Operationalising the “One Health” approach in India: facilitators of and barriers to effective cross-sector convergence for zoonoses prevention and control

Abstract

Background There is a strong policy impetus for the One Health cross-sectoral approach to address the complex challenge of zoonotic diseases, particularly in low/lower middle income countries (LMICs). Yet the implementation of this approach in LMIC contexts such as India has proven challenging, due partly to the relatively limited practical guidance and understanding on how to foster and sustain cross-sector collaborations. This study addresses this gap by exploring the facilitators of and barriers to successful convergence between the human, animal and environmental health sectors in India. Methods A mixed methods study was conducted using a detailed content review of national policy documents and in-depth semi-structured interview data on zoonotic disease management in India. In total, 29 policy documents were reviewed and 15 key informant interviews were undertaken with national and state level policymakers, disease managers and experts operating within the human-animal-environment interface of zoonotic disease control. Results Our findings suggest that there is limited policy visibility of zoonotic diseases, although global zoonoses, especially those identified to be of pandemic potential by international organisations (e.g. CDC, WHO and OIE) rather than local, high burden endemic diseases, have high recognition in the existing policy agenda setting. Despite the widespread acknowledgement of the importance of cross-sectoral collaboration, a myriad of factors operated to either constrain or facilitate the success of cross-sectoral convergence at different stages (i.e. information-sharing, undertaking common activities and merging resources and infrastructure) of cross-sectoral action. Importantly, participants identified the lack of supportive policies, conflicting departmental priorities and limited institutional capacities as major barriers that hamper effective cross-sectoral collaboration on zoonotic disease control. Building on existing informal inter-personal relationships and collaboration platforms were suggested by participants as the way forward. Conclusion Our findings point to the importance of strengthening existing national policy frameworks as a first step for leveraging cross-sectoral capacity for improved disease surveillance and interventions. This requires the contextual adaptation of the One Health approach in a manner that is sensitive to the underlying socio-political, institutional and cultural context that determines and shapes outcomes of cross-sector collaborative arrangements.

From the Intersection of Food-Borne Zoonoses and EU Green Policies to an In-Embryo One Health Financial Model

“…There is a strong policy impetus for the OH cross-sectoral approach to address the complex challenge of zoonotic diseases—particularly in low/lower- and middle-income countries (LMICs), where there is limited policy visibility on zoonotic diseases—especially high-burden endemic diseases that disproportionately affect marginalised rural populations [ 57 ].…”

“…It is necessary to promote the health of animals for their own sake, but also for the sake of the humans living with them [ 62 ]. Collaboration must be tailored to the surveillance objective and context, characterised by a wide range of factors (i.e., epidemiological, ecological, economic, social, and environmental); successful cross-sectoral collaboration is largely rooted in mutual trust and respect between the different actors [ 57 ].…”

Employment status of AFROHUN-Uganda one health alumni, and facilitators and barriers to application of the one health approach: a tracer study

“…Limited funding impeded the use of the one health approach in organisations employing the AFROHUN Uganda OH alumni [ 42 , 67 – 69 ]. The current study revealed that organisations employing one health alumni did not have adequate funds to facilitate the application of the OH approach into their programs.…”

“…The OH approach is a proven panacea for solving global health challenges [ 4 ], however, its operationalization remains a challenge across sectors and disciplines [ 5 – 7 ]. The lack of effective coordination mechanisms, commitment by the different stakeholders, including government entities and other employers, has hampered the development of the OH workforce [ 8 ]. Lack of relevant policies to support institutionalization and decision-making processes, conflicting priorities between the different stakeholders, limited budgets, poor governance and leadership, and variability in sub-cultures within sectors and disciplines also remains a challenge to the operationalisation of OH [ 9 – 12 ].…”

Is the Indian health system resilient? Lessons from COVID-19

“…Since February 2020, the Indian Council of Medical Research (ICMR) has assiduously worked towards the development of research and technological innovations to control the virus [2]. A firm policy momentum for the development of a "One Health" strategy [13] was also palpable when the 2021 union budget allocated a specific portion for its effective implementation. Henceforth, investments have been made to develop core capacity to deliver the One Health approach to prevent, detect, and respond to infectious disease outbreaks in animals and humans [14].…”