Impact case study database

Figure 1. Summary of the impacts described in RF2014 and in this impact case study.

Reported in REF2014: Impact of mass trypanocidal treatment on human cases of HAT

The establishment of the SOS partnership in 2006 led directly to the development of cattle treatment strategies to reduce HAT infections. These strategies all but eliminated rHAT from Uganda. However, this action was always intended to be a one-off intervention for emergency use [5.1]. Deployment of mass drug administration is human resource-intensive, and repeated administration of trypanocidal drugs at scale runs risks of developing drug resistance. Crucially, trypanocidal drugs could not prevent cattle from reinfection by infected tsetse flies.

New since REF2014: Challenge of sustainably maintaining low levels of infection

Since REF2014, the challenge has been to maintain low levels of infection in an economically sustainable fashion. This is now being achieved through changes to Ugandan government policy based on our novel research since REF2014, which identified that RAP spraying only 25% of cattle with insecticide could cost-effectively result in sustainable suppression of the tsetse vector. The Minister of Agriculture, Animal Industry and Fisheries of Uganda states that this research “ directly provided the scientific evidence which underpins our national strategy and policy for sustainable control of sleeping sickness and animal trypanosomiasis in Uganda” [5.2].

Delivery of this national policy is coordinated through COCTU, which now mandates routine spray of 25% of the cattle population using RAP [5.1]. This activity is scaled up using a catalytic model, working together with local veterinary services, 3V Vets and community farmers. The initial target in 2014 was to spray 25% of cattle (n=412,521) in 23 high-risk districts for rHAT on a regular basis. The costs for this are met by COCTU, and any additional costs by the farmers themselves, who recognise the benefits of vector control in not only suppressing rHAT transmission but also protecting cattle against ticks [5.2].

COCTU confirms that the catalytic model has “ *directly supported over 1,000,000 treatments of cattle a year since 2016, introducing farmers to this new approach and supporting the farmers to adopt this cheap and effective technology for healthier animals and to prevent sleeping sickness spreading in the community.*” [5.1].

New since REF2014: Impact of routine cattle spraying on health and welfare

The elimination of HAT from Uganda, achieved through the emergency action described in REF2014, is now being sustainably maintained through the new national policy of routine spraying with insecticide, informed by our novel research [5.1; 5.2]. The success of the catalytic model is seen in the increasing numbers of cattle sprayed over time: 250,000 cattle (30% of all cattle in the target districts) in 2014, 1,000,000 cattle (50%) in 2016 and 1,500,000 cattle (70%) in 2018. Altogether, since 2014, 5,671,266 RAP treatments have been delivered, with 3,277,173 paid for by COCTU and the remainder paid for by the community [5.3a; 5.4]. The farmers readily exceed the target of spraying 25% of animals, as insecticide treatment has the additional desirable effect of protecting the cattle from tick-borne diseases.

As a result of this routine spray treatment managed sustainably by farmer communities themselves, human cases of HAT in Uganda have remained at negligible levels since 2014; 14 cases recorded by COCTU in 2016 and 5 in 2019 (compared with 473 recorded in 2005 prior to the SOS activities) [5.3b, c; 5.4].

New since REF2014: Impact on the economy

The Ugandan Minister of Agriculture, Animal Industry and Fisheries describes the financial impact of the new policy of routine insecticide spraying as follows: “ One of the most dramatic outcomes of this research is the fiscal benefit to the farmer of this more sustainable approach, which results in increased revenues of USD30 per head of cattle. This financial benefit was the key driver for policy recommendation by COCTU to promote cattle spraying at community level which has directly resulted in over 1,000,000 cattle receiving regular treatment since 2016 across 23 districts of Uganda. An additional benefit of this approach is the wider range of diseases which are prevented by this vector-based control methodology, including disease transmitted by ticks.” [5.2.]

Given that over 1,000,000 cattle are treated annually, the increase of USD30 per head of cattle results in over USD30,000,000 (GBP21,910,000; 10-20) per year of increased productivity in impoverished rural communities in Uganda [5.4]. A recently published cost-benefit analysis indicated that the increased revenue from cattle results in a mean annual income per household of USD125 (GBP91; 10-20) [5.5]. Moreover, since only a proportion of cattle need to be treated, disease control can be undertaken by a limited number of wealthier farmers, as village cattle are co-grazed, and does not represent a financial burden for poorer communities [5.1].

New since 2014: Impact on local capacity building

The catalytic model for delivering the national policy of routine spraying has helped to build local public health expertise and human capital through mobilising and training local vets and farmers.

This is coordinated through the 3V Vets initiative, a delivery network for veterinary products and services established in 2009 as part of the SOS partnership [5.6a]. In 2014, 3 of these vets, now operating financially sustainable businesses, came together to form a joint purchasing company, 3V Vets Franchise, which procures products on a commercial basis from a number of importers and suppliers [5.6b].

Facilitated by COCTU, the 3V Vets have identified and trained individuals in villages to become Animal Resource Key (ARK) persons. ARKs help to deliver the catalytic model for rHAT control through providing link points for cattle owners to access insecticides required for spraying from the local vet [5.4]. Between 2013 and 2017, 453 ARKs were trained to understand the basics of insecticide dilution, proper handling of the chemicals involved, animal spraying techniques, entrepreneurship, as well as the scientific basis for spraying animals [5.4]. The intention was for each ARK to spray a minimum of 50 head of cattle per day for 20 days a month, totalling 1,000 cattle per month. COCTU reimburses each ARK USD0.98 per head of cattle sprayed; thus, this activity represents significant contribution to the ARKs’ monthly income, since they typically only use a few hours a day to carry out spraying and can spend the rest of the day engaging in other income-generating activities [5.4].

In this way, the catalytic model has empowered local communities to take charge of disease control in their area and add to their income at the same time, ensuring long-term cost-effectiveness and sustainability of the HAT control strategy. The buy-in from the local communities is illustrated by their investment of over UGX398,000,000 Ugandan shillings (GBP78,400, 08-19) towards the cost of RAP activity between 1 July 2016 and 30 June 2017 [5.4].

New since REF2014: Impact on international guidelines and consensus

Our research and the resulting action through SOS and COCTU has been widely highlighted by WHO (2014, 2016, 2017 [5.7a-c]) and FAO (2017 [5.7d]) as one of the most successful examples of One Health in practice globally. In addition, the academic One Health community has noted the leading role of SOS: for example, an OIE Scientific and Technical Review (2014) highlighted the importance of COCTU’s established One Health platform for trypanosome disease management [5.8] and an international review published in PLoS Neglected Tropical Diseases in 2014 concluded that “This PPP could be a model for other regions and diseases in order to develop a sustainable prevention and control system.” [5.9; p.3].