Over the last 5-10 years, countries throughout Africa have implemented the One Health approach, recognizing benefits through enhanced collaboration between human, animal, environmental health and other related sectors. However, there is still little evidence on factors that support or hinder the implementation of the approach.
This working paper has used a mixed-methods approach to explore current challenges and lessons learned from One Health operationalizations. Firstly, we conducted a systematic mapping of the existing evidence on One Health operationalizations in Africa (Savilaakso ?et al., 2024). Secondly, we held expert consultations with One Health practitioners in the three countries Kenya, Uganda and Ethiopia. Based on existing categories of the International Health Regulations and Performances of Veterinary Services, as well as environmental, food and other related aspects, we developed score cards that enabled experts to rank One Health implementations and further needs for operationalization at different levels (national, district and community).
Our results show implementation progress but also the need to improve multi-sectoral actions at different levels within a country or region to further facilitate the One Health approach. Lack of sustainable cross-sectoral collaboration due to dependence on partner funding is a major concern as is the perception that One Health creates extra work that is not part of standard tasks for many stakeholders. Establishment of high-level leadership, resource allocation within state budgets, legal frameworks, joint prioritization and curricula development are some aspects mentioned in both the literature studies and expert consultations. Experts thought that One Health in Kenya, Uganda and Ethiopia was well implemented in areas of human and animal health and AMR, but that environmental health issues such as chemical events, natural disasters, or biodiversity loss were only poorly addressed. They recommended that new initiatives should concentrate on further integrating collaborative actions into the daily business of animal, human and environmental services and job descriptions. Most studies continue to emphasize the need for One Health rather than assessing its implementation.
This working paper concludes that One Health requires a scaled approach from community to district (subnational), province and national levels. Special attention should be given to address current implementation challenges at the subnational level and across borders. Furthermore, One Health will have to be institutionalized and fully owned by the different services involved to make existing initiatives sustainable. More practical evidence is needed on how One Health can be operationalized at the interface of different ministries and levels, and to understand context-specific outcomes of One Health approaches for different health areas in the three countries.