‘One Health’ Actors in Multifaceted Health Systems: An Operational Case for India

Abstract

The surging trend of (re)emerging diseases urges for the early detection, prevention, and control of zoonotic infections through the One Health (OH) approach. The operationalization of the OH approach depends on the contextual setting, the presence of the actors across the domains of OH, and the extent of their involvement. In the absence of national operational guidelines for OH in India, this study aims to identify potential actors with an attempt to understand the current health system network strength (during an outbreak and non-outbreak situations) at the local health system of Ahmedabad, India. This case study adopted a sequential mixed methods design conducted in two phases. First, potential actors who have been involved directly or indirectly in zoonoses prevention and control were identified through in-depth interviews. A network study was conducted as part of the second phase through a structured network questionnaire. Interest and influence matrix, average degree, network density, and degree of centralization were calculated through Atlas.Ti (ATLAS.ti Scientific Software Development GmbH, Berlin, Germany), UCINET (Analytic Technologies, Lexington, KY, USA) software. The identified actors were categorized based on power, administrative level (either at the city or district level), and their level of action: administrative (policy planners, managers), providers (physicians, veterinarians), and community (health workers, community leaders). The matrix indicated that administrative actors from the district level were ‘context setters’ and the actors from the city level were either ‘players’ or ‘subjects’. The network density showed a strength of 0.328 during the last outbreak of H5N1, which decreased to 0.163 during the non-outbreak situation. Overall, there was low collaboration observed in this study, which ranged from communication (during non-outbreaks) to coordination (during outbreaks). The private and non-governmental actors were not integrated into collaborative activities. This study concludes that not only collaboration is needed for OH among the sectors pertaining to the human and the animal health system but also better structured (‘inter-level’) collaboration across the governance levels for effective implementation.

The application of the One Health approach in the management of five major zoonotic diseases using the World Bank domains: A scoping review

“… Republic of Guinea Rabies Anthrax Brucellosis Avian Influenza Lushasi et al, 2020 [ 70 ] To assess feasibility and possible impact of Integrated Bite Case Management for rabies surveillance in Tanzania. Tanzania Rabies Yasobant et al, 2020 [ 83 ] To identify and categorize stakeholders for control and prevention of zoonotic diseases at the human–animal health system interface and identify challenges in intersectoral collaboration during outbreak and peace time. India Avian Influenza (zoonoses as general) Zuhriyah et al, 2020 [ 75 ] To identify the factors required for control of the rabies in Domphu, Indonesia.…”

One Health activities to reinforce intersectoral coordination at local levels in India

“…Intersectoral interactions at the village/sub-district level have occurred most frequently during disease outbreaks and have been observed across the country ( 22 , 36 , 41 , 42 ). These interactions often involve OH coordination and response between stakeholders at national, state, and district levels, usually with a top-down approach that directs, initiates, and supports response from lower-level stakeholders.…”

“…Intersectoral collaboration is most common during disease outbreaks and stems from the urgent demand for action and human resources. A network analysis by Yasobant et al shows that intersectoral interactions between actors at different levels (administrative, service providers, and community) of the health system in Ahmedabad, India are greater during an outbreak situation than during non-outbreak periods and they are directed in a top-down approach ( 22 ). Outside of outbreaks, there is little incentive for intersectoral collaboration.…”

The Past, Present, and Future of One Health in India: A Narrative Review

“…At the highest level are the administrative actors comprising policy makers, program implementers and planning and management leaders. At the lowest level are community actors consisting of village leaders, health workers, and various community leaders from governmental as well as non-governmental organizations [ 7 ]. Robust methodological tools for multicriteria analyses and, a health management system thinking approach have been developed to support the implementation of this approach.…”

“…Yet institutionalizing and functioning of various sectors related to this commission is challenging and difficult to implement [ 6 ]. Though this approach is facing difficulties in operationalization and implementation in South Asian countries, the transdisciplinary approach mandates all sectors to work together with shared responsibilities and challenges [ 7 ]. The interaction between humans, animals, and ecosystems is inevitable.…”