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In an extensive literature review, the author develops policy recommendations to facilitate scaling up community-based animal health systems to the national level. Noting that human and animal health services in rural areas have much in common, and that an extensive literature studies policy regarding primary healthcare for humans exists, she surveys that literature for observations and conclusions applicable to policy analysis of primary animal healthcare. She notes differences in the history and development of the two delivery systems. The push for human health services came with a worldwide initiative agreed at a high level in 1978. Health for All was set out as a moral imperative, and programmes have been strongly top-down. Delivery of animal health services, by contrast, has been viewed mainly in terms of economic development, and community-based systems have been cobbled together bottom-up, with NGOs taking the lead. As a result, community animal health workers are not integrated into national systems, and how they are trained and monitored varies even within districts. More broadly, the author details regional differences in community-based animal healthcare initiatives. Whereas in Asia there is considerable government involvement, private practitioners hold much more sway in East Africa. Although the literature is sparse on West Africa and Latin America, professional acceptance of community health workers appears to be high in both regions. The core of the paper is devoted to elaborating six criteria for assessing community-based animal health systems, which the author adapts from studies on primary healthcare systems for humans. She argues that the criteria - equity, efficiency, accessibility of services, quality of services, human resources and financial resources - must be addressed when scaling-up community-based programmes. The author recommends that policymakers clearly state their national animal health objectives and encourage dialogue between NGOs and existing national structures to allow better coordination of efforts and more equitable and consistent delivery of animal health services in rural areas. She adds that bringing community animal health workers into institutional frameworks - and agreeing a standard training curriculum - would improve equity in the distribution of benefits.


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