Successes and challenges of the One Health approach in Kenya over the last decade

Abstract

More than 75% of emerging infectious diseases are zoonotic in origin and a transdisciplinary, multi-sectoral One Health approach is a key strategy for their effective prevention and control. In 2004, US Centers for Disease Control and Prevention office in Kenya (CDC Kenya) established the Global Disease Detection Division of which one core component was to support, with other partners, the One Health approach to public health science. After catalytic events such as the global expansion of highly pathogenic H5N1 and the 2006 East African multi-country outbreaks of Rift Valley Fever, CDC Kenya supported key Kenya government institutions including the Ministry of Health and the Ministry of Agriculture, Livestock, and Fisheries to establish a framework for multi-sectoral collaboration at national and county level and a coordination office referred to as the Zoonotic Disease Unit (ZDU). The ZDU has provided Kenya with an institutional framework to highlight the public health importance of endemic and epidemic zoonoses including RVF, rabies, brucellosis, Middle East Respiratory Syndrome Coronavirus, anthrax and other emerging issues such as anti-microbial resistance through capacity building programs, surveillance, workforce development, research, coordinated investigation and outbreak response. This has led to improved outbreak response, and generated data (including discovery of new pathogens) that has informed disease control programs to reduce burden of and enhance preparedness for endemic and epidemic zoonotic diseases, thereby enhancing global health security. Since 2014, the Global Health Security Agenda implemented through CDC Kenya and other partners in the country has provided additional impetus to maintain this effort and Kenya’s achievement now serves as a model for other countries in the region. Significant gaps remain in implementation of the One Health approach at subnational administrative levels; there are sustainability concerns, competing priorities and funding deficiencies.

Establishing National Multisectoral Coordination and collaboration mechanisms to prevent, detect, and respond to public health threats in Guinea, Liberia, and Sierra Leone 2016–2018

“…The Prime Minister's office or any other office at the highest policy level like the president's office serves as the ideal coordinating body because of its primary mandate to coordinate all government sectors. However, there is no one size fit all and countries have the final decision on where they may anchor their platforms [20][21][22][23]. For example, Uganda agreed to establish a rotating coordination system, building on lessons from its success in controlling Trypanosomiasis [21].…”

“…In this scenario, equity in managing the Platform is achieved by giving each sector a designated period to coordinate the platform, which will empower each ministry and build leadership capacity. Kenya is another success story, where the platform has been anchored at the Ministry of Health for quite some time and has been functioning well [20,22,23].…”

“…There is documented evidence that "coordinated investigations between One Health sectors yield higher statistical power to elucidate public health relationships as compared to silo investigations and that the approach can result in improved resource efficiency" [20][21][22][23][24][25]. Greater preparedness and response can save lives, and prevent the economic catastrophes of uncontrolled health security events [22].…”

A One Health framework for integrated service delivery in Turkana County, Kenya

“…The ZDU has provided an institutional body to address One Health issues of concern (e.g. zoonoses, antimicrobial resistance) through capacity building, research, workforce development, and coordinated investigation and outbreak response (Munyua et al 2019). The expansion of One Health at the subnational level has mainly consisted of the ZDU and partner organizations setting up county One Health units to enhance communication between health and livestock sectors to address zoonotic diseases.…”

“…While adoption of One Health at the national level is significant, more progress is needed at the county and subcounty levels. Challenges include sustainability, competing interests, and a lack of coordination platforms (Munyua et al 2019;Kimani et al 2016). Further, One Health policy can do more to address the specific challenges of service delivery constraints experienced by pastoralists.…”