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This article was downloaded by: [Wageningen UR Library] On: 30 April 2014, At: 05:43 Publisher: Taylor & Francis Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK International Journal of Agricultural Sustainability Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/tags20 Institutional dimensions of veterinary services reforms: responses to structural adjustment in Northern Ghana abcd b c Kwadwo Amankwah , Laurens Klerkx , Owuraku Sakyi-Dawson , e d b Naaminong Karbo , Simon J. Oosting , Cees Leeuwis & Akke J. van der d Zijpp a Animal Health and Production College, PO Box TL 300, Tamale, Ghana b Knowledge, Technology and Innovation Group, Wageningen University, PO Box 8130, 6700 EW Wageningen, The Netherlands c Department of Agricultural Extension, College of Agriculture and Consumer Science, University of Ghana, PO Box LG 68, Legon, Ghana d Animal Production Systems Group, Wageningen University, PO Box 338, 6700 AH Wageningen, The Netherlands e Animal Research Institute, Council for Scientific and Industrial Research, PO Box AH 20, Accra, Ghana Published online: 29 Apr 2014. To cite this article: Kwadwo Amankwah, Laurens Klerkx, Owuraku Sakyi-Dawson, Naaminong Karbo, Simon J. Oosting, Cees Leeuwis & Akke J. van der Zijpp (2014): Institutional dimensions of veterinary services reforms: responses to structural adjustment in Northern Ghana, International Journal of Agricultural Sustainability, DOI: 10.1080/14735903.2014.909635 To link to this article: http://dx.doi.org/10.1080/14735903.2014.909635 PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. 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Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions Downloaded by [Wageningen UR Library] at 05:43 30 April 2014 International Journal of Agricultural Sustainability, 2014 http://dx.doi.org/10.1080/14735903.2014.909635 Institutional dimensions of veterinary services reforms: responses to structural adjustment in Northern Ghana ∗ Kwadwo Amankwaha,b,c,d, , Laurens Klerkxb, Owuraku Sakyi-Dawsonc, Naaminong Karboe, Simon J. Oostingd, Cees Leeuwisb and Akke J. van der Zijppd a Animal Health and Production College, PO Box TL 300, Tamale, Ghana; bKnowledge, Technology and Innovation Group, Wageningen University, PO Box 8130, 6700 EW Wageningen, The Netherlands; c Department of Agricultural Extension, College of Agriculture and Consumer Science, University of Downloaded by [Wageningen UR Library] at 05:43 30 April 2014 Ghana, PO Box LG 68, Legon, Ghana; dAnimal Production Systems Group, Wageningen University, PO Box 338, 6700 AH Wageningen, The Netherlands; eAnimal Research Institute, Council for Scientific and Industrial Research, PO Box AH 20, Accra, Ghana This study examines the effect of the post-1980s’ structural adjustment reforms on the delivery and smallholders’ use of veterinary services in two districts in Northern Ghana. Our analytical framework distinguishes between allocative, cognitive, and normative institutions to analyse the effects on four areas of service delivery: (1) prevention; (2) clinical services; (3) provision of drugs, vaccines, and other products; and (4) human health protection. The reforms were accompanied by substantial reductions in the allocation of both financial and human resources to public veterinary services; this in turn induced fragmentation in service supply, preferential service to progressive (or wealthy) farmers, and non-adherence to international protocols for livestock health reporting. A few communities self-organized to access veterinary services. Thus, the reforms triggered changes mostly in formal allocative institutions, but these triggered further changes in informal allocative, cognitive, and normative institutions that structured the impact of the reforms. The paper concludes that institutional change is not a one-off outcome of an intervention. Rather, such interventions trigger new dynamics that policy-makers and analysts need to take into account. This requires regular monitoring of anticipated and unanticipated effects of privatization and decentralization to enable policy adjustment. Keywords: institutions; public goods; veterinary services; smallholder livestock keeping; structural adjustment; Ghana 1. Introduction Like other rural services such as extension, in recent years veterinary services in developing countries have undergone major reforms including decentralization and privatization (Sen and Chander 2003). These reforms of public agricultural services were the direct result of structural adjustment policies (SAPs) promoted by the International Monetary Fund (IMF) and World Bank over the past two decades (World Bank 2009). The SAPs were based on the argument that many developing countries had failed to create incentive systems for the efficient delivery of goods and services in the agricultural sector, and that market mechanisms would do a better job (Smith 2001). Hence, the SAPs sought to reduce the role of the public sector in the provision of goods and services and enhance that of the private sector (Woodford 2004). As a result, services were decentralized and/or privatized. Decentralization concerns the transfer of administrative ∗ Corresponding author. Email: kojo116@yahoo.com # 2014 Taylor & Francis 2 K. Amankwah et al. responsibility, fiscal resources, and political authority from central government agencies to sub- national government entities, to non-governmental organizations, or to the private sector (Robin- son 2007). Privatization is the transfer of power, resources, and functions from government to the private sector, non-governmental organizations, and civil society (Rondinelli 1981). These reforms have affected a broad spectrum of rural development strategies and activities, including agricultural research, input supply, rural financial services, agricultural extension, veterinary services, and water resources management (Smith 2001). In the case of veterinary services, the reforms aimed to increase the role of private markets in services delivery, lower public expenditures, improve the quality and coverage of the services provided to livestock owners, and enhance effective control of animal diseases that endanger human health (Smith 2001). In developing countries, the reforms resulted in the privatization of selected tasks, decentralization of veterinary organizations, and a move towards confining the state veterinary services to delivery of public goods services (Cheneau et al. 2004). Although Downloaded by [Wageningen UR Library] at 05:43 30 April 2014 previous studies report on both pros and cons of decentralization and privatization (e.g. Sen and Chander 2003, Ahuja 2004, Leonard 2004, Woodford 2004), there are few in-depth studies of the interactions among the diverse stakeholders and the transformations of formal and informal insti- tutions that result from decentralization and privatization. Nonetheless, as some studies indicate (Robinson 2007, Awortwi 2010), the outcomes of decentralization reforms are often mediated by a number of institutional factors beyond the control of local officials, such as the prevailing pol- itical context, power dynamics at local and national levels, and lack of financial resources. All too often, the reforms were pursued without due attention to complementary changes in the broader governance structures and socio-economic conditions. For Ghana also, there is little recent infor- mation on how the diverse actors reacted to the reforms of the public veterinary services. The present study aims to fill this gap by examining the effects of privatization and decentra- lization on veterinary services delivery in Northern Ghana by assessing (1) the changes in delivery of animal health services and (2) stakeholders’ responses to the reforms. To provide an analytical lens for the study, the following section outlines dimensions of veterinary services reform to understand the different elements that constitute veterinary services provision, and the kind of institutions that influence the provision of, and are affected by, reforms. Section 3 describes the case and the research methods. In Section 4, the findings are presented. The paper ends with a discussion and conclusions. 2. Dimensions of reform of veterinary services 2.1. Types and nature of veterinary services In this study, the term ‘service provision’ refers to the execution of a process intended to enhance the productivity of resource use in on-farm operations. Examples include technological and business advisory work, and regulations aimed at plant and animal disease control. Goods pro- vision, on the other hand, refers to the provision of material goods, for example, fertilizer distri- bution (Smith 2001). Smith (2001) distinguishes four main categories of veterinary services: (i) preventive services (avoiding the outbreak of diseases); (ii) clinical or curative services (treatment of diseased animals and control of production- limiting disorders); (iii) production and distribution of drugs, vaccines, and other products (such as artificial inse- mination); and (iv) human health protection (inspection of marketed animal products including live animals in markets, during transportation, and on farms). International Journal of Agricultural Sustainability 3 Prior to decentralization and privatization, in most sub-Saharan African countries veterinary services were predominantly delivered by the public sector. Changes brought about by the reforms include assigning the private sector the responsibility for delivery of services considered to be private goods, such as clinical services (e.g. diagnosis and treatment) and production and distribution of drugs and vaccines. On the other hand, the public sector retains responsibility for human health protection services (i.e. meat inspection, quarantine, and quality control). Several preventive services have spill-over effects. Hence, they are either delivered by the public sector or funded collectively by the affected livestock owners (Smith 2001). However, certain goods and services have mixed public and private characteristics. For example, vacci- nation to control zoonotic diseases such as anthrax and rabies has a strong private service com- ponent but has beneficial effects on human health. Consequently, public veterinary services often take responsibility for control of these zoonoses. Thus, the reforms distinguish between public and private goods to prescribe channels of veterinary services delivery (Umali et al. 1994). Downloaded by [Wageningen UR Library] at 05:43 30 April 2014 2.2. Results of reforms of veterinary services A review of the literature reveals that the reforms of veterinary services delivery have yielded mixed results. On the positive side, some studies indicate that the availability and use of veterinary drugs are significantly higher in developing countries that have privatized services and drug supplies than in countries maintaining government monopolies (Sen and Chander 2003). After reforms, tsetse-fly control in Zimbabwe and Botswana and vaccination in Morocco have significantly improved, and the corresponding cost has been considerably reduced (Holden 1999). A number of studies indicate that poor people are willing to pay for clinical and preventive veterinary services (Ahuja 2004, Leonard 2004). Reforms appear to have benefitted less-skilled veterinary service providers such as para-veterinarians, technical assistants (TAs), and community animal health workers (CAHWs). According to Woodford (2004), in subsistence and extensive livestock production systems, less-qua- lified personnel adapted better to reforms in delivery of services than veterinarians. Such para-veter- inarians acquire skills through practice, are often members of the same ethnic group as their clients, reside in communities where livestock is found, have lower income aspirations, and can handle 80– 90% of the veterinary interventions in extensive livestock production systems. On the negative side, Turkson and Brownie (1999) reported only limited evidence that priva- tization has improved veterinary services delivery in developing countries. The SAPs were often regarded as imposed by donors; policy-makers often saw them as a cause rather than a solution to financial problems (Woodford 2004). Animal health policy-makers were technically oriented and had limited change management skills. The deregulation and deployment of para-veterinarians induced by the reforms were perceived as a threat by veterinarians. Furthermore, service delivery by less-qualified staff was constrained by unresolved issues such as how to supervise and resupply them and how to maintain effective two-way communication with supervisory veterinarians (Ahuja 2004). Privatization also resulted in a high concentration of private veterinary practices in urban centres, leaving rural areas uncovered (Woodford 2004). Moreover, in many developing countries, in the absence of a formal system, unregulated informal animal health delivery systems have evolved. Thus, in many sub-Saharan countries including Ghana, the SAP-induced reforms have brought about a reduction in quantity and/or quality of veterinary services to poor commu- nities (Turkson and Brownie 1999, Woodford 2004). 2.3. Understanding reforms through the lens of different institutional dimensions In this study, we look at privatization and decentralization as a form of institutional change that has allocative, cognitive, and normative dimensions (Scott 1995, Elzen et al. 2012). Institutions 4 K. Amankwah et al. are informal and formal rules or norms actually used by a set of individuals to organize repetitive activities that produce collective outcomes (Ostrom 1992). Allocative institutions deal with the way scarce resources are distributed and/or exchanged (Weimer 2006) and relate, for example, to payment through market arrangements, but also allocative mechanisms used by the state, e.g. subsidies. Cognitive institutions refer to the common interpretive framework of meaning (Scott 1995). In the context of this study, cognitive institutions relate to the way knowledge and skills or expertise are (re)organized. For example, the transfer of technology model is a cog- nitive view of research and development that many agricultural scientists have adopted and used to plan and manage the innovation process (Douthwaite et al. 2001). Normative institutions com- prise the values, norms, and roles which an actor experiences as social expectations, prescriptions, or moral obligations. These include regulations, enforcement mechanisms, and adherence to stan- dards (Scott 1995). The different institutions are connected to one another in defining practices, standards, and policies (Pacheco et al. 2010). Downloaded by [Wageningen UR Library] at 05:43 30 April 2014 Using the categories of veterinary services outlined in Section 2.1, we describe stakeholder responses to the decentralization and privatization dynamics for each category. Then, we examine how the diverse responses are connected to the allocative, cognitive, and normative insti- tutional dimensions. 3. Research setting and research methods 3.1. Choice of research setting Multiple methods of qualitative and quantitative (Neuman 2000) design were employed to examine the provision of veterinary services to smallholder crop – livestock farmers in the Upper West Region (UWR) of Ghana. The region (and two districts within it) was selected as the study area because it has the highest number of food-insecure households in Ghana (Quaye 2008) who are likely to suffer from a change in fully funded veterinary services from public to partly private provision. The region is located in the north-western corner of Ghana stretching from Longitude 98 35′ N to 118 N and Latitude 18 25′ to 28 50′ E. Exploratory interviews with staff from the Ministry of Food and Agriculture (MoFA) in Lawra and Nadowli in UWR resulted in the purposive selection in each district of two communities noted for livestock production. Tables 1 and 2 provide the farming system characteristics of the study communities. All four communities belong to the same tribe, Dagaaba. The majority of households at Orbili are Traditionalist (over 90%), at N. Tankyara the majority are Christian (over 90%), at Tangasie the majority are Traditionalist (60%), and at Tabiasi the majority (60%) are Moslem. Of the Table 1. Population, households, and percentage of households keeping livestock in the four study communities. Percentage of households keeping livestock (%) a Community Population (#) Household (#) Cattle Sheep Goats Pigs Chicken Guineafowls Orbili 302 52 15.4 55.8 94.2 57.7 96.2 9.6 N. Tankyara 321 66 34.8 39.4 84.8 39.4 80.3 27.3 Tangasie 1186 131 6.1 24.4 71.0 97.0 81.7 24.4 Tabiasi 2773 171 70.8 47.4 77.2 11.7 77.8 28.7 a Ghana Statistical Service (2010) population approximation. Source: Fieldwork (2012). International Journal of Agricultural Sustainability 5 Table 2. Average farm size (acres) of households in the four study communities. Households (#) Mean Standard deviation Orbili Grain crops 51 5.9 2.79 Leguminous crops 51 3.2 1.18 N. Tankyara Grain crops 66 4.8 2.40 Leguminous crops 55 1.1 0.77 Tangasie Grain crops 97 5.7 4.16 Leguminous crops 93 4.9 3.72 Tabiasi Grain crops 144 10.7 5.12 Leguminous crops 63 2.5 1.19 Downloaded by [Wageningen UR Library] at 05:43 30 April 2014 Note: Grain crops: millet, sorghum, maize, and rice; leguminous crops: groundnuts and cowpeas. Source: Field survey (2012). household heads, 82% are illiterate. The main types of livestock kept are goats and sheep, cattle, pigs, chickens, and guineafowls (see Table 1). Few households at Orbili and Tangasie own cattle, largely due to theft. Over 60% of the households owned cattle about 20 years ago (ICRA and NAES 1993). Tabiasi has deployed measures that have helped to minimize theft. The ecological zone is mainly Guinea Savannah characterized by low vegetative growth of grasses, shrubs, and sparsely distributed trees. Rainfall is unimodal and occurs from May to October, with a dry season the rest of the year. The dominant farming system is crop – livestock mixed farming. The crops grown are cereals (millet, sorghum, and maize) and legumes (ground- nuts and cowpeas) (see Table 2). Table 2 shows that N. Tankyara and Tabiasi have the smallest and largest farm sizes, respectively. The farm sizes reflect the availability of arable land. Apart from Tabiasi, the communities cultivate both compound and bush farms. Compound farming is the cultivation of the plot around the homestead. Bush farms are further away from residences (0.5 kilometre or more). Compound farming compels the farmers to tether animals to prevent grazing on cropped fields during the farming season from May to October. Tethering restricts animal movement and feeding, with consequent increases in diseases and mortalities. Tabiasi has adequate arable land; thus, farmers there have only bush farms and hence do not tether animals. In the dry season, animals are free range, roam freely, and are exposed to theft and pre- dators such as dogs. Communal grazing land is the principal resource for livestock feeding. The characteristics of the other key stakeholders, MoFA staff, are shown in Table 3. TAs and technical officers (TOs) are less-skilled technicians who work directly with smallholder farmers. The other staff members play supervisory or advisory roles. 3.2. Data collection and analysis To obtain an overview of the study area, a quantitative survey was conducted in January 2012 to characterize the farming systems. Focus group discussions were held in the first half of 2012 in each of the four communities about their experience of veterinary services delivery before and after decentralization and privatization. In the second half of 2012, in-depth interviews in the local language (through an interpreter) were conducted with five elderly farmers per com- munity on their personal experiences of the reforms. In both the focus group discussions and the in-depth interviews, farmers compared the period before and after the reforms. The topics discussed included who the veterinary TOs were, types of veterinary services accessed by 6 K. Amankwah et al. Table 3. Characteristics of key MoFA staff with an active role in the veterinary services reforms. Staff category Qualification or training Main role TA Six weeks training Assists TO in providing services to clients/ farmers TO Three-year certificate Veterinary services to clients/farmers DVO Veterinary medicine Supervises veterinary TO at district level degree District Director BSc or higher degree Head of district Deputy Director and Director of BSc or higher degree Policy advisors at VSD and MoFA VSD headquarters farmers, requests made to the TOs and responses received, charges, vaccination regimes, and Downloaded by [Wageningen UR Library] at 05:43 30 April 2014 mortality rates. In-depth interviews were also conducted with traders, Fulani herdsmen, and licensed and unlicensed veterinary drugstore operators identified through snowball sampling on their viewpoints on changes in the veterinary services they employ and/or deliver. MoFA staff from national headquarters, regional, and district level were interviewed about their experi- ences of the changes before and after the reforms. Documents about MoFA’s decentralization and privatization (Humado 2003, Amezah 2007) were reviewed. Direct observations were also used to collect data. For example, we spent about 10 hours observing customers purchas- ing veterinary drugs from four licensed stores and two hours at one unlicensed store watching customers. We interviewed 10 livestock traders and tracked eight of them from Babile Market (the biggest livestock market in Lawra District) to the two main southern Ghana markets (Kumasi and Accra). For an overview of the research methods and numbers of actors inter- viewed, see Table 4. Qualitative data (from field notes and transcripts) were analysed using Atlas.ti version 5. The data were coded using the questions: ‘What is the actor doing or saying in this data segment?’ ‘What salient factors affect the actor’s actions and what are the consequences?’ Guided by these analytical questions, concepts were identified and short notes or memos written for each concept. Patterns in terms of recurrent and concurrent concepts were identified, and narrative summaries were composed from the memos (Neuman 2000). The quantitative survey data were summarized using descriptive statistics. Table 4. Overview of research methods and sample categories in the study. Research method Study sample unit Total respondents Survey HH heads in four villages 355 Focus group discussion Groups of 12 members in three villages 36 In-depth interviews Farmers in four villages 20 TOs 12 Deputy Directors (VSD Headquarters) 4 Deputy Directors (MoFA Headquarters) 2 Senior Staff MoFA (UWR) 7 Traders 10 Fulani herdsmen 3 CAHW 2 Licensed veterinary store operators 4 Unlicensed veterinary store operators 2 Total 457 International Journal of Agricultural Sustainability 7 4. Findings The findings are organized into three sections: first, we give an overview of the evolution of the reforms, followed by crosscutting changes introduced by the reforms. Then, we present salient changes in the four types of veterinary service (preventive, clinical, drug provision, and human health protection). 4.1. Overview of the evolution of the reform There have been over five decades of reforms, and Table 5 traces the evolution of the agricul- tural reforms within the context of national policies and programmes. As Table 5 shows, the Provisional National Defence Council (PNDC) Government took over a country saddled with economic crisis and consequently had few options. They turned to the World Bank and the IMF and subscribed to their policy conditions in 1983 (Toye 1992). However, before SAP Downloaded by [Wageningen UR Library] at 05:43 30 April 2014 adoption, the PNDC already made it explicit that its basic policy position in 1982 was ‘to promote participatory democracy through a decentralized government system’ (Ahwoi 2010, p. 1). The architects of local government decentralization in Ghana posited that this involved ‘the transfer of functions and powers, skills and competence and means and resources from Central Government to local government authorities’ (Ahwoi 2010, p. 7). They employed Table 5. Reforms in Ghana: chronology of events from 1960 to 2012. Year Event 1960 –1966 Centralized governance system adopted during the first republic. The state pursued extensive investment in infrastructure and large-scale industries which proved unprofitable 1970 –1980 Ghana transformed itself from a middle-income country into a low-income country on the brink of bankruptcy 1981 –1982 New government (PNDC) declared commitment to decentralization in stated policy position: to promote participatory democracy by introducing a ‘truly decentralized government system’ 1983 Adoption of structural adjustment programmes (SAP) consequent to collapse of the economy and few options available to the PNDC 1987 –1995 Privatization of veterinary services 1987 –1997 Unified Extension System implemented nationwide 1988 Local Government Law, PNDCL 207promulgated: District assemblies established as basic local government units 1989 –1993 PAMSCAD to mitigate hardships suffered by poor people as a result of SAP 1993 Local Government Act 462 and Civil Service Law PNDCL 327 promulgated to back establishment of decentralized departments of district assembly including MoFA, Ministry of Health, and Ministry of Education and Ghana Education Service 1996 –2000 Ghana Vision 2020 to guide Ghana into becoming a middle-income country by 2020 1997 Decentralization of agricultural services and Unified Extension System 2003 New government (NPP) promulgated Local Government Service Act 656: Department of Agriculture and others retained as departments of the district assemblies; Ministry of Health, and Ministry of Education and Ghana Education Service excluded and placed under Central Government 2003 –2005 Ghana Poverty Reduction Strategy (GPRS I) to accelerate growth and reduce poverty 2007 –2009 Growth and Poverty Reduction Strategy (GPRS II) to consolidate gains in GPRSI and to reduce further poverty 2012 Fiscal decentralization of district assembly scheduled to begin but not effected by September 2012 Source: Toye (1992), Ahwoi (2010), Field interviews (2012). 8 K. Amankwah et al. decentralization as a process with political, administrative, and fiscal elements. The political aspect involved the establishment of district assemblies or local government structures; the administrative component related to the establishment of decentralized departments such as MoFA and the Ministry of Health as part of district assemblies; and the fiscal aspect entailed an arrangement to transfer resources to district assemblies to enable them to perform to expec- tations (Ahwoi 2010, Awortwi 2010). Thus, the government’s main objective for decentralization of MoFA was to accommodate the ministry as one of the departments under the district assembly (i.e. local government service). MoFA’s reforms entailed merging 11 parallel departments under one administrative head, i.e. the district or regional director (Humado 2003). Table 5 also shows that the MoFA reforms are one of a number of interventions induced by the SAP and other programmes. It is striking that the SAP interventions apparently worsened the plight of poor people in society, as indicated by interventions such as the Programme of Actions to Mitigate the Social Costs of Adjustments Downloaded by [Wageningen UR Library] at 05:43 30 April 2014 and Development (PAMSCAD, a US$90 million donor-supported intervention) that sought to lessen hardships experienced by the poor and vulnerable groups consequent to the SAP (Ahwoi 2010). The foregoing forms the backdrop to the decentralization and privatization of veterinary services in Ghana. This study focuses on how the various actors responded to the MoFA reforms. 4.2. Crosscutting changes introduced by the reforms The reforms set in motion a number of fundamental changes in the allocation of public expendi- tures, supply of technical personnel, participation of private practitioners in service delivery, control of resources for veterinary activities, and demand for veterinary services. The changes simultaneously aimed to scale down public-sector involvement and increase private-sector par- ticipation. These changes are described below. 4.2.1. Dwindling public funding for veterinary services The reforms of the public veterinary service were driven by the financial crisis in the early 1980s (Turkson and Brownie 1999). For instance, the proportion of the national budget allocated to the Veterinary Services Department/Directorate (VSD) (nationwide) declined steadily from 0.4% in 1990 to 0.1% in 1994, followed by a rise in 1995 (Turkson and Brownie 1999, p. 35). In the past five years, a similar decline has been recorded for VSD (i.e. headquarters; figures for nationwide not available): from 0.08% in 2007 to 0.02% in 2011 (MoFA 2007 – 2011). In the post-reform period, the government did not invest in con- struction, equipment, and vehicles but continued to pay salaries. For example, between 1990 and 1995, public expenditure for investment and staff salaries in veterinary services fell by 20.5% and 3.6%, respectively (Turkson and Brownie 1999). Between 1995 and 1997, the investment expenditure fell to zero. The data available from 2008 to 2011 also show that invest- ment was zero (VSD 2009 – 2011). In addition to the reduction in funding, the number of public veterinary technical staff (veter- inarians and technicians) has decreased in relation to the livestock population since the reforms (Table 6). The staff reduction was achieved by ending the automatic employment of graduates from agricultural colleges and universities, and by retrenching veterinary TAs. The reduction in staff was prompted by implementation of SAP and economic recovery programme in Ghana from 1983 onwards (Turkson and Brownie 1999). The staff reduction has a knock-on effect on the availability of TOs for veterinary services delivery in rural communities International Journal of Agricultural Sustainability 9 Table 6. National trends in public veterinary service performance. Period Employed veterinary technical staff TLUa to veterinary technical staff ratio Pre-reform (1990– 1995) 1009 1245.3 Early reform (1996–2000) 786 1819.6b Post-reform (2001–2010) 755 2242.7b a TLU (Tropical Livestock Unit): cattle ¼ 0.70; sheep/goats ¼ 0.10 (Otte and Chilonda 2002). b TLU values from 1997 were based on projections. Source: Staff list, VSD (2012), ISSER (2000, 2011). 4.2.2. Private practice offered by veterinarians and CAHWs In the mid-1990s, the government encouraged and supported veterinary professionals to enter private practice. In 1997, there were two private veterinarians in Ghana (Staff list, VSD, Downloaded by [Wageningen UR Library] at 05:43 30 April 2014 2012); in 2011, there were 18 (Diop et al. 2012). According to a VSD deputy director, private veterinarians were only able to establish in major cities such as Accra and Kumasi where they focused on pets (e.g. cats, dogs). The government also promoted a CAHWs’ scheme. CAHWs were selected by communities, trained in basic animal healthcare, and provided with starter kits by VSD. Between 1995 and 2000, 1007 CAHWs were trained nationwide (VSD records, Accra, 2012). They charged nominal fees for their work in their respective communities and were supervised by the TO and the district veterinary officer (DVO). The CAHW licences were renewed annually by VSD. The consensus among the veterinary personnel whom we interviewed was that the scheme worked for a few years and then broke down. Only one of our four study communities (Tabiasi) had an active CAHW. He told us that only few farmers consulted him because the majority had learnt to treat their animals themselves. Farmers in a second community (N. Tan- kyara) said that they had previously made use of their CAHW but that this person had stopped providing services. Another important factor that contributed to the collapse of the CAHW scheme was that, over time, the scheme lost the support of both veterinarians and para-veterinarians. A deputy director at VSD headquarters and a DVO (TO by rank) in the study area explained that the CAHWs were restricted to providing basic animal healthcare treatment but that many went beyond that and pro- vided injections and even engaged in surgery. According to the deputy director, We [VSD] trained CAHWs to treat wounds, de-tick, and arrange meetings. They were not supposed to inject or do surgery. When they did inject, other farmers saw it and copied them. Thus, we brought self-medication by farmers upon ourselves. The VSD officers implied that they had begun to perceive CAHWs as competitors, and cooperation with them waned. However, in two communities in this study with records of CAHWs activities, the CAHWs did not perceive themselves as competing with the veterinary TOs. For example, at Tabiasi, the CAHW said that he always referred cases beyond his compe- tence, e.g. vaccinations, post-mortems, to the TO, but that he had not been backstopped by the (new) TO since 2007. He concluded that TOs are not supervised and monitored so they do not deliver the services expected of them. Similarly, at Tankyara, the CAHW said the main reason he stopped practicing was that the TO with whom he used to work was transferred and the new TO discontinued the working relationship. Apparently, VSD staff may have undermined the scheme by withdrawing support even in instances where the CAHWs operated within their prescribed limits. 10 K. Amankwah et al. 4.2.3. Control of resources for veterinary activities at district and regional levels One of the main changes that decentralization imposed on public veterinary services was a new organizational structure. Before the reform, a direct chain of command linked the VSD director and field staff through the regional veterinary officer (RVO), as shown in Figure 1(a). After the reforms, communication was channelled through the District Director, Regional Director, and the Chief Director and copied to the RVO and the Director of VSD along the way (see Figure 1(b)). MoFA’s new organizational structure meant that the District Director became the cost centre manager with discretionary control over the quarterly budget allocation for district veter- inary activities. Among the veterinary and other MoFA staff whom we interviewed, the con- sensus was that giving control over public veterinary services to the MoFA District Director is Downloaded by [Wageningen UR Library] at 05:43 30 April 2014 Figure 1a. (a) Before decentralisation: line of communication in VSD. Notes: TA, technical assistant; TO, technical officer; VSD, Veterinary Services Department; MoFA, Ministry of Food and Agriculture International Journal of Agricultural Sustainability 11 Downloaded by [Wageningen UR Library] at 05:43 30 April 2014 Figure 1b. (b) After decentralisation: line of communication in MoFA. Notes: TO, technical officer; AEA, agricultural extension agent; VET, veterinary; MIS, Management Infor- mation System; PPRS, plant protection and regulatory services; EXT, extension; ENG, engineering; WIAD, women in agricultural development; PPMED, Policy, Planning, Monitoring and Evaluation Directorate; APD, Animal Production Directorate. the most significant constraint inhibiting animal health services delivery in the post-reform period, as illustrated by the viewpoint of a non-veterinarian. A Regional Director who had been District Extension Officer and District Director before and after decentralization explained that there are issues [in veterinary services] that require use of money. Because its money is subsumed under DADU and RADU [district and regional agriculture development unit, respectively], the direc- tor can take the money allocated to veterinary work and use it, and by so doing deny veterinary services their share at the time they might request money. 12 K. Amankwah et al. This connects to findings by Humado (2003) who reported that many District Directors used funds meant for veterinary service activities for other purposes, thus reflecting incomplete decen- tralization in that the District Directors were accountable neither to their former headquarter bosses in Accra nor to the District Assembly because a local government service had not been established. 4.2.4. Shifting demand for veterinary services The broader social context affected veterinary services delivery over the course of the reforms. For example, demand for public veterinary services shifted from cattle farmers to owners of both small ruminants and cattle because of incessant cattle theft. Twenty years ago, over 80% and 60% of households owned small ruminants and cattle, respectively, in UWR (ICRA and NAES 1993). Excluding Tabiasi, 79.5% and 15.7% of households kept goats and cattle, respect- Downloaded by [Wageningen UR Library] at 05:43 30 April 2014 ively, in three communities in 2012 (extrapolated from the data in Table 1). This is reflected in the change in demand for veterinary services by households keeping small ruminants and cattle in the communities (Table 7). In two (Tabiasi and N. Tankyara) of our four study communities, we observed an increase in the demand for, and use of, public veterinary services. Two inter-related factors contributed to this: first, in these two communities, groups of farmers self-organized to create access to veterin- ary services. For example, in Tabiasi, respondents told us that, during the past five years, the incumbent veterinary TO was almost always absent from the community. In response, the farmers organized themselves into groups to use the services of the previous veterinary TO who had been transferred to another district, about 80 kilometres away. The farmers explained that they willingly pay a higher price for this TO’s services because he is very effective. The Tabiasi TO (from 1997 to 2007) explained his approach as follows: My main goal is to satisfy the farmer. If he is satisfied, tomorrow he will look for you. You see the only thing is to make sure you do effective work for them to see. If they have confidence in you, they are prepared to pay. Another TO (retired in 2004) was also convinced that farmers would pay for satisfactory veter- inary services. Farmers in Kumalsa (Lawra District) remembered that his services helped to reduce livestock mortality in their community. In the two other communities, Orbili and Tangasie, most farmers said they only used clinical services when they observed illness in their flocks, and this information from focus group discus- sions was confirmed by the respective TOs. This is consistent with an earlier study (Amankwah et al. 2012) that found that most farmers keep livestock for purposes of security in bad times, for sale during food shortage, but not as a business for profit. Hence, they limit costs and accept Table 7. Number of smallholder households with livestock in each of the four study communities and percentage using public veterinary services. Number of households with ruminant % of households with livestock using Community livestock services Tangasie 100 9.0 Tabiasi 148 61.5 Orbili 51 9.8 N. Tankyara 56 74.4 Source: Field interviews (2012). International Journal of Agricultural Sustainability 13 disease and mortality (Amankwah et al. 2012). However, 9 out of 12 TOs interviewed believed that most smallholders are what Rogers (2003) called ‘laggards’ who are reluctant to change their animal health practices. Apparently, the TOs do not understand the principle of risk avoidance that characterizes the smallholder farming system (Animal Research Institute 1999). In summary, we can conclude that the allocation of financial and human resources for the delivery of public veterinary services was considerably reduced. In addition, theft reduced the demand for veterinary services for cattle. The reduced resource allocation affected the quality of service delivery. The government’s reaction boiled down to ‘let’s wait and see what happens’ or ‘let’s see how people cope’. The next section examines ‘what happens’ in the delivery of the four categories of veterinary services. 4.3. Changes in each of the four veterinary service categories Downloaded by [Wageningen UR Library] at 05:43 30 April 2014 Table 8 summarizes the salient changes that occurred at national and community levels in the four categories of veterinary service consequent to the reforms and actors’ responses within the frame- work of the identified institutional dimensions. A description and example of each service follows. 4.3.1. Preventive vaccinations: shift in procurement from public to private sector and cessation of mass vaccinations by organized teams of technicians Preventive vaccinations were the main focus of veterinary interventions in the pre-reform period. The reforms changed two important aspects of preventive vaccination. The first change relates to procurement of vaccines (for diseases such as Peste Des Petits Ruminants [PPR], anthrax, and Newcastle disease in poultry). Respondents from VSD headquarters reported that, prior to the reforms, VSD imported vaccines without having to go through lengthy procurement procedures. However, for the greater part of the post-reform period it has become impossible to access gov- ernment funds in time to procure vaccines. Consequently, VSD has made alternative arrange- ments with private traders to import them. However, because of frequent changes in VSD directors (retirement almost every two to four years) and because of the unofficial nature of the arrangements, vaccine procurement at national level has fallen short. For instance, according to officials at the Central Laboratory at Pong Tamale (the unit responsible for distribution and sale of vaccines in Northern Ghana) and the TOs in the study area, from June 2011 to August 2012, in the whole of Ghana no routine PPR vaccinations took place. The second important change in preventive vaccination relates to the organizational arrange- ments for the delivery of vaccination services. During the pre-reform period, annual mass vacci- nations of livestock were administered by teams of veterinary technicians. In the post-reform period, vaccinations have been provided on an ad-hoc basis or in selected communities by indi- vidual TOs. Vaccination teams are now only mobilized when serious disease outbreaks occur in the districts and emergency disease control is required. TOs at community level have responded in diverse ways to the changes in procurement and organization of vaccination services. Six out of nine veterinary TOs in the study area only deliver vaccination services to progressive (rich) farmers or to a few communities that are ready to pay for animal healthcare interventions. Three out of nine TOs do not provide vaccinations at all. Inter- views with farmers suggested that two of these three were absent from their post most of the time, using office hours to engage in personal affairs. The third TO explained that he does not undertake late vaccinations because the animals may be sick already and vaccination might contribute to livestock mortality. The changes are reflected in livestock mortalities in the communities. For example, Orbili, N. Tankyara, and Tangasie ranked high livestock mortality rates as a priority con- straint, next to water shortage in the dry season. Mortality rates in 2010 were 63% among kids 14 K. Amankwah et al. Table 8. Changes in categories of veterinary services and typology of institutional responses. Category of veterinary service Allocative institutions Cognitive institutions Normative institutions Preventive In the post-reform period, Recurrent shortages in vaccine Public Procurement Act 663 vaccinations VSD arranged with supply at national level of 2003 made it private traders to import Team of TOs for mass cumbersome for VSD to vaccines vaccination disbanded; secure funds in time to Reduction in public funding Individual TOs deliver import vaccines services in limited number of villages Clinical A service charge introduced, CAHWs trained in basic Annual renewal of CAHWs’ services requiring clients to pay for animal health care by VSD licence by VSD initially services Many Fulani herdsmen and made the scheme effective, Downloaded by [Wageningen UR Library] at 05:43 30 April 2014 Private practice of farmers have learnt by trial- but later the arrangement veterinarians and and-error to practice self- broke down community livestock medication Quality standards not upheld: workers (CAHWs) TOs complain about lack of in- public personnel engage in introduced service training in the post- private practice (Diop et al. reform period 2012), treat animals, and under-report Drug supply Privatization of drug Only 30% of drugstore Nebulous regulation of distribution and sale operators have veterinary veterinary drug supply and shifted responsibility from training (Gyabaah-Yeboah stores by Food and Drugs the public to the private 2005) Board sector Drugstore operators educate Only 44% of veterinary drugs Increase in number of Fulani customers that drug on Ghanaian market herdsmen and farmers administration is based on registered with Food and who purchase veterinary body weight Drugs Board (Gyabaah- drugs from stores (for self- Yeboah 2005) medication) Public health District Director designated Many technical staff have left Decentralization and Unified sole spending officer at VSD; inadequate staff for Extension System district level disease surveillance, meat introduced Reduction in public funding inspection at many urban Livestock census and cattle slaughter slabs, and branding ceased monitoring movement of Non-adherence to animals international OIE protocols The general public is often and standards sensitized in the media to The Veterinary Surgeons Bill avoid meat from unhygienic of 2010 that seeks to grant abattoirs (Mensah 2013) authority for meat inspection to VSD prepared but not passed (under one year); 59% among lambs (under one year); 47% among goats (over one year); and 12% among sheep (over one year) (Amankwah et al. 2012). 4.3.2. Clinical services at district level and cost of farm-gate clinical services Two changes in clinical services recurred in the interviews with most of the veterinary personnel: the cost of farm-gate clinical services and the treatment of ill animals by farmers themselves. Before the reforms, the allowances for fuel and maintenance allowed the TOs to use their International Journal of Agricultural Sustainability 15 motorbikes to attend to reported ill animals and conduct disease surveillance. Veterinary drugs were issued to the TOs from the district office store, and at the end of the month returns were sub- mitted to the office. However, after the reforms, the allowances were often delayed and a quarter (three months) or more might pass before allowances were paid. Many TOs report that they have to buy drugs directly from the market rather than through the DVO, who often marks up the price. In addition to the mandated service charge for attending to ill animals, many TOs charge farmers for fuel because they do not receive the transport allowance in time. A VSD Deputy Director observed that, because of hardships, many TOs under-reported the services they provided in order to avoid payment of service charges. For example, since 2009, farm visits and house calls attract a service charge of 2 Gh¢ and 3Gh¢ per treatment of a sheep/goat and cattle, respectively (Fees and Charges Act 793, 2009). A TO said that in 2011 his ‘monthly service charge sometimes was 3Gh¢ or 5Gh¢’. He reasoned that it was not worth- while to use his own funds to buy drugs and then pay service charges to the government. This is Downloaded by [Wageningen UR Library] at 05:43 30 April 2014 typical of TOs who paid service charges. In response to the reduced number of veterinary staff, the increased cost of accessing public service, coupled to the increased importance of livestock as ‘savings’ for meeting needs and emer- gencies in households, many smallholders have taken up self-medication. ‘Self-medication is a practice whereby clients purchase drugs and vaccines and administer these to their animals without consulting veterinary staff’ (Turkson 2008, p. 19). Cattle-owning farmers especially indi- cated that self-medication has risen after the reforms, as indicated at a focus group meeting at Tabiasi. As one of them indicated: At first, people didn’t realise the importance of animals, but today everything you do involves money. Examples are health insurance, school fees, fertiliser, and naming ceremony, to mention just a few. More to the point, there isn’t any vet. So if you do not treat your own, [whiles] the means are numer- ous, a time will come when you will be at risk [no cattle to fall back on for cash]. So this is the major reason why farmers are forced to learn about some of these issues. The most common form of self-medication is treatment of wounds and skin diseases, using either herbs or orthodox products such as iodine solutions and insecticides. The second is prophylaxis and curative treatments using herbal preparations, notably a common salt solution with dawadawa (a fermented condiment prepared with beans of a tree legume, Parkiabiglobasa) that animals can drink. Third, farmers inject ill animals using antibiotics such as oxytectracycline and procaine peni- cillin. The fourth type is top-up treatment when the TO has failed to cure an ill animal. Most small- holders cannot afford a follow-up visit by the TO so they monitor their animals and provide the needed follow-up treatment themselves. The top-up treatment often involves both herbal prep- arations and orthodox products. The first and second types of self-medication were common in all four communities studied. The third and fourth types were observed mostly in Tabiasi. 4.3.3. Drug supply: privatization of veterinary drug sale and lax quality controls The main change in drug supply relates to the privatization of veterinary drug distribution and sale that began in the mid-1990s. Prior to this privatization, VSD procured and distributed all veter- inary drugs in Ghana mainly through its field staff. After privatization, VSD withdrew from mar- keting veterinary drugs and chemicals (excluding vaccines), and private individuals or companies took over these functions. An outcome of privatization is that licensed shops now sell veterinary drugs in the country’s major cities and towns. Increasingly, however, unlicensed itinerant traders sell veterinary drugs in towns and rural communities with little or no quality control. For instance, in Tabiasi, Fulani 16 K. Amankwah et al. herdsmen are the main source of veterinary drugs. In an interview, the chief Fulani herdsman in that village indicated that he buys drugs from stores in the regional capital, Wa. Two other Fulani herdsmen said that the cattle owners often do not make provision for veterinary treatment but hold them responsible in the event of mortality. Hence, they are compelled to treat the animals using both conventional and herbal preparations in cases of ill-health so as to prevent mortality and keep their herding job. Interviews with four of the six licensed veterinary store operators in Wa revealed that traders who cross the border from Burkina Faso are other important sources of veterinary drugs for the Fulani and farmers. One of the operators concluded that Fulani herdsmen have taken over the job of veterinary officers. In Nandom, which is close to N. Tankyara, veterinary drugs are sold in unlicensed table-top shops on weekly market days. Two Deputy Directors of VSD said that, by law, the Food and Drugs Board has responsibility for the sale of drugs on the open market and there is not much VSD can do about it. Downloaded by [Wageningen UR Library] at 05:43 30 April 2014 4.3.4. Public health service: non-adherence to international protocols The most important change with respect to public health services relates to difficulty about col- lecting data on livestock diseases, stock movements, and animal numbers. The reforms have affected VSD’s reporting on disease surveillance to the World Organisation for Animal Health (OIE), the FAO, the International Bureau of Animal Resources, and the International Livestock Research Institute (Humado 2003). A gap analysis of public veterinary services in Ghana con- ducted by OIE consultants (Diop et al. 2012) blamed the new MoFA structure introduced by the reforms (see Figure 1(a) and 1(b)). According to Humado (2003), the new structure placed emphasis on extension services deliv- ery and led to a reduction in the capacity of veterinary staff to deliver services because of lack of staff. Furthermore, budget allocation shortfalls resulted when district directors committed a dis- proportionate percentage of funds to their area of specialization and administrative expenses (especially vehicle repair and fuel), to the disadvantage of technical services such as veterinary services delivery. Additionally, a number of public services have ceased, including the annual national livestock census and the branding of cattle before issuing movement permits to traders to enable them to transport animals across district boundaries. Meat inspection has also been affected by the changes. For example, visits to the central abattoirs in Accra and Kumasi during this study showed that they have qualified veterinary officers to conduct meat inspection. However, visits to two slaughter slabs attached to small ruminant markets in Kumasi and another in Accra showed that they did not have veterinary officers for meat inspection. A VSD official stationed at one of the central markets in Accra lamented over the growing number of slaughter slabs in the city where the department cannot conduct meat inspection because of the lack of manpower. In summary, the reforms gave the public and private sectors shared responsibility for deliver- ing veterinary services. One of the four service categories, drugs distribution and sale, was shifted entirely to the private sector. For the other three categories (prevention, clinical, and human health protection), the public sector retained responsibility for production and distribution, but funding was shifted to the private sector. However, the public sector had to improvise in order to continue to provide these services. The gaps have been persistently renegotiated and filled by activities of various actors in response to dynamics in the institutional elements (Gyabaah-Yeboah 2005). 5. Discussion A number of theoretical and policy implications can be derived from our study. In line with the analytical lens set out in Section 2.3, we raise two main issues: (1) allocative institutions and International Journal of Agricultural Sustainability 17 coverage of veterinary services and (2) the interconnectedness of the three institutional dimen- sions (allocative, cognitive, and normative) in veterinary services reforms. 5.1. Allocative institutions and coverage of veterinary services Our findings indicate that changes in the allocation of resources were the major contributor to the reduction in coverage and delivery of veterinary services. Allocative institutional issues come to the fore in two significant changes: a substantial reduction in the allocation of finan- cial and human resources to public veterinary services, and placing VSD under a non-veter- inarian director at district level. The response of the public sector included unequal service delivery in communities, focus on progressive (rich) farmers, farmers’ increased transaction cost in accessing services, and cheating by public veterinarians and para-veterinarians through private practice and under-reporting. Consequently, the quality of service declined, Downloaded by [Wageningen UR Library] at 05:43 30 April 2014 and non-adherence to international protocols for reporting livestock diseases prevailed. In the private sector, many farmers and Fulani herdsmen purchased and administered veterinary drugs that had not been subject to quality control. Only a few communities self-organized to access veterinary services; this indicates farmers’ limited willingness to pay for effective veter- inary services. We call attention to the fact that the process of shifting responsibility from the public to the private sector was not regulated. Consequently, the reforms resulted in unintended negative responses from both public- and private-sector actors. Our findings reinforce earlier critical studies of veterinary services reforms in Ghana (Turkson and Brownie 1999, Turkson 2008) and Cameroon (Gros 1994) as well as in several other developing countries (Woodford 2004). These studies also show that governments substantially reduced public expenditure on veterinary services and passively engaged in the reform process. The public sector proved unable to respond to the emergence of an informal animal health delivery system characterized by the prevalence of self-medication and the absence of quality control. 5.2. The interconnectedness of the institutional elements in veterinary services reforms Our findings also show that the responses of the diverse actors to the reforms can be structured according to three dimensions of institutions (allocative, cognitive, and normative) that are inter-linked or explain further changes. For example, reductions in public funding and staff numbers led veterinary TOs to mark up the price of service provision (i.e. changes in allocative institutions induced further change). The breakdown of public-sector controls (change in norma- tive institution) led to easy access to veterinary drugs on the open market. Such changes within the veterinary services domain, in turn, interacted with other institutional elements and forces outside the reforms. For example, farmers’ increased dependence on livestock to meet livelihood needs led many farmers to appropriate knowledge and skills for self-treatment (i.e. change in cognitive institutions). This widespread self-medication cannot be captured in public-sector reports; this contributes to non-observance of the international protocol for reporting livestock diseases (a nor- mative issue). The institutional analysis of the responses to the reforms indicates the need to con- sider emergent cognitive and normative institutional changes that are triggered by changes in allocative institutions. As discussed, the reforms introduced changes primarily in formal alloca- tive institutions. The analysis of the responses to these changes shows that they are not a one-off outcome of the reforms. Instead, they interact with a whole set of other institutional changes at national, district, and community levels. This suggests that policy-makers who implement change in one institutional dimension can expect the emergence of a new institutional setup that involves other institutional dimensions. 18 K. Amankwah et al. Our findings reflect those of a number of studies – not only in veterinary services provision but also in other disciplines – showing that institutional elements interact in unforeseen ways, with unintended consequences for the outcomes of reforms (Gros 1994, Harrington et al. 2001, Munyua and Wabacha 2003). For example, integrated natural resources management research shows that there are inter-linkages among policies and institutions, farm-level practices, plant and animal growth, biophysical processes, and impacts and outcomes, with consequences for food security, poverty alleviation, and environmental protection (Harrington et al. 2001). Our study shows that changes in allocative institutions are inter-linked with changes in cognitive and normative (including regulative) institutions. These changes prompted both public- and private-sector actors to engage in practices that may have negative externalities and may under- mine the efficacy of disease management (following Liebenehm et al. 2011). Downloaded by [Wageningen UR Library] at 05:43 30 April 2014 6. Conclusions This study examined the outcomes of decentralization and privatization reforms for the delivery of veterinary services and smallholders’ use of these services in two districts in Northern Ghana, where the settlements are scattered and an extensive system of livestock keeping pre- vails. The study shows that these outcomes have not been altogether positive. The sharp reductions in financial and staff resources allocated for public-sector veterinary services have led to irregular mass vaccinations against contagious animal diseases, greater inequity of service delivery, the collapse of quality controls of drugs, the proliferation of drugs from infor- mal sources on the market, often inadequately informed self-medication, and the moonlighting of public veterinarians and para-veterinarians for private purposes. This ‘litany of woes’ does not necessarily imply a return to the public-sector system installed by the British colonial power. The public sector still has a relevant role to play, e.g. for surveillance and control of infectious or zoonotic diseases, guarantee of quality control of drugs and vaccines, and adher- ence to international protocols for livestock reporting systems. Our study shows that the public sector requires urgent action to enable it to play these essential roles. On the other hand, the self-organization of a few communities to effectively use veterinary staff and the apparent will- ingness of farmers to pay for effective services suggest that strategies to mainstream the deliv- ery of customer-oriented services by private para-veterinarians to groups in rural areas may hold prospects. The study also shows that measures to implement agency-driven change, such as economizing on public-sector costs (i.e. change in allocative institutions) trigger unforeseen and inter-linked institutional changes in other domains with unintended conse- quences. 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