1. Introduction
The Kingdom of Cambodia is a Southeast Asian (SEA) country of 181,035
km2 that shares borders with the Lao People’s
Democratic Republic (PDR) in the north, Thailand in the north and west,
and Vietnam to the south and east. Cambodia consists of 24 provinces and
one municipality, with a population estimated to be about 16.9 million
(World Population Review, 2021).
Agriculture is integral to the
life of smallholder farmers in rural communities, with cattle-raising
important, providing a source of income, asset storage, manure for
fertiliser, transport and on some farms, draught power
(Young et al., 2014b). Cattle-raising is
often operated alongside other activities, particularly rice and crop
production and other off-farm activities
(Samkol, Sath, Patel, Windsor, &
Holtenius, 2015; Young et al., 2014b).
Animal disease outbreaks pose significant threats to livestock sectors
in Cambodia, both from the economic impacts of the disease and the
measures required to reduce disease introduction risk. FMD is recognised
as the most significant transboundary animal diseases (TADs) affecting
large ruminants in the Mekong region of SEA and beyond, particularly
Cambodia (Blacksell, Siengsanan-Lamont,
Kamolsiripichaiporn, Gleeson, & Windsor, 2019). FMD causes significant
financial impacts in Cambodia, both at smallholder farmer households
(Young et al., 2013b) and the national
levels (Young et al., 2014c). Despite
many years of attempted FMD control by individual countries assisted by
regional coordination through the SEACFMD program of the World
Organisation for Animal Health (OIE) office in Bangkok, numerous factors
have prevented the successful control of FMD within the region. These
include ‘informal’ transboundary movement of livestock and their
products, challenges in implementing vaccination programmes, the
circulation of multiple and emerging virus topotypes and lineages,
low-level technical capacity and biosecurity of veterinary services at
national levels, limited farmer knowledge of FMD management, failures in
the timely reporting and response to outbreaks, and limitations in
national and international FMD control programmes
(Blacksell et al., 2019). In Cambodia, a
survey of smallholder farmers (n=300) found that FMD outbreaks occurred
every year during the study period, with a morbidity rate of over 30%
(Sieng et al., 2021a). Biosecurity and
vaccination practices were inadequate and it was concluded that poor
knowledge of disease transmission and biosecurity, with low FMD
vaccination coverage and a focus on treatment, contributed to regular
FMD outbreaks in these communities.
Due to the lack of veterinary personnel and officials at the district
and provincial levels, the Cambodian veterinary authority’s significant
task was to provide a para-veterinary animal health service enabling
most farmers to access basic veterinary services when required.
Para‐veterinarians are considered crucial in providing front‐line
veterinary care and advice to smallholder farmers in countries with
under‐resourced national veterinary services, although often these
individuals undergo basic training with minimal monitoring and
evaluation of performance and knowledge levels
(MacPhillamy et al., 2021). The
para-veterinarians in Cambodia are the Village Animal Health Workers
(VAHW) system that was established in early 1990, involving the
selection of a local livestock-interested farmer to receive some
training in basic village-level animal health services provision for
smallholder farmers, particularly the vaccination of cattle for
haemorrhagic septicaemia (HS) in rural communities
(MacPhillamy et al., 2019). Similar
approaches have been adopted and implemented in many developing
countries, including Afghanistan (Leyland,
1993), Kenya (Blakeway, 1993;
Mugunieri, Irungu, & Omiti, 2004),
Ethiopia (Admassu et al., 2005) and Nepal
(Moktan, Mitchelhill, & Joshi, 1990) and
have shared similar purposes and goals.
The Department of Animal Health and Production (DAHP); now General
Directorate of Animal Health & Production (GDAHP) aimed to have one
VAHW per village in every province across the country. The VAHW
selection process in Cambodia required basic literacy, experience with
livestock care and husbandry, and a willingness to learn and obtain
qualifications. They were often a part-time local animal health service
provider, supported in part by providing farm labour or with a little
help from the community. The DAHP commenced VAHW training in the 1990s,
with initial support from Non-Government Organisations (NGOs) and the
Food and Agriculture Organisation of the United Nations (FAO)
(Calba et al., 2014). VAHWs received basic
training of one-month duration in animal health and a starting kit from
the training providers, enabling the provision of fee-based basic animal
health services to smallholder farmers, including treatments and
vaccinations within their village. The VAHWs usually purchase veterinary
drugs and related equipment from local veterinary drugstores and
suppliers at the district or provincial level.
One of the important roles for the VAHWs is to contribute to government
disease control programs by reporting disease outbreaks, especially FMD,
to the District Office of Animal Health and Production (DOAHP). Further,
VAHWs should assist in diagnostic investigations and volunteer their
participation in the national vaccination campaigns, particularly
against Haemorrhagic Septicaemia (HS) and FMD, as required. The VAHWs
have been described as an important local resource, enabling persons
with some animal health skills to assist smallholder farmers
(Tornimbene, Chhim, Sorn, Drew, &
Guitian, 2014). They may also provide an important role in information
exchange between local veterinarians and the community, particularly in
improving biosecurity to prevent highly pathogenic avian influenza
(HPAI) (Bhandari, Wollen, & Lohani,
2011). The VAHWs were considered highly accessible, available,
affordable, and trustworthy relative to other service providers
(Admassu et al., 2005;
Peeling & Holden, 2004). Most VAHWs work
closely with local authorities at village, commune, and district levels,
especially during national vaccination campaigns (Government officials,
personal communication, May 24, 2014).
Although the VAHWs was intended to provide local animal health services
and assistance to local veterinary authorities in livestock disease
prevention programs in their communities, their contributions to these
tasks was uncertain (Stratton et al.,
2015). A cross-sectional survey of VAHWs (n=445) from 19 provinces in
Cambodia in 2008, used ‘guided group interviews’, to examine the roles
of VAHWs and found they had good contact with farmers, with 61.5%
making more than one farm visit daily, yet incomes from these services
were low (Stratton et al., 2015). In
2015, a closed‐ended cross‐sectional study of VAHWs (n=80) from two
provinces (Takeo and Tbong Khmum provinces) found positive associations
between income generated from VAHW activities (p = .01) and the
frequency of visiting farmers (p < .0001), although almost
90% of VAHW reported that they use antibiotics to treat FMD affected
animals (MacPhillamy et al., 2019),
potentially contributing to antimicrobial resistance risks (AMR).
In Cambodia, the severe socioeconomic impacts from FMD suggest an
appropriate, sustainable national FMD control program is required
(Blacksell et al., 2019;
Young, Suon, Andrews, Henry, & Windsor,
2013a; Young et al., 2016). However, due
to the absence of effective biosecurity and the necessary emergency
disease management and control measures, including the routine culling
of infected animals and restrictions on the movement of animals and
animal products, vaccination is becoming increasingly appropriate to
assist in the control of FMD. However, the vaccination coverage of the
national large ruminant population against FMD in the nationwide
epidemic in 2010 was estimated at 2.7%, compared with 43.8% for HS
(Young et al., 2013a). The low adoption
of FMD vaccination has continued with only 170,000 (5.3%) and 267,000
(8.3%) doses of FMD vaccine were imported (GDAHP and Private sectors)
and used in 2019 and 2020 (cattle and buffalo population is 3,225,147
heads) compared to 2,015,000 (64.5%) and 1,790,000 (55.5%) doses of HS
vaccine, respectively (H. Ponnaka, personal communication, November 18,
2020). It is readily apparent that preventive strategies for FMD control
are mainly absent in Cambodia, and even in areas where vaccination has
been applied, it has been insufficient to prevent ongoing FMD outbreaks
(Sieng & Kerr, 2013) .
There is currently no evidence that VAHWs have been privately providing
FMD vaccination services to their own and farmers’ animals within the
communities. This objective of this study was to further assess the
knowledge, attitudes, and practices (KAP) including the involvement of
VAHWs in the provision of animal health services and FMD in particular,
including the identification of potential opportunities for more
engagement of VAHWs in provision of private vaccination services in
their communities. This information may provide insights that could
advise and assist animal health policy-makers in improving national
livestock disease control programs in the country and TAD in the wider
SEA region.