The 3 V Vets / The SOS Initiative

It was the SOS Initiative that led to the inception of IKARE in 2006. In IKARE’s early days all resources were fully dedicated to the SOS (Stamp Out Sleeping Sickness) initiative, launched in Kampala, Uganda in October 2006.

IK was alerted to the threat of two strains of human sleeping sickness converging in Northern Uganda through its then IK 2000 Fund portfolio company, Ceva Santé Animale, a global veterinary health company. Uganda is the only sub-Saharan country to, in addition to the animal form (Nagana) of the disease, also be affected by both human forms of the Human African Trypanosomiasis (HAT), as sleeping sickness is also called. This is a lethal parasitic disease, spread by the tsetse fly, and there is no vaccine or preventive medication available. At the time (2006), this zoonotic disease still killed more than 100 people every day in Africa, affecting mostly poor and rural populations.

In 2005, a World Health Organization (WHO) initiated conference in Addis Ababa warned of the geographic convergence in Northern Uganda of the two types of human endemic HAT (Tb.rhodesiense and Tb.gambiense) and called for an emergency intervention. In a previously war-torn area with very limited health services, it would have been next to impossible to correctly diagnose and treat people affected by one or other of the disease strains. In addition to the direct threat to themselves and their animals, communities affected by the disease often need to sell off livestock to pay for medical and treatment expenses, which sets them back financially.


PHASE 1 – IKARE AND THE SOS PUBLIC PRIVATE PARTNERSHIP (2006)

To respond to the call for an emergency intervention, a public private partnership (PPP) was formed during the late summer of 2006, under the name of Stamp Out Sleeping Sickness (SOS) Initiative with IK/IKARE as one of the partners. The others were: 

  • Ugandan government represented by UTCC/COCTU 
  • Makerere University, Veterinary College, Uganda
  • University of Edinburgh, The Royal (Dick) School of Veterinary Studies, UK
  • Ceva Santé Animale, France

The two main objectives of the intervention, as set out in the PPP Agreement, were the following:

  1. To prevent the northward spread of the rhodesiense strain of the disease and prevent the two forms of the disease (rhodesiense and gambiense) from geographically converging. This prevention and subsequent control were to happen through administering mass treatment to an estimated 220,000 cattle (targeting 85% of the estimated cattle stock) in five districts in the north, and, in addition, protecting these cattle from reinfection by spraying them with an insecticide, using the RAP (Restricted Application Protocol) – chosen for its affordability and efficiency, as previously researched and verified through field trials, but never administered and tested on a larger scale;
  2. To build awareness of sleeping sickness, its causes and its control mechanisms among the cattle farmers and within their rural communities.

As agreed in the PPP Agreement, final-year veterinary students from Makerere University, supervised by their teachers, would undertake the mass treatment and spraying of cattle (with drugs and insecticide provided pro bono by Ceva). While interacting with the District Veterinary Officers (DVOs) and farmers, they were to, in parallel, sensitise the local communities on sleeping sickness and the importance of regularly continuing to spray their cattle. Sampling of cattle before and after treatment, to track the prevalence of parasites in cattle blood, would be undertaken by PhD students from the University of Edinburgh's veterinary college. The necessary funding, which IK/IKARE committed to, for keeping veterinary students and researchers in the field and analysing samples, was estimated at US$190,000. The RAP was chosen because previous research had shown that spraying cattle on the legs and belly would suffice, as tsetse would typically bite there for their blood meal, and it would be affordable for farmers going forward.

When alerted to the situation, IK approached the case like an investment case, even while only looking for sustainable impact, not a financial return. We did due diligence (light), we talked to relevant stakeholders and we discussed how we could best try to ensure sustainability beyond the emergency intervention. IKARE was founded as a conduit for channelling the IK support.

Initially, IKARE, working closely together with Ceva and the two universities and COCTU (Coordinating Office for Control of Trypanosomiasis in Uganda), funded the emergency treatment and insecticide spraying for close to 250,000 cattle in five districts in Northern Uganda undertaken by the Makerere Veterinary College graduating students and the taking of blood samples in the field to monitor the prevalence of trypanosomiasis/parasites. The Veterinary College saw this as a great opportunity to provide its final year graduating students with in-field training.

In a next step, a few years later, an additional 200,000 plus cattle were treated and sprayed in two adjacent districts with funding from the Department for International Development (DFID)/University of Edinburgh. This was undertaken in parallel with the rollout of the second cohort of 3V Vets.

 

PHASE 2 – IKARE AND THE 3V VETS INITIATIVE (2009)

In 2009, when blood sampling indicated that the numbers of rhodesiense parasites in cattle were increasing again and human cases did not continue to reduce in the SOS area, IKARE decided to instead focus its engagement on building a sustainable delivery network for veterinary products and services. Following a fact-finding mission, IKARE came to realise that such a supporting infrastructure was in all essence lacking in these Northern districts. Farmers need to be made aware of the importance of regularly spraying their cattle to keep them free from tick and tsetse-borne diseases, with an insecticide effective on both – thus also protecting their families and communities against sleeping sickness. And once the awareness is there, the farmers need to have regular access to quality veterinary products and services without having to travel for hundreds of kilometres to secure them. 

This basic animal health infrastructure was achieved by providing start-up financing and mentoring support to a number of the young graduate veterinarians, enabling them to set up their own practices in the five SOS districts, complementing the work of the DVOs typically residing in the major towns. Each community-based 3V vet in addition built a network of partners stretching further into each district. This network in turn provided work for more than 200 self-employed spray people regularly offering their services to farmers on a commercial basis.

3V Vets Franchise
Of the 11 young graduate veterinarians who were in 2009 and 2011 provided with the start-up financing package (grants and soft loans), after 18–24 months five were operating financially sustainable businesses. In 2014, three of these vets came together to form a joint purchasing company, 3V Vets Franchise, which today procures products on a commercial basis from a number of importers/suppliers.

The Franchise today provides purchasing, logistics and advisory services to five 3V Vets shops and the spray persons attached to these, as well as to a few independent shops set up in the area over recent years. The 3V Vets shops provide a wide range of products and services which farmers require for their livestock, like deworming products, antibiotics and vaccines. The insecticide sprays and nagana treatment products for cattle (bought from different suppliers) are only a small part of sales and could on their own never carry a sustainable business. Occasionally, the 3V Vets are also contracted by the government to undertake public good spraying exercises, etc, now that the infrastructure is there.

Impact and results
While statistics on human cases in the area are somewhat unreliable, the trend (both as seen in the numbers reported by WHO and as compiled from records kept by the two clinics catering for patients affected by the disease in the SOS area) is very positive. From around 257 reported cases in the SOS area during 2005, i.e. before the launch of SOS Uganda, in 2018 and 2019 respectively, only three cases were reported, with a steady reduction seen since 3V Vets started operations in 2009/10.

The successes of the PPP and emergency intervention were noted at the first WHO stakeholders meeting on rhodesiense human African trypanosomiasis held in Geneva in October 2014 at which IKARE participated. The meeting also discussed exploring with Social Finance and DFID, UK the feasibilities of raising the first-ever DIB (Development Impact Bond) to further the control of sleeping sickness. This never came about. But, thanks to the joint efforts of COCTU and the 3V Vets network, and as also noted by WHO in 2017 in connection with the UTTC’s (Ugandan Trypanosomiasis Control Council) 25th jubilee celebrations conference in Jinja, human sleeping sickness is on its steady way to elimination in Uganda.

“We wanted to leave something sustainable behind, not just fly in and then fly out again. Asking ourselves why farmers were not spraying their animals on a regular basis in spite of the mass-interventions having been successful, we found a number of gaps. And we addressed them, one by one. With community-based vets that run sustainable businesses, today farmers in the SOS area have access to the knowledge and tools necessary to keep their live-stock healthy and free of disease.”
Anne Holm Rannaleet, Executive Director, IKARE Ltd