Pastoralists in sub-Saharan Africa have limited access to public services due to their mobile lifestyle, economic and political marginalization, and the limited health infrastructure that is common to arid and semi-arid lands (ASALs) where they primarily reside. This often results in poor health outcomes, including increased rates of maternal, neonatal, and under-5 mortality. One Health approaches that integrate human and animal health service delivery can help to improve pastoralists' health through increased vaccine coverage and improved access to services. Kenya has institutionalized One Health at the national level; however, progress at the subnational level has been limited due to sustainability concerns, competing priorities, and insufficient coordination platforms. To address this gap, this paper presents a One Health framework (OHF) to aid in the implementation of integrated human and animal health policies in Turkana County, which can act as a model for other ASALs. Utilizing a grounded theory design, we conducted semi-structured interviews and focus group discussions with human health, animal health, and pastoralist stakeholders. Inadequate engagement with the public sector was identified as a major limitation by community members. Factors that contributed to this include distance to health facilities and restricted department capacities such as availability of vehicles, personnel, and cold chain maintenance. Our proposed OHF harnesses the existing structure of service delivery in Turkana and establishes an official coordination mechanism to implement One Health activities, through the form of mobile "One Health Huduma Centres", offering a range of public services. This innovative framework is supported by stakeholders in Turkana and can improve service delivery constraints thereby improving the health of Turkana pastoralists.

In Kenya, pastoralists grapple with significant health and livelihood challenges due to livestock, zoonotic, and human diseases. These diseases threaten the sustainability of their unique food production system and its considerable value. Disease control and prevention in arid and semi-arid lands (ASALs) are currently inadequate due to underfunded and ill-adapted health programs coupled with a shortage of personnel. Participatory epidemiology (PE) presents a valuable tool for understanding community perceptions of disease importance and epidemiology, thereby aiding in improving control measures and promoting community involvement in centralized service delivery programs. Yet, the use of PE has been primarily confined to livestock and zoonotic diseases, leaving perceptions of human disease and the complex interplay between pastoralists, their livestock, and the rangelands unexplored. To address this gap, we utilized PE to achieve three objectives: 1) establish links between human and livestock diseases, 2) determine perceptions of disease priorities, and 3) assess knowledge of disease epidemiology. Our findings indicate that the relationships between human and livestock diseases primarily manifest in two categories: disease symptoms and zoonoses. Disease priorities differed between locations, with no apparent pattern emerging that human or livestock diseases are considered more important. Importance indicators such as prevalence, mortality, morbidity, and spatial/temporal variation were shared across human and livestock diseases. Diseases perceived as more prevalent and deadly were deemed most significant, while those seen as less prevalent, less deadly, and exhibiting more spatial/temporal variation were considered less critical. Our results underscore the added value of broadening the application of PE to include human diseases, which can help to improve disease prevention and control initiatives among pastoralists. Future studies and human, animal, and environmental health programs can leverage and expand upon our approach, combining it with traditional sero-syndromic surveillance to address health challenges among pastoralists in ASALs in Kenya and beyond.