One Health Units as innovative models for health service delivery in pastoralist communities of East Africa
Full Solution
OHU Service Delivery in Filtu district (Ethiopia)
Andrea Rossetti
The One Health for Humans Animals Environment and Livelihood (HEAL) project adopts a bottom-up, context-specific, evidence-based, transdisciplinary approach to increase the accessibility to human and animal health services and enhance the management of natural resources in pastoralist areas of East Africa. In this region, nomadic pastoralists are among the most vulnerable and hard-to-reach communities, often excluded from the provision of essential social and health services. The project reshapes service delivery in the form of One Health Units (OHU). By nurturing collaboration, coordination and communication between service providers working in human, animal, environmental and rangeland health, the OHU provides integrated services to the pastoralists and their livestock and supports communities to sustainably manage the rangelands they rely on. The OHU is jointly managed by the pastoralist communities, through Multi-Stakeholder Innovative Platforms (MSIP) and the local authorities, through the One Health Task Force (OHTF).
Last update: 04 Jul 2024
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Context
Challenges addressed
There are an estimated 268 million nomadic pastoralists in Africa. These communities live in arid and semi-arid lands where pastoralism is probably the only viable option to access seasonally available pasture and water and make sustainable use of natural resources. Pastoralists rely on livestock for nutrition, livelihood and income. Because of their mobile lifestyle and dispersal over wide geographical areas, they have limited access to health services. They are usually excluded from disease surveillance programs despite their high vulnerability to human, animal and zoonotic infectious diseases. Pastoralists are also particularly vulnerable to climate-related disasters (e.g., drought and flooding), food insecurity, and conflict (e.g., over access to resources). Supporting the coordination and collaboration of service providers working in different sectors, and the communication between pastoralist communities and local authorities, the OHU provides a sustainable solution to social, ecological and climate challenges.
Location
Somali, Ethiopia
Oromia, Ethiopia
Marsabit, Kenya
Isiolo, Kenya
Gedo, Somalia
East and South Africa
Process
Summary of the process
The three collaborative platforms (MSIP, OHTF, OHU) work together to establish and maintain a new service delivery model that ensures that pastoral communities can access and use essential health services for their families and livestock and implement improved natural resource management. Continuous communication and open dialogue are maintained between the OHTF and the MSIP to enable the collective and functional governance of the OHU. The OHTF coordinates with the OHU to ensure that services are jointly planned and delivered in line with national policies and local development plans. During their meetings, OHTF members analyse the technical and operational challenges met by the OHU and jointly identify suitable and sustainable actions to address them. The MSIP coordinates with the OHU to ensure the community oversight of services provided. During their monthly meeting, MSIP members analyse the needs of their community and discuss how the OHU can help addressing them. This information is used to shape services delivered by the OHU to specific community groups in specific locations and times. A Standard Operating Procedure guide the establishment and delivery of quality, effective and uniform OHU services across different sites.
Building Blocks
Multi-Stakeholders Innovation Platform (MSIP)
The Multi-Stakeholders Innovation Platform (MSIP) is a collaborative platform for community members. It includes about 15-20 women and men selected by the community and representing different community groups (e.g., traditional and religious leaders, community-based service providers, traditional healers, teachers, businessmen/women, representatives from the local rangeland institution). Where possible, MSIPs build on already established and functional groups that work at the community level on a voluntary basis. MSIP members are trained on the concept of One Health, leadership and management. Other training activities can be organised to enhance their skills and competencies and ensure their active engagement in specific community-based interventions. The MSIPs meet on monthly basis to discuss local issues and jointly identify suitable solutions to, for example, disease outbreaks and other health threats, livestock densities and movements, pasture availability, and water access.
Enabling factors
- Initial engagement of traditional and local leaders to increase community ownership
- Balanced representation of all groups to ensure participation of the entire local community
Lesson learned
Non-financial incentives (e.g., training, clean-up kits, visibility items) motivate the voluntary-basis group and can support its active engagement in the long-run.
One Health Task Force (OHTF)
The One Health Task Force (OHTF) is a collaborative platform for the local government. It usually mirrors the structure of the One Health platform at the national level. The OHFT generally consists of 5-7 people representing the local administration and the core line ministries (Health, Agriculture and Livestock, Environment and Natural Resource or equivalent). Other members may include representatives from the Women and Social Affairs, Education, and Disaster Risk Prevention and Management. The OHTF oversees the organization and delivery of the integrated health services via the OHU and guarantees the monitoring of its performance. OHTF members are trained on the concept of One Health and the Standard Operating Procedures for the establishment of the OHU. Selected OHTF members are trained as trainers to support cascading the training to service providers and other government staff. By taking increasing ownership and responsibility, the OHTF ensures the sustainability of the OHU and its gradual recognition and funding as effective service delivery model for pastoralist communities.
Enabling factors
- National One Health structure in place to ease operationalisation at the community level
Lesson learned
The OHTF can facilitate the communication with One Health institutions at the sub-national and national level, promoting the recognition of the OHU in national development and strategic plans.
One Health Unit (OHU)
The One Health Unit (OHU) is a collaborative platform for service providers and community-based actors. It serves as primary means for the planning and delivery of integrated human, animal, environmental and rangeland health services at the community level. The OHU can be mobile, static or a mix of the two delivery modes. Mobile OHUs follow the routes of pastoralists and their livestock, providing services according to a monthly schedule and addressing the needs of different herding communities. Static OHUs provide services from a shared facility (e.g., human/animal health post, water point or other village gathering site) where service providers work side by side. The OHU is staffed by service providers coming from different government departments, including health workers from the local Health Office or referral Health Facility, animal health technicians from the local Livestock Office or any public or private veterinary facility, and National Resource Management officers or Environmental Health officers from the local Office. The OHU also includes community-based actors (such as Community Health Volunteers and Community Animal Health Workers) which facilitate the mobilisation of people and guide the discussion around health threats and other events affecting local communities.
Enabling factors
- Joint training of service providers to create trust and support collaborative approaches
- Joint supportive supervision to further the collaboration across sectors during service delivery
Lesson learned
Gender-balanced OHU team can improve the quality and acceptability of health services and ultimately increase their utilisation by all community members.
Impacts
In the Inception Phase (March 2019–October 2020), the HEAL partners engaged in wide investigations to understand the local context and design the service delivery model that could effectively address the needs of pastoralist communities. In the Pilot Phase (November 2020–October 2024), the project managed to establish 16 OHUs, governed by 8 OHTFs and 38 MSIPs. Fifty (50) local authorities and service providers were trained on the One Health principles and the OHU Standard Operating Procedures. The OHUs coordinate to deliver sector-specific (human, animal and rangeland health) services and collaborate to provide cross-cutting services, including education and awareness activities and response to outbreaks. The OHU rangeland component aims to build the capacities of communities to address the degradation of rangelands and restore their productivity with the final goal of improving livestock production and health and thus contributing to enhance the nutrition, health, and livelihoods of pastoralist communities. Until March 2024, the OHUs reached more than 88,000 people and 1.1 million animals with preventive and curative services. An exit survey conducted on 1,479 OHU clients revealed that 100% of users are satisfied with the services provided, with 87% appreciating the integration of services and 96% reporting that the OHU was the nearest service provision site to their residence.
Beneficiaries
The beneficiaries of the OHU are the pastoralist communities and their livestock. The OHU benefits communities challenged by unfavourable environmental conditions and poor availability/accessibility to services and vulnerable people such as women and children.
Sustainable Development Goals
SDG 1 – No poverty
SDG 2 – Zero hunger
SDG 3 – Good health and well-being
SDG 5 – Gender equality
SDG 6 – Clean water and sanitation
SDG 13 – Climate action
SDG 15 – Life on land
Story
Adoy receiving treatment through the OHU
HEAL Consortium
Adoy Sheik Oumer is a 42-year-old woman and a mother of eight children. She lives in Arda Ola, one of the seven kebeles in Moyale woreda (Somali Region of Ethiopia) where the HEAL project established a One Health Unit (OHU). The village is 20 km away from Moyale town, where the closest health facility is.
The day Adoy accesses the OHU in her own village for the first time, she was glowing. Addressed by the project staff, she said: “I am having a nagging back pain that could stay for days. I would not afford to pay 200 birr for a motor bike trip to Moyale to get treatment for this. Whenever I or any member of my family get sick, we keep worrying about the long trip we have to take to Moyale which even worsens our condition on the way. For our sick animals, we even don’t take them. If we can, we travel to Moyale and consult animal health workers, who will then listen and sell us medicine without examining the animals.”
“So, I would have just stayed at home with the pain and see what happens,” continued Ado, “if it was not for the One Health service that came all the way home. Thank God!” Adoy came to the One Health Unit outreach services for the first time having heard about the previous four rounds of support. She is particularly happy to see animals being treated alongside pastoralists because “you can’t carry sick camels on a motor bike and take them to a long walk to access healthcare service, which had been a long standing and very serious problem”.
Thanks to the outreach team that came to her village, Adoy received proper assistance and the prescribed medicine with no need to travel a long distance. The nurse also advised her to do some physical exercises to relieve her pain. Adoy brought her sick goat and cow to the OHU as well and received medicine from the animal health worker on the site. Adoy says, “I have never heard and seen such a team treating us and our animals at the same time and place. It is wonderful!”.
