Hostname: page-component-76d6cb85b7-dqfph Total loading time: 0 Render date: 2026-07-17T13:24:54.582Z Has data issue: false hasContentIssue false
  • English
  • Français

Knowledge gap among one health key actors on multi-sectoral coordination at national and sub-national levels in Tanzania

Published online by Cambridge University Press:  28 October 2024

A response to the following question: How can we improve and facilitate multi-sectoral collaboration in warning and response systems for infectious diseases and natural hazards to account for their drivers, interdependencies and cascading impacts?

Valentina T. Sanga Open the ORCID record for Valentina T. Sanga [Opens in a new window] ,
Abubakar S. Hoza  and
Esron D. Karimuribo
Valentina T. Sanga*
Affiliation:
Prime Minister’s Office, Disaster Management Department, One Health Section, Dodoma, Tanzania Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, College of Veterinary Medicine and Biomedical Sciences, Morogoro, Tanzania
Abubakar S. Hoza
Affiliation:
Department of Veterinary Microbiology, Parasitology and Biotechnology, Sokoine University of Agriculture, College of Veterinary Medicine and Biomedical Sciences, Morogoro, Tanzania
Esron D. Karimuribo
Affiliation:
Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, College of Veterinary Medicine and Biomedical Sciences, Morogoro, Tanzania
*
Corresponding author: Valentina T. Sanga; Email: sangavalentina2@gmail.com
Rights & Permissions [Opens in a new window]

Abstract

Knowledge about One Health approach and its importance among the practitioners and the community in addressing health threats is of paramount important. This study aimed to assess knowledge of One Health actors on multi-sectoral coordination in addressing health risks in selected regions of Tanzania. A descriptive study was conducted from June to August 2023 in selected regions of Arusha, Iringa and Dodoma where quantitative and qualitative data were collected from 101 participants representing the line ministries and sub-national regional and district levels. Descriptive analysis was done using EPI INFO 7.2.5.0 statistical software and Microsoft excel. Results showed a decreasing proportion of participants reporting to be aware of One Health approach at the National level with 100.0% awareness and only 32.3% awareness at the district level. It was also revealed that 76.9% of the participants at the national level had received One Health training through short courses, workshops meetings, and Continuous Professional Development (CPD) courses compared to the varying proportions of 57.7% and 19.4% at the regional and district level, respectively. Limited awareness of different professional disciplines on One Health approach is the major challenge in its operationalisation and institutionalisation at sub-national levels. Awareness creation to One Health actors and advocacy to policy and decision-makers at all levels will enhance implementation, multi-sectoral coordination and collaboration among key actors in addressing health risks emergencies.

Keywords

One Healthmulti-sectoral coordination and collaborationcommunicationknowledge and multidisciplinary

Information

Type
Results
Information
Research Directions: One Health , Volume 2 , 2024 , e14
Check for updates
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
Copyright
© The Author(s), 2024. Published by Cambridge University Press

Introduction

One Health (OH) is an approach which promotes coordinated multi-sector and multidisciplinary collaborative efforts at sub-national, national and global levels to prevent, respond and control health threats (Hailat et al., Reference Hailat, Amiri, Debnath, Rahman, Nurul Islam, Fatima, Khader and Al Nsour2023; Mumford et al., Reference Mumford, Martinez, Tyance-Hassell, Cook, Hansen, Labonté, Mazet, Mumford, Rizzo, Togami, Vreedzaam and Parrish-Sprowl2023). One Health as defined by the Quadri partite One Health High-Level experts is “an integrated, unifying approach that aims to sustainably balance and optimise the health of people, animals and ecosystems” (UNEP, WHO, FAO, and WOAH, 2021). It recognises the health of humans, animals, plants, and the wider environment (including ecosystems) which are closely linked and interdependent. The approach mobilises multiple sectors, disciplines and communities at varying levels of society to work together to foster well-being and tackle threats to health while addressing the collective need for clean water, energy and air, safe and nutritious food, taking action on climate change, and contributing to sustainable development (UNEP, WHO, FAO, and WOAH, 2021). The optimal health of humans, animals, plants and their environment depends on the effectiveness and adherence to principles of prevention, control and timely response to health risks (Erkyihun and Alemayehu, Reference Erkyihun and Bereke2022).

In recent years, health threats which impend human and animal health, food security and the economic prosperity of nations have increased globally (Sinclair, Reference Sinclair2019; Bs and Nambiar, Reference Bs and Nambiar2020). Experience has shown that some of these threats may assume rapid regional or global spread between animals and humans. Emerging diseases of animal origin such as Severe Acute Respiratory disease and highly pathogenic avian influenza (H5N1) occurred in China in 2004–2006 (Martin et al., Reference Martin, Pfeiffer, Zhou, Xiao, Prosser, Guo and Gilbert2011; Farag et al., Reference Farag, Nour, Islam, Mustafa, Khalid, Sikkema, Alhajri, Bu-Sayaa, Haroun, Van Kerkhove, Elkholy, Malik, Reusken, Koopmans and AlHajri2019); Ebola which occurred in West Africa in 2014; as well as Corona Virus Disease-19 (COVID-19) outbreak in China in late 2019 (Onyekuru et al., Reference Onyekuru, Ihemezie, Ezea, Apeh and Onyekuru2020). These are typical examples of the pandemics that triggered a public health crisis and challenged effective national and global response, with disastrous results for human health and well-being and food security (Connolly, Reference Connolly2017).

In African countries, including Tanzania, zoonotic pathogens continuously pose risks to both animal and human health and their well-being as well as threatening national and global health security (Hassan et al., Reference Hassan, Affognon, Rocklöv, Mburu, Sang, Ahlm and Evander2017; Nantima et al., Reference Nantima, Ilukor, Kaboyo, Ademun, Muwanguzi, Sekamatte, Sentumbwe, Monje and Bwire2020; WHO, FAO, OIE, 2019). Human health is dependent on the health of animals and the environment, thus the link between humans, animals and ecosystems is very important to ensure diseases are prevented or contained at the source (FAO, UNEP, WHO and WOAH, Reference Sinclair2022). Responding to these complex health challenges requires coordination, collaboration, communication and capacity building between and within multiple sectors and disciplines through the OH approach (Vigilla-Montecillo et al., Reference Vigilla-montecillo2023).

It is obvious that OH operationalisation is important at all levels in order to strengthen health security at the country and global levels (Joshi et al., Reference Joshi, Hafner, Twesigye, Ndiaye, Kiggundu, Mekonnen, Kusu, Berthé, Lusaya, Acho, Tuala, Siddiqua, Kaboré, Aidara and Guzman2021; Alimi, Reference Alimi2023). Understanding the close interaction between humans, animals and the environment is key to the prevention and control of emerging and re-emerging diseases (Muhanga et al., Reference Muhanga, Malungo and Kimario2019). In Tanzania, OH was adopted in 2015 when the first One Health strategic plan (OHSP) (2015–2020) was officially launched and revised in 2022 (OHSP 2022–2027). The OHSP guides OH implementation in the country. Therefore, this study aimed at assessing knowledge of One Health actors on multi-sectoral coordination in addressing health risks in selected line ministries, districts of Iringa, Dodoma and Arusha regions, Tanzania. In the context of this study, One Health actors refer to the professionals working in human health, animal health, environmental health, wildlife and crop and plant health sectors whose job descriptions involve the implementation of programmes and interventions requiring OH approach. The main focus was to explore the understanding of OH operationalisation at all national, regional and the district level and to identify gaps and factors contributing to ineffective coordination of One Health activities among sectors in Tanzania.

Methodology

Study area

The study was conducted in three regions of Tanzania, which included Dodoma, Arusha and Iringa (Figure 1). The line ministries were selected to represent the national level OH actors. Two districts were selected in each region namely Kondoa and Kongwa in Dodoma region; Iringa and Mufindi in Iringa region; and Arusha and Monduli in Arusha region. The sites were selected because they comprise a better prototype of studying human-animal-ecosystem interactions due to the presence of various wildlife-bordering areas including Manyara and Arusha national parks in Arusha; Ruaha national park in Iringa; and Swaga Swaga and Mkungunero game reserves in Dodoma which present high-risk areas for infection spill over from animals to humans.

Figure 1.

A map indicating districts where the study was conducted.

Study design and population

A descriptive study using semi-structured questionnaire and key informant interviews with key OH actors was conducted from June through August 2023. The questionnaire included closed and open-ended questions. Both quantitative and qualitative data were collected from key OH actors from the National, regional and district levels. Purposive and convenience sampling was used to recruit the participants based on their availability and accessibility at their working areas and according to their professionalism and employment responsibilities (Palinkas et al., Reference Palinkas, Horwitz, Green, Wisdom, Duan and Hoagwood2015; Bhardwaj, Reference Bhardwaj2019). Key informant views were conducted with participants (n = 5) who previously worked in One Health Coordination Desk currently the One Health Section on multi-sectoral collaboration and coordination in the Prime Minister’s Office. Both written and verbal consents were thought from the study participants prior to the interviews.

Data collection

Data were collected at three levels: first, at the National level which involved the line ministries which are key players for the National One Health operationalisation, that is, the Ministry of Health (MoH), Ministry of Livestock and Fisheries, Ministry of Agriculture (MoA), Vice President’s Office-Environment and Ministry of Tourism and Natural Resources. The second level was at the region (equivalent to a province in other countries) and the third level was as at the district. Data were collected from government officials who are the key players for OH Implementation at their respective levels which included Public Health officers, Veterinary officers, Animal Health officers, Environmental officers, Wildlife officers, and Agricultural officers (Figure 2). The inclusion criteria for this study were people working in livestock, wildlife, health, agriculture (crop and plant health) and environment sectors having Certificate, Diploma, Bachelor degree, Master’s degree and PhD level of training in their respective disciplines.

Figure 2.

Levels and type of professionals interviewed at the national (n = 13), regional (n = 26) and district levels (n = 62) involving participants from wildlife, livestock, public health, environment and agriculture sectors.

Conveniently and purposively selected participants were drawn depending on the respondent’s expertise and roles in their workplaces as described in their respective job descriptions and are available at their work places. Based on the principle of saturation (Sim et al., Reference Sim, Saunders, Waterfield and Kingstone2018), a total number of 101 participants reached the saturation point on questions asked. Data collected focused on understanding the general knowledge of OH, the personal particulars (age, education, and work experience of professionals) and the supporting guidelines that enable OH operationalisation for easy coordination at their respective workplaces (Table 1). The awareness was assessed by identifying the ability of the participants to explain the meaning of OH approach and its operationalisation; whether they know or understand OH competencies and describe the health risks that requires OH approach.

Table 1.

Types of data collected to identify knowledge gaps in One Health and multi-sectoral coordination and collaboration in Tanzania

Data analysis

Quantitative data were analysed using EPI INFO 7.2.5.0 statistical software for epidemiology from Centers for Disease Control and Prevention where descriptive statistical analysis like frequencies and percentages was carried out to assess knowledge and practice. Content analysis was used in analysis of qualitative data collected, where conceptual analysis and inductive approach were used to identify related concepts in the participant’s text answers and group them into categories (Bengtsson, Reference Bengtsson2016; Kleinheksel et al., Reference Kleinheksel, Tawfik, Wyatt and Winston2020; Hennessey and Barnett, Reference Hennessey and Barnett2023). The concepts were coded manually in Microsoft Word document and then codes were tallied in a Microsoft Excel sheet for frequency analysis. The information or concepts analysed were information sharing, importance and advantages of OH, limitations of OH implementation and recommendations to improve operationalisation of OH.

Results

Socio-demographic data

A total of 101 participants were recruited in this study, where 71.3% (n = 72) were male and 28.7% (n = 29) were females. The participants in respective age categories were: 18–30 years (8.9%); 31–43 years (53.5%); 44–56 years (32.7%) and above 56 years (4.0%). The majority of participants had working experience of 5–10 years (n = 23) and 10–15 years (n = 25), respectively. Additionally, it was found that 0.9%% (n = 1) of the participants had certificate level of education; followed by 24.8% (n = 25) diploma holders, degree holders 57.4% (n = 58) and Master’s and PhD holders 16.8% (17) respectively. Looking at the distribution of the participants' education levels, the majority of the participants at the national level had higher degree qualifications 69.2% (n = 9), whereas at the regional and district levels, the majority had bachelor degree 61.5% (n = 16) and 62.9% (n = 39), respectively as presented in Table 2.

Table 2.

Indicating social demographic data of the participants

Awareness of One Health and multi-sectoral coordination and collaboration

Results of awareness on OH and; multi-sectoral coordination and collaboration indicated a decreasing proportion of participants who reported to be aware on OH approach from 100.0% (n = 13) at National level to 32.3% (n = 20) at the district level (Table 3). Forty-Seven percent (n = 48) of the participants responded that they have heard about One Health before; however, we observed that most of them do not understand what exactly OH is and how it operates. Although awareness on multi-sectoral coordination was observed to be relatively better, still lower proportion of the participants at the district level had limited knowledge on multi-sectoral coordination. It was further observed that higher proportion of the participants (76.9%) at the national level had received training on One Health through either formal training in higher learning institutions, short courses, attending workshops and meetings or through CPD courses compared to 57.7% at the regional and 19.4% at district levels who received OH training. Regarding whether participants at different levels are awareness on the existence of Guidelines or Standard Operating Procedures (SOPs) related to OH implementation, results revealed that district level had the lowest proportion of participants (only 4.8%) who are aware of existing OH guidelines (Table 3).

Table 3.

General awareness of OH actors at national and sub-national levels on One Health approach, multi-sectoral coordination and existence of OH guidelines/SOPs

When disaggregated by sector, results revealed that professionals in the livestock sector were more aware of the OH approach by 20.8% (n = 22) followed by professionals in the health sector 12.9% (n = 38), then Wildlife 6.9% (n = 13), environment 4% (n = 4) and agriculture 3% (n = 3). On the other hand, most participants were aware of multi-sectoral coordination. Considering whether there was communication among sectors, only 21.8% (n = 22) of participants from the human health sector reported to occasionally communicate with their counterparts in the livestock sector mainly during the events of rabies and anthrax outbreaks. However, respondents in the wildlife sector reported to communicate with their counterparts in the livestock sector during occurrence of diseases with potential of transmission between wildlife and livestock animals. Other sectors like agriculture and environment rarely communicate as illustrated in the Table 4.

Table 4.

General awareness of OH actors on One Health, multi-sectoral coordination and OH guidelines by sectors

One Health operationalisation at different levels

The findings on OH operationalisation at various levels show that 100.0% of the participants at the National level were aware of the collaboration and communication involving multiple sectors being coordinated through the Prime Minister’s Office compared to 76.0% and 46.8% at the regional and district level, respectively. Awareness on the advantages of OH approach was seemingly better at the national level by 100.0% (n = 13), followed by 96.2% (n = 25) at the regional level and 69.4% (n = 43) at the district level; similar trend was observed in ways of sharing information among the different sectors. However, the regional level 42.3% (n = 11) reported understanding on the mechanism for promoting multi-sectoral collaboration on OH implementation during public health threats, while the national level 38.5% (n = 5) and 12.9% (n = 8) at the district level had limited knowledge (Table 4). It was further observed that, participants from all levels were not aware of the mechanisms that promote multi-sectoral collaboration, despite of being aware of the various communication channels used by the government, particularly during response to various public health emergencies including use of government seculars, letters and electronic (e-mails) means of communication being commonly sources of communication at these levels. Moreover, it was also reported that delayed and/or ad hoc communication for OH issues lead to ineffective coordination and collaboration during disease outbreak response among key sectors, which requires OH approach at different levels (Table 5).

Table 5.

Awareness on the role of communication and information sharing in promoting OH operationalisation in preventing public health risks at different levels

Furthermore, 50.0% of participants admitted that OH operationalisation was important and key in the prevention of public health risks despite the limited knowledge among professionals at the sub-national level, as one respondent once said: “In my opinion, One Health is important because it brings sense of ownership and enable resource sharing.” Another respondent replied, “I think OH is important because it helps to promote coordination and collaboration among professionals and in disease prevention.”

Moreover, participants when asked for the experience of collaboration among sectors, most of them explained that disease outbreaks or health emergencies were the situations, which require collaboration, communication and support between sectors. The responses from the participants from health sector said “collaboration is based on the event occurred, when there is an outbreak, we are collaborating with livestock sector to respond.” When participants from the livestock sector were asked to mention type of diseases they collaborate, one said, “in case there is an outbreak of anthrax or events of dog bite we usually collaborate with health sector.” In addition, one participant quoted saying “through practice in responding to zoonotic diseases such as anthrax and rabies under the coordination of Prime Minister’s Office, I have seen the importance of applying One Health approach, because it allows team work and learning from others and thus helping each other.” A summary of responses on advantages of One Health is presented in Box 1.

Box 1:

Summary of responses of the participants and key informants regarding the advantages of OH in prevention of health risks.

Advantages of One Health Approach

  • I think, OH brings the sense of ownership and enable sharing of resources

  • In my understanding, OH promotes coordination and collaboration at all levels

  • In my opinion and knowledge, OH allows sharing of expertise between professionals

  • In my understanding One Health approach is important in prevention of diseases thus promoting health security

  • I think, OH helps in building team work, accountability and ownership

  • In my view, One Health enhances information sharing among departments and sectors for timely response

  • Through my experience in responding to diseases like rabies, OH offers opportunity to learn from other professionals, build sense of trust thereby strengthening collaboration

Despite the majority of participants acknowledging the importance of OH and associated advantages, implementation of OHA at all levels is still a challenge. The study participants could point out some limiting factors like coordination and limited knowledge on their roles which they consider hindering the adoption of OHA at different levels. A statement from one of the participants exemplifies this;

“Yes, we want sectors to work together in responding and prevention of diseases, are there clear stated roles and responsibilities for all OH actors? Who will be the overall coordinator especially at our regional and district levels?”

Among the major challenges observed in this study were limited knowledge and lack of awareness on OHA among professionals mainly at the sub-national level. Participants perceive OH to be a new approach and a new project introduced like any other implementation projects that will last for a couple of years and phase out. One participant from the district level who was once involved in an anthrax outbreak response had the following opinion;

“I hope this project if well implemented can help in disease prevention. May be let me ask, ‘’how long will this project be implemented? I am thinking of sustainability issues after the end of this project.”

However, many participants argued that inadequate resources among the sectors was also a challenge especially in the livestock sector compared to human health sector. Sharing resources for implementation of OH activities is envisaged as one of the advantages of adopting OHA, in spite this realisation it would be quite challenging for the resource-rich sectors to share their resources with another sector, leading to sectors continuing to work in silos (Box 2). One participant from the national level said; “It is true that OHA helps to tackle complex health problems using scarce resources available, but in reality, this is very difficult to be implemented.” Let’s take one example when a zoonotic disease outbreak occurs, and it is time to deploy a multi-sectoral team for response but in many occasions, you might find no early engagement of other key sectors is done.

Box 2:

Summarises Participants views on the limitations of OH implementation at different levels

Limitations of OH implementation

  • I think lack of awareness among professionals may hinder OH operationalisation

  • In my opinion, absence of clear roles and responsibilities among sectors hinders coordination of sectors as one can think their roles are being shifted

  • I think, you may have guidelines, well stated roles and responsibilities but if there are no adequate resources especially funding, implementation of OH will remain a big challenge

To promote OH operationalisation and improve multi-sectoral coordination and collaboration at the sub-national level, the participants provided several recommendations presented in Box 3.

Box 3:

Participants recommendations on improving OH operationalisation at the national and sub-national levels.

Recommendations

  • I think creating awareness at sub-national level will change the mindset of practitioners especially on sharing of resources.

  • Nothing can be properly implemented if there is no policy and guidelines, so I think it is important to develop integrated policy and strategy, which will be used by all, sectors and provide clear channels of command and disseminate them.

  • In my opinion, we need to improve communication and coordination.

Discussion

The study presents findings on general knowledge for One Health operationalisation at national and sub-national levels in Tanzania. Overall, four critical gaps were identified through this study, which hinder the institutionalisation and implementation of OH approach in the country, including:

• Inadequate knowledge concerning OH approach among professionals.

• Absence of OH guiding documents, which describe the roles and responsibilities of each player at the sub-national level.

• Ad hoc communication and collaboration among sectors resulting to inadequate sharing of information and working in silos and,

• Inadequate resources (financial) to support implementation of OH activities

The study revealed that since the introduction of the OH approach and the launching of the first OHSP (2015–2020), OH operationalisation has been quite effective at the national level. Knowledge gap among One Health key actors has been identified by this study to be a major challenge in operationalising OHA at the sub-national level. These findings are similar to the study conducted in Morogoro which identified inadequate health literacy and low collaboration between human and animal sectors (Muhanga et al., Reference Muhanga, Malungo and Kimario2018; Reference Mtui-Malamsha, Assenga, Swai, Msemwa, Makungu, Chinyuka, Bernard, Sallu, OleNeselle, Ponsiano, Kazwala, Kimera, Nonga and Folorunso2019; Mtui-Malamsha et al., Reference Mtui-Malamsha, Assenga, Swai, Msemwa, Makungu, Chinyuka, Bernard, Sallu, OleNeselle, Ponsiano, Kazwala, Kimera, Nonga and Folorunso2020). Also, a study conducted in East Africa and India on zoonotic diseases revealed that there was insufficient knowledge on zoonotic diseases which led to unhealthy practices regarding zoonotic disease prevention and control among livestock keepers (Ba et al., Reference Ba, Kane, Diallo, Bassoum, Boh, Mboup, Faye, Bedekelabou, Dieng, Diop, Badiane, Ridde and Faye2021; Majiwa et al., Reference Majiwa, Bukachi, Omia and Fèvre2023).

Furthermore, OHSP 2022–20 has highlighted knowledge gap among One Health key actors as one of the factors that hinder the operationalisation of OH in Tanzania. Although, some participants had information on OH received from various trainings, yet the knowledge about One Health concept and its importance in prevention of zoonoses and other public health risks is still limited among various One Health actors at the national and sub-national levels as well as the community in general (Muhanga et al., Reference Muhanga, Malungo and Kimario2019). This disparity in awareness is probably because those at the national levels are availed with more training/workshop/meetings CPD opportunities than those at the sub-national levels. Overall, participants from the livestock and human sectors had enough knowledge on the range of zoonotic risks. Interaction and collaboration between sectors and application of OH approach in tackling health risks were limited. Collaboration with other institutions was during outbreaks, however, other actors from the environment and agriculture sectors were less involved in response to zoonoses. These findings are similar to the study conducted in India to identify potential actors with an attempt to understand the current health system network strength (during an outbreak and non-outbreak situations) at the local health system, where there were low collaboration and communication among OH actors (Yasobant et al., Reference Yasobant, Bruchhausen, Saxena and Falkenberg2020).

The findings on whether study participants had awareness on coordination, collaboration, communication and capacity building which are key competencies in OH implementation have shown that most of the participants at the national level were more aware than their counterparts at the sub-national level. Although, most of our study participants at all levels showed a good understanding on multi-sectoral collaboration, the study revealed they believed that sectors should only collaborate during disease outbreak response and prevention. There were ad hoc collaborations and communication and no mechanisms for promoting OH collaborations. Also was evident that there was limited data and/or information sharing among sectors. As argued in previous studies on successful pillars for OH operationalisation, there is a direct need for capacity building on OH competencies among various OH players in addressing public health threats at human-animal-ecosystem interface as well as breaking the silos among sectors (Gwakisa et al., Reference Gwakisa, George, Sindato, Ngonyoka, Nnko, Assenga, Sharadhuli Kimera and Ole Nessele2023; Zhong and Fouque, Reference Zhong and Fouque2023). Moreover, the Tripartite Guide to address zoonotic diseases in countries and currently the Quadripartite guide emphasise on sectors responsible for OH at national and sub-national levels to collaborate and coordinated using OHA during preparedness and response to zoonoses (WHO, FAO, and WOAH, 2019).

Achievement in addressing complex health challenges in the human, animal and environmental interface requires not only the understanding of OH approach but how application of the core OH competencies in responding to such threats. Therefore, the need to create and raise awareness among different One Health actors at all levels is critically important in order to enhance the prevention, response and control of health risks. Coordination, collaboration, communication and capacity building across and within sectors at the global, national and sub-national levels are required for effective preparedness, prevention, detection and response to endemic, re-emerging and emerging zoonoses and other health threats. Such core competencies are required for efficient and effective operationalisation of OH across the sectors. Several studies have highlighted collaboration and coordination on preparedness and response to public health risks at the local level being a major challenge (Buregyeya et al., Reference Buregyeya, Atusingwize, Nsamba, Musoke, Naigaga, Kabasa, Amuguni and Bazeyo2020; Asiedu-berkoe et al., Reference Asiedu-berkoe, Chandi, Bandoh, Atsu, Lokossou, Antara, Sarkodie and Kenu2022; Onyango et al., Reference Onyango, Onguru and Atieno2023), therefore calling for governments commitment in advocating for OH approach for better response to public health threats (Ribeiro et al., Reference Ribeiro, Burgwal and Regeer2019; Yasobant et al., Reference Yasobant, Bruchhausen, Saxena and Falkenberg2019). Zoonotic diseases not only affect both human and animal populations but also have great economic impact across countries. To tackle them, there is a need to strengthen surveillance in all sectors. Coordinated actions and communication among sectors enhance data and information sharing. A study conducted in Chad on strengthening surveillance of zoonotic diseases with particular focus on rabies exemplified how OH enhances collaboration and communication among sectors and disciplines for successful prevention and control of rabies (Naïssengar et al., Reference Naïssengar, Oussiguere, Madaye, Mbaipago, Mindekem, Moyengar, Madjadinan, Ngandolo, Zinsstag and Léchenne2021).

Tanzania has made good progress in ensuring that the One Health is operationalised by establishing the One Health section at the Prime Minister’s office – Disaster Management Department, guided by Disaster Policy 2004 and Disaster Management Act no. 6 of 2022. Furthermore, One Health Strategic Plan 2022–2027 and various guidelines for the prevention of zoonotic diseases were developed to guide the implementation of the OH approach in the country. On the other hand, lack of effective dissemination of such OH guiding documents for implementation of OH at all levels might have contributed to inefficient collaboration, coordination and operationalisation of OH at different levels.

Further, we identified that each department works independently in many instances except during emergencies. Participants experience has shown that, the practice of multi-sectoral coordination, collaboration and communication at the sub-national level is mainly between the human health and livestock sector, implemented during outbreaks such as anthrax and rabies. In such instances, normally Regional or District Medical Officers (RMO or DMO) are responsible for coordinating outbreak response. In case of other disasters like floods, earthquakes and landslides, coordination is done by the Disaster Focal Person, who is a Planning and budgeting officer at the Planning Departments in the respective regions and districts.

Information sharing among sectors was found to be a critical challenge, and this is largely due to lack of well-established mechanisms to promote OH issues across sectors. Since the electronic Government Authority (eGA) is fully functional at all levels in Tanzania, there is a need to strengthening Information Communication and Technology Departments and integrate them with OH issues in different sectors. To change the cause of action, we propose strengthening multi-sectoral collaboration and digitalise information and data sharing for better improvement of communication and information sharing for early detection, prevention and control of zoonoses, emerging and re-emerging diseases and other public health threats as suggested by others (Amri et al., Reference Amri, Chatur and Campo2022; Mremi et al., Reference Mremi, Rumisha, Sindato, Kimera and Mboera2022). Such efforts are likely to improve communication, collaboration and coordination among the sectors at all levels (Ribeiro et al., Reference Ribeiro, Burgwal and Regeer2019; Yasobant et al., Reference Yasobant, Bruchhausen, Saxena and Falkenberg2019; Gooding et al., Reference Gooding, Bertone, Loffreda and Witter2022).

As revealed throughout the study, where majority of the participants at almost all levels had low knowledge and understanding of OH and its operationalisation, need for capacity building cannot be underscored. There is a need to establish tailor-made training programmes for different professionals from different sectors that can equip them with the basic OH concepts and competencies. Training programmes including CPDs that were developed by the Africa One Health University Network (AFROHUN) could be used as prototypes to build OH capacities in different sectors. Professionals from the different sectors should be encouraged to enrol for such programmes either virtually or face-to-face sessions depending on the design of the training and be offered CPD credits for either renewal of their professional licensures or as a recognition of on-job certified training. Moreover, there has to be a mechanism to utilise only such professionals who have undergone OH CPD or on-job trainings during preparedness, response and in preventing any health emergency requiring OH approach. This way it will motivate the professionals from the different sectors to enrol and be trained in various OH trainings. These initiatives will ensure professionals advance their OH knowledge through CPD courses, and or short courses offered by accredited CPD providers.

Furthermore, the government through the ministry responsible for education, should back up the efforts made by OH stakeholders like AFROHUN, who supported the integration of OH contents in the existing curricula of certificates and diploma for the National Vocational Training Awards. This provides a framework of Technical Vocational Education and Training qualification for the middle cadre human health, environmental health, agriculture, wildlife management and human health institutions. This will help to create awareness of OH approach from the grass root level and build a strong foundation for OH’s key competencies.

One Health approach is critical for early detection and prevention of health threats. The participants at the sub-national level who expressed their enthusiasm to have more awareness on the concepts noticed the importance of a unified approach. The findings are similar to the study conducted by Zhong and Fouque (Reference Zhong and Fouque2023) who explained the advantages of the multi-sectoral approach in controlling vector-borne diseases as it influences synergy and coherence, knowledge and expertise, reinforces sharing of scarce resources and thus increases sustainability for both institutional and financial aspect among sectors (Joshi et al., Reference Joshi, Hafner, Twesigye, Ndiaye, Kiggundu, Mekonnen, Kusu, Berthé, Lusaya, Acho, Tuala, Siddiqua, Kaboré, Aidara and Guzman2018; Erkyihun and Alemayehu, Reference Erkyihun and Bereke2022; Zhong and Fouque, Reference Zhong and Fouque2023).

Despite the advantages and efforts made to operationalise OH in the country, limitations for its operationalisation were identified in this study. Limited knowledge on One Health; lack of effective dissemination of OH guidelines; inadequate coordination, collaboration and communication; inadequate resources and inadequate information and data sharing mechanisms cause difficulties to operationalise One Health approach. Thus, to ensure effective implementation of OH, governments need to address the challenges to support its operationalisation for the optimal health of humans, animals and ecosystems (Hailat et al., Reference Hailat, Amiri, Debnath, Rahman, Nurul Islam, Fatima, Khader and Al Nsour2023).

Study limitations

In assessing the knowledge of One Health actors on multi-sectoral coordination in addressing health risks there were some limitations. Absence of some of the participants from the agriculture, environment, wildlife and livestock professional being out of their work places because of other commitments was the limitation to this study. As well as most of the responses given by participants were subjective opinions/views missing clear evidence to support their answers.

Conclusion and recommendations

This study aimed at assessing knowledge of One Health actors on multi-sectoral coordination and operationalisation in addressing health risks. Generally, limited awareness of different professionals on OH approach across sectors is the major challenge in the operationalisation and institutionalisation of OH at sub-national levels. Sectors continuing working in silos is yet another challenge despite having awareness on multi-sectoral coordination and collaboration among them. In addition, lack of information and data sharing, absence of joint plans of action and guiding documents at the sub-national level compromise the implementation of OH at the sub-national level.

We recommend awareness creation at all levels to enhance proper coordination and collaboration for early detection and prevention of zoonoses and other health risks requiring OH approach be instituted and strengthened at all levels. We also recommend repackaging and dissemination of various OH guidelines tailored to specific professional qualifications and cadres at different levels. Despite participants being aware of multi-sectoral collaboration neither practised nor shared the information and or data among them, this calls for the need to strengthen collaboration, systems thinking and information technology among sectors. This will enable real-time reporting and sharing of information and or data for immediate response and therefore promoting health security.

Data availability statement

Authors confirm that the data supporting this study’s findings are available from the corresponding author.

Acknowledgements

Authors wish to acknowledge the directors and officers from the line ministries, regional and district levels for the support during data collection. We also extend our gratitude to different experts and professionals who spared their time for the interviews during the whole period of the study. Finally, we extend our acknowledgement to the Prime Minister’s Office, Disaster Management department for granting time to conduct this study.

Author contributions

All authors equally contributed to the development of this paper. V.S designed, conceptualised, analysed and writing of the paper. E. D. K and A. S. H conceptualised, designed, reviewed and edited the manuscript. All authors read and approved the final manuscript paper for submission.

Financial support

No funding was received for this study from any grant or funding agencies in the public, commercial or non-profit sectors.

Competing interests

Authors declares no conflict of interest.

Ethical statement

The study was granted research clearance from Sokoine University of Agriculture with reference number SUA/ADM/R.1/8/1025.

References

Connections references

Fernandez de Cordoba Farini, C (2023) How can we improve and facilitate multi-sectoral collaboration in warning and response systems for infectious diseases and natural hazards to account for their drivers, interdependencies and cascading impacts? Research Directions: One Health 1, e11. https://doi.org/10.1017/one.2023.4.CrossRefGoogle Scholar

References

Alimi, Y (2023) Strengthening coordination and collaboration of One Health approach for zoonotic diseases in Africa.CrossRefGoogle Scholar
Amri, M, Chatur, A and Campo, PO (2022) Intersectoral and multisectoral approaches to health policy : an umbrella review protocol. Health Research Policy and Systems 1(1), 1–5. https://doi.org/10.1186/s12961-022-00826-1.Google Scholar
Asiedu-berkoe, F, Chandi, G, Bandoh, D, Atsu, B, Lokossou, V, Antara, S, Sarkodie, B and Kenu, E (2022) State of public health emergency preparedness and response capacity of Ghana.CrossRefGoogle Scholar
Ba, MF, Kane, NM, Diallo, MKK, Bassoum, O, Boh, OK, Mboup, FZM, Faye, EHB, Bedekelabou, AP, Dieng, SD, Diop, FN, Badiane, M, Ridde, V and Faye, A (2021) Knowledge, attitudes and practices on rabies among human and animal health professionals in Senegal. Pathogens (Basel, Switzerland) 10, 11282.Google ScholarPubMed
Bengtsson, M (2016) How to plan and perform a qualitative study using content analysis. NursingPlus Open 2. https://doi.org/10.1016/j.npls.2016.01.001.CrossRefGoogle Scholar
Bhardwaj, P (2019) Types of sampling in research. Journal of the Practice of Cardiovascular Sciences 5(3), 157. https://doi.org/10.4103/jpcs.jpcs_62_19.CrossRefGoogle Scholar
Bs, M and Nambiar, V (2020) COVID-19: an insight into SARS-CoV-2 pandemic originated at Wuhan City in Hubei Province of China Coronaviruses. Journal of Infectious Diseases and Epidemiology 6(4), 146. https://doi.org/10.23937/2474-3658/1510146.Google Scholar
Buregyeya, E, Atusingwize, E, Nsamba, P, Musoke, D, Naigaga, I, Kabasa, JD, Amuguni, H and Bazeyo, W (2020) Operationalizing the One Health approach in Uganda. Challenges and Opportunities 10, 250–257.Google ScholarPubMed
Connolly, J (2017) Governing towards 'One Health': establishing knowledge integration in global health security governance. Global Policy 8, 483–494. https://doi.org/10.1111/1758-5899.12505.CrossRefGoogle ScholarPubMed
Erkyihun, GA and Bereke, M (2022) One Health approach for the control of zoonotic diseases. Zoonoses 2(1). https://doi.org/10.15212/ZOONOSES-2022-0037.CrossRefGoogle Scholar
FAO, UNEP, WHO and WOAH (2022) One Health joint plan of action (2022–2026). https://doi.org/10.20506/bull.2022.2.3324.CrossRefGoogle Scholar
Farag, E, Nour, M, Islam, M M, Mustafa, A, Khalid, M, Sikkema, R S, Alhajri, F, Bu-Sayaa, A, Haroun, M, Van Kerkhove, M D, Elkholy, A, Malik, S M R, Reusken, C, Koopmans, M, AlHajri, M M (2019) Qatar experience on One Health approach for middle-east respiratory syndrome coronavirus, 2012–2017: a viewpoint. One Health 7(), 100090. https://doi.org/10.1016/j.onehlt.2019.100090.CrossRefGoogle ScholarPubMed
Gooding, K, Bertone, M P, Loffreda, G, Witter, S (2022) How can we strengthen partnership and coordination for health system emergency preparedness and response ? Findings from a synthesis of experience across countries facing shocks. BMC Health Services Research 22(1), 1–19. https://doi.org/10.1186/s12913-022-08859-6.CrossRefGoogle ScholarPubMed
Gwakisa, P, George, J, Sindato, C, Ngonyoka, A, Nnko, H, Assenga, J, Sharadhuli Kimera, S and Ole Nessele, M (2023) Pillars for successful operationalization of one health as an ecosystem approach: experience from a human-animal interface in the Maasai steppe in Tanzania. One Health Outlook 5, 11. https://doi.org/10.1186/s42522-023-00087-0.CrossRefGoogle ScholarPubMed
Hailat, E, Amiri, M, Debnath, N, Rahman, M, Nurul Islam, M, Fatima, Z, Khader, Y and Al Nsour, M (2023) Strengthening the One Health approach in the eastern mediterranean region corresponding author. Interactive Journal of Medical Research 12, 1–5. https://doi.org/10.2196/41190.CrossRefGoogle Scholar
Hassan, OA, Affognon, H, Rocklöv, J, Mburu, P, Sang, R, Ahlm, C and Evander, M (2017) The One Health approach to identify knowledge, attitudes and practices that affect community involvement in the control of Rift Valley fever outbreaks. PLOS Neglected Tropical Diseases 11(2), e0005383. https://doi.org/10.1371/journal.pntd.0005383.CrossRefGoogle ScholarPubMed
Hennessey, M and Barnett, T (2023) Method in limbo? Theoretical and empirical considerations in using thematic analysis by veterinary and One Health researchers. Preventive Veterinary Medicine 221, 106061. https://doi.org/10.1016/j.prevetmed.2023.106061.CrossRefGoogle ScholarPubMed
Joshi, M P, Hafner, T, Twesigye, G, Ndiaye, A, Kiggundu, R, Mekonnen, N, Kusu, N, Berthé, S, Lusaya, E P, Acho, A, Tuala, R T, Siddiqua, A, Kaboré, H, Aidara, S S, Guzman, J (2021) Strengthening multisectoral coordination on antimicrobial resistance : a landscape analysis of efforts in 11 countries. Journal of Pharmaceutical Policy and Practice 14(1), 1–17. https://doi.org/10.1186/s40545-021-00309-8.CrossRefGoogle ScholarPubMed
Kleinheksel, AJ, Tawfik, HE, Wyatt, TR, Winston, NR (2020) Demystifying content analysis. American Journal of Pharmaceutical Education 84, 127–137. https://doi.org/10.5688/ajpe7113.CrossRefGoogle ScholarPubMed
Majiwa, H, Bukachi, SA, Omia, D and Fèvre, EM (2023) Knowledge, perceptions, and practices around zoonotic diseases among actors in the livestock trade in the Lake Victoria crescent ecosystem in East Africa. Frontiers in Public Health 11(January), 1–12. https://doi.org/10.3389/fpubh.2023,Google Scholar
Martin, V, Pfeiffer, DU, Zhou, X, Xiao, X, Prosser, DJ, Guo, F and Gilbert, M (2011) Spatial distribution and risk factors of highly pathogenic avian influenza (HPAI) H5N1 in China. PLoS Pathogenes 7(3), e1001308. https://doi.org/10.1371/journal.ppat.1001308.CrossRefGoogle ScholarPubMed
Mremi, IR, Rumisha, SF, Sindato, C, Kimera, SI and Mboera, LEG (2022) Comparative assessment of the human and animal health surveillance systems in Tanzania: opportunities for an integrated one health surveillance platform comparative assessment of the human and animal health one health surveillance platform. Global Public Health 0(0), 1–17. https://doi.org/10.1080/17441692.2022.Google Scholar
Mtui-Malamsha, N, Assenga, J, Swai, E, Msemwa, F, Makungu, S, Chinyuka, H, Bernard, J, Sallu, R, OleNeselle, M, Ponsiano, E, Kazwala, R, Kimera, S, Nonga, H, Folorunso, F (2020) Subnational operationalization of One Health: lessons from the establishment of One Health rapid response teams in Tanzania. Transactions of the Royal Society of Tropical Medicine and Hygiene 114(7), 538–540. https://doi.org/10.1093/trstmh/trz138.CrossRefGoogle ScholarPubMed
Muhanga, M, Malungo, J and Kimario, K (2020) One Health Approach (OHA) in selected urban settings in Tanzania: Knowledge, attitudes, awareness, and practices. Tanzania Veterinary Journal. https://doi.org/10.4314/tvj.v37i1.9s.CrossRefGoogle Scholar
Muhanga, MI, Malungo, JRS and Kimario, KA (2019) One Health Approach (OHA) in selected urban settings in Tanzania : knowledge, attitudes, awareness, and practices. Awareness, and Practices 37.Google Scholar
Mumford, EL, Martinez, DJ, Tyance-Hassell, K, Cook, A, Hansen, GR, Labonté, R, Mazet, JAK, Mumford, EC, Rizzo, DM, Togami, E, Vreedzaam, A and Parrish-Sprowl, J (2023) Evolution and expansion of the One Health approach to promote sustainable and resilient health and well-being: a call to action. Frontiers in Public Health 10, 1056459. https://doi.org/10.3389/fpubh.2022.1056459.CrossRefGoogle ScholarPubMed
Naïssengar, K, Oussiguere, A, Madaye, E, Mbaipago, N, Mindekem, R, Moyengar, R, Madjadinan, A, Ngandolo, R, Zinsstag, J, Léchenne, M (2021) Acta tropica challenges to improved animal rabies surveillance : experiences from pilot implementation of decentralized diagnostic units in Chad. Acta Tropica 221, 105984. https://doi.org/10.1016/j.actatropica.2021.105984.CrossRefGoogle ScholarPubMed
Nantima, N, Ilukor, J, Kaboyo, W, Ademun, ARO, Muwanguzi, D, Sekamatte, M, Sentumbwe, J, Monje, F and Bwire, G (2020) The importance of a One Health approach for prioritising zoonotic diseases to focus on capacity-building efforts in Uganda. Revue Scientifique et Technique de l'OIE 38(1), 315–325. https://doi.org/10.20506/rst.38.1.2963.CrossRefGoogle Scholar
Onyango, ND, Onguru, DO and Atieno, OA (2023) Effectiveness of multisectoral collaboration in implementation of One Health Approach for control of zoonoses in Kisumu, Kenya. One Health & Implementation Research 3(2), 30–41. https://doi.org/10.20517/ohir.2022.29.CrossRefGoogle Scholar
Onyekuru, NA, Ihemezie, EJ, Ezea, CP, Apeh, CC and Onyekuru, BO (2020) Impacts of Ebola disease outbreak in West Africa: implications for government and public health preparedness and lessons from COVID-19. Scientific African 19, e01513. https://doi.org/10.1016/j.sciaf.2022.e01513.CrossRefGoogle Scholar
Palinkas, LA, Horwitz, SM, Green, CA, Wisdom, JP, Duan, N and Hoagwood, K (2015) Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Dental Survey 42(5), 533–544. https://doi.org/10.1007/s10488-013-0528-y.Purposeful.Google ScholarPubMed
Ribeiro, S, Burgwal, LHMVan De and Regeer, BJ (2019) Overcoming challenges for designing and implementing the One Health approach : a systematic review of the literature. One Health 7, 100085. https://doi.org/10.1016/j.onehlt.2019.100085.CrossRefGoogle Scholar
Sim, J, Saunders, B, Waterfield, J and Kingstone, T (2018) Can sample size in qualitative research be determined a priori? International Journal of Social Research Methodology 21, 1–16. https://doi.org/10.1080/13645579.2018.1454643.CrossRefGoogle Scholar
Sinclair, JR (2019) Importance of a One Health approach in advancing global health security and the sustainable development goals. Revue Scientifique et Technique de l'OIE 38(1), 145–154. https://doi.org/10.20506/rst.38.1.2949.CrossRefGoogle ScholarPubMed
UNEP, WHO, FAO, and WOAH. (2021) One high-level expert panel.Google Scholar
Vigilla-montecillo, KR, et al. (2023) Awareness, knowledge, attitude, and practices ( A-KAP ) assessment of the One Health approach in health sciences education webinar series participants in select universities in the Philippines. Journal of Global Health Reports 7, 1–8. https://doi.org/10.29392/001c.75304.CrossRefGoogle Scholar
WHO, FAO, O (2019) A tripartite guide to addressing zoonotic diseases in countries taking a multisectoral, one health approach.Google Scholar
Yasobant, S, Bruchhausen, W, Saxena, D, Falkenberg, T (2019) One health collaboration for a resilient health system in India: learnings from global initiatives. One Health 8(January), 100096. https://doi.org/10.1016/j.onehlt.2019.100096.CrossRefGoogle ScholarPubMed
Yasobant, Sandul, Bruchhausen, Walter, Saxena, Deepak and Falkenberg, T (2020) , One Health, actors in multifaceted health systems: an operational case for India. Health Care 8(4), 387.Google ScholarPubMed
Zhong, Q and Fouque, F (2023) Break down the silos : a conceptual framework on multisectoral approaches to the prevention and control of vector-borne diseases. The Journal of Infectious Diseases 222(Supplement_8), S732–S737. https://doi.org/10.1093/infdis/jiaa344.CrossRefGoogle Scholar
Figure 0

Figure 1. A map indicating districts where the study was conducted.

Figure 1

Figure 2. Levels and type of professionals interviewed at the national (n = 13), regional (n = 26) and district levels (n = 62) involving participants from wildlife, livestock, public health, environment and agriculture sectors.

Figure 2

Table 1. Types of data collected to identify knowledge gaps in One Health and multi-sectoral coordination and collaboration in Tanzania

Figure 3

Table 2. Indicating social demographic data of the participants

Figure 4

Table 3. General awareness of OH actors at national and sub-national levels on One Health approach, multi-sectoral coordination and existence of OH guidelines/SOPs

Figure 5

Table 4. General awareness of OH actors on One Health, multi-sectoral coordination and OH guidelines by sectors

Figure 6

Table 5. Awareness on the role of communication and information sharing in promoting OH operationalisation in preventing public health risks at different levels

Author comment: Knowledge gap among one health key actors on multi-sectoral coordination at national and sub-national levels in Tanzania — R0/PR1

Published online by Cambridge University Press:  28 October 2024
DOI: https://doi.org/10.1017/one.2024.12.pr1 [Opens in a new window]
Valentina Sanga [Opens in a new window] Disaster Management Department, Prime Minister's Office, Dodoma, Dodoma, Tanzania
Revision round: 0
Role: author

Comments

No accompanying comment.

Decision: Knowledge gap among one health key actors on multi-sectoral coordination at national and sub-national levels in Tanzania — R0/PR2

Published online by Cambridge University Press:  28 October 2024
DOI: https://doi.org/10.1017/one.2024.12.pr2 [Opens in a new window]
Richard Kock [Opens in a new window] Independent Scholar, Kent, United Kingdom of Great Britain and Northern Ireland
Revision round: 0
Role: Editor in Chief
Recommendation/decision: major-revision

Presentation

Overall score 4 out of 5
Is the article written in clear and proper English? (30%)
4 out of 5
Is the data presented in the most useful manner? (40%)
4 out of 5
Does the paper cite relevant and related articles appropriately? (30%)
5 out of 5

Context

Overall score 4 out of 5
Does the title suitably represent the article? (25%)
5 out of 5
Does the abstract correctly embody the content of the article? (25%)
5 out of 5
Does the introduction give appropriate context and indicate the relevance of the results to the question or hypothesis under consideration? (25%)
4 out of 5
Is the objective of the experiment clearly defined? (25%)
5 out of 5

Results

Overall score 5 out of 5
Is sufficient detail provided to allow replication of the study? (50%)
5 out of 5
Are the limitations of the experiment as well as the contributions of the results clearly outlined? (50%)
5 out of 5

Author comment: Knowledge gap among one health key actors on multi-sectoral coordination at national and sub-national levels in Tanzania — R1/PR3

Published online by Cambridge University Press:  28 October 2024
DOI: https://doi.org/10.1017/one.2024.12.pr3 [Opens in a new window]
Valentina Sanga [Opens in a new window] Disaster Management Department, Prime Minister's Office, Dodoma, Dodoma, Tanzania
Revision round: 1
Role: author

Comments

No accompanying comment.

Decision: Knowledge gap among one health key actors on multi-sectoral coordination at national and sub-national levels in Tanzania — R1/PR4

Published online by Cambridge University Press:  28 October 2024
DOI: https://doi.org/10.1017/one.2024.12.pr4 [Opens in a new window]
Richard Kock [Opens in a new window] Independent Scholar, Kent, United Kingdom of Great Britain and Northern Ireland
Revision round: 1
Role: Editor in Chief
Recommendation/decision: minor-revision

Comments

Dear Authors,

We have now obtained all the review comments needed for your manuscript. Your manuscript has been reviewed by two reviewers and myself, and major revisions have been recommended before it can be accepted for publication. Please consider these review comments when resubmitting your response note and revised manuscript.

Yours sincerely,

Pablo Alarcon

Editor comments:

Overall comment: This is a very interesting manuscript that aims to capture awareness and perceptions of One Health of government workers in Tanzania at multiple levels and for multiple sectors. The information is very useful; however I have several comments that need to be addressed in my view before accepting this manuscript.

Comments on Introduction:

Line 31-33: “…response to public health risks”. I would rephrase this to just “health risk” and not to “public health risks”. Public health risks implies that the concept of One Health is anthropocentric and focussed around human health, which is not true. The One Health concept is about achieving an adequate balance between environment, animal and human health. If changing the sentence, reconsider if the reference is still appropriate.

Line 40: COVID is not consider a zoonotic disease. There is no transmission between animals and humans. It may be true that the virus may have had an animal origin, but that is not enough to named it as zoonotic disease. Rather than using the term Zoonotic disease, I would suggest you use the term as Emerging diseases of animal origin.

Line 58: “OHSP” and “OH” these acronyms need to be indicated earlier when first mentioned

Line 61-63: “One Health actors” – this is a confusing statement as there is also no definition of what is a One Health actor. The term implies that there are people specifically involved in One Health activities, which are different from people just working on public health, animal health or environmental health. If the aim is to assess the knowledge of those One Health people (those working at the interface), then it is fine. However, if you are trying to assess the OH across a range of strategic health professionals, then I suggest you rephrase the aim.

Comments on methods:

Line 77-78: Again, please define what you mean by “One Health stakeholders”. What criteria was used to identify and select these?

Line 81-84: I suggest you move these sentences to the introduction, just after stating the aim of the study.

Line 85-88: See my previous comment. More information about selection criteria is needed. Are you selecting people working at the interface? So with multiple health sectors? How did you identify these people?

Section 2.3 – I suggest producing a diagram with the different levels and type of people interviewed.

Line 111-113 – Please rephrase the sentence. It is also not clear what you mean by the “variable that were analysed”. That expression is more suited for quantitative data.

Also, provide further information on how the qualitative data was analysed. How were the codes extracted and grouped? How were themes identified? However, I do not think the authors did a thematic analysis, but their analysis seems to me more closely aligned to a manifest content analysis approach. I suggest you see the following reference: “Hennessey and Barnett (2023).Method in limbo? Theoretical and empirical considerations in using thematic analysis by veterinary and One Health researchers”

Comments of results:

Line 118: “ranging from 18 and above”. That is a very wide range, but also not very precise. I would assume all your participants will be 18 and above years old. I suggest authors described the age categories in the narrative also.

Line 119: What do you mean by all participants “had knowledge of the certificate to”? Please rephrase. Also, as before, I suggest authors add more informative on the description of the participants. For example, the percentages on degrees and how this varies depending on the level.

Line 124: How was their awareness on the One Health approach determine? Did you simply asked them if you are aware of it, or did the researcher managed to assess whether their perception of OH approach is correct? Otherwise, I would question whether the participants are truly aware of OH approach, or if they merely may have heard of this but may not really understand it. What you classify as awareness is important for this study and need to be explained.

Box 1- These are interesting perceptions. However most statements are based on “I think” “in my view” “In my understanding”. Do the authors got any information on whether these opinions are based on actual experience, or mostly on a perception of how OH could be useful?

Please introduce the acronym of OHA when first used

Line 170: It is an interesting quote, but also a bit confusing. The quote implies that they have shown the author some data on OH awareness at National and subnational level, which is what this study is actually trying to find out. Can this please be clarified? Or was this an interview done after the results were obtained?

Also it is quite interesting that OH is thought as a project rather than an approach.

I recommend that authors also provide some descriptive analysis on how the results are different between participants of different sectors (human health, animal health and environmental health). Normally the argument has been that the animal health sector is more proactive in One Health than the human health.

Line 174-177: “…privileged sectors…”. Is this a word used by participants? If so, please use inverted commas. If not, perhaps authors should rephrase this, as it provides an opinion that some sectors are unfairly better funded than others. One can argue that human health sector could be underfunded in most government, given the high demands of the sector. However, I agree that sharing of resources can be a political decision or lead to silo working when resources are not shared. This is indeed an essential element of OH, and there are tools that can help with it.

Comments on discussion:

Authors need to provide a discussion on the limitations of the study.

Line 193: “for the last past years…” I suggest to change this to “since 2015”, as the date of the manuscript is not 2020.

Line 200-205: I suppose the question is why is there an awareness gap and how the OH plan in Tanzania aims to solve this? IS there anything from this study that can be used as recommendation to improve the OH action plan in Tanzania?

Line 209: suggest to remove “As the definition of OH stated in the introduction” to a very long and complex sentence

Line 214: “the level of coordination…. were higher…” – Authors should be careful in drawing such conclusions. So far, the study has captured the level of awareness and people opinion on the advantages and limitations. This does not proof that the level of coordination etc. is actually higher (although it probably is).

Line 2016-217: Same comment as above. This are just perceptions of some people interviewed. I would rephrase it as “it was found that some (one?) participants believed that sectors….”

Line 218-220: I don’t think this has been included in the results.

Line 252-257: Collaboration is indeed motivated when there is an awareness and people understand the value of it. In this case, it would be useful for authors to analyze their data to see if there are different in awareness between people working in the human, animal or environmental sector.

Comments on conclusion: At the moment the conclusion read that a statement of what is important and what is needed, but without linking it to the finding of their project. I suggest the conclusions do incorporate a summary of what has been found in this study and what key recommendations can be drawn.

Author comment: Knowledge gap among one health key actors on multi-sectoral coordination at national and sub-national levels in Tanzania — R2/PR5

Published online by Cambridge University Press:  28 October 2024
DOI: https://doi.org/10.1017/one.2024.12.pr5 [Opens in a new window]
Valentina Sanga [Opens in a new window] Disaster Management Department, Prime Minister's Office, Dodoma, Dodoma, Tanzania
Revision round: 2
Role: author

Comments

No accompanying comment.

Decision: Knowledge gap among one health key actors on multi-sectoral coordination at national and sub-national levels in Tanzania — R2/PR6

Published online by Cambridge University Press:  28 October 2024
DOI: https://doi.org/10.1017/one.2024.12.pr6 [Opens in a new window]
Richard Kock [Opens in a new window] Independent Scholar, Kent, United Kingdom of Great Britain and Northern Ireland
Revision round: 2
Role: Editor in Chief
Recommendation/decision: accept

Comments

Thanks for addressing our comments. The manuscript has now been accepted for publication.