Systems' Barriers and Facilitators of One Health Programs that Address Zoonotic Diseases: A Review of the Literature

Abstract

Purpose: To identify the facilitators and constraints of effective implementation strategies in One Health (OH) programs that address zoonotic diseases with the Interactive System Framework (ISF). Methods & Materials: A scoping of the literature of peer-reviewed English articles reporting OH implementation programs with the PRISMA method was done. Only articles or reports with information on the process of implementation and strategies were included. The following Databases were included in the search: PubMed, MEDLINE, EMBASE, Scopus, and Web of Science as well as gray literature, such as government reports. Barriers and facilitators were organized with the ISF structure. Results: The facilitators of OH implementation at the system level were: comprehensive funding structures that prioritize long-term goals, regions that prioritize strengthening institutions, bottom-up strategies built from the community to reach sustainable goals and research networks and collaboration that incentivize knowledge exchange. Key stakeholders’ capabilities besides the usual management roles are active advocacy and creation and management of collaborations.System structural barriers included governance systems with unclear goals and roles. Top-down funding frameworks created silos and prevented inter-sectoral and trans-disciplinary collaborations. In some countries, there is a lack of a formal policy decision-making process to guarantee proper prioritization of policies. Conflicting priorities between stakeholders from different sectors may create rivalries over budget allocation. Another system structural barrier is how to assess cost-benefit across different domains to evaluate OH programs. OH requires high levels of collaboration and a trans-disciplinary approach; therefore, the variability of sub-cultures within disciplines is a challenge for managing OH programs. Conclusion: A shift of perspective is needed to understand that results will not be achieved within institutions or organizations but shared among OH programs. OH program adoption may be increased through funding strategies that create incentive structures through joint budgets or special grants for OH activities. More research is needed at the system level to assess how systems structures reinforce or prevent interactions between animal and health systems and to explore OH systems structure and leadership roles that facilitate diffusion of implementation. Lastly, study governance types that best facilitate OH collaboration and delivering results and accountability.