An Experience in One Health Practices: The

case of Moyo District

Dr. Lali Mundrugo-Ogo, D.V. (BVM, MBA)

Dr. Akule R.( Dip AH, BVM)

Outline of Presentation

• Background• Practices of One Health• Purpose of the Analysis• Methodology• Findings and Discussion• Constraints• Conclusion• Recommendations

• Background• The concept of” one health” was embraced in

Moyo district way back in the 1990s. In 1993 a joint technical committee under the chairmanship of the then DMO, was formed for emergency control of tsetse and trypanosomosis in Moyo.

Background (cont’d)

• A committee consisted of District Medical Officer(DMO) as Chairman , District Veterinary Officer (DVO) as secretary, District Entomologist(DE), Secretary for Mass Mobilization, Secretary for Health, Secretary for Production, Representatives of the DES(CAO) and all NGOs related to Trypanosomosis and tsetse control was formed.

Background (cont’d)

• This committee worked jointly to combat the Trypanosomiasis menace till 1995 when there was break up and eventually funding stopped by 1997. However this marked the beginning of close working relations between Veterinarians and Physicians in modern times in Moyo.

Practical Extension of 1990s experience

From year 2000 onwards, there continued the sharing of technical expertise in disease diagnosis, information, training in basic laboratory skills, participation in active screening of Trypanosomiasis and brucellosis, control of rabies, sharing facilities such as fridges, laboratory materials &reagents, sharing of vehicles during mass vaccination campaigns.

Purpose of the Analysis

• Assess progress made in the experimentation of One Health Approach

• Document the good and bad practices, strengths and weaknesses of collaborative inter-disciplinary work to inform future actions

• Share experiences with others on what has been done• Make recommendations to government and other

stakeholders on the policy actions needed to leverage on the good practices for synergy in service delivery

Materials and methods

• Review of reports in the Offices of DHO and DVO

• Review of Literature on One Health• Personal Experiences

Scope:

• The Period under Review spans from 1993 to 2012• Moyo District has projected population of 412,000

spread in 2 Counties and 9 sub-counties.• Moyo is bordered to the North and Northeast by

South Sudan, to the West is Yumbe, to the South is River Nile that separates it from Adjumani and to the Southeast is Arua District

Map of Moyo District

Diseases of common Concern in Moyo

• Rabies(2 recorded deaths in 2012), Trypanosomiasis, Cysticercoses, Epilepsy, tuberculosis, brucellosis and Salmonellosis (Zoonotic)

• Previously annually occurring epidemics like cholera, meningitis

• Recently high prevalence of hepatitis B

Areas of inter-disciplinary collaboration

• Joint Public Awareness campaigns• Joint planning Meetings• Report Sharing• Facility Sharing• Joint research programmes• Joint Surveillance and Diagnostic services

Results

Joint awarenes campaigns

Joint Planning meetings

Report Sharing Facility Sharing Joint Research Joint Surveillance0

5

10

15

20

25

% of Collaboration time

% of Collaboration time

Collaboration areas(cont’d)

• Talk shows held for Control of Rabies: DVO & DSO/DHO on local FM station.

• General Awareness Campaigns with ADEO, DSO, OPM

• In 2003: PHC Supervisor of ADEO spearheaded formation of a rabies control committee with the membership of DVO, DDHS,LCV Sec for Health, RDC, OPM and all UNHCR agencies (ADEO, AAH,IAS,ACORD,JRS) .

Meetings

Multidisciplinary teams held meetings:• On Trypanosomiasis control, Rabies control

and as part of Epidemic preparedness task force.

Sharing Facilities

The Veterinary sector was less resourced in the 1990s and

2000-2005 in laboratory facilities, cold chain facilities and transport especially vehicle.

• screening and diagnostic tests in Hospital and private clinics for trypanosomosis, brucellosis and sometimes to rule out tuberculosis from samples obtained from abattoirs.

• DHOs cold chain technicians always provided support whenever the veterinary department had problems.

Sharing of facilities(Cont’d)

Equipment sharing: • vaccutainers, needles & holders, reagents

have been supplied to the Vet Lab by the Hospital

• Recently the hospital ran out of slides; while their order was being awaited the veterinary laboratory provided these materials.

Joint Research, diagnostic and surveillance activities

• In 1997 DVO and MO i/c SS developed a joint research

proposal to validate the data on the non-reservoir status of

cattle to T.b.gambiense in West Nile

• Joint surveillance & screening of trypanosomosis by Vet

Dept and Moyo hospital Lab Technicians throughout 2000,•

Joint Research surveillance(cont’d)

• Joint research involving MuK(FVM) , Vet Dept, and

Hospital Lab Technician(2002) on Trypanosomiasis,

• Joint research involving Dept and Gulu University

medical school and NALIRI on trypanosomiasis.

•

Research, Diagnoses and Surveillance

In 2003, both veterinary and hospital laboratory

technicians participated in diagnostic and field

operations organized by the Veterinary department

• Joint training as preparedness against Avian Influenza

Research, diagnoses Surveillance

• 2009 the epilepsy research project conducted in

Moyo by Gulu University Medical School involved

full participation of both the veterinary and

medical health professionals.•

Joint training

In 2002, DVO nominated a Lab technician from

Moyo Hospital to train with a Veterinary

surgeon on laboratory diagnosis in MAAIF/

NADDEC to improve disease diagnosis.

Referrals and Reporting

For control of rabies.• All dog bite cases reported to Hospital/Clinic were

refered to veterinary department for verification of risks of rabies.

• The Veterinary department investigates health of the biting dog and advises the medical personnel accordingly.

Initiatives to Collaboration

Medical Veterinary Entomology0

5

10

15

20

25

30

Series1

Explanation

• 67% of initiatives from Veterinary sector• 25% of initiatives from the Medical sector• 8% of initiatives from the Entomologist

Benefits of Collaboration by Sector

Medical Veterinary Both Vet & Med.0

5

10

15

20

25

Series1

Comment

• Both Veterinary and Medical Depts. equally benefitted from the collaboration regardless of the source of initiative.

Impact of Collaboration:C.Cellulosae Cases in Moyo S/C

Moy

o

Moy

o

Oth

ers

Moy

o

Oth

ers

Moy

o

Oth

ers

Moy

o

Oth

ers

Moy

o

Moy

o

Oth

ers

Oth

ers

Oth

ers

Oth

ers

Moy

o

Oth

ers

Moy

o

moy

o

Oth

ers

Oth

ers

1998 1999 2000 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

0

2

4

6

8

10

12

14

16

Freq

Explanation

• Highest recorded incidences in 1999• From 2000 to 2008 there was increased sharing

of reports between Vet and health Depts.• Around 2009/2010 : Period of Conversion of

Vets to NAADS• 2011: The study by Gulu University on the

relationship between Epilepsy and C.Cellulosae Prevalence

Confirmed cases of Rabies in Sub-counties between 1998 to 2012

Metu Moyo Moyo Laropi Itula Laropi laropi0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

Explanation

• There was increased reporting of dog bite cases

• As a result these positive rabies cases were confirmed in the Laboratory at NADDEC

• Deaths due to rabies avoided as result of early intervention except for 2 cases in2012 that were reported late

• Lack of sustainable formal structure of cooperation

• Initiative by COCTU collapsed with end of funding for joint operations.

• Existing “disciplinary silo” mentality that excludes horizontal cross-disciplinary collaboration

• Money-driven systems(money-orientedness)

Constraints

Constraints (cont’d)

• COCTU funding for tryps. • UNICEF refrigerators (1997-2002 not allowed

for storage of Animal vacines)

Conclusion

• One Health Approach is the way to go for disease control

• In the experience of Moyo, it worked well at some time but did not work some of the time

• The impact was considerable in raising awareness that led to increased reporting in case of animal/dog bites and demand for meat inspection that controlled tapeworm

Recommendations

• Formalize and customize intra- and multidisciplinary collaboration: information sharing, joint surveillance,

• Re-orientation of the professionals in the intra- and multidisciplinary work

• Build capacity of professionals in leadership and management skills

• Relevant Policy to back up the collaborative structure

References

• Moyo DLG: DVO reports• www.wikipedia/ One Health• Personal Experiences: Dr Akule Dr. Lali Mundrugo-Ogo

Thank you for listening