Integrated evaluation of livestock health programs: a contribution based on the case of public-private partnerships

Si les partenariats public-privé (PPP) en santé publique sont étudiés depuis les années 1980, dans le domaine vétérinaire peu d'entre eux ont été évalués. Pourtant, de nombreux PPP dans ce domaine sont mis en œuvre à travers le monde. Ces PPP représentent des approches conjointes dans lesquelles les services vétérinaires publics et des parties prenantes privées tels que des vétérinaires privé·es, des associations de producteur·rices ou des entreprises privées, travaillent ensemble pour relever des défis complexes en matière de santé animale. Dans cette thèse, il est question de PPP pour la surveillance, la prévention et le contrôle de maladies animales infectieuses. Si des avantages de ces formes de collaborations existent, elles présentent aussi des risques. L’objectif de cette thèse était de développer un cadre d’évaluation intégrée en s’intéressant aux attributs et aux propriétés de ces PPP. Ces derniers informeraient l’évaluation du processus et de la portée de ces PPP pour en limiter les risques et favoriser des effets positifs. Ce travail de thèse s’appuie à la fois sur des cadres pré-existants (de l’approche réaliste en santé publique et de la durabilité), sur une revue de la littérature, et sur les thèmes émergeant de l’analyse de 4 cas d’étude, qui ont été mis en dialogue pour aboutir à un cadre d’évaluation. Des approches participatives ont été mobilisées dans les cas d’études, permettant de considérer la pluralité des points de vue des parties prenantes impliquées ou impactées par ces PPP. Des opinions, perceptions, et interprétations nuancées et diverses ont ainsi été recueillies. Ces approches ont ainsi permis d’appréhender l’organisation des PPP et leurs effets tels que perçus par ces acteur·rices, favorisant une vision systémique du PPP. Dans un premier temps, une revue de la littérature sur les évaluations des PPP dans le domaine vétérinaire et de la santé publique a permis d’identifier les différentes méthodologies et critères d’évaluation existants. Cette revue nous a permis de proposer une première ébauche de cadre d’évaluation des PPP centré sur le concept de la durabilité. Le cadre d’évaluation proposé peut se découper en analyse du contexte, analyse du processus et analyse des résultats des PPP. Dans une deuxième partie de la thèse, pour être en mesure d’opérationnaliser l’analyse de contexte, deux méthodologies sont proposées. Une perspective historique d’un PPP au Paraguay permet de retracer l’émergence de la collaboration entre le secteur public et le secteur privé pour le contrôle de la fièvre aphteuse, et d’identifier les différents facteurs qui ont influencé la structuration de ce PPP. Une cartographie de parties prenantes au Laos, dans une perspective ex ante d’un éventuel PPP pour la gestion de l’antibiorésistance, permet d’identifier les connexions entre les parties prenantes, de comprendre comment elles s’influencent mutuellement, et d’explorer leurs intérêts et contraintes. Dans une troisième partie de cette thèse, pour être en mesure d’analyser le processus de fonctionnement d’un PPP, un outil d’évaluation de la qualité du processus des PPP a été développé. Ce développement a été permis grâce aux critères identifiés dans la revue de littérature, une élicitation d’opinions d’expert·es (du secteur public et du secteur privé) et deux cas d’études. Cet outil s’intéresse particulièrement au fonctionnement de coordination, de collaboration et de gouvernance des PPP. Cet outil a ensuite été appliqué sur un PPP en Tunisie correspondant au mandat sanitaire vétérinaire. Finalement, dans une quatrième partie de la thèse, une application participative du chemin d’impact sur un PPP en Ethiopie dans le secteur de la volaille a permis de s’intéresser aux résultats et impacts permis par le PPP, ainsi que la contribution du PPP pour atteindre ces impacts. Les parties prenantes ont identifié une diversité d’impacts qui ont été caractérisés par des indicateurs. Le cadre d’évaluation intégrée développé dans cette thèse vise à identifier des points d’amélioration des processus et des résultats des PPP en matière de santé des humains, des animaux et des écosystèmes, dans une perspective de durabilité. Ces objectifs s’intègrent donc explicitement dans une approche One Health, comprise comme appartenant aux sciences de la durabilité. Plusieurs difficultés liées à l’opérationnalisation de l’évaluation ont été identifiées, notamment la considération de la dimension environnementale et la participation des parties prenantes impactées négativement par les PPP. Ces difficultés limiteront la mise en place de changements des PPP évalués et donc les chances de favoriser une trajectoire plus durable. Pour dépasser ces difficultés opérationnelles, ce cadre d’évaluation peut être utilisé dans une perspective d’accompagnement sur le long terme par une équipe interdisciplinaire d’évaluateur·rices. Ces travaux méritent d’être continués et ce cadre d’évoluer. Par exemple, il serait intéressant de considérer d’autres échelles d’évaluation comme l’échelle individuelle ou l’échelle des réseaux d’acteur·rices. Il serait aussi intéressant de proposer des analyses de risques, d’approfondir l’analyse des jeux de pouvoir, et de réfléchir à une réelle considération de la dimension environnementale dans l’évaluation des PPP en santé animale.Although public-private partnerships (PPPs) in public health have been studied since the 1980s, few have been evaluated in the veterinary domain. However, many PPPs in this field are being implemented around the world. These PPPs represent joint approaches in which public veterinary services and private actors, such as private veterinarians, producer associations or private companies, work together to address complex animal health challenges. This thesis focuses on PPPs for the surveillance, prevention and control of infectious animal diseases. While there are advantages to these forms of collaboration, there are also risks. The objective of this thesis was to develop an integrated evaluation framework by focusing on the attributes and properties of these PPPs. These would inform the evaluation of the process and outcomes of these PPPs to limit the risks and favor positive effects. This thesis work is based on pre-existing frameworks (realistic approach in public health and sustainability), on a literature review, and on the themes emerging from the analysis of four case studies, which were put into dialogue to arrive at an evaluation framework. Participatory approaches were mobilized in the case studies, allowing for the consideration of the plurality of viewpoints of stakeholders involved or impacted by these PPPs. Nuanced and diverse opinions, perceptions, and interpretations were thus collected. These approaches have made it possible to understand the organization of PPPs and their effects as perceived by these stakeholders, allowing a systemic vision of the PPP. First, a review of the literature on the evaluation of PPPs in the veterinary domain and public health allowed us to identify the different methodologies and evaluation criteria that exist. This review allowed us to propose a first draft of an evaluation framework for PPPs centered on the concept of sustainability. The proposed evaluation framework can be divided into context analysis, process analysis and outcome analysis of PPPs. In a second part of the thesis, in order to be able to operationalize the context analysis, two methodologies are proposed. A historical perspective of a PPP in Paraguay traces the emergence of the collaboration between the public and private sectors for the control of foot and mouth disease, and identifies the different factors that influenced the structuring of this PPP. A mapping of stakeholders in Laos, from an ex-ante perspective of a potential PPP for the management of antimicrobial resistance, allows us to identify the connections between stakeholders, to understand how they influence each other, and to explore their interests and constraints. In a third part of this thesis, in order to be able to analyze the operating process of a PPP, a tool for assessing the quality of the PPP process was developed. This development was made possible thanks to the criteria identified in the literature review, an elicitation of expert opinions (from the public and private sectors) and two case studies. This tool focuses on the coordination, collaboration and governance functioning of PPPs. This tool was then applied to a PPP in Tunisia corresponding to the veterinary health mandate. Finally, in the fourth part of this thesis, a participatory application of the impact pathway on a PPP in Ethiopia in the poultry sector focused on the outcomes and impacts enabled by the PPP, as well as the contribution of the PPP to achieving these impacts. Stakeholders identified a variety of impacts that were characterized by indicators. The integrated evaluation framework developed in this thesis aims to identify points of improvement in the processes and outcomes of PPPs in terms of human, animal and ecosystem health, from a territorial sustainability. These objectives are therefore explicitly integrated into a One Health approach, understood as belonging to the sciences of sustainability. Several difficulties related to the operationalization of the evaluation have been identified, including consideration of the environmental dimension and the participation of stakeholders negatively impacted by PPPs. These difficulties may limit the implementation of changes in the PPPs evaluated and therefore the chances of promoting a trajectory towards a more sustainable territory. To overcome these operational difficulties, this evaluation framework can be used in a long-term support perspective by an interdisciplinary team of evaluators. This work deserves to be continued, and this framework to evolve. For example, it would be interesting to consider other scales of evaluation such as the individual scale or the scale of stakeholder networks. It would also be interesting to propose risk analyses, to deepen the analysis of power games, and to reflect on a real consideration of the environmental dimension in the evaluation of PPPs in animal health.2. Zero hunger3. Good health and well-bein

Use of stakeholder mapping and analysis to explore the food animal drugs supply chain in Lao PDR

Objective Reducing the inappropriate and uncontrolled use of antimicrobials in food animals is a key measure promoted by international organisations to tackle antimicrobial resistance (AMR). This requires a clear understanding of the drugs supply chain, including information about drivers and barriers for access. As such data was not available for Lao PDR, we have implemented a study to identify stakeholders of the food animal’s antimicrobial map flow (public and private) and to analyse their roles, behaviour and interactions regarding drugs supply. Method We first compiled all the information about regulation of drugs importation, access, sources and stewardship available in Lao PDR. Then semi-structured interviews with key informants were organised to identify actors of the supply chain, their interactions and position regarding the risk of AMR and possible changes in national legislation. Finally, we organized three multi-stakeholder’s meetings with representatives of all sectors, to discuss the results of previous stakeholder mapping. Results We managed to identify 21 main stakeholders involved in the drugs supply chains, with their respective role and influence. Informal pathways of antimicrobial supply were mapped, identifying illegal sources of drugs from Vietnam, Thailand or China. Drugs restricted to human usage were found to be easily purchased by farmers to treat livestock. Discussion In the framework of the on-process AMR surveillance plan in food animals, these results help to identify constraints and barriers regarding the implementation of new regulations on antimicrobial usage in Lao PDR. Acknowledgment: Thanks to the Regional Office for Asia and the Pacific of the Food and Agriculture Organization of the United Nations, the Fleming Fund and GREASE platform for their financial support. Thanks to the Faculty of Agriculture of the National University of Laos for their collaboration.BASELINE REVIEW OF ANTIBIOTIC PRACTICES AT FARMS' LEVEL IN LAO PDR INCLUDING GAP ANALYSIS AND STAKEHOLDER MAPPIN

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

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

Engaging the actors to ensure impacts of public–private partnerships

Evaluation and actor engagement are essential to ensure performance and sustainability of actions implemented, especially under public–private partnerships (PPPs). In the context of the OIE PPP initiative, the OIE and CIRAD have developed a participatory evaluation method to assess the added value of PPPs in the veterinary domain

The Diversity of Impacts Brought by Sound Implementation of Public-Private Partnerships in the Veterinary Domain

Public Private Partnership (PPP) is defined as a joint approach in which the public and private sector agree responsibilities and share resources and risks to achieve common objectives that deliver benefits in a sustainable manner. However only limited information is available on the added value of PPP in the veterinary domain. The aim of this study was to identify the different benefits and impacts lead by PPPs implemented in this field. A structured questionnaire survey was implemented by the World Organisation for Animal Health (OIE) to collect data on the different types of PPPs worldwide (n=181 countries). Three case studies were selected from the survey results (n=97) for CIRAD to implement an in depth impact assessment. An expert opinion elicitation involving around 40 experts was performed using semi-structured interviews and an expert meeting in October 2018 to validate the list of benefits and impacts developed. Sixteen categories of benefits (direct effect) and five categories of impacts (long term influence) were identified: stronger national economy; greater trust in public and private partners; reduced business risk and increased opportunities; improved public health (reduced zoonotic risk and improved food security) and societal issues such as livelihood improvement and reduction in gender inequality. This study represents the first practical attempt to represent the diversity of impacts that proper implementation of PPPs in the field of veterinary domain could generate. This work is currently contributing to the development of OIE guidelines to promote good practices for impactful and sustainable PPPs in the veterinary domain

Typological analysis of public-private partnerships in the veterinary domain

Public-Private Partnerships (PPPs) are defined as a collaborative approach in which the public and private sector share resources, responsibilities and risks to achieve common objectives and mutual benefits in a sustainable manner. PPPs are identified as a key solution to reinforce Veterinary Services. However only limited information is available on the scope, added value and enabling factors of PPPs in this sector. The aims of this study were to develop a typology of PPPs in the veterinary field and to identify key success factors and obstacles to their implementation. A structured questionnaire was sent to all 181 World Organisation for Animal Health (OIE) Member Countries and to 47 private contacts. 36 different variables characterizing PPP initiatives were collected. 97 examples of PPPs were retrieved from 76 countries. Dimensionality reduction techniques were combined with clustering and discrimination methods to establish a typology of PPPs and to derive a set of simple rules to classify new instances of PPPs. Three clusters were identified, separated according to two main variables: the type of private partners and the type of interaction. Cluster 1, transactional PPPs, represented the traditional understanding of PPPs by Veterinary Services, initiated and funded by the public sector, giving service delivery accreditation to mostly private veterinarians; cluster 2, collaborative PPPs, included partnerships between producer associations and public Veterinary Services, driven by trade interests; cluster 3, transformational PPPs, represented joint programs initiated and funded by private companies and initially driven by business development objectives. Specific success factors and key obstacles affecting the performances and sustainability of these initiatives were identified for each cluster. This study represents the first practical attempt to develop a meaningful typology of PPPs in the field of animal health and to identify fundamental obstacles currently inhibiting the development of PPPs, and suggests ways to support national Veterinary Services in overcoming these obstacles.Public-Private Partnerships (PPPs) are defined as a collaborative approach in which the public and private sector share resources, responsibilities and risks to achieve common objectives and mutual benefits in a sustainable manner. PPPs are identified as a key solution to reinforce Veterinary Services. However only limited information is available on the scope, added value and enabling factors of PPPs in this sector. The aims of this study were to develop a typology of PPPs in the veterinary field and to identify key success factors and obstacles to their implementation. A structured questionnaire was sent to all 181 World Organisation for Animal Health (OIE) Member Countries and to 47 private contacts. 36 different variables characterizing PPP initiatives were collected. 97 examples of PPPs were retrieved from 76 countries. Dimensionality reduction techniques were combined with clustering and discrimination methods to establish a typology of PPPs and to derive a set of simple rules to classify new instances of PPPs. Three clusters were identified, separated according to two main variables: the type of private partners and the type of interaction. Cluster 1, transactional PPPs, represented the traditional understanding of PPPs by Veterinary Services, initiated and funded by the public sector, giving service delivery accreditation to mostly private veterinarians; cluster 2, collaborative PPPs, included partnerships between producer associations and public Veterinary Services, driven by trade interests; cluster 3, transformational PPPs, represented joint programs initiated and funded by private companies and initially driven by business development objectives. Specific success factors and key obstacles affecting the performances and sustainability of these initiatives were identified for each cluster. This study represents the first practical attempt to develop a meaningful typology of PPPs in the field of animal health and to identify fundamental obstacles currently inhibiting the development of PPPs, and suggests ways to support national Veterinary Services in overcoming these obstacles

Résilience de la Wallonie face aux risques environnementaux : Note transversale de synthèse et de recommandations

Le Congrès sur la résilience de la Wallonie avait pour objectif d’établir un diagnostic des vulnérabilités de la Wallonie face aux risques environnementaux ; d’élaborer une vision d’une Wallonie résiliente et d’aboutir à des recommandations en termes d’outils de gouvernance et de monitoring pour mieux anticiper et gérer ces risques. La présente note de synthèse établit les recommandations issues de cet événement

Different kettles of fish: Varying patterns of antibiotic use on pig, chicken and fish farms in Lao PDR and implications for antimicrobial resistance strategies

International audienceThe rapid intensification of the livestock sector in Southeast Asia has been found to be associated with an expanding use of antibiotics (ABU) and the rise of antimicrobial resistance (AMR) in both humans and livestock. This study aimed to explore the views and practices of commercial pig, poultry and fish farmers regarding antibiotics in Lao People's Democratic Republic, where data on antibiotic use and AMR remain scarce. A multistage cluster sampling method, based on the random selection of villages in two provinces of Vientiane, was used. A total of 364 farmers, corresponding to 454 farm units, were surveyed using a questionnaire and farm visits. This study found a widespread use of antibiotics (261 out of the 454 farm units used antibiotics). The predominance of antibiotics considered critically important antibiotics for human medicine was of great concern. Results from a logistic regression model showed that antibiotics were found less frequently in fish farm units compared to pig and poultry farm units, and more frequently in specialized farms than in livestock-fish farms. Multiple factor analysis and hierarchical cluster analysis revealed three profiles of farmers, each with distinct patterns on knowledge, attitudes and practices regarding ABU and AMR. Cluster 1 held a positive attitude regarding preventive measures and information about antibiotics. In cluster 2, there was a view that antibiotics should be used for prophylactic treatment such as disease prevention. Cluster 3 was characterized by farmers with weak knowledge who were unfamiliar with antibiotics and uncertain about details concerning antibiotic use. This cluster was associated with a significantly lower use of antibiotics than the two other clusters in the regression model. The results of this study may help the Laotian government to adapt strategies to control AMR by focusing on the use of critical antibiotics and prophylactic treatments and by tailoring measures to farmers’ profiles