3.2. Barriers to Vaccine Uptake Encountered by Men and Women Farmers
Men farmers in Murang’a identified 16 barriers to vaccine uptake, Kwale 17, Ibanda 15, and Arua 22, while women identified 15, 20, 14, and 16, respectively. By site, combining both men’s and women’s contributions, a total of 18 vaccine uptake barriers were identified in Murang’a, 23 in Kwale, 21 in Ibanda and 29 in Arua. Of the identified barriers, both men and women identified 13 similar barriers in Murang’a, 14 in Kwale, 8 in Ibanda, and 9 in Arua. Table 2
provides a list of barriers faced by men and women farmers. Site-specific barrier lists are provided as part of the supplementary materials (Table S1–Table S4)
. The following are the main barriers identified in the four study sites:
(a) Vaccine costs:
Three vaccine pricing structures were used in the four case studies, each resulting in different vaccine costs to the farmer. In Murang’a, farmers were required to pay a cost of 50 Kenya shillings (0.5 United States Dollar (USD)) per animal if they took their animals for vaccination in a central place and 100 Kenya shillings (1 USD) if they preferred vaccinations to be done at home since it was not standard practice. Where farmers needed to hire additional labor to move cattle to vaccination points, extra costs were incurred. Where a farmer could not afford the vaccination fees for all eligible animals, preference was given to the more productive and valued animals and the rest were left out. In all the 14 FGDs, farmers reported the vaccine cost as high as not all community members could comfortably afford, particularly if they had many animals.
In Kwale, the County government bore the cost of the vaccine and delivery. However, households that did not participate in building community crushes or intended to use community managed cattle dips as vaccination venues were charged a cost of 5–10 Kenya shillings (0.05 USD–0.1USD) for every vaccinated head of cattle or goat by cattle dip/crush committees (7 FGDs; 3-M, 4-W). The fee was levied by other community members and dip committees to aid in the maintenance of the facilities. The fee was considered a deterrent especially by farmers with large livestock numbers.
Except for one FGD, all other discussion groups in Ibanda (14FGDs; 7-M, 7-W) and Arua (13 FGDs, 7-M, 6-W) cited cost as a major barrier to vaccine uptake. In these areas, farmers were required to pay for the indirect costs incurred by the veterinary departments as they delivered livestock vaccines, but not the direct cost of the vaccine. The prices ranged from 2000 Uganda shillings (0.5 USD) per head of cattle to 3000 Uganda shillings (0.78 USD) in some circumstances. The perception of the vaccine cost being high was also driven by the belief that farmers should not have to pay for government provided vaccines. Where farmers could not afford to have all their eligible animals vaccinated, they either stayed away from the exercise or gave preference to the more productive animals and left out unproductive ones.
(b) Choice of and distances to vaccination points:
Farmers in all 14 FGDs conducted in Murang’a identified the choice of livestock vaccination points as a vaccine uptake challenge. The farmers kept zero grazed animals, which were unaccustomed to long-range movements. Consequently, moving the animals to vaccination points was difficult. This was further compounded by the distance that had to be covered and the number of animals that a farmer wanted to be vaccinated. Farmers living in distant places from the vaccination points experienced more difficulties moving their animals than those living closer. Moving more than one animal to vaccination points was more challenging. Difficulty with moving animals to vaccination points introduced an indirect cost of vaccines since farmers who were not able to manage their animals hired labor to assist with the task. Similarly, in Kwale, farmers from all 16 FGDs identified the long distances to livestock vaccination points as a barrier to livestock vaccine uptake. Although most farmers in the area kept local livestock breeds that were accustomed to movement in search of water and pasture, distances to vaccination points were amplified by the limited number of areas with crushes where livestock vaccination was conducted as reported in 14 FGDs (7-M, 7-W). According to six FGDs (3-M, 3-W), farmers in Arua were also faced with having to trek lengthy distances to access vaccination services based on proximity to selected vaccination points.
(c) Fear of disease spread during livestock vaccination campaigns:
At the vaccination points, farmers cited the possibility of their animals being infected with disease from the use of one needle to vaccinate many animals and through contact between animals from many households as barriers to vaccine uptake. Farmers from 13 FGDs (7-M, 6-W) in Murang’a and 3 FGDs (2-M, 1-W) in Ibanda were concerned that their animals could be infected with diseases from other animals through the use of a single needle to vaccinate many animals. This thinking was drawn from practice in human health where needle sharing is not acceptable due to the risk of spreading disease from one person to another. In Murang’a 11 FGDs (7-M, 4-W) and Kwale 9 FGDs (4-M, 5-W), reported the possibility of disease spread through contact of animals from different households and indirectly through the spread of pests such as ticks and tsetse flies as a barrier.
(d) Fear of vaccine side effects:
Upon vaccination, farmers from 11 FGDs (6-M, 5-W) in Murang’a were concerned about the possible side effects of the administered vaccine. The vaccine side effects identified included abortions among in-calf animals (9 FGDs; 5-M, 4-W), decrease in milk production for few days from the day of vaccination (3 FGDs;1-M, 2-W), animals swelling on the vaccination site (2 FGDs; 2-W) and becoming sickly (1 FGD; W). Farmers tended not to present in-calf animals for vaccination to prevent the occurrence of abortions, save the calf, and safeguard their investment in artificial insemination services used to fertilize the animal. In Kwale, three FGDs (1-M, 2-W) identified tail tip loss (2 FGDs; 1-M, 1-W) and abortions (1 FGD; W) as the vaccine side effects they had encountered. In Ibanda, 11 FGDs (5-M, 6-W), identified vaccine side effects such as reduced milk yields (1 FGD; W), abortions in in-calf animals (6 FGDs; 3-M, 3-W), animals becoming sick or dying (6 FGDs; 3-M, 3-W), and tail tips falling off after vaccination (1 FGD; M) as deterrents to vaccine uptake. Of the identified vaccine side effects, abortions were the main concern for farmers from the three sites.
(e) Disinterest in vaccines:
Among the farmers that never took their animals for vaccination in Murang’a, disinterest (11 FGDs;6-M, 5-W), qualified as farmers being fully aware that a livestock vaccination exercise was taking place and being able to manage the transactional costs associated with the animal vaccination but still choosing not to have them vaccinated anyway, was reported. This attitude came from farmers not seeing any visible difference between animals that were vaccinated and those that were not, therefore, concluding that livestock vaccination was unnecessary. A similar observation was made in Kwale in 12 FGDs (6-M, 6-W) in areas where vaccine provision was irregular.
(f) Lack of or limited access to vaccination information:
Most farmers in Murang’a received information on impending vaccination exercises as demonstrated by the low number of FGDs (2 FGDs; 1-M, 1-W) that identified lack of vaccination information as a barrier. From the sub-County veterinary offices, vaccination information was relayed through veterinary personnel to the public administration (chiefs, assistant-chiefs, and village elders), schools, churches, mosques, posters pinned in public spaces, and from farmer to farmer. The information comprised of the vaccine to be offered, the species targeted, cost of vaccine, date and place of vaccination. However, men farmers reported in one FGD that the time when one got the information was important because it affected the ability to raise the money required for the vaccination exercise. Longer notices were preferred to shorter ones. In Kwale, farmers from 14 FGDs (8-M, 6-W) reported that lack of vaccination campaigns information contributed to low uptake of vaccines. Veterinary officers relayed vaccination information to public administrators for onward dissemination to community members, but the administrators were not efficient in reaching out to community members. Further, farmer to farmer sharing of information on vaccination was not common.
In Ibanda, six FGDs (3-M, 3-W) and in Arua, five FGDs (2-M, 3-W) reported that delayed, limited, or lack of access to vaccination campaign information affected farmers ability to prepare for vaccine uptake. In both areas, farmers received vaccination campaign information from the Local Council (LC) Chairmen 1 and 2. The leaders shared the information through churches, mosques, and social events like weddings and funerals. Information sharing was also achieved through farmer to farmer communication. Notices were also placed in marketplaces where people tended to congregate. In consultation with Resident District Commissioners (RDC), veterinary officers could be allocated air-time on radio to make an announcement of upcoming vaccination campaigns. The method was, however, found not to be effective because not many community members listened to the local government radio in the hours that the announcements were made.
(g) Mistrust of veterinary vaccines and veterinary officers:
In Kwale, eight FGDs (5-M, 3-W), comprising of more men’s groups than women’s, identified mistrust of veterinary vaccines as a barrier to uptake. The mistrust was fueled by the belief that the veterinary department offered farmers vaccines for free because they were being tested for efficacy, about to expire, faulty, or were intended to reduce the livestock population in the area by inducing infertility and death. More men than women farmers were suspicious of the vaccines because they mainly targeted cattle, a major asset whose ownership and control was culturally ascribed to them. The same barrier was reported in eight FGDs (4-M, 4-W) in Ibanda. The farmers mistrusted vaccines provided by the veterinary personnel, particularly those in private practice because they were not effective when administered to the animals, a factor blamed on poor storage and maintenance of the cold chain. In Ibanda, the mistrust of vaccines was closely linked to mistrust of veterinary personnel, a barrier identified in five FGDs (3-M, 2-W). The mistrust was cultivated by previous farmer experience with vaccines offered by some veterinary personnel not being effective and some rogue veterinary personnel offering farmers placebos instead of the needed medicines and vaccines. For instance, farmers reported that rogue veterinary personnel provided them (farmers) with water for clear colored vaccines and a yellow colored soft drink for injectable tetracycline.
(h) Livestock ownership patterns:
In Ibanda, due to existing culturally defined livestock ownership patterns, women could access livestock and livestock products but had limited decision making capacity over cattle (5 FGDs; 1-M, 4-W). Therefore, even when women wanted the families’ cattle vaccinated, if the men (heads of household) did not consent, their animals did not benefit from the vaccination exercise. This barrier affected women farmers more because of power relations between them and their spouses at a household level.
(i) Poor access roads:
Farmers in Kwale (7 FGDs; 4-M, 3-W) and Arua (2 FGDs; 1-M, 1-W), reported that in the planting season, there was the challenge of a lack of defined paths to move livestock through since most land was unfenced and occupied by crops at the time. Livestock was, therefore, likely to destroy or feed on the planted materials leading to conflicts among community members.
(j) Cultural beliefs:
In Murang’a, farmers from nine FGDs (4-M, 5-W) reported that bringing their healthy and productive animals to public spaces exposed them to envy from other farmers resulting in them “being looked at with a bad eye”, locally referred to as “githemengu”, which was believed to lower milk production and even lead to death of the animals. It would also expose animals to injuries and theft, therefore, compromising the animals’ safety and security (4 FGDs; 3-M, 1-W). In Ibanda, two FGDs (1-M, 1-W), reported that in observation of cultural beliefs, specific animals in some households could not be vaccinated so as not to compromise the totem status they held. In Kwale, farmers feared exposing all their livestock for fear that persons with ill intent would use witchcraft to reduce the wealth of the owner (2 FGDs; 1-M, 1-W).
(k) Religious beliefs:
In Murang’a, members of the “Akorino” religious sect, who did not believe in utilizing medical services for humans and veterinary services for animals, were reported not to avail their animals for vaccination in nine FGDs (5-M, 4-W).
(l) Waiting time in vaccination points:
In Murang’a (4 FGDs; W) and Kwale (3 FGDs; W), women farmers decried the time spent in the vaccination centers waiting for the service to be delivered because it compromised their ability to engage in other domestic responsibilities.
(m) Inadequate vaccines:
In Arua, Kwale, and Murang’a, during vaccination campaigns, farmers in six FGDs (4-M, 2-W), two FGDs (1-M, 1-W) and one (FGD; W), respectively, reported that the vaccine available was not always adequate to cover all eligible animals hence some farmers missed out. Women in one FGD in Ibanda also reported that vaccines that could be bought in veterinary supplies shops were not always available because the proprietors preferred to only sell fast moving items. This caused a delay in vaccine access and delivery as reported in five men’s FGDs in Ibanda. A similar challenge was reported in a men’s FGD in Kwale where due to delays in vaccine procurement processes, the veterinary department sometimes acquired vaccines after the disease that was intended for control had spread extensively.
(n) Farmer availability:
In Murang’a, Kwale, and Ibanda farmers from four FGDs (2-M, 2-W); one (FGD; M), and one (FGD; W), respectively, stated that in some instances, vaccination dates were set on days when some farmers had commitments that made it impossible to participate in the vaccination exercise. Thus, farmer availability determined vaccine uptake. The unavailability for vaccine uptake could also be triggered by weather patterns. For instance, in Kwale, during the dry season, farmers practicing pastoralism moved their animals in search of water (1 FGD; M). Thus, if vaccine delivery was conducted far from where they had moved the animals to, the probability of not presenting the animals for vaccination was high.
(o) Difficulties in restraining animals:
In Arua (3 FGDs; 1-M, 2-W) and Kwale (1 FGD; W), farmers reported difficulties in manually restraining animals for vaccination, particularly in places where there were no crushes. This challenge affected women farmers more than men farmers since it was an energy intensive exercise.
(p) Shame of having unhealthy animals:
In Murang’a from two FGDs (1-M, 1-W), farmers with less appealing animals as a result of poor management reportedly did not take their animals for vaccination for fear of becoming objects of shame in the community.
(q) Lack of knowledge of vaccine importance:
In Arua (11 FGDs; 5-M, 6-W), Ibanda (2 FGDs; W), and Kwale (1 FGD; W), lack of knowledge of the importance of vaccines was identified as a deterrent to vaccine uptake. This was attributed to the lack of awareness-creation sessions with the farmers.
(r) Inadequate numbers of veterinary officers:
In Arua and Kwale, lack of or having few well-trained veterinary officers was identified as a barrier to vaccine uptake because of difficulties in accessing services as reported in eight FGDs (4-M, 4-W) and five FGDs; (3-M, 2-W), respectively.
Lethargy, qualified as being in the knowledge that there was an ongoing livestock vaccination campaign but not participating because of not wanting to tire one-self (4 FGDs; 3-M, 1-W) was also a deterrent to vaccine uptake in Arua.
(t) Fear of animal loss:
In Kwale, farmers (6 FGDs; 3-M, 3-W) identified fear of animal losses in vaccination sites and while moving to and from vaccination points as a barrier.
(u) Shortness of vaccination campaign duration:
Farmers in Kwale decried the shortness of the time allocated for vaccination campaigns (5 FGDs; 3-M; 2-W) because they felt it was not adequate to have all their animals vaccinated and would like more time allocated for the service.
(v) Use of herbal medicines:
In one FGD for men farmers, the use of herbal medicines for livestock treatment was identified as a deterrent for livestock vaccines uptake. The perception was driven by the belief that herbal medicines were capable of treating and preventing livestock diseases, hence there was no need for using vaccines.
(w) Preference for curative rather than preventive treatment:
Women farmers in two FGDs, one in Murang’a and one in Arua, reported having a preference for the uptake of curative rather than preventive services since it was not always the case that when animals were vaccinated that there would be an outbreak of the disease vaccinated against.