1. Introduction
The Kingdom of Cambodia is a Southeast Asian (SEA) country of 181,035 km2 that shares borders with the Lao People’s Democratic Republic (PDR) in the north, Thailand in the north and west, and Vietnam to the south and east. Cambodia consists of 24 provinces and one municipality, with a population estimated to be about 16.9 million (World Population Review, 2021). Agriculture is integral to the life of smallholder farmers in rural communities, with cattle-raising important, providing a source of income, asset storage, manure for fertiliser, transport and on some farms, draught power (Young et al., 2014b). Cattle-raising is often operated alongside other activities, particularly rice and crop production and other off-farm activities (Samkol, Sath, Patel, Windsor, & Holtenius, 2015; Young et al., 2014b).
Animal disease outbreaks pose significant threats to livestock sectors in Cambodia, both from the economic impacts of the disease and the measures required to reduce disease introduction risk. FMD is recognised as the most significant transboundary animal diseases (TADs) affecting large ruminants in the Mekong region of SEA and beyond, particularly Cambodia (Blacksell, Siengsanan-Lamont, Kamolsiripichaiporn, Gleeson, & Windsor, 2019). FMD causes significant financial impacts in Cambodia, both at smallholder farmer households (Young et al., 2013b) and the national levels (Young et al., 2014c). Despite many years of attempted FMD control by individual countries assisted by regional coordination through the SEACFMD program of the World Organisation for Animal Health (OIE) office in Bangkok, numerous factors have prevented the successful control of FMD within the region. These include ‘informal’ transboundary movement of livestock and their products, challenges in implementing vaccination programmes, the circulation of multiple and emerging virus topotypes and lineages, low-level technical capacity and biosecurity of veterinary services at national levels, limited farmer knowledge of FMD management, failures in the timely reporting and response to outbreaks, and limitations in national and international FMD control programmes (Blacksell et al., 2019). In Cambodia, a survey of smallholder farmers (n=300) found that FMD outbreaks occurred every year during the study period, with a morbidity rate of over 30% (Sieng et al., 2021a). Biosecurity and vaccination practices were inadequate and it was concluded that poor knowledge of disease transmission and biosecurity, with low FMD vaccination coverage and a focus on treatment, contributed to regular FMD outbreaks in these communities.
Due to the lack of veterinary personnel and officials at the district and provincial levels, the Cambodian veterinary authority’s significant task was to provide a para-veterinary animal health service enabling most farmers to access basic veterinary services when required. Para‐veterinarians are considered crucial in providing front‐line veterinary care and advice to smallholder farmers in countries with under‐resourced national veterinary services, although often these individuals undergo basic training with minimal monitoring and evaluation of performance and knowledge levels (MacPhillamy et al., 2021). The para-veterinarians in Cambodia are the Village Animal Health Workers (VAHW) system that was established in early 1990, involving the selection of a local livestock-interested farmer to receive some training in basic village-level animal health services provision for smallholder farmers, particularly the vaccination of cattle for haemorrhagic septicaemia (HS) in rural communities (MacPhillamy et al., 2019). Similar approaches have been adopted and implemented in many developing countries, including Afghanistan (Leyland, 1993), Kenya (Blakeway, 1993; Mugunieri, Irungu, & Omiti, 2004), Ethiopia (Admassu et al., 2005) and Nepal (Moktan, Mitchelhill, & Joshi, 1990) and have shared similar purposes and goals.
The Department of Animal Health and Production (DAHP); now General Directorate of Animal Health & Production (GDAHP) aimed to have one VAHW per village in every province across the country. The VAHW selection process in Cambodia required basic literacy, experience with livestock care and husbandry, and a willingness to learn and obtain qualifications. They were often a part-time local animal health service provider, supported in part by providing farm labour or with a little help from the community. The DAHP commenced VAHW training in the 1990s, with initial support from Non-Government Organisations (NGOs) and the Food and Agriculture Organisation of the United Nations (FAO) (Calba et al., 2014). VAHWs received basic training of one-month duration in animal health and a starting kit from the training providers, enabling the provision of fee-based basic animal health services to smallholder farmers, including treatments and vaccinations within their village. The VAHWs usually purchase veterinary drugs and related equipment from local veterinary drugstores and suppliers at the district or provincial level.
One of the important roles for the VAHWs is to contribute to government disease control programs by reporting disease outbreaks, especially FMD, to the District Office of Animal Health and Production (DOAHP). Further, VAHWs should assist in diagnostic investigations and volunteer their participation in the national vaccination campaigns, particularly against Haemorrhagic Septicaemia (HS) and FMD, as required. The VAHWs have been described as an important local resource, enabling persons with some animal health skills to assist smallholder farmers (Tornimbene, Chhim, Sorn, Drew, & Guitian, 2014). They may also provide an important role in information exchange between local veterinarians and the community, particularly in improving biosecurity to prevent highly pathogenic avian influenza (HPAI) (Bhandari, Wollen, & Lohani, 2011). The VAHWs were considered highly accessible, available, affordable, and trustworthy relative to other service providers (Admassu et al., 2005; Peeling & Holden, 2004). Most VAHWs work closely with local authorities at village, commune, and district levels, especially during national vaccination campaigns (Government officials, personal communication, May 24, 2014).
Although the VAHWs was intended to provide local animal health services and assistance to local veterinary authorities in livestock disease prevention programs in their communities, their contributions to these tasks was uncertain (Stratton et al., 2015). A cross-sectional survey of VAHWs (n=445) from 19 provinces in Cambodia in 2008, used ‘guided group interviews’, to examine the roles of VAHWs and found they had good contact with farmers, with 61.5% making more than one farm visit daily, yet incomes from these services were low (Stratton et al., 2015). In 2015, a closed‐ended cross‐sectional study of VAHWs (n=80) from two provinces (Takeo and Tbong Khmum provinces) found positive associations between income generated from VAHW activities (p = .01) and the frequency of visiting farmers (p < .0001), although almost 90% of VAHW reported that they use antibiotics to treat FMD affected animals (MacPhillamy et al., 2019), potentially contributing to antimicrobial resistance risks (AMR).
In Cambodia, the severe socioeconomic impacts from FMD suggest an appropriate, sustainable national FMD control program is required (Blacksell et al., 2019; Young, Suon, Andrews, Henry, & Windsor, 2013a; Young et al., 2016). However, due to the absence of effective biosecurity and the necessary emergency disease management and control measures, including the routine culling of infected animals and restrictions on the movement of animals and animal products, vaccination is becoming increasingly appropriate to assist in the control of FMD. However, the vaccination coverage of the national large ruminant population against FMD in the nationwide epidemic in 2010 was estimated at 2.7%, compared with 43.8% for HS (Young et al., 2013a). The low adoption of FMD vaccination has continued with only 170,000 (5.3%) and 267,000 (8.3%) doses of FMD vaccine were imported (GDAHP and Private sectors) and used in 2019 and 2020 (cattle and buffalo population is 3,225,147 heads) compared to 2,015,000 (64.5%) and 1,790,000 (55.5%) doses of HS vaccine, respectively (H. Ponnaka, personal communication, November 18, 2020). It is readily apparent that preventive strategies for FMD control are mainly absent in Cambodia, and even in areas where vaccination has been applied, it has been insufficient to prevent ongoing FMD outbreaks (Sieng & Kerr, 2013) .
There is currently no evidence that VAHWs have been privately providing FMD vaccination services to their own and farmers’ animals within the communities. This objective of this study was to further assess the knowledge, attitudes, and practices (KAP) including the involvement of VAHWs in the provision of animal health services and FMD in particular, including the identification of potential opportunities for more engagement of VAHWs in provision of private vaccination services in their communities. This information may provide insights that could advise and assist animal health policy-makers in improving national livestock disease control programs in the country and TAD in the wider SEA region.