Description of the condition
Despite significant international efforts, health gaps between the rich and the poor continue to widen around the world, with the largest gaps occurring in the poorest countries (WHO 2005). These results are not surprising given that many indicators of health are strongly linked to poverty, including life expectancy, childhood mortality, maternal health, communicable diseases and mental health (WHO 2005; Lopez 2006; Prince 2007; UN 2007; UN 2012). Poverty also negatively impacts health outcomes through broader determinants of health, such as malnutrition, literacy and environmental conditions, prompting many to approach health and well-being using a framework that incorporates multiple dimensions of poverty. The Sustainable Livelihood Framework expands on the traditional definition of poverty from a simple measure of consumption or income to a more holistic approach which considers five basic types of capital: natural, human, financial, physical and social (DFID 1999; World Bank 2001). Such an approach defines good health not simply as the absence of disease, but as a measure of human well-being, and more closely represents how the poor perceive poverty (Narayan 2000; World Bank 2001). Poverty reduction strategies focused on the most disadvantaged populations have the potential to impact health positively through multiple pathways by supporting and improving livelihoods through multiple dimensions.
Description of the intervention
It has been estimated that globally, two-thirds of poor rural households keep livestock (LID 1999). The poor may employ different livelihood strategies in regard to livestock keeping, using them simply as a means of savings and protection from inflation, for subsistence and as a buffer against household shocks, or for the accumulation of assets (Kitalyi 2005). Given these potential roles and strategies, Morton 2000 has suggested classifying livestock as natural, financial and/or social capital under the Sustainable Livelihood Framework.
Non-governmental organizations (NGOs) and government agencies in high-income countries have invested significantly in livestock development programs as a means to alleviate poverty. The complex relationships between livestock keeping and the poor provide a multitude of entry points for livestock based interventions, which is reflected in the structural variability of livestock programs. The most widely recognized type of livestock intervention is the rotational lending scheme, in which the initial investment for livestock purchase is made by the donor, and the recipient is expected to repay this loan by passing on offspring from the livestock to other community members. This type of program allows the poor to overcome a lack of financial capital and/or credit acquisition for initial livestock purchase (Heffernan 2005). Other programs have promoted increased animal production as a means to improve beneficiary nutritional status (Leroy 2007). In Kenya, the Ministry of Agriculture implemented the National Dairy Development Program to increase local dairy production by smallholder farmers in order to meet local demands. The program supported increased dairy production through a zero-grazing based program with crossbred cows and cultivated fodder. In the Kilifi District of the Coast Province, this program was shown to increase household income, food purchases, school fee payments and book purchases; beneficiary households also reported increased intake of animal protein through increased household milk consumption (Mullins 1996). Alternatively, a program may focus on improving livestock health directly, leading to improved programmatic and beneficiary outcomes. Livestock kept by the poor are vulnerable to disease and poor health due to increased exposure to infectious disease agents, suboptimal management, and lack of access to animal health services (Perry 2005). Frequently, the poor have relatively few animals, and therefore the loss of an individual animal has greater significance compared to farmers with fewer resource limitations. Kneuppel 2010 studied the effects of a Newcastle disease vaccination program for chickens on household food intake and food insecurity in rural Tanzania. Newcastle disease is a viral disease which can cause up to 100% mortality in unvaccinated chicken flocks (Sonaiya 2004), but can be mitigated with an economical and easily administered vaccine (Foster 1999). The study found that households that participated in the vaccination program had increased ownership of chickens and increased household egg consumption compared to control households not participating in the program.
How the intervention might work
Livestock play pivotal roles in the livelihoods of the poor, not only by producing food, but by generating income, increasing crop productivity through manure production and draught power, acting as living savings accounts, and enhancing social status (Randolph 2007). The Sustainable Livelihoods Framework provides a way to describe different household assets and what roles those assets play in risk mitigation and strategy development, leading to improved livelihoods (Figure 1; Carney 1998). The Framework also provides a theoretical basis to explore the ways in which livestock may contribute to different assets and/or livelihood strategies (Randolph 2007).
The five types of household assets are indicated within the dotted box in Figure 1: human, financial, physical, natural and social. Households face a wide range of risks (vulnerabilities) which can impact household assets and livelihoods. Depending on available household assets and outside influences (government agencies, social context, policies, etc.) households create livelihood strategies to mitigate risk and vulnerability. If successful, the outcomes of these strategies reinforce and improve the household asset base. Within this theoretical framework, livestock programs can improve livelihoods by positively impacting each type of household asset (Figure 1; solid boxes with dashed arrows leading to household asset category).
While the true interrelationships between livestock interventions and household activities are likely best represented by a web of feedback loops with positive and negative impacts (Randolph 2007), a simplified analytic framework representing the proposed theoretical underpinnings of livestock interventions in low- and middle-income countries was adapted to guide this review (Figure 2; Carney 1998, Randolph 2007). Livestock interventions have a variety of immediate outcomes related to household physical, financial, natural and social assets, such as the acquisition of assets, improved financial status through income or non-cash proxies and improved soil fertility through the use of manure. These immediate or proximate outcomes are linked to directly measurable health outcomes through a causal pathway that includes intermediate outcomes which correlate to livelihood indicators and household assets. Understanding these pathways is key to understanding how livestock interventions truly impact individuals and communities, and to the development of improved, evidence-based initiatives in the future.
Why it is important to do this review
Livestock development programs have a long history as a means of poverty alleviation for the poor globally; however, the relationships between livestock keeping and a family’s livelihood strategies are very complex, with both positive and negative impacts on outcome measures for household assets. Evaluating the effects of such interventions is difficult and requires a carefully designed study intervention as well as local, contextual knowledge of the livestock/human/poverty interface for the targeted population (Randolph 2007). Additionally, the long history of international livestock programs provides an opportunity to review and assess the costs associated with program design, implementation and evaluation. To date, no systematic review of livestock interventions and the resulting impact(s) on health or well-being (or both) has been conducted. Such a review will improve the understanding of the complex relationships illustrated above, and lead to a theoretical framework for best practices, including cost-benefit analyses, that could be applied and adapted to a multitude of settings. The promise of improving the livelihoods of vulnerable populations and the continued investment in livestock programs by government and development organizations justifies the need to more fully understand and evaluate such interventions.