Introduction:

Discussion

Key takeaways

This review highlights a central paradox of the One Health approach in Africa: its strategic importance is widely recognized, but how much it’s actually put into practice still varies.

So the main difficulties no longer lie solely in the lack of a conceptual justification for One Health. They mostly concern the ability of systems to turn this approach into permanent mechanisms for collaboration, funding, monitoring, and decision-making.

The approach should therefore be understood as a transformation of health governance methods rather than as the addition of another vertical program.

From political support to implementation

Having national strategies and platforms is an important step, but it doesn’t guarantee they’ll actually work on a day-to-day basis. A multisector platform that has no budget, no decision-making power, no common indicators, and no monitoring mechanisms risks staying mostly just on paper. So putting things into action requires moving from declarative governance to operational governance.

Governance as a major determinant

Governance appears as a cross-cutting factor in implementation. Preventing zoonoses, fighting antimicrobial resistance, environmental monitoring, and epidemic preparedness involve different institutions. An effective response therefore requires mechanisms to resolve priority conflicts and allocate resources according to common goals. One Health structures should be integrated into national health security mechanisms rather than operating as parallel systems.

Funding and sustainability

Funding is another key factor. Relying too much on vertical or temporary funding can lead to building capacities that shrink when projects end. A sustainable strategy should therefore gradually include One Health's essential functions in national budgets and the strategic plans of different sectors.

Data and integrated monitoring

Integrated surveillance is one of the areas where the One Health approach can really add value. However, integration shouldn’t be confused with just collecting data. The priority should be on creating systems that turn data from different sectors into information that can be directly used for decision-making. This means harmonizing definitions, indicators, formats, and alert procedures.

Community participation and local adaptation

Community engagement is an essential part of One Health. Communities experience environmental changes and human-animal interactions firsthand. So, they can play an important role in the early detection of events. However, their involvement should be seen as a partnership. Interventions need to consider economic constraints and local practices rather than just delivering recommendations.

Implications for the resilience of health systems

One Health's potential contribution to resilience mainly relies on four mechanisms: anticipating risks before they escalate, detecting signals from multiple sectors, coordinating responses quickly, and adapting systems to evolving threats.

So, One Health can help shift healthcare systems from being mostly reactive to being more preventive and forward-thinking.

However, this contribution depends on the strength of the health systems themselves. One Health can't sustainably make up for the lack of human resources, labs, funding, or governance.

Gaps in the literature and research priorities

The available data show several areas that need more research. Studies describing the implementation of One Health platforms are more common than evaluations of their actual effectiveness. Data to measure the impact of One Health on health outcomes, early detection, risk reduction, or epidemic response costs are still insufficiently documented in many contexts. Economic analyses are also needed to determine the most efficient investment methods. Furthermore, environmental aspects are still less integrated into surveillance systems than human and animal aspects.

There is finally a need for common indicators to assess how operational One Health is at both national and subnational levels. Future research should therefore focus on implementation evaluations, longitudinal studies, economic analyses, governance assessments, and approaches that measure the impact of One Health on the resilience of health systems.

Implications for African health policies and systems

The lessons from this review help highlight several operational priorities. First, One Health should be integrated into national health security policies rather than treated as a standalone program. Second, national coordination mechanisms should have clearly defined mandates, indicators, and resources. Third, human, animal, and environmental surveillance systems should gradually become interoperable. Fourth, investments in laboratories, human resources, and digital systems should be seen as shared investments across multiple sectors.

Fifth, communities should be involved in the design, implementation, and evaluation of interventions. Finally, technical and financial partners should support the strengthening of national capacities and their sustainability rather than focusing solely on temporary or vertical arrangements.

Main lessons from the literature on one health in Africa

• Prevention and monitoring of zoonoses

Preventing zoonoses has always been one of the main areas where One Health is put into practice. Keeping an eye on both people and animals at the same time helps spot warning signs earlier and guide investigations.

The effectiveness of such an approach, however, depends on the sectors' ability to share information and launch coordinated investigations. Simply having parallel monitoring systems doesn’t count as One Health surveillance.

One of the main lessons is that integration should be organized around common procedures: compatible case definitions, alert mechanisms, investigation protocols, sharing results, and clearly defined responsibilities.

• Antimicrobial resistance

Antimicrobial resistance really highlights the need for an integrated approach. The use of antimicrobials in human and veterinary sectors, as well as environmental contamination, all contribute to a problem that can't be effectively tackled by just one sector [5,7,8].

A One Health strategy to fight antimicrobial resistance should therefore combine microbiological monitoring, monitoring antimicrobial use, infection prevention, responsible use of medications, infection control in healthcare facilities, proper veterinary practices, and environmental monitoring.

For African health systems, the challenge is especially about building lab capacities and data systems that can track resistance trends and generate information that's comparable across sectors.

• Environmental risks and climate change

Environmental changes are altering the conditions under which populations are exposed to infectious agents and vectors. Deforestation, land-use changes, urbanization, and climate changes can transform habitats and interactions between species [3,9].

Projections about the evolution of interspecies transmission risks highlight the importance of connecting climate, ecological, entomological, animal, and human data [13].

With this in mind, One Health surveillance should gradually integrate weather and environmental data into traditional epidemiological monitoring systems. This kind of integration could improve the ability to anticipate certain events rather than waiting for them to ramp up in human populations.

• Preparing for and responding to epidemics

Recent major health crises have shown the limits of strictly sectoral responses. Ebola outbreaks, yellow fever flare-ups, and the COVID-19 pandemic required coordination between human health, animal health, the environment, food security, research, and governance [4,7].

One of the main lessons is that coordination needs to be prepared before a crisis. So, multisectoral platforms shouldn't be activated only in an emergency. Preparation should include joint exercises, pre-established protocols, communication mechanisms, lab capabilities, and clearly defined decision-making chains.

• Community involvement

Communities play a central role in putting One Health into action. They are often an early source of information about unusual changes observed in humans, animals, or the environment. Community workers, farmers, local veterinarians, and other local players can help with early detection and spreading prevention measures. However, community participation shouldn’t just be about passing on messages. It should also include local knowledge, risk perceptions, cultural practices, and economic constraints that influence behavior.

• Digital systems, data, and labs

The fragmentation of information systems remains a major obstacle to the integration of One Health. Human, veterinary, and environmental surveillance data are often produced in different formats, on different schedules, and through different institutional channels. 

Developing interoperable digital platforms could make data sharing easier and improve early detection. Advances in genomics and laboratory networks also offer significant opportunities to strengthen pathogen surveillance [15]. 

However, digital transformation doesn't automatically guarantee better collaboration. Issues like data ownership, privacy, governance, access, cybersecurity, and cross-border sharing also need to be considered.

Obstacles to the operationalization of one health in Africa

• Institutional Fragmentation

One of the main obstacles lies in the way administrations are organized into relatively autonomous sectors. Ministries and institutions responsible for health, livestock, agriculture, and the environment can have different priorities, budgets, information systems, and decision-making mechanisms. This fragmentation reduces the ability to develop a coordinated and sustainable response.

• Insufficient human resources

Making One Health operational requires professionals who can work beyond their own disciplinary field. The needs especially include epidemiologists, veterinarians, doctors, biologists, environmental specialists, biostatisticians, data experts, and public health professionals. So, capacity building should go beyond traditional training and include interdisciplinary skills.

• Insufficient funding and external dependence

Monitoring, labs, digital systems, training, and epidemic preparedness all need sustainable investment. External funding has helped build many capacities, but relying too much on partner funding can weaken program continuity. One Health investments should gradually be integrated into national budgets for health, public safety, agriculture, and the environment.

• Low data interoperability

Just producing data isn't enough. Data needs to be accessible, comparable, understandable, and usable for decision-making. The lack of common standards and ways to exchange it limits the ability to turn data from different sectors into practical information.

• Difficulties adapting to local contexts

One Health interventions need to take into account the economic, social, cultural, and environmental realities specific to different African regions. Farming practices, ways of using natural resources, population mobility, and perceptions of diseases vary widely. So, a one-size-fits-all strategy applied across the continent might not fully consider the local risk factors.

Ways to implement one health to strengthen health systems' resilience

• Institutionalize multisectoral governance

Effective governance must go beyond informal collaborations. Countries should have clearly mandated national One Health mechanisms, with sufficient institutional authority and involving the relevant sectors. These mechanisms should allow for joint planning, setting common indicators, coordinating investments, sharing data, periodically evaluating activities, and coordinated preparedness for health emergencies.

The One Health Joint Plan of Action 2022–2026 provides an important international framework to support this institutionalization [14].

Aligning with the 2005 International Health Regulations and the regional strategies led by Africa CDC can also help strengthen the consistency of health security policies [15].

• Set up sustainable financing mechanisms

Funding is a fundamental condition for sustainability. Investments need to cover human resources, labs, monitoring, digital systems, research, training, as well as epidemic preparedness and response all at the same time. International mechanisms like the Pandemic Fund can support national capacities. However, external funding should help build up domestic investments gradually rather than serve as a permanent substitute. Economic analyses and cost-effectiveness evaluations should also be more integrated into investment decisions.

• Integrate the monitoring systems

Effective One Health monitoring should allow for combining human, animal, and environmental data. An operational model can link human surveillance, animal surveillance, environmental monitoring, labs, integrated analysis, alert systems, decision-making, and interventions. This chain can only work if responsibilities, sharing procedures, and reporting timelines are clearly defined.

• Strengthen diagnostic and genomic capabilities

Laboratories are an essential part of One Health. Developing networks of labs that can share microbiological and genomic data can improve the identification of pathogens and our understanding of how they spread. Investments should come with quality assurance systems, staff training, and ways to use the results for public health decisions.

• Develop interoperable digital systems

Digital transformation offers significant opportunities to integrate data from different sectors. However, the goal shouldn’t just be to create more platforms. It should be to enable the interoperability of existing systems. Data standards, sharing protocols, data governance, privacy protection, and cross-border sharing agreements all need to be defined alongside each other.

• Integrate communities

Communities should be seen as partners in monitoring, not just as recipients of interventions. Community monitoring systems can help spot unusual events in humans and animals early on. Including local knowledge and community players can also make prevention measures more acceptable.

• Develop a One Health workforce

Training is a strategic investment. 

Training programs for doctors, veterinarians, nurses, biologists, epidemiologists, and environmental professionals should include common skills in epidemiology, surveillance, risk analysis, communication, outbreak management, data analysis, and the principles of One Health. 

Ongoing training and multisectoral exercises should complement initial training.

Limits of the review

This review has several limitations. Its narrative nature does not allow for producing an overall quantitative estimate of the effectiveness of One Health interventions. Moreover, the heterogeneity of African countries in terms of health systems, governance, resources, and environmental risks limits the direct generalization of lessons from one context to another. The available literature may also be influenced by differences between countries in research and publication capacities, which can lead to unequal representation of national experiences. Finally, the diversity of approaches and indicators used in different studies makes direct comparison of results difficult and highlights the need to develop common evaluation frameworks for One Health implementation.

Conclusion

One Health is now seen as a clear and necessary response to the complex health threats facing Africa. Recent crises have shown that human health can no longer be considered in isolation. It is essential to take into account animal health and the environment. An integrated approach allows for anticipating risks, taking action earlier, and limiting the scale of crises.

The implementation of the One Health concept relies on collective will. It requires going beyond institutional silos and strengthening collaboration across sectors. It is also necessary to create shared governance frameworks. It involves a sustained investment in training, research, and information systems, in order to turn principles into concrete actions in the field.

Integrating One Health at the heart of public health and development policies represents a strategic opportunity for Africa. This approach can strengthen the resilience of health systems, protect populations, and preserve the ecosystems on which they depend. By focusing on prevention, collaboration, and coordinated actions, One Health offers a concrete and tailored way to address current and future health challenges.

Declarations

Clinical trial number: not applicable.

Funding : this article received no external funding.

Ethics approval and consent to participate : not applicable.

Consent for publication : not applicable.

Availability of data and materials : data sharing is not applicable to this article as no datasets were generated or analyzed.

Competing interests : the authors declare that they have no competing interests.