Regional Conference on Veterinary Paraprofessionals in Asia

The Regional Conference on Veterinary Paraprofessionals in Asia was held in Bangkok, Thailand from 6 to 8 December 2017. A total of 94 participants attended the workshop, including representatives from veterinary authorities, VSBs, VPP associations and educational institutions for VPPs training of 23 OIE Member Countries, representatives of 13 relevant agencies, and OIE and GALVmed staff. The Conference started with the opening remarks delivered by Dr Lois Muraguri, Director of GALVmed, Dr Matthew Stone, Deputy Director General of OIE and Dr Wacharapon Chotiyaputta, Director of International Livestock Cooperation Division, Department of Livestock Development, Thailand.

Day 1 began with Session 1 on overviews of the GALVmed and the OIE. The GALVmed’s vaccine production and marketing for smallholders and the OIE’s sixth Strategic Plan were introduced. The OIE standards on the quality of veterinary services, veterinary legislation and Terrestrial Code definitions related to veterinary paraprofessionals (VPPs) were described. This was followed by Session 2 in which challenges and opportunities for VPPs in delivery of veterinary services in Vietnam, Afghanistan, the Pacific Islands, Mongolia, Myanmar and Indonesia were presented. Discussion was made after the presentations which provided a review of current situation of VPPs in Asia and how best VPPs can contribute to delivery of quality veterinary services in cooperation with other cadres. Day 1 ended with Session 3 on working group discussion. Participants were divided into six groups to discuss on linking veterinarians and VPPs with regard to the current existing relationships between veterinarians and VPPs in the public and private sectors, the specific mechanisms/actions to improve/strengthen these relationships, the countries/systems that offer best practice of a health complementary relationship between veterinarians and VPPs and how to address the OIE definition of VPP with regard to the term “under the responsibility and direction of a veterinarian”. The group discussion feedback was summarized as the followings:

VPPs are present in many countries in both public and private sectors. The relationship between Vets and VPPs, particularly in the private sector, is however often competitive with VPPs being seen as a threat to the profession. It was recognised that this needs to be addressed to create a more collaborative, healthy relationship between vets and VPPs.
There is lack of clarity on the role and scope of work of VPPs in many countries. In some countries, VPPs are not legally recognised. Given the crucial role VPPs play, it was agreed that the legal recognition of VPPs was necessary.
A veterinary statutory body is required in every country to regulate the veterinary domain including stipulating requirements for the training, qualification, scope of work/role and supervision of VPPs.
Where VPPs exist, there are variations in categories, training and qualifications. It was recognised that whilst the local context needs to be borne in mind, it would be helpful for the OIE to give guidance to countries on the minimum competencies of different categories of VPPs.
There are different models for meeting the requirement of supervision under the OIE definition of VPP. There is no one correct method and the approach taken needs to be mindful of local context.
There are a few examples of what may be considered good/best practice of Vet-VPP engagement but these examples need to be investigated/studied to understand why and how they work and if they are replicable to other geographies.
The last mile presents particular challenges particularly in rural/remote areas. CAHW were recognised as filling a gap in the system and playing a crucial role in veterinary service delivery. It was appreciated that their role needs to be taken into account in finding solutions to the challenge of quality vet service delivery.
The critical role that all actors, including VPPs, have on AMR was recognised as was the need to have clear guidelines on dispensing and use of antimicrobials and related products in the field setting.
Creative use of IT and mobile phone technology were cited as examples of innovative ways to address supervision of VPPs so as to maintain accountability and quality assurance for delivery of vet service when direct supervision by vets is not practical.

Day 2 started with the recap of Day 1 and followed by Session 4 focusing on the regulatory and administrative frameworks for VPPs. This session included the presentations on Policy Perspectives in Delivery systems in rural and poor setting in India, the VSBs in Asia and Pacific region, the Regulatory and administrative challenges and opportunities for VPPs in Thailand, Napal and Vanuatu, and the Africa’s experience in setting up VPP associations. Session 5 was the round table discussion of the representatives from the FAO RAP, the Heifer International (Nepal), the GALVmed, the Hester Biosciences, the Brooke, Papua New Guinea and the AVSF on their perspectives on VPPs from the field. After that was Session 6, the training of VPPs in Asia and Pacific, which demonstrated the trainings of VPPs in India, Nepal, Afghanistan, Cambodia, Australia and some countries in the region i.e. Indonesia and Vietnam. The followings were the summary of presentations given in Day 2.

Veterinary Statutory Body (VSB): Some countries in the region do not have a VSB. In some cases, there are VSBs but these do not regulate VPPs. Some VSBs are not fully autonomous and are e.g. under the Ministry of Agriculture or are under a membership association. There is need for clarification and distinction between the functions of a VSB and those of an Association. In countries where there are different VSBs regulating vets and VPPs, the need for a spirit of true partnership within VSBs that aspire to regulate fully across the veterinary domain was recognised. This spirit of partnership is also necessary when bringing VPPs under the oversight of existing VSB which may be dominated by the veterinarians.
There is need for countries to conduct a manpower needs assessment to increase their understanding of the gaps and where personnel are most needed. This would inform decisions on e.g. numbers of vets and VPPs to be trained. Countries are more likely to be aware of the situations in their countries – e.g. census data on number of vets, animals, etc. – if there is a VSB.
There is need for clarity of the role of VPPs vis a vis vets and other service providers. Where VPPs are not recognised or the system is not very well regulated, understanding the situation on the ground could begin to address this ambiguity as it would be a starting point to define the gaps, the functions that are needed and subsequently, the roles and responsibilities of vets, VPPs and other service providers.
It was suggested that there is need for consideration of mechanisms for career progression of VPPs.
The last mile presents particular challenges particularly in rural/remote areas. CAHW were recognised as filling a gap in the system and playing a crucial role in veterinary service delivery. It was appreciated that their role needs to be taken into account in finding solutions to the challenge of quality vet service delivery.
There are opportunities for VPPs in the private sector and innovative models for maintaining accountability and quality assurance for service delivery as required under OIE standards.
Where VPPs exist, there are variations in training and qualifications. It was recognised that there is need to clarify categories of VPPs functioning in a country, their qualifications and training required relative to their scope of work, duties or tasks. It was suggested that model training curricula would be useful.
Most of the country experience shared has related to VPPs participating in field service activities supporting animal health programmes, aligned with the Animal Health VPP track in the draft OIE Competency Document. Some very interesting and highly relevant examples of formal systems to manage VPPs are in activities aligned to the Veterinary Public Health track. In particular, VPPs performing meat inspection in export assurance systems require clear procedures, training and veterinary oversight in order to withstand trading partner audits.
Few examples of formal systems aligned with the Laboratory VPP track have been presented, although it is recognised that technical staff in animal health and food safety laboratories are making an important contribution. Promoting the use of the OIE Competency Document would be useful to structure, formalise and authorise Laboratory VPPs.

Day 3 started with the recap of Day 2, then following with Session 7 focusing on the work of the OIE ad hoc Group on VPPs competencies and core curriculum. The evolution of the OIE work on veterinary education and VPPs was elaborated. The results of global analysis of VPPs from WAHIS and PVS Pathway, and the VPP curricula were described and the preliminary OIE competencies for VPPs and the preliminary core curriculum for VPPs were introduced. Session 8 was the group discussion on roles of VPPs to ensure prudent use of antimicrobials. The main issue of discussion was if VPPs should be allowed to prescribe and administer antimicrobials and if so, what the regulatory conditions would be. Most participants greed that VPPs should be allowed to administer antimicrobial drugs under the veterinary supervision. However, for VPPs to prescribe antimicrobials, some participants disagreed and some had an opinion that if there is no veterinarian, VPPs should be allowed to prescribe under the condition that they should have well training and have commitment to use antimicrobial drugs properly. Then, the Conference ended with Session 9 on building consensus and recommendations on way forward. A draft recommendations of the Conference is as attached.