorer SSA countries. 42. Salary/Non-salary Ratio. As a result of these trends, the salary/non-salary budget ratio, a key indicator of the efficiency of the livestock services, remained about the same, although again it varied greatly from one country to another. (a) In West Africa the regional average improved from 75:25 in the 1970s to 65:35 in the 1980s, but this improvement is largely due to the change in Cote d'Ivoire, which moved from a ratio of 70:30 in 1975 to 35:65 ratio in 1986. If Cote d'Ivoire is excluded from this calculation, the average ratio in the nine remaining countries remains at a poor 75:25. Three countries improved, but 4 of the 10 countries under consideration remain in the very poor 85:15 range, where it is impossible to provide effective service. (b) In Eastern and Southern Africa the average ratio declined from a very good 50:50 in the mid-1970s to a still acceptable 55:45 in the mid-1980s. However, this average is mainly based on the good budget allocations of Zimbabwe and Kenya and does not include some of the 14/ Botswana, Cameroon, COte d'Ivoire, and Zimbabwe. - 18 - countries with less favorable budget allocations, like Sudan, Somalia, and Madagascar. Furthermore, Zimbabwe recently expanded its activities in the communal areas, with the result that the ratio in this country has deteriorated. This would also affect the overall average. 43. In summary, the public sector livestock institutions in a sample of 20 SSA countries doubled their staff over the past decade. In most countries, staff levels are adequate or more than adequate to carry out all public sector tasks. A number of countries have increased their total budget correspondingly, and on a regional aggregate basis, the deterioration in non- salary operating funding seems to have been checked. In several countries, however, the staff increase has meant an erosion of the purchasing power of the individual salaries of these staff, or a decline in the non-salary operat- ing funds for these staff. Thus, many countries continue to have poorly motivated staff and inadequate resources to satisfy sharply increased demands, and there is still a need for reforms and for the government to disengage from some of its previous tasks. But countries vary greatly in this regard, and therefore it is important to prepare institutional and public expenditure analyses and reorganization plans on an individual country basis, as already recommended elsewhere (de Haan and Nissen, 1985). - 19 - CHAPTER VI THE LIBERALIZATION OF DRUG AND VACCINE IMPORT AND DISTRIBUTION (i) Drug Imports 44. Until recently, drug imports in most francophone SSA countries were handled by a parastatal monopoly and in most anglophone countries by the private sector. The majority of the parastatal drug companies were poorly managed and developed serious financial problems because of their high overhead and the below-cost pricing of the drugs, frequently forced upon them by central ministries under the mistaken impression that the producer would not pay the full price. As a result of these restrictive policies, only a part of the demand was satisfied through official channels and an active parallel (black) market emerged outside the control of the government. 45. Drug availability seems to have improved where drug imports and distribution have been privatized. A comparison of drug consumption per VLU under different distribution regimes, although confounded by climate and price differences and illegal trade between countries, shows that between 1985 and 1988, for example, the average consumption of drugs in countries with a government monopoly 15/ was US$0.14 per VLU per year, whereas the consumption in countries that had adopted a freer trade policy 16/ was US$0.46 per VLU per year. 46. However, external donors continue to support the establishment and rehabilitation of parastatal companies overseeing drug imports and distribu- tion, as in the case of Bank-funded projects in Cameroon, Chad, Guinea, and Mauritania. The rationale is that (a) the private sector in some of these countries is not interested in servicing the remote areas, (b) parastatals are better able to handle the donations in veterinary drugs, and (c) these parastatals need to generate funds for the government livestock service. The terms of agreement in all projects stipulate that the parastatal is to be privatized once the company is reorganized. 47. Some may therefore question whether it is appropriate for donors or the government to continue supporting such parastatals. Experience so far indicates that these organizations are difficult to convert to private operations. Where specific deadlines have been agreed upon (as in the Guinea and Cameroon livestock projects), they have had to be postponed repeatedly. Experience also seems to indicate that drug distribution is not adversely affected when it is taken out of the public sector altogether. In the few 15/ On the basis of estimates available from Benin, Burkina, Chad, Mauritania, Niger, and Rwanda for any year between 1985 and 1988. 16/ On the basis of estimates available from Cameroon, CAR, Cote d'- Ivoire, Ghana, Mali, Senegal, and Kenya for any year between 1985 and 1988. Madagascar, which recently moved from a monopoly to a free import policy was not included because of its transitory nature in this respect. - 20 - countries with only private importers (Ghana, Kenya, Zimbabwe), distribution to the remoter areas is as good or better than it is under any parastatal company. Furthermore, the private sector tends to show less interest inparticipating when a public company is involved. In fact, consumption has been lower in countries that have maintained a parastatal company besides the private importers in comparison with those that relied entirely on the private sector for their imports. 48. Even on the semiarid pastoral rangelands where the density of livestock and humans is low, it is difficult to justify keeping the government in charge of drug distribution. The CAR has found that distributing through local herders' associations under the umbrella of a national federation (Box 1) provides a far superior alternative, and perhaps this ought to be considered as the future model in these countries. Even in those cases where the public sector needs to be involved in drug distribution, it should restrict its activities to supporting the private sector by distributing drugs in remote areas, and should not move into import or wholesale trade. Other arrangements could be envisioned under which the government subcontracted drug distribution in remote areas to private distributors, compensating them with a special subsidy for the extra cost involved. Such arrangements have not yet been tried in Bank-funded projects, but might be preferable to the costly maintenance of parastatals. 49. Foreign Exchange Controls and High Inflation. Although many African countries have been moving toward freer foreign exchange markets, currency restrictions are still preventing drugs from becoming widely available. A common approach to this problem is to have outside donors refinance the revolving funds, but this is only a temporary solution and drug supply comes to a halt the moment the foreign exchange source dries up. When foreign exchange controls are lifted, there is an initial period of high inflation, which makes it difficult to refinance revolving funds where the average turnaround time for drugs is longer than six months. During this period, the value of the local currency can drop by more than half. In the Bank/GTZ- funded Animal Health Project in Somalia (GTZ, 1987), for example, the DM value of the fund was reduced to 57 percent of its original value after the first year of operation and to only 35 percent after 28 months of operation. The problem is especially acute in public sector agencies or projects, where price changes are generally slow and well behind the pace of inflation. In such circumstances, countries need a very dynamic price mechanism with a high margin to achieve a continuous alignment between sale price of drugs and the exchange rate. (ii) Vaccine Production 50. Another trend that needs to be watched closely is the growing public sector involvement in vaccine production. The number of vaccine production laboratories in SSA has virtually doubled in the past 10 years and all major livestock-producing countries (and also some countries with smaller livestock populations) now have their own vaccine production laboratories. This trend accelerated in the mid-1980s following the 1982 rinderpest outbreak and the resulting scramble for scarce rinderpest vaccine. In the wake of this strong expansion, however, there is a large excess capacity in the region. - 21 - Box 1. Drug Supply through Producers' Organizations in the Contral African Republic Under Emperor Boukassaoo reign In tho mid-1970c, the Control African horders were faced with an almost complete collapse of the government livestock service, and thus formed a private and autonomous National Association of Control African herders (ANEC) to provide drugs and animal hoalth care, crucial In this disease-prone tsete zono. After an lnitll period under poor loadership, a now Secretary-Ceneral was appointed In 1982. With the support of tho Bank/IFAD/ADF-funded First Livestock Project, ANEC developed Into an efficient Institution, lmporting and distributing key livostock lnputs and ropresenting the horders at the national levOl. The necessity of access to drugs for the survival of cattle and the ethnic homogeneity of the Mbororo herders, who sse-ntially migrated into tho CAR in the last half century and neoded a cohesive and united front to survive 1n their now hostilo environment, contributed to the success of their organization. The First Livestock Projects support for ANEC cme about after tho project failed to establish a drug distribution system through the government's livestock service, as originally envisaged. In effect, the support to ANEC meant a complete roversal In policy as tho Credit Agreemnt of the First Livestock Projoct explicitly stipulated that ANEC should withdraw from all animal health activities. To broaden its gross roots participation, the national activities are now being tied to local associations and unions of associations under the national umbrolla. Its name was changed in 1988 from ANEC to FNEC (National Federation of Contral African Livestock Owners). Donor support to FNEC and its grass roots associations continues under the ongoing National Livestock Project. Success in the animal health field has been lmpressivo. Sales of drugs and other inputs have increased dramatically, as shown in Figure 1. SALES OF VETERINARY DRUGS AND OTHER INPUTS 1.7 - 1.8 1.4- 1 .3 1.2 1.1 z 1.0 0.9 0.8 A) 0.7- 0.8 0.5 0.4.- 0.3 0.2 H__ K 0.0 _ _ _ _ _ _ 1981 1982 1982 1983 1984 1985 1988 1987 1988 J an -Oc t, \lOst-rtec ) LrESTOCK SERVICE C= ANEC/FNEC This Input distribution component is now fully self-sustainablo. In 1988, tho organization made a profit of USf230,000 on tho sales of these Inputs, and while the component has still one expatriste adviser (who could oven be paid from the profits), a qualified local sales manager Is progressively taking over. It is now starting to branch out into other commercial activities, notably in cattle exports and daily collection and processing. With the success of input distribution, FNEC's image has greatly improved, not only among the herdors, but also at the national level, and FNEC has become a strong voice and political power reprosenting the horders, which Is extremely Important for this pastoral minority. FNEC's overall sustainability will depend on the quality of its national leadership, the government's respect for Its autonomy, and the degree to whIch It Is able to reprosent all livxstock producers in the CAR. - 22 - For example Cheneau (1984) estimated an annual vaccine production capacity for rinderpest of 270 million doses (for a cattle population of 140 milliont), for CBPP of 117 million and for FMD of about 50 million, whereas actual production was only respectively 92 million, 16 million and 21 million. From his figures an overall capacity utilization of 37 percent for the vaccines against the contagious diseases and of 29 percent for vaccine production against the less contagious diseases can be calculated. Since then, the capacity has further increased. Furthermore, the vaccines used for the most common diseases (rinderpest, common poultry diseases like New Castle disease) are produced more economically in established large-scale laboratories. Except for private laboratories in Kenya (Welcome) and Botswana (Rhone Merieux), all laboratories are government-owned and usually under the supervision of the livestock department. Because of the existing overcapacity, practically all laboratories have operating deficits, and what should be self-financing operations depend on subsidies from the government, frequently even above the direct payment of salaries from the treasury. Data from Cameroon, Chad, Mali, and Senegal show a production cost of about US$0.10 per dose, with a sales price ranging from US$0.03 to US$0.05 per dose. The Senegal laboratory is reportedly able to self-finance its vaccine production. 51. This proliferation of national vaccine laboratories should be discouraged, especially now that emergency buffer stocks of rinderpest vaccine are being maintained in five selected SSA laboratories under PARC. 17/ The argument that local operations produce foreign exchange savings has very limited value as vaccine production requires a high share of imported supplies. The strategy should be to develop regional cooperation, and to consolidate the many small national laboratories into larger, more specialized regional laboratories. Furthermore, any plan for the construction of new laboratories, or the expansion of existing ones, needs to be reevaluated in light of the fact that consolidation would help to attract private interest. Most current national laboratories are too small to attract such attention. For this reason, the World Bank has not included the privatization of vaccine production in its policy dialogue with SSA countries; reforms in this field have been limited to reducing the most obvious distortions, for example, by organizing vaccine production in separate self-contained and self-financing units that charge real prices. (iii) Drug Distribution 52. Until recently, only the staff of veterinary services were allowed to distribute drugs, and this is still the case in some countries. In the francophone countries, this restriction applied to practically all drugs, and in the anglophone countries to the dangerous drugs. Such restrictions were fully justified in the first half of the century, when the available drugs were distributed free to the producers, were expensive in relation to livestock prices, contained ingredients toxic to humans, and improper use produced serious side effects. In the past three decades, however, mass production techniques have reduced drug costs, and research has eliminated many unwanted 17/ Dakar (Senegal), Bamako (Mali), Farcha (Chad), Debre Zeit (Ethiopia), and Nairobi (Kenya). - 23 - side effects. In many countries, however, the deteriorating salaLry/non- salary ratio of livestock services has led to the removal of service staff and drug distribution from the field. As a result, distribution points are in many cases 100-200 kilometers apart (Provost, 1987) and this has given rise to a flourishing black market. With the aid of external support, many countries have therefore introduced more liberal distribution, which includes several channels (trained private livestock technicians, traders and producers) (para. 65-69). 53. The degree to which drug distribution and application have been liberalized varies from the unrestricted distribution of all drugs to the restricted sale of prescription drugs, to very restrictive policies for all drugs that need to be injected. Several countries maintain an unjustified discriminatory system, whereby government technicians are allowed to distribute and apply prescription drugs, whereas private technicians at the same level are prohibited from distributing or administering these drugs. 54. Most externally financed projects, including those funded by the World Bank, have supported a more liberal policy and have expanded the list of drugs that can be purchased without prescription 18/. Without such a policy, it is impossible to interest non-professionals in private veterinary care (para. 67). Preliminary experience seems to justify this approach, as black marketeering and adulteration have declined since availability has improved. In the Central African Republic, where drugs have become more available through official channels, the share of drugs purchased by herders on the black market fell from 67 percent in 1982 to 18 percent in 1985 and was down to only 7 percent in 1988. Furthermore, the majority of the herders and lower-level technicians are able to properly handle these drugs (para. 67). 18/ Those opposed to free distribution argue that when laymen hand:Le drugs, the incorrect (under) dosage is given and chemoresistance may develop. This danger would be especially acute in the case of trypanocides and antibiotics, and therefore their administration needs to be restricted to qualified personnel. The number of trypanocide drugs available on the market is very limited (only 2 basic formulas), and chemoresistance to these trypanocides would have disastrous consequences for livestock development in the sub-humid zones. Similarly, the improper use of antibiotics not only can lead to resistance of the disease agent, but can also have adverse effects on human health. Finally, the liberal distribution of drugs would reduce drug sales as a source of income for self-employed veterinarians, who cannot charge fees for advice per se but can recover the cost of the service via charges for drugs. On the other hand, proponents of a more liberal distribution policy argue that trypanocides are of enormous importance to the survival of whole populations of Zebu animals in the sub-humid zones and their timely availability for prophylactic and curative purposes is critical for the herders. It would be extremely risky for the producer to have to depend on unreliable government service for their distribution and injection. - 24 - 55. In summary, drug availability at the producers' level has improved in several countries since the private sector--particularly producers' groups- -took on some of the responsibility for drug imports and substitution. Thus there seems to be little justification for continued government support of parastatal veterinary drug companies, especially in development projects. Because of the excess capacity in vaccine production in SSA, practically all national vaccine production laboratories are incurring hefty financial losses. The sensible way out of this problem would be to consolidate several national laboratories into larger regional institutes, although this is a politically sensitive issue. At all cost, these countries should try to avoid building new installations. - 25 - CHAPTER VII PRIVATIZATION OF CLINICAL INTERVENTIONS (i) Introduction 56. The question of whether countries should be privatizing veterinary services has been at the forefront of all recent discussions on animal health policies. There are a number of compelling reasons for such a move. For one thing, a substantial number of veterinary activities (clinical interventions, voluntary vaccinations, and other preventive schemes) are exclusively private in nature and have a clientele that is willing to pay for the services, as has amply been demonstrated. Privatization is also justified on social grounds in view of the large number of veterinarians and livestock technicians graduating in SSA each year who cannot be absorbed by the public sector. Privatization is a high-profile component of most recently approved Bank- funded operations (Cameroon, Chad, Guinea, and Kenya), as well as those under preparation in Madagascar, Nigeria, Senegal, Tanzania, and Uganda. In most of these projects, privatization is not restricted to the development of professional veterinary practices, but, what is more important, includes the transfer of public sector tasks to other levels (middle-level technicians, veterinary auxiliaries, and producers). The approaches used up to date in these different categories are outlined in the following paragraphs. (ii) Professional Veterinarians 57. Self-employed veterinary professionals, common in other parts of the world, are still rare in SSA. At present, they are operating in 16 out of 30 countries surveyed by Chabeuf (1990)), but mainly in the urban centers (for small animals), in the commercial livestock industries in Zimbabwe and Botswana, and in some cases in areas with high potential, such as the Highlands of Kenya (see box) and Madagascar. Private veterinary care has been--and in many instances still is--stifled by (a) unfair competition from public services, which dispense subsidized treatments and often use para-veterinary staff to compete with would-be professional private veterinarians; (b) a preference for--and sometimes an obligation to employ--new graduates in the civil service; (c) uncertain availability of drugs and equipment; and (d) perceived poor financial perspectives, especially in the pastoral and smallholder areas. 58. These disincentives are now being addressed in the context of general adjustment programs and recently approved livestock projects, and special incentives (para. 61) are being established to improve profitability. Income projections for private veterinarians in Bank staff appraisal reports vary from US$4,000 to US$35,000 per year (Annex 4). Such projections seem to be somewhat optimistic as the earnings from a private practice are likely to be below the income earned by a government veterinarian in many parts of Africa. But this should not deter professional veterinarians from considering self-employment, as it will be impossible to fully absorb veterinary graduates - 26 - Box 2. A Dairy Cooperative Society Organizes Its Own Animal Heaith Service The Limuru Dairy Cooperative Society, located some 40 kilometers north of Nairobi, is one of the most successful cooperatives in Kenya. Founded in 1982 with 72 members, it now boasts 4,496 members delivering about 23,000 liters per day. Its business has grown from collecting and selling milk to supplying farm inputs and credit, operating a dairy farm, and running AI and clinical services. It has also invested in buildings in Nairobi and Limuru, which have been fully paid for. Its annual gross turnover of business is about US36.24 million. The society and its members used to depend on the government for AI and veterinary services. However, the quality of government service was deteriorating for a number of reasons, including the lack of transport and shortage of fuel, drugs, supplies and equipment, oll of which were largely due to inadequate operating funds in the government budget. In 1985, the society's leaders decided members would fare better if the society organized and operated its own AI and veterinary service. They approached the Department of Veterinary Services to assist them in this endeavor. They employed a veterinarian and an artificial inseminator on a full time basis. The veterinarian was responsible for establishing and running an AI service, and managing the health program for the society's 342 grade dairy cows on its dairy farm, and had to be on call to treat clinical cases for farmers. Clinical cases are paid for in accordance with services rendered and the distance traveled by the veterinarian. In 1988 there were 150 cases treated each month with an average charge of about KSh. 135 CUS36.76) per case including a transport charge of KSh. 2 (USSO.10) per kilometer. Vaccinations and Al services are given at roadsides of a predefined circuit as well as on call at farms for the first service. Farmers seem to be happy with the reliability and effectiveness of the AI service and demand is increasing despite the high charge (KSh. 40) compared with that of the government service, priced at KSh. S per insemination. The society is planning to expand its animal health services by taking over the operation of dips and opening up its services to nonmembers as well. The foregoing shows that farmers' organizations can indeed decrease their dependence on government for the provision of animal health services and that farmers are prepared to pay the full cost provided that these services are prompt and effective. Governments, donors, and NGOs should encourage them to organize and run their own animal health care services. in government posts, 19/ new graduates will have to adapt to the actual situation, and only privatization can provide the impetus needed to improve the quality of veterinary services 20/. The marginal profitability does mean, however, that in the professional practices preference needs to be given to areas with higher potential, such as those in which dairy production is more intensive, those around urban centers with a growing poultry industry, and those with some ranching. In addition, private professional veterinarians could--in some countries, they already do--play a central role in the import and wholesale distribution of drugs. In those areas of production with lower 19/ By applying the standard requirements for the supervision of preventive and sanitary control tasks (para 37) and present staffing (para 36), one can calculate about 2,000 veterinarians to be available for self-employment in clinical and subcontracting of preventive tasks. 20/ The number of graduates from the veterinary faculties in Kenya, Tanzania, and Zimbabwe each year constitutes 10-20 percent of the total number of veterinarians in these countries. - 27 - potential, veterinary care needs to be delegated to middle- and lower-level technicians or to producers themselves, ideally under the supervision of private professional veterinarians. Although basic animal health care has been successfully introduced at the middle and lower levels, (para. 65-69), the basic animal health care system in SSA has not yet been adequately linked up with private professional veterinarians. This is a critical issue that needs more attention in future project design. 59. Although some issues still need to be resolved (para. 62), interest in privatization is rising in the changing policy climate in SSA, and in the face of frozen recruitment and retrenchments of public servants in many countries. In a survey carried out during the preparation of the Uganda Livestock Project, 90 percent of the veterinarians responding indicated they were interested in developing private practices. A similar positive reaction was obtained in Tanzania. Informal contacts with groups of veterinarians in Cameroon, Mali, Niger, Nigeria, and Senegal have yielded the same results. 60. Another encouraging development is the creation and rehabilita- tion of national associations of veterinarians (NAV). Such professional associations are already strong in Kenya and Zimbabwe and are now being created or rehabilitated in Cameroon, Madagascar, Mali, Nigeria, Tanzania, and Uganda. NAV are non-government organizations that represent the interests of the veterinary profession and can be highly effective interlocutors in these discussions. Although NAV have only been involved in the preparation of privatization for Bank-financed projects in Kenya, Tanzania, and Uganda, they are expected to be included in a Madagascar project as well (with a view to strengthening the Madagascar Veterinary Association). NAVs were very effectively used in Uganda and Tanzania to assess the extent to which govern- ment veterinarians were interested in privatization. It should be noted, however, that if the responsibilities of the Livestock Service and the NAV are not clearly defined, project preparation can be hindered, rather than helped, as occurred in the preparation of the Kenyan Animal Health Project. Senior government officials assumed that the primary initiative had to come from the Kenyan Veterinary Association, but that since this organization was a private institution, it could not benefit from external funding. NAVs are not yet strong enough to give business management training and administrative support to private veterinarians and would require technical assistance until their membership fees can support such activities. 61. Operations funded by the World Bank and other donors include numerous special incentives to encourage countries to establish private veterinary practices, as outlined below. These incentives also apply to middle-level technicians starting a private animal health care enterprise. (a) financial support in the form of credits (Chad, Cameroon, Guinea), sometimes supplemented by grants consisting of a six-month to one- year initial stock of drugs (CAR, Chad, Cameroon) for those leaving government service; (b) assurances that the government will continue to pay a partial salary for a limited period in those areas where livestock density is too low to provide an adequate income; - 28 - (c) assurances that the government would subcontract services (vaccina- tion, meat inspection, dip supervision, artificial insemination) at remunerative rates to self-employed veterinarians (Chad, Cameroon, not including meat inspection) (this seems to be one of the more attractive incentives, as it would provide the individual a guaranteed income, and at the same time produce net savings for the government); (d) transfer of facilities and transport to the private operator, who would then pay only for their maintenance and operation; (e) assurances that the government will stop all curative and noncompul- sory preventive interventions in a certain area, as soon as private individuals have established themselves in that area (Chad and Guinea) or a pilot area is identified in which public livestock services would stop handling all non-public functions at a certain date so as to avoid all unfair competition from the public sector (Cameroon); (f) the provision of a one- to two-year leave of absence for government employees to test the feasibility of private activities without any loss of income security should the test fail (Chad and Guinea); and (g) the free or subsidized provision of office and laboratory facilities combined with part-time employment, which combines (c) and (d). Some of these incentives are now also being introduced in national legislation, in efforts not supported by external funding (Mali, Senegal). These measures were introduced in 1987 in Guinea and CAR, and later in Cameroon and Chad. It is too early to tell whether they provide a powerful enough incentive to encourage the development of private veterinary practices. 62. Experience thus far suggests that the following two issues merit specific attention in project design: (a) Balance between the Public and Private Sector. This balance is of concern not only at the macro level, but also at the micro level. All Bank-funded projects seeking to develop private veterinary care also seek to improve the performance of public sector tasks, in part because the tasks are important in themselves and need to be strengthened, but also because it is vital to interest the government in the overall project. However, the investment in equipment, the financing of allowances, and the funding of clinical services can give government veterinarians strong advantages over any newly established private ones and may discourage government veterinarians from leaving the public sector. This is thought to be the case in the Kenyan, Guinean, and Chadian projects. (b) Full Cost Recovery by Government Services. There is an innate resistance in the public sector to charge real costs for the services it provides. Still, it is essential to do so if the private practitioner is to be assured of an adequate income. The problem is well illustrated in the Kenya Animal Health Project, where, at negotiations, government fees were established below cost price, - 29 - and were finally introduced after a considerable delay, which killed all interest in self-employment. The Kenyan government argued that this delay was necessary because services first had to be improved to a level where producers would be willing to pay for them. However, experience elsewhere (and in Kenya; see Box 2.) shows that farmers are quite willing to pay for veterinary service. Thus, valuable opportunities to develop sustainable services were missed. 63. A comprehensive approach, which will eliminate all unfair competition from the public service, therefore seems to be a prerequisite for the success of professional private veterinary practices. Such an environment will be provided under the recently approved Cameroon Livestock Sector Development Project, in which the government will stop providing all treatments and voluntary vaccinations in certain zones, and will be charging the full costs in the remaining parts of the country. 64. In summary, in the past the countries of SSA did not provide a framework of appropriate incentives and this discouraged private veterinary practice, managed by professional veterinarians, from developing. Although the environment is improving in many countries and special incentives are being introduced through externally financed projects, opportunities will remain limited to the more productive systems and to those in peri-urban areas. Great care should be taken in project design to eliminate unfair competition from the public sector. Such a threat may arise if the public sector components of projects designed to develop private veterinary care are unduly streng- thened. Nongovernment national associations of veterinarians could play an important role in promoting and safeguarding private interests, but governments need to accept them as equal partners in the discussions and allow their activities to be funded by external donors and NGOs. (iii) Other Groups 65. Considerable experience with privatization has been gained among veterinary groups with lower-level skills, notably (a) private middle-level technicians with one to four years of technical training after primary training for the sedentary production systems; and (b) producer representatives (auxiliaries) with varying educational backgrounds specially trained for the pastoral production systems. These non-professionals are better equipped to serve the extensive production systems in particular, because (a) their income aspirations are below the level a professional expects and can be met in most production systems; (b) communication between the nonprofessional animal health worker and the producer--frequently from the same ethnic group--is generally better than between the professional veterinarian and the producer, who are frequently from different ethnic backgrounds; and (c) a large proportion (80- 90 percent) of the veterinary interventions required in the extensive production systems are simple and can be done by less-qualified persons, especially if they are properly supervised. 66. Although private nonprofessional animal health care is a fairly recent phenomenon in SSA, it is now being tested in at least 10 countries in about three million Livestock Units and is expected to be introduced in much broader scope in another 10 countries. Nonprofessional systems seem to be providing a viable alternative to the poorly functioning public systems. Middle-level technicians have been successfully employed in nonprofessional - 30 - animal health care in the FAC-financed GDS (Sanitary Defense Group) project in Southern Chad, which was established in the late 1970s and now operates with about 50 technicians, who mainly look after work-oxen for cotton farmers. The sustainability of that operation was demonstrated during Chad's period of civil unrest in the early 1980s, when most groups continued functioning. Middle-level technicians have also been used in the FAC-financed village poultry health system in Burkina Faso, which now operates in about 50 villages and has developed a fully sustainable system of poultry vaccinations for about 2 million village poultry (see Box 3.). Examples of satisfactorily operating veterinary auxiliaries include (a) the GTZ/World Bank-sponsored nomadic Animal Health Assistants now working in 52 teams in three districts of Somalia; (b) the World Bank/IFADIADF-sponsored animal health assistants working in 60 pastoral groups in the CAR; (c) the network of 200 auxiliaries sponsored by the World Bank, FAC, and Economic Cooperation Fund of (CCCE) in Niger; and (d) OXFAM-sponsored animal health assistants in Eastern Chad. A list of ongoing and expected projects with nonprofessional animal health care is included in Annex 2. Box 3. Village Poultry Production in Burkina The FAC-financed Burkina Village Poultry Project has successfully established a self-financing network of village poultry vaccinators in the Central Region of Burkina. A total of about 330 vaccinators, selected by the local communities and trained for throe days in the most common poultry diseases and their prevention, vaccinate about 2 million a year and treat (internal and external parasites) about 1.5 million poultry from about 100,000 households. The vaccination of 2 million poultry out of a total population of 7 mill ion has effectively stopped the previously recurring epidemics, which each year killed 60 percent of the village poultry population, and has increased poultry production by about 1,000 tons per year. With the commercial sector and imports reportedly having remained stable or decreased, the 26 percent decline in consumer price between 1980 and 1988 can probably be attributed to the effects of the project as well. A large problem that still needs to be addressed is the volume of vaccinations, which, in spite of an already significant adjustment in the number of vaccinators (from 800 envisaged at project conception to 330 now) is still too low to be sufficiently attractive. Planners now envisage a continuing reduction in the number of vaccinators, plus expansion into the vaccination of village sheep and goats, designed to bring the annual income of the vaccinator from USS100 to USS800. 67. Reliable data on the quality of the service provided by nonprofes- sional agents are scarce. Surveys in the Central African Republic indicated that about 90 percent of the herders-auxiliaries there have used a drug against internal parasites correctly, 85 percent of the producers diagnosed trypanoso- miasis correctly, and 75 percent of the herders calculated the dosage within 10 percent of the recommended amounts. Vaccinations against Anthrax and Blackleg were carried out properly as well. These figures compare favorably with surveys on the level of expertise of government field staff in some countries, which frequently show lower scores for proper disease diagnosis and correct dosage. Experience in Senegal, Zaire, and in the GTZ-financed Somalia project corroborate the auxiliaries' expertise in diagnosing disease and judging dosage. However, more research and monitoring will obviously be required to adequately assess levels of expertise. 68. The positive findings reported above (para. 67) come from auxiliaries recruited mainly from pastoral populations. Consequently, they already possess broad experience in livestock raising and are more likely to diagnose diseases - 31 - correctly and apply appropriate drugs in the required doses. It is not clear whether similar positive results would be obtained with auxiliaries recruited from populations relatively new to livestock raising. Experience with veterinary services for the work-oxen of crop farmers provided through the cotton companies (Cameroon, Chad and Mali) suggests that the farming population involved had a much lower level of skill in diagnosing and treating animal disease and that it was difficult to recruit auxiliaries sufficiently familiar with livestock raising. A two-pronged approach, that is, to follow a rather liberal drug distribution policy for the traditional pastoral livestock raisers, using their representatives as the main channel, and a more cautious distribution policy using higher-qualified technicians for the less skilled producers, seems therefore indicated. 69. A number of important lessons can be drawn from past experience concerning the organization of nonprofessional animal health care: (a) Organizational Context. Nonprofessional animal health care cannot be fully sustained unless the auxiliary is integrated into a group or association at the grass roots level and there is a reliable supply system for equipment and drugs at the national level. A condition of the most recently approvednonprofessional animalhealth care projects 21/ was that producers' groups be established not only for animal health care but as a tool for the transfer of other tasks (water point and range management) from the public to the private sector. Thus, animal health care becomes the catalyst for group formation, which leads to more comprehensive communal resource management. The input supply side seems to be the weakest link. Input supply for the auxiliaries is generally handled by the project or is left to a parastatal company, thus seriously endangering post-project sustainability. The only exceptions are the Ituri, Zaire, and CAR regional and national producers' associations, which are developing into fully self-financing, sustainable institutions. (b) Selection and Training of Auxiliaries. It is important for the veterinary auxiliary to come from the community he or she is to serve, particularly in the pastoral production systems, and to maintain close ties with his community during the training period. For example, the first group of auxiliaries in the Bank/IFAD/ADF- funded CAR First Livestock Project were selected on the basis of literacy rather than origin and representation, and when they returned after their three months of training, they had no group to fall back on and failed completely. The course format was therefore changed into a short (3-6 days), frequently repeated (every six months) program, involving not only the auxiliary, but also the traditional hierarchy. A similar situation occurred in the Eastern Senegal Project and on a national scale in Ethiopia, where outside so-called veterinary scouts failed, and specially selected auxiliaries are succeeding (see Box 4.). 21/ Including the Bank funded projects in Cameroon, CAR, Chad, Guinea, Mali (ODEM), Mauritania, Niger, Eastern Senegal, and Zaire (Ituri). - 32 - Box 4. Service Cooperatives in Ethiopia Employ Animal Health Auxiliaries Since 1975, farmers In Ethiopis have been organized in peasant associations (PA.). Groups of S-10 PAs are forming service cooperativos for the purpose of procuring and distributing inputs and slIling their crops. At present there are soe 20,000 PAs and about 4,170 service cooperative. In view of the organizational problem and shortage of manpower and rosources to provide animal health sorvices for farmrs, the current strategy of the government is to encourage the srvice cooperatives to partly assum these tasks. In the IDA-financed Fourth Livestock Development Project, participating sorvice cooperatives build cattle crushes and drug stores at their own expense and recruit auxiliaries from their own communities for government training. The recruits aro given practical training in general livestock husbandry and simple animal health techniques, including deworming, tick control, castration, and the treatment of external infections. When they return from training, they become auxiliaries mployed by the service cooperatives. Their tasks include managing the drug store of the sorvice cooperative, assisting farmrs In the application of drugs and simple treatments, assisting government veterinary staff in teaching farmers and liaising betwoen them and the farmers In disseminating information such as dates and places of farmer training and vaccination campaigns and notifying veterinary staff on disoase outbreaks. Animal health assistants visit the service cooperativo *very 16 days to givo *xtenslon advise to farmers and to treat their livestock. The main objective of the project is to service 1,500 service cooperatives in five years. A promising start has been made. About 112 service cooperatives have started participating in the first year of the project. The veterinary authoriti*s are convinced that this system is working and could b the cornerstone of their animal health extension service ln the future. In the 1970s, Ethiopia had tried to place similar auxiliaries, called veterinary scouts, among pastoral groups to render similar service but without much success. The veterinary scouts were government employes, who chose to live in the towns where the government offices were located instead of with tho horders. What makes the current auxiliaries different is that they are the employees of the farmers and are directly accountable to the officers of the service cooperatives, who can dlsmiss them should they become unproductive. (c) Remuneration. Although it is important to integrate the auxiliary into an association, there is a danger that the auxiliary will become a poorly remunerated social worker. When that happens, the interest of the auxiliaries dies quickly. Consequently, a combination of a small retainer paid by the association and a margin on the sale of drugs seems to be essential to maintain the auxiliaries' interest. (d) Government Involvement. Nonprofessional animal health care should develop as a private activity, and the government's role should be restricted to technical support/training and ex-post control and should exclude day-to-day management. However, if there has been a tradition of public sector involvement and control, some degree of involvement may be expected to continue when the auxiliary movement/associations become national in scope. Thus, in the CAR there is a tendency for the government to get involved in the management of the successful livestock producers' association, FNEC. (e) Bank Suitability. Establishing a nonprofessional animal health care system is a location-specific, protracted, and incremental task, without a high funding requirement. The World Bank and SSA governments are not as well equipped to handle such a task as NGOs, which therefore should be encouraged to assist in the development of pastoral associations. The approach used in Cameroon--where the government subcontracted an NGO (with Bank/IFAD funds) to establish - 33 - pastoral associations--is therefore particularly interesting and should be closely monitored. 70. Groups and Special Animal Health Tasks. Group responsibility for animal health tasks ranges from the management of all health tasks and artificial insemination, as in Kenya (see Box 2.), to the simpler tasks of managing dips and the veterinary stores. Experience with group management of dips has been mixed. The turnover in group-managed dips in the Ituri, Zaire, and CAR First Livestock Project was much higher than in government- managed ones, although in the CAR, access to the (subsidized) dips became an inequitable political tool in the hands of the presidents of the groups. In Kenya, the community performed rather poorly in maintaining the required acaricide level of the dipping fluid, with the result that tick-borne disease accounted for 90 percent of all reported diseases, whereas in areas with government-operated dips, tick-borne diseases constituted only 20 percent of the reported diseases (Leonard 1984). The present policy in the Kenya Animal Health Project is to transfer the dips to the community but to improve government monitoring of the dip operation. 71. Success in managing veterinary stores also depends on the control and quality of management. The overall financial management of these seems better in the more hierarchically structured and more tightly controlled pastoral societies than in crop farmers' groups. Group veterinary pharmacies appear to be operating satisfactorily in the Eastern Senegal Project, Mali ODEM Project, Mauritania Livestock Project, and Zaire Ituri project. In all these projects, the association's revolving funds are now also used for additional functions besides the veterinary pharmacy. Post-project sustainability is the main concern. In the CAR First Livestock Project, for example, the average balance for the 20 revolving funds for the pharmacies tripled between 1983 and 1985, and pharmacies had an average turnaround time of three months; in 1986, in the between-project period, 40 percent of the revolving funds suffered from leakage, but there was marked improvement from 1987 onward, under the new project. This project is now working on establishing an improved internal control system, and on strengthening the role of the auxiliary in directly managing the revolving fund. 72. In summary, the initial experiences with private nonprofessional animal health care have been positive, especially when integrated into producers' groups. In several countries, this has proved to be a promising alternative to the public sector veterinary health care system, although little information is yet available on after-project sustainability. Preliminary results suggest that suitably trained auxiliaries, especially from a pastoral background, correctly diagnose and apply the principal drugs used against the most common diseases. However, some important steps still need to be taken. The countries of SSA should now focus on establishing a reliable input supply system, involving private veterinarians in the management of private nonprofessional health care, clarifying the relationship between the official livestock service and the nonprofessional animal health care system, and ensuring quality control and financial sustainability. - 34 - CHAPTER VIII IMPACT AND LESSONS LEARNED 73. The measures recently introduced in animal health care in SSA are still too new to provide a full and objective assessment of their impact. However, a few general comments can be made on the basis of the experience to date. At this stage, it is essential to continuously monitor the unfolding impact of these reform measures so that the conclusions of this report can be empirically tested. (a) The imports and distribution of veterinary pharmaceuticals can be- -and increasingly are being--handled entirely by the private sector, and efforts in this field need to be pursued. The private sector also needs to be involved in vaccine production, which is still publicly managed, although privatization here needs to be preceded by consolidation of SSA's many small laboratories in larger regional units. (b) Full cost recovery for government services is an essential prerequisite for any private involvement in veterinary services. Cost recovery for these services has been widely introduced in SSA over the past decade and has yielded satisfactory results for clinical and prophylactic intervention, but, as expected, has been less successful in the more marginal activities like cattle dipping and artificial insemination. (c) During the 1970s and early 1980s, staff recruitment was dispropor- tionate to the available operating means and thus had an adverse effect on the efficiency of government services, but this trend has now leveled off, although imbalances persist in many countries. (d) Private nonprofessional veterinary services have been successfully developed with producers' groups. Their representatives (auxilia- ries), if properly trained, have been shown to be capable of carrying out most treatments correctly, and group formation around animal health has been an important precursor to other cooperative activities. (e) The countries of SSA are just beginning to use self-employed veterinarians. Favorable conditions have been created in several projects for veterinarians to start privately. More experience needs to be gained before definite conclusions can be drawn about this venture. (f) More and more African decision makers are becoming aware of the fact that they need to find alternative ways to organize and finance veterinary services. - 35 - 74. A rough assessment indicates that at present: (a) about 50 percent of veterinary pharmaceuticals in SSA are imported through the private sector; (b) about 60 percent of these drugs are administered through producers (predominantly) and veterinary auxiliaries; and (c) about 2 percent of SSA's livestock population is being regularly treated by trained veterinary auxiliaries who are privately employed, and over the next five years this figure is expected to expand to about 40 percent. 75. It is still too soon to estimate the impact of these initiatives on SSA's meat and milk production. An idea of their potential can be gained by looking at the FAC-financed Burkina Village Poultry Project (Box 3.) and the two new-style animal health projects (Zaire Ituri Project and Central African Republic First Livestock Project) that have been completed and have had an ex-post evaluation. Under the Ituri and CAR projects, meat yield appears to have increased by 1500-2000 tons by project completion (and is expected to reach 10,000-15,000 tons at full development) and to have had an ex-post Economic Rate of Return in excess of 15 percent and 36 percent in the respective projects. Progress on the ongoing new-style projects also seems satisfactory; the average overall performance rating for the Bank's livestock- only projects under implementation is at par with the average of agricultural projects, whereas the ratings of the old-style projects of the 1970s were consistently lower. 76. Thus, the overall initial results are encouraging, although any definite claim of success would be premature. It seems that if this course is continued--supplemented with other technologies such as simple feed improvements, small stock development, smallholder cattle fattening and dairy operations, which have all shown some degree of promise in ongoing livestock projects--livestock should be able to play a catalytic role in SSA's agricultural development and alleviate the huge meat and milk deficit projected for SSA in the twenty-first century. - 36 - ANJIAL HEALTH SERVICES IN SUB-SAHARAN AFRICA INITIAL EXPERIENCES WITH ALTERNATIVE APPROACHES REFERENCES CITED Anteneh, A., 1985. Financing Livestock Service in Some Countries of East and Southern Africa. International Livestock Centre for Africa. LPA Working Paper No. 6. Addis Ababa. Anteneh, A., 1983. Financing Animal Health Services in Some African Countries. International Livestock Centre for Africa. LPU Working Paper No. 1. Addis Ababa. Centre Technique de Cooperation Agricole et Rurale, Convention ACP, 1984. Actes du Seminaire sur une Structure de Sante Animale de Base, Bujumbura, Burundi, 24-26 octobre 1984. Chabeuf, N., La privatization et le role de la production de vaccins, de l'approvisionnement et de la distribution en medicaments veterinaires. Paper presented at the meeting on Privatization of Livestock Services, Feldhafing, August, 1990. Cheneau, Y., La production de vacccins. Report for the OIE, Paris, 1984. De Haan, C. and Nissen N.J., 1985. Animal Health Services in Sub-Saharan Africa. The World Bank. Technical Paper No. 44. Washington, D.C. Food and Agriculture Organization of the United Nations, 1981. Agriculture Towards 2000, PAO, Rome. Leonard, D.K., 1984. The Supply of Veterinary Services. Conference on Livestock Policy Issues in Africa. International Livestock Centre for Africa. Addis Ababa. German Foundation for International Development, 1986. Proceedings of International Workshop on Constraints and Strategies for Livestock Development and Improvement of Animal Health, 23-28 January, 1986, Berlin. GTZ, 1987. Proceedings of an International Workshop on Private Basic Animal Health Care. Bangui. Provost, A., 1987. Contraintes I l'Amelioration de la Sante Animale dans les SystAmes Africaines d'Elevage sur Parcours Pastoraux Extensifs. Workshop on Constraints and Strategies for Livestock Development and Improvement of Animal Health, 23-28 January, 1986, Berlin. German Foundation for International Development (DSE), Berlin. - 37 - Sarma, J. S., Patrick, Y, 1985. Livestock Products in the Third World: Past Trends and Projections to 1990 and 2000. International Food Policy Research Institute. Research Report 49. Washington, D.C. Sandford, S., 1983. Management of Pastoral Development in the Third World. John Wiley and Sons, Chichester. World Bank, 1987. Financing Health Services in Developing Countries: An Agenda for Reform, World Bank Policy Study, The World Bank, Washington, D.C. - 38 - ANNEX 1 Page 1 of 2 ANIMAL HEALTH SERVICES IN SUB-SAHARAN AFRICA INITIAL EXPERIENCES WITH NEW APPROACHES AN ESTIMATE OF LOSSES CAUSED BY DISEASES 1. The losses caused by animal health problems are classified in direct losses because of mortality and indirect losses because of decreased growth, fertility and work output (morbidity losses). Estimates of direct losses are in the order of US$ 2 billion per year. The importance of indirect losses is more difficult to estimate, but are generally thought to be in the same order. The break down of the direct losses per class of animals is as follows: Category Total Population Av. Mortality Av. Price Total Loss (million head) (Z) (US$) (million US$) Cattle Calves 40 20 40 320 Adults 120 5 200 1200 Sheep & Goats Lambs/kids 80 25 10 200 Adults 140 10 20 280 Pigs All 10 10 30 30 Poultry Village 400 20 2 160 Intensive 100 5 3 15 Total 2205 The total of US$ 2 billion concurs with figures provided by FAO (1985). 2. There is a lack of quantitative information on the relative importance of the different diseases. Disease surveys carried out in specific regions, frequently in the framework of a project, show an overwhelming importance of internal parasites especially as a cause of young stock mortality. Furthermore they show, slightly less but still very important, losses caused by diseases transmitted by external parasites (ticks, e.g. East Coast Fever, Anaplasmosis, etc. especially in East and Southern Africa). The losses resulting from the major contagious diseases Rinderpest and Contagious Bovine Pleuro-Pneumonia (CPBB), are relatively - 39 - ANNEX 1 Page 2 of 2 insignificant, because of the reasonable level of immunity resulting from national annual vaccination campaigns, resuscitated after the major outbreaks in 1982-1983. The major cost concerning these diseases consist inmaintaining immunity at the level required to prevent a repetition of such general outbreaks. The vaccination against Rinderpest is therefore the main--and sometimes only--task of SSA's livestock services. Under most: of Africa's extensive production systems, Foot and Mouth Disease (FMD) does not result in major economic losses and therefore does not warrant a generalized vaccination coverage. Blanket vaccination might be justified in intensive dairy production and for those countries (presently Botswana, Zimbabwe and provisionally Madagascar), which have a preferential access for meat and meat-products to the European Economic Community, but only from meat produced in FMD free zones. Trypanosomiasis or animal sleeping sickness, transmitted by the tse-tse fly, precludes raising of trypano- sensitive breeds (90 percent of SSA's cattle population and 70 percent of SSA's small ruminant population) in tse-tse infested areas, unless maintained permanently on a drug regime. Peste de Petit Ruminant (PPR) is a major killer of ship and goats in the humid zones of West and Central Africa. The use of tissue culture Rinderpest (TCR) vaccine, which has been found effective against PPR, is increasingly being used. New Castle disease, coccidiosis and fowl pox are the major killer diseases of poultry. Vaccines are available for all diseases. A number of countries (Burkina Faso, Senegal, Cote d'Ivoire, etc.) have started vaccinations of village poultry with good effect. - 40 - ANNEX 2 Page 1 of 3 ANIMAL HEALTH SERVICES IN SUB-SAHARAN AFRICA INITIAL EXPERIENCES WITH NEW APPROACHES LIST OF IMPORTANT PROJECTS AIMED AT PRIVATIZATION OF VETERINARY CARE Country Donor(s) Main Focus Burkina FAC Village poultry/small ruminant vaccinations Central African Rep. IDA/IFAD/EEC/FAC Drug distribution and herders training through national herders federation Cameroon IBRDIIFAD Private import and distri- bution systems, private practices for professional and mid-level technicians Chad GTZ Veterinary auxiliaries Chad EEC/IDA/FAC/ADB Privatization with professional veterinarians, mid-level technicians and herders associations (auxiliaries) Chad FAC Privatization with auxiliaries in cotton region Cote d'Ivoire CCCE /GTZ/FAC Village Pharmacies and private auxiliaries Ethiopia IDA Service cooperatives and auxiliaries Guinea (Conakry) IDA/CCCE/FAC Private imports, and privatization at various levels Kenya IDA/IFAD/OPEC Private professional practices, privatization of dips; cost recovery - 41 - ANNEX 2 Page 2 of 3 Mali IDA Herder associations, auxiliaries Nigeria IBRD/EEC Studies Senegal (Eastern IDA Herder and village Senegal) associations Somalia (Animal Health) IDA/GTZ Veterinary auxiliaries Somalia (Central Range- lands) IDA Cost recovery measures Sudan (Western savannah) IDA Privatization with prof. practices auxiliaries Uganda De facto privatization, External support in advanced stage of planning Zaire (Ituri) IDA/FAC/CIDA Regional herder associations and auxiliaries - 42 - ANNEX 2 Page 3 of 3 -------------------------------------------------------------------------__--__---------- Total Loan/Credit Pro3ect Veterinary Amounts Costs Component Year Country Project No" US I million US I million X -------------------------------------------------------------------__--------__---------- WEST AFRICA 1988 CAMEROON Livestock Sector Dev. Project 34.6 55.2 19 1986 C.A.R National Livestock Project 11.9 37.3 38 1988 CHAD National Livestock Project 13.6 37.2 70 1988 GUINEA Livostock Sector Rehab. Project 9.8 22.2 64 1986 MAURITANIA Socond Livestock Project 7.6 18.1 42 1988 NIGERIA Second Livestock Project 81 128 20 Total 163.5 298 Avg 32 EAST AND SOUTHERN AFRICA 1985 BOTSWANA Land Managemnt Projoct 10.7 17.6 6 1987 ETHIOPIA Fourth Livestock Projoct 39 67.2 S1 1988 KENYA Animal Health Project 1S 47 100 1988 SOMALIA Central Rangelands II 19 33.3 7 198S SOMALIA Animl Hoelth Project 4.3 11.6 100 Total as 166.9 Avg 5S _______________________ --- - - ------------------------------------------ -------------- - 43 - ANNEX 3 ANIMAL NEAL H SERVICES IN SUS-SAA4RAN AFRICA Page I of I INITIAL EXPERIENCES WITH NEW APPqOACHES A SUMMARY OF XEY ANIMAL SEALT4 CAPE POLICIES IN iSA ... .. _... ... ...... ......... _.... ..... __.__............................... _....... *__.__.............__.__....... .... ............. _._... ... ............... ....................._......... _ COST RECOVERY ' IRUGS ...... ....... ........... ..................._ . ..................... ........__ ._.________._ _._._____.......... VACCINATIONS CLINICAL REVENUE tIP1R0 I i ;; :OUN RY NON-COMPULS. COPULS. ORUSS INTERYENTIONS 31PS TO LIV. SERY. OISTRIBUTION .OlNISTRATION CONSOL:DTtN *EST Af^'CA 9ExIN FULL FULL FULL FREE N.A. YES S6W. RESTRICTIVE RURK1MA FULL FULL FULL FULL M.A. ? FREE C CAMEROON FULL FULL FULL FULL N.A. PART OV./PRIV. RESTRICTIVE YES C.A.R. FULL FULL FULL FREE PART YES PRIV. FREE YES CHAD PART FREE FULL PART N.A. YES S6ay. RESTR./FREE 4ES COTE D'IOIRE FREE FREE PART/FULL PART/FREE FREE YES PRIV. RESTRICTIVE No BANBIA FULL FREE FULL FULL N.A. No . PRIV. RESTRICTIVE `ES GHANA FULL FREE FULL FULL ? No ' PRIV. RESTRICTIVE tES GUINEA PART PART FULL PART N.A. YES : 6aY. FREE YES MALI FULL FULL FULL FREE N.A. NO 60V./PRIV. RESTRICTIYE VES MAURITANIA FULL FULL PART PART/FULL N.A. YES SOY. FREE No NISER PART FREE PART/FULL FREE N.A. go say. RESTRICTIVE NO N1IERIA FULL/PART/FREE FREE PARTIFULL FREE l.A. No : PRIV. RESTRICTIVE FART SENEGAL FULL FREE FULL PART N.A. YES ./PRIV. RESTRICTIVE YEi EASTERN I SOUTHERN AFRICA : BOTSWANA FULL FREE FULL FULL NO P PRIV. qESTRICTIVE NO 3URUNDI FREE FREE PART/FULL PART FREE No soY. RESTRICTIVE Na ETHIOPIA FULL FREE FULL FULL ? tES WOYV/PRIN. FREE No KENYA FULL/PART FREE PART PART PART Ne PIly. RESTR./FREE YES RAQAGASCAR : FULL FREE PMT/FULL PAT/FREE FREE No SOV./PRIV. RESTRICTIVE YES RNANDA FREE FREE PART FREE FREE NO soy. RESTRICTIVE NO SOMALIA FULL FREE FULL FULL N.A. No 60./PR2V. FREE fES SUDAN FULL FREE FILL PART FREE NO PIly. RESTRICTIVE TANZANIA FULL FREE FULL MT PART NO SY./PRIV. RESTRICTIVE ZANSIA FREE FRE FULL PART PART ? ? ? ZINANE : FREE/FLL FREE FULL PUT FREE No PRIV. RESTRICTIVE N0 -- - - - ------- --- - - -- - - ---------------- - 44 - ANNEX 4 Page 1 of 1 ANIMAL HEALTH SERVICES IN SUB-SAHARAN AFRICA INITIAL EXPERIENCES WITH NEW APPROACHES STATISTICAL DATA ON VETERINARY HEALTH CARE IN A NUMBER OF SSA COUNTRIES (1985-1988) CASHFLOW STATEMENT ITEM CAMEROON CHAD CuZNA CASH OUTFLOW Vohicl- 18000 2000 900 Housing 6500 5000 2700 Veterinary Eiquipmet 2000 1000 900 Drugs 26000 7000 Operating Coent 8000 1000 COO Debt Servine Soo Tota.I 506 16000 6000 CAS INFLOW Drugs 34000 11000 900 Subcontraete 7000 500 900 Clinic 11000 1000 0OO Loan 25000 12000 O000 Total 77000 24500 10400 Av. Inflow Frst Ye"r 26500 o500 4400 Aw. Intlow full Delop. 8s000 10700 4000 ANIMAL llEALTII SERVICES IN SUB-SAIARAN AFRICA INITIAL EXPERIENCES WITII NEW APPROACIIES STATISTICAL DATA ON VETERINARY HEALTH CARE IN A NUMBER OF SSA COUN1RIES (1985-88) I I I I I COUNTRY LIVESTOCK POPULATION LIVESTOCK LIVESTOCK HUMAN (TLU) I I Sb (1906) UNITS UNITS POPULATION PER, I I Cattle Sb GOat Camls Hotr*. Asses Pigs Poultry TW VLU PWOULATION I I (000) (000) (000) (000) (000) (000) (000) (000) (000) (000) 1 I I I BENIN () 1000 1500 1400 0 5 I 000 10000 1 1194 1573 4042000 0.5o I 12 I RUXIMA (b) 2000 2000 U00 6 70 200 200 21600 I b000 5071 7904706 O U I I I CAMERIN (b) 4100 2600 00 0 0 26 *7 Soo 15000 1 5649 4981 10446000 0. 51 I4 ? CtAR (b) 100 U5 970 0 0 0 150 2000 I 1415 1900 2740000 0.52 1 I t I CHAD (b) 1400 2260 2000 421 160 255 6 5000 1 5505 4452 5001000 0.69 1 I 6 I COTE D IVOIE (o) 02 1200 6O0 0 0 0 200 10000 1 986 1202 10200000 0.09 1 I0I a""A (a) 1154 1014 1420 0 0 0 460 6409 1 1206 1712 13500000 0.10 1 I GUINEA (b) 1000 400 440 0 0 a 47 11000 1 1473 1917 8226000 0.24 1 1101 MALI (b) 400 6460 0060 190 64 542 54 14000 1 5032 6272 7620225 O.6 I 111 1 MURITANIA (b) 1220 5900 51SO "O 146 400 0 3000 1 2791 1005 1946000 1.45 1 112 I NIGER (b) 5680 55O 7650 414 290 506 U4 14000 1 4025 6466 6s6000 0.01 I 114 1 SENEGAL (b 20o0 2500 1200 7 200 200 200 10500 * 2532 3177 6397000 0.40 1 I I TOTAL 2000 230447 5071U 190 940 1049 2761 119C09 1 31402 39486 01027930 0.36 1 I I I II I I I I EASTERN! AFRtICAI I l I I- I I I I ETHIOPIA (c) 26000 25500 17260 1050 IUO 5015 19 54000 I 27091 U3663 46100000 0.59 1I 117 1 KENA (c) 12000 7000 *200 400 0 0 96 20000 1 10139 14160 21161000 0.61 1 1la IRWNDA () O0 *0 970 0 0 0 100 1001 025 640 5757000 0.11 1 I I TOTAL 50060 306o0 26450 1650 IO0 5901 216 77050 1 56465 40671 75100000 0.53 1 I I SOIIhI AFRICA I I Il I I 120 1 OTSWANA (c) * 600 1600 0 11 48 29 4100 1 2727 5742 990000 2.75 1 121 1 MADAGASCAR (e) 10400 SW 1500 0 0 0 1400 16000 1 7920 11310 9906000 0.79 1 124 1 TANAMIA () 14500 4100 6O5 0 0 170 160 10000 1 11401 155UU 22462000 0.61 1 125 I ZAM(IA 2600 52 0O 0 0 0 2055 2000 1 2460 4067 673000o O. I 126 1 ZIMAO (a) 510 *00 2410 0 0 0 199 10000 I 4577 6310 12000000 0.6 I I I I I I I TOTAL SOUIIRN AFRICA t610 6022 12216 0 11 215 4665 50100 1 29166 40990 62167000 O. I I I I I I I GRAND TOTAL 104176 65699 69424 5628 2651 6077 7659 264069 1 99101 129040 207094930 0.40 1 N..a() * 100 (5) 1a 4 % (451905~~~~~~~~~~~~~~~~~~~~~~~~~~~~o2 STATISTICAL DATA ON VETERINARY HEALTH CARE IN A NUMBER OF SSA COUNTRIES (1985-1988) Izmmuininsuauin.aaamauIuw----…___________________~~~---- ------------- I I ==a_ =ww _ _ _ _~~ I I II I COUNTRY I Veterlnarla STAFFING STRUCTURE I I and VLU PFr VLU Per I I I other klor Medium lovel Privat. V-t. Other support Tot&l Vterinrrian support staff I I I level suportI | - m... ..... ........... |====uaa~us - -- a=__===_____________ II1 I BENIN (a) I $1 *w2 ~160 416 13949 4737 1 2I 21 BRKINA (b) I 190 10 - 309 629 19321 9U32 1 1 I CAAEROIN (b) I 112 296 4 *97 1004 44473 6584 1 14 1 C.A.R (b) I 46 287 - 3U 349 43060 0636 1 III CH"D (b) I 79 76 - 616 971 68348 4990 1 I 6 I COTE O'IVOIRE (a) I so 222 6 1161 1441 20724 609 1 16I GHANA (a) I 100 500 1000 1600 17122 1141 1 I 01 GUINEA (b) I 150 485 - 562 1140 12067 1942 1 110 I MALI (b) I 244 260 1 647 1161 26706 6916 1 Ill I MAIRITMIA (b) I 41 102 - 123 286 76196 13702 1 112 1 NICER (b) I *0 301 - 320 680 92636 8601 1 114 I SENEGAL (b) I 174 290 6 451 906 1B269 4340 1 I I TOTAL 1 1346 3040 10 6172 106C7 29367 4233 1 I I EASTERN AFRICA I II I I I I I 4- 116 I ETHIPIA (c) I 99 64 - 976 1166 342061 16376 1 0' 117 1 KENYA (c) I 509 462 4 4347 5304 279a6 1467 1 113 I RgANDA (a) I 41 234 - ll 68 20433 936 1 I I TOTAL I 649 770 4 633 7062 76302 36C3 1 I I SOUTHERN AFRICA I I I . I 120 I BOTSANA (c) I 26 201 a 392 a1 14960 3704 1 121 1 MADAASCAR (C) I 63 193 4 632 936 179624 6061 1 124 I TANZANIA (c) I 148 46 9 2870 2567 106776 3146 1 126 I ZAMBIA (c) I 2U 522 0 70 326 17232 4629 1 126 1 ZIMSA3ll (1) I 5 160 35 2660 2766 114729 1169 1 I I TOTAL SOUTHERN AFRICA I 522 1112 51 6072 7706 78612 2975 1 I I GRAND TOTAL I 2616 4922 71 17677 25316 61407 2900 1 Mote: (a) * 1907 (b) 1906 (c) - 196 (d) 19064 t.n nx 4- STATISTICAL DATA ON VETERINARY HEALTH CARE IN A NUMBER OF SSA COUNTRIES (1985-1988) I _ I I _;= =--;:=ou= I I I ALLOCATION OF I COUNTRY I EXENDITURES I I Salaries Other Costs Salares Other Coets Ewchange Salary Budget Other Budget I I I(Through Natloal Budget) (local currency) rate (US$) (US$) I I 1 I MNIN I I 9I.1X 1.91 316000000 6000000 300.00 1060000 20000 1 1 2 1 DUKINA 1 99.21 0.61 567193000 5000000 300.00 1967310 16007 1 I I I CAHEROON b I 74.61 24.41 3001000000 916000000 300.00 10003333 3063333 1 I 4 I C.A.R b I 76.01 26.0 226000000 76000000 300.00 760000 263333 1 I S I CHAD (h) 1 72.61 27.4X 303000000 116000000 800.00 1026667 388607 1 1 a I COTE D'IVOIRE (.) I 37.51 02.5X 2100000000 3600000000 J00.00 7000000 11666607 I I O I GHANA ( I 46.91 61.11 255104000 200874000 190.00 1343074 1404600 I 1 9 I GUINEA (b I MA MA MA NA 426.00 NA NA I 110 I MALI (bI 90.7X 9.3X 740100000 76000000 300.00 2467000 263333 1 II 1 IMANITANIA Ib I 71.9ff 26.11 66000000 21900000 76.00 736042 206168 1 112 I UlQEa (6 I 50.21 40.6X 220096000 166007000 300.00 766500 520290 1 114 1 SENEGAL (b) 37.01 13.01 1060007000 161310000 300.00 3802023 637700 1 I I TOTAL I 62.51 87.5X 30701909 18400746 1 I I EASTERNt AFRICA I I I I I 116 I ETHIOPIA (c) I MA MA NA NA 2.07 NA MA I 117 1 KENYA (|) 1 64.31 45.7X 9308096 7896079 1.00 9368696 7096079 1 110 I RWANDA (a) I 09.31 30.71 27573640 12200960 75.00 307647 162000 1 1 1 TOTAL I 64.71 46.81 9736343 8068369 I 1 I SOuTHEN AFRICA I I I I I 120 1 BOTSWANA (c) I 46.21 63.61 9698600 11308400 1.70 6706000 6652000 1 121 1 MADAGASCAR (c) I 74.11 25.91 1200000000 440000000 1430.00 .681119 307692 1 124 1 TANZANIA (a) I 59.41 40.60 141290000 96576000 906.00 1471771 1006021 1 125 I ZAMBIA (c) I 70.21 29.61X 11709409 4978400 12.70 922000 392000 1 16 1 ZIMBASWE (I) 1 2.91 47.11 16000000 16000000 1.60 10000000 8888689 1 1 1 I 52.41 47.6X 18979090 17246602 1 1 1 TOTAL SOUTHERN AFRICA I I I I I I I GRAND TOTAL I 57.61 42.4X 69410142 43706709 1 --------------------------------------------------------------------------------------------------__________________________ Note: (a) * 107 (b) * 1900 (C) * 1965 (d) 1904 0 1-h STATISTICAL DATA ON VETERINARY UETH CARE IN A NUMBER OF SSA COUNTRIES (1985-1988) I_ I ___--Itu;==s===sUss I I I VETERfINAY IAUBS VETERINARY OIIU EXPEEITURES ON VETERINRY I NLUER OF VACCINATIONS I I ChIOTIRY I PWCNAS PCHASED DRUS PER T*W I I I I 2y 0,.,....t. I Cattle S. Ruminantr I I I (Lesel Cunry) (US S) (US 2) I N I I I Rp Cony. PCII other WPR I I I 1 35MM (a) I U9600000 FCFA 1 112000 1 0.07 1 64355 64 622004 1214ChJ 120757 1 1 2 1 euKI"A (b) I 227700274 FCFA I 792007 * 0.22 1 13*4922 49 1293040 906521 93247 1 I a I CA_E (b) I SS0000 FCFA 1 1200000 1 0.24 1 2000000 49 1460000 0 75000 I 141 C.A.l (6) I 461000000 FCFA I 1040000 1 0.24 1 127101U 71 005000 000000 0 I I I I CHAD (6) I OI000000 FCFA I 20UU53 1 0.0 1 2190091 OC 300000 200000 40623 1 I 6 I COTE * IVOIRE (.) I 801000000 FCFA I 1005555 1 1.04 1 006720 72 2642 172000 161194 1 I 9I CUAN (a) I 4f7100S CfDIS I 1623200 1 1.41 1 411000 42 104000 21000 0 1 I* 0INA (b) I - fS I - I - I Na - No 20034 109031 I 110 I MALI (b) I 560 236 FCFA I 16OO44 1 0.27 1 1822771 40 129569 1027997 71930 1 111 1HUUITA II (b) I _0000W 1 28158 1 0.09 I Na - No 413500 270000 1 112 1 NI96R (b I I 100000000 FCFA I 585550 I 0.10 I Na - No 2926874 067340 1 114 1 SENEOAL (b I 203060164 FCFA I 0005U 1 0.27 I 1636000 61 1630000 244100 46900 I I I TOTAL I 1 10221594 1 0.12 111902600 42 7490811 0205979 2100920 1 I I I I I I I 1 1 EASTERN AFRICA I 1 I I I Il I I I JI. I1 I 114 I ETHIOPIA (e) I - I O I 0.00 I No - No - - I III I KENY (C) I 17000000 KWOUND I 17000000 I 1.56 1 2536974 24 446067 2600000 436712 1 II$ I RW"A (a) I SOOOOOO tft I O6 647 I 1.07 1 Na - No 001262 132800 1 I ITOTAL I 1 1706411 1 0.40 1 1 II SIUIEN AFRICA I I I I I II I I I I I 120 1 0OTSAU (e) I - I a I 0.00 1 1057000 125000 1 121 1 MADAG4SCAR ( I _0 *00 1 419350 I 0.06 1 2114957 1200000 1 124 1 TANZANIA I 60000000 ta" I 700a88 I 0.02 1 6900092 10914 1 I AUIA (c) I - I 0 1 0.00 I - - I ISO I E (a) I I 01 0.00 I I II I I I I I I I TOTAL SWUIE AFRICA I I 7501014 1 0.20 1 1 I I I 1 1 1 1 I IOUR TOTAL I I 27638000 1 0.20 1 1 N.ts (a) * 1367 ss*1 .4~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~o I Z ------- - -- - - ---- -- - - ------ ------- ------ ------ ------- ------ ------ ------- ------ ------ ------- ------ ------ ------- ------ ------ Iml~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ * -- -- -- -" -- -- b- - - - - - - - - - m - - - - - - - ''' | | g§t1 | g g- - - - - E~~~~~~~~~~~~~ rt~~~~~~r - - a -~~~~~~~~~~~~~~~~~~~~~~~r- ' - i C ; - a Ct: 5 t ; t_ 3~~~ et~~~~~~~~I 'C~~~~~~l * 0 > 3 . 0,*eI _ . . . ,'g* ....... 1|. § |i||gt * L4~0 * .. ,"§¢.,srzv '4.i: i | IY | X"§8Iit .1 mcZ5uIII r '4~~~~ Pr r - 30 I ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~~~~ - -- - - - - - -E; - - -. s -E - - - - -e -> - ---- X U N_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ _ _______________[______ z 6 y I j0 1 9>Pd '. 1d3-;g~~~~~~~~~~~~I .~ Itu 9Xzv --------___-____________~~~~~~ - 6q -~~~~~~~~~~~~~~~~~~~~~~~~~~~~f Distributors of World Bank Publications ARGENTINA FINLAND MEXiCO 7 or ncsr Caeto Hirls. 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Bo 1141 CapeTonw(D00 RECENT WORLD BANK TECHNICAL PAPERS (continued) No. 100 Veldkamp,RecommendedPracticesforTesting Water-Pumping Windmills No. 101 van Meel and Smulders, Wind Pumping: A Handbook No. 102 Berg and Brerns, A Case for Promoting Breastfeeding in Projects to Limit Fertility No. 103 BanerJee, Shrubs in Tropical Forest Ecosystemns: Examples from India No. 104 Schware, The World Software Industry and Software Engineering: Opportunities and Constraints for Newly Industrialized Economies No. 105 Pasha and McGarry, Rural Water Supply and Sanitation in Pakistan: Lessons from Experience No. 106 Pinto and Besant-Jones, Demand and Netback Values for Gas in Electricity No. 107 Electric Power Research Institute and EMENA, The Current State of Atmospheric Fluidized-Bed Combustion Technology No. 108 Falloux, Land Infornation and Remote Sensing for Renewable Resource Management in Sub-Saharan Africa: A Demand-Driven Approach (also in French, 108F) No. 109 Carr, Technology for Small-Scale Farmers in Sub-Saharan Africa: Experience with Food Crop Production in Five Major Ecological Zones No. 110 Dixon, Talbot, and Le Moigne, Dams and the Environment: Considerations in World Bank Projects No. 111 Jeffcoate and Pond, Large WaterMeters: Guidelinesfor Selection, Testing,andMaintenance No. 112 Cook and Grut, Agroforestry in Sub-Saharan Africa: A Farmer's Perspective No. 113 Vergara and Babelon, The Petrochemical Industry in Developing Asia: A Review of the Current Situation and Prospects for Development in the 1990s No. 114 McGuire and Popkins, Helping Women Improve Nutrition in the Developing World: Beating the Zero Sum Game No. 115 Le Moigne, Plusquellec, and Barghouti, Dam Safety and the Environment No. 116 Nelson, Dryland Management: The "Desertification" Problem No. 117 Barghouti, Timmer, and Siegel, Rural Diversification: Lessons from East Asia No. 118 Pritchard, Lending by the World Bankfor Agricultural Research: A Review of the Years 1981 through 1987 No. 119 Asia Region Technical Department, Flood Control in Bangladesh: A Plan for Action No. 120 Plusquellec, The Gezira Irrigation Scheme in Sudan: Objectives, Design, and Performance No. 121 Listorti, Environmental Health Components for Water Supply, Sanitation, and Urban Projects No. 122 Dessing, Support for Microenterprises: Lessons for Sub-Saharan Africa No. 123 Barghouti and Le Moigne, Irrigation in Sub-Saharan Africa: The Development of Public and Private Systems No. 124 Zymelman, Science, Education, and Development in Sub-Saharan Africa No. 125 van de Walle and Foster, Fertility Decline in Africa: Assessment and Prospects No. 126 Davis, MacKnight, IMO Staff, and Others, Environmental Considerations for Port and Harbor Developments No. 127 Doolette and Magrath, editors, Watershed Development in Asia: Strategies and Technologies No. 128 Gastellu-Etchegorry, editor, Satellite Remote Sensingfor Agricultural Projects No. 129 Berkoff, Irrigation Management on the Indo-Gangetic Plain No. 130 Agnes Kiss, editor, Living with Wildlife: Wildlife Resource Management with Local Participation in Africa No. 131 Nair, The Prospects for Agroforestry in the Tropics No. 132 Murphy, Casley, and Curry, Farmers' Estimations as a Source of Production Data: Methodological Guidelines for Cereals in Africa No. 133 Agriculture and Rural Development Department, ACIAR, AIDAB, and ISNAR, Agricultural Biotechnology: The Next "Green Revolution"? The World Bank Headquarters European Office Tokyo Office 1818 H Street, N.W. 66, avenue d'Iena Kokusai Building Washington, D.C. 20433, US.A. 75116 Paris, France 1-1 Marunouchi 3-chome C Chiyoda-ku, Tokyo 100, Japan Telephone: (202) 477-1234 Telephone: (1) 40.69.30.00 M Facsimile: (202) 477-6391 Facsimile: (1) 47.20.19.66 Telephone: (3) 3214-5001 Telex: wuLi 64145 WORLDBANK Telex: 842-620628 Facsimile: (3) 3214-3657 RCA 248423 WORLDBK Telex: 781-26838 Cable Address: NlTBAFRAD WASHINGTONDC CD W t-1 o rD CD tz Cover design by Walton Rosenquist ISBN 0-8213-1773-3