Document review.

Throughout the preparation and implementation of the fieldwork, the UF-based team conducted a document review of peer-reviewed literature, institutional reports, and project reports. Relevant documents were identified through internet searches as well as by reference from experts and informants during the fieldwork.

Key informant interviews.

Fieldwork was initiated with semi-structured interviews of purposively selected experts from the public and private sector, government, and international donors. Key informants were interviewed in one-on-one meetings by a member of the field team to identify the main actors, entry points, and distribution sites for livestock vaccines, as well as to improve understanding of the vaccine value chain and vaccination practices. Some of these interviews occurred in Dakar, where actors at national level provided an overall view of the vaccine distribution systems in Senegal. The in-country coordinator was critical to making email and phone introductions and connections to the initial key informants; a snowball sampling technique then included other actors in the VVC who were subsequently interviewed. Overall, the team conducted a total of 23 KIIs.

Individual interviews.

Individual interviews (n = 30) were conducted with actors at the community level throughout the region of Kaffrine, including animal health workers and livestock keepers. These interviews aimed to capture their roles at the community level and their decision-making power related to the use of vaccines. Socio-demographic data on participants was collected to capture barriers and intersectionality at the lower nodes in the vaccine value chains.

Focus group discussions.

To engage further the perspectives and experiences at the community level, focus group discussions (FGD; n = 31) were conducted with separate groups of men and women. Facilitators used open-ended questions about livestock keeping, livestock diseases, access to vaccines, and acceptance of vaccines to understand various aspects of VVCs. One member of the research team facilitated the discussion, while at least one additional member took notes to document this discussion. The information collected throughout these discussions contributed to a better understanding about the different roles and responsibilities of men and women in the respective VVC, as well as the identification of the elements of intersectionality (gender, ethnicity, livelihood, socio-economic class, etc.) that most affected participation in the VVC. During notetaking, attention was given to the interactions between the participants in relation to livestock vaccination practices at the community level.

Public distribution system: Value chains for PPR/H and I2.

There are many similarities between the VVCs for PPR/H and I2. Both vaccines are produced by the National Livestock and Veterinary Research Laboratory (Laboratoire National d’Elevage et de Recherches Vétérinaires, LNERV), which is part of the Senegalese Institute for Agricultural Research (Institut Sénégalais de Recherches Agricoles, ISRA), the national agricultural research organization (see National vaccine producer/ISRA in Fig 2). LNERV/ISRA is the only vaccine producer in the country. Before the start of the vaccination campaign, MEPA places an order with LNERV/ISRA for the estimated required number of vaccine doses. Vaccines are then transported down through the public veterinary system, which is embedded within a broader livestock and animal production system, as follows:

1. The Regional Service of Livestock & Animal Production is charged, among other functions, with enforcing and overseeing all veterinary functions on behalf of the state. For the purposes of this analysis, the collection of veterinary functions out of this office will be referred to as Regional Veterinary Services.
2. The Departmental Service of Livestock & Animal Production, serve the four departments located in the region of Kaffrine, those being the departments of Kaffrine, Birkelane, Malem Hodar, and Koungheul. One of their key functions is to assess the number of animals by species in their territory and provide an estimate of the number of vaccines needed. This information is relayed to the Regional services, so that an order can be placed with the Directorate of Veterinary Services within MEPA ahead of the vaccination campaign. Similar to the regional level, for the purposes of this analysis, the collection of veterinary functions out of this office will be referred to as Departmental Veterinary Services.
3. Veterinary Posts represent the public veterinary system at the level of communes (municipalities correspondents to small towns or regrouping several rural villages). The Heads of these posts are trained as ’livestock technical agents’, having graduated from the National Training Center for Livestock and Animal Industry Technicians (Centre National de Formation des Techniciens de l’Elevage et des Industries Animales, CNFTEIA), situated in Saint-Louis. Among other functions, they execute the vaccination campaigns and provide recommendations to livestock keepers. The number of Veterinary Posts in each department varies. According to our informants, there are four Heads of posts each in the departments of Birkelane and Malem Hodar, 6 in Kaffrine, and 8 in Koungheul, for a total of 22 in the region. At the moment of writing, there is one additional post unfilled in Kaffrine.
4. In addition to c) above, in some areas, MEPA has issued a health authorization or permit (in French, mandat sanitaire) to private veterinarians. As established by a 1995 law, this permit gives them legal priority to administer vaccines on behalf of the state during the official vaccination campaign. These veterinarians with the government authorization/permit are paid, for each dose of vaccine administered, a small vaccination fee from the livestock keepers and are additionally compensated by the state. The vaccine is still provided by the government.

At the bottom of the VVC there is a diverse set of community animal health workers or agents, referred to locally with various French terms such as auxiliaires and relais–henceforth referred to solely as relais. These individuals have often received short training through a veterinary expert, an NGO, or a development project, and are equipped to perform several animal health-related services, including the administration of some vaccines. Relais are not public employees but are self-employed individuals, who get paid for the services they provide directly by the livestock keepers and, sometimes, by private veterinarians, if performing a service on their behalf.

One main difference to note stems from a Senegal law, which precludes individuals without at least the qualification of livestock technical agent from administering live vaccines, such as PPR/H. As a result, community level animal workers (the relais) are allowed to administer vaccines to poultry animals but not to small ruminants, creating in practice a gap between the VVCs for PPR (PPR/H) and ND (I2 or ITA-new).

Private distribution system: Value chain for ITA-new.

The ITA-new vaccine against ND is produced by a foreign laboratory (LAPROVET) and imported by large private companies in Senegal, which specialize in the import of livestock products and act as wholesalers. While in the hands of private actors, vaccine imports are still subject to regulation by the state and require MEPA’s authorization. Imported vaccines are distributed through the private system, with importers/wholesalers selling to private veterinarians, each of whom has their pharmacies and sale points, serving the public directly or through the same relais that work in the public distribution system with technical livestock agents (see Fig 2).

Higher-level nodes of the VVCs in Kaffrine.

The highest node of the VVCs is at the central level in Dakar, where decisions about which vaccine to produce or to import, and in which quantities, are made every yearInformation about constraints to (women’s) engagement in the VVC at this level was derived largely from interviews with key informants (ISRA, the Ministry of Livestock, importers, and private sector companies). Possibly due to the limited presence of women at higher level (four of our five key informants were men), gender factors were not explicitly mentioned. Instead, it appears that relevant issues that preoccupy actors at this level were of technical and/or logistical nature. The main constraint emphasized by livestock personnel at the upper nodes of the VVCs is the disruption in vaccine procurement, which, in the case of the I2 vaccine, is related to limited access to Specific Pathogen Free eggs, which are an essential inputAnother constraint to increased production (applicable in the case of PPR/H) is posed by the requirement of freeze dryers. Bottlenecks and interruptions in the production of the vaccine were blamed for delays in vaccine orders, transport, and distribution further down the system. Key informants pointed out that any interruption in the production and/or administration of vaccines is doubly deleterious, since it potentially reduce vaccine effectiveness and thus fosters skepticism about the benefits of vaccination among livestock keepers.

Middle nodes of the VVCs.

The middle nodes of the VVCs include the regional and departmental levels. These are key nodes where the vaccines are supposed to be stored safely and made promptly available during the vaccination campaigns. The interviews with veterinarians in the public and private distributions systems and the livestock technical agents pointed to two sets of constraints at this level–pertaining respectively to logistical bottlenecks and lack of women’s representation.

Too wide catchment areas and lack of cold chain. The geographical dispersion of the population, the size of the catchment areas and the limited number of posts equipped with suitable refrigeration systems are identified as key challenges to the effective and inclusive distribution of vaccines. Veterinary posts have only coolers to preserve the cold chain and there are only 22 of them in the whole Kaffrine region. The Heads of two Veterinary Posts, in Gnibi and Boulel, for instance, are supposed to cover, respectively, 21 and 42 villages. Not surprisingly, the heads of Veterinary Posts we interviewed repeatedly complained about the excessive demands of their jobs, and the lack of the necessary resources–motorbikes and relais–to serve the population efficiently and effectively.

Overall lack of female representation. Apart from the Head of Regional Veterinary Services being a woman at the moment of writing, there are not many other women veterinarians or technical agents involved in the veterinary services. Out of 22 technical livestock agents in the Kaffrine region, only four are women. This is attributed to both the limited upward mobility Senegalese women face, as well as the restrictive gender norms. The power of social norms is demonstrated in the explanation given by one of the female relais informants. In describing why women do not serve in higher-level positions, she said, “Women are generally found at the consumer level [of vaccines] … It will be difficult for beneficiary women to move to other nodes along the livestock vaccine value chain, because this would require intellectual capacities that they do not have” (Interview, female relais).

Lower nodes of the VVCs in Kaffrine: Animal health providers.

At the community level, we collected data from both animal health providers (relais) and from livestock keepers themselves. Both play important roles and reflect different intersectional experiences, so we have divided findings from the lower nodes into these two groups. Community relais have an important role in that they connect the livestock keepers to veterinarians or Heads of Veterinary Posts. The relais may be men or women, and though some serve as community relais for particular livestock diseases, such as a PPR or ND relais, many serve more generically as community relais, thus are utilized by both the public and private vaccine distribution systems, as well as by livestock development projects. Themes that emerged from GITA analysis of this relais are presented below.

Women have less access to training and education. Some projects include women in training programs, some offering opportunities for them to become relais, others simply offering gender in agriculture training. By and large, trainings are highly valued by community members, men and women. However, women’s limited education constrains the degree to which they succeed in leveraging such opportunities. Adult literacy rates in Senegal are 40% for women and 65% for men (according to UNESCO data from 2017). Limited literacy and numeracy reduce women’s ability to systematically document their activities, productivity, and impact–endeavors that are advantageous if not essential for relais. Since trainings are found to be transformative by participants of either sex, the failure to successfully recruit women as vaccinators or relais has the potential to further marginalize women in this system. In one focus group, participants indicated that “no matter who you are, if you go through a training, you will come out a different person”. Some female relais report that the opportunity of attending seminars and trainings has changed the way they communicate with their husbands, improving their ability to garner support from them. Unfortunately, since projects reportedly target areas that are closer to the road and to fuel sources, communities that are geographically isolated hardly benefit from these opportunities and remain further marginalized. Women in isolated rural communities tend to be even more penalized in terms of training opportunities, given they face additional, gender-specific mobility constraints when compared to men. In addition to training, a general lack of knowledge about the importance of livestock vaccination was also cited, especially by animal health service providers, as an important barrier that limits some livestock keepers from benefitting from improved animal health. To the extent that rural women in Kaffrine tend to have lower access to formal and informal education, as well as other informal sources information, this problem is likely to affect women more than men.

Gender norms limit women’s success as a relais. Gender norms can significantly limit women’s ability to succeed as a relais. For example, access and use of a motorbike, which greatly facilitates the effectiveness and efficiency of a relais in doing his/her job, is culturally and economically limited for women to a greater extent than men. Even if a woman had access to a motorbike, it is reported that she would most likely need to find someone to accompany her. Of two relais located in the same commune (Gnibi), the man responded he uses a cooler and motorbike to cover 21 villages, while the woman stated that she mainly serves the households in town. Others noted that women have significant constraints on their time, and that maternity leave and marriage presented real barriers for female relais in completing their work. Relais are not provided supplies necessary to preserve a cold chain, so when their work requires it, they must access their own cooler and ice. Some trainings have supplied coolers to relais, but they still must purchase ice. For women, this requires economic independence or reliance on and support of their male partners. Gender norms also paint a picture of women as having less courage and physical strength than men–with some participants questioning whether women can wrangle and manage small ruminants. While some women and some men indicated that women can do whatever men can do, most agreed that, nonetheless, it is not culturally sanctioned for female relais to do much of what male relais do.

Lower barriers to the ND VVC foster greater motivation among women than men. Men and women’s engagement as relais also differ by value chain; most relais involved in PPR are men, whereas most relais for ND are women. This is, in part, based on cultural beliefs and norms, which limit women’s ability to fully engage in the management of small ruminant care. Furthermore, poultry is widely regarded as a woman’s space, except in the case of large commercial poultry operations where men are predominant. Thus, women also report significantly greater motivation than men to serve as relais in the ND VVC, due to the benefits they derive as poultry producers. Some actors indicate that women relais are more likely to stay in their position and are more reliable than men. Participants also indicate that despite a lack of monthly salary, the potential to earn small amounts of income and improve the health of their poultry motivates women to serve as poultry animal health workers. Conversely, men tend to minimize the work associated with such low-earning positions, emphasizing the lack of incentives. Importantly, even though participants indicate that women have fewer constraints in serving as ND relais and more motivation, constraints still exist: demands on women’s time for household responsibilities are significant in the early morning and late evening, which are also the times that are best/easiest to vaccinate poultry.

Lower nodes of the VVCs in Kaffrine: Livestock holders.

During KIIs and especially FGDs, livestock keepers shared their different experiences and perceptions about men’s and women’s roles in Senegalese society, how vaccines are used, by whom, and what barriers exist across the region. The application of GITA analysis yielded the following themes.

Men have greater power over vaccination use, but women want acknowledgment. Most men keep cattle, horses/donkeys, and small ruminants (mostly sheep), while women keep poultry and small ruminants. Men and women did not agree on how responsibilities for large and small ruminants vary by gender. Men claim to have main responsibilities for ruminants for instance, while women claimed they are the ones who mostly take care of small and sometimes large ruminants, on a daily basis–even if they formally belong to the husbands. Women see themselves as suitable livestock keepers–in some communities claiming to know better than men how many animals a household has, what diseases affect which animals, and what the animals eat. Women’s ability to manage small and large-stock is limited, however, by their inability to travel at night to seek veterinary assistance, locate animals that did not come home at night, etc. Some men described women as unable to secure transport (a cart) to go to the vet, needing a man in order to do so; others disagreed. Women find it easy to keep poultry, which is compatible with their normal household work and, when things go well, can be quite lucrative. Men tended to agree with that and demonstrated little to no interest in poultry, for reasons already mentioned–small poultry is associated with women’s space–but also because mortality is perceived to be high and not worth their effort.

Knowledge of vaccination is uneven, especially among uneducated women. Knowledge of livestock diseases is mixed, with some respondents reporting feeling hopeless in the face of livestock diseases that they do not recognize or are unable to treat. While most men and women don’t know the exact names of diseases, symptoms are known and well-described. Barriers to animal health identified among men and women were similar; these included not only poor access to veterinary services, but additional barriers such as lack of feed, lack of pasture (grazing land) and water, and lack of enclosed spaces to keep animals safe. Confusion about vaccination exists, underscored by a common inability to distinguish between injections for treatment and those for prevention. Anecdotes about part of the herd dying after vaccination are often repeated, fostering confusion, especially in communities who have had no direct training. Some farmers prefer to seek services from a traditional animal health practitioner or healer, stating that traditional veterinary medicine is just as effective as western medicine. Women, in particular, shared a lack of understanding about how the system can serve them and, specifically, about how vaccines work. Women who know how to vaccinate chickens are those who have received training, a skill many focus group participants demanded.

Confidence in the vaccine distribution system is lacking, especially among some groups. The first line of access for the health care of small ruminants is almost always the technical livestock agent or a private veterinarian rather than a relais. In some areas the assigned veterinarian is well-known and respected, while in others, people lament their tardiness and delays, including in vaccine administration. If the veterinarian is not available when an animal is sick, men report that they may seek help from the community relais. In some cases, men and women have confidence in the relais, but in others, for small ruminants, and especially among men where the relais is a woman, they lack confidence that the relais can help them. Especially in underserved locations, it is not uncommon to consult traditional healers also for animals.

Remoteness of communities/households is a key barrier and intersects with poverty. Geographical distance from veterinary services was identified as a key factor preventing communities from accessing veterinary services, especially in the rainy season when roads are washed out. Among keepers of small ruminants, the distance to vaccination locations (often referred at ‘vaccination parks’) and the associated costs of transporting animals are a key constraint. Poverty among livestock keepers exacerbates geographical distance and represents an added barrier for many families. The lack of willingness and/or ability of relais to serve them exacerbates their disadvantage. Remote households without young family members who can travel with animals to vaccination parks or veterinary posts are among the most vulnerable.

The vaccination system often fails transhumant households. Vaccination campaigns occur prior to the start of annual migration of livestock, primarily cattle and mall ruminants, to grazing areas (transhumance), which typically occurs at the beginning of the rainy season. However, vaccination delays are common, as noted earlier, because of overall procurement and distribution issues. This has real consequences for mobile pastoral communities, whose animals are difficult to reach once herds start moving north. Attitudes among sedentary populations about transhumant livestock practices were mixed. In some settled communities (largely Wolof), Fulani herders were blamed for spreading diseases through shared water points. Community members indicated that herders did not vaccinate their livestock, and that when confronted to present vaccination cards, the Fulani failed to do so. In contrast, another settled community described Fulani herders as exemplars–receiving informal training on vaccination, having an exceptional relationship with the technical livestock agent, and regularly administering the vaccines.