Typological analysis of public-private partnerships in the veterinary domain

Striving for long term sustainability - is it time we changed our approach to animal health in low- and middle-income countries?

Animal health and agricultural productivity in low- and middle-income countries have been the focus of research for development (R4D) projects for decades, with varying levels of success when considering the long-term sustainability of interventions. Many of these projects have been funded, designed and implemented by researchers from high income countries, and therefore risk neglecting the cultural nuances and complex country histories that can influence their success. This opinion piece suggests three broad recommendations: (1) implementing culturally congruent practices to improve disease control and prevention practices at the village level; (2) promoting public-private partnerships to improve control of transboundary animal diseases; and (3) improving national animal health and veterinary services and their governance to improve disease surveillance, control and prevention. Development researchers need to consider implementing these approaches in future projects to improve the suitability and sustainability of interventions and acknowledging the current technical capacity of host countries. Foreign donor organisations need to ensure their funding guidelines and reporting requirements allow for these recommendations to be adequately implemented.

Access to Veterinary Drugs in Sub-Saharan Africa: Roadblocks and Current Solutions

Background

Access to veterinary drugs for livestock has become a major issue over the last decade. Analysis has tended to focus on the demand for these products, while studies looking at the drivers behind their use generally focus on farmer behavior and interactions between veterinarians and farmers. However, the use of drugs also depends on structural factors that determine the functioning of the drug supply chain and farmers' access to the drugs. This article presents an overview of the factors that limit access to veterinary drugs in sub-Saharan Africa (SSA) as well as the international policy tools and arrangements that claim to improve it.

Methods

We have conducted a scoping review of the scientific and grey literature as well as the publicly-available data from both the animal health industry and international organizations. We aimed to gather information on the veterinary drugs market in SSA as well as on the international norms, recommendations, guidelines, and initiatives that impact SSA farmers' access to these drugs.

Findings

We highlight numerous barriers to veterinary drug access in SSA. The SSA market is highly dependent on imports, yet the region attracts little attention from the international companies capable of exporting to it. It suffers from a high level of fragmentation and weak distribution infrastructures and services, and is driven by the multiplication of private non-professional actors playing a growing role in the veterinary drug supply chain. The distribution system is increasingly dualized, with on the one hand the public sector (supported by development organizations) supplying small scale farmers in rural areas, but with limited and irregular means; and on the other side a private sector largely unregulated which supplies commercial and industrial farming systems. Different innovations have been developed at the international and regional levels to try to reduce barriers, such as homogenizing national legislations, donations, and vaccine banks. Alongside decades-old inter-state cooperation, many new forms of public-private partnerships and other hybrid forums continue to emerge, signaling the private sector's increasing influence in global governance.

Conclusions

Policies on animal health would be bolstered by a better understanding of the drivers behind and the components of access to veterinary drugs in different regional and national contexts. Inequalities in drug access need to be addressed and a market-driven approach adopted in order to strengthen our understanding of what determines veterinary drug use at the farm level. Policies should balance the interests of the various stakeholders, being careful not to reinforce bias toward certain diseases deemed "interesting" and neglect others that could prove to be highly important for veterinary public health.

Evaluation of Public–Private Partnership in the Veterinary Domain Using Impact Pathway Methodology: In-depth Case Study in the Poultry Sector in Ethiopia

Public–private partnerships (PPPs) in the veterinary domain are joint approaches in which public veterinary services and private actors such as private veterinarians, producers' associations, or private companies work together to address complex animal health challenges. They are implemented worldwide and can help to strengthen the capacities of veterinary services, but few have been evaluated. None of the evaluations developed in the veterinary domain explicitly addressed PPPs, their complex program design, their evolving governance, and coordination system, and their impacts. This work represents the first application of the participatory impact pathway methodology for the evaluation of a PPP in the veterinary domain. The PPP evaluated aimed at developing the poultry sector in Ethiopia and improving poultry health service coverage, particularly in remote areas. The combination of semi-structured interviews (n = 64) and collective reflection during three workshops (n participants = 26, 48, 18), captured the viewpoints of public and private partners, actors who influenced the partnership, and actors impacted by it. The context of the PPP was analyzed, and the causal relationships between the PPP and its impacts were investigated. This work showed that collaboration between the public and private sector occurred at several administrative levels. The actors considered a variety of impacts, on the economy, business, trust, and health, which were then measured through different indicators. The actors also identified the added value of the PPP to enrich those impacts. The participatory impact pathway methodology helped to strengthen the engagement of actors in the PPP and to formulate recommendations at the policy level to favor positive results. This case study represents a milestone in building a participatory evaluation framework of PPP in the veterinary domain.

Understanding the veterinary antibiotics supply chain to address antimicrobial resistance in Lao PDR: Roles and interactions of involved stakeholders

In response to the global call to mitigate risks associated with antimicrobial resistance (AMR), new regulations on the access and use of veterinary antibiotics are currently being developed by the Lao government. This study aims to explore how the implementation of these new regulations might effectively reduce and adapt the sale, distribution and use of veterinary antibiotics in Lao PDR. To this end, we used the theory of change, framing the AMR issue within the context of the stakeholders involved in the veterinary antibiotics supply chain. Qualitative and quantitative methods were used to collect data, based on questionnaires (n=36 antibiotic suppliers, n=96 chicken farmers, n=96 pig farmers), and participatory tools such as a workshop (n=10 participants), semi-structured interviews (n=20), and focus group discussions (n=7 participants). The stakeholders' understanding of the AMR issue and potential challenges related to the implementation of new regulations regarding access and use of antibiotics, were also investigated. We mapped the veterinary antibiotic supply chain in Lao PDR, and analysed the roles and interactions of its stakeholders. Twenty-three stakeholders representing the private and the public sectors were identified. Many informal and formal links connected these stakeholder within this supply chain. The lack of veterinarian-farmer interaction and the evolving nature of the veterinary antibiotics supply chain accentuated the challenges of achieving behaviour change through regulations. Most of the antibiotics found on farms were categorized by the World Health Organisation's as critically important antibiotics used in human medicine. We argue that AMR risk mitigation strategy requires dialogue and engagement between private and public sectors stakeholders, involved in the importation, distribution, sale and use of veterinary antibiotics. This study further highlighted that AMR is a complex adaptive challenge requiring multi-sectoral approach. We believed that a sustainable approach to reduce and adapt veterinary antibiotics use should be prepared in collaboration with stakeholders from private and public sectors identified in this study, in addition to the new regulations. This collaboration should start with the co-construction of a common understanding of AMR issue and of the objectives of new regulations.

An evaluation tool to strengthen the collaborative process of the public-private partnership in the veterinary domain

Public-private partnerships (PPPs) in the veterinary domain are widely implemented worldwide and can help to strengthen the capacities of Veterinary Services. Few analyses have been made of these initiatives. This study is aimed at developing an evaluation tool based on participatory approaches and focusing on the quality of PPP processes in the veterinary domain. The tool was divided into ten sections relevant to PPP process organisation and activities. The 44 evaluation criteria and six quality attributes (operationality, relevance, acceptability, inclusiveness, adaptability, and stability) were identified based on literature review and case-study application. The tool was adjusted during four regional PPP training workshops bringing together stakeholders from both public and private sectors. Finally, the tool was validated through an experts' elicitation process and applied in the field in Paraguay. The tool was developed in a non-normative perspective to help the partners adapt the PPP to their specific context, to maximize the opportunities and minimize the risks of such collaborations, and to formulate adapted recommendations to strengthen and improve the PPP collaborative process and thus the outcomes. In an ex-ante perspective, this tool would also help public and private actors to engage and develop a PPP process following the best possible practices. The aim of this tool is to help decision making in terms of PPP development and implementation in the veterinary domain to ensure the added value and relevance of such a collaborative approach in different countries worldwide.

A Qualitative Analysis of the Commercial Broiler System, and the Links to Consumers' Nutrition and Health, and to Environmental Sustainability: A South African Case Study

Food systems face growing challenges to meet targets of Zero Hunger (SDG 2), and South Africa is no exception given its triple burden of malnutrition, foodborne disease outbreaks, and threats of climate change to food production. Broiler meat is South Africa's most affordable meat option, supporting household food and nutrition security. Although considered healthier and less environmentally harmful than ruminant meat, it is not without food safety risks and environmental impacts. This research aimed to present the foremost commercial broiler system narratives in South Africa, around targets of SDG 2, and to discuss key considerations for policymakers. Twenty-nine key informants and stakeholders, purposively selected to cover a wide range of opinions, participated in semi-structured interviews. Transcripts underwent a qualitative framework analysis. Results showed a highly efficient system, dominated by a small number of interlinked large-scale actors, vulnerable to competition from cheaper imports, yet pressurized to maintain high food safety and environmental impact standards, with a price-sensitive consumer base. Existing policies lack integration and enforcement capacity, and are undermined by siloed government departments, and mistrust and power struggles between public and private sectors. We propose removal of silo walls, and trust building through participatory policy development, with collaborative and transformative public-private partnerships that are designed to build capacity to deliver sustainable solutions.

Brucellosis in dairy herds: Farm characteristics and practices in relation to likely adoption of three potential private-public partnership (PPP) vaccination control strategies in West and Central Africa

Brucellosis is regarded as one of the highest burden zoonotic diseases to persist in many regions globally. While sustained vaccination against B. abortus in an endemic setting can markedly reduce the prevalence of large ruminant and human brucellosis and benefit local livelihoods, the implementation of effective and sustainable control programmes has often failed in the worst affected areas. In a cross-sectional study of 728 peri-urban dairy farmers in nine areas of six West and Central African countries, levels of commercialization and farm characteristics were examined alongside B. abortus seroprevalence estimates to hypothesize the most appropriate model for brucellosis vaccination delivery in each country. Demographic and economic data were collated and used to describe the farming systems currently in place. Furthermore, these data were utilized in a likelihood assessment to generate a quantitative score to hypothesize which of three private-public partnership (PPP) vaccine delivery models, that is 1) transformative, 2) transactional or 3) collaborative, would be most appropriate in each setting. The study sites had substantial differences in their levels of dairy commercialization and the farming practices employed; the heterogeneity across the study sites was evident in the conclusions of which models would be appropriate for vaccination delivery. While Lomé (Togo) had a strong indication for a transformative PPP model, Burkina Faso had strong indication for the collaborative PPP model. Of the remaining study sites, the scores were less dominant for any one model with Cameroon and Ivory Coast sites only just scoring highest on the transformative model and Senegal and Mali sites only just scoring highest on the collaborative model. Interestingly, none of the countries included in the study scored highest on the transactional model which currently is the most commonplace delivery model in the majority of sub-Saharan African countries.

Knowledge and remaining gaps on the role of animal and human movements in the poultry production and trade networks in the global spread of avian influenza viruses - A scoping review

Poultry production has significantly increased worldwide, along with the number of avian influenza (AI) outbreaks and the potential threat for human pandemic emergence. The role of wild bird movements in this global spread has been extensively studied while the role of animal, human and fomite movement within commercial poultry production and trade networks remains poorly understood. The aim of this work is to better understand these roles in relation to the different routes of AI spread. A scoping literature review was conducted according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) using a search algorithm combining twelve domains linked to AI spread and animal/human movements within poultry production and trade networks. Only 28 out of 3,978 articles retrieved dealt especially with the role of animal, human and fomite movements in AI spread within the international trade network (4 articles), the national trade network (8 articles) and the production network (16 articles). While the role of animal movements in AI spread within national trade networks has been largely identified, human and fomite movements have been considered more at risk for AI spread within national production networks. However, the role of these movements has never been demonstrated with field data, and production networks have only been partially studied and never at international level. The complexity of poultry production networks and the limited access to production and trade data are important barriers to this knowledge. There is a need to study the role of animal and human movements within poultry production and trade networks in the global spread of AI in partnership with both public and private actors to fill this gap.