Nomad health: co-production between academic and non-academic actors
The overarching aim of the Jigjiga University One Health Initiative (JOHI) is to improve the health and well-being of mobile pastoralists and agro-pastoralists and their animals in the Somali Region of Ethiopia through building of research and development capacity at the University of Jigjiga. While we decided on the overall objectives between the academic partners of the University of Jigjiga, the Armauer Hansen Research Institute, and the Swiss Tropical and Public Health Institute, we did not know about the priorities and expectations of the communities and authorities at the outset.
From its inception, the JOHI followed an iterative participatory stakeholder process. Periodically, communities, authorities, health professionals, and scientists met to discuss the project together in different locations in Jigjiga or at the study sites. We held workshops as plenary sessions with all participants, followed by focus group discussions and field visits with informal group discussions in health centers or pastoralist camps. Because most participants were not fluent in English, the participants used the Somali language and translated summaries into English. We documented results of discussions on flip charts or notes and compiled them into reports.
During the inception phase of the project, a two-day stakeholder workshop in Jigjiga brought together representatives of communities, human and animal health authorities, and the research team. We assumed that each actor had his or her own knowledge of the system and priorities and interests for research and interventions. We used open unguided questions like ‘What are the most important issues for your livestock’ to elicit spontaneous statements and comments. These were listed and every participant could rank them according to their priorities. In this way, the different actors raised issues like access to livestock markets or safe drinking water amidst issues of healthcare and the lack of available drugs. At this stage, we identified the priorities of the project together with the main beneficiaries, service providers, and scientists.
After an initial training phase at the University of Basel, the students developed the research protocols depending on the project goals and their own interests. The students focused on the nutritional status of children, the frequency of maternal healthcare use, the prevalence of diseases transmissible between animals and humans and the rangeland characteristics. The students’ supervisors subsequently visited the field research sites and held conversations with pastoralists and service providers.
In a further stakeholder meeting, the students presented their first research results to the communities and authorities, who added insights based on their own experiences. A second group of students was subsequently trained at the University of Basel and chose complementary topics like the quality of drinking water, integrated surveillance of human and animal diseases, and assessment of the rangeland quality by the pastoralists. After the end of their field research, the students again presented their results to the communities and authorities, and proposed interventions which could be tested at small scale.
In this way, adaptation of tuberculosis treatment for mobile pastoralists, use of solar disinfection and water filtration to improve provision of drinking water, and a mobile phone based human and animal disease surveillance and response system were identified as the interventions in which the communities and authorities were most interested and willing to participate. At this stage of the project, the communities and service providers co-produced transformational knowledge on how to specifically implement these interventions in a way that is adapted to their culture and societal practices. These context specific adaptations of interventions could not have been achieved by an academic scientist alone in a university office.
The above described interventions were subsequently implemented. We observed that the communities started to use the surveillance system, but there were no resources to pay for ambulance services, in particular, there was no money to pay for fuel. One physician, a member of the JOHI team, then held group discussions with the women in the community, who were most concerned with regard to effective emergency service during childbirth. In some communities, it was possible to establish village solidarity systems to ensure sufficient financial resources to pay for emergency evacuations at all times.
Further rounds of stakeholder meetings will follow up on how the ambulance services function and the perceived effectiveness of the surveillance and response system. Periodic transdisciplinary stakeholder meetings are an important part of JOHI to develop locally adapted interventions to improve the health and wellbeing of pastoralist communities and their animals.
Why do you think these stakeholder meetings are important? We look forward to reading your thoughts.
Author: Prof. Dr. Jakob Zinsstag