Perspectives for future research
The objective of all research about mobile pastoralists should be improvement of their condition and health status (Obrist et al. 2007, 2010; Zinsstag et al. 2011). That is why it is crucial that research is geared to the needs of the pastoralists and their sustainable development. Research can play an important role in accompanying and evaluating implementations to detect and solve problems and difficulties as fast as possible and in assessing the effectiveness of interventions.
Information about the health and the demography of mobile pastoralists is essential to plan, implement and monitor interventions (Weibel et al. 2008). However, long-term studies are difficult to conduct in mobile pastoralist settings because the composition of the camps is highly dynamic and it is almost impossible to follow up the same persons over time (Schelling et al. 2003; Weibel et al. 2011). This is why the installation of a demographic surveillance system is very desirable. First attempts using biometric data like digital fingerprints proved to be impractical (Weibel 2009; Weibel et al. 2011). New trials with mobile phones are being carried out, and the first results show their effectiveness as tool for demographic and health surveillance (Jean-Richard 2013). Mobile phones have great potential for the follow up of transhumance routes, the surveillance of human and animal diseases, telemedicine, emergency evacuation and long-term follow-ups of treatments like an adaption of the WHO strategy against tuberculosis for pastoral settings. In this way, a vast field of action including communication, surveillance and interventions has opened up and should lead to new solutions for a better handling of patients in remote pastoral settings.
The approach of North–South research partnership has proved to be fruitful because it facilitates the conception and running of research projects. This cooperation should therefore be extended, not only between partners of the North and the South, but also to foster South–South cooperation. To prevent failures, it is important to minimise the power imbalance. Especially when funds are provided by the North, it is critical that all partners be included in planning the research and interventions and follow the deontology of research partnerships (www.kfpe.ch/11-Principles/). The more funding is acquired by all partners, the better all partners engage with joint projects and perceive their ownership. This approach enhances ownership and takes better account of the priorities of all partners.
Perspectives for future development
Aiming at sustainable development, a participatory and transdisciplinary approach bringing together scientists, authorities and pastoralist community representatives is essential so that different parties can discuss their expectations and express their priorities. By including mobile pastoralists in the process of planning and implementation of interventions, they gain ownership and assume their responsibilities more easily.
Based on the results of the research and the participatory stakeholder workshops, an intersectoral policy to support mobile pastoralist communities was elaborated in Chad, conceived for a length of 10 years. It was prepared under the patronage of the Ministry for Economy and Planning and should simultaneously improve health, education and access to natural resources of mobile pastoralists. However, so far this policy has not been implemented, as rapidly changing ministers and the inherent organisational structure of governments favour single-sector policies. In March 2013, the Ministry of Health of Chad announced the creation of a directorate of pastoralist health and there is increasingly tangible self-organisation among pastoralist communities.
Similar long-term research and support programmes are certainly desirable. Even if these programmes can be conceived and elaborated with the help of NGOs or international organisations, in the end, it is the state that has to assume its responsibility to implement large-scale programmes. Only in this way could the situation of the mobile pastoralists be improved in a sustainable way. Ultimately, political will and financial and administrative power are indispensable, which emerge slowly at the example of the planned directorate for the health of mobile pastoralists in Chad. In Sahelian countries, where the state is often unable to provide social services to the settled population, it is particularly difficult to initiate development programmes for nomads. Even if these intersectoral programmes are the most sustainable choice, their initiation is long and their implementation complicated. As the experience in Chad has shown, the realisation of such a programme can be delayed for a very long time. Ideas about a more specific programme focused on health are currently being discussed, which might be easier to implement and would have better chances to be realised although the results would be less comprehensive than the intersectoral approach. In the case of Chad, multi-sector approaches are, however, increasingly being considered. They were recommended at the national development forum in January 2012 and during the Transhumance Festival in November 2012 in Ouadi Djedid. The Chadian government is currently considering the establishment of water points, health centres, schools, animal health centres, food stocks and the creation of markets at several sites in the country.
Medium-term interventions could be envisaged, implemented at least initially in close collaboration with organisations of development cooperation. These approaches include information, education and communication campaigns to inform mobile pastoralists about the existence, symptoms and transmission of diseases in humans and animals. In this way, risk factors and therefore the transmission of diseases could be reduced. Furthermore, sensitisation campaigns initiated by the health centres could contribute to improving their acceptance with the mobile pastoralists so that they seek treatment earlier and more easily in case of serious sickness. These interventions need to be based on the support and participation of the pastoral communities and authorities to target access and the intrinsic capacity of communities to face threats to their health and well-being. Searching for better access to health services for mobile pastoralists remains a challenge.
In addition, the education of community healthcare workers like nurses, midwives and animal health extension workers would be very helpful. They would reach remote communities, be mobile and would either accompany the pastoralist groups or be called when needed. They could treat daily health issues and contribute to prevention with the help of modern communication technologies. All this has become much easier with the new technologies of mobile communication. Mobile schools or other forms of basic education are also essential to improve individual capacities of mobile pastoralists and to consolidate their position in society.
It would also be of great benefit to try to institutionalise the dialogue between settled farmers and mobile pastoralists. These two groups often compete for the same rare resources – land and water – leading to conflicts. Regular mutual exchanges could help a more peaceful living together.
Due to the close contact between the pastoralists and their livestock, the health of humans and animals cannot be considered separately because the well-being of both is closely entwined. That is why the approach of ‘one health’ in interventions is highly beneficial to both human and animal health. Based on the experience gained from research and interventions during the past years, the advantages and synergies of such an approach have become evident. This knowledge can be transferred and used in other populations which live in close contact with animals. Beyond the better cooperation of human and animal health, environmental and ecological considerations should also be taken into. We therefore increasingly use the approach of ecohealth (www.ecohealth.net), which accounts for the provision of health services within a sustainable socio-ecological system.