Impact matrix analysis and cost-benefit calculations to improve management practices regarding health status in organic dairy farming

Final Report Summary - IMPRO (Impact matrix analysis and cost-benefit calculations to improve management practices regarding health status in organic dairy farming)

Executive Summary:
The organic dairy sector has developed rapidly. Premium prices reflect the consumer expectation that animal health is better in organic than in conventional systems. An interdisciplinary EU-project (IMPRO) aimed to assess the current state and investigate options to reduce the prevalence of production diseases (PDs). Results of on-farm assessments in four different European countries (DE, FR, SE, ES) revealed that PDs varied a lot between organic farms and did not generally differ from levels reported in conventional dairy farms. It is concluded that the enhanced minimum standards approach in organic agriculture has failed to promote a reduction in PDs. Generalised recommendations for health measures are often both ineffective and inefficient as they do not always suit the specific farm situation. They result in hindering farmers’ readiness to invest in costly health measures. Farmers often do not know which measure they should prioritize in order to combat particular problems and which investments could provide an appropriate return on capital.
Within IMPRO, a farm centric and equifinal approach has been developed, based on the principle that the same end state (low level of PDs) can be achieved via different paths. The new approach to provide ways of reducing selected PDs (mastitis, metabolic and fertility disorders, and lameness) is based, inter alia, on an impact matrix as a participatory concept (involving farmer, veterinarian and advisor) for diagnostic work. The feedback from the project was encouraging and provided positive incentives for further development of a farm level diagnostic approach. Competition would be an effective motivator if reduced levels of PDs made an impact on farmers' market returns.
Additionally, a pilot project was conducted to deal with the question whether the use of homeopathy and phytotherapy holds potential to replace the use of antibiotics in treating bacterial infectious diseases keeping negative side effects to a minimum. Literature reviews revealed that cure rates after treatment with either antibiotics, alternative treatments or a placebo varied greatly between the studies. None of the scientific studies with alternative products have been re-produced. Thus, the use of homeopathic or phytotherapeutic products cannot claim to have a reliable and repeatable effect and a prognostic validity. Evaluations on organic dairy farms in Germany, France and Spain revealed that each farmer had developed his/her own treatment strategy; regardless of the principles of homeopathy. This contradicts with the principle that remedies are means to an end. Effectiveness of treatments in farm practice is highly context-dependent. It requires a lege-artis procedure, including follow-up checks, documentation of the recovery progress, and the involvement of highly skilled people. Otherwise, alternative treatments are at risk to increase health and welfare problems due to lack of therapeutic success and thus extended suffering of diseased animals. Deciding which level of therapeutic success and what prevalence of PDs is acceptable should not be left to each farmer to decide for themselves. These values are essential to the common good and should be set using external reference values.
The large PD variation amongst organic dairy farms goes against consumers’ expectations and conflicts with the ethos of a brand label reflecting greater homogeneity. The EC should particularly focus on farms with below-average performance. Farmers who produce products at lower production costs yet risk higher prevalence of PDs are favoured above farmers who invest money, time and effort without obtaining premium prices for higher quality. Thus, unfair competition is an important impediment to any possible improvements. To reduce and prevent unfair competition, regular monitoring of health data is required. In IMPRO, tools have been constructed that are suited to support this demand. Minimum standards should be supplemented by target values with respect to the prevalence of PDs. Processors, manufacturers and retailers should encourage farmers to place greater emphasis on tackling PDs by offering bonuses when a low prevalence of PDs has been achieved and penalties when a high one is present, in order to bring the milk payment system more in line with the premium value expected from organic dairy products.

Project Context and Objectives:
Animal health status in organic dairy farming does not in all respect meet consumers’ expectations. Improvements are crucial for welfare reasons and to support and strengthen consumers’ confidence and their willingness to pay premium prices. These are urgently needed to cover the higher production costs in organic farming and thus ensure a viable European organic dairy production. Previous herd health planning has contributed to improving farm management and has prepared the ground for further advancements.
The strategic aim of this project was to substantially overcome the weak points in current health management strategies on organic dairy farms and increase the possibilities for proactive herd health management. This was aimed for by a multidisciplinary and participatory approach to develop innovative and preventive solutions, involving researchers with a thorough experience in conducting applied research. Scientific and technological objectives of the project were accordingly:
• to develop a participatory and farm-centric tool for a sound diagnostic procedure at the farm level, identifying the most effective measures to improve animal health;
• to evaluate farm-specific costs and benefits of recommended measures, to optimise farm-specific allocation of available resources, and to emerge incentives;
• to examine the motivation and attitudes of farmer, advisor, and veterinarian directly involved in health management practice;
• to elaborate reference values for achievable standards for the animal health status;
• to develop a pro-active monitoring protocol aiming for improved effectiveness of preventive and treatment strategies and for a reduction in the use of allopathic remedies;
• to assess the manageability of alternative treatments according to the state-of-the-art;
• to develop a software-based tool including health monitoring, farm diagnostics’ procedures, cost-benefit calculation, and break-even analysis.
The rationale for this research proposal is that the animal health status in European organic dairy farms must be improved and the relatively weak success achieved so far by traditional herd health planning and management too. The most relevant weak points in herd health management are:
• The need for a comprehensive diagnostic procedure to assess the farm specific aetiology of the prevalent multi-factorial diseases has not been considered appropriately.
• Measures recommended by advisors, veterinarians or farmers often have not been validated with respect to their effectiveness and efficiency.
• While health plans follow general conclusions about interactions between individual health related factors, the huge variability of risk factors, their interactions, and the complexity deriving therefrom have not been considered adequately.
• Effectiveness of treatments either with allopathic or with alternative remedies to cure diseased animals although being crucial are often not addressed thoroughly.
• Constraints and conflicting areas at the farm level when facing limited availability of resources, e.g. labour time and incentives, are often ignored.
• Perception, attitudes and motivation of farmers in relation to animal health problems have been widely neglected, especially with respect to specific incentives for health improvements.
• Cost-benefit calculations are crucial to identify the most efficient measures and to provide incentives for the farmer to implement those measures to improve animal health.
• Perspectives and perception of advisors and veterinarians are seldom addressed, although playing an eminent role with respect to farm management.
Reasons for the current unsatisfactory situation in organic dairy farming are manifold and differ considerably between farms as do the multi-factorial production diseases. Identifying the main causes for the specific problems as well as the main constraints in farm management practices is essential when striving for improvements in animal health.
A profound diagnostic procedure at different scales (animal, herd, and farm level) is the starting point of any initiatives: the more comprehensive the diagnostic procedure and the more precise the diagnosis, the easier to identify the corresponding remedial measure. Thus, effectiveness and efficiency of health improving measures at different levels (e.g. farm management, preventive measures, treatment of diseased animals) are closely related to extent and soundness of the diagnostic procedure with respect to the aetiology of production diseases. Currently, the potential success of herd health planning is dependent to a high degree on the expertise and the persuasive power of those who give advice. Without a validation process with respect to the given advice, there is a high risk that the advice fails to be effective and efficient. It may derive from a narrow or self-centric perspective and/or based on insufficient expertise deduced from limited knowledge available by the persons involved. Additionally, it does not support progress to look for some positive results without knowing why they might have occurred. The majority of currently available supporting tools only consider the expected impact in relation to single diseases while for an optimisation a multiple disease approach is necessary. Moreover, advice is often based on extraction and application of general rules to individual farms, without accounting for farm specific characteristics as well as restrictions or limitations with respect to available resources. Due to the large variability with respect to farm structures, resources, constraints, and animal health problems deriving therefrom, there is a need to assess comprehensively the farm specific situation in relation to the prevalent production diseases, and the conflicting areas within the management while focusing on the farm as a farm system.
Improvements will only be possible if herd health plans are designed and targeted specifically in response to the disease profile present on an individual farm, requiring a comprehensive herd health monitoring concept, best provided by a software-based tool linked to different sources of data. To increase the preparedness of the farmers to implement the recommended measures it is of high importance to assess farmers’ attitudes and perception in order to communicate and address the recommendations appropriately.
In general, organic dairy farmers are expected to be motivated to obtain a high level of animal health, which is a principle of organic farming. Constraints that prevent farmers from seeking advice and making use of recommended measures are manifold. Often, the need for additional labour efforts and increasing cost for health improvements might prevent implementation. Therefore, cost-benefit relationships of recommended measures (efficiency) are essential to convince the farmer into action. Apart from the general option to honour a higher health status by premium prices, the most relevant incentives are expected when a plausible and sound argumentation can be developed showing where investigations in animal health management will result in monetary benefits that exceed the investments and contribute to additional values (Win-win-situation).
Scientific and technological objectives in detail
Development of a participatory and farm-centric diagnostic tool
A sound diagnostic procedure at the farm level is an essential precondition to identify the most appropriate treatments and management measures to improve animal health. The farm specific interconnectedness of health related variables will be assessed on dairy herds by making use of an impact matrix. The impact matrix serves as an innovative diagnostic tool to narrow down relevant factors involved in the development of multi-factorial production diseases at the farm level. Simultaneously, farm specific options and constraints to improve animal health status will be identified. The impact matrix is based on a participatory approach, involving farmer, veterinarian, and advisor. It will be used to gain a comprehensive insight from different perspectives and achieve agreement about a ranking order of the measures that are expected to most likely improve animal health in farm specific situations.
Cost benefit analysis
Given the current lack of information on the economic impact of production diseases in organic dairy farming, we will develop a partial budgeting model, which is able to evaluate the farm-specific costs and farm-specific benefits of recommended measures. We will also develop of a linear programming model to optimise the farm-specific allocation of available resources (constraints) by selecting the measures resulting in the highest improvement of health status on the farm or the highest improvement of farm income.
Mental incentives and barriers
Beside cost factors, thought patterns, perceptions and attitudes have to be addressed when striving for an improvement in health management. The project will examine the motivation of the stakeholders directly involved in disease management. Reactions and attitudes towards the participatory approach will be analysed. Farmers’ attitude towards preventive and treatment protocols will be assessed and possible constraints identified. In addition, farmers’ and veterinarians’ attitude, motivation, and knowledge about alternative treatments and expertise to correspond to the state-of-the-art will be evaluated.
Health status ex ante and ex post
Prevalence rates of production diseases and replacement rates will be assessed before making use of the impact matrix as part of a diagnostic procedure. Additionally, the status in relation to the specific estimations of the individual farmer, advisor, and veterinarian on how to improve animal health status will be assessed. Results gained ex ante will be compared with those obtained by the proposed procedure with respect to the farm specific measures identified to be most effective and efficient and with the ex post animal health status. Common ground and differences between farms and European regions will provide options to elaborate reference values for an achievable minimum standard with respect to prevalence rates, providing orientation for farmers, advisors, retailers, consumer groups and administration bodies at the regional, national and European level.
Improving monitoring and prevention on the herd level
By developing a pro-active monitoring protocol adapted to organic dairy production, we aim for improving effectiveness of preventive and treatment strategies. The phrase: ‘Prevention is better than cure’ will be assessed at the farm level with respect to the manageability, based on cost-benefit calculations, of the efforts needed to implement effective proactive strategies, and with respect to reduction in the use of chemically allopathic treatments.
Appropriate use of alternative treatments
The state of the art on alternative treatments in dairy, pig and poultry production, research projects in the field, findings that have been made, the degree of cooperation between institutes and the possibilities to reduce antibiotics will be assessed. Manageability of alternative treatments will be assessed by capturing farmers’ and veterinarians’ attitude, motivation, knowledge and expertise in relation to the state-of-the-art. Diagnostic procedures and the use of homeopathic and phytotherapeutic treatments will be assessed on-farm and reflected with respect to usability, feasibility, relevant preconditions necessary to apply the protocols and the demands for homeopathic treatments according the state-of-the-art. In addition, an overview of legal and factual prescriptions and constraints in connection with the use of alternative treatments in Europe will be generated. This will lead to policy recommendations regarding this topic.
Development of software-based tool
The single tools will be integrated into a comprehensive software-based tool including health monitoring, impact matrix serving as a diagnostic and participatory concept to narrow down the identification of the farm specific aetiology of prevalent production diseases, and appropriate farm specific measures suited to overcome constraints and improve animal health. The tool will include a protocol to calculate farm specific costs, cost-benefit and break even analysis. The software tool will be tested with respect to usability and feasibility on organic dairy enterprises by integrating feedback from the farmers, advisors and veterinarians involved in the test.
Widespread dissemination
The project structure is intended to make the best possible use of the project results by farmers, veterinarians, and other stakeholders, and to ensure fruitful exchanges with the scientific community. Key stakeholder groups will be integrated on different scales (farm, regions, European context) that will allow exchanges between researchers and major stakeholders and increase awareness of major challenges and solutions in organic and low input dairy systems. Regulatory bodies at national and at EU-level, organic farming and consumer organisations and other stakeholders will be informed about the results and innovations brought by the project. Dissemination of the obtained results and management tools will be ensured in co-operation with subcontractors in different countries across Europe to trigger technology transfer of project results to application on organic and conventional dairy farms. A knowledge platform will be established to support collaborative behaviour in the supply chain to increase the uptake of innovations.

Project Results:
1 Main results WP2:
1.1 Farm selection
The goal to recruit 200 organic dairy farms was reached, although the distribution was not equal between the countries. All farms fulfilled the overall project requirements, i.e. availability of test-day milk records since January 2012, organic for at least one year, expected to be in operation at least for the immediate future, and “common” herd size (not too small). Figure 1 shows the location of farms in France, Spain, Germany and Sweden. The locations of the 55 French farms were distribu-ted as follows: 24 farms in the department Morbihan, 24 farms in Loire Atlantique, and 24 farms in the region of Lorraine. The 60 German farms were located as follows: 11 farms in Northern Germany, 28 farms in Central Germany, and 21 farms in the South of Germany. The majority of the 28 Spanish farms were located in the green Spain model, i.e. in Galicia (11), Asturias (8), Cantabria (3), Basque country (3), Catalonia (1), and Pyrenean part (1), with one farm in the dry Spain model. The 57 Swedish farms were located as follows: 13 farms in the North and West Sweden, 15 Farms in the Central east Sweden, 23 farms in Central Sweden, and 6 farms in South Sweden. A complete description of the farms can be found in Deliverable 2.3. Some characteristics are briefly presented in Table 1.
1.2 On-farm protocol
An on-farm protocol to collect structural characteristics of the visited farms was developed and applied. The protocol was used to record information on animal health status, resources, management measures and general characteristics. In addition, a lameness assessment of the dairy cows was also performed during the visit.
1.3 Participatory and farm-centric approach
An approach to herd health advisory services that was participatory and farm-centric was developed. The approach involved a farm visit by an advisor and a veterinarian, which was done together with the farmer and, in the project, a researcher. Each visit started with a short farm walk focusing on the dairy herd, feed, and buildings. Subsequently, baseline data on animal health and welfare collected in a previous visit and retrieved from farm and milk records was presented by the researcher and used as a source of input for the first part of the discussion. After reviewing the baseline data, an Impact Matrix was filled by the farmer, the veterinarian and the advisor in a participatory process moderated by the researcher. The Impact Matrix analysis was performed to identify the farm-specific key variables which are expected to have a strong impact on the behaviour of the individual farm system, the knowledge of whom may support decision-making concerning animal husbandry and consequently animal health. The output diagram of the Impact Matrix was presented by the researcher and discussed with farmer, veterinarian, and advisor. Beside the identification of core driving factors, the approach contains a mediation capacity and enhances the participatory process, integrating the different perspectives and expertise of the farmer, the farm veterinarian and the farm advisor. At the same time an economic tool for cost calculations related to animal health was fed with data from the specific farm by the researcher. The outcome of the economic tool, which was developed in WP5 of the IMPRO project, provides an indication of the costs caused by a number of production diseases on the specific farm. The calculated costs were also used as background information for the following discussion.
After looking at the data reflecting the animal health status, the farm systems’ interrelationships and the calculated costs of diseases, the farmer was given the opportunity to express his/her view on the current animal health situation. The advisor and veterinarian were asked to comment on the farmer’s statement. For each of the four production disease complexes ‘metabolism’, ‘reproduction’, ‘claws and limbs’, and ‘udder’, and for ‘calf health’ (all countries except DE) the participants were asked to identify if they were (a) to be improved, (b) to be stabilized, or (c) in no need for action. If areas with the need for stabilization or improvement were identified, all participants were encouraged to make suggestions for potential management measures that contribute to the achievement of these goals, keeping in mind the systemic roles of related variables. Proposed and discussed measures were documented by the researcher. Those measures which the farmer could imagine to implement in the near future were merged into an action plan. The action plan is a common agreement on a farm-specific set of measures identified to be the most effective and tailored to the specific health problems, the possibilities and resources as well as limitations and constraints on the individual farm.
The approach was generally considered as a useful, albeit time-consuming, support for on-farm discussion about the animal health situation between multiple stakeholders. The Impact Matrix analysis needs to be supported with additional analytical tools, such as information from regular monitoring of health and productivity at the farm, to arrive at actual and concrete health plans. The level of expertise of farm veterinarians and advisors influenced the outcome of the approach significantly. Finally, the obtained scores in the Impact Matrix are very farm and situation specific which makes comparison, analysis and interpretation of the results of the Impact Matrix a challenge.
1.4 Health plans
The first step at each farm was to identify areas in need for improvement (or stabilization). Figure 2 presents the proportion of herds that identified a particular area as a target for improvement.
With the exception of France, udder health was the most common area to be identified as in need for improvements. In France, claw disorders were the main focus whereas metabolic disorders were identified as in least need for improvements. Swedish herds were least inclined to improve claw health. The individual health plans were set up according to the particular conditions in each farm. The level of detail of these health plans varied considerably and ranged from a very detailed description of what should be done to a more superficial identification of areas that should be investigated further. The health plans were indeed very individual, reflecting the farm centric approach, and thus cannot be summarized across countries or even within country.
The number of measures in the health plans varied between 0 and 21 per farm, where France had the lowest (median 1) and Sweden the highest (median 12). The health plans were generally implemented to a relatively high degree (median 67%), but with a large variation between countries where Spain had the lowest (median 33%) and France the highest (median 82%).
1.5 Ex-ante on-farm assessment of health
Data from the national recording systems was retrieved. The data in the databases are not freely available and in all countries permission from the participating farmers and database managers had to be received before the data could be collected. The national recording systems are not harmonized and recordkeeping is vastly different, as is the amount of information that is recorded. For the purpose of IMPRO, mainly data that was available in all participating countries was used, and transformed into a common file structure. Common procedures for calculations of key performance indicators (KPI) were therefore devised and applied by all countries. Indicators were calculated for the time-period before the first herd visit, i.e. from January 2012 until December 2012. Some KPI’s and their changes are presented in Table 2 and 3.
1.6 Ex-post on-farm assessment of health
The same data was retrieved from the national recording system also after the herd visits had been performed, i.e. from January 2014 until December 2014, in order to try to identify changes from ex-ante, but no systematic differences were seen.
2 Main results WP3:
2.1 Approach and outputs
A promising way to improve herd health on organic dairy farms is to promote the use of herd health planning activities by farmers, based on periodic monitoring of the herd health and implementation of preventive actions adapted to the situation of the farm. However, an important condition for the uptake of herd health planning activities by farmers is their perceived pertinence by farmers. A dialogue between farmers and their advisors is necessary to achieve a good relevance and perceived pertinence of advisory activities and recommendations on animal health management. Tools for monitoring and prevention that can be adapted to every farm situation in organic dairy production in Europe were developed in the IMPRO-project. The conception and the evaluation of the tools relied on the hypothesis that in order for the tools to be used and their effectiveness ensured, they should not only be complete and based on scientifically sound knowledge but should also promote the dialogue between farmers and advisors and be adapted to field-use.
Using a participatory research approach for the design a Herd Health Program Management (HHPM) program was considered the most appropriate approach to achieve its relevance on the field, aiming for acceptable tools, to be known and used by the targeted end-users. To promote innovation it is necessary to supplement scientific knowledge with local knowledge from stakeholders. Using a participatory research approach, brought together dairy farming stakeholders and scientists, to foster the dialogue between the two groups and develop innovative solutions for sustainable agriculture.
Outputs of WP3 consist of: (1) herd health monitoring and preventive protocols developed and improved with a participatory research approach; (2) a framework developed and implemented to evaluate the protocols; and (3) results of the evaluation after implementation in 40 organic dairy farms in different contexts of production in Europe (20 in France and 20 in Sweden).
2.2 Herd health monitoring and preventive protocols
Prototype versions of monitoring and preventive protocols and of a HHPM program using the protocols were developed, based on the most recent scientific evidence, the expertise of the research teams, and of external experts in animal health.
First, the main health disorders that are considered to have a negative influence on cows’ health, welfare and production were identified as targets of the HHPM program. Based on their importance in terms of possible negative impact on animal welfare, five health topics were selected: reproductive health and performances, udder health, locomotor disorders and metabolic disorders. Calf health was included, as it was considered as an area that receives relatively little attention in advisory programs, even though important calf mortality rates can be found on certain farms and veterinary drugs are used to treat sick calves. The research team applied the concept of a HHPM program as a basis for the conception and use of proactive disease monitoring and prevention tools. The general concept of a HHPM program is to create an interaction between monitoring and prevention activities, in a feedback loop: regular and frequent herd health monitoring activities are put in place and, for health topics identified as weak, putative causes are sought and preventive or corrective action implemented using the prevention tool. The subsequent monitoring activities can show whether the installed prevention activities improved the situation or not. Prevention activities can then be adapted and so on.
An initial draft of a herd health monitoring tool, which consisted of a set of health indicators with suggested alert levels and monitoring frequency, was conceived by the two research teams invol-ved (France and Sweden). Different sources of information were used to develop the monitoring tool, examples of indicators were drawn from the Welfare Quality® protocol for lameness, from the ‘Cow signals’-method and from the literature.
An initial draft of the preventive tools was designed for each of the five health topics, listing the risk factors per health domain. Experts in animal health acted as reviewers of the monitoring and prevention tools. These experts were animal health scientists, veterinarians and advisors from France and Sweden who were consulted for their technical knowledge of the health topic in question. The reviewers were asked to assess the tools on the following points: their scientific pertinence, whether elements where missing, if they were feasible for use in the field and to verify the level of details required. At least one expert was assigned to each protocol, however in general several reviews were performed to complement the tools.
Initial versions of the HHPM program and accompanying tools were submitted to potential end-users to identify key issues that could impair the compliance of users, in particular farmers, to the designed HHPM program. In dedicated workshops, they gave their feedback on the proposed initial draft of the HHPM concept and the tools. As national conditions could differ, in terms of existing farm system and advisory services, end-users both in France and Sweden were invited to participate. The participants’ recommendations, from both workshops, were combined and integrated, when possible, in the version of the HHPM program that was to be tested. The aim was to ensure the feasibility of the implementation of the HHPM program by the participants in their daily work context (Figure 3).
Version of the HHPM program to be tested
The HHPM program to be tested functions as follows (Figure 4): a standard list of herd health monitoring indicators and their thresholds indicating a herd health problem are provided to farmers and their advisors. At the start of each visit the monitoring indicators have to be verified. When one or more monitoring indicators reach the alert threshold indicating a problem, this is expected to trigger the farmer and the advisor to open the corresponding prevention protocol to help them to identify risk factors present on the farm and decide corresponding actions to correct the situation.
To improve the monitoring tool, workshop participants’ thoughts on that subject were taken into account in the test version of the HHPM program and its tools: at the start of the HHPM program, farmers were allowed to choose freely indicators, corresponding alert thresholds and monitoring frequency for the herd health monitoring of their herd, together with their advisor (Figure 5). Figure 3 describes the proposed method to co-construct a farm specific monitoring tool.
The prevention tool test version displays participants’ recommendations in the sense that it is organized in ‘objectives to attain’, rather than proposing a detailed list of recommendations of good management practices (Figure 6). Prevention protocols were organized per health topic and were subdivided in more specific health problems. For example, calf health were subdivided in neonatal mortality, diarrhoea, respiratory diseases and umbilical infections. All risk factors of disease were listed, marked as major or minor risk factors and organized in themes, such as feeding, housing and hygiene.
2.3 Framework and research strategy to evaluate the protocols and HHPM
Framework and intervention study
A framework was designed to evaluate the protocols and HHPM programme. The steps and criteria to be evaluated considered health management practices, relationships between the famers and the advisor, and herd health situation. Results were considered at implementation, in the short and in the long terms (Figure 7). This framework and the details of the research protocols were discussed in the stakeholders’ workshops (see above). The aim was to ensure both the feasibility of the implementation of the HHPM program by the participants in their daily work context and fulfilling the research objectives. For that purpose not only the HHPM program was adapted, but also the research strategy and protocol for its evaluation.
An intervention study was performed in a total of 40 farms in France and Sweden. The choice of the two countries was motivated by the fact that they represent different contexts in terms of existing organic farming systems and animal health advisory services. After researchers’ introduction to the use of the HHPM program, the program was implemented by farmers and their advisors in animal health on the farms during a period of 12 months, without the presence of researchers. The impact of the HHPM program was evaluated based on: users’ compliance to the HHPM-program; the programs’ ability to fulfil its intended use, concerning monitoring and prevention activities; to stimulate dialogue between farmers and advisors; the programs’ ability to influence animal health monitoring and disease prevention practices and the programs’ effectiveness in terms of improving herd health.
Participants were asked to implement the HHPM program and have at least 3 farm visits per farm in a period of 12 months in Sweden and 4 in France, following visit 0. These visits were conducted in the absence of a researcher with the objective to mimic as much as possible a real-life advisory situation (Figure 8).
Evaluation of the compliance to the HHPM- program
As researchers were not present during the visits following visit 0, to be able to evaluate which elements of the HHPM-program were implemented, the advisor sent to the research team a report after each visit. Participants compliance to the HHPM program was evaluated, based on the number of visits performed, the implementation of monitoring activities as planned, the use of the preventive protocols after a herd health alert, the proposition of recommendations to improve a deteriorated health situation, the presence of a discussion on recommendations made during the previous visits and implementation of recommended measures of previous visits if there were any.
Evaluation of the HHPM program’ impact on herd health
To assess the effectiveness of the HHPM program in terms of improvement in herd health, health situations before and after the intervention were evaluated and compared to the evolution of the herd health situation in control herds from the corresponding countries. In addition, differences between French and Swedish farms were assessed. Herd health and (reproductive) performance indicators were calculated for two distinct periods.
2.4 Results of the proactive approach
The implementation of the HHPM program designed during this thesis proved to be able to stimulate dialogue between farmers and advisors. This was facilitated by certain of the adaptions made to the HHPM programs’ tools during its participatory design process with potential end-users, such as the co-construction step of the monitoring indicators and the choice of ‘objectives to attain to prevent disease’, rather than a list of recommended measures to implement.
The participatory approach to co-construct a herd health monitoring tool tested on the 40 organic dairy farms led to the creation of unique herd health monitoring tools on each participating farm (Figure 9). Even in Sweden, where farmers are more used to work with standardized health indicators, all farmers chose a unique set of indicators. All farmers accepted to monitor multiple production diseases simultaneously. Moreover, the discussion on the choice of indicators proved to be a source of information on farmers’ objectives and the animal health situation.
Among 40 farmers/advisors, 89% monitored all health topics. In case of a health alert, 79% discussed on the risks and prevention with the prevention protocols and most agreed on recommendations for change in practices. In the short-term, one third of the farmers were able to implement all the recommendations (some needing time or budget not yet available). This information can be used by advisors to adapt their advice and/or advisory services to farm specific situations. For advisors this method can be seen as a concrete example of how to initiate HHPM programs on farms. The designed HHPM programs’ tools serve different functions. The content of the monitoring and prevention tools provides users with documents that summarize and organise the most important information on the most common production diseases of dairy cattle. The creation of these protocols was a time-consuming process (several months of work of two persons) and required the expertise of different experts in animal health management. It can be used as a manual to look up information on certain disease conditions, as a checklist to identify risk factors present on the farm (in a pro- active or reactive way). The HHPM program provides thus technical support for the management of production diseases. Moreover, certain of its expected functional uses were acknowledged by most of the participants, such as its ability to identify health problems at an early stage and the identification of relevant risk factors in case of herd health problems (Figure 10).
The tool has been shown to have the capacity to influence different factors that are determining the perceived pertinence of advice by farmers, e.g. it contributes to the exchange of information on farm objectives and constraints, and connects health management practices to health outcome. The approach chosen to evaluate the HHPM program’s effectiveness allowed to evaluate; participants’ appreciation of the effectiveness of the tool on herd health, compliance to the program, its influence on the relationship between farmer and advisor and the tools’ functionalities. An effect on herd health was not found, but this might be due to methodological difficulties of evaluating such complex interventions. The evaluation of the whole implementation process allowed showing that the program can function in field conditions. Furthermore, seen from an action perspective, feedback from the participants allowed identifying areas for improvement of the tools and provides stakeholders and decision-makers with detailed information on the context within which it was implemented.
IMPRO has produced two innovative and effective tools available for monitoring and prevention. It revealed the importance of a participatory approach to design and implement such protocols. In particular, the necessary adaptation by farmers of the tool for their own farm shows that ‘one-size fits all’ approach for health management programmes is not relevant but a common framework to develop a health management programme adapted to each case should be preferred.
3 Main results WP4
The appropriateness of treatments is not only reliant on the efficacy of the remedies under standardized conditions, but depends to a high degree also on the presence of crucial factors on the farm level which are required to achieve a high therapeutic success. These include among others: expertise to formulate a profound anamnesis and diagnosis according to the leading symptoms, diagnosis in relation to potential resistance to therapy, availability of expertise on alternative treatments, options for the appropriate application of remedies, and last but not least for the consecutive control of the therapeutic success.
3.1 Protocol and decision trees for homeopathic treatments
To assess the manageability of alternative treatments according to the state-of-the-art, farms protocols / decision trees for the diagnostic procedure and the use of homeopathic treatments in the case of most frequent diseases appropriate for homeopathic treatment (including mastitis, endometritis) have been developed in co-operation with experts from the International Association for Veterinary Homeopathy (IAVH). The decision trees are seen as suited to serve as guidance and reference regarding the state-of-the-art.
3.2 Assessment of manageability and preconditions
A comprehensive on-farm assessment was conducted to estimate whether the requirements, necessary to apply the protocols and the demands for homeopathic treatments according the state-of-the-art are prevailing under commercial conditions. For this purpose, five different questionnaires were developed in collaboration with IAVH members to gain insight in the expertise of farmers; the farm management; the use of homeopathy by farmers; the use of homeopathy by veterinarians; and the point of view of veterinarians who were not familiar with homeopathy. Before the questions were addressed to the target groups, a final testing under the conditions of farm practice was performed by scientists in each participating country resulting in the questionnaires’ final version. A total number of 64 farms were visited in Germany, France and Spain, respectively. Farmers were interviewed face to face by researchers and native homeopathic veterinarians.
The results of the survey displayed considerable heterogeneity in the use of homeopathic remedies on the farms within and between countries. The on-farm assessment of the conditions existing on many farms for homeopathic treatment often revealed poor hygiene and preventive management. Separate sick pens were rarely available. Most farmers used boxes for both diseased and calving animals without implementing some kind of disinfection measures. Early detection measurements (e.g. body condition scoring, foremilk samples, udder palpation, the California mastitis test, measurement of body temperature etc.) were rarely performed and - if implemented - seldom documented. Thus, structural and non-structural requirements on the test farms were often far from being appropriate to ensure an early detection of diseased animals and a target-oriented treatment.
The questionnaires to the farms revealed that there were no uniform treatment procedures among the farms in the use of homeopathy, neither for anamnesis, diagnosis nor for selection and application of the homeopathic remedy. Each farmer seems to have developed his/her own homeopathic treatment strategy; regardless of the principles of homeopathy. Moreover, most farmers only had a poor level of awareness of the principles of homeopathy; as evaluated by the homeopathic experts. In many cases, farmers’ behaviour was illegal by making use of homeopathic products not approved for food-producing animals without involving the veterinarian to rededicate these products for human use by following both European regulations and the cascade principle. The assessment of treatment success was mainly performed only visually by the farmers, increasing the risks that partially recovered or subclinical diseases can be overlooked resulting in relapse or chronic disease. Finally, it was revealed that homeopathic treatment and the outcomes were rarely or never documented. Therefore, no information about the homeopathic substances applied and the healing rates for food-producing animals under homeopathic treatments are available. The results indicate that a homeopathic lege-artis treatment of diseased food-producing animals is missing. For several reasons, farmers do not implement appropriate follow-up checks to assess whether treatment is effective in the farm situation.
Concerning the differences between the costs of homeopathic and conventional treatments, it was impossible to come up with valid data due to the numerous contributing and confounding factors involved. In general, the following estimations can be provided. While the costs for homeopathic remedies only contribute slightly to the total treatment costs, the time spent by a veterinarian in implementing the various parts of the whole treatment procedure and the salary he/she claims to cover the resulting labour seem to be the most relevant cost drivers. When looking at the comprehensive list of measures included in an accurate lege-artis treatment method, it is seen that most of these are only partly implemented in farm practice. Thus, farmers often try to spare expense by reducing the quantities they select from the total catalogue of possible measures the veterinarians offer. This often means farmers carry out what they feel able to, without a veterinarian. However, reducing the economic concerns of treatment mainly to the size of the bill (loss aversion) that has to be paid to the veterinarian is not compatible with the principles of organic agriculture. Such a narrow perspective not only ignores the high risk of weak therapeutic effects, the consequences for animal health and welfare and the associated extended suffering for the farm animals. The short-sightedness also ignores relevant economical aspects: particularly the negative side effects of unsuccessful treatment on the productivity of diseased farm animals, extended calving interval, the higher risks for the development of other diseases, the risks of pathogen distribution throughout the herd, and last but not least the increased risk of necessary culling.
Currently, the degree of attention and efforts to minimise production diseases and to increase therapeutic success is left to the subjective decisions of the farmers, increasing the risk of unsuccessful treatments and extended suffering for diseased animals. Farmers neither face penalties nor benefits regarding possible efforts in increasing treatment success. While ignoring the differences between milk from healthy and diseased cows and paying the same premium price, retailers do not offer adequate incentives but promote unfair competition. As a consequence, a high number of farmers strive for a reduction in labour and production costs to the expense of treatment success and animal health and welfare. The Commission Regulation (EC) No 889/2008 is not suited to prevent unfair competition and inappropriate treatment and should thus be reconsidered.
3.3 Comparison of allopathic and homeopathic treatments
A randomised clinical control trial (RCT) and a field trial were conducted to assess the effective-ness of the homeopathic treatment strategy. In the RCT, three treatment strategies (use of allopathy, homeopathy, and placebo) in the case of bovine clinical mastitis were assessed. The start of the RCT was delayed so that it was not possible to finalise the trial within the project period. While the trial will be finalised beyond the project period, the current report can provide only preliminary results. An additional study took place on 63 farms in Germany, Spain and France. The farmers were asked to keep comprehensive records of their treatments for mastitis with conventional and homeopathic remedies over a time period of a year.
The clinical control study revealed that homeopathic treatment achieved only poor cure rates in comparison to those of the placebo and antimicrobial treatments. In contrast, the antimicrobial treatment achieved the highest bacteriological cure rates. The follow-up check 28 days after the initial treatment revealed, that only 24 out of 127 infected udder quarters (19%) had fully recovered; mainly after an antibiotic treatment (46%), followed by the placebo (37%) and homeopathic treatment (17%). The different treatment strategies showed no impact on the health status of the non-treated three udder quarters of the cows.
The one-year-mastitis-study on organic dairy farms revealed curing rates which ranged between 20.8% up to 44.8% among the farms for a successful therapy of clinical mastitis when a homeopathic remedy was used.
Despite best possible conditions for the use of homeopathy in the RCT, no positive therapeutic effect could be evidenced. It can thus be expected that a homeopathic treatment will not obtain better results in daily farm practice. The clinical study indicates that a successful treatment depends to a high degree on the pathogen species that might have caused the clinical mastitis. For the responsible use of antimicrobial remedies, it should be mandatory to take milk samples for microbiological analysis before the start of a mastitis treatment. The choice of whether or not to use antimicrobial remedies should in the first place be made on the basis of laboratory results.
3.4 Investigating legal and factual conditions in Europe
Knowledge on the legal conditions and factual findings regarding the use of homeopathy in the EU is scarce. Therefore an overview and comparison between European countries was elaborated. The International Association of Veterinary Homeopathy was subcontracted to undertake the assessment by engaging veterinarian practitioners with expertise in homeopathy in various European countries. While the use of homeopathic products is regulated in most European countries, the extent and depth of detail of the regulations vary to a high degree between countries. Homeopathy can be used for treating food-producing animals in all European countries, where a feedback was available. In these countries (except Sweden), veterinarians are allowed to prescribe and administer homeopathy. Farmers are also allowed to administer in all these countries, except for Estonia, Latvia and Lithuania. There is no obligation for veterinarians to undergo training when they want to prescribe homeopathic remedies. Quite differently is dealt with the obligation to keep records and the control of these records. The same is true for the more specific regulations concerning homeopathic remedies and the related educational requirements. There are hardly any unitary remedies (without indication) registered for veterinary use in the Member States, although veterinarians, specialized in homeopathy, in general prefer to work with these remedies. It seems that the costs for this procedure are far too high for veterinary homeopathic remedies in relation to their potential revenue earning and are mainly avoided by manufacturing companies. In Member States with a tradition of the use of homeopathic remedies, homeopathic remedies are registered for both human and veterinary use. However, only veterinarians are allowed to rededicate human homeopathic products to be used for food-producing animals. On the other hand, some complex remedies (with indication) are registered for veterinary use, which can also be given by the farmer without prescription from a veterinarian.
The factual findings revealed that in most countries, farm animals are only treated with homeopathic remedies by veterinarians to a limited extend. In a few countries (Austria, Germany, France) such treatment is somewhat more common. Half of the respondents rated that they use homeopathy in more than 30% of their treatments. In countries where homeopathy is more commonly used, the respondents saw partly good options for the education and training of veterinarians in homeopathy. In most countries, the use of homeopathy on farm animals was estimated to be higher than the proportion of veterinarians using homeopathy for farm animals. However, due to the fact that only veterinarians were questioned, a considerable number of unrecorded treatments conducted by non-veterinarian practitioners and farmers can be assumed. Moreover, the quality of information received from the respondents differed considerably between countries. Overall, the results strongly indicate that the use of homeopathy in European Countries is highly heterogeneous.
The heterogeneity in the legal conditions in European countries regarding the use of homeopathy emphasises the need to harmonise rules within the EU. On the other hand, the EU-Guidelines on veterinary medical products are not well adapted to the peculiarities of homeopathic veterinary products. The factual findings revealed that the expertise in homeopathy and the remedies available in farm practice varies considerably between farms and countries. An animal health inspection and monitoring procedure should be established which provides information on the effectiveness of treatment in farm practice to avoid prolonged suffering of diseased animals.
4 Main results WP5
Because tools and approaches have to be adopted by the farmers in order to take effect, the objective of WP5 was to identify potential incentives and socio-economic barriers towards improvements with respect to animal health on organic dairy farms.
4.1 Analysing farmers’ perception towards animal health problems
The first part of WP5 (Task 5.1) was aimed at determining the importance of the management area animal health in relation to other management areas (calf rearing and grassland management). After all, to dairy farmers animal health is only one aspect of farm management and resources may be allocated to other more preferred areas. Without knowledge about the relative importance of animal health to farmers, (veterinary) advisors may experience this as non-compliant with their advice. An adaptive conjoint analysis was performed to elicit farmers’ preferences within the EU. This conjoint analysis was carried out in collaboration with the first farm visit in WP2. A total of 215 farmers participated originating from 70 French, 60 German, 28 Spanish and 57 Swedish organic dairy farms. The management areas udder health and claw health represented animal health management whereas barn, calf and pasture management represented potential conflicting management areas.
Because four managerial areas were evaluated (grassland management, calf rearing, claw health and udder health), the preference scores would be 25 % if farmers were indifferent in their preferences for these managerial areas. Results (Table 4) indicated that EU organic dairy farmers differed in their preferences for improved animal health management within the farming system. In general, improved calf management was the most preferred area and improved claw health management was found to be least preferred. Part-worth utilities within the managerial areas showed that proper colostrum supplementation was seen as very important. Cluster analyses on claw health and udder health measures resulted in respectively seven and nine distinct preference profiles. Unawareness of veterinary advisors of an advice directed at an unfavourable management area could explain why individual farmers remain non-compliant with the advice. This knowledge will allow veterinary advisors to improve their advice by showing e.g. the potential benefits of their advice.
4.2 Evaluation of the intention and motivation to implement recommendations
In a further part of the work, a study in the same four countries examined farmers’ intentions towards improving the animal health status of their organic herds. To do so, the Theory of Planned Behaviour was used. The first study was merely descriptive and aimed at explaining differences between farmers (task 5.2). It was found that dairy farmers across the four countries were positive about taking additional preventative measures to improve the health status of their herds, measured as the intention to improve the health status of their herds. They believed this would result not only in improved herd physical performance, such as milk yield and fertility, but also in greater cost effectiveness and improved job satisfaction for them. From the statistical analysis, it appeared that the farmers’ background attitude was linked to the intention to improve the health status of their herd. Thus, a number of interesting predictors of the intention to improve health emerged (Table 5).
Most study farmers would implement a tailored package of health improvement measures designed by the study team. Higher rates of uptake are most likely in the case of younger farmers. Also farmers who make greater use of veterinarians and professional advisory services and those supplying specialist milk-marketing chains are expected to implement recommended measures to a higher degree. Furthermore, farmers will be most likely to take-up additional health promotion if it is compatible with their everyday farming activities and if they have strong business performance goals aimed at maximising the physical performance of the herd.
4.3 Development of an economic module to evaluate the required resources and benefits of recommended measures
In task 5.3 the costs-benefit relations of health related measures were studied. Besides understanding determinants of farmers to reduce the prevalence of production diseases on their farm, it is important to evaluate the economic consequences. To give a good advice to the dairy farmer, veterinarians and animal health advisors should estimate the costs of disease as correctly as possible. Failures to do so may lead to wrong priorities in animal health management advice.
The first objective of our study was thus to explore the costs of mastitis, lameness, ketosis and metritis as estimated in practise by farmers, veterinarians and animal health advisors. The second objective was to estimate the costs of each disease using a disease costs estimation tool. The third objective was to study whether farmers, veterinarians or advisors tended to over- or underestimate the costs of disease. During the second farm visit (WP2), the farmers were asked to participate in this study and to make their herd health records available for the cost estimations. The veterinarian and farm health advisor of each participating farm were asked to participate along with the farmer to calculate the farm specific costs.
To estimate the disease costs of mastitis, ketosis, lameness and metritis a cost estimation tool was constructed in which disease costs comprised the following parts: milk production losses, discarded milk, treatment, culling and destruction. Technical model input included: number of dairy cows, number of cases of clinical mastitis, SCC, fat/protein ratio, treated cases of ketosis, number of culled or death cows. Economic model input included: milk price, feed costs, costs of labour, slaughter value, replacement value, penalties paid and bonuses missed. For each economic input value, a country specific reference value was given. During the second farm visit (WP2) the farmers, veterinarians and advisors were first presented with the overall performance of the dairy herd (e.g. milk yield, number of cows) and current health situation (e.g. number of (sub)clinical cases, SCC and lameness scores) and asked to estimate the total costs for each disease separately and solely based on these records. Secondly, the costs estimation tool was performed and results were presented and discussed with the farmer, veterinarian and advisor.
The participating farmers did not think they were able to estimate the costs of disease since they felt not qualified to estimate these costs. The costs of mastitis on herd level were assessed by the disease costs estimation tool at an average of €8,050/year, €10,613/year and €11,099/year for German, Spanish and Swedish farms. The costs of lameness were assessed at an average of €4,579/year, €2,565/year and €3,357/year for German, Spanish and Swedish farms. The costs of ketosis were estimated at an average of €2,152/year, €345/year and €2,405/year for German, Spanish and Swedish farms, respectively. The costs of metritis were estimated at an average of €2,060/year, €477/year and €460/year for German, Spanish and Swedish farms, respectively.
On average, the costs of mastitis, lameness, ketosis and metritis were underestimated by more than 50% 32%, 40%, 49% and 40% of all cases and overestimated by more than 50% 19%, 23%, 27% and 45% of all cases. During a farm visit, farmers, veterinarians and advisors gave estimates which were, generally, in-line with each other’s response. From this task, it can be concluded that disease costs varied substantially within a country due to different input, either economic or technical. The farmers, veterinarians and advisors were found to either overestimate or underestimate the costs of production disorders by a substantial amount. Besides, some farmers, veterinarians and advisors found themselves unqualified to estimate the costs. Because economic arguments are, at least partly, a reason to adopt preventive measures or not, these results stress the importance to use a structured framework when estimating the costs of production diseases on-farm, before advising preventive measures.
The developed tool was further developed to be able to use in practise to estimate the failure costs of production diseases as well as to evaluate the cost-effectiveness of preventive measures.
4.4 Development of a linear programming model to optimise allocation of resources in managing multi-factorial syndromes
In the next phase (task 5.4) a theoretical framework was developed that can support farmers, veterinarian and/or animal health advisors in their decision making process towards animal health management and were to best allocate their scarce resources given the individual nature of each dairy farm. The proposed framework the “Animal Health Management Frontier” reveals the trade-off between preventive efforts made to reduce disease incidence and the effect this has on failure costs (Figure 11).
Via a linear programming technique a technical efficient frontier and current frontier can be constructed. These frontiers can be directly compared and yield useful insights in the efficiency of the current preventive effort made. Moreover, comparisons between multiple production disorders can be made to determine priority areas in animal health management. This approach was illustrate with an example where two diseases mastitis (M) and ketosis (K) are compared on a farm with a herd size of 100 dairy cows. In this case Cm,j is €235 and Ck,j is €120, NmaxM, is 35 NminM is 10, NmaxK is 90, NminK is 5%. Effort to reduce M is indicated by a rank score of 5 and effort to reduce K is indicated by a score of 2. Current FCT,curr of M are estimated at €4,500 and FCT,curr of K are estimated at €3,000. Solving for αeff,M, αeff,K, αfarm,M, and αfarm,K gives alpha values of 1.6 0.6 3.2 and 1.3 respectively. Two constructed frontiers (technically efficient and current) are presented for each disease in Figure 12, where the horizontal arrows represent an increase in effort and vertical arrows represents an increase in efficiency.
If the farmer increased the preventive effort by 1, this would result in a decrease of €178 in FCM and a decrease of €757 in FCK. Thus, increasing efforts in reducing ketosis prevention gives a higher pay-off than increasing efforts in mastitis prevention, even when the failure costs of mastitis are higher than the failure costs of ketosis. However, it is obvious in this example, that the farmer is not efficient. The current animal health management frontiers, both for ketosis as well as for mastitis are far above the technically efficient frontiers. If the farmer could become fully efficient, the same level of effort would yield a decrease of €1,816 in FCM and a decrease of €2,097 in FCK. Unless the estimated minimum incidence of disease was wrong, there is quite some room to improve the efficiency of currently applied preventive measures. As the figure shows, for both diseases the biggest gains can be attained by becoming more efficient, rather than increasing the levels of effort.
4.5 Policy recommendations on addressing animal health issues
Finally, a policy implementation document was created by partners 1, 4 and 7 (task 5.5). Within this document, the novel farm level diagnostic approach towards the improvement of animal health on organic dairy farms was explained. It was made clear that this novel participatory approach, including the necessary tools, has shown to be well received by dairy farmers and their advisors. Given the difference in expectations of consumers and the reality of a high level of production diseases on organic dairy farms, a wider implementation of the IMPRO approach is recommended. The EU Commission, National governments, dairy processors, retail and organic stakeholders all should play a role in further processes that are suited to improve the currently unsatisfying situation.
5 Main results WP6
The objective of WP6 was the development of a prefiguration of a software-based decision support tool for herd health management in organic dairy farming. It should integrate the different tools which were developed in the IMPRO project. In a test-phase farmer, veterinarians and advisors were asked to put tools from the current version of the IMPRO toolbox to use and to evaluate the usability. Results from the assessment will be used to improve the software applications. The IMPRO toolbox differs from other software applications in two aspects. The current prefiguration of the toolbox is a collection of working tools which are not yet combined into one application. Each of the tools requires extensive training to get familiar with the software and the method. Furthermore, the tools are designed to support a participatory approach to elaborate farm specific strategies aiming at a reduced prevalence of production diseases. Therefore, it is no standalone software but embedded in a methodological approach for a new and innovative advisory concept.
5.1 IMPRO toolbox
The toolbox contains tools for different aspects of the complex challenge of herd health management (Figure 13). The tools might be used separately but complement each other in aiming for a prioritisation of measures in relation to a specific farm situation. They are designed to be used by farm advisors and veterinarians as well as dairy farmers in a participatory manner (see D6.4).
While several tools were elaborated and applied in the different workpackages, the herd monitoring tool, the profitability assessment and the impact matrix module were developed within WP6.
5.2 Herd monitoring tool and Overview on Herd-Health data
Improvements of animal health will only be possible if herd health plans are designed and targeted specifically in response to the individual farm situation, requiring a comprehensive herd health monitoring concept. Easily assessable information on the herd health status can be obtained from milk recording data.
The Data Service Paretz Ltd. refined and enhanced their herd management software “HERDEplus” considering the demands of all project partners regarding an intensive health controlling and monitoring. In this regard, the focus was on the assessment of milk recording data, including milk yield and milk compounds (fat, protein, urea, somatic cell count) in combination with performance indicators for fertility and reproduction.
Evaluations of animal health are based on herd data. If not recorded directly by the users (farmers, advisors, veterinarians) on a daily base, required data can also be accessed from laboratories of the milk recording companies and central data sources. Data interfaces were developed on an international level and common definitions of indicators form the basis for a standardized use of data across all countries participating in the IMPRO project. For countries using the diagnosis codes of the International Committee on Animal Recording (ICAR), an additional analysis of the prevalence of different types of diseases is accessible.
For the test-phase, an overview on the herd health status was prepared with “HERDEplus” for each farm. The overview was based on the farms’ milk recording data and contained information on milk yield, somatic cell counts, udder health, nutrient supply, fertility and culling rates. The information was supplemented by results from the profitability assessment.
5.3 Profitability assessment
Currently, animal data are mostly not linked to economic data. No connections are made between economic figures of a dairy farm and courses of individual lactations, diseases of cows, culling etc. To provide an economical evaluation of the livestock, animal production data from “HERDEplus” were linked to costs and net proceeds from general economic farm data in terms of a cost-benefit-calculation. The “Profitability Analysis Cow” is currently a prototype based on Microsoft EXCEL. For the test-phase, the toolbox contained the results of the profitability assessment, provided by Data Service Paretz Ltd, for each farm.
An impact matrix is a concept for the application of a system approach to enhance an adaptive management approach. The basic concept is a square matrix built up by the system relevant variables, forming the rows and columns. The fields of the matrix, showing the impact from one variable to the other, are filled with figures from 0 to 3, representing the strength of influence. Calculating these figures reveals the systemic roles of each variable in the system in question.
Currently, the tool contains two prefigured sets of variables, one more general (13 variables) and one shorter variable set (8 variables). The list of 13 variables was used in WP2. It represents the perspective from a meta-level facilitating a view on the whole farm system. The level of aggregation covers the variation of structural differences between various organic dairy farming systems and the involved countries. The process and variables are presented in the deliverable D2.2 of the IMPRO-project. The definitions given for each variable, as well as the indicators are described comprehensively and easily assessable within the software. Experiences in WP2 revealed that the variables used in the matrix should be adapted to the farms specific situation. Therefore, different options for the impact matrix are provided in the toolbox: the very general set of 13 variables, used in WP2, and a more condensed set of 8 variables suitable to get to know a farm specific situation for a new advisor / veterinarian. Furthermore, individual variables sets, targeted to specific problem areas can be created. However, the elaboration of a variable list requires insight in the methodological approach and an understanding of the main features of the theoretical background.
5.4 Assessment of the test-phase
23 farmer, 15 veterinarians and 3 advisors in the United Kingdom and The Netherlands were involved and provided their assessment on the usefulness and usability of the tools. Most of the participants (56 %) valued the toolbox as a useful addition to their usual process of decision making, providing a better understanding of the herd health situation. The assessment revealed valuable insights on weak points in the tools to be used for further improvements.
At the same time it became clear that a new approach which is a tedious task because it forces participants to leave old path, change perspectives and deal with complexity and uncertainty, will only be broadly valued if other stakeholders (particularly retailers) put more pressure on the goal to reduce the prevalence of production diseases in organic dairy production which is urgently needed to justify the premium prices of organic labelled products.
6 Main results WP9
Because of increasing public concern regarding the development of antibiotic resistance, the question arise whether the use of alternative treatments particularly homeopathy and phytotherapy holds potential to replace the use of antibiotics in treating bacterial infectious diseases. This question cannot simply be answered with “yes” or “no” but is faced with a highly complex issue which depends on various prerequisites, including the efficacy of medicinal products under standardised conditions, the effectiveness of products under heterogeneous farm conditions, the availability of expertise to ensure therapeutic success, a cost-benefit outcome relationship where positives outweigh negatives, and last but not least keeping negative side effects that might compromise the issues of animal health and welfare (AHW) to a minimum. At the beginning of the project, two comprehensive literature reviews were conducted comprehensively considering previous scientific studies on the efficacy of homeopathy and phytotherapy in farm animals. Additionally, workshops were organised to grasp views and perspectives of different experts on this issue. Moreover, requirements for an effective use of phytotherapy in pig and poultry production were identified. Finally, economic considerations regarding the implications of the effectiveness of remedies were reflected.
6.1 Research projects in the field of homeopathy
In the case of homeopathy, search results revealed a total number of 62 trials performed within 48 publications fulfilling the predefined criteria. Thirty-one trials showed a significantly higher efficacy of the homeopathic remedy in comparison to a control group, whereas 23 showed no medicinal effect. Cure rates for the treatments with conventional remedies, homeopathy or placebo varied to a high degree. Looking at all the studies, not even one study was repeated under comparable conditions. Consequently, the use of homeopathy lacks any reproducibility and cannot claim to have sufficient prognostic validity where therapeutic efficacy is concerned. When striving for high therapeutic success in treatment, the employment of homeopathy in replacing or reducing antibiotics requires evidence of efficacy confirmed by Randomised Controlled Trials under modified conditions.
6.2 Research projects in the field of phytotherapy
Where phytotherapy was concerned, the majority of the 53 scientific studies identified showed limitations in the study design as well as for presentation and standardisation of the botanical remedies studied. This makes it impossible to compare studies on remedies derived from the same plant as well as reproducing these studies in the future. Although most studies tend to conclude that phytotherapeutic remedies have potential, it is not possible to draw firm conclusions. As was the case with homeopathy none of the scientific studies with phytotherapeutic products have been reproduced and thus impacts of phytotherapeutic products are lacking reproducibility.
In the past, only few research bodies in Europe have been involved in research on veterinary homeopathy and phytotherapy, with little manpower dedicated to the area. Insufficient support from funding bodies seems have led to a poor research infrastructure, although many of those questioned clearly expressed the need for more research in the area. This limits opportunities for efficient research on veterinary homeopathy and phytotherapy.
6.3 Different experts' views and perspectives
Two experts’ workshops, each lasting a whole day, were arranged to receive feedback on scientific reviews on the efficacy of either homeopathy or phytotherapy as well as to identify important factors influencing the effectiveness and use in research and farm practice. For each workshop twelve participants from 6-8 European countries with different expertise, background in research or veterinary practice, and varying positions towards homeopathy or phytotherapy were invited to share and discuss their views and opinions, guided by a professional moderator.
Participants in each workshop confirmed that the studies, evaluated in the reviews, showed various weak points in study design. In studies on homeopathy the individualised homeopathic treatment procedure was usually not appropriately considered. In studies testing phytotherapy, the specifica-tion of content or composition of ingredients and dosage of the applied botanical was generally poor. According to the workshop participants, main obstacles for homeopathic treatment were seen in the lack of expertise when using the remedies. The use of homeopathy by veterinarians in practice is also influenced by the corresponding national legislation (supporting or declining homeopathy). Homeopathic remedies for humans bought directly over the counter currently fill comparably simple and cheap possible gaps in availability for the use in food producing animals. They are usually applied without advice of an expert or the required veterinarian prescription.
Products of phytogenic origin can be found under various terms and the same botanicals are used as remedies and feed additives. Only few registered veterinary phytotherapeutic products are available, potentially due to high costs for approval combined with small profits and no protection or patent of the composition or content of the product. Investment in research and development is often not attractive for manufacturers. As a consequence, botanical products are sold and used as feed additives, which leaves decisions on indication for treatment and dosage to the farmer. Without adequate knowledge regarding which level of efficacy can be expected from different botanicals and which dosage is required to achieve it, a results-driven use of these products cannot be expected. A general estimation was that veterinarians and other users are often lacking sufficient expertise in phytotherapy and homeopathy, respectively. Profound knowledge about the effectiveness of treatments in farm practice does not exist and documentation of treatments and especially of the outcomes is not established on farms.
In order to identify appropriate alternative strategies, studies in farm animals for the reduction of antibiotics should be supported. The efficacy of alternative treatments, as well as dosage and indications for treatments, should be proven by a scientific approach using an appropriate study design, particularly Randomised Controlled Trials (RCT). According to the workshops, this type of study design is applicable to homeopathic and phytotherapeutic products although some adaptations to the specific need of a homeopathic treatment procedure or phytotherapeutic guidelines are required. Guidelines for standardisation of phytotherapeutic remedies on content and ingredients or - for multicomponent herbs - by metabolomic fingerprinting, could support transparent research, reasonable use and appropriate dosage. Currently, homeopathic and phytotherapeutic products are often not registered for veterinary use and therefore not available for treatment by veterinarians. It was proposed to adapt legislation to better describe phytotherapeutic remedies as a class of products and harmonise with human regulations. A registration procedure for veterinary homeopathic and phytotherapeutic remedies on a European level could improve the availability of these remedies for veterinarians.
Effectiveness of any treatment, conventional or alternative, applied in practice depends upon several external factors. Thus, promising results in scientific studies concerning the efficacy of remedies require further evaluation of the effectiveness in practice. To achieve this, it is necessary to monitor the use and effectiveness of treatments by establishing a monitoring programme, documenting the use of treatments, alternative as well as conventional, combined with the monitoring of production diseases on the farm level. Such information is essential for the individual farm as well as for large scale studies to assess the impacts of (new) treatments, interventions or diseases for the benefit of animal health and welfare and food safety. Current use of homeopathy and phytotherapy is mostly performed by lay people as established and standardised expertise and training is not available. This is critical for an appropriate and effective use and especially with respect to the animal welfare issue, as ineffective treatments will extend suffering of diseased animals. Veterinarians, trained in this way, should supervise the treatment of food-producing animals with homeopathy or phytotherapy, too. Beside the need of further RCTs to prove efficacy of remedies, there is simultaneously a need to establish a monitoring system to assess the effectiveness of treatments in farm practice and to shed some light into a farm practice that currently lacks transparency.
6.4 Preconditions for an effective use of phytotherapy in pig and poultry production
To gain insight regarding the current use of phytotherapeutic remedies on conventional pig and poultry farms in France, Germany, Netherlands and Spain, and the context in which these remedies are used, a questionnaire was circulated. The results showed considerable heterogeneity in the use of phytotherapeutic products, but the main purpose seemed to be prevention. In many cases, essential prerequisites for the target-oriented and effective use of phytotherapeutic products were missing. Inappropriate diagnostic procedures and monitoring of treatment success as well as the limited availability of expertise made it hard to establish an appropriate level of therapy success on the farm level.
6.5 Simulation models for the economic evaluation of therapies in broiler and pig farms
Normative models for broiler and pig farms were developed to simulate the economic impact of infection diseases. The models can simulate various infections, diagnostic protocols and treatments. The models were demonstrated on infectious diseases in broilers and fattening pigs that cause growth impairment or increase mortality. These simulations give an indication of the economic importance of the cure rate that treatments have for these infectious diseases and how much financial gain could potentially be achieved by improving diagnostic procedures. Improved diagnostics may also be useful for the reduction of the use of antibiotics. As infections can be diagnosed earlier less animals may be infected which may reduce the amount of antibiotics required to treat animals or increase to possibilities to use alternative treatments. The results of the simulations indicate that earlier diagnosis and hence earlier start of treatment will increase the potential of treatments or strategies to deal with an infection. The findings of our study indicate that improved diagnostics will increase labour income of broiler and fattening pig farms, which means that there is financial room to improve diagnostics. Furthermore the simulations give an indication of the financial effect (i.e. changes in costs like death animals and revenues delivered live weight resulting in changes in the labour income of the farm) of various cure rates, which is useful in comparing treatment with antibiotics with alternative treatments.
6.6 Synopsis regarding options and limitations in the use of alternative remedies
The effectiveness of alternative treatments in farm practice represents a very complex issue and is highly context-dependent. Effectiveness is doubtful without a consistent implementation of a lege-artis procedure, including early registration of symptoms, detailed diagnostic procedure, removal of the main causes, selection of the appropriate remedies, follow-up check of the recovery progress and documentation of the success of therapy. Thus, the employment of homeopathy or phytotherapy in favour of conventional products cannot be sanctioned unless these alternative products are administered by highly skilled and responsibly operating people. Otherwise, alternative treatments might enhance the risk for increasing health and welfare problems due to lack of therapeutic success and thus extended suffering of diseased animals.
Apart from the significant uncertainties regarding the effectiveness of alternative treatments in farm practice, differences in their mode of action make alternative treatments largely unsuitable for the replacement of antibiotics for group treatment, being the main scope of application for antibiotics.
Improving preventive measures on the farm level and increasing therapeutic success by implementing a lege-artis treatment procedure requires considerable labour time and cost. In this conflicting area, farmers neither benefit when their animals have a high level of therapeutic success and low prevalence of production diseases (PDs) nor face penalties when they deviate considerably from the average. Furthermore, retailers do not offer adequate incentives and do not cover the additional costs which are necessary to improve the success rates of therapy. The farmers are thus left alone in managing the trade-offs.
Remedies are means to an end. However, the end result can vary widely, ranging from a missing to a complete recovery from problematic issues. Therapeutic success in the individual and cure rates on the herd level do not only depend on selecting the appropriate remedy but on the herd level, they are the result of the overall effort invested in the prevention and treatment measures. And vice versa, the level of envisaged cure rate determines the means and the degree of effort required to achieve the target sets in the context of the farm system involved. Deciding which level of therapeutic success and what prevalence of PDs is acceptable should not be left to each farmer to decide for themselves. These values are essential to the common good and should be set using external reference values.
Organic livestock production shows that enhanced basic standards cannot be expected to result in improved therapeutic success and the reduction of PDs. The impacts of the various influencing factors should be validated by studying the outcomes of the highly complex processes instead of focussing primarily on input criteria. The way farm specific disease prevention and treatment measures are managed certainly influences the prevalence of selected PDs and the issues of animal welfare and food safety. Thus, systems for monitoring selected PDs are urgently needed to provide orientation for all stakeholders, to check whether targets set are being achieved and to reduce unfair competition when animal products from farms with quite different levels of PDs and therapeutic success gain the same market price. Lacking economic incentives for successful and evidence based animal health management and penalties for the significant impairment of common goods, the current market conditions support unfair competition between farmers at the cost of animal health and welfare of farm animals.

Potential Impact:
1 On-farm assessment of effective measures by an impact matrix (WP2)
The organic dairy sector has developed rapidly over the last decades. Premium prices reflect (in part) the consumer expectation that animal health is better in organic than in conventional systems. Results of on-farm assessments in four different European countries (DE, FR, SE, ES) revealed that the prevalence of production diseases (PDs) varied a lot between organic farms and did not generally differ from levels reported in conventional dairy farms. It is concluded that the enhanced minimum standards approach in organic agriculture has failed to promote a reduction in PDs. Generalised recommendations for health measures are often both ineffective and inefficient when they do not suit the specific farm situation. On the other hand, farmers often do not know which measure they should prioritize in order to combat particular problems and which investments could provide an appropriate return on capital.
The equifinal approach of IMPRO is based on the principle that in open systems a given end state can be reached by many potential means (Figure 14 ). It emphasizes that the same end state may be achieved via many different paths or trajectories. While in closed systems, a direct cause-and-effect relationship exists between the initial condition and the final state of the system, open systems operate quite differently. Farm systems, as open systems by nature, can ensure a high adaptability of farm animals to heterogeneous living conditions and can achieve a low level of production diseases with different initial conditions and in many different ways. A low PD-level is the outcome of complex interactions between various factors within the farm system and which can be strived for by an appropriate farm management. From the farmers’ perspective, it is most important that he/she is encouraged to envisage the goal of a low PD-level if it is mandatory for all other organic competitors.
A sound diagnostic procedure at the farm level is an essential requirement to identify the most appropriate treatments and management measures to improve animal health. The farm specific interconnectedness of health related variables are assessed by using an impact matrix. The impact matrix serves as an innovative diagnostic tool to narrow down relevant factors involved in the development of multi-factorial production diseases at the farm level. Simultaneously, farm specific options and constraints to improve animal health status are identified. The impact matrix is based on a participatory approach, involving farmers, veterinarians, and advisors. It is used to gain a comprehensive insight from these different perspectives and achieve agreement about a ranking order of the measures that are expected to most likely improve animal health in the farm. The procedure enables an intersubjective identification of the most effective measures in the context of individual farms, expected to improve the prevalence rate of production diseases and replacement rates. In the IMPRO project, tools have been developed to apply the proposed participatory approach.
The IMPRO project delivers a novel participatory approach including the accompanying tools that can be used to reduce the prevalence of production diseases on organic dairy farms. Implementation of the participatory approach to animal health management on organic dairy farms will be both crucial to achieve successful improvements and at the same time difficult to achieve. The initial barrier will be farmers actually realising they have a problem and, then making the decision to change their practices. This decision, once taken, can then be brought into implementation with assistance from the farmers’ advisors and veterinarians, if consulted. However, it should be realised by policy-makers that organic dairy farmers in the EU are a diverse group who approach their farming from a range of different perspectives with varying goals and values. They also vary in age, training and levels of financial resources. The level of implementation depends on farmers’ motivation to do so as well as on their advisors’ beliefs in a new approach.
Advisors and veterinarians will need to assess whether the farmer they are advising in our recommended participatory approach is concerned about their poor animal health position either from a welfare approach, or a financial one, or both. Whichever stand point the farmers come from, it is likely that the cost effectiveness of the recommended change measures should be stressed in order to achieve full ‘buy in’ by farmers. It is well known that it is not easy to change people’s beliefs and habits with regard to animal health. Moreover, it has been shown (amongst others in the IMPRO project) that these beliefs and habits greatly differs between farms as well as between advisors. Therefore, support is needed to overcome resistance and/or barriers to change their habits and beliefs.
The feedback from the project was encouraging and provided positive incentives for further development of a farm level diagnostic approach and may have positive effects on future health planning activities /Herd Health and production management (HHPM) in (organic) dairy production. Farmers would be encouraged to work towards a low level of PDs if this goal were mandatory for all organic competitors. Competition would be an effective motivator if reduced levels of PDs made an impact on farmers' market returns.
The need for benchmarking of health status in (organic) livestock production was recognized and thus that harmonized and comparable data need to be available across Europe. All stakeholders identified that the current health status of organic dairy production is not satisfactory and according to the expectations of consumers. Benchmarking of health status was recognized as potentially useful in order to create a more “even playing field”, either through imposing penalties/required actions or by giving premiums/support. The large observed variation in health and production parameters between farms and countries can motivate and inspire improvement.
2 Improving monitoring and prevention on the herd level (WP3)
The proactive disease monitoring and prevention tools which have been developed in the IMPRO project demonstrated their ability to stimulate changes in health management practices in herds involved in the project. Several farmers involved in the project declared they will continue the proactive process.
Implementation of these tools should be promoted by the veterinarians. The co-construction step of the monitoring protocol creates a favourable situation for the veterinarians to resume the dialogue with organic farmers. Several veterinarians involved in the project have already used this pro-active tool in other dairy farms. Further efforts should be made to wildly disseminate the tools for their appropriation. Communications in French and European professional congresses are already planned in 2017. Additionally, the preventive tool has already been used by vet students in their curriculum in 2016. A further action will be to integrate a presentation of the tools in continuing education programmes for veterinarians.
The IMPRO project gave the opportunity to the French researchers in animal health to initiate new collaboration with organic stakeholders. Since 2013, the IMPRO researchers have set up and facilitated a national network “Animal Health in Organic Livestock Farms” in order to further develop research projects in relationship with stakeholders and from an interdisciplinary perspective. Among others, results of IMPRO have been discussed and direct continuations of the IMPRO project have been funded (regional and national funding). Thanks to the involvement of many scientists, advisors, vets and farmers, the monitoring and prevention tools have been disseminated through this network. Moreover, the tools have been improved and adapted to sheep production. Instruction for use of the tools will be written to explain and facilitate their appropriate use by health advisors. Adaptation of the approach to develop similar tools in other livestock productions is currently under discussion for new research projects.
3 Manageability of alternative treatments (WP4)
Treatment with homeopathic remedies in farm practice leaves ample room for improvements. A main barrier seems to be the fact that, for several reasons, farmers do not implement appropriate follow-up checks to assess whether a treatment strategy has been effective in the long run. Farmers neither face penalties nor benefit regarding possible efforts in increasing treatment success. This implies the risk that a high number of farmers strive for a reduction in labour and production costs to the expense of treatment success and animal health and welfare. Evaluations on organic dairy farms in Germany, France and Spain revealed that there were no uniform procedures for homeopathic treatment in the case of mastitis. It seemed that each farmer had developed his/her own treatment strategy; regardless of the principles of homeopathy and a lege-artis treatment strategy. The Commission Regulation (EC) No 889/2008 has not evidenced to be suited to prevent inappropriate treatment and should thus be reconsidered.
The considerable heterogeneity in the legal conditions in European countries regarding the use of homeopathy emphasises the need to harmonise rules within the EU. On the other hand, the EU-Guidelines on veterinary medical products are not well adapted to the peculiarities of homeopathic veterinary products. The factual findings indicate that the expertise in homeopathy and the remedies available in farm practice varies considerably between farms and countries. According the EC-Regulation on organic agriculture, animals shall be treated immediately if they become sick. Alternative remedies shall be used in preference to chemically-synthesized allopathic veterinary treatment or antibiotics, provided that their therapeutic effect is effective. However, neither an immediate treatment nor the effectiveness of treatment is ensured in farm practice. Therefore, an animal health inspection and monitoring procedure should be established which provides information on the effectiveness of treatment in farm practice to avoid prolonged suffering of diseased animals.
4 Socio-economic implications of changes in the management (WP5)
While market prices of conventionally-produced milk are currently facing a dramatic decline because of global over-supply, prices for organic dairy products – although already on a high level for years - are still increasing, resulting in a price premium in excess of 20 cents per kg of milk. The existence of this price premium reflects, in part, consumer expectation that they are compensating farmers for higher expenditures on animal health and welfare, with the expectation that these states are better under organic than conventional systems. While the organic production method is characterised by an enhanced level of minimum standards that go beyond the conventional level, the price gap raises the question of whether organic producers actually do offer a higher level of animal health and welfare. The willingness of consumers to continue to pay premium prices is expected to be influenced in the long run on the availability of evidence to support these expectations.
Thus, improvements to the health of organic livestock are crucial to support consumers’ confidence and their willingness to pay premium prices, which are essential for organic farmers to cover their higher production costs. However, it cannot be expected that a further enhancement of minimum standards (more of the same approach) is suited to reduce the prevalence of production diseases. Consequently, a new approach is required which provides commercially viable and target-oriented incentives to organic producers to develop further a fair and sustainable brand label.
Efforts to implement preventive measures can be costly and this is a particular barrier when farmers don’t know if a return on investment is likely. Farmers are often not fully aware which health issue they should prioritize and the efficiency of different measures to combat particular problems and which resources (skills, capital, and labour) are needed and which investments are suited to provide an appropriate return of investments. In general, this information is farm specific and not accessible by general scientific knowledge or published advisory recommendations.
Competition is an appropriate tool to improve the currently unsatisfying situation in organic dairy production. However, competition would only be effective if there were some impact on market returns in relation to a lower prevalence of production diseases. Unfortunately, there is no such market mechanism at present. Thus, the motivation of farmers is limited to the realisation of more aspirational targets for health states; an improved understanding of the potential and means to reduce sub-optimal health states; a desire to reduce economic losses from sub-optimal health states; and a desire to achieve these health gains at least cost.
5 Development of a software-based decision support tool (WP6)
The IMPRO-toolbox fulfils an important ‘knowledge transfer’ objective of the IMPRO project, i.e. bringing the achievements of the research to farm practice. The purpose of the toolbox is to provide tailored support to individual organic dairy farmers in their efforts by supporting their decisions in reducing the prevalence of production diseases. In a test phase, the majority of the participants valued the toolbox as a useful addition to their usual process of decision making, providing a better understanding of the herd health situation. But it became clear that the new equifinal approach enrolled by IMPRO will only be broadly valued if production diseases (i.e. specific levels of production diseases) evolve as a strategic target in organic dairy production.
Currently the socio economic framework of dairy farming aims at increased production and reduced costs. This is true also in organic dairy farming. The IMPRO tools are not aiming at production traits in the first place but at reducing the prevalence of production diseases, emerging from interaction in a farm system, while considering costs and benefits. This represents a quite different approach in comparison to the predominant agricultural and veterinary advisory approaches.
6 Outreach Activities (WP7)
Early on in the life of the IMPRO project, an attractive and carefully worded brochure was designed and several hundred copies were distributed across Partner countries in both hard and electronic forms. To do this, a logo was commissioned from a professional design company to convey both the organic ‘message’ and that of dairy production by both colour and design means.
By month 4 of the project, a website had been designed and set-up to present both project news and, also, the various project deliverables. This website attracted considerable attention during the 4-year life of the project and, as well as soliciting direct requests for information about the project, many page impressions were noticed as well as full hits. In the last year of the project (until September 2016), on average 49,000 page impressions and 76,000 hits occurred per month. Following an article in the Parliament Magazine in the summer of 2016, these impressions and hits have increased.
Until now four scientific publications have been published in in peer reviewed scientific journals. Drawing on material derived in WP5, two scientific paper have been published. The first was aimed the farmers’ perception towards health problems in relation to other managerial areas. This paper was instigated by Partner 4 (WU) and was based on D5.1. Material was collected in the four countries of the initial data collection (DE, FR, SE and SP). Farmers did differ considerably in their preference for improvement of animal health in relation to other managerial areas. The paper was published in the renowned journal ‘Animal’. The second paper, based upon D5.2 was prepared on assessing, and understanding the study farmers’ (from the same 4 countries) intentions to improve herd health. The paper was instigated by Partner 7 (UREAD) who was responsible for ‘Outreach’ (WP7), together with partners 1, 2, 3 and 4. It was published in another renowned journal ‘Preventive Veterinary Medicine’. At the time of writing both articles already received some citations and requests for copies and further details about the project and its data collection instrument/questionnaire. Based on research in WP2 and WP3 a publication on the opportunities of French veterinarians to improve advisory services for organic dairy farmers was published under the lead of partner 3 in the journal ‘Preventive Veterinary Medicine’. Results of WP9 resulted among others in a review on the efficacy of homeopathy in livestock in the journal ‘Veterinary Record’, published by Partner 1.
Nine more papers are in preparation or already accepted by scientific journals. Partner 1 initialized three papers on results from WP2. The first aiming at the prevalence of production diseases in European Dairy farms was submitted to Livestock Science and is under revision. A second paper focuses on the options to improve animal health in dairy farms by using an Impact Matrix was submitted to Agricultural systems and is under revision. Partners 2, 3 and 5 participate in both publications. The third paper is prepared together with partner 2 on results from the Impact Matrix assessment on farm factors related to production diseases (submitted to Animal, under revision). An article on the prevalence of lameness and risk factors in organic dairy herds, based on WP2 data, is prepared under the lead of partner 2 in collaboration with partners 1, 3, and 5 and will soon be submitted to the journal Animal.
Partner 3 is leading the preparation of another paper in collaboration with partner 2 on the use and effectiveness of the herd management tools elaborated in WP3. Partner 5 initiated the writing of a paper together with partner 2 on challenges in the use of phytotherapy in livestock, based on results in WP9. Structural characteristics of the organic dairy system in Europe are the topic of a paper prepared by partner 2 together with partners 1, 3, and 5. Partner 4, in collaboration with other partners, is finishing two more scientific papers, based upon D5.3 and 5.4. Both papers are also aimed at high ranking scientific journals to reach scientific impact.
As well as the article published mentioned above, there have been many workshops, conference and journal article submissions resulting from this project. More than 30 abstracts have been published and will be published in due time in conference proceedings. The full impact of these items will be experienced during 2017 and beyond.
Additionally, in respect of impact, it is worth mentioning that several of the young researchers employed on the project have already, or will in due course, submit their PhD theses based on work carried out during the life of the project.
In conjunction with the holding of the final project dissemination meeting in Brussels in month 48, a 4-page ‘results and recommendations’ brochure was produced and distributed widely by both hard copy and electronic means. This has since been ‘picked up’ by the farming press considerably in several countries. The coordinator announced the Final IMPRO workshop in the EU event calendar and on the website EU events. The EU-event newsletter for early September 2016 mentioned this meeting and promoted IMPRO as the ‘project of the month’.
7 Options and limitations in the use of alternative remedies (WP9)
A pilot project was conducted to deal with the question whether the use of homeopathy and phytotherapy holds potential to replace the use of antibiotics in treating bacterial infectious diseases keeping negative side effects to a minimum. Literature reviews revealed that cure rates after treatment with either antibiotics, alternative treatments or a placebo varied greatly between the studies. None of the scientific studies with alternative products have been re-produced. Thus, the use of homeopathic or phytotherapeutic products cannot claim to have a reliable and repeatable effect and a prognostic validity.
Remedies are means to an end. The effectiveness of treatments in farm practice is highly context-dependent and is doubtful without the consistent implementation of lege-artis procedure, including follow-up check and documentation of the recovery progress. Thus, the employment of homeopathy or phytotherapy in favour of conventional products cannot be sanctioned unless these alternative products are administered by highly skilled people. Otherwise, alternative treatments are at risk to increase health and welfare problems due to lack of therapeutic success and thus extended suffering of diseased animals. Therapeutic success in the individual and on the herd level is the result of the overall effort invested, while the envisaged level of PDs determines the degree of effort required to achieve the target sets. Deciding which level of therapeutic success and what prevalence of PDs is acceptable should not be left to each farmer to decide for themselves. These values are essential to the common good and should be set using external reference values.
Several important constraints for research and development of phytotherapeutic remedies was highlighted that currently hinder efficient use of these substances in cattle, pig and poultry production and proposes potential ways for resolving these issues. This makes a starting point for improving the conditions for research as well as availability of scientifically validated products. This can in turn lead to an improved health status and reduced use of antibiotics in animal production. Besides this, the potential economic advantages of a proper, prudent approach towards the use of diagnostics has been shown for pig and poultry sectors. This approach consists of more effort on early (automated) detection and diagnosis of diseases, that enable early application of treatments disease of problems. Since these findings were relatively a-specific, they can and will be used as arguments to change a mindset with regard to and will have long-term impacts.
8 Reconsidering the best practice approach in animal science
The results of the IMPRO project showed that organic dairy farming in general failed to achieve a lower prevalence of production diseases in comparison to conventional production. This fact is not only questioning the relevance of enhanced minimum standards for the health issue but also the prevailing best practice approach in animal science. This is characterized by focusing in the first place on single factors, and by generalizing the results achieved by this approach. At the same time, the context and context-variant processes within a farm system are widely ignored. Lack of success in reducing the prevalence of production diseases despite improved living conditions as implemented in organic dairy farming and despite a long history of research work in animal and agricultural science should provide an impetus for reflecting the role of animal science and their obvious lack of problem solving capacity.
The risk of oversimplification by dealing with the best practice approach refers also to therapeutic strategies when relying on evidenced-based medicine (EBM). The concept behind EBM seems very persuasive: a set of best practices validated by rigorous experiments which provides practitioners with treatments they can trust because they have been evaluated by randomized controlled trials, preferably double blinded. However, EBM should be trusted only if the science behind best practices is comprehensive. The results of the IMPRO project have shown that this is currently not the case. Best practices often take the form of simple rules to follow. However, practitioners work in very complex situations.
Best practices approaches rely on controlled studies that vary one thing at a time, rarely more than two or three. The protocol that works with one problem may be inappropriate for the others. Nevertheless, best practices are formulated for general populations, but practitioners treat individuals and need to take the context and individual differences into account. A treatment that is generally ineffective might still be useful for a subset of animals. Further, practitioners should not be finished once they select a treatment; they often have to adapt it. They need expertise to judge whether a diseased animal is recovering at an appropriate rate. Effectiveness of a treatment plan has to be monitored and it has then to be modified or replaced if it is not working well. The same is true for the farm management when implementing preventive measures on the farm level.
In face of a general lack of success in preventive and therapeutic strategies in organic dairy farming and due to the complexity of biological processes in the development of production diseases, evidence of successful management strategies has to be produced on the farm level. The proportion of animals that are not able to adapt to and cope with suboptimal living conditions while showing their incapability through signs of disturbances and production diseases seems to be a reasonable indicator to discriminate between farms regarding their performance with respect to animal health and welfare. This facilitates options to honour performances beyond the average with premium prices.
The IMPRO project has introduced and tested various tools to deal with the complexity within and the variability between livestock systems when striving for improvements of animal health and welfare in organic dairy farming. The previous attempts cannot claim to have solved the core issues addressed above but can be seen as an approach worth considering when trying to find a way out of the self-imposed immaturity and limited problem solving capacity in animal science when relying primarily on best practice approaches.
9 Exploration of policy options
In the sections that follow, policy recommendations are made that are appropriate to different levels of governance.
EU Commission
The large variation among organic dairy farms regarding the prevalence of production diseases contradicts consumers’ expectations with respect to added values and premium prices justifying them. Moreover, it is in conflict with the ethos of a brand label reflecting greater homogeneity in particular traits such as health and welfare status. When striving for a fostering of organic agriculture it is recommended that the EC focus its efforts on measures which narrowing the range of variation in health state between farmers by raising the performance of those farms with below-average performance.
Such large variation fulfils resembles unfair competition as organic farmers receive the same price for their products although the quality in terms of animal health and welfare and product quality is different. Those farmers producing products with lower productions costs while risking a higher prevalence of production diseases are favoured towards those farmers who invest effort and investment without obtaining premium prices for a higher quality. Thus, ‘unfair’ competition is a relevant barrier for any improvements. To reduce and prevent unfair competition, regular monitoring of health data (including milk recoding data) is required, demanding a unique methodology to estimate and assess health data and establish independent data surveillance as part of the certification process. Tools have been elaborated in the IMPRO project that might serve as the basis of such monitoring approaches.
To support the organic agriculture movement to improve the animal health and welfare situation, we recommend that this issue should be directly addressed in the EC organic regulation as a self-contained aim of the production process. The minimum standards should be supplemented by target values with respect to the prevalence of production diseases which should not be exceeded without facing consequences. This provides orientation for both, producers, retailers and consumers.
Moreover, the EU Commission may support a large scale European project, rolling out of the developed participatory approach, and designed in such a way that a thorough effectiveness analysis can be carried out. Research into effective and fair methods to change the milk payment system so that farmers who do pay good attention to animal health will be rewarded, could support the supply chain approach towards this problem.
National governments
Governments through their Ministries of Agriculture would need to take the lead by publicly backing the participatory approach in various media used by farmers. In the few EU countries where a state-funded advisory service exists (e.g. Ireland), direct funding could be provided for this purpose; in others, some financial help could be given to the commercial advisory organisations for this. To counteract the development of unfair competition between farmers and to provide reference values for orientation, the National governments should establish a monitoring system regarding the prevalence of selected production diseases on organic dairy farms.
Dairy processors, manufacturers and retailers
Consumers, and their representative bodies, might in due course demand improved herd health in those supplying their dairy produce. In addition, they might possibly be prepared to pay more for produce emanating from such a background. Thus, the processors, manufacturers and retailers should be encouraged to force change on farmers regarding animal health through a two-pronged approach e.g. by offering bonuses for good health and penalties for a poor health status on-farm.
Such stakeholders should be reminded that poor health risks the loss of confidence in consumers who purchase organic products and may lead to a loss of sales and competitive advantage. Dairy processors and retailers should look at their payment system and think about methods to bring the milk payment system more in line with the value items of the organic dairy products they produce.
Other organic stakeholders
For many customers, a low level of production diseases is a trait of process quality. This trait is closely related to the demand of consumers for “healthy products from healthy animals”, encompassing the issues of animal welfare and food safety. Professional bodies involved in livestock farming, such as national governing bodies for veterinarians, farm advisors and farm costing services should provide courses and advice on the participatory approach. Farm assurance schemes should also be encouraged to promote, or insist on the participatory adoption approach as a condition of membership. Marketing orders and agreements would allow producers to promote orderly marketing through collectively influencing the supply, demand or price of a particular commodity. A possible binding market order could enclose different grades within the organic production, e.g. milk products from farms which differ in their prevalence of production diseases.

List of Websites:
http://www.impro-dairy.eu

Final Report Summary - IMPRO (Impact matrix analysis and cost-benefit calculations to improve management practices regarding health status in organic dairy farming)

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