Geovet: access to drugstores and veterinary services in East Africa

Our project leverages high-resolution geospatial data from the farming community in Kenya to investigate how proximity to veterinary drugstores and veterinary service providers influences farm-level antimicrobial use and resistance. The project will generate recommendations for improving the management and regulation of drug stores, while also enhancing farmers' accessibility to services.

Dishon M Muloi

The focus of our project is the unregulated access to veterinary antibiotics in Kenya, which is exacerbated by the country’s rapid agricultural expansion. Despite existing regulations that restrict sales of antibiotics by prescription only, our past investigations have shown widespread over-the counter sales of antibiotics. While not unique to Kenya, it reflects a broader regional problem balancing rapid livestock intensification with poor veterinary services and resource constraints. In Kenya, the unregulated sale of antibiotics in veterinary drugstores—often staffed by unqualified personnel and motivated by profit—contributes to harmful use of antibiotics.  Our solution targets the root causes of this challenge: the insufficient access to qualified veterinary services, and the potential excessive presence of veterinary drugstores. While global statistics highlight the severity of AMR impact in human and animal health, our project specifically addresses the local context within Kenyan communities and aim to be extrapolate findings across East Africa. Our interventions seek to improve the regulation of drugstores, enhance access to qualified veterinary services by farmers, and ultimately, protect animal health and safeguarding the livelihoods of famers.

The ultimate beneficiaries of our project will be the small-holder, semi-intensive farmers, aiming to enhance their access to veterinary care and advice, which in turn, will improve their livelihoods through healthier livestock. As intermediate to facilitate this process, our target audience will be animal health authorities across East Africa, as well as international organisations to further provide support to local authorities.  Specifically, the data generated from this study will also be valuable to Kenya’s national veterinary medicines regulator, the Veterinary Medicines Directorate, in their efforts to improve service provision and policy implementation related to drug store registration and pharmacovigilance.

Concretely, to understand and meet the farmers' needs, we will employ a two-pronged engagement approach. Firstly, we will conduct epidemiological surveys, incorporating interviews and ethnographic studies, to explore the current landscape of antibiotic access, usage practices, and attitudes towards AMU and AMR. Secondly, we will organise workshops with farmers to create mobility scenarios to estimate a travel “friction” surface across Kenya to reliably calculate travel times between farms, veterinarians and drugstores.  The later will be conducted on the model established by Molenaar et al 2023 (Frontiers in Public Health), and through a collaboration with Professor Nicolas Ray (University of Geneva).

Our project is a public good for two reasons: first, we aim to assemble a large database of drugstores and veterinarians that will be made available in open access. We anticipate making our findings on the location of drugstores available on resistancebank.org or another platform that could be specifically designed for Kenya, with a dedicated website supported by a Shiny App that will be designed based on the experience gained acquired in developing resistancebank.org. The platform will be hosted on VMD's website, with VMD maintaining its ongoing updates as new stores emerge.

While the primary objective of this database is to support public health decisions, it may also be of broader interest to commercial entities seeking, for example, to market products such as veterinary diagnostics. Second, the end goal of our project is to inform public health authorities with the outcome of our analysis. Additionally, the Ph.D. student who will lead the work is anticipated to come from East Africa and received training in spatial statistics with Dr. Van Boeckel in Switzerland. This approach to research collaboration aims to develop analytic know-how in Kenya rather than conduct 'helicopter research' by sending a European student for a one-off experience in Kenya.

Our target population is farmers, especially geographically isolated farmers, as well as animal health authorities in Kenya. We primarily aim to help the first target group by revealing potential 'veterinary deserts', where access to antibiotics is limited, and by identifying where training of drugstore owners may be necessary to improve the quality of the veterinary advice received. Additionally, our findings will also be presented to Kenyan veterinary authorities on the potential of antibiotic overconsumption associated with higher drugstore density. This information could serve as an evidence base to potentially inform actions to regulate the number or density of drugstores and/or the types of antibiotics they sell (for example the restricting the sale of certain antibiotics to prescription-only) or limiting the number of providers in certain areas to prevent competitive marketing practices that could lead to antibiotic overuse.

We intend to use the Trinity Challenge, and the pilot in Kenya as a springboard to acquire more substantial funding to map access to drugstores, and veterinary services across low- and middle-income countries. With the case-study, we believe that we could show the added value of having fine scale information on animals’ health to address pressing challenges such as AMR. To the best of our knowledge, no international organization is currently leading similar effort on a fine spatial scale, and we foresee that it could have high added value both for improving access to veterinary care, but also for epidemic preparedness against a much broader range of diseases than AMR.

Success will be measure by the following indicators: firstly, the response rate for positive enrolment of farmers in our survey, secondly number of veterinary drugstore identified and database developed, thirdly, our ability to see the outcome of our research be integrated/cited in future regulation implemented in Kenya and other East African countries.   

Our project is a pilot, thus we do not anticipate significant barriers to securing funding, as the request is aimed at obtaining resources to run the pilot. While major hurdles during the planning, implementation, and coordination of field activities remain a possibility, the team (through D. Muloi, A.Moodley, and E. Fèvre) is highly experienced in executing largescale field epidemiological surveys within livestock systems in Kenya and similar LMIC settings. This experience includes data collection from both veterinary drug stores and farms, along with collaborating with relevant government entities. Similarly, from an analytical standpoint, the team anticipates minimal challenges, given Dr. T. Van Boeckel's pioneering work in applying fine-scale maps to animal AMR epidemiology. Our proposed approach has been extensively employed in research on other globally concerning diseases like HIV and malaria. The primary challenge in comprehending the role of drug stores in AMU and AMR lies in large-scale, high-resolution data collection – the very objective of our proposed project.

The Trinity challenge perfectly fits the general objective of our research: strengthening the evidence base on AMR/AMU in LMICs through collecting new data from the community and the existing database we have built for the last 5 years. Furthermore, the emphasis on the development of analytics methods is the core of our work philosophy to generate actionable evidence for policymakers that could lead to concrete recommendations such as tightening regulations on veterinary drugstores.

Findings from this project will be relevant to institutions working to improve AMU stewardship in animal health in Kenya, specifically the Veterinary Medicines Directorate and the Directorate of Veterinary Services. Spatial data generated by this study will be made available to the VMD. This data will assist in improving both service provision and planning tools, similar to how recent human health facility mapping has demonstrated positive effects on the delivery of human healthcare (source: https://ij-healthgeographics.biomedcentral.com/articles/10.1186/1476-072X-8-13).

We will share findings at workshops with government officials, meetings with key local decision-makers, and at national conferences (Veterinary Associations Annual Conferences), as well as through reports submitted to County/National government. We aim to see our findings adopted by regional and international organizations in global animal health. In particular, we will seek to strengthen existing links with the African Union - InterAfrican Bureau for Animal Resources, World Animal Health Organization (David Sherman), and Food and Agriculture Organization (Madhur Dhingra).

A. Moodley currently serves as the Global Chair of the newly formed AMR Multi-Stakeholder Partnership Platform, an initiative by the Quadripartite to coordinate AMR activities globally; this will facilitate access to policy institutions where our findings could have a significant impact.