COMMUNITY BASED INTERVENTIONS FOR CONTROL OF ZONOTIC DISEASES IN INDIA

Zoonoses are those diseases and/or infections which naturally transmitted between vertebrates’ animals and humans.

Emerging zoonoses have been defined as zoonoses that are newly recognised or newly evolved, or that have occurred previously but show an increase in incidence or expansion in geographical, host or vector range . Most of emerging infectious diseases are considered to be either viral or bacterial . However, zoonotic parasitic diseases, particularly protozoan, nematodes, cestodes and trematodes are showing increasing trend in recent past.At prsent whole world is fighting with COVID19 Pandemic.Our PM has appealed to the people of our country to follow the advisory of the govt so that the further infection in the community can be checked.He also appealed to the country people to maintain the JANTA CURFEW on 22nd March (Sunday) from 7am to 9pm in order to break the chain of infection.Besides this he appealed the common people to maintain the social distancing.

The integrated approach of veterinary and human

medicine to prevent and control diseases of animal origin forms

the basic principle of one health. Zoonoses are fundamental

determinants of community health (Stephen et al., 2004). One of the principal causes of the emergence and re-emergence of such

diseases is the increased risk of exposure to certain pathogens.

This is because of several factors such as animal and human diet

changes, increased densities of production animals or wildlife

population, human and animal population displacement, increased

contacts with wildlife reservoirs due to various outdoor leisure

activities, accelerated degradation of natural environment and

global warming (Wilcox and Gubler 2005). Moreover, the host

defence is also showing increasing breakdown due to

immunosuppression and emergence of drug-resistant bacterial

strains. Evidently, apart from the prevention and control of the

pathogens in animals and humans by movement restrictions,

vaccination, improved diagnosis and treatment, raising awareness

in the community about the disease and its control measures is

very important in the present-day scenario. Community

participation is, therefore, widely promoted as an important

feature in different projects concerning disease control. However,

the definition, applications and expectations of community

participation vary considerably among the professionals including

veterinarians.

The grassroots involvement of local communities in a

zoonotic disease prevention and control programme depends on

ensuring that these communities understand the disease in its

varied dimensions. The commitment of the community towards

the control of disease is possible only through efficient awareness campaign which will allow better disease reporting

and vaccination coverage. Community involvement in health

generates in individuals a sense of responsibility for their own

health and welfare. Higher the level of self reliance and social

awareness, more the individuals will accept responsibility for

protecting their animals and themselves from disease hazards

transmitted directly or through foods of animal origin or

vectors. Community-based zoonotic disease surveillance

system may be helpful in making better assessment of the

impact of disease in the population as the reliance on official

reports alone may lead to gross underestimation of the problem

(Mariner 2002). Hence, epidemiological surveys should

include the resources such as livestock owners, community

animal health workers, para-veterinarians, abattoir workers,

etc.

Community is defined as a social group of group of

people sharing an environment, interest, belief, resources,

preferences, needs, risks, common leadership and a number of

other conditions and degree of cohesiveness (McMillan and

Chavis 1986). The community involvement in a programme is

necessary for the sustainability of a community initiation. It

also makes it easy to access the local constraints and

opportunities. The extension programmes initiated by the

government also require involvement of the community for

sustainability. Hence, empowering the community to

participate in the health issues is essential for the success of

such projects.

Community participation in health development has been

identified and adopted as one of the fundamental strategies for

accomplishing the priority objectives of the primary health care.

According to the declaration of the International Conference in

Primary Health Care (1978, Alma-Ata), “Community participation is the process by which individuals and families assume responsibility for their own health and welfare and for those of the community, and develop the capacity to contribute to their and the community development.” Community participation results in involving people to solve their own problems. Moreover, such participation is a basic human right and fundamental principle to democracy.

The participation process in a community includes

initiation, preparation, participation and continuation.

Community assessment is the most important activity in caring

for people in the community (Wilcox, 1994). Knowing the

health situation of the people living in the community can lead

and help the public health personnel in implementing

appropriate and effective interventions to improve the health

status of people.

There are seven tools that are effectively used for community assessment. These are convenient to use and can help public health personnel understand the community (Chuengsatiansup, 2002).

i. Community mapping: Mapping is the only method which

helps the public health personnel to rapidly see the whole

community. While mapping, they can observe the

community surroundings, environment, people’s way of

life and living situation. It helps them understand the

physical and social aspects of the community. Community

mapping helps the health personnel not only in getting the

picture of the community area but also to learn about the

community.

ii. Kinship mapping: It is the method to describe the genetic relationship of people in the community and how they care for their relatives. It helps the public health personnel develop a better understanding about their way of living.

iii. Community organisation structure: A community

structure means the relationship of people in a community.

Community organisations should have memberships, same

goals of life and management. Knowing the community

organisations helps the public health personnel know

where to start working with the community.

iv. Community health system: Usually public health

personnel use their thinking to dominate people in a

community without understanding about their way of life

and beliefs. The community health system assists in

changing the endless beliefs and faith of the community

and also helps in understanding the potential in them to

tackle various health issues.

v. Community calendar: Understanding everyday life of

people in the community is a tool to know about the

diseases related to people’s behaviour and nature of work

performed during the period.

vi. Cultural activity: It shows the practical relationship and

lifestyle of people in the community. If the public health

personnel understand it, they will understand the role of the

community.

vii. Life history: The assessment on the occurrence of a disease

in a community can be made by knowing the life history of

people. For example, rearing of cattle by feeding the animals

on the wet floor under their house, especially in the north-east

regions of India, makes the community more prone to TB.

Community Animal Health Workers ———————–

The main reason for failure in disease control programme

is the inability to instill confidence in the beneficiaries about the

value of the campaign. This can be generally overcome by

community dialogue. Once a common understanding is reached,

an agreement that is termed as ‘community contract’ (FAO, 2000)

can be made where each side clearly states what can be done. The

community remembers the broken promises, intended or not,

usually long; so the veterinary team may not get a second chance.

As each community is characteristic by unique traditional

institutions, customs and experiences, there is no one ideal

approach in practice that can be recommended. One general

model that has worked well in animal health care in broad

spectrum of culture is the community animal health workers.

Animal health projects have been relatively successful in many

developing countries, which involved community participation

as the guiding principle for project design and implementation.

These projects worked with local people to describe and

analyse the animal health concerns and to identify the

solutions. The communities selected people who would work

as community-based animal health workers (CAHW). The

concept of CAHW probably arose from experiences in the

human health sector. CAHW systems have a key role in

strengthening the capabilities (epidemiological surveillance,

disease control, animal disease reporting systems) of veterinary

services in remote areas (Catley 2002). Community-based

animal health delivery systems can also assist in animal

identification systems, traceability systems, and animal

movement control systems. In remote areas of developing

countries where infrastructure and enforcement of regulations

in weak, CAHWs have an important, but as yet untapped, role

to play in raising awareness on the need for these capabilities.

They have already proven to be excellent entry-points for

human health, relief and conflict management issues in many areas of Africa. They should be personally accountable during animal health programme and campaign.

Kudumbashree (meaning prosperity of the family) is a

women-oriented community based mission launched by the

Government of Kerala in 1998 for wiping out absolute poverty

from the state through concerted community action under the

leadership of Local Self Governments and is today one of the

largest women empowering projects in India (Government of

Kerala 2007). Women self-help group movement has gathered

momentum as a powerful instrument for socio-economic

transformation of poor people in India. The attitude of these self-

help groups towards livestock raising was high (Anand, 2002).

The Kudumbashree workers have been successfully engaged in

collection of waste from households on a nominal charge and the

improvement of the communities in the disposal of this waste has

been successful in certain areas of Ernakulam and

Thiruvananthapuram corporation areas in Kerala. Hence, these

workers can be mobilised for animal health care activities by

training them and making them accountable for the work done by

them through regular monitoring by the veterinarians of the area.

Role of Community ————————-

Health programmes are unlikely to succeed if community

involvement is not an integral part of the structure and execution

at local level. Laws, regulations and veterinary policy measures

alone will not bring the desired results. Moreover, the individuals

and the community must be willing to acquire new knowledge,

and to translate it into wholesome habits and constructive

behaviour patterns. Human, animal health and veterinary public

health (VPH) systems are responsible for providing clear

information and explaining the favourable and adverse

consequences of various intervention measures being proposed, as

well as their relative costs. The core functions of VPH involve

diagnosis, surveillance, epidemiology, control, prevention and

elimination of zoonoses. VPH activities can improve human health by reducing exposure to hazards arising from interaction with animals and animal products. Hence, there is an urgent need to expand the links between human and animal medicine.

Community participation plays an integral role in the

implementation of VPH programmes. It can be achieved by

encouraging the participation of all stakeholders, including

women and children in decision-making at the local level so as

to increase the ownership accountability and sustainability. The

strategies to get community participation in VPH programmes

include the use of trained auxiliaries to deliver VPH services

locally, involvement of communities in the development and

management of VPH programmes, using participatory field

research to identify community priorities, evaluating the impact

of VPH programmes and making appropriate adjustments,

involving NGOs already working in the area in both human

and animal health, increasing the outreach to women in rural

areas and coordinating with human health services in the

region(WHO, 2002).

Evolving Community Participation ————————-

Community members should be completely involved as

participants in the health programmes in their communities.

They have the important advantages of speaking the local

dialect, knowing how to reach people, enjoying social

acceptance and they also know the local situations or local

needs. Both in rural and urban areas, community groups are all

important in the planning and implementation of programmes.

They provide the resources needed for adapting plans to local

conditions, carrying out tasks at little or no cost, and

overcoming constraints. They must be informed about their

approach and their role in achieving the aims of the

programme. By the process of education and by acquiring experience and knowledge, individuals and communities learn

to understand their own situation and be motivated to solve

their problems. Community involvement in health generates in

individuals a sense of responsibility for their own health and

welfare. To be successful, they have to acquire the capacity to

evaluate the situations, choose options and determine their

contributions. In other words, individuals and families, and the

community as a whole, are not obliged to accept the otherwise

conventional solutions that may be imposed, but are not

suitable.

In the early phases of a control programme, the general

public, especially of communities in endemic areas, have to be

made aware of the danger to health as well as the economic

importance of zoonoses and foodborne diseases. One of the most

effective methods has been found to be the discussions in small

groups. In such discussions, the health worker (educator) suggests

some kind of concrete action, for example, formation of working

committees, which may be constituted soon after the discussions.

Such committees have proved to be extremely useful in the early

phases of several control programmes. The most common

teaching aids and media are posters, documents, pictures, slides,

films, radio and television programmes. Communicating the

health message is very important, and different methods and

techniques need to be combined to accomplish the educational

purpose. However, the information must be correct, complete and

acceptable to the people. The language of the messages must be

understandable.

Types of Community Participation ———————-

Participation of the community can be sought in

different ways that influence its effectiveness (Table 27.1). The

organizational principles of national zoonoses control

programmes should depend on the epidemiological pattern of

the diseases and on the availability and structure of health care services. They are interrelated with farming practices, habits

and levels of urbanization, as well as trade in animals and

animal products. It is important that health education and

community participation should be included in a zoonoses

control project or food hygiene programme from the start and

should be closely linked to and coordinated with all changes to

it.

Seven types of community participation —————–

Type of participation — Description

Manipulative participation (Co-option)

Community participation is simply a pretence, with people’s representatives on official boards who are unelected and have no power.

Passive participation (Compliance)

Communities participate by being told what has been decided or already happened. It involves unilateral announcements by an administration or project management without listening to people’s responses. The information belongs only to external professionals.

Participation by consultation

Communities participate by being consulted or by

answering questions. External agents define problems and

information gathering processes, and so control analysis. Such a

consultative process does not concede any share in decision-

making, and professionals are under no obligation to take on

board people’s views.

Participation for material incentives

Communities participate by contributing resources,

such as labour, in return for material incentives (e.g. food,

cash). This type of participation is quite common. However,

people have no stake in prolonging these practices when the

incentives end.

Functional participation (Cooperation) ————

Community participation is seen by external agencies as a means to achieve project goals. People participate by forming groups to meet predetermined project objectives; they may be involved in decision-making, but only after major decisions have already been made by external agents.

Interactive participation (Co-learning) People participate in joint analysis, development of action plans and formation or strengthening of local institutions. Participation is

seen as a right, not just the means to achieve the project goals. The process involves inter-disciplinary methodologies that seek multiple perspectives and make use of systematic and structured learning processes. As groups take control over local decisions and determine how available resources are used, they have a stake in maintaining structures or practices.

Self mobilization (Collective action) People participate

by taking initiatives independently of external institutions to

change systems. They develop contacts with external

institutions for resources and technical advice they need, but

retain control over how resources are used. Self-mobilisation

can spread if governments and NGOs provide an enabling

framework of support. Such self-initiated mobilisation may or

may not challenge existing distributions of wealth and power.

Source: Adapted from Pretty (1994) and Cornwall (1996).

Communicable Disease Control ——————-

Many studies document the benefits of using a

community participatory approach to relief in emergency

settings and to development in post-emergency phase for

controlling communicable diseases. Community participatory

relief programme can deliver aid in a timely manner, ensure

that resources reach the most vulnerable and poorest

individuals, enhance rather than weaken the existing health

structures and empower communities to take more control of

their lives

Zoonoses Control Programmes

Planning at local level regarding the control of zoonotic

diseases depending on the need of the community and

organisation of resources is required for the successful

implementation of project. The implementation requires:

1. Selection of the community;

2. Mapping of the risk groups in the community;

3. Identification of risk hotspots;

4. Participatory community risk assessment; and

5. Participatory community risk assessment planning.

The community public health education requirements

include: ————-

1. Sensitization of trainers of trainees (public) on all relevant

public health matters;

2. Public awareness in schools, religious and political fora;

3. Creating awareness among the decision makes especially

village leaders, stakeholders in local government/councils;

4. Retraining of meat inspectors and other service providing

cadres involved in meat inspection; and

5. Sensitizing consumers or general public using television

and radio programmes.

For implementation of zoonoses control programmes,

advocacy is needed to influence the people, policies and systems

to bring about widespread changes in the community. Zoonoses

control programmes should be included sectorally as well as

within the institution in order to sustain the efforts for a longer

period of time. This can be achieved by involving various

stakeholders and by organising workshops at various levels. For

example, community participation has been recognised as a key

factor in the effectiveness of rabies prevention and control. Stray

dogs in developing countries pose a major threat of rabies, so this

segment of the dog population needs to be particularly targeted

for rabies control and prevention campaigns. However, such dogs

are frequently considered as community or neighbourhood dogs in

many developing countries including India. As a result, any

drastic dog population control measures often generate resentment among the community. It is, therefore, crucial to build trust between the community and the personnel engaged in the dog population management work. Success can be achieved by educating the school children about rabies, who is turn help in

creating further awareness about the disease in their family. They

can also assist by reporting rabies suspected dog cases in their

community.

The success in the prevention and control of major

zoonoses depends on the capability to mobilize the community

participation and on coordination and intersectoral approaches,

especially between veterinary and public health services. For

example, the avian influenza outbreaks in many countries

especially Indonesia and Thailand, could be controlled due to

active participation of the communities and coordinated efforts

of the health and the veterinary sectors and the government

authorities. Similarly, rabies control in Kisumu district of Kenya was initiated in 2010 by the combined effort of

veterinary and medical personnel due to alarmingly high cases

of dog bite. The programme was started by creating awareness

among the village leaders about the need of vaccination against

rabies in dogs who in turn motivated the other members of the

community. The community members were mobilised to

identify households raising dogs and doing door-to-door

vaccination. People who refused to vaccinate the dogs were

penalised by taking the expense of post-bite vaccination

(Omemo 2010).

These and many other examples have shown that

community participation is vitally important in order to achieve

good results (Deborn et al., 2001). We need to understand the

community potential, community perspective on zoonoses and

zoonoses mainstreaming. There should be no passing of

responsibilities but sharing of responsibilities for control of

diseases. The desired level of improvement may not take place

unless people want change and intend to make it happen.

Reference-on request