3. Results
3.1 Characteristics of VAHW participants
Due to time and resource constraints, a total of 198 VAHWs participated
in the survey, with 43% (n = 85) from Prey Chhor district in KC, and
14% (n = 27) from Sampov Meas district plus 39% (n = 78) from Bakan
district, both in PS. Eight VAHWs (4%) from neighbouring villages in
Korn Dieng district in PS also participated in the study. The majority
of VAHWs were males (91.4%, n = 181) (Table 1) of mean ages 43 (SD =
9.32) and 47 (SD = 8.44) in KC and PS, respectively.
>Insert table 1<
This indicated a clear male-domination of local animal health services
in these rural communities. The male VAHWs were asked to explain why few
female villagers sought this job, with responses on contributions to low
female VAHW numbers including fear of travelling alone within the
community (89%, n = 161); culture and tradition forcing women to manage
household affairs (86%, n = 156); low confidence in working with large
animals (80%, n = 145); and lack of communication skills (76%, n =
138). Most of the VAHWs in the study areas had a better education in
comparison to other farmers within the villages. All of the 198 VAHWs
participating in this study responded to the question of education. Of
these, 28% (n = 55) and 34% (n = 67) had completed primary school,
42% (n = 83) and 51% (n = 101) secondary, and 25% (n = 49) and 13%
(n = 26) high school in KC and PS, respectively. Only six VAHWs in both
study provinces had completed tertiary education. In addition to their
role as VAHWs, most participants in both study areas (89%, n = 176) )
were directly involved in farming activities. A small proportion of the
VAHWs were also government officials or managed small businesses.
Two-thirds of the VAHWs worked mainly with large ruminants (cattle)
rather than small animals and poultry. It was noted that demand for
animal health services for small animals and poultry was very low, with
farmers considering treating these animals as unjustified.
3.2 Household assets and financial situation
The majority of VAHWs owned rice fields. The mean average area in PS was
3.0 ha (SD = 0.9 ha) compared to 1.1 ha (SD = 0.8 ha) in KC. One-quarter
of VHAWs in KC and half in PS owned land for other crops (1.0 and 0.7
ha). VAHWs in PS owned slightly more village chickens (33; SD = 31) and
ducks (25; SD = 54) on average than VAHWs in KC. The VAHWs in KC owned
slightly more pigs (6.9; SD = 8) on average than VAHWs in PS. VAHWs
owned an average of 4 cattle (SD = 3) in both study areas. Of 85 and 113
VAHWs, 6% (n = 5) and 18% (n = 20) reported they had not owned any
cattle in KC and PS, respectively. As only 10 VAHWs in PS had raised
buffalo with cattle, buffalo were excluded from the study. Nearly
one-third of VAHWs in KC had borrowed money (31%, n = 26) in 2013,
although the proportion was higher in PS (53%, n = 60). The majority of
VAHWs not borrowing money stated (90%, n = 53) in KC and (87%, n = 46)
in PS that they had no need, with a small proportion mentioning that
high-interest rates and the unwillingness of moneylenders to provide a
loan were their primary reasons. Of the VAHWs borrowing money, less than
20% used the money to buy animals, with 19% and 8% using the money to
buy veterinary equipment, drugs, and vaccines in KC and PS,
respectively. The purchase of agricultural materials was an important
reason for most VAHWs in KC (42%) and PS (60%) with other purposes, as
reported by VAHWs, summarised in Table 2.
>Insert table 2<
3.3 Training and experiences
The majority of VAHWs were trained by the technical staff from the POAHP
(74%), with the remaining participants trained by technical staff from
DAHP (22%) and Non-Government Organisations (NGOs). During their time
as VAHWs, 67% (n = 57) in KC and 89% (n = 101) in PS had received
refresher training on animal health and production. The participating
VAHWs had provided animal health services to livestock smallholder
farmers for an average of 8.4 (SD = 4.89) and 11.2 years (SD = 6.15) in
KC and PS, respectively. Many VAHWs in both study provinces had a good
level of experience, with 40% (n = 79) having more than a decade. The
majority of the VAHWs admitted that they enjoy their work as local
animal health service providers in their communities.
3.4 Sources of household income in 2013
In general, the incomes of VAHW households varied between the study
areas. The mean annual household income in 2013 was USD 1,627 (USD 75 -
USD 8,110, SD = 1,401.8) in KC and USD 1,593 (USD 50 - USD 7,050, SD =
1,269.5) in PS. The total income of the VAHW household was sourced from
5 main categories: agricultural cropping (rice and other crops),
off-farm employment, sale of animals, animal health services, and
vaccination services. Rice and other crops were the dominant income
source in KC (41%) and PS (60%). The remaining income sources in KC
and PS were off-farm employment (21%; 11%), sale of animals (17%;
16%), animal health services (20%; 9%), and vaccination services
(1%; 4%). Thus the proportion of VAHW annual household income
generated from their provision of animal health services was found to be
approximately 21% and 13% in KC and PS, respectively.
3.5 FMD vaccination experiences and practices
The majority of VAHW (96%, n = 190) stated that the primary purpose of
vaccination is to protect animals against preventable diseases. However,
approximately one-third of the VAHWs (34%, n = 67) also believed that
vaccination helped the animal gain weight and grow faster, and
one-quarter of VAHWs (25%, n = 49) thought vaccination could help treat
sick animals. Nearly all surveyed VAHWs believed that only healthy
animals should receive the vaccination. When asked for vaccination
services on their animals during the last three years (2011 - 2013),
most of them reported vaccinating their animals against HS, while only
one-third vaccinated their animals against FMD in 2013 (Figure 3).
>Insert figure 3<
The study identified that there were no private HS and FMD vaccination
services provided in their communities. The majority of VAHWs reported
that HS and FMD vaccination programs were conducted through the
government-subsidised vaccination program, and only some animals in each
household herd were vaccinated against FMD and HS during the vaccination
day. Approximately two-thirds of VAHWs (64%, n = 56) reported that more
than half of the household herd was vaccinated against HS, whereas only
27% (n = 17) reported the herd was vaccinated against FMD in KC. In PS,
72% (n = 80) of VAHWs acknowledged that more than 50% of the household
herd was vaccinated against HS, whereas only 15% (n = 7) of the herds
were vaccinated against FMD. All VAHWs reported that DAHP/POAHP provided
FMD vaccines, and they were asked to provide vaccination services during
the vaccination campaign (80%). Interestingly, when asked if they have
never vaccinated their animals against HS and FMD during the three
years, the study found that 10% (n = 8) and 49% (n = 39) of VAHWs in
KC (n = 80) and 8% (n = 7) and 60% (n = 56) in PS (n = 93),
respectively, admitted that they had not. Even though VAHWs are local
animal health service providers, none of them had vaccinated their
animals every six months. Over three-quarters of VAHWs in both study
areas had vaccinated their animals against HS once every year during the
three years, while only one-third and almost half had vaccinated their
animals against FMD in KC and PS, respectively (Figure 4).
>Insert figure 4<
The main reasons for not re-vaccinating their animals every six months,
nearly one-third (29%, n = 21) of VAHW in KC and nearly half (44%, n =
38) in PS, refused to answer the question. Ranking of not re-vaccinating
animals every six months by reason (from 1 to 3 with one as most
important reason and three least important reason) found that the most
common reason was the availability of vaccine (KC 49%, n = 35; PS 35%,
n = 30), followed by the assumption that one vaccination every 12 months
was sufficient to protect the animals (KC 15%, n = 11; PS 17%, n =
15). The high price of FMD vaccine, availability of vaccines only during
the outbreak, the waiting for free FMD vaccination were also ranked as
primary reasons by the minority of VAHWs. Nearly all cattle in the age
group >3 years old and <1 year old in both study
provinces were vaccinated against HS. Nearly one-third of cattle in the
age group >3 years old were vaccinated against FMD, while a
lower proportion of younger age group of 1 - 3 years old and
<1 year old have received the vaccination (Figure 5).
>Insert figure 5<
Four main activities were identified during the provision of the service
by a VAHW, including providing animal health and husbandry advice during
the farmer household visits and the village meetings, animal treatments,
and vaccination. The relationships and responsibilities between various
stakeholders such as veterinary authorities, local authorities,
projects, vaccine suppliers, animal health service providers, and
smallholder farmers are illustrated (Figure 6).
>Insert Figure 6<
Well over half of the VAHWs (81%, n = 160) interviewed, reported that
they provided animal health services to large ruminants, 14% (n = 28)
to pigs and 6% (n = 12) to poultry more than 50% of their animal
services. Above 60% (n = 119) of VAHWs in both study areas provided
their animal health services in their villages and other villages (2 - 5
villages), while the other 25% (n = 50) provided services within their
village. The remaining 15% (n = 30) of VAHWs provided animal health
services to more than five villages. Most of VAHWs (90%) acknowledged
that other VAHWs also came to offer general animal health services in
their villages.
3.6 Association with FMD vaccination practices
Among five variables examined, there was no evidence of a relationship
between FMD vaccination practice by the VAHW and education (P = 0.141),
annual household income (P = 0.202), the number of years working as VAHW
(P = 0.524), and the number of villages covered (P = 0.490). However,
there was evidence of relationships between the age group of VAHW and
the FMD vaccination practised (X 2 = 4.321, df =
1, P = 0.041). In this case, for FMD vaccination practices, older VAHWs
were more likely to advocate for FMD vaccination when vaccines were
available from the veterinary authorities.
3.7 Vaccine cold storage and administration experiences and practices
Nearly all VAHWs reported that a cold box was an essential means of
storing vaccines. Alternatively, only a few VAHWs living close to the
district and provincial town were able to access electricity and use a
refrigerator to store vaccines with other foods and drinks. Many VAWHs
reported storing vaccines by using the cold box at neighbouring
households. Approximately one-third of VAHWs reported that they were the
only person in the family responsible for the vaccine cold box, with the
remaining participants not answering this question. However, no VAHWs
used a thermometer to monitor the temperature in the cold box. About
two-thirds of VAHWs were confident in agreeing that a temperature range
of between 2 - 8oC was an appropriate range for
vaccines, with the remaining VAHWs considering that under
2oC and above 8oC were the suitable
temperature ranges for storage of vaccines. All VAHWs were asked the
question, “did VAHWs ever get reports of adverse reactions in
vaccination programs in 2013?” and over 70% (n = 60) in KC and 50% (n
= 57) in PS advised having received complaints from farmers. Of these,
79% (n = 156) in both provinces received less than three complaints
from smallholder farmers in 2013, with the remainder having more than
three in the same period. A lump at the inoculation site was the most
common reason for the complaint identified by smallholder farmers,
followed by inappetence.
In response to questions on HS and FMD vaccination costs, the majority
of the VAHWs indicated that private vaccination was nonexistent in the
study areas. However, they believed that the cost of FMD vaccination per
head would be USD 1.3 (SD = 1.6) for HS and USD 2.1 (SD = 1.9) for FMD
if the private sector provided vaccination services. The majority of
VAHWs revealed that the actual fee that they received from the farmers
during FMD vaccination service through government-subsidised HS and FMD
programs was USD 0.2 (SD = 0.1) per head. The POAHP arranged this fee to
help cover the operational cost of the vaccination program. The mean
recovery period for FMD was reported to vary from 9 days (SD = 7.2) to
23 days (SD = 20.8). The average cost for treating FMD infected animals
was estimated at between USD 18.7 (SD = 13.1) to USD 34.7 (SD = 25.7)
per head. The majority believed that the possibility of recovery rate
was higher in adults (80%) than growing steers or heifers (50%).
Nearly three-quarters of VAHWs advised they had not received any
training or information on the impacts of losses due to FMD or the
economic benefits of control programs, with the remaining VAHWs not
responding to this question.
3.8 Number of VAHWs reported by the POAHP
The number of villages and VAHWs stratified by year and province between
2011 and 2020 at 10 year intervals is displayed (Table 3). There were
considerable variations in the total number of VAHWs distributed in each
province, including the number of female and percentage VAHWs between 25
provinces and municipality and the total number of VAHWs in the country
between 2011 and 2020. The number of VAHWs in Thbong Khum province is of
interest as this province was formed when Kampong Cham province was
split in two by a Royal Degree on 31st December 2013.
Thus the number of VAHWs in Tbong Khmum was zero prior to 2014. It is
also notable that the number of VAHWs decreased in 18 provinces (72%)
between 3% - 72%, increased in 4 provinces (16%) between 1.5% - 63%
and remained the same in 3 provinces (12%) in 2020 when compared to
2019. These findings indicate that there has been a considerable decline
in the number of VAHWs in the most recent two years, and is a concerning
trend. The proportion of female VAHWs was consistently low throughout
the period of 10 years between 2011 to 2020, with the mean at 8.26% (SD
= 1.019). The reasons provided as to why females did not want to become
an VAHW, was investigated with the chiefs and vice chiefs of 15 POAHPs,
including two female chiefs. They reported the reasons as follows: low
confidence in working with large ruminants (56.3% - 78.4%); travel,
personal security and safety concerns (52.3% - 69.6%); Khmer cultural
issues (40.4% - 55.6%); and negative influences from family members
(12.4% - 19.4%).
>Insert Table 3<
The VAHWs records indicated that the total number of VAHWs fell slightly
from 12,420 in 2017 to 11,786 in 2018, 11,747 in 2019, and then dropped
to 8,920 in 2020. The total number of VAHWs in 2020 declined by 28.2%,
24.4% and 24.1% compared to 2017, 2018 and 2019, respectively. The
number of females was consistently very low, declining from 1,039
(8.4%) in 2017, to 971 (8.3%), 927 (7.9%) and 581 (6.2%) in 2018,
2019 and 2020, respectively. The number of VAHWs considered as active,
was also consistently low, at 5,328 (42.7%), 5,326 (45.0%), 4,150
(39.0%) and 4,915 (55.1%) in 2017, 2018, 2019 and 2020, respectively
(although it is noted that the POAHP only commenced recording the number
of active VAHW from 2017). The mean proportion of female VAHW (6.45% -
8.41%) and active VAHW (40.25% - 55.66%) in each province and between
2017 and 2020 is provided (Table 4). The low proportions of both active
and female VAHWs reported by the POAHP throughout the last 4 years
(between 2017 to 2020) are of concerns, particularly as males remain the
dominate gender of the majority of VAHWs in the country during the past
10 years.
>Insert Table 4<
Following examination of the VAHW records, 5 provinces with the highest
‘dropout’ rate were selected for further analysis. In 2020, the
proportion of VAHWs had dropped by 67.5%, 66.7%, 57.6%, 43.5% and
35.9% in Mondulkiri, Kandal, Siem Reap, Kampong Cham and Battambang
provinces when compared to 2019, respectively. The most common reasons
why VAHWs ceased their activities in 2020 is displayed (Figure 7). An
investigation of the reasons why so many VAHWs ceased their activities
in these 5 provinces, the chiefs of the POAHP reported the reasons as
follows: they did not want to continue their jobs as local animal health
services provider (52.1% - 71.5%); migration (14.3% - 38.4%); home
relocation (0% - 15.9%); and increasing age or death (1.7% - 8.9%)
(Figure 7).
>Insert Figure 7<
3.8 Perceptions of VAHWs on importance of diseases and vaccination
VAHWs were perceived to have an essential role in assisting the
DOAHP/POAHP in the provision of primary animal health services to
smallholder farmers in their communities. In considering the
effectiveness of past vaccination programs, four possible factors for
effectiveness were identified and ranked from very important to not
important. Most VAHWs acknowledged that splitting doses of vaccine, poor
quality of vaccines, poor crush sites, incorrect storage of vaccines,
and prolonged vaccination times are very important factors for
vaccination success in both studies areas. The majority of VAHWs
believed inadequate knowledge of diseases and vaccination (92%, n =
182) by farmers was an important factor preventing them from
participating in the vaccination programs, followed by poor vaccination
campaigns administration and lack of accessibility to FMD vaccines
(Table 5). The majority of VAHWs (87%, n = 172) believed that
improvement in the knowledge of local authorities, especially village
and commune chief on animal diseases and vaccination, was a very
important factor that can be instrumental in improving future
vaccination rates in their communities. Other factors influencing the
uptake of vaccination by farmers included improved coordination and
cooperation between local authorities and the district and provincial
veterinarians, followed by improved communications enabling raising
important issues in every village meeting with farmers. Most VAHWs
advised that the POAHP/DOAHP should have appropriate planning, better
awareness programs, and good training programs for farmers. Most VAHWs
believed that the most important factors to improve the effectiveness of
vaccination programs were the need to establish appropriate vaccination
planning, using only good quality vaccines, working with different
stakeholders to get more farmer participation, and establishing
appropriate crush sites for more efficient animal restraint.
>Insert table 5<
4. Discussion
The guided group discussion survey of VAHWs (n=198) in the two study
provinces of Kampong Cham and Pursat in Cambodia provides details of
their KAP’s on animal health and disease prevention programs in their
communities. The study found that the number of female VAHWs
participation in the survey was very low (8%) although this was
consistent with the reported average percentage of female VAHWs in 2010
(8.4%) (Stratton et al., 2015), 2015
(7.7%) and 2020 (6.2%) (MAFF, 2017,
2020). The mean proportion of female
VAHWs in the country during the 10 years between 2011 and 2020 was
8.26% (SD = 1.019). The investigation with the chiefs and vice chiefs
of the ten provinces, suggested that the low female participation rate
as VAHWs was due to three main reasons: low confidence in working with
large ruminants; travel, personal security and safety concerns; and
Khmer cultural issues. These three responses provided by the chiefs and
vice chiefs of the POAHP were consistent with those provided in
interviews with the 198 VAHWs, including 17 female VAHWs.
The study identified that despite VAHWs providing local animal health
services in these provinces, the annual household incomes from these
activities were not well rewarded, contributing only an average of 21%
(KC) and 13% (PS) of the total household annual income in 2013. Crop
cultivation, off-farm employment, and the sale of animals as income
sources were shown to be more important for VAHW incomes. This is
consistent with a previous study from 2008 that identified most VAHWs
(66%) from 19 provinces earned less than 40% of their household income
from animal health and vaccination services
(Stratton et al., 2015). However, a 2015
survey of VAHWs from Takeo and Tbong Khmum provinces identified that
although incomes from VAHW activities were also generally low with
monthly incomes predominantly within the USD 48.80 – USD 97.50 income
bracket (38%), 62% of VAHW earning over USD 97.50/month had over 10
years of VAHW experience, and there also appeared to be a strong
association between income generating activities and frequency of
contact with district animal health authorities
(MacPhillamy et al., 2019).
The survey data identified that many VAHWs cease their activities for
various reasons, including the low income generated from the provision
of local animal health services. Information from the GDAHP annual
reports indicated that nationwide, the number of VAHWs had decreased in
2020 (8,920) by 28% and 27% compared to records from 2011 (14,861) and
2015 (12,221), respectively. The number of VAHWs continues to decline in
many provinces in the coming year (POAHP, personal communication,
December 16, 2020). Despite the decrease in the total number of VAHWs,
the recent records indicate that not all VAHWs had been providing active
animal health services and assistance to the veterinary authorities at
the district and provincial levels. The mean of active VAHW in the
country for the last 4 years (2017 - 2020) was 46% (SD = 6.735).
Personal communication with chiefs and vice chiefs of the five provinces
with higher dropout rates of VAHWs, suggested that resignation or
cessation of VAHW activities due to low incomes is the most important
reason, followed by migration, house relocation, and increasing age or
death. For the sustainability of the VAHW program, this suggests that
increasing the roles for VAHWs in their communities is required,
enabling them to earn a more reasonable and sustainable income to
support their families.
The majority of VAHWs provided their animal health services to large
ruminants rather than pigs or poultry, and these findings were similar
to the previous reports from Cambodia
(Bhandari et al., 2011;
MacPhillamy et al., 2019;
Stratton et al., 2015) and northern
Malawi (Huttner, Leidl, Jere, & Pfeiffer,
2000). It should be noted that although VAHWs may wish to provide
animal health services to poultry, farmers generally do not think it
worthwhile spending money for low-value village poultry. The study also
found that 75% of VAHWs provided animal health services to the farmers
in their village and other villages, generating more income for their
households. This suggests that more effective VAHWs could receive more
calls and generate more income from providing their services both within
and between villages during the disease outbreaks. However, it is noted
that frequent VAHWs travel and contact with different animals is a
high-risk activity for disease transmission, requiring high standards of
biosecurity practice. Currently, this knowledge of VAHWs remains
limited. The Cambodian government is aware of the usefulness of having
VAHWs serving their rural communities by delivering animal health
services including treatment and vaccinations, but also potentially in
the reporting of new disease outbreaks (cases) and contributing to a
more effective national disease surveillance system. As recently
suggested, refresher training on simple biosecurity measures for VAHWs
is very important to enhance their preventive and biosecurity activities
during household visits, and they can provide advice on this aspect to
other villagers (MacPhillamy et al., 2019;
MacPhillamy et al., 2021). The VAHWs
during the interview displayed an understanding of FMD and the purpose
of vaccination. However, the study revealed that they do not adequately
vaccinate their own livestock against that important disease, with 50%
of VAHWs have never vaccinated their animals against FMD during 2011 -
2013. The application of Chi-Square test results indicated that in this
survey, general education, annual household income, number of years
working as VAHW, and number of villages covered, were not associated
with FMD vaccination practices by VAHWs. This finding suggests that no
matter how well educated, wealthy, hardworking, and experienced is a
VAHW, this may not influence FMD vaccination uptake. However, the
analysis did indicate that uptake of FMD vaccination was associated with
the age group of VAHW.
It is likely that those VAHWs who never vaccinated their animals against
FMD may not have received the FMD vaccine from the government-subsidised
FMD vaccination program, or their villages were excluded from the
government-subsidised FMD vaccination program. Low FMD vaccination rates
as reported by VAHWs were due to limited access to FMD vaccine either at
the POAHP or local veterinary drug stores and no private sector FMD
vaccination service was provided in this survey area. As this preventive
disease program was invariably due to vaccination for large ruminant
provided for free (government-subsidised vaccination program)
previously, it is likely that VAHWs and smallholders expected this to
remain so. However, a minority of VAHWs may intend to provide, and
smallholder farmers may intend to receive private FMD vaccination,
although this is often difficult for them to organise as FMD vaccines
are expensive and only available in vials of 50 doses. This requires the
VAHWs to arrange and work with smallholder farmers seeking to have their
animals vaccinated. It is also likely that VAHWs’ unwillingness to
organise private FMD vaccination within their own communities may be due
to their perceived low benefits from providing this service,
particularly as the treatment of sick animals with antimicrobials
enables them to generate more income for the families. With limited
understanding of the benefits of providing a whole of village ‘fee for
service’ vaccination option, they may prefer to wait for the limited
government-subsidised vaccination program to be delivered, with more
opportunities to treat sick animals due to low vaccination rates,
potentially could generate more household income for VAHWs.
This field survey conducted in both study provinces involved 198 VAHWs.
There are several considerations associated with this group discussion
survey. Firstly, the results present a snapshot of activities undertaken
during three calendar years, and it is recognised that the performances
of interviewed VAHWs will change over time. Secondly, for overall
reported activities, such as treatment and vaccination, the data
obtained may be considered representative for VAHWs in the whole
province. Thirdly, there is always an issue with the accuracy of the
response as interviewed VAHWs may be reluctant to provide correct and
true information if they know it is against the existing government or
social policy or norms.
This study from 2013 confirmed that as disease prevention programs
relied on a limited budget from the veterinary authorities, subsidies
for the FMD vaccination program were inadequate to provide effective
immunological protection of the livestock population for FMD prevention
or suppression. Despite increasing availability of FMD vaccine, this
situation still exists in 2021.
Private FMD vaccination services provided by VAHWs and local
veterinarians in the study area were nonexistent in 2013 and remain
extremely sub-optimal in 2021. Unavailability of FMD vaccination
services and lack of a reliable vaccine supply in the communities was
identified as an important problem involving the absence of links and
communication between vaccine demands from communities and vaccine
supplies from vaccine retailers. The DAHP (now GDAHP) and POAHP should
recognise this as an important issue that needs attention, as
appropriate solutions to improve the participation of VAHWs in
government and private disease prevention programs are required.
Introducing information into short training programs for VAHWs and
smallholder farmers on the importance of economic losses due to FMD and
benefits from disease prevention is considered necessary to improve
future vaccination uptake and disease control programs in Cambodia. The
conclusion from the 2013 study confirmed that it is worthwhile for
farmers to participate in the full-fee bi-annual FMD vaccination program
if there are average annual outbreaks with a morbidity rate of
approximately 30% and two major outbreaks with morbidity rate above
50%, in the ensuing five years (Sieng,
Patrick, Walkden-Brown, & Sar, 2021b). This is consistent with
conclusions from the 2015 survey that also suggested that improved
training of VAHWs could ensure they remain important in supporting the
under‐resourced national veterinary services
(MacPhillamy et al., 2021). In that study,
binomial logistic regression modelling found the length of employment
(p = .003), reporting of pig diseases (p = .007), recommending the
quarantine of newly purchased animals (p = .008), treatment of cases of
HS with antibiotics (p = .032) and the washing of footwear with water
when entering or leaving a farm (p = .008), were all positively
associated with a higher (≥92%) animal health and biosecurity knowledge
score (MacPhillamy et al., 2021).
Increasing information is emerging on the importance of FMD vaccination
and biosecurity in Cambodia and the importance of progressing this issue
more effectively with VAHWs and smallholder farmers is necessary as this
may contribute significantly to the improvement of the vaccination
uptake by rural communities and assist the development of more effective
disease control strategies in the country
(MacPhillamy et al., 2019;
MacPhillamy et al., 2021;
Stratton et al., 2015;
Young et al., 2013a;
Young et al., 2017;
Young et al., 2016). The veterinary
authorities at the central and provincial levels need to focus their
attention on several aspects of the vaccine supply chain, including
provision of sufficient doses of high quality vaccines from reliable
vaccine suppliers that are matched to currently circulating FMD
serotypes. VAHWs need to be better informed on FMD vaccination and
trained to understand that they could generate more income from
protecting their animals and the majority of livestock within the
communities from diseases. Further, they should contribute to informing
smallholders on FMD prevention and ensuring that farmers learn to trust
that regularly vaccinated animals that are fully protected is a far more
effective and sustainable animal production system than the current
situation, where a vulnerable population exists and the income of VAHW
is largely derived from the expensive treatment of sick animals,
potentially incurring AMR and food safety risk. Further, the lessons
learned from delivery of large FMD vaccination programs in the Mekong
region need greater awareness by all involved in TAD control in Cambodia
and beyond (Blacksell et al., 2019;
Nampanya, Khounsy, Abila, & Windsor,
2018).
As this study was limited to two provinces involved in a defined
research project, caution is advised in interpreting these findings as
representative of the majority of Cambodia. This caution has been
advised in the 2015 cross-sectional study that was also conducted within
defined research project in two provinces
(MacPhillamy et al., 2019), that examined
disease reporting by VAHWs in Cambodia and found much lower contact
between VAHW and district animal health authorities than recorded from
the broader 2008 study in 19 provinces
(Stratton et al., 2015). These variations
in findings likely reflect spatial, temporal and methodological
differences between the studies, particularly as in the 2008 study, the
districts were randomly selected whilst the VAHWs were purposively
selected. The 2015 study (MacPhillamy et
al., 2019) and our 2013 study, purposively selected the study locations
and used a probability sampling method to select VAHWs, with both
techniques possibly introducing selection bias through increased contact
of researchers with the VAHWs. Although the sample size of this 2013
study and the 2015 study is considerably smaller than that used in 2008,
the studies do show that the issues identified here are similar across
most provinces (MacPhillamy et al., 2019;
MacPhillamy et al., 2021;
Stratton et al., 2015).
Animal health extension approaches to improving disease control and
biosecurity practices have been investigated in Cambodia, with
participatory ’applied field research’, ’on the job’ training plus
’formal’ training programmes found to encourage smallholder farmer
motivations through nutritional interventions that improve the value of
their cattle ’bank’, offer better marketing opportunities and creating a
more receptive environment for introduction of disease risk management
for infectious and other production limiting diseases
(Nampanya, Suon, Rast, & Windsor, 2012).
It was suggested that in lieu of a widespread public awareness programme
to deliver mass education of smallholder farmers in disease prevention
and biosecurity, livestock development projects in SE Asia should be
conducting intensive training in disease risk management if trading in
large ruminant livestock and large ruminant meat is to continue to
progress and contribute to improve smallholder incomes and help address
global food security concerns. Additional research is suggested to
determine the best possible extension and public awareness activities
and methods for encouraging VAHWs, smallholder farmers, and local
authorities to be involved in livestock disease prevention programs,
particularly if the development of sustainable private disease
preventive programs is to be advocated.
Improvement of FMD control requires the cooperation of villagers, VAHWs,
and village leaders in disease reporting, with either improved funding
of government vaccination services and/or development of a private FMD
vaccination service. Both strategies should be accompanied by training
programs for farmers on disease transmission and the importance of
biosecurity and vaccination, including information on the cost-benefits
of treatment versus full fee bi-annual FMD vaccination
(Sieng et al., 2021b;
Sieng et al., 2021a). These initiatives
are urgently required in Cambodia if the substantial increase in future
FMD vaccination rates currently needed is to be achieved.
In conclusion, the findings from
the field survey and desktop review of the contributions of the VAHWs to
Cambodian livestock health services, indicate that the VAHW system is
currently weak with a limited capacity to provide the level of services
required to manage and control FMD in Cambodia. It is suggested that the
GDAHP requires more effective policies that can strengthen the current
VAHW system and improve the capacity for service delivery. The promotion
of the VAHW role as a potential sustainable small business model through
the sale of higher-level services to increasingly valuable livestock, is
a suggested strategy. This strategy would enable higher retention rates
of ‘active’ status VAHWs, potentially improving their contributions to
disease reporting, surveillance and TAD control. These policies should
also recognise the important issue of gender equity and encourage more
women to become active VAHWs and potential leaders of local rural
businesses. A critical component of the change management process
required by all stakeholders involved in promotion of livestock
development in Cambodia, is the development of gender sensitive training
programs. These are urgently required if the currently weak VAHW system
is to be strengthened and offer the required contributions to regional
food security through enhanced livestock health and production,
including TAD control.