The One Health Concept

Lecture_02
 OHC Objectives
1. Introduction to OHC concept and approaches
2. Interaction of Human, Animal and Environmental health
3. Principles of integrated Zoonotic disease prevention and
control
4. Impact of zoonotic diseases in the context of One Health
5. Integrated emergency preparedness and response to
zoonoses: role of laboratory in Surveillance, Response
and Biosecurity
6. Community mobilization and participation in One Health
approach
 Definitions 1: what is One Health?
1. Collaborative effort of multiple health science
professions, together with their related disciplines, and
institutions working locally, nationally, and globally to
attain optimal health for people, domestic animals,
wildlife, plants, and the environment

2. An approach to improve health and well-being

through the prevention of risks and the mitigation of
effects of crises originating at the interface between
humans, animals, and their environments
Everybody matters!
 Definitions 2: what is Eco-health?
1. Involves the health of humans, animals,
ecosystems and the environmental
sustainability and socioeconomic stability in
the framework
2. Approach - more of a biodiversity focus, with
an emphasis on all living creatures, implying
that parasites, unicellular organisms, viruses
have a value and should be protected
3. Includes anthropologists with a focus on
indigenous people for indigenous and local
knowledge
Opportunities for disease to spread rapidly:

1. Expansion of human and animal

populations
2. Changes in climate and land use
3. Increased international travel and trade
provide
One Health is the sum total health
 Applications of OH Approach
• Most countries lack adequate mechanisms for administrative and
technical collaboration among Animal, Public & Environment sectors

• Zoonotic disease events & Emergencies

1. Lack of joint preparation
2. Lack of established mechanisms for collaboration
3. Results in confusion and delay responses
4. Poor Health outcomes
Applications of OH Approach…
• Endemic zoonotic disease threats - the lack of
coordinated:
– Planning
– Information sharing
– Assessment
– Control activities
• Hence complicated implementation of effective disease
control

Lessons from
• Ebola & HN51 avian influenza outbreaks in in 2014
• COVID-19 in 2019
Applications of OH Approach…
• One Health approach - endorsed by FAO, OIE and WHO to:
– Improve prevention, detection and response
• Country level - National One Health Platform provides government
and stakeholders with a mechanism to:
– Improve multi-sectoral coordination
– Collaboration to strengthen:
1. Prediction
2. Prevention
3. Detection
4. Response to emerging pandemic threats eg., COVID,
EBOLA
• One Health is a conceptual extension of
traditional public health thinking, approaches
and methodologies
• Address the risks of global pandemics of
emerging and re-emerging diseases such as
COVID-19, Ebola, Marburg and SARS
• Greatest advantages of OH - seen in countries
where endemic diseases such as malaria,
cholera, and meningitis still occur in
epidemics.
The case of Liberia
 Challenges in OHC
1. Shortages of human and animal health personnel
 Lack of consistent and complete data on H&A resources
 Disconnect between planning and policy development
 Effectiveness, Facilitation, Location of H&A health systems
 Emigration of highly trained professionals, specialists
2 Uneven geographical distribution of the workforce: urban vs
rural settings
3 Inefficient utilization and overlapping roles of human health
and animal health personnel
4 Inadequate working environment: is the health worker
equipped?
 Challenges in OHC…
5. Governance structures and accountability mechanisms that do not
effectively engage stakeholders, including health workers and
citizens, in:
a. Setting priorities
b. Developing policy
c. Implementing
d. Evaluating

6. Inadequate mechanisms in place for administrative and technical

collaboration among the:
a. Animal health
b. Public health
c. Environment sectors
d. Other sectors and disciplines
 Overcoming the Challenges
1. Advocate, communicate and mobilize resources for
health programme activities
– Build information base for H&A health resources for both
human and animal health
2. Invest strategically in human resources for health
development.
• Build capacity in planning and managing human
resources for health by developing learning
opportunities eg., training national focal points,
organizing knowledge exchange by peer-reviewing
mechanisms
3. Align human resources for health policies and
interventions
 Has this worked?
1. Controlling human trypanosomiasis –
I. Control of tsetse vector – environmental modification
II. Control in man
III. Control in animals

2. Rabies:
I. Post Exposure Prophylaxis (PEP)
II. Mass dog vaccination
III. Good communication between human and animal health
services
3. Others: Echinococcosis, Taeniasis/Cysticercosis, Schistosomiasis
 Identified Newest threats
Antimicrobial Resistance (AMR)
Soil-transmitted helminthiases (STHs)
– Highest global burden of parasitic disease after malaria
– Most prevalent in the poorest communities
– Need for multidisciplinary approach that includes:
a. Environmental scientist
b. Health professionals
c. Social scientists (e.g. behavior and implementation of education,
sanitation programs)
Newest threat: Antimicrobial Resistance (AMR)
MULTISECTORAL, ONE HEALTH APPROACH
• One Health is a collaborative, multidisciplinary, & multisectoral
approach that can address urgent, ongoing, or potential health threats
at the human-animal-environment interface at subnational, national,
global, and regional levels

• Multisectoral - more than one relevant sector working together (e.g.

on a joint program or response to an event), but does not imply that
all relevant sectors are working together

• Multidisciplinary - multiple disciplines working together (i.e. in a

single ministry or research institute employing physicians, nurses,
veterinarians, epidemiologists, laboratory scientists, basic scientists,
and other health professions)

• Taking a One Health approach means that all relevant sectors and
disciplines are involved
 Benefits- Effective Multisectoral
1. Response to zoonotic disease events and emergencies is more
timely and effective.
2. All sectors have the information they need.
3. Decisions are based on accurate and shared assessments of the
situation.
4. Accountability to each other and to decision makers ensures
action by all sectors.
5. Regulations, policies, and guidelines are realistic, acceptable, and
implementable by all sectors.
6. All sectors understand their specific roles and responsibilities in
the collaboration.
7. Technical, human, and financial resources are effectively used
and equitably shared.
8. Gaps in infrastructure, capacity and information are identified
and filled.
9. Advocacy for funds, policies, and programmes is more effective
 Key factors that affect sustainability
1. Political will: high level political will, and commitment and engagement from all
the relevant sectors
2. Resources: sufficient and equitably distributed human and financial resources,
from domestic sources
3. Context: establishment of the activities within existing national infrastructure and
considering national circumstances
4. Common goals: strategies and activities based on shared needs, common
objectives and health priorities, and having shared benefits
5. Strong governance: strong national governance structures, aligned legal and policy
frameworks and guidance, and compliance with existing regional and
international standards
6. Routine coordination: effective and routine coordination among all relevant
sectors for planning and implementation
7. Routine communication: effective and routine communication among all relevant
sectors and at all appropriate levels for the national context
8. Strong sectoral systems: strong and effective health systems within the individual
sectors
9. Recognizing successes: documented evidence of improved outcomes
COSTS AND BENEFITS OF OH APPROACH IN ZOONOTIC DISEASES:
1. OH - makes the best use of limited resources of money and personnel
2. OH - Improves the efficiency and effectiveness of zoonotic disease
management, so that costs are reduced
3. Strengthening systems and coordination across the human health, animal
health and environment sectors can provide a strong return on investment
4. Costs are reduced by: avoiding duplication of activities and performance
may improve by improving synergies – e.g. sharing of laboratory facilities by
multiple sectors
5. Reduced risks from zoonotic diseases including indirect societal losses such as:
– Impacts on livelihoods of small producers
– Poorer nutrition
– Restriction of trade and tourism
6. Value added for each of the sectors –
– Justify investment in this approach to zoonotic diseases
– Serve as an advocacy tool
– Help policy-makers understand how costs & benefits are shared across
sectors
COMMUNICATION AMONG & BETWEEN
STAKEHOLDERS
• To control zoonoses there is need for:
– Continuous, effective communication, across the government and
within and among partner organizations and other relevant
stakeholders, including media and the public
• Trustworthy, transparent and consistent communication establishes
credibility with national and international stakeholders and partners
• Modern technology (e.g. mobile telephone networks, the internet)
allows people to receive information about zoonotic disease
outbreaks from many sources, which may result in misinformation
and confusion
• Preparedness and response teams should include specialists in
communication so that stakeholders receive accurate, timely,
comprehensive, and consistent messages.
• Identifying and training spokespeople from all sectors, and from
communities, can ensure messages are delivered and build trust with
all audiences
SOCIAL DETERMINANTS OF ONE HEALTH
• Multisectoral OH – Need to consider the conditions in which people
are born, grow, live, work and age
• Conditions - influenced by factors such as :
1. Politics, cultural norms, values, and beliefs
2. Economy
3. Distribution of power
4. Gender
5. Whether people live in an urban or rural community.
• Consider:
– Social context of zoonotic disease transmission
– Implications for vulnerability among different groups of people
should also be considered.
 Social Determinants in OH
One health approach seeks to:
1. Establish partnerships with and engage social scientists (sociologists,
anthropologists and demographers, among others), in the planning,
implementation and evaluation of policies, programmes, research
and training
2. Develop communication strategies which consider gender, indigenous
and minority populations and diverse cultural practices
3. Educate community health workers, programme managers and
policy-makers about the most pressing social influences on zoonotic
disease prevention and control within each country
4. Consider gender in the development, implementation and evaluation
of country plans and education and training programmes for
zoonotic diseases
5. Use available research to explore and understand social determinants
of health in their country
6. Integrate knowledge and behavior change into all aspects of zoonotic
disease control.
 MULTISECTORAL, OH COORDINATION MECHANISM [MCM]

MCM- formalized, standing group that acts to strengthen or develop

collaboration, communication, and coordination across the sectors
responsible for addressing zoonotic diseases and other health concerns
at the human-animal-environment interface
MCM - responsible for coordination, leadership, and governance of
efforts among the relevant sectors to achieve jointly determined and
agreed common goals.
Membership of the MCM
• Defined by relevance of a stakeholder but must include:
1. Human health, animal health, environment sectors,
wildlife and vectors
2. Government staff - decisions must be linked to policy and
action
3. Representation from the sectors and disciplines is
equitably balanced in numbers and authority
4. Communications staff are included to align messages
across sectors. This is especially important in emergencies.
5. Stakeholders outside government eg., NGO/Private
companies:
• Including them as observers or advisors
• Including them as members of MCM subgroups
• Convening an advisory stakeholder group for the MCM
Identifying and analyzing relevant stakeholders
• Relevant stakeholders are identified and included
• A stakeholder analysis is a consultative process with the
following components:
1. Definition of objective: the objective of the activity for
which the stakeholders are being identified is clearly
defined;
2. Stakeholder identification: all relevant stakeholders to the
activity are identified
3. Stakeholder categorization: the relationships among the
stakeholders and their priorities are mapped and analysed
4. Stakeholder engagement: discussion with each stakeholder
on how they can be engaged.
• Relevant stakeholders for zoonotic diseases are those that are
key to national management of the health threat to be
addressed
Ensuring sustainable coordination of MCM will need:

1. Mapping of infrastructure and stakeholders - This ensures MCM has

knowledge of all multisectoral, One Health activities and zoonotic
disease activities.
2. Mobilizing and allocating funding and resources - Ensure sustainable
and equitable financing among all relevant sectors is critical for ensuring
continuity of programmes to decrease risks from zoonotic diseases.
• Resources are required for both:
– Emergencies (e.g. outbreak investigation, laboratory surge capacity,
quarantine)
– Routine activities (e.g. functioning of the MCM, routine surveillance,
routine animal and human immunization programmes).
3. Ensuring coordinated communication and advocacy –
• MCM communicates with key stakeholders to increase awareness of the
MCM’s role and engagement in its activities
4. Monitoring and evaluation of function and impact - help governments:
• Make improvements in zoonotic disease frameworks, strategies and
policies
• Contributes to the sustainability of the MCM
Examples of stakeholders to be
included in the MCM
1. Government departments or
agencies responsible for:
– Human health
– Animal health
– Wildlife
– Vector control • Radiation safety
– Environment. • Disaster management,
2. Government departments or • Regulatory bodies
agencies responsible for:
• NGOs
• Animal production
• Industry
• Food safety
• Medical associations,
• Finance
• Farmers associations
• Security
• Media
• Transport
• Universities
• Trade
3. Neighbouring countries or
• Chemical safety trading partners.
• Eradicating polio
stakeholders
• Toxoplasmosis
stakeholders
 Roles of various stakeholders in the MCM:
• Government stakeholders –
– Implementing measures for risk reduction and responding to
zoonotic diseases
– Planning and coordination.
• Private sector –
– Implement risk reduction practices to avoid production and
economic losses. Eg., Farmers choice, vaccine or drug production
companies
• Academia
– Holds expertise and information needed for disease confirmation,
data analysis, and other specialized technical activities
– Key role in training of the workforce esp technical skills
– Training in implementation of a multisectoral, One Health
approach.
• Communities - key stakeholders
– Leaders- religious, indigenous populations, political