Ask an Expert: "What Does Sustainable, Community-Led Animal Health Care Look Like in Northern Canada?"

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In this edition of Ask an Expert, we spoke with Hannah (Tsai-Ping) Liao, whose MSc research at the University of Guelph examined what decades of Community Animal Health Worker (CAHW) programs can teach us about building sustainable, community-led animal health systems in northern Canada.

Community Animal Health Worker (CAHW) programs have been used around the world for decades to extend animal health services into places where veterinary care is limited or difficult to access. At their simplest, the idea is straightforward: equip trusted local people with animal health knowledge and practical skills so they can provide basic care within their own communities.

But what makes that model last?

That question became the focus of Hannah (Tsai-Ping) Liao’s Master of Science (MSc) research at the University of Guelph’s Ontario Veterinary College. Working in collaboration with Veterinarians Without Borders North America (VWB), Hannah examined CAHW programs globally and gathered perspectives from people involved in community animal health initiatives to understand not only what works, but why programs sometimes struggle to sustain their impact.

Her research revealed a much more complex picture than training alone. Sustainable programs depend on everything from ongoing veterinary mentorship and appropriate compensation to community trust, continuing education, data collection, regulatory support and long-term funding. They must also strike a difficult balance: maintaining standards for quality and safety while remaining flexible enough to reflect the realities of individual communities.

In May 2025, she travelled with VWB to Gjoa Haven, Nunavut, where she saw many of the questions she had been studying play out in practice—and encountered another form of expertise that could never come from a literature review.

Now a PhD candidate at York University, Hannah joins us for this edition of Ask an Expert to explore what decades of CAHW experience can teach us about building community-led animal health systems in northern Canada.

Q: Community Animal Health Worker programs have existed around the world for decades. What did you set out to understand through your research, and why was northern Canada an important context to explore?

Hannah: Much of the existing research on CAHW programs comes from Africa and Asia, where programs have traditionally focused on livestock, working animals, food security and zoonotic disease. There is much less research on how this type of model could function in the Global North, particularly with companion animals and dogs in remote northern communities.

That was an important gap for me. Northern Canada faces significant barriers to veterinary care, but the social, cultural, geographic and regulatory contexts are very different from many of the places where CAHW programs have traditionally operated.

My research combined a review of existing programs with surveys and interviews with people who had experience working with CAHWs and related animal health initiatives. I wanted to understand the patterns across those experiences: What consistently supports success? What problems keep appearing? And which lessons could help inform a framework appropriate for northern Canada?

There was also a personal connection. I grew up in a region where access to veterinary care and animal health resources was limited. That shaped my belief that anyone who loves and cares for their animals should have access to the knowledge and services needed to keep them healthy.

Q: After looking across those international experiences, what separated the strongest CAHW programs from those that struggled?

Hannah: One thing that became clear is that a successful CAHW program is not simply a training program. Training is one part of a much larger system.

The strongest programs had sustainable funding, ongoing training and continuing education, access to supervision, appropriate supplies and resources, and opportunities for CAHWs to develop professionally. Selecting the right people was also important. CAHWs need technical skills, but they also need to be motivated, trusted within the community and able to communicate effectively with the people they serve.

Community support was one of the strongest components across the programs in my research. That makes sense because CAHWs often succeed precisely because they are accessible and already part of the community.

But sustainability also depends on what surrounds them. A well-trained person cannot provide consistent animal health services without access to medications, equipment, veterinary advice, continuing education or a way to support themselves financially.

So the question becomes less, “Can we train someone to do this?” and more, “What system needs to exist around that person so they can continue doing it safely and effectively?”

Q: Your research found that many CAHW programs encounter the same problems repeatedly. Why do these challenges persist?

Hannah: This was one of the most important findings for me. There have been CAHW programs operating internationally for decades, but there is limited long-term evaluation and relatively little comparison across programs. As a result, similar problems can occur again and again without the lessons necessarily being carried forward.

Training without adequate follow-up is one example. CAHWs inevitably encounter situations outside their initial training. If there is no accessible veterinary supervision, mentorship or refresher training, maintaining confidence and quality of care becomes difficult.

There can also be practical gaps: inadequate supplies, inconsistent data collection, limited funding and insufficient compensation. Research has shown that inadequate training or support can have consequences ranging from improper wound management and medical-waste handling to inappropriate medication use, including risks related to antimicrobial resistance.

That is why I see continuing education, mentorship and telehealth as essential rather than optional. Some programs also provide short placements or refresher opportunities where CAHWs can experience different clinical environments and more advanced procedures.

Training creates initial capacity. Continuity is what protects and strengthens it.

Q: Your findings also point to a tension between standardization and flexibility. How do you maintain quality without imposing a one-size-fits-all model?

Hannah: I don't think standardization and flexibility have to be opposites.

Certain elements should be standardized. CAHWs need clear competencies, appropriate training materials, defined scopes of practice, supervision and ways to evaluate whether services are being delivered safely and effectively. Data collection and record keeping are also important, both for monitoring animal health and for understanding whether the program itself is working.

But the way those elements are implemented needs to remain flexible.

A CAHW program in a livestock-dependent community in East Africa may have very different priorities from one serving dogs in a northern Canadian community. The diseases, animals, geography, available infrastructure, regulations and cultural relationships with animals may all differ.

So I think we should standardize quality, but not standardize communities.

For northern Canada, that means beginning with local knowledge and a community-led needs assessment rather than arriving with a predetermined program. It also means involving community members, veterinarians, policymakers and other local knowledge holders early enough that they can genuinely shape the model—not simply react to something that has already been designed.

Q: CAHWs are sometimes thought of primarily as people who provide basic animal care. Does their potential role extend beyond that?

Hannah: Absolutely. One of the reasons CAHW programs are so relevant to One Health is that their role can extend beyond treating individual animals.

Because CAHWs are present within communities, they can contribute to disease surveillance by recognizing unusual health patterns, recording treatments and illnesses, and connecting that information with veterinarians or public health systems. This can support earlier detection and prevention of diseases such as rabies and other zoonoses.

Quality CAHW programs can also support antimicrobial stewardship through education about appropriate medication use and dosage, and contribute to environmental health through safe disposal of medical waste and locally appropriate approaches to animal population and livestock management.

Data becomes very important here. When CAHWs consistently record animal health information, that information can help identify disease trends, improve programs and strengthen preparedness for future health or environmental emergencies.

It can also demonstrate impact. Communities need evidence if they are going to advocate for policy support or secure longer-term funding. In that sense, data collection isn't simply an administrative task—it can become part of building a sustainable local animal health system.

Q: When you travelled to Gjoa Haven, what did you learn that the international evidence couldn't teach you?

Hannah: Gjoa Haven gave me a much deeper appreciation for the importance of relationships and local knowledge.

During our knowledge-exchange activities, community members were highly engaged. They asked questions, shared concerns about animal health and talked openly about the roles dogs play in the community. What struck me was how much knowledge was already there.

Many community members had developed an incredible ability to understand dog behaviour through years of close observation and experience. That kind of knowledge is different from veterinary training, but it is still expertise.

That changed the way I thought about knowledge exchange. It shouldn't be one-directional, with researchers or veterinarians arriving to teach a community. Veterinarians bring clinical and technical knowledge, but community members bring cultural knowledge, practical experience and an understanding of local animals and local realities that outsiders simply cannot have.

Even the way we shared information mattered. Materials were available in English and the local Inuktitut dialect, and a local translator helped make the community event more accessible. Those details may seem small, but they are part of building trust and creating space for genuine participation.

For me, Gjoa Haven reinforced that the strongest model is based on two-way learning.

Q: If training is only the beginning, what does a sustainable animal health system need to build around a CAHW?

Hannah: It needs several interconnected layers of support.

CAHWs need practical experience alongside veterinarians so they can build confidence and apply what they have learned in real situations. They need ongoing mentorship and a way to contact veterinary professionals when they encounter something beyond their scope. In remote communities, telehealth can be particularly valuable for maintaining that connection between veterinary visits.

They also need continuing education, reliable supplies, clear responsibilities and opportunities to learn from other CAHWs. Community feedback needs to continue throughout the program so it can adapt as priorities change.

Monitoring and evaluation should also be built in from the beginning rather than added at the end. Success will not necessarily look the same in every community, so communities should help determine which outcomes matter locally. At the same time, collecting consistent information can demonstrate whether the program is improving access, supporting disease prevention and strengthening local capacity.

Ultimately, sustainability means moving away from a model where outside veterinary teams are the entire system. Visiting clinics can remain an important part of care, but CAHWs can create continuity between those visits and connect communities to a broader network of veterinary expertise.

Q: You’ve said CAHWs should ultimately be recognized as skilled professionals rather than simply volunteers. Why does professionalization matter?

Hannah: Compensation was an important sustainability issue in my research. Programs can struggle to retain CAHWs when people are expected to provide skilled, valuable services without enough compensation to support their own livelihoods.

That affects more than retention. If the role isn't sustainable for the person doing it, it becomes difficult to maintain consistent services, supervision and follow-up within the community.

I think there is an opportunity in northern Canada to think more deliberately about recognized credentials, clear scopes of practice and career pathways. CAHW training could provide transferable skills and potentially introduce Northern and Indigenous youth to careers in animal health, while continuing education could allow existing CAHWs to build their skills over time.

There are regulatory questions that need to be considered as well. CAHWs are not veterinarians, so programs need clarity around what they can safely provide, when veterinary supervision is required and how their competencies are recognized.

Partnerships between communities, governments, veterinary organizations and educational institutions could help create that structure. If CAHWs are going to become a meaningful part of the animal health system, their role needs to be supported as one.

Q: If we looked ahead ten years, what would tell you that community-led animal health care in northern Canada had truly succeeded?

Hannah: Success would not mean that every northern community suddenly had the same CAHW program. In fact, I would hope they didn't. It would mean communities had been able to develop animal health systems that reflected their own needs, priorities and relationships with animals, while having access to the veterinary expertise and resources needed to support them.

It would mean CAHWs had appropriate training, recognition and support; communities could define and measure what success meant for them; and programs had enough evidence and stability to secure sustainable funding rather than continually relying on short-term projects.

What gives me optimism is that so much of the foundation already exists. In northern communities, I saw tremendous knowledge, commitment and deep relationships between people and their animals. Communities don't need someone to come in and tell them how to care for their animals. They already have knowledge and strengths to build from.

CAHW programs can add veterinary expertise, practical training, mentorship and resources to that foundation. The goal isn't to replace local knowledge or create permanent dependence on outside organizations. It's to strengthen local capacity so communities can increasingly lead and sustain their own animal health systems. To me, that would be success.