What are enablers to implement One Health in Africa?

On 3^rd November each year, the international community celebrates the One Health Day. The One Health approach fosters collaboration across human, animal, plant and ecosystem health to optimize health in all these four areas. While the idea that the health of humans is linked to the health of the earth and its multi-species inhabitants is not new, disciplines have undergone a process of specialization that has hampered this holistic view and thus collaboration across sectors. Threats such as Anti-Microbial Resistance have to be addressed in a common effort across sectorial and national boundaries. Furthermore, the added value of a closer collaboration between human and animal sectors have been scientifically proven in the fields of rabies and brucellosis for instance, both diseases that are transmissible between animals and humans.

The 8^th World One Health Congress in South Africa

At the recent 8^th World One Health Congress in Cape Town, South Africa from 20 to 23 September 2024, participants showcased cutting-edge research results and discussed challenges in One Health implementation in the policy world. For the first time, the World One Health Congress was held in Africa. Among those present was Afrique One, the oldest research consortium in One Health research capacity strengthening in Africa that has received funding from the Wellcome Trust since 2009. Afrique One has embedded training modules into emerging One Health Master's programmes across West Africa (including institutions in Senegal, Togo and Benin) but also in Belgium and extended One Health to non-communicable diseases and mental health. Additionally, the consortium contributed to developing national One Health platforms and regional governance mechanism, evaluation systems and strategic plans.

One Health has a long tradition on the African continent. As in other regions of the world, there are a lot of communities in Africa who live in close contact with the animals they raise. One of these communities, the Dinka, a pastoralist community in South Sudan inspired Carl Schwabe to coin the scientific concept of One Medicine that later became popularized as the One Health approach. Changing human-animal relationships and their implications for the health and wellbeing of different species constantly raise new questions. Some of these questions are being addressed in an ongoing research project in social anthropology that examines the role of animals in people’s livelihoods in sub-Saharan Africa.

While promising, One Health has yet to reach its full potential

Previous World One Health Congresses had a strong focus on conceptual aspects. However, in South Africa discussions on how to operationalize the approach have gained prominence. Commentators were unanimous that research on One Health needs to shift to more applied research of how to successfully and sustainably implement the approach.

While One Health is a promising concept, its practical implementation has proven more difficult than initially thought. Established sectoral boundaries and procedures constitute obstacles to collaboration and effective use of resources. Its advancement, usually in the form of One Health platforms, has been slowed by many economic, legal, social, and work-related obstacles, some of which are often unrecognized.

Understanding the critical factors which support or inhibit the effective implementation of the One Health approach in Africa

Recently, we have conducted research on One Health implementation in Africa with a focus on Kenya, Ethiopia, and Uganda. Our investigation combined a systematic mapping, which is a comprehensive overview of existing research, with expert consultations. The systematic mapping involved searching several databases, including policy documents and grey literature to identify lessons learnt on One Health implementation in Africa. Expert consultations were facilitated by scorecards and open-ended questions on One Health implementation in different health areas and at different institutional and social levels in Kenya, Uganda and Ethiopia.

Our research revealed that despite the acknowledged urgency of implementing One Health and its collaborative nature, high-level leadership and coordination among key institutions are still inadequate. Due to the perceived additional workload and lack of integration into standard tasks, sustainable cross-sectoral collaboration and partnerships prove to be more difficult to establish.

A second limit of its present implementation is that One Health in Africa has mostly been implemented in the fields of diseases transferred from animals to humans and antimicrobial resistance. Other critical areas such as plant health, biodiversity, and environmental resource management have not gained enough attention so far.

A third challenge is that the implementation of One Health initiatives in Africa is often heavily reliant on external funding, leading to long-term sustainability concerns. As one of the research participants pointed out: We have different donors pushing different agendas. At the end of the day, you can’t align the outcomes and achievements […] It is until the government can identify resources to provide annual budgets for One Health that we can have sustainable interventions [...]. (Interview Uganda)

What needs to be done

In terms of policy recommendations, countries need to establish dedicated high-level leadership in offices of Prime Ministers, Finance Ministries or Development Ministries to balance power dynamics and drive One Health implementation. This has to go hand in hand with the development of legal frameworks to clarify roles, responsibilities, and standard operating procedures for involved institutions at all levels from community level (involving community health workers, and community animal health workers) to district, province, and national levels, addressing all existing gaps.

To facilitate the development of cross-sectoral collaborations in different fields of health, such as surveillance, for instance, targeted technical support is needed: You need to be passionate about this One Health concept, because you realize it is a lot of work, just trying to sit and establish response mechanism for some of these diseases [...]. (Interview Kenya)

Last but not least, One Health has to be prioritised within state budgets to ensure sustainability and reduce reliance on external funding.

To maximize the advantages of One Health, we need better multisectoral relationships at the global, regional, national, and local levels. This requires a broad understanding of the existing situation in employing One Heath. Hence, capacity-strengthening opportunities are needed to develop relevant curricula to foster interdisciplinary perspectives and One Health collaborations. To move forward, research must investigate how One Health principles can be effectively implemented at the intersection of different ministries, such as agriculture, health, and environment. Furthermore, to make One Health still more appealing to decision-makers, researchers need to measure the economic, social, and environmental returns on investments of One Health interventions in specific contexts.

Further Reading

One Health High-Level Expert Panel (OHHLEP), Adisasmito, W.B., Almuhairi, S., Behravesh, C.B., Bilivogui, P., Bukachi, S.A. et al. (2022) One Health: A new definition for a sustainable and healthy future. PLoS Pathogens 18(6), e1010537. DOI: 10.1371/journal.ppat.1010537.

Zinsstag, J., Kaiser-Grolimund, A., Heitz-Tokpa, K., Sreedharan, R., Lubroth, J. et al. (2023) Advancing One human–animal–environment Health for global health security: what does the evidence say? Lancet 401(10376), 591–604. doi: 10.1016/S0140-6736(22)01595-1.

Zinsstag, J., Schelling, E., Crump, L., Whittaker, M., Tanner, M. and Stephen, C. (eds.) (2020) One Health: The Theory and Practice of Integrated Health Approaches. 2nd edn, CAB International, Wallingford, UK.

Additional Information

Image credit: Kathrin Heitz-Tokpa, Afrique One

About the Authors

Kathrin Heitz-Tokpa

Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire

University of Basel, Basel, Switzerland

Andrea Kaiser-Grolimund

University of Basel, Basel, Switzerland

Swiss Tropical and Public Health Institute, Allschwil, Switzerland

Durham University, UK