on land use. The priority-setting process started from health-system-driven approaches – pragmatic in the sense that interventions could be carried out by the health and veterinary services and be validated by involved scientists – and moved incrementally towards the inclusion of other community priorities. The participants identified new research and intervention objectives and, consequently, trust and mutual respect were gradually built. The programme became the interlocutor between pastoralists and the authorities, and the communities were empowered to take their own initiatives (Schelling et al., 2008).
In conjunction with the stakeholder workshop in 2005 a process of inter-ministerial planning of a national action plan to support nomadic communities in Chad started under the leadership of the Ministry of Planning in collaboration with eight other ministries (Fig. 6.1A). However, intersectoral negotiations with so many ministries proved to be too ambitious and were not feasible. The new course, where the MoH took the lead, turned out to be more operational. During the workshop in 2013, the MoH announced the creation of a directorate for the health of mobile pastoralists. Activities that are implemented as a result of the transdisciplinary process, particularly the joint human and animal vaccination campaigns – currently in trans-frontier zones – are maintained and led by the government. There is also a presidential decree for full Expanded Programme on Immunization (EPI) coverage for pastoralist children along with polio vaccination days. The ‘Association des jeunes nomades’ is more active and prominent than ever, regarding the problem of pastoralists as an institutional problem. These dynamics of pastoralist representation would hardly have been possible some years earlier when only a few pastoralists had received higher education. Finally, the stakeholders voiced a desire to seek new innovations such as use of mobile technology to assess demographic and health parameters of pastoralist families and their livestock (Jean-Richard et al., 2014).
Fig. 6.1.(A) Transdisciplinary stakeholder workshop on the shores of Lake Chad, bringing together national Chadian authorities, pastoralist communities and scientists. (B) Stakeholder workshop in Gode, Somali Regional State, Ethiopia. Pastoralist women, health professionals and scientists discuss health care in their communities. Photos courtesy of J. Zinsstag.
The iterative problem-oriented programme aimed at improving access to health care for the nomadic pastoralists of Chad started with little information on important health issues. However, ownership by the communities for interventions was achieved by their participation in knowledge generation as equal partners, together with local authorities and scientists in a transdisciplinary approach. Unexpected outcomes emerged, for example the pastoralist communities organized themselves to provide schooling for their children, which received support from UNICEF. They have also stated that their overall security improved substantially. Generalizations for other settings can hardly be made, but where communities interact with authorities in a process to identify acceptable institutional and legal frameworks, arrangements for social service development in a given context can be achieved. The long-term commitment of all partners continues and has broadened the scope of research to other mobile communities, for example in Somali Regional State in Ethiopia (Fig. 6.1B) as well as seasonal workers and inter-provincial migrants in Vietnam.
Surveillance and response to zoonotic diseases in Maya communities of Guatemala: a case for One Health
The overall aim of a project among Maya communities in the Petén region of Guatemala was to promote a transdisciplinary One Health approach for developing a novel and culturally appropriate surveillance and response system for zoonotic diseases. Participants of a project inception workshop in September 2016 represented: (i) programme and policy-oriented government officials from the Ministries of Health and of Livestock (35%); (ii) Guatemalan academics from the Universidad del Valle de Guatemala interested in zoonosis research (28%); (iii) community representatives including Maya elders from the ACGERS Council seeking to improve health conditions in their towns (17%); (iv) Swiss academics interested in developing surveillance systems using a One Health approach (10%); (v) private industry (Tigo telecommunications company) looking at potential cell phone applications (7%); and (vi) an international development cooperation (3%).
Key steps in a transdisciplinary process are to clarify the interests of the initially identified stakeholders involved, openly discuss these interests, and jointly agree on which ones will be addressed by the forming partnership. Equal footing of all partners was not assumed to emerge naturally in the discussions. Therefore, social scientists analysed how multiple conditions of the project’s partnership related to ethnicity, language use, world-view (cosmology), values (axiology) and epistemology (all of which encompass ‘culture’) affected the participation of stakeholders in the process and subsequent outcomes of the project. Diverging initial interests coexisted according to literacy and education of participants, economic status, degrees of rurality, and ethnic background, and varied also according to participant’s position in hierarchical power structures. Backward planning was used to understand the steering team’s assumptions during different project phases. Figure 6.2 shows the backward planning process starting from the intended goal of having all partners co-define the final project objectives, later assessing underlying assumptions. These were then translated into questions which guided the verification process.
Fig. 6.2. The backward planning process. This was used as transdisciplinary (TD) Moment 1, one of two reflexive moments included in the workshop held at the inception of the One Health project aimed at developing a culturally appropriate surveillance and response system for zoonotic diseases in Maya communities of Guatemala.
From the initial analyses, it was observed that communication across groups was challenged by linguistic diversity, with Spanish as the primary mother tongue of 77% of participants, followed by Maya Q’eqchi’ (13%), Swiss German (7%) and English (3%). Knowing that language use reinforces or leverages existing power differentials and the ability to put forth one’s interests (Brenneis, 1988), on-site translation between Q’eqchi’, Spanish and English was organized during the workshop. Multilingualism was the most immediate challenge to address to ensure equal footing of participants. Context analysis demonstrated a more pervasive problem, that of historical exclusion of indigenous groups and a recent post-war setting that eroded the social fabric, with negative effects in inter-ethnic relations (Flores et al., 2009). Having looked at intersectionality issues, the coexistence of multiple layers of identity that intertwine to create further exclusion (Fiorati et al., 2018), it became evident that factors of ethnicity, rurality, poverty, literacy, gender roles and seniority enhanced power differentials among participants. Mutual trust was not a given and merely being invited to the workshop did not guarantee equal participation. Moreover, a lack of interest in mutual learning due to ethnocentric behaviour had been documented in a similar context (Flores et al., 2009). In response to this contextual complexity, the workshop was planned to include two reflexive moments to make participants aware of the multiplicity of knowledge systems and coexisting values and to realize its richness. One exercise required participants to draw or write names of animals that they liked having around, feared, respected and found useful. Results were shared in small groups, which then presented their agreements to the plenary. This allowed participants to see how their livelihood context and culturally determined values shaped their views, therefore becoming aware of how diverse the human–animal interface was among participants. Another exercise showed six pictures of symbols and situations that belonged to either biomedical or Maya medical knowledge systems, and asked participants to write down what they saw. For example, when projecting a picture of cells under a microscope, participants
