review · Frontiers in Public Health
One Health connects human, animal, and environmental health to tackle complex threats such as epidemics, zoonotic diseases, and antimicrobial resistance. While collaborative platforms have advanced in wealthier nations, developing countries face distinct implementation challenges. A systematic review assessing evidence from low- and middle-income settings identified critical obstacles and facilitating factors. The primary barriers to executing One Health programmes include limited political will, weak governance systems, and shortfalls in human, financial, and logistical resources. Conversely, implementation is enabled by establishing clear reference framework documents, ensuring strong multisectoral coordination, and holding joint meetings across sectors to advocate for integrated health approaches. Adequate funding and technical support from international partner organisations are also essential to sustain these initiatives and build resilient health systems.
Controlling disease outbreaks and drug-resistant infections requires close coordination across human, animal, and environmental health domains. Identifying the specific structural barriers and enablers in low- and middle-income countries assists public health authorities, international donors, and governments in designing workable governance models and allocating resources where they are most needed to prevent future global health emergencies.
The abstract focuses on public policy and multisectoral governance frameworks, and it does not indicate an application pathway.
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Introduction: One Health is a concept that establishes the link between humans, animals and the environment in a collaborative approach. Since One Health's inception, several interventions have been developed in many regions and countries worldwide to tackle complex health problems, including epidemics and pandemics. In the developed world, many collaborative platforms have been created with an international strategy to address issues specific or not to their environment. Unfortunately, there is a lack of synthesis on the challenges and opportunities Low and Middle-Income Countries (LMICs) face. Methods: Following The Preferred Reporting Elements for PRISMA Systematic Reviews and Meta-Analyses (PRISMA), we conducted a systematic review. We applied a search strategy to electronic bibliographic databases (PubMed, Embase, Global Health, Web of Science and CINAHL). We assessed the included articles' quality using the Mixed Methods Appraisal tool (MMAT). Results and discussion: A total of 424 articles were initially identified through the electronic database search. After removing duplicates (n = 68), 356 articles were screened for title and abstract, and 16 were retained for full-text screening. The identified barriers were the lack of political will, weak governance and lack of human, financial and logistics resources. Concerning the enablers, we listed the existence of a reference framework document for One Health activities, good coordination between the different sectors at the various levels, the importance of joint and multisectoral meetings that advocated the One Health approach and the Availability of funds and adequate resources coupled with the support of Technical and Financial partners. Conclusion: One Health strategy and interventions must be implemented widely to address the rising burden of emerging infectious diseases, zoonotic diseases, and antimicrobial resistance. Addressing those challenges and reinforcing the enablers to promote managing global health challenges is necessary. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/record_email.php, Unique Identifier: CRD42023393693.
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DOI: 10.3389/fpubh.2023.1252428
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