Think Big, Start Small by ryy82944


									                        G   L O B A L   P   L A N T     C   L I N I C
                             CABI    Ro th am ste d Res ea rc h   F ER A

Think Big, Start Small
developing a plant health system for Nepal

              Solveig Danielsen and Dannie Romney

              May 2009

  World Vision International Nepal   SECARD Nepal
                      GLOBAL PLANT CLINIC
The Global Plant Clinic (GPC) is managed by CABI in alliance with Rothamsted Research and
the Food and Environment Research Agency (FERA). The GPC provides and coordinates
plant health services in Africa, Asia and Latin America. It has an expert diagnostic service for
all plants and types of problems and regularly publishes new disease records. The GPC trains
plant doctors and scientists, establishes plant health clinics and builds plant health systems. We
link extension, research and farmers and work with all sectors to improve regular and reliable
access to technical support and advice. Our aim is to create durable plant health services for
those who need them most.

World Vision (WVIN) is a Christian relief, development and advocacy organisation dedicated to
working with children, families and communities to overcome poverty and injustice. Motivated
by our Christian faith, World Vision is dedicated to working with the world’s most vulnerable
people. World Vision serves all people regardless of religion, race, ethnicity or gender.

                              SECARD NEPAL
Society for Environment Conservation and Agricultural Research and Development
Nepal (SECARD) is a not-for-profit, non governmental organization registered and affiliated
with Government of Nepal. Our main aim is to develop sustainable agriculture system with
optimal use of local resources with conservation of agro ecological landscape. SECARD Nepal
advocates for the promotion of eco-friendly ecological and sustainable organic farming
practices through its different programs and projects.

Dr Eric Boa                                          Mr Surendra Dhakal
CABI, Bakeham Lane, Egham, Surrey                    WVIN, Besishahar, Lamjung, Nepal
TW20 9TY, UK.                                ;                           ;
  +44 1491 829044/069                                  +977 066 520016
                                                     Mr Raj Kumar Adhikari
Dr Rob Harling
                                                     SECARD Nepal, GPO Box 24695, Kathmandu
c/o CABI, Bakeham Lane, Egham,               
Surrey TW20 9TY, UK.                                   +977 01 6221199 (o); +977 9841580307 (c)                    

                                                     Mr Bed Prasad Khatiwada
                                                     Helvetas Nepal
         Rapid Progress for Plant Health
It is only 6 months ago that the first plant clinic pilots were initiated in
Nepal by WORLD VISION NEPAL (WVIN), SECARD and partner
organisations in collaboration with the GLOBAL PLANT CLINIC (CABI, UK).
Yet, progress has been fast and the Nepalese lead organisations have
already started to define a vision for a nation-wide plant health system.
The development of a plant health system in Nepal follows two parallel
strategies: one, through practical implementation of plant health clinics to
test and adapt the model, gather experience and evidence; and two,
through wider engagement of national stakeholders in plant health to
encourage integration and policy dialogue.
The GLOBAL PLANT CLINIC paid a short 5.5-day visit to Nepal in May 2009
to support this development. It was an intense and fruitful visit that
started with a one-day multi-stakeholder workshop in Kathmandu,
followed by a visit to the plant clinic in Besishahar, which included
practical exercises in monitoring and clinic register management. We
visited IAAS in Sundarbazar and had in-depth discussions with WVIN and
SECARD about clinic operations and strategies for plant health systems
development. This report is a short summary of our visit.
We were impressed to see the progress achieved and the strong
commitment of the Nepalese partners to pursue their goals. Many
struggle with working in partnerships, the Nepalese just do it! It was an
enriching experience with lots of new learning and inspiration to share
with other countries.
We are indebted to WVIN and SECARD for the excellent organisation of
our trip, their dedication and hard work and for the warm welcome they
gave. Thanks to all the plant doctors, to the people we met at the
stakeholder meeting and IAAS, for their enthusiasm and participation and
for sharing their views and thoughts.

                        DR. SOLVEIG DANIELSEN
                Global Plant Clinic Alliance – CABI Associate
                          DR. DANNIE ROMNEY
          Global Director Knowledge for Development – CABI Africa
ADO       Agricultural Development Officer

ADP       Area Development Programme

CBO       Community-based Organisation

CDC       Community Development Centre

CECOD     Centre for Environment and Community Development

CEED      Environment and Economic Development Centre

CTEVT     Council for Technical Education and Vocational Training

DADO      District Agriculture Development Office

DLSC      District Livestock Service Centre

DOA       Department of Agriculture

          Forum of the Integrated Development of Herbs and Agriculture for
          Poverty Alleviation

GPC       Global Plant Clinic (CABI)

HICAST    Himalayan College for Agricultural Science and Technology

IAAS      Institute of Agricultural and Animal Science

IPPC      International Plant Protection Convention

MOAC      Ministry of Agriculture and Cooperatives

NARC      National Agricultural Research Council

NGO       Non Governmental Organisation

PPD       Plant Protection Department

RADO      Regional Agriculture Development Office

          Society for Environment Conservation and Agricultural Research and

UAE       United Arab Emirates

VDC       Village Development Committee

WHO       World Health Organisation

WVIN      World Vision Nepal

1   Progress so far ................................................................................... 2

2   A busy clinic in Besishahar ............................................................. 3

3   Monitoring progress and quality of the clinics ....................... 8

4    Building a plant health system for Nepal .............................. 12

1. Plant doctors and monitoring team at Besishahar clinic ............................... 16
2. Examples of problems presented at the plant clinic ...................................... 17
3. Monitoring report from visit to the Besishahar clinic ................................... 18
4. Stakeholder workshop participants .................................................................. 20

1 Progress so far
In December 2008 the GLOBAL PLANT CLINIC (GPC-CABI) visited Nepal for the first time to train
plant doctors and assist with the establishment of local plant health clinics. An article in the
magazine LEISA1 about plant clinics in Bolivia, Nicaragua and Bangladesh had inspired WORLD
VISION NEPAL (WVIN) to try implementing this new type of public plant health service in a
Nepalese context. Two pilot clinics were run in Besishahar and Sundarbazar and 23 plant
doctors received module 1 of the basic course ‘How to become a plant doctor’. These encouraging
initial experiences are documented in the first GPC report2.
Since December, the plant clinic initiative has developed fast. Another NGO, Society for
Environment Conservation and Agricultural Research and Development (SECARD),
implemented two mobile clinics in the Kathmandu area3. These early clinic events raised a lot
of interest. Farmers were eager to bring in samples and discuss management options with the
plant doctors. Many different crops and plant health problems were presented and the plant
doctors realised that diagnosing the problems and giving good advice is challenging.
WVIN and SECARD saw that the clinics fill an important gap in providing advice to farmers and
that there is scope for making better use of existing capacities and resources through effective
clinic operations. The two organisations started discussions on how to explore the full potential
of the clinics by engaging more stakeholders around the creation of a national plant health
system. For WVIN and SECARD the clinics are of strategic importance, since they help fulfil
broader mandates around food security, environmental protection, nutrition, health and
improved livelihoods.
In May 2009 the GPC visited Nepal for the second time to support the further development of
a national plant health system. It was a short but fruitful visit that included a national
stakeholder workshop, a monitoring visit to a mobile plant clinic in Besishahar, visits to partner
organisations as well as working sessions on plant clinic management and strategic planning.
This report is a short summary of the main outcomes of our visit.

                                                                      An ideal idea for Nepal

                                                                      The local plant health clinics allow more
                                                                      farmers to get access to plant health
                                                                      services. The clinics fill a gap in the
                                                                      current attention to farmers and they
                                                                      also make better use of existing
                                                                      capacities and resources.

1   Bentley J, Boa E, Danielsen S, Zakaria AKM. 2007. Plant clinics for healthy crops. LEISA Magazine 23, 16-17.
2   Boa E, Harling R. 2008. Starting Plant Health Clinics in Nepal. Global Plant Clinic, UK. 18 pp.
3   Adhikari R.K. 2009. Plant Health Clinic Initiative in Nepal. SECARD Nepal. 12pp.

2 A busy clinic in Besishahar
For the time being WVIN has decided to run bi-weekly clinics in Lamjung, rotating between
Besishahar and Sundarbazar. We visited the clinic in Besishahar haat bazaar on May 10 and
used the opportunity to test a simple monitoring method (see next chapter).
The clinic was set up to be a massive public event. Seventeen plant doctors attended the
session (Annex 1), which lasted for around 3 hours, from 11am to 2pm. The plant doctors
represented a variety of backgrounds and skills including: NGO staff, government extension
staff (from the District Agriculture Development Office–DADO), input dealers (agrovet
suppliers), as well as academic staff from the Institute of Agriculture and Animal Science
(IAAS). Most of them had received the GPC course in December 2008.
The event was well organized. WVIN had anticipated a massive turn out and prepared a
reception table. Here the farmers lined up with their samples, the samples were recorded in a
book and given numbers and then the clients were passed on to be attended at one of the six
tables. Any prior concern about the plant doctor team being too big immediately vanished.
They were all kept busy during the entire event.

      Keeping good order. Before seeing the plant doctors, the clients had to register and wait for their turn.

A total of approximately 75 farmers (13 men, 62 women) brought 111 samples. Table 1
summarises the number of clients and samples brought in. The clinic had been announced by
flyers and radio spots and by communicating through the WVIN partner organisations. The
clients came from 6 VDCs (Village Development Committee), Baglungpani being the most
distant community, 11 km from Besishahar (Table 2).
The clinic was dynamic and interactive. Talks and discussions went on at great length. People
listened, observed and expressed their opinion about symptoms, possible causes, appropriate
control measures and many other issues of relevance to plant health and crop production.
Although the plant doctors attended the clients individually, the clinic often became a venue
for spontaneous exchange of views and experiences. This mutual learning between farmers and
plant doctors is invaluable and an added benefit of the clinic. The people were eager to learn
but plant doctors do not know everything. They also need to listen and learn to be able to
respond to needs of the clients.

Several students from IAAS attended the clinic. There is no better way to learn than by being
exposed to real-life challenges. The students were eager to participate and test their own
knowledge. Also they found out that they can learn a lot from the farmers.

    Table 1. Users and queries recorded at                  Table 2. Clinic coverage. Plant health clinic in Besishahar,
    the plant clinic in Besishahar, 10 May 2009             Lamjung Province, 10 May 2009

                                                            VILLAGE DEVELOPMENT        DISTANCE FROM          NO.
    ITEM                               NO.                  COMMITTEE (VDC)           BESISHAHAR (KM)       SAMPLES    %

    Female users                        62                  Gaonshahar                        6               38       34

    Male users                          13                  Besishahar                        0               23       21

    All users                           75                  Baglungpani                      11               21       19

    Female queries                      90                  Banjhakhet                        4               19       17

    Male queries                        17                  Aapchour                         3,5              2         2

    Not recorded                         4                  Bhakunde                          5               3         3

    All queries                        111                  Not recorded                      -               5         5

                                                            GRAND TOTAL                                      111       100

Twenty seven different crops were brought to the clinic, cucumber being the most frequent
‘patient’ with 15%, followed by maize, tomato and orange (Table 3). No projects deal with
such a diversity of crops and problems, but the plant clinics do. Rural families rely on a wide
range of crops for multiple purposes, for selling, home consumption, fodder, fuel, decoration
and more. They have a legitimate motive for requesting advice on any crop or plant that has a
value to them, even the most insignificant plant that does not appear in the national statistics of
economically important crops.

“This is nice, not only for the farmers, but also for us.      Writing a good prescription requires careful thought.
We learn a lot when we discuss with farmers,” Hari             Students from IAAS were eager to learn how to attend the
Krishna Panta, Teacher at IAAS Sundarbazar                     clients at the plant clinic in Besishahar.

Table 4 highlights the most important pests and diseases found in the top four crops presented
at the clinic day. The long list of plant health problems in different crops illustrates the big
challenge the plant doctors face.

Table 3. Crops presented at the plant clinic and their             Some problems are easily recognised with a
frequencies. Besishahar, Lamjung Province, 10 May 2009
                                                                   little practice, e.g. fruit fly, powdery mildew,
CROP                                        NO.      %             downy mildew and stem borer. In contrast,
Cucumber                                     17      15            more general symptoms such as wilt, root
Maize, tomato                                11      10            rot, yellowing, leaf blight and curling can be
Orange                                       10       9            difficult to diagnose on the spot since the
Bean                                         9        8            causes can be multiple. For some plant
Pumpkin                                      7        6            doctors it is not easy to say ‘I don’t know what
Bitter gourd, citrus                         6        5
                                                                   it is’. But it may be necessary to consult other
                                                                   colleagues or send the sample to a laboratory
Brinjal, sponge gourd                        5        5
                                                                   before an exact answer can be given. Being
Cowpea                                       4        4
                                                                   honest creates credibility. Six samples were
Litchi                                       3        3
                                                                   sent to the GPC for identification.
Peach, radish, squash                        2        2

Bottle gourd, broad leaf mustard, chilli,
                                                Another challenge is to assess how the
coffee, lemon, lime, okra, papaya, pea,         disease/pest affects the plant and what
potato, snap bean                  1     1
                                                action is needed. Sometimes the best advice
Total                            111    100
                                                is ‘don’t do anything, it is not important’ or
                                                ‘wait and see how it develops’. In other cases
it may be too late to save the crop, for instance in the advanced stages of bacterial wilts.
Complex problems are common too. We saw a cucumber sample affected by powdery mildew
and virus. What is the more serious of the two? How do they affect the plant? What needs to
be done? Giving good advice requires a thorough assessment of the problem.

    Fruit fly is a common problem in cucurbits. The plant            Many citrus trees suffer from complex ‘dieback’ or
    doctors recommend sanitation, cow urine and pheromone            ‘decline’ problems. Yellowing and leaf drop are
    traps to control it. Pheromone traps have become widely          common symptoms. The plant doctors recognize
    available through input shops but still many subsistence         that these problems are difficult to diagnose.
    farmers do not know about them.

The plant doctors took up the challenge with a lot of courage and mutual support. They
recognise the need for more practice and further training in diagnosis and the importance of

linking up to diagnostic laboratories. They are eager to know more about low-cost quick tests,
such as the home-made test kit for ‘citrus greening disease’, which is being produced at very
low cost at the Southern Fruit Research Institute in Vietnam4.

                      Table 4. Summary of plant health problems in the four most important crops
                       presented at the plant clinic in Besishahar, Lamjung Province, 10 May 2009

   1. CUCUMBER (17 QUERIES)          2. MAIZE (11 QUERIES)        3. TOMATO (11 QUERIES)       4. ORANGE (10 QUERIES)

   Problem                No.     Problem               No.   Problem                 No.     Problem                 No.

   Fruit fly               6      Stem borer             7    Fruit borer              3      Borer                   1

   Aphids                  4      Army worm              3    Leaf blight              2      Die back                5

   Powdery mildew          3      Maize hopper           1    Late blight              1      Greening disease        2

   Collar rot              2      White grub             1    Early blight             1      Citrus decline          1

   Mites                   2                                  Faulty planting          1      Mites                   1

   Nutrient deficiency     2                                  Fungus                   1      Virus                   1

   Epilechna beetle        1                                  Grasshopper              1      Scale insect            1

   Downy mildew            1                                  Hail stone damage        1      Poor management         1

   Stem borer              1                                  Helicovera               1

   Fruit borer             1                                  Nutrient deficiency      1

   Pumpkin beetle          1                                  Cutworm                  1

                                                              Virus                    1

                                                              White grus               1

                                                              Red ant                  1

                                                              Stem borer               1

   Total *                 24     Total                  12   Total                    18     Total                   13

                                * The total number of problems is higher than the number of
                                 queries since some samples have more than one problem

WVIN plans to improve the infrastructure of the haat bazaar and allocate a fixed stall for the
clinic in the future. That will make the service more accessible and public and enhance its
profile. With a good location and a cadre of committed plant doctors, the plant health clinics
of Lamjung will ensure regular and reliable plant health services to the farmers in the district.

                                                                                           The Besishahar clinic
                                                                                           was well attended. The
                                                                                           clients waited patiently
                                                                                           for their turn and
                                                                                           engaged themselves in
                                                                                           long conversations with
                                                                                           the plant doctors and
                                                                                           other fellow farmers.

4 Kelly P, Danielsen S. 2008. Fruitful Plant Clinics. Stories about plant doctors and plant patients from Viet

Nam. Global Plant Clinic, UK. 15 pp.

A note on culture, gender and ethnicity
The majority of clinic clients in Lamjung are women. There appear to be a number of reasons
for this. Firstly, in many rural communities women comprise 60 per cent of the population, with
the male population being predominantly very young or very old. Young healthy men often
work overseas as uneducated labour in UAE, Saudi Arabia and Qatar, while those that are well
educated often go overseas to study and do not return. Secondly, in Lamjung the predominant
community is the Gurung community where women are often the household decision makers.
The matriarchal nature of the Gurung society reflects the fact that for many years the Gurungs
have been known as military men who leave to work as Gurkhas for the British army, leaving the
women to run the households. In other areas and ethnic groups, men are more commonly
decision makers, even when most of the agricultural work is carried out by women.
A third reason for the female dominance at the Lamjung clinics may be due to the way the clinics
are advertised. WVIN has experienced that the most successful way of advertising is through
flyers distributed by motivators working in their partner organisations and through word of
mouth. As the motivators target the most disadvantaged members of society through mother
groups and mixed groups with female dominance, women comprise the major target group.

       A public service. The plant clinics are open to anyone who wants advice about a plant health problem.

                   Serving society. The Lamjung Province has a team of dedicated plant doctors
                who are willing to share and exchange knowledge and experience with the farmers.

3 Monitoring progress and quality of the clinics
As part of the establishment of plant health clinics, the GPC teaches a 3-day training course on
‘Monitoring Progress and Quality of Plant Clinic Service’5 based on experiences and iterative learning from
Nicaragua, Bangladesh and Vietnam. The purpose of the course is to enable people who run clinics
to design a monitoring system, which allows them to assess clinic progress and quality on an on-
going basis. Our brief visit to Nepal did not allow us to run the course; however, we used the
Besishahar clinic day as an opportunity to introduce some of the basic principles of monitoring and
to apply the monitoring form developed previously in Bangladesh and Vietnam.
A good monitoring system is essential to document clinic progress, assess the service quality,
identify weaknesses and difficulties and define actions for continuous improvement. The
methods should be simple and practical for those who manage them, and applied in a conscious and
systematic way. Monitoring is a help to improve the quality and efficiency of the work, and to
create accountability. It is not just an administrative requirement or a control mechanism. Plant
doctors in different countries have different backgrounds and working conditions. It is therefore
important that the monitoring system is adjusted to the specific context.
The monitoring form is designed to make a brief assessment of the quality of the diagnoses and
advice and the general performance of the clinic. It is not enough to assess whether the advice is
technically correct, plant doctors must also consider whether the advice is feasible for the farmer.
Are the recommended inputs available and accessible? What are the labour requirements? Can
the farmers afford it? Do the plant doctors give consistent advice? Other factors such as
communication and attitude of the plant doctors, connectivity with laboratories and experts,
register management and clinic outreach should also be assessed during the monitoring visits.
Allocating tasks before the visit helps ensure that everybody knows their role. Four tasks were
defined among the monitoring team members (Annex 1): 1) revise clinic register, 2) fill the form,
3) take photos and short videos, and 4) take notes and interview plant doctors and farmers.

    Record keeping. Keeping good registers is part of   ‘How can I help you?‘ It is important that the plant
    good clinic performance. The registers are key to   doctors take their time to ask questions about the
    document what the plant clinics do.                 problems presented.

After the clinic visit we met with all plant doctors to reflect on the day and discuss selected plant
health problems (Annex 2), how to recognise them and what to recommend. This triggered lively

5 Danielsen   S, Kelly P. 2008. Monitoring Progress and Quality of Plant Clinic Service. GPC-CABI, UK. 22 pp.

interactions around farmers’ practices and possible solutions. The plant doctors also discussed
how to organise the clinics in the future and ensure good clinic performance. Their opinions and
feedback were considered in the monitoring report (Annex 3).
The following day the WVIN-SECARD-GPC monitoring team met to write up the report, reflect
on each point and type up the queries in Excel. The report summarises the main findings and
recommendations (Annex 3). Overall, the team was satisfied with the clinic day. It was
appreciated by the clients; there was a good dynamic and a lot of interest. The plant doctors were
eager and respectful in the attendance of clients and they did their best to assist the farmers in
solving their problems. Often the plant doctors asked their colleagues when they needed help.
There are things that need to be improved. The plant clinics are still new to everyone and the
plant doctors need more practice and guidance on client attendance and record keeping to
ensure uniformity and quality. Often they did not ask enough questions about the problems
presented. The disease symptoms explain part of the problem, but to understand the scope of
the problem and the farmer’s perceptions and beliefs, it is necessary to ask more questions6.
When did the problem start? How is the disease distributed in the field? How does it develop?
What have you done to control it? Only then the plant doctor can decide what advice to give7.
                                                              The clinic session showed how plant doctors
                                                              with different profiles can complement each
                                                              other. Those with a strong technical background
                                                              were good at diagnosing symptoms but often
                                                              they tended to jump to a conclusion without
                                                              asking many questions. In contrast, plant doctors
                                                              with a more practical background were better at
                                                              asking in-depth questions about the problems.
                                                              The Besishahar clinic is well-placed at the haat
    A good clinic venue. The haat bazaar in Besishahar        bazaar installations. However, more publicity is
    is spacious and has a tin roof. The big clinic sign
                                                              needed to signal that it is a public service for
    and the multitude of clients attracted the attention of
                                                              everyone, not only WVIN partners. A permanent
    others who approached the clinic to see what it was.
                                                              sign by the road will help enhance visibility.
Capturing feedback from farmers is crucial to find out if the clinic responds to their needs and
whether the advice works. Interviewing farmers and writing short stories help record peoples’
views, ideas and knowledge. The plant doctors should keep a separate notebook to record
feedback systematically. The clients interviewed at the clinic expressed their satisfaction with the
service. Having access to information and advice on any plant health problem is not an everyday
event for small-scale farmers. Some of them said that they would like to be able to buy inputs at
the clinic and that the clinic should visit more remote areas too, so that more farmers can benefit.
IAAS is keen to share their knowledge and available resources to support the plant clinics. The
participation of IAAS staff in the clinic event shows this commitment. It is obvious to use the
IAAS lab as reference lab for the Lamjung clinics. The clinic organisations and IAAS should
start to discuss practical arrangements for sample referral, define roles, responsibilities and
procedures to ensure effective delivery of results.

6   The principles of ‘field diagnosis’ are taught in Module 1 of the basic course ‘How to become a plant doctor’.
7   Modules 2 and 3 go more into the principles of giving advice and designing extension messages.

                                                                      Feedback from the clients. This lady had
                                                                      the opportunity to express her opinion
                                                                      about the plant clinic on national television,
                                                                      Sagarmatha TV. She appreciated the
                                                                      advice she received on cabbage diseases,
                                                                      but she would like the clinic to move to
                                                                      other areas too, so that more farmers can
                                                                      get access to the service.

Clinic registers
Good management of clinic resisters is another
                                                                  Table 5. Extractable data from the clinic registers
means to monitor and document what clinics do.
                                                                  QUANTITATIVE                     QUALITATIVE
The registers are an invaluable source of
quantitative and qualitative information (Table 5)                # clients and queries            Quality of diagnosis
that, properly managed, can be used to take                       # crops and problems             Quality of advice
strategic and operational decisions to continuously               # communities
improve the quality and scope of the clinics.                     Disease distribution
                                                                  (spatial and temporal)
We gave demonstrations of Excel databases from
other countries and showed examples of how to
analyse the data and what to make of the information. The GPC has recently compiled, cleaned
and analysed clinic data from Bolivia, comprising approx. 6500 queries from 9 clinics. Once the
data are presented in a synthesised way it becomes apparent what a powerful decision-making
tool the clinic register is. Table 6 shows some of the potential uses of the registers.

                   Table 6. Examples of what properly managed clinic registers can help do

                   ► Identify major crops and diseases and their distribution

                   ► Identify new and emerging diseases (link to quarantine authorities)

                   ► Document coverage of the clinics

                   ► Identify themes for massive public campaigns

                   ► Identify weaknesses of plant doctors and target further training

                   ► Identify needs for further research

                   ► Identify needs to link with other institutions

                   ► Provide supporting evidence for advocacy

The Besishahar data presented in Tables 1–4 were extracted from Excel. The analyses can go
even further and include an assessment of the quality of the advice given for some of the
problems presented. Due to time constraints we did not include that in this report. However,
such ‘quality checks’ should always be on the agenda of the ‘medical conferences’ (see p. 10) to
stimulate discussions and joint learning.
It is important to get a good start with the register to avoid time-consuming corrective work in
the future. By entering the queries in a simple Excel sheet on a regular basis and summarizing
and analyzing the data by using the ‘filter’ function and ‘pivot tables’, the data handling
becomes manageable.

Excel is sensitive to spelling mistakes and the number of spaces inserted, and differing spellings
for the same term are recognized as separate categories. For instance, ‘orange’ and ‘orange
trees’ are recognized as two different categories and that complicates the analyses. To avoid
such mistakes we recommend the following for data entry:
1. Use uniform terms for crops, diagnosis and other fixed categories, e.g. decide whether you
   use ‘Potato’ or ‘Potatoes’ and ‘Greening disease of citrus’ or ‘Citrus greening disease’.
2. Avoid spelling errors and extra spaces.
3. Use ‘drop-down menus’ in the columns where fixed terms have been decided.
4. If more than one problem appears in the same sample, add a column for each diagnosis
   (Diagnosis2, Diagnosis3 etc.). You may consider doing the same for the recommendations
   if more than one is given.

About monitoring plant clinics
Monitoring is not just about filling a form; it is a conscious and systematic process that requires
attention. There are many things to do during a monitoring visit and it is important to keep
eyes and ears open to capture any observations and information related to the operation of the
clinic. Short videos and photos are useful as they can help capture the clinic dynamics and
specific situations. Reflecting on them afterwards stimulates active group discussion.
The monitoring report should be a practical tool that helps the plant clinic organisations keep
track of what is going on at the clinics and continuously improve their performance. Therefore
it is important to include critical reflection in the report as well as concrete recommendations
for follow-on actions.
Too many monitoring reports end up on a shelf without ever being used. One way to ensure that
the clinic reports are used actively is by holding monthly or bi-monthly meetings (or ‘medical
conferences’) with plant doctors and network members to discuss any theme of relevance to the
clinics, here among the findings and recommendations of the monitoring visits. Such ‘medical
conferences’ are invaluable spaces for interaction, planning and joint learning.
Although we had very short time to introduce the principles of monitoring and prepare the
visit, it was an eye-opening experience. It takes time to get used to a new role. Being a plant
doctor is different from being part of a monitoring team. Raj Kumar from SECARD said “It was
difficult to be an observer, it was a different role. I tried to be conscious about what I did, gathering information
from different source and internalizing it. It is fruitful for us in our further work.”

                                                                             A different role

                                                                             Monitoring plant clinics
                                                                             implies various activities,
                                                                             but most of all it requires
                                                                             an open mind, to listen,
                                                                             observe and reflect on
                                                                             what is going on.

4 Building a plant health system for Nepal
Health systems are well known for humans and animals, but new for plants. The development
of plant health systems is work-in-progress. The idea started in 2005 in Nicaragua where the
Plant Healthcare and Diagnostic Network was established to provide backstop support to the
local plant health clinics8 and to conduct actions of wider national interest. This shift in
approach encouraged new thinking, as a ‘system’ in which the different actors involved in plant
health (disease surveillance, quarantine, pesticide and seed regulation, research, education,
extension, input suppliers) organise themselves to complement each other and take better
advantage of capacities and resources, which in many cases already exist but are underused.
World Health Organisation (WHO) defines ‘health systems’ as follows9:
          “A health system consists of all organizations, people and actions whose primary intent is to
          promote, restore or maintain health. This includes efforts to influence determinants of health
          as well as more direct health-improving activities. A health system is therefore more than the
          pyramid of publicly owned facilities that deliver personal health services. It includes, for
          example, home care; private providers; behaviour change programmes; vector-control
          campaigns; health insurance organizations; occupational health and safety legislation. It
          includes inter-sectoral action by health staff, for example, encouraging the ministry of
          education to promote female education, a well known determinant of better health”.
The health actors and interventions of the human health system have their equivalent in the
plant world. Working as an integrated system rather than individual institutions has
implications for the way people and institutions organise and conduct their work. Nepal is now
taking important steps towards building their own plant health system.
Stakeholder workshop
WVIN and SECARD staff recognised that
for plant health clinics to become
widespread in Nepal under a plant health
systems framework, it is important that
the public and private sector take
ownership of the idea.
A workshop was organised by WVIN
(Lamjung office), SECARD and the              Building good networks. The establishment of a plant health

District Agriculture Development Office       system depends on effective networks to complement actions
                                              and skills.
(DADO, Kathmandu office) on May 8 in
Kathmandu to bring together different organisations working in plant health to discuss the clinics
and agree a way forward. Thirty-four participants from NGOs, education, research, public sector
extension and the plant protection directorate attended as well as a representative of farmers’
cooperatives (Annex 4). An agrovet supplier was also invited but was too busy to attend.

8 Danielsen S, Fernández M. (Eds.) 2008. Public Plant Health Services for All. Plant Healthcare and

Diagnostic Network, Managua, Nicaragua. 73 pp.
9 WHO 2007. Everybody’s business: Strengthening health systems to improve health outcomes. World

Health Organisation, Geneva, Switzerland. 44 pp.

The purpose of the workshop was to introduce the plant clinic concept to a broad plant health
audience, share results and experiences obtained so far and to discuss ways forward to develop a
plant health system for Nepal.
Presentations were made by WVIN and SECARD about how clinics were being integrated into
organisational activities, while the DADO representative from Kathmandu gave an overview of
Nepalese agriculture and explained how the clinics could contribute to the Ministry plans. He
summarised the issue by saying “nothing goes right if agriculture goes wrong”. The pesticide registrar
quoted Norman Borlaug who said “Plants do speak to you if you have the capacity to listen to them”.
The clinics are a way of listening to the plants.
The GPC made a presentation about plant clinics in other countries and how the concepts and
operations have developed over the years. A short DVD about the plant clinic initiative in
Bangladesh was shown to illustrate the dynamics and potential of the clinics and the wider
integration of plant health actors, such as diagnostic laboratories and input suppliers.
Participants were highly enthusiastic about what they saw and heard about the clinics and were
already thinking about how they could contribute to supporting the clinics. One said that farmer
field schools can be tapped into the clinic concept, and others mentioned that the clinics could
help mitigate epidemics and misuse of pesticides. An entomologist from NARC said, “clinics are
not new to us. Farmers come to our lab and we are always ready to help.” University representatives
expressed their willingness to cooperate and put their expertise at the disposal of the clinics. They
would also like to integrate student so they get real-life experience at the clinics.
All recognised the role of the public sector in coordinating efforts and integrating plant clinics
into their service delivery mandate. However, they also stressed that the clinics should be
incorporated into policy. “Without policy we can not programme in the future” said the pesticide registrar.
The group agreed to operate as a committee to raise awareness and influence policy change.
At the same time, there was an overwhelming sense that there is no time to waste. Policy
change can be slow they said, and it is important to start trying out clinics, learning from
experiences and using successes to convince the government. A two-track approach is needed,
learning by doing with partners at the field level as well as engaging with mid and senior level
managers in the partner organisations to influence change.

  Towards a joint vision for plant health. The stakeholder workshop on plant clinics held on 8 May 2009 marked the
  first step towards the development of a plant health system for Nepal

The WVIN team from Lamjung and SECARD in Kathmandu are already pilot testing clinics and
planning regular clinics working with local partners. WVIN team leaders from Area Development
Programmes in Lalitpur, Bhaktapur and Kathmandu also committed their teams to exploring
ways to fit clinics into their programmes where agriculture is supported as a livelihood option.
They agreed to link with the Lamjung office to learn lessons from their experiences.
The participants worked in three groups to discuss how the clinics might work in Nepal. Some
felt that the plant doctors needed longer training to improve their diagnostic skills and were
worried that the title ‘plant doctor’ was not appropriate. This issue has been discussed in other
countries as well. We explained that the plant doctor title is an unofficial title describing the
type of service, rather than the qualifications of individuals. The plant doctors act as community
health workers, a well-known and recognised function in human and animal health. They have
basic training in field diagnostics and symptom recognition, allowing them to diagnose and give
advice on the most common pest and disease problems, thus filling a gap in service delivery to
farmers at local level. Their ability to resolve more complex problems is limited. Therefore, the
clinics rely on regular backstopping from people and institutions with strong scientific
backgrounds to develop and improve knowledge and skills of the plant doctors and to provide
help when needed, e.g. from labs and research. This is why the systems thinking is crucial to
ensure the integration of complementary skills and actions.
People had lots of suggestions on how the clinics could work. One group suggested there
could be fixed clinics operating regularly in market places as well as mobile clinics that visited
remote areas. They said there should be good documentation to share learning and small
questionnaires could be used regularly to get feedback from farmers, plant doctors, local
leaders and others on how the clinics are working. They said the service should be free of
charge at first but that charges could be introduced at a later stage.
In another group, participants talked about how to make the clinics most effective. They said
that recommendations should be local and take account of individual farmer circumstances.
For example, a farmer with a small kitchen garden could not afford pesticides. Pesticides may
not be necessary for only a few infected plants that could be uprooted instead and it would not
be helpful to recommend treating crops when it was already too late. They also suggested that
photos, fact sheets and small quick tests could be used to improve diagnosis and prescriptions
and efforts should be made to link the clinics with providers of eco-friendly technologies, such
as botanicals and biopesticides.
The workshop concluded that the working group should start small but think big. Organisations
should start to try running clinics but at the same time plan ways to show policymakers their
value, making sure they build networks and learn together what works and what doesn’t. A key
approach is to keep it simple and make best use of human and other resources that are already
available rather than waiting for laboratories to be installed or for large numbers of highly
trained people.
There is a role for everyone in a plant health system. The commitment expressed by the
stakeholders and their willingness to contribute is the first and foremost condition for the
vision to come true. As expressed by Anil Chandra from WVIN, “we have strong will power to work on
plant health clinics”. The real challenge is to change roles, attitudes and ways of working to ensure
effective partnerships. These are the basics for creating broader institutional change.


Annex 1        Plant doctors and monitoring team at Besishahar clinic

TIME AND PLACE: 10 May 2009, haat bazaar installation, Besishahar, Lamjung

     NO.   NAME                      ORGANIZATION               TRAINED BY GPC
    Plant doctors
      1    Basu Dev Pant             Agrovet Dealer             Yes

      2    Shiva Kanta Khanal        DLSC, Lamjung              Yes

      3    Ramji Thukuri             Agrovet Dealer             Yes

      4    Hari Krishna Tiwari       DADO, Lamjung              Yes

      5    Nava Raj Baral            DADO, Lamjung              Yes

      6    Janma Jaya Gaire          IAAS, Lamjung campus       Yes

      7    Kishor Chandra Dahal      IAAS, Lamjung campus       Yes

      8    Saraswoti Bhandari        WVIN                       Yes

      9    Ram Bhakta Neupane        CEED Nepal                 Yes

     10    Suresh Baral              FIDHAPA                    Yes

     11    Bijaya Poudel             CECOD Nepal                Yes

     12    Jiban Jung Thapa          CHESS Nepal                Yes

     13    Santosh Adhikari          IAAS, Lamjung campus       No
     14    Shova Dhakal              IAAS, Lamjung campus       No
     15    Min Raj Pokhrel           IAAS, Lamjung campus       No
     16    Hari Krishna Panta        IAAS, Lamjung campus       No
     17    Krishna Bahadur Karki     IAAS, Lamjung campus       No
    Monitoring team
     18    Anil Chandra Neupane      WVIN                       No
     19    Bed Prasad Khatiwada      Helvetas Nepal             Yes
     20    Raj Kumar Adhikari        SECARD Nepal               Yes
     21    Solveig Danielsen         GPC                        Expert
     22    Dannie Romney             GPC                        Expert

Annex 2          Examples of problems presented at the plant clinic

FRUIT FLY IN CUCURBITS ► A frequent patient. The         CUCUMBER MOSAIC ► Virus symptoms are
   plant doctors are familiar with the symptoms.            sometimes confused with nutrient deficiency.

LYCHEE MITES ► Although mites show typical               BUTTERFLY LARVAE IN CAULIFLOWER ► Insect
   symptoms in lychee, a sample was sent to the             problems are common in brassicas and often
   GPC for confirmation                                     easy to diagnose.

A MIXED PROBLEM IN RADISH ► The root shows signs         A MIXED PROBLEM IN CUCUMBER ► The leaf has
   of insect damage as well as some blackish rot.           clear powdery mildew symptoms, but the
   The rot may be a secondary infection. Sample             underlying leaf yellowing appears to have a
   sent to the GPC for identification.                      different cause, maybe a virus. Sample sent to
                                                            the GPC for identification.

    Annex 3           Monitoring report from visit to the Besishahar clinic

                                                            Clinic       Date              Report done by
                        PLANT CLINIC
                   MONITORING FORM                      Besishahar 10.05.2009        Raj K. Adhikari

1. Monitoring team:                  2. Name of plant doctors present :
Bed, Raj, Anil, Dan, Sol             See Annex 1
3. Record keeping period             4. Is the register filled correctly?
10th May, 2009                       In general yes, the plant doctors tried their best but not all registers are
                                     uniform and complete. Not all queries were recorded due to the time
                                     pressure causes by the large number of clients waiting for their turn
5. Quality of the diagnosis and recommendations (observed in the records)
The majority of the queries appear to have been handled correctly. All the plant doctors were found to try
their best to diagnose the problems and make a good recommendation but going through the
records/register, we found that lack of uniformity is the major weakness, i.e. same problem was diagnosed
as a fungal problem by some doctors and as an insect related problem by others. Some plant doctors
identified management related or season related problems for which other doctors said they were due to
poor soil nutrition and yet others reported them as bacterial diseases. Some cases of wrong
recommendations were found.
6. Quality of the diagnosis and recommendations (observed during the visit)
70% considered good quality, 30% needs improvement. Lack uniformity and confidence among some of the
plant doctors were seen during the process of diagnosing and giving recommendation but they made an effort
to be aware and explain the problems to the farmers with adequate illustration. The plant doctors with high
skills do better, but they tend to jump to the answer. The less skilled plant doctors asked more questions.
There were cases of correct diagnosis but inappropriate advice, e.g. incorrect pesticide. The rest are fine and
7. Communication and attitude of the plant doctors?
Variation in communication is seen. Some plant doctors were interacting more with farmers and some less.
In general, the plant doctors should listen more to farmer. Few doctors were using some English technical
terms during communication which should be minimized.
The plant doctors were trying to create a good environment. No bad attitude was seen during the clinic
period however some were less interested to receive the cases. Those of high academic profile identified the
problem immediately after receiving the problem without asking many questions and started to give
recommendations, while plant doctors of less academic profile asked more questions and explained more
about the crop and the problem. Sometimes they forgot to address the problem brought by the client. Plant
doctor who felt difficulty in diagnosis interacted with others to identify the problem and provide correct
recommendation. This is a strength and good attitude. The clients were satisfied with the attitude of the
plant doctors.
8. Staff rotation and other staff issues?
There were 17 plant doctors and all were kept busy. Future staffing of the clinic needs to be planned.
9. Regularity and venue of the clinic? Material and equipment?
Until now, the clinics are in piloting stage, however, WVIN is planning to operate regular bi-weekly clinics,
rotating between Sundarbazar (every second Saturday of the month) and Besishahar (every fourth Saturday of
the month). The Besishahar clinic is based at the local market centre i.e. haat bazaar which is accessible to most
of the farmers and farmers can get multiple benefits i.e. selling their products, visit the clinic, buying inputs.
Up to now, plant doctors are only using a knife and some photo sheets. It is said that WVIN will provide some
basic tools to the plant doctors, such as hand lens, forceps, scissors, petri dish, more photo sheets.

10. No. of samples sent to a lab. Contact with labs, research institutions, other networking?
Six samples were sent to GPC Laboratory. A collaborating network is already established between WVIN
and IAAS, Lamjung, DADO, Local NGOs, SECARD Nepal and GPC.
11. Publicity activities carried out?
For the publicity of the clinic, information was broadcasted from local FM radio. Furthermore, hand bills
were prepared and distributed. More importantly, personal communication was also done through field visit
by field staffs. Most of the clients reported that they knew about the clinic from the organization staffs, others
from neighbouring farmers while some were told the same day by other clients who were bringing samples to
the clinic.
12. Feedback from clients?
Clients were quite happy and satisfied with the clinic and plant doctors. They realized that the clinic is
fruitful for them. A farmer said …'yes, I found out what happened with my cucumber… I will try to manage it according
the recommendation of the doctor'. A woman said 'this is quite fruitful, doctors respond well but with out any inputs…we
were expecting them…if possible….please……'
13. General appreciation
We appreciate the clinic and plant doctors. It was a dynamic event and people showed a lot of interest and
willingness to interact and learn. The plant doctors tried their best to solve the problems brought by the
farmers. Farmers were treated respectfully.
14. Recommendations / Action point
   • Listen more to farmers and ask more questions. Don’t jump to quick conclusions and solutions,
      even when you know what the problem is. Let the client explain the problem.
   • Write more details in the prescription, not only chemical curative measures but also the preventive
      and curative measures through cultural, physical, and biological (if possible and available).
   • Use local or Nepali language in the prescription as well as during describing the problem and
      solution. Try to minimize the use of English words.
   • Write the full name of the plant doctor in the prescription.
   • Make carbon copies of prescriptions
   • Categorize doctors according to skills, mix and match at the tables.
   • Put pamphlets by the agrovets and teashops, put a board by the road at the regular clinic site.
   • Make more photo sheets, starting with the most important problems (WVIN and SECARD have
   • Use a separate notebook to record feedback from farmers (perceptions, practices, effect of advice)
   • Ensure rigorous management of the clinic registers
   • Keep separate register for samples sent to labs (form given to WVIN and SECARD)

   • Discuss how to systematize your clinic operation procedures
   • Make short guidelines on how to fill the clinic register (Raj will do)
   • Discuss the usefulness of the monitoring form and whether adjustments are needed
   • Organise refresher training for the plant doctors
   • Identify key players in the area and arrange monthly/bi-monthly follow-up meetings as part of the
      monitoring system (‘medical conferences’).
   • Link to labs (IAAS and others) and define process of referral
   • Map the relevant capacities and resources in the region (labs, universities/research, input suppliers,
      extension, and others). Who are they? Where? What do they do? How can you create mutual
      benefit? Start to consider means of engagement, roles and responsibilities of network members.

Annex 4                  Stakeholder workshop participants

          “Sharing cum Visioning Workshop on Plant Clinic Initiative in Nepal”
                            WVIN Lamjung ● DADO Kathmandu ● SECARD Nepal
                                     May 08, 2009 Kathmandu, Nepal

N O.   NAME                       ORGANIZATION                 DESIGNATION             EMAIL
 1     Dr. Yubak Dhoj G.C         IAAS Rampur                  Asst. Professor
 2     Anil Chandra Neupane       WVIN Lamjung                 CDC           
 3     Balram Koirala             DADO Bhaktapur               Senior ADO    
 4     Nirmala Adhikari           Farmers Cooperative          Chairperson
 5     Ram Hari Marahatta         Farmers Cooperative          Member        
 6     Achyout Pd. Dhakal         DADO Kathmandu               Senior ADO    
 7     Gautam Shrestha            HICAST                       Asst Lecturer 
 8     Krishna Prasad Adhikari    DADO Lamjung                 Senior ADO
 9     Ram Bhakta Neupane         CEED Nepal                   Prog. Coordinator
10     Dr. Gopal Bd. K.C.         IAAS Lamjung                 Campus Chief  
11     Jagadish Bhakta Shrestha   PPD                          Pesticide register      Jagadishbshrestha
12     Lal Bahadur Pun            WVIN Bhaktapur               Team Leader   
13     Jnyan Narayan Shrestha     WVIN Lalitpur                Team Leader   
14     Surendra Babu Dhakal       WVIN Lamjung                 Team Leader   
15     Sundar Lama                WVIN Kathmandu               Team Leader   
16     Suraj K. Pokhrel           SECARD Nepal                 Community facilitator
17     Kul Dip Ghimire            Regional plant Prot. Lab     Plant Prot. Officer
                                  Pesticide Regulation and
18     Jhalendra Prasad Rijal     Management Division          Plant Prot. Officer
19     Ram Chandra Bhatta         Nagarik Daily                Media Reporter
20     Abdulah Miya               Kantipur Daily               Editor        
21     Sudeep Kumar Dhungana      Communication Corner         Reporter      
22     Banik Raj Kafle            DADO Lalitpur                Senior ADO
23     Bishnu Pradad Pokhrel      SECARD Nepal                 Prog. Supervisor
24     Sarad Chandra Aryal        Voice of Youth FM            Reporter      
25     R.B. Sunar                                              Reporter
26     Bed Pd. Khatiwada          SECARD Nepal                 Vice Chief    
27     Pradip Neupane             SECARD Nepal                 Coordinator   
28     Raj K. Adhikari            SECARD Nepal                 Program Officer
29     Dr. Shree Baba Pradhan     Dept Entomology NARC         Head of Department
30     Sarala Sharma              Dept Plant Path. NARC        Head of Department
31     Kishor Khadka              Headline                     Reporter in Chief
32     Keshav Khadka              UNESCO
33     Dannie Romney              CABI Africa                  Global Director K4D
34     Solveig Danielsen          GPC-CABI                     Consultant    

 the Global       Plant Clinic
   Healthy Plants for Healthy People

   Plantas Sanas para Gente Sana

Des Plantes Saines pour des Gens Sains


                        KNOWLEDGE FOR LIFE

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