AFROHUN-Kenya conducted a desk review of One Health policy and other documents in Kenya and evaluated the capacity of the current framework for addressing complex health issues using a One Health approach. The desk review aimed to generate evidence that can inform more efficient and effective implementation of policy instruments using a One Health approach.
Building on the review, AFROHUN Kenya engaged government and other stakeholders in a one-day meeting to present and deliberate on the findings of the review. The meeting involved stakeholders drawn from government ministries, research institutions, universities, public health organizations, non-governmental institutions, international organizations, such as FAO and others, and professional bodies, such as Kenya Veterinary Association (KVA), and Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU).
This article discusses the findings and the stakeholders’ views of the findings. The stakeholders’ meeting that was held in March 2021, aimed to determine how the implementation of One Health approach could be scaled up with specific reference to policies and publications, basing the discussion on the findings.
The meeting was attended by stakeholders from academia, research institutions, national government and county governments, Non-Governmental Organizations, Global Health Security Agenda (GHSA) partners, professional regulatory bodies, and the One Health Platform (ZDU).
Several key findings were generated from this desk review, and a few are discussed here as they were shared in the stakeholders’ meeting.
Overall, the review findings demonstrate that One Health has advanced from being a concept/principle to become an approach that many countries, including Kenya are embracing.
In specific terms:
- The main issues of interest and focus for One Health and their corresponding stakeholders have not changed. These are zoonotic diseases; antimicrobial resistance; food safety and food security; vector-borne diseases; environmental contamination; and other health threats shared by people, animals, and the environment (CDC, 2018).
- The findings also revealed increasing human population, increased proximity between wild and domestic animals and human beings, disruptions in environmental conditions and habitats and increased movements of people, animals and animal products. This has led to increased spread of diseases. The desk review found that the One Health approach has been effectively deployed to fight health concerns at the human-animal-environment interface, including zoonotic diseases.
- The approach has not only enhanced capacity in the prevention and control of emerging infectious diseases but has also improved the management of other public health threats. There was synergism whose impact improved communication, heightened surveillance, decreased lag-time in response, enhanced health and economic savings, and advanced public efficacy among several others.
- Some of the gains the review found that the implementation of One Health approach in Kenya has yielded, included: 1) Joint training (veterinarians and medical doctors trained jointly) of One Health workforce through the Field Epidemiology and Laboratory Training (FELTP) program; 2) the establishment of One Health Institutional Framework – the National One Health Office known as the Zoonotic Disease Unit (ZDU) which was established in 2012 to promote and coordinate multi-sectoral surveillance and outbreak response activities between ministries responsible for public and animal health in Kenya; 3) the development of One Health Strategic Plan 2012 – 2017; 4) institutional capacity building through establishment of One Health units in devolved government units (counties) across the country from 2013; 5) strengthening the surveillance system for early detection of zoonoses/use of mobile phone-based active disease surveillance; 6) institutional collaborative research on Brucellosis, Anthrax, RVF, Q-Fever, MERS-Cov, and Rickettsia, among others; 7) on-going Population-Based Infectious Disease Surveillance (PBIDS) and research on potential zoonotic diseases in small mammals; 8) close collaboration between ZDU, multilateral and bilateral agencies and partners, local and international research institutions and universities working on zoonoses in Kenya; 9) funding and coordination of key One Health projects – e.g., for brucellosis and rabies; 10) interdisciplinary collaboration at the government level; and finally, 11) integrated and coordinated disease investigation and response.
The review however, revealed that amid these gains, there are still challenges and shortcomings that need to be addressed, including: 1) inadequate One Health policy provisions; 2) poor resourcing of surveillance, disease reporting and laboratory diagnosis services; 3) fragmented and disconnected governance of sectors responsible for health, animal health and environment; 4) slow adoption of One Health approach at sub-national level (county and sub-county); 5) lack of incorporation of environmental health into the mainstream One Health approach; 6) inadequate numbers of trained experts in One Health approach; 7) lack of clarity about the definition, concept and scope of One Health approach; 8) under-recognition and inadequate understanding of economic benefits of One Health approach; 9) poor communication; 10) lack of guidance on how to operationalize the One-Health approach at national level; 11) weak capacity for surveillance and response in the animal health sector as compared to the public health sector;12) inadequate training activities for One Health; 13) insufficient deployment of improved technologies in data management in disease surveillance, prevention and control; 14) battles over curricular time in training programs at universities where One Health training activities are being conducted; 15) issues related to licensing and certification; 16) interdisciplinary/intersectoral disagreements and mandates; and 17) sustainability of One Health initiatives in the absence of supporting donors and partners.
Through the review, it was realized that there exists a glaring absence of the environmental health sector/component from the One Health decision-making table. The Centre for Disease Control and Prevention (CDC)pointed out that the vital starting point in including the environmental health sector/component at the decision-making table includes the following: defining what “environment” constitutes; establishing the threats to public and animal health; and identifying the environmental actors to be engaged in One Health activities.
A broad definition of the term “environment” has all along been the stumbling block to the inclusion of relevant stakeholders from the environmental sector in decision making. KWS (Kenya Wildlife Service); CORE GROUP; HORN (One Health Regional Network for the Horn of Africa) were concerned that the definition of the term “environment” should be specific, not broad. This will enhance clarity and the need to include the environmental health sector/component at the decision-making table.
The Ministry of Health (MOH) and World Animal Health Organization (OIE) were very concerned about this because it is a core area of One Health. Consequently, collaboration between One Health stakeholders and players in other sectors like energy, built environment, industry, agriculture and transport is vital.
To effectively scale up the One Health approach, the stakeholders suggested facilitating students in universities and other institutions of higher learning outside AFROHUN Kenya’s networks to have access toAFROHUN’s activities and One Health materials.
Continuing professional development in One Health is lacking. This needs to be fast-tracked and AFROHUN Kenya and other One Health stakeholders agreed to help in developing the relevant modules for the activities.
Scaling up the implementation of One Health requires capacity building up to the community level. Therefore, putting to good use the existing One Health models for community capacity building was critical. It was agreed that learning from the International Livestock Research Institute’s (ILRI) HEAL Training approach/model would be very beneficial in scaling up the implementation of One Health Approach.
For the successful implementation of the One Health approach in Kenya, the review found out that the following aspects related to One Health should be in place: a favourable policy environment; the establishment of institutional frameworks; building institutional capacity; conducting research; recognizing the role of the stakeholders; forging multi-disciplinary/multi-sectoral collaborations and partnerships; workforce development; having a robust/strong communication/information dissemination system; sustainable resourcing (funding); community engagement; engineering a cultural shift in the management of public health threats; and seeking and establishing political goodwill.
Stakeholders recommended that AFROHUN Kenya bring on board and collaborates with tertiary institutions of learning. Such institutions include but are not limited to the Animal Health Industry Training Institutes (AHITIs), and the Kenya Medical Training Colleges (KMTCs).
Scaling up the implementation of One Health approach also involves assessing environmental aspects. Consequently, EcoHealth Alliance and the World Bank have developed a tool for assessing the environmental aspects of One Health which was piloted in Ghana. This tool will be used together with other existing assessment tools such as IHR (International Health Regulations), JEE (Joint External Evaluation), and PVS (Performance of Veterinary Services).
While making the concerted efforts to scale up the implementation of One Health approach in Kenya, AFROHUN Kenya is supporting and undertaking curricula reviews. It has also designed new and exciting experiential learning multidisciplinary training programs. An example of this is the Master of Science in Infectious Diseases and Global Health (MSc – IDGH) Course. This has been developed to be hosted jointly by the University of Nairobi and Moi University.
To be more impactful, the implementation of One Health approach should not only be scaled in the institutions of higher learning but also in the wider community. This is the basis for retooling trainers and trainees in institutions of higher learning so that they can become effective in the wider community. They do this by educating communities on the existence and transmission of zoonotic and infectious diseases, while engaging national and sub-national governments to integrate One Health approach into national policy and strategic planning.
In conclusion, there is considerable progress made in the implementation of the One Health approach. New collaborative engagements, research and innovations will certainly bolster the implementation of One Health approach in Kenya for the attainment of improved public health.