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Rationalizing the public veterinary service
Public sector financing and employee incomes
Veterinary services delivery by non-veterinarians: animal health assistants (AHAs), animal health technicians (AHTs), auxiliaries and livestock owners
Services in low-potential, marginal areas
Liberalization of veterinary input supply
Membership organizations (MOs) as deliverers of veterinary services
Cost recovery
Balance of animal health education with national needs
The government and its
public veterinary service may alter their recruitment policies
either to employ sufficient new staff with the necessary skills,
or to provide training so as to meet the requirements of the
newly rationalized public veterinary service. The automatic
hiring of all new veterinary graduates needs to cease, as
happened in Kenya in 1988 (Wamukoya, Gathuma and Mutiga, 1995),
Senegal and Mali. Staff recruiting should be in accordance with
the needs for annual replacement both in numbers and skills
required.
Wise management, sufficient time, judicious transfer to reorganized posts and enhanced cost recovery may counter the need to make current employees redundant. Should staff need to be reduced, this may be accomplished through a combination of natural attrition, early retirement incentives, retraining, or forced redundancy. Encouragement of the private sector should lead to employment growth in industry, private practice, consultation, marketing of agricultural products and primary livestock production, thus creating employment opportunities for staff made redundant.
Redundant
employees should have opportunities for retraining to develop
skills required for private sector employment, whether in
clinical veterinary practice, with industries or even with
non-veterinary medicine-related employment. Awarding government
contracts by tender to private practitioners to undertake public
or shared responsibilities serves as an inducement to leave
government service and offers a potential remuneration, while
assuring that essential services are performed (Fassi-Fehri and
Bakkoury, 1995). Agreed early retirement plans with compensation
can be made attractive to public sector veterinary staff.
Re-employment and retirement policies should be consistent with
the overall government employment-related policies and laws.
International institutions and donors could support programmes
for downsizing of the public sector where this is an option.
It is generally recognized,
on the basis of various profiles and recommendations, that the
target percentage for personnel costs should be between 40-50
percent of the total public veterinary service budget, thus
allowing for an adequate operational budget (Cheneau, 1985;
Umali, Feder and de Haan, 1992). Furthermore, if the income of
public sector veterinarians is significantly below the cost of
living for comparable professionals, there will be severe strain
on the integrity with which they perform their regulatory
functions. It is critical to address these issues in the
restructuring process.
With public
veterinary service staff adequately compensated, a
non-competition policy with the private sector can be strictly
enforced. Persistent unauthorized delivery of commercialized,
privatized services by government employees should result in
disciplinary action, leading ultimately to dismissal. Should
commercialized services be so lucrative, there is no reason why
they should not be delivered by the private sector.
This is a highly
contentious issue requiring consensus within the veterinary
profession and with stakeholders. An agreed plan is needed that
focuses on a practical method to employ these persons in a
productive manner and at the same time protect the public from
substandard service.
Livestock owners have a major role in animal health which is not always fully appreciated. They are relied upon to report diseases to local veterinary personnel, public and private. In many countries livestock owners treat and vaccinate their own animals legally with nonprescription drugs and vaccines. The reason for this is that owners have the legal right to do as they wish with their own property, within limits imposed by local legislation and cost efficiency. For treatment and vaccination by lay-persons to be tolerated, risks to the public need to be minimized and animal welfare maximized. This can only be accomplished through education and compliance monitoring.
The vital and economically viable services that AHAB, AHTs and auxiliary personnel perform in marginal areas, particularly in low-input low-output livestock systems, and/or with low value livestock species need to be recognized. Community-based primary animal health care workers have an important niche in the delivery of services in developing countries.
There is a need to define clearly the tasks permitted to various cadres of the animal health team; the remedies and vaccines they are permitted to administer and the procedures and tests they are allowed to carry out. Different decisions about these issues will be dictated by the ecological and economic conditions the livestock production system of each country. In making these decisions, however, the countries establishing regulations need to ensure that producers who desire economic animal health interventions are able to obtain them; that the long-term quality needs of producers are being secured; and that problems with the abuse of remedies are avoided. In all cases, the economic welfare of both the animal health cadre and the producers forms a legitimate basis for decision-making.
Under any
circumstances, the effectiveness of animal health assistants,
technicians and auxiliaries will be enhanced if they are
incorporated within structures that provide technical advice,
support and guidance from veterinarians. An example of animal
health auxiliaries (village relais) being successfully
incorporated into the national veterinary services is in Burkina
Faso. Auxiliary-level persons were trained under a project to
administer Newcastle disease vaccine and were subsequently
incorporated with the national veterinary service.
Mounting experience
indicates that AHAB, AHTs and auxiliary personnel are more
dependable in delivering veterinary services in marginal,
low-potential areas than the public veterinary services or
private sector veterinarians. Where the economic value of
individual animals is low, owners will i) accept a certain level
of loss before agreeing to pay for veterinary services; ii)
become skilled in diagnosing and treating their own animals; iii)
demand access to veterinary remedies and vaccines with which,
often on the advice of a veterinarian, to treat their own
animals; and iv) request skilled diagnostic advice, often from
post mortem and laboratory methods (Baker, 1995). They offer an
affordable alternative to deliver selected services, even on a
commercialized basis and are often highly motivated. In many
countries (such as Bangladesh) women are the primary providers of
basic animal health services in communities.
The public veterinary service still has responsibilities for implementing public service mandates in the marginal, low-potential regions. To exercise these responsibilities, methods of delivery through other providers or outright subsidies need to be implemented. Policy-makers in the public veterinary services need to examine how NGOs, membership organizations, communities or the private sector are providing goods and services in other countries and benefit from lessons learned.
A delivery
programme needs to be designed that meets the client's needs in
an economical manner and still carries out government
responsibilities. Numerous examples are presented in a
forthcoming FAO policies and strategies document (in
preparation).
Nearly all veterinary
related activities are highly dependent on a regular and assured
availability of quality inputs (FAO, 1994). In many African
countries, input procurement and distribution have been a
monopoly of the government veterinary services. With the
restriction of operational budgets, both procurement and
distribution have been limited. This situation has given rise to
implementation of cost recovery and revolving funds for both
private and public goods and services. These programmes,
implemented within the government veterinary services, have met
with varying success in terms of equity, sustainability and
motivation of public service veterinarians to meet the palpable
demands of their public employer versus those of their
producer-client.
An alternative approach is to liberalize procurement and distribution of inputs through the private sector (Cheneau, 1984). Pharmaceutical distributors have generally responded favourably to input liberalization by supporting veterinarians and/or pharmacists to provide remedies, chemicals, equipment and some vaccines to the public. Experience to date indicates that sales of quality inputs by private providers have increased while availability of black market inputs have declined (de Haan and Bekure, 1991; Angniman, 1996).
Commercialized procurement and delivery of veterinary inputs by the private sector have generally made these goods more available, avoided some of the problems associated with government monopolies and revolving funds, and proved robust in times of civil disorder. There is, however, a clear need for the public veterinary service to exercise its responsibility for quality certification of inputs, for restricting use of dangerous remedies and chemicals to qualified providers, and for pharmaco-surveillance of the efficacy of remedies and vaccines.
If nothing
else, the transition period affords an opportunity to repeal
archaic laws that prohibit or restrain liberalization of
veterinary remedies trade, cost recovery and other free-market
activities. At the same time, laws need to protect the consumer
from fraud and abuse.
Membership organizations
provide common benefits to members and are financed and managed
by the persons they serve. Membership organizations reside within
the private sector (Holder, Ashley and Bazeley, 1996) but are
sometimes referred to as the third sector. They range in scope
from grassroots community groups to associations of those with
specialized interests such as dairy cooperatives. Numerous
examples demonstrate that MOs are most capable of employing
veterinarians and other animal health care providers to deliver
private good livestock services. The membership organization's
veterinary service providers have been contracted to provide some
services of a public good nature (e.g. compulsory vaccinations,
research and extension) in the same was as private practice
veterinarians.
These organizations may assume some of the roles of the public sector, particularly in controlling diseases with externalities (foot-and-mouth disease, tsetse-transmitted trypanosomiasis) or quality control of livestock products (freedom of milk from antibiotic residues). Membership organizations, by virtue of their structure, may offer economies of scale for delivering public, private or shared responsibility services; they develop an acceptable mechanism to share the costs and benefits of purely public goods; and they are likely to ensure that tailor-made services demanded by their members are accessible.
Membership
organizations and NGOs may represent unique opportunities to
deliver a broad spectrum of services, particularly under
conditions of budget restrictions and inadequate delivery of
services by government and private practitioners (Schillhorn van
Veen and de Haan, 1995; Mehraban, Barker and Ward, 1996;
Sidahmed, 1995). Nonetheless the state should retain ultimate
responsibility for oversight of those functions designated as
public (see Division of responsibilities, p. 3) and should
delegate only their execution.
Cost recovery is the
concept of "user-paid" fees for specific services that
are acquired from the public veterinary services, by virtue of
its professional responsibility, but that also financially
benefit the owner of livestock or products. Cost recovery can be
applied even where there are some positive externalities.
In theory, purely public goods such as public health should be financed by the national treasury or by an obligatory user fee (tax) on those who benefit. Where both the public and an identifiable private owner benefit, the cost needs to be apportioned. This is the economic basis for cost recovery for such services as vaccination for notifiable (gazetted) diseases, meat inspection for interstate commerce, and for herd disease status certification.
An example is the mandated hygiene inspection of meat shipped across state borders or internationally. Inspection and occasional condemnation of livestock are a nuisance and a cost to the livestock producer, meat-packing industry and the consumer. At the same time certified government inspected and passed meat is more marketable and hence more valuable than meat that has been inspected. As inspection is both a burden and an asset, some or all of the costs can be recovered as user fees from the industry. These are legitimate costs of doing business that may be passed along to the consumer.
Experience indicates that cost recovery sensitizes the public to the inevitable need to pay for some goods and services, thus paving the way towards acceptance of full commercialization. Within the government services, cost recovery is a pragmatic, but hopefully temporary, way to supplement inadequate personnel and operational budgets in some countries.
It frequently is desirable to place the revenues from user fees into revolving funds to assure that sufficient will be available for the services to be provided. Revolving funds should be managed by the immediate users (public, private or both). This provides incentive and motivation to both providers and payers of services (Sidahmed, 1995).
Revolving
funds should not reduce the state's responsibility to pay for
services that are of a public good nature. It is possible and
sometimes desirable that revolving funds be excluded from the
government budget, where they will be free from treasury or
International Monetary Fund restrictions. Such funds can then be
a prelude to privatization, particularly when they are managed by
end-users at the local level.
A reasonable numerical
balance of graduates between annual output and needs eliminates
some pressures when restructuring veterinary services. It is
extremely difficult, nonetheless, to estimate this balance
largely because an equitable balance varies according to the
perception of the various stakeholders. Clear deficits may be
made up in a matter of months, by importing veterinarians from
countries with a surplus, or within a few years through educating
animal health assistants via the veterinary science curriculum.
Excesses are a glut on the market and rather more difficult for
national economies to absorb.
Rational utilization of veterinary expertise has a marked effect on the perceived number of graduates required. Published norms for the number of veterinarians or auxiliary personnel per thousand tropical livestock units do not make much sense if scant operational budgets restrict purchase of fuel for transportation or fees for services are so high as to preclude affordable care. The public is not well served by major deviations from balance. With too few providers, services may not be available or are too expensive for large sections of society, while too many providers are expensive for governments to train and employ and cause highly competent private practitioners to be undercompensated. Likewise, competent practitioners cannot survive long term as they may not earn sufficient fees to be able to invest in new equipment and acquire skills provided by further education.
Overcapacity to produce veterinarians may be avoided through regional veterinary schools. Here the combined needs of several countries can be produced in one veterinary faculty that supports a critical mass of expertise offering quality education. A regional veterinary school, by definition, leads to a "harmonized curriculum" that in turn allows for reciprocal registration of graduates among the countries. In addition to the cost savings in eliminating excess veterinary schools, reciprocal registration increases mobility and opportunities for veterinarians to fill gaps in demand. Where excess educational capacity already exists, faculties may exploit opportunities for providing continuing education, short-course refresher training, in-service training to meet governmental needs; or vocational courses for animal health assistants and auxiliary personnel.
Likewise,
the training of auxiliary personnel needs to be approached
cautiously. Auxiliaries must survive in the private sector
(McCorkle and Mathias, 1996) subject to market forces, often in
marginal livestock areas. They need sufficient skills to provide
reliable, needed and cost-effective services but are constrained
by excessive costs incurred by long-distance travel and the low
density of livestock populations. A proper balance needs to match
the supply of auxiliary personnel with expected demand. The
concept that auxiliary personnel in reality are primarily
livestock owners or farmers and only provide animal health or
husbandry services part-time has proved successful in the Central
African Republic, northeast Thailand and Afghanistan.