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EcoHealth and One Health – Moving from concepts to
implementation: “Learning by doing” through case studies
Fred Unger
International Livestock Research Institute, Hanoi, Vietnam
One Health Master Class – SEA-EU-NET 2015
CIRAD, Kasetsart University, Bangkok, Thailand
27 May 2015
Presentation outline
• EH versus OH and their history in SE Asia (a short review)
• Case study, learning by doing
• Final reflections and conclusions
Eco Health & One Health
Various definitions (open to debate): range from quite
rigid to very flexible!
One-Health
- biomedical focus: human + animal + wildlife
-focus on communicable diseases
-Operationalized/ institutionalized
EcoHealth:
-environment & socio-economic aspects – pioneered outside
‘traditional’ health
-communicable & non-communicable diseases (dioxin; heavy
metal toxicity
-academic / research / complexity
Eco Health and One Health - Compare
Eco Health – One Health Contrast
Eco Health
Originated in biological
Ecology/land conversation
Complexity focus/systems
Communicable/non communicable
diseases
Pioneered from IDRC
‘Bottom Up’
Vets, Medicals, epidemiologists,
ecologists, social scientists,
philosophers, indigenous
perspectives, etc. Eco health
One
Health
Integrated approach
One Health
Schwabe‘s One Medicine
One world/One Medicine
(Zinsstag)
More quantitative/
Biometric focus
(animal/human/widlllife)
Communicable diseases
Vets, medicals, some
ecologist
Currently institutionalized
(FAO, OIE)
Modified after IAEA 2014
OneHealth/EcoHealth in SE Asia
• One-Health
– Various initiatives started in late 2000th
in a response to HPAI
International Ministerial Conference on Avian and Pandemic
Influenza, New Delhi, Dec 2007, FAO, OIE, and WHO – to
develop a joint strategic One World, One Health framework
– IMCAPI, 2008 & 2010; Stone Mountain, 2010
– Meanwhile much more initiatives emerged
• Eco-Health
– Introduced by IDRC to SE Asia mid of the 2000
– Initial approach through exiting informal researcher network
– IDRC funded various projects: APAIR, EcoEID, FBLI, BECA and
EcoZD
– New initiatives emerged
• INDOHUN
• THOHUN
• VOHUN
• MYOHUN
EcoEID
Emerging Pandemic Threats Program
PREDICT • RESPOND • PREVENT • IDENTIFY
EHRCs
GHI
ACIAR GHSA
Case studies “learning by doing”
 From previous or ongoing ILRI projects in SE Asia
• ILRI EcoZD, project highlights and 2 case studies
• Pig Risk (Vietnam)
 Com Across
• Laos case study
GHGI
Ecosystem Approaches to the Better Management of
Zoonotic Emerging Infectious Diseases in Southeast Asia
(EcoZD)
Key components
 Appraisal & Consultative Process
 Outcome Mapping: demonstrate behaviour changes of targeted groups
• Innovative Eco Health research in all 6 countries (“learning by
doing” case studies)
– Trans-disciplinary collaboration between institutions & teams –
– New for most of the team members
• Establishment of two Eco Health Resource Centres at
Chiang Mai University (CMU) and Universitas Gadjah Mada
(UGM) in Indonesia
• Networking with other OH, EH initiatives
Outcome mapping as M&E tool
Layer 1: Relationship between EcoZD project & 8 teams to influence teams’
changes in knowledge, attitude, and practices (KAP).
A Two-layer process
CAMCAMCHICHI
LAOLAO
CMUCMU
JTVJTV
VTNVTNINDIND
UGMUGM
ILRI-
EcoZD
ILRI-
EcoZD
Slaughterhouse
owners
Slaughterhouse
owners
StudentsStudents
Para
professional
Para
professional
Layer 1Layer 1
Layer 2Layer 2
Layer 2: Relationship between teams & their boundary partners (BPs) to support
BPs’ changes in KAP.*
• An participatory planning, M&E tool
• Outcomes = changes in KAP & behavior of targeted groups
Eco ZD - EH story – general reflections
• Project did not come with pre-determined research questions,
there was plenty froom for adaptation in the proposal
• Learning by doing EcoHealth approach
• Emphasis on capacity building - an approach where teams made key
research decisions and were supported in implementation
• Multi-year process of inter-personal relationship/trust-building
• Amendments made based on own but also reflections of partners
– 2 EHRC established
Challenges across all teams
• Various definitions (EcoHealth and OneHealth)
• Identification of a common research interest
• Budget sharing
• Social science vs. biometric science expertise
• Qualitative vs. quantitative research – synthesis of both
• Two-dimensional capacity-building requirement
• Technical
• EH concept
• EH incorporation in the case studies – reality check – often more VPH or
at most OH than EH
• Policy engagement
Case study 1:
Yunnan/China
”
Ecosystem approaches to the better management of zoonotic
emerging infectious diseases in the South East Asia Region
Case study 1: Yunnan, China
1. Identification of common research topic
Researchers from 4 different institutions with different locations,
priorities and interests :
•Yunnan Agriculture University (Vet Fac)
•YAGAS, Yunnan Academy of Grasslands and An. Science
•Yunnan Endemic Disease Control and Prevention Institute (YEDCPI)
•Yunnan Animal Science and Veterinary Institute (ASVI)
Partners Interests and Expertise
Institute Focus diseases Expertise
Yunnan Endemic
Disease Control
and Prevention
Institute (YEDCPI)
 Leptospirosis
 Schistosomiasis
japonica
 Hantaviral diseases
 Bartonellosis
 Brucellosis,
Toxoplasma
Detection, identification, and isolation
of pathogens; Serological survey;
DNA Sequencing, Lab tech., field
epidemiology, pathogen ecology
Yunnan Animal
Science and
Veterinary Institute
(ASVI)
 TB, Brucellosis
 E. coli, salmonellosis
Diagnostic and monitoring methods,
epidemiology, pathogen
characterization, control and
prevention, economic and public
health impacts
Yunnan
Agricultural
University (YAU)
 Schistosomiasis
japonica
 toxoplasma
 Hepatitis E., E. coli
Pathogen ecology, epidemiology,
pathogenesis, prevention and control
Yunnan Academy
of Grassland
Animal Sciences
(YAGAS)
 Fluke
 Brucellosis, TB
 Tape worm
Epidemiological investigation, clinical
diagnosis, livestock genetics,
production system, livestock ecology
and management
Brucellosis & Toxoplasmosis
in Yunnan
Approach (identification of research topic):
•Repeated meetings including stakeholders but also community
visits, some with ILRI others not
•Timely process (nearly 12 months)
– Feb 2009 to Jan 2010 (scoping visit of filed sites)
•Facilitation and consensus building skills needed
•Trust and relationship building takes time in China (some partners
we had relations before, others not)
•Our choice was TB and Brucellosis
•Anyhow consensus on Toxoplasmosis & Brucellosis in ethnic
groups
Eco ZD case study:
Yunnan/China
”
Ecosystem approaches to the better management of brucellosis
and toxoplasmosis with focus on ethnic minorities
Brucellosis and Toxoplasmosis, Yunnan, China
Related challenges (identification of research topic)
•Jan 2010, Scoping visit
• to better understand the production system and socio-cultural
aspects
• Team surprised us with serological sampling in humans and
animals. Purely biometric approach but still weak sampling
protocol.
• Research agreement was not even signed!
• Philosophy: sampling, sampling, sampling
•Set back needed
• First thoughts on recruitment of a national EH champion
Case study:
Brucellosis & Toxo in Yunnan
Problem:
• Brucellosis is a serious concern in Northern China
• Dairy sector promoted with animal movements from north to south
• No or limited information on prevalence's
• Toxoplasma: Lack of any update information in animal sector and
PH concern
No studies on perception/awareness of involved groups and
stakeholders
Classical vet approach (demanded by most tam members):
• Prevalence study in targeted livestock populations
Developing of an EH framework
Mapping of stakeholders, partners & groups involved
21
Brucellosis
control
Public health authorities
(central/local officers, local
hospitals)
LS officers
(central/local)
Local
administration
officers
Policy makers
Socio economic experts
Butchers, meat
vendors
Milk vendors,
butchers
Farmers/
herders
Donors, international
organizations &
universities
Associations
(if any or to be
established)
Communities
Outpatients
Animal husbandry
expert
EH (study) framework for Yunnan study
22
The problem:
Brucellosis &
Toxoplasmo
sis in
Yunnan
Public health authorities
(hospitals and local) (IDI)
•Review of existing information
•General Z knowledge
•Specific action B & T patients
•Collaboration with PH
Vet officers/stations (IDI)
•Review of existing
information
•General Z knowledge
•Specific action B & T
•Control
•Collaboration with PH
Farmers (QX)
• Production data
•AH and disease prevention
•Reproductive disorders
•Zoonoses and OH
•Waste management
Past unit, milk vendors (FGD):
•Zoonoses knowledge
•Quality control
•Sanitation
•Inspection by authorities
Villagers (with/without
livestock) (FGD)
• Animal husbandry
•Zoonoses
•Risk factors
•AH services
•PH services
•Source of information
Butchers (IDI)
•General Z knowledge
•Specific knowledge B & Toxo
•Health check and status
•Hygiene and training
•Waste management
Hospital case review:
•Clinical cases
Literature review
Survey:
•Dairy farms (milk)
•People at risk (serum)
Brucellosis & Toxoplasmosis
in Yunnan
2. No experience with an EH approach
• Strong silo-thinking and biometric driven research team
• Continued demand for biological sampling
• No thoughts on qualitative methods
– Very limited understanding of qualitative tools or socio-cultural aspects
despite the study focus on ethnic minorities
• Limited understand of EH principles
Approach: Frequent visit of ILRI scientist
Identification of an EH champion (Fang Jing)
Short training on EH (probably too late)
Relationship and trust building
Gain ownership by local authorities
Brucellosis & Toxoplasmosis in Yunnan
Qualitative research
3. Perception on qualitative research tools
– Some team members had perception that qualitative research is not
valid, not scientific and therefore not useful
– Mainly more dominant in senior staff (vets of MD’s)
– Often related to the fact that epidemiological sample size calculations
used for quantitative tools may not apply the same way as for
qualitative research
– Younger researchers more open but often challenged by hierarchical
issues
•If than used (qualitative tools) there was a perception from again
more senior researchers that they can do it themselves (more like
”everybody can do this”)
Qualitative research
FGD and in depth interviews
We know how to do it ...
Brucellosis & Toxoplasmosis in Yunnan
Perception on qualitative tools
Approach: Frequent visits of ILRI scientist
EH champion (Fang Jing)
Training modules on qualitative tools including
Relationship and trust building
Learning by doing - success:
After being trained and implementation, most of team
members were exited on the use of FGD and IDI
Mainly driven by the collected data
» new views, they would never had thought about it
» Opportunity for triangulations …
New challenge emerged
Brucellosis & Toxoplasmosis
in Yunnan
4. Synthesising qualitative and quantitative research results
• Focus was on collection and analysis of biological samples and
quantitative data
• No experience with qualitative data analysis at all
• Latest now team members realised that “everybody can do it “
without some training might be wrong
Approach: First part of analysis strongly guided/done by EH
champion e.g. In depth interviews in village doctors
Further analysis done jointly (IDI, butchers)
All others done by team (IDI, village Vets) and FGD
Brucellosis & Toxoplasmosis in Yunnan
Synthesising qualitative and quantitative research results
QX Vet QX PH Butch
er QX
Linkages
to
Serology
Triangu
lation
FGD
Triang
ulation
IDD
Potential
RF
Toxo/Bru
c
Quality
of QX
data
Select
for
analysis
Comments
General data
training, number of staff x x x
General Z knowledge
Knowledge x x x
Most important Z x x x
Surveilance and control x x x
Bruc and Toxo (awareness,
perception)
Knowledge x x x
Diagnostic tests x x
Handling of patient with B/T x
Collaboration with vet sector
when x x
which topic x x
action x x
General hygiene
place for slaughter x
hygienic measured x
protecive clothes x
Health status and check x
Brucellosis & Toxoplasmosis
in Yunnan
4. Synthesising qualitative and quantitative research results
FGD IDI QX Check list
Demographic (e.g.
gender/ethnics)
Gender,
differed by
actor
Knowledge on zoonoses Lowest in
butchers
Lowest in
butchers
Risk practices Some raw milk
and meat
consumption in
some villagers
No indications
of raw m/m
consumption
No indications
of raw m/m
consumption
NA
System services (vets)
Brucellosis & Toxoplasmosis
in Yunnan
Other challenges and observations:
•Hierarchical differences between researchers
•Unfortunately the most “EH open” researcher was the
youngest and also facing EN language difficulties
•Deficits in report/paper writing (mainly due to language
barriers)
•Existing publications (mainly in Chinese)
•Team highly motivated but tendency to derail in direction
•Transaction costs (to facilitate various meetings)
•True Co-funding provided (25%, the only team among 8)
Qualitative research
Challenges
FGD understanding and language barriers
Case study 1: Brucellosis and Toxoplasmose in
Yunnan
”
Final reflections: - finally one of the best and highly motivated team
- Incentive: invited by FAO to Beijing to present results
- Extended networking (e.g. EHRC and PE)
Final reflections: - finally one of the best and highly motivated team
- Incentive: invited by FAO to Beijing to present results
- Extended networking (e.g. EHRC and PE)
Case study 2:
Optimizing Rabies Control in Bali: An Ecohealth Approach.”
Case study 2:
Optimizing Rabies Control in Bali: An Ecohealth Approach.”
Selection of study topic and teams
• ILRI facilitated a call for proposals for EH case studies
(4 proposals submitted)
– Rabies in Bali
– AI in humans and animals (Java)
– Small holder chicken – a socio economic perspective for HPAI
(Yogyakarta)
– Toxoplasmosis in animals and human (Yogyakarta)
External panel evaluated each proposal
– ILRI, NARS Indonesia, FAO, EH champions
Case study 2:
Optimizing Rabies Control in Bali: An Ecohealth Approach.”
The problem:
• Rabies is an emerging zoonoses since its recent introduction
• Conventional control measures show limited success
• Prominent role of dogs in Bali society
– Initial mass culling (Strychnine) faced strong obligations (local and
international)
– Obligations against population control measures
Classical vet approach:
Vaccination in dogs and sterilisation
Case studies 2:
Optimizing Rabies Control in Bali: An Ecohealth Approach
Eco Health perspective:
Better understand:
• Social cultural relationship between dogs and the Balinese
community
• Dog population in Bali and its dynamics.
• Dog ecology in Bali and measure its contact intensity with
other animals and human.
To develop a model for sustainable Rabies prevention, control,
and eradication at banjar level through community
empowerment and behavior change.
Aligned with Vaccination campaigns in dogs (FAO, LS services)
EH (study) framework
Optimizing Rabies Control in Bali
Control of Rabies
in Bali focus on communities
Socio-science
-Social cultural
believes
Environments
− Waste problems
(“feed places”)
− Monkeys
Human health
- Capacity
- Acceptance of Post
exposure vaccination
Community
- Acceptance
- Feasibility
(human and dog
health)
Political
perspectives
- Law and regulation
- Enforcement
Vet Science
-Epidemiologist
- Practionaires
- Capacity
Tourism:
- Major source
of income
Private
sector
-Vaccines
-An. Welfare
Media
-Social
acceptance
Ecohealth Approach
Dissemination:
Pilot Village (A
community-based
approach) +
Awareness in
Elementary School
Dog ecology Study
(Behavior, Fecundity
and Demography of
Dog)
Social Culture Study
System Thinking
(ecohealth
principle (EP) #1)
Knowledge to Action
(EP # 2)(Governor of
Bali)
Trans-diciplinary
Approach (EP# 3), e.g.
research from various
backgrounds
Participation (EP # 4)
Equity (EP # 5), e.g.
male more responsibly
in dog raising
Sustainability(EP# 6)
e.g. village cadre’s
traind
Review
Case study:
Optimizing Rabies Control in Bali: An Ecohealth Approach.”
Challenges and approached to address them
• Socio-cultural study – mainly based on qualitative
approaches
– International consultant from University of Edinburgh
– PHD student from local partner
• Publication issues
– Who publishes what in a transdisciplinary team
– Publications demanded for almost all team members
– Use of double lead authorships - some journals support this
Final reflection
• Scientifically strong team members of various backgrounds
• Most of them EH experienced from other IDRC studies
Case study 3:
Salmonella spp. IN PIG SLAUGHTERHOUSES AND PORK MARKETS
ASSOCIATED WITH HUMAN HEALTH IN HUNG – PIG RISK
Map of Vietnam
Source: http:/www, trelangkienviet,com
5
Scase study 3: Salmonella spp. IN PIG SLAUGHTERHOUSES AND PORK
MARKETS ASSOCIATED WITH HUMAN HEALTH IN HUNG YEN, VIETNAM
Quantitative research
•Assess Salmonella contamination
•Determine potential risk factors
Quantitative research
•people’s and stakeholders
perception related to Salmonella
contamination with the potential
risks in practice
• People’s living around slaughter
houses (IDI)
• Pork consumers (IDI)
• Community vets
• Community health workers (IDI)
• SH workers (FGD)
• Pork sellers (FGD)
• Local authorities, party
committee (IDI)
• Biological sampling
• Semi-structure QX
• Check lists
42
Case study 3: Challenges & approaches
• Convince participants on acceptance of FGD and IDI
• Each takes 30-40 min
• Most difficult in pork sellers and people living around SH
Approach: Repeated approach to convince for participation
incentive
• Designing of outlines
• FGD and IDI looked more like a long questionnaire
• Huge amount of collected information
• 35-40 pages of transcript from FGD and IDI
Approach: Got help from a national social-scientist
MSC student (a vet) was smart and proactive
43
Case study 3: FFFGD initial outline People living around SH
Introduction: Group introduction
Reason why we are here
Self-introduction: I am ---, this is ----
2. Basic information about the respondents your family?
3. Animal husbandry
Raise pigs or not and for how long?
Some information about keeping pigs in villages, who have animals/pig
Reason to kept pig or not kept (any complain/disturbance)
4. Perception and Awareness about the slaughterhouse:
- Pork provided for community from where?
From SH, butcher, market or supermarket or other
- The presence of SH in the community?
What and how do you know about it/them?
Expected: Where, how far, how long, owner, time of slaughter, number of pig, how they transport…
- The affect of the SH:
List and ranking (using proportional pilling) and discuss why
Benefits (pork access, job, others...)
Disadvantages/disturbances (noise, environmental pollution, risk of diseases, house prices, any others ...)
Reflect/complain by the respondents, if any
If yes to whom (community, local government, slaughter house ...)?
What are the complains?
What should be changed?
Food safety and hygiene: (quarantine, disinfection, cleaning, housing…)?
Vet service: inspection?
Environment: waste, smell
Any reaction or change of situation, and what is the response/measure
Is it getting better or worst
- People's perception about standard criteria to be applied in the SH:
- List of criteria about the ‘standard’ SH from your perspective
- The slaughterhouse you described satisfied or not, how a future SH should be,
what should be done?
- Why should they change?
- If the meat price will increase due to investment towards a improved slaughterhouse, are they willing to pay, how much
higher can be accepted?
44
Case study 3: Pig risk
Exiting results from focus groups discussions in pork sellers
1. Prefer to use wood surface tables in stead of other types(e.g.
versus stainless steel)
• Vietnam government currently upgrades markets (LIFSAP)
• Most of food sellers still use their old cutting boards
2. Use of cloth to dry pork, clean equipment, hand or table, some
consumers related “wet” looking meat to low meat quality
3. Use of cupboard at market stools, same reason as under 2
4. Use of masks: in response to buyers/consumers perception that
sellers may have a health problem.
5. Knowledge of zoonoses: PRRS and FMD, CSF, leptospirosis,
cysticercosis, misperception on FMD, CSF
Results of FGD help a lot to understand used practices
not in the line with regulations
The problem
•Parasitic zoonoses are often neglected disease and endemic in the Laos
•Some characteristics of animal production and food consumption habits in
Laos, can promote zoonotic disease transmission
– high density of both human and animal populations in close proximity;
– a smallholder production systems with mixed species and little/no
biosecurity;
– abattoirs and wet markets operating with rudimentary hygiene,
– widespread consumption of raw/undercooked blood, meat, fish, organ
tissues, raw leaf vegetables…
– Use of untreated wastewater and sewage for agriculture
Case study 4:
LAO LONG-TERM STUDY ON ZOONOTIC DISEASES OF LIVESTOCK
WITH A FOCUS ON PARASITIC DISEASES
Case study 4:
LAO LONG-TERM STUDY ON ZOONOTIC DISEASES OF LIVESTOCK
WITH A FOCUS ON PARASITIC DISEASES
Objectives
•To provide an overview on parasitic zoonoses from secondary data
•To identify parasitic zoonosis distribution for prioritized parasites in animals
and humans (southern part of Laos).
•Better understand farmers ’ KAP’ linked to parasitic zoonoses along the
pigs and fish commodity chains.
•Improve animal health/productivity by a better knowledge on diseases
drivers, and suitable control options related to: AH, PH & well-being
•Reduce animal and human health risks cf. food borne diseases through a
better understanding of risk factors
•Develop a cross-sectoral collaboration platform and dissemination strategy
Case study 4:
LAO LONG-TERM STUDY ON ZOONOTIC DISEASES OF LIVESTOCK
WITH A FOCUS ON PARASITIC DISEASES
• Team members include expertise from different backgrounds and
expertise
– Animal science, public health, social science
Strat up challenges:
• Identification of the research topic
– Concerns that this is too broad
– Disease focus, rather tendency to narrow it down from the begin to a
specific disease e.g. by livestock species or specific
disease/parasitoses
– Consensus to focus on zoonotic endoparasites/helminthes
Case study 4:
LAO LONG-TERM STUDY ON ZOONOTIC DISEASES OF LIVESTOCK
WITH A FOCUS ON PARASITIC DISEASES
Start up challenges:
•Research objectives, activities and expected outputs sometimes
disconnected
– Objectives and related activities had the tendency to be narrowed in
terms of groups and actors involved e.g. only farmers initially involved
– Synthesis component from various activities missing
•Strong preference on the use of biometric approaches
– Biological sampling (serological) for specific diseases and focus on
prevalence estimates
– Expressed repeatedly by team members in various meetings/
discussions
•Limited understanding of EH principles
Case study 4:
LAO LONG-TERM STUDY ON ZOONOTIC DISEASES OF LIVESTOCK
WITH A FOCUS ON PARASITIC DISEASES
Objectives Activities
1. 1.1
1.2
1.3
1.4
2. 2.1
2.2
2.3
2.4
3. 3.1
3.2
3.3
3.4
Case study 4:
LAO LONG-TERM STUDY ON ZOONOTIC DISEASES OF LIVESTOCK
WITH A FOCUS ON PARASITIC DISEASES
Case study 4:
LAO LONG-TERM STUDY ON ZOONOTIC DISEASES OF LIVESTOCK
WITH A FOCUS ON PARASITIC DISEASES
EcoHealth
principle
Characteristics How to do
this in
practice
(Activities)
Challenges How to
overcome the
challenge?
Required
support by the
coordination
unit
Transdisciplin
ary research
Participation
Equity &
Gender
System-
thinking
Sustainability
Research-to-
action
Final reflections & conclusions
– Identification of a common research interest can be challenging
• sometimes “painful” and time consuming, strong consultative process
needed
– Junior versus senior
– Language barriers
– Silo thinking prominent in biometric dominated research teams
• Strong focus on biological sampling
– Social science vs. biometric science background
• Social science involvement remained a constant challenge
• Qualitative vs. quantitative research
• Synthesis of research results often the biggest challenge
Final reflections & conclusions
• Allocate sufficient time to expected changes of teams operations
• Trust building & incentives
• Identify & engage potential EH champions
• Continued mentoring on how to best incorporate EH in the proposals,
field work and analysis
– Balanced use of external & national experts
• Develop and use an evaluation system
• EH stories should be developed and documented
• Easier to achieve early success with partners already experienced in EH
e.g. Indonesia. More difficult but perhaps more significant, with teams
with no previous exposure to multi-disciplinary approaches (e.g. China)
Final reflections & conclusions
– Two-dimensional capacity-building requirement
• Technical (proposal writing/implementation/methodological)
• EHRC concept
– Sharing of credits for publications in a multidisciplinary
team
– Policy engagement
– Sustainability

Final reflections & conclusions
 Flexible adaptive/consultative approach needed
 Reflections from Outcome mapping (Layer 1)
Teams demanded a combined approach:
Strong demand for “leaning by doing” case studies but additional
capacity building on EH through training and mentoring needed
The presentation has a Creative Commons licence. You are free to re-use or distribute this work, provided credit is
given to ILRI.
better lives through livestock
ilri.org
Special thanks to the former EcoZD team and its partners
In particular: Jeff Gilbert, Delia Grace, Hung Nguyen
and Delia Grace

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EcoHealth and One Health – Moving from concepts to implementation: “Learning by doing” through case studies

  • 1. EcoHealth and One Health – Moving from concepts to implementation: “Learning by doing” through case studies Fred Unger International Livestock Research Institute, Hanoi, Vietnam One Health Master Class – SEA-EU-NET 2015 CIRAD, Kasetsart University, Bangkok, Thailand 27 May 2015
  • 2. Presentation outline • EH versus OH and their history in SE Asia (a short review) • Case study, learning by doing • Final reflections and conclusions
  • 3. Eco Health & One Health
  • 4. Various definitions (open to debate): range from quite rigid to very flexible! One-Health - biomedical focus: human + animal + wildlife -focus on communicable diseases -Operationalized/ institutionalized EcoHealth: -environment & socio-economic aspects – pioneered outside ‘traditional’ health -communicable & non-communicable diseases (dioxin; heavy metal toxicity -academic / research / complexity Eco Health and One Health - Compare
  • 5. Eco Health – One Health Contrast Eco Health Originated in biological Ecology/land conversation Complexity focus/systems Communicable/non communicable diseases Pioneered from IDRC ‘Bottom Up’ Vets, Medicals, epidemiologists, ecologists, social scientists, philosophers, indigenous perspectives, etc. Eco health One Health Integrated approach One Health Schwabe‘s One Medicine One world/One Medicine (Zinsstag) More quantitative/ Biometric focus (animal/human/widlllife) Communicable diseases Vets, medicals, some ecologist Currently institutionalized (FAO, OIE) Modified after IAEA 2014
  • 6. OneHealth/EcoHealth in SE Asia • One-Health – Various initiatives started in late 2000th in a response to HPAI International Ministerial Conference on Avian and Pandemic Influenza, New Delhi, Dec 2007, FAO, OIE, and WHO – to develop a joint strategic One World, One Health framework – IMCAPI, 2008 & 2010; Stone Mountain, 2010 – Meanwhile much more initiatives emerged • Eco-Health – Introduced by IDRC to SE Asia mid of the 2000 – Initial approach through exiting informal researcher network – IDRC funded various projects: APAIR, EcoEID, FBLI, BECA and EcoZD – New initiatives emerged
  • 7. • INDOHUN • THOHUN • VOHUN • MYOHUN EcoEID Emerging Pandemic Threats Program PREDICT • RESPOND • PREVENT • IDENTIFY EHRCs GHI ACIAR GHSA
  • 8. Case studies “learning by doing”  From previous or ongoing ILRI projects in SE Asia • ILRI EcoZD, project highlights and 2 case studies • Pig Risk (Vietnam)  Com Across • Laos case study
  • 9. GHGI Ecosystem Approaches to the Better Management of Zoonotic Emerging Infectious Diseases in Southeast Asia (EcoZD)
  • 10. Key components  Appraisal & Consultative Process  Outcome Mapping: demonstrate behaviour changes of targeted groups • Innovative Eco Health research in all 6 countries (“learning by doing” case studies) – Trans-disciplinary collaboration between institutions & teams – – New for most of the team members • Establishment of two Eco Health Resource Centres at Chiang Mai University (CMU) and Universitas Gadjah Mada (UGM) in Indonesia • Networking with other OH, EH initiatives
  • 11. Outcome mapping as M&E tool Layer 1: Relationship between EcoZD project & 8 teams to influence teams’ changes in knowledge, attitude, and practices (KAP). A Two-layer process CAMCAMCHICHI LAOLAO CMUCMU JTVJTV VTNVTNINDIND UGMUGM ILRI- EcoZD ILRI- EcoZD Slaughterhouse owners Slaughterhouse owners StudentsStudents Para professional Para professional Layer 1Layer 1 Layer 2Layer 2 Layer 2: Relationship between teams & their boundary partners (BPs) to support BPs’ changes in KAP.* • An participatory planning, M&E tool • Outcomes = changes in KAP & behavior of targeted groups
  • 12. Eco ZD - EH story – general reflections • Project did not come with pre-determined research questions, there was plenty froom for adaptation in the proposal • Learning by doing EcoHealth approach • Emphasis on capacity building - an approach where teams made key research decisions and were supported in implementation • Multi-year process of inter-personal relationship/trust-building • Amendments made based on own but also reflections of partners – 2 EHRC established
  • 13. Challenges across all teams • Various definitions (EcoHealth and OneHealth) • Identification of a common research interest • Budget sharing • Social science vs. biometric science expertise • Qualitative vs. quantitative research – synthesis of both • Two-dimensional capacity-building requirement • Technical • EH concept • EH incorporation in the case studies – reality check – often more VPH or at most OH than EH • Policy engagement
  • 14. Case study 1: Yunnan/China ” Ecosystem approaches to the better management of zoonotic emerging infectious diseases in the South East Asia Region
  • 15. Case study 1: Yunnan, China 1. Identification of common research topic Researchers from 4 different institutions with different locations, priorities and interests : •Yunnan Agriculture University (Vet Fac) •YAGAS, Yunnan Academy of Grasslands and An. Science •Yunnan Endemic Disease Control and Prevention Institute (YEDCPI) •Yunnan Animal Science and Veterinary Institute (ASVI)
  • 16. Partners Interests and Expertise Institute Focus diseases Expertise Yunnan Endemic Disease Control and Prevention Institute (YEDCPI)  Leptospirosis  Schistosomiasis japonica  Hantaviral diseases  Bartonellosis  Brucellosis, Toxoplasma Detection, identification, and isolation of pathogens; Serological survey; DNA Sequencing, Lab tech., field epidemiology, pathogen ecology Yunnan Animal Science and Veterinary Institute (ASVI)  TB, Brucellosis  E. coli, salmonellosis Diagnostic and monitoring methods, epidemiology, pathogen characterization, control and prevention, economic and public health impacts Yunnan Agricultural University (YAU)  Schistosomiasis japonica  toxoplasma  Hepatitis E., E. coli Pathogen ecology, epidemiology, pathogenesis, prevention and control Yunnan Academy of Grassland Animal Sciences (YAGAS)  Fluke  Brucellosis, TB  Tape worm Epidemiological investigation, clinical diagnosis, livestock genetics, production system, livestock ecology and management
  • 17. Brucellosis & Toxoplasmosis in Yunnan Approach (identification of research topic): •Repeated meetings including stakeholders but also community visits, some with ILRI others not •Timely process (nearly 12 months) – Feb 2009 to Jan 2010 (scoping visit of filed sites) •Facilitation and consensus building skills needed •Trust and relationship building takes time in China (some partners we had relations before, others not) •Our choice was TB and Brucellosis •Anyhow consensus on Toxoplasmosis & Brucellosis in ethnic groups
  • 18. Eco ZD case study: Yunnan/China ” Ecosystem approaches to the better management of brucellosis and toxoplasmosis with focus on ethnic minorities
  • 19. Brucellosis and Toxoplasmosis, Yunnan, China Related challenges (identification of research topic) •Jan 2010, Scoping visit • to better understand the production system and socio-cultural aspects • Team surprised us with serological sampling in humans and animals. Purely biometric approach but still weak sampling protocol. • Research agreement was not even signed! • Philosophy: sampling, sampling, sampling •Set back needed • First thoughts on recruitment of a national EH champion
  • 20. Case study: Brucellosis & Toxo in Yunnan Problem: • Brucellosis is a serious concern in Northern China • Dairy sector promoted with animal movements from north to south • No or limited information on prevalence's • Toxoplasma: Lack of any update information in animal sector and PH concern No studies on perception/awareness of involved groups and stakeholders Classical vet approach (demanded by most tam members): • Prevalence study in targeted livestock populations
  • 21. Developing of an EH framework Mapping of stakeholders, partners & groups involved 21 Brucellosis control Public health authorities (central/local officers, local hospitals) LS officers (central/local) Local administration officers Policy makers Socio economic experts Butchers, meat vendors Milk vendors, butchers Farmers/ herders Donors, international organizations & universities Associations (if any or to be established) Communities Outpatients Animal husbandry expert
  • 22. EH (study) framework for Yunnan study 22 The problem: Brucellosis & Toxoplasmo sis in Yunnan Public health authorities (hospitals and local) (IDI) •Review of existing information •General Z knowledge •Specific action B & T patients •Collaboration with PH Vet officers/stations (IDI) •Review of existing information •General Z knowledge •Specific action B & T •Control •Collaboration with PH Farmers (QX) • Production data •AH and disease prevention •Reproductive disorders •Zoonoses and OH •Waste management Past unit, milk vendors (FGD): •Zoonoses knowledge •Quality control •Sanitation •Inspection by authorities Villagers (with/without livestock) (FGD) • Animal husbandry •Zoonoses •Risk factors •AH services •PH services •Source of information Butchers (IDI) •General Z knowledge •Specific knowledge B & Toxo •Health check and status •Hygiene and training •Waste management Hospital case review: •Clinical cases Literature review Survey: •Dairy farms (milk) •People at risk (serum)
  • 23. Brucellosis & Toxoplasmosis in Yunnan 2. No experience with an EH approach • Strong silo-thinking and biometric driven research team • Continued demand for biological sampling • No thoughts on qualitative methods – Very limited understanding of qualitative tools or socio-cultural aspects despite the study focus on ethnic minorities • Limited understand of EH principles Approach: Frequent visit of ILRI scientist Identification of an EH champion (Fang Jing) Short training on EH (probably too late) Relationship and trust building Gain ownership by local authorities
  • 24. Brucellosis & Toxoplasmosis in Yunnan Qualitative research 3. Perception on qualitative research tools – Some team members had perception that qualitative research is not valid, not scientific and therefore not useful – Mainly more dominant in senior staff (vets of MD’s) – Often related to the fact that epidemiological sample size calculations used for quantitative tools may not apply the same way as for qualitative research – Younger researchers more open but often challenged by hierarchical issues •If than used (qualitative tools) there was a perception from again more senior researchers that they can do it themselves (more like ”everybody can do this”)
  • 25. Qualitative research FGD and in depth interviews We know how to do it ...
  • 26. Brucellosis & Toxoplasmosis in Yunnan Perception on qualitative tools Approach: Frequent visits of ILRI scientist EH champion (Fang Jing) Training modules on qualitative tools including Relationship and trust building Learning by doing - success: After being trained and implementation, most of team members were exited on the use of FGD and IDI Mainly driven by the collected data » new views, they would never had thought about it » Opportunity for triangulations … New challenge emerged
  • 27. Brucellosis & Toxoplasmosis in Yunnan 4. Synthesising qualitative and quantitative research results • Focus was on collection and analysis of biological samples and quantitative data • No experience with qualitative data analysis at all • Latest now team members realised that “everybody can do it “ without some training might be wrong Approach: First part of analysis strongly guided/done by EH champion e.g. In depth interviews in village doctors Further analysis done jointly (IDI, butchers) All others done by team (IDI, village Vets) and FGD
  • 28. Brucellosis & Toxoplasmosis in Yunnan Synthesising qualitative and quantitative research results QX Vet QX PH Butch er QX Linkages to Serology Triangu lation FGD Triang ulation IDD Potential RF Toxo/Bru c Quality of QX data Select for analysis Comments General data training, number of staff x x x General Z knowledge Knowledge x x x Most important Z x x x Surveilance and control x x x Bruc and Toxo (awareness, perception) Knowledge x x x Diagnostic tests x x Handling of patient with B/T x Collaboration with vet sector when x x which topic x x action x x General hygiene place for slaughter x hygienic measured x protecive clothes x Health status and check x
  • 29. Brucellosis & Toxoplasmosis in Yunnan 4. Synthesising qualitative and quantitative research results FGD IDI QX Check list Demographic (e.g. gender/ethnics) Gender, differed by actor Knowledge on zoonoses Lowest in butchers Lowest in butchers Risk practices Some raw milk and meat consumption in some villagers No indications of raw m/m consumption No indications of raw m/m consumption NA System services (vets)
  • 30. Brucellosis & Toxoplasmosis in Yunnan Other challenges and observations: •Hierarchical differences between researchers •Unfortunately the most “EH open” researcher was the youngest and also facing EN language difficulties •Deficits in report/paper writing (mainly due to language barriers) •Existing publications (mainly in Chinese) •Team highly motivated but tendency to derail in direction •Transaction costs (to facilitate various meetings) •True Co-funding provided (25%, the only team among 8)
  • 32. Case study 1: Brucellosis and Toxoplasmose in Yunnan ” Final reflections: - finally one of the best and highly motivated team - Incentive: invited by FAO to Beijing to present results - Extended networking (e.g. EHRC and PE) Final reflections: - finally one of the best and highly motivated team - Incentive: invited by FAO to Beijing to present results - Extended networking (e.g. EHRC and PE)
  • 33. Case study 2: Optimizing Rabies Control in Bali: An Ecohealth Approach.”
  • 34. Case study 2: Optimizing Rabies Control in Bali: An Ecohealth Approach.” Selection of study topic and teams • ILRI facilitated a call for proposals for EH case studies (4 proposals submitted) – Rabies in Bali – AI in humans and animals (Java) – Small holder chicken – a socio economic perspective for HPAI (Yogyakarta) – Toxoplasmosis in animals and human (Yogyakarta) External panel evaluated each proposal – ILRI, NARS Indonesia, FAO, EH champions
  • 35. Case study 2: Optimizing Rabies Control in Bali: An Ecohealth Approach.” The problem: • Rabies is an emerging zoonoses since its recent introduction • Conventional control measures show limited success • Prominent role of dogs in Bali society – Initial mass culling (Strychnine) faced strong obligations (local and international) – Obligations against population control measures Classical vet approach: Vaccination in dogs and sterilisation
  • 36. Case studies 2: Optimizing Rabies Control in Bali: An Ecohealth Approach Eco Health perspective: Better understand: • Social cultural relationship between dogs and the Balinese community • Dog population in Bali and its dynamics. • Dog ecology in Bali and measure its contact intensity with other animals and human. To develop a model for sustainable Rabies prevention, control, and eradication at banjar level through community empowerment and behavior change. Aligned with Vaccination campaigns in dogs (FAO, LS services)
  • 37. EH (study) framework Optimizing Rabies Control in Bali Control of Rabies in Bali focus on communities Socio-science -Social cultural believes Environments − Waste problems (“feed places”) − Monkeys Human health - Capacity - Acceptance of Post exposure vaccination Community - Acceptance - Feasibility (human and dog health) Political perspectives - Law and regulation - Enforcement Vet Science -Epidemiologist - Practionaires - Capacity Tourism: - Major source of income Private sector -Vaccines -An. Welfare Media -Social acceptance
  • 38. Ecohealth Approach Dissemination: Pilot Village (A community-based approach) + Awareness in Elementary School Dog ecology Study (Behavior, Fecundity and Demography of Dog) Social Culture Study System Thinking (ecohealth principle (EP) #1) Knowledge to Action (EP # 2)(Governor of Bali) Trans-diciplinary Approach (EP# 3), e.g. research from various backgrounds Participation (EP # 4) Equity (EP # 5), e.g. male more responsibly in dog raising Sustainability(EP# 6) e.g. village cadre’s traind Review
  • 39. Case study: Optimizing Rabies Control in Bali: An Ecohealth Approach.” Challenges and approached to address them • Socio-cultural study – mainly based on qualitative approaches – International consultant from University of Edinburgh – PHD student from local partner • Publication issues – Who publishes what in a transdisciplinary team – Publications demanded for almost all team members – Use of double lead authorships - some journals support this Final reflection • Scientifically strong team members of various backgrounds • Most of them EH experienced from other IDRC studies
  • 40. Case study 3: Salmonella spp. IN PIG SLAUGHTERHOUSES AND PORK MARKETS ASSOCIATED WITH HUMAN HEALTH IN HUNG – PIG RISK Map of Vietnam Source: http:/www, trelangkienviet,com 5
  • 41. Scase study 3: Salmonella spp. IN PIG SLAUGHTERHOUSES AND PORK MARKETS ASSOCIATED WITH HUMAN HEALTH IN HUNG YEN, VIETNAM Quantitative research •Assess Salmonella contamination •Determine potential risk factors Quantitative research •people’s and stakeholders perception related to Salmonella contamination with the potential risks in practice • People’s living around slaughter houses (IDI) • Pork consumers (IDI) • Community vets • Community health workers (IDI) • SH workers (FGD) • Pork sellers (FGD) • Local authorities, party committee (IDI) • Biological sampling • Semi-structure QX • Check lists
  • 42. 42 Case study 3: Challenges & approaches • Convince participants on acceptance of FGD and IDI • Each takes 30-40 min • Most difficult in pork sellers and people living around SH Approach: Repeated approach to convince for participation incentive • Designing of outlines • FGD and IDI looked more like a long questionnaire • Huge amount of collected information • 35-40 pages of transcript from FGD and IDI Approach: Got help from a national social-scientist MSC student (a vet) was smart and proactive
  • 43. 43 Case study 3: FFFGD initial outline People living around SH Introduction: Group introduction Reason why we are here Self-introduction: I am ---, this is ---- 2. Basic information about the respondents your family? 3. Animal husbandry Raise pigs or not and for how long? Some information about keeping pigs in villages, who have animals/pig Reason to kept pig or not kept (any complain/disturbance) 4. Perception and Awareness about the slaughterhouse: - Pork provided for community from where? From SH, butcher, market or supermarket or other - The presence of SH in the community? What and how do you know about it/them? Expected: Where, how far, how long, owner, time of slaughter, number of pig, how they transport… - The affect of the SH: List and ranking (using proportional pilling) and discuss why Benefits (pork access, job, others...) Disadvantages/disturbances (noise, environmental pollution, risk of diseases, house prices, any others ...) Reflect/complain by the respondents, if any If yes to whom (community, local government, slaughter house ...)? What are the complains? What should be changed? Food safety and hygiene: (quarantine, disinfection, cleaning, housing…)? Vet service: inspection? Environment: waste, smell Any reaction or change of situation, and what is the response/measure Is it getting better or worst - People's perception about standard criteria to be applied in the SH: - List of criteria about the ‘standard’ SH from your perspective - The slaughterhouse you described satisfied or not, how a future SH should be, what should be done? - Why should they change? - If the meat price will increase due to investment towards a improved slaughterhouse, are they willing to pay, how much higher can be accepted?
  • 44. 44 Case study 3: Pig risk Exiting results from focus groups discussions in pork sellers 1. Prefer to use wood surface tables in stead of other types(e.g. versus stainless steel) • Vietnam government currently upgrades markets (LIFSAP) • Most of food sellers still use their old cutting boards 2. Use of cloth to dry pork, clean equipment, hand or table, some consumers related “wet” looking meat to low meat quality 3. Use of cupboard at market stools, same reason as under 2 4. Use of masks: in response to buyers/consumers perception that sellers may have a health problem. 5. Knowledge of zoonoses: PRRS and FMD, CSF, leptospirosis, cysticercosis, misperception on FMD, CSF Results of FGD help a lot to understand used practices not in the line with regulations
  • 45. The problem •Parasitic zoonoses are often neglected disease and endemic in the Laos •Some characteristics of animal production and food consumption habits in Laos, can promote zoonotic disease transmission – high density of both human and animal populations in close proximity; – a smallholder production systems with mixed species and little/no biosecurity; – abattoirs and wet markets operating with rudimentary hygiene, – widespread consumption of raw/undercooked blood, meat, fish, organ tissues, raw leaf vegetables… – Use of untreated wastewater and sewage for agriculture Case study 4: LAO LONG-TERM STUDY ON ZOONOTIC DISEASES OF LIVESTOCK WITH A FOCUS ON PARASITIC DISEASES
  • 46. Case study 4: LAO LONG-TERM STUDY ON ZOONOTIC DISEASES OF LIVESTOCK WITH A FOCUS ON PARASITIC DISEASES Objectives •To provide an overview on parasitic zoonoses from secondary data •To identify parasitic zoonosis distribution for prioritized parasites in animals and humans (southern part of Laos). •Better understand farmers ’ KAP’ linked to parasitic zoonoses along the pigs and fish commodity chains. •Improve animal health/productivity by a better knowledge on diseases drivers, and suitable control options related to: AH, PH & well-being •Reduce animal and human health risks cf. food borne diseases through a better understanding of risk factors •Develop a cross-sectoral collaboration platform and dissemination strategy
  • 47. Case study 4: LAO LONG-TERM STUDY ON ZOONOTIC DISEASES OF LIVESTOCK WITH A FOCUS ON PARASITIC DISEASES • Team members include expertise from different backgrounds and expertise – Animal science, public health, social science Strat up challenges: • Identification of the research topic – Concerns that this is too broad – Disease focus, rather tendency to narrow it down from the begin to a specific disease e.g. by livestock species or specific disease/parasitoses – Consensus to focus on zoonotic endoparasites/helminthes
  • 48. Case study 4: LAO LONG-TERM STUDY ON ZOONOTIC DISEASES OF LIVESTOCK WITH A FOCUS ON PARASITIC DISEASES Start up challenges: •Research objectives, activities and expected outputs sometimes disconnected – Objectives and related activities had the tendency to be narrowed in terms of groups and actors involved e.g. only farmers initially involved – Synthesis component from various activities missing •Strong preference on the use of biometric approaches – Biological sampling (serological) for specific diseases and focus on prevalence estimates – Expressed repeatedly by team members in various meetings/ discussions •Limited understanding of EH principles
  • 49. Case study 4: LAO LONG-TERM STUDY ON ZOONOTIC DISEASES OF LIVESTOCK WITH A FOCUS ON PARASITIC DISEASES Objectives Activities 1. 1.1 1.2 1.3 1.4 2. 2.1 2.2 2.3 2.4 3. 3.1 3.2 3.3 3.4
  • 50. Case study 4: LAO LONG-TERM STUDY ON ZOONOTIC DISEASES OF LIVESTOCK WITH A FOCUS ON PARASITIC DISEASES
  • 51. Case study 4: LAO LONG-TERM STUDY ON ZOONOTIC DISEASES OF LIVESTOCK WITH A FOCUS ON PARASITIC DISEASES EcoHealth principle Characteristics How to do this in practice (Activities) Challenges How to overcome the challenge? Required support by the coordination unit Transdisciplin ary research Participation Equity & Gender System- thinking Sustainability Research-to- action
  • 52. Final reflections & conclusions – Identification of a common research interest can be challenging • sometimes “painful” and time consuming, strong consultative process needed – Junior versus senior – Language barriers – Silo thinking prominent in biometric dominated research teams • Strong focus on biological sampling – Social science vs. biometric science background • Social science involvement remained a constant challenge • Qualitative vs. quantitative research • Synthesis of research results often the biggest challenge
  • 53. Final reflections & conclusions • Allocate sufficient time to expected changes of teams operations • Trust building & incentives • Identify & engage potential EH champions • Continued mentoring on how to best incorporate EH in the proposals, field work and analysis – Balanced use of external & national experts • Develop and use an evaluation system • EH stories should be developed and documented • Easier to achieve early success with partners already experienced in EH e.g. Indonesia. More difficult but perhaps more significant, with teams with no previous exposure to multi-disciplinary approaches (e.g. China)
  • 54. Final reflections & conclusions – Two-dimensional capacity-building requirement • Technical (proposal writing/implementation/methodological) • EHRC concept – Sharing of credits for publications in a multidisciplinary team – Policy engagement – Sustainability 
  • 55. Final reflections & conclusions  Flexible adaptive/consultative approach needed  Reflections from Outcome mapping (Layer 1) Teams demanded a combined approach: Strong demand for “leaning by doing” case studies but additional capacity building on EH through training and mentoring needed
  • 56. The presentation has a Creative Commons licence. You are free to re-use or distribute this work, provided credit is given to ILRI. better lives through livestock ilri.org Special thanks to the former EcoZD team and its partners In particular: Jeff Gilbert, Delia Grace, Hung Nguyen and Delia Grace