System Thinking and Citizen Participation Is Still Missing in One Health Initiatives – Lessons From Fifteen Evaluations

Abstract

Tackling complex public health challenges requires integrated approaches to health, such as One Health (OH). A key element of these approaches is the integration of knowledge across sectors, disciplines and stakeholders. It is not yet clear which elements of knowledge integration need endorsement to achieve best outcomes. This paper assesses 15 OH initiatives in 16 African, Asian and European countries to identify opportunities to improve knowledge integration and to investigate geographic influences on knowledge integration capacities. Two related evaluation tools, both relying on semi-quantitative questionnaires, were applied to two sets of case studies. In one tool, the questions relate to operations and infrastructure, while the other assigns questions to the three phases of “design,” “implementation,” and “evaluation” of the project life cycle. In both, the question scores are aggregated using medians. For analysis, extreme values were identified to highlight strengths and weaknesses. Seven initiatives were assessed by a single evaluator external to the initiative, and the other eight initiatives were jointly assessed by several internal and external evaluators. The knowledge integration capacity was greatest during the project implementation stage, and lowest during the evaluation stage. The main weaknesses pointing towards concrete potential for improvement were identified to be a lack of consideration of systemic characteristics, missing engagement of external stakeholders and poor bridging of knowledge, amplified by the absence of opportunities to learn and evolve in a collective process. Most users were unfamiliar with the systems approach to evaluation and found the use of the tools challenging, but they appreciated the new perspective and saw benefits in the ensuing reflections. We conclude that systems thinking and associated practises for OH require not only specific education in OH core competencies, but also methodological and institutional measures to endorse broad participation. To facilitate meta-analyses and generic improvement of integrated approaches to health we suggest including knowledge integration processes as elements to report according to the COHERE guidelines.

One Health gains momentum in Africa but room exists for improvement

“…For instance, academic institution based One Health stakeholders seem to have strength in the areas under learning while the government-owned implementers/coordinating mechanisms (the NOHPs) have strength in systemic organization supporting One Health, it behoves these agencies to facilitate integration mechanisms that promotes cooperation and collaborations among themselves. Such suggestions for more integration and collaboration among various team members, disciplines and sectors have been advocated including allowing room for system thinking, and identification of clearly mapped out theory of change, which should ensure that despite differing goals and independent scientific domains, common aims in One Health can be pursued [ 6 , 7 , 18 , 22 , 25 ]. In our context, theory of change is “an outcomes-based approach which applies critical thinking to the design, implementation, and evaluation of One Health initiatives and programs intended to support change in their context” [ 26 ].…”

“…Previous evaluations have indicated the challenges associated with planning, thinking, sharing and learning, but also the working and systemic organization [ 7 , 18 , 22 , 25 ]. Such challenges include those related to sharing of data, information and communication, competition instead of complementarity, lack of adequate preparedness, lack of focused capacity development in One Health institutions, duplicity of roles, understaffing, over-dependence on external funding, lack of legal and monitoring/evaluation frameworks to support One Health, cross-border limitations preventing epizonal approach to addressing issues, lack of systemizing the One Health implementation, lack of subnational One Health platforms to transform policies into actions, insecurities and political instabilities, lack of co-creation, co-planning and co-implementation of projects and inadequate advocacy among others.…”

“…Furthermore, many studies have advocated that the inclusion of theory of change, monitoring, evaluation and learning frameworks, and tools for standardized evaluation of One Health policies into the overall national One Health engagement will sustain the future of One Health approach in Africa and elsewhere [ 18 , 22 , 25 ]. Future engagements should continue to respond to the need of the society and be outcomes-driven.…”

“…The tool was an outcome of multiple collaborations berthed by the Cooperation on Science and Technology Action Network for Evaluation of One Health (NEOH, http://neoh.onehealthglobal.net/ ). Other tools included the following; Ontario Ministry of Agriculture, Food and Rural Affairs (OMAFRA) One Health priority tool, the One Health Zoonotic Disease Prioritization (OHZDP) tool, antimicrobial use (AMUSE), World Health Organization CHOosing Interventions that are Cost-Effective (WHO-CHOICE), Evaluating knOwLedge Integration Capacity (EVOLvINC) and Avenir One Health Tool (OHT) [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] ]. In addition, platforms are being created for coalescing toolkits and resources for various aspects of One Health [ 15 , 19 , http://bit.ly/ohafrica ].…”

Research on Citizen Participation in Government Ecological Environment Governance Based on the Research Perspective of “Dual Carbon Target”

“…Gradually in recent years, the citizen participation in the form of diversity, in addition to being able to rely on the people's congress system, political consultative system and the grassroots autonomy system, and other countries outside the political system to participate in government administration, democratic appraisal government, government officials, online q&a, and policy hearing form also gradually rise, but in the construction of local government, a large part of become a mere formality, the lack of actual effect. In addition, citizen participation is usually related to policy development, water and electricity prices, and demolition of housing, but it is rare to apply it to ecological environment governance [ 13 ]. Some local governments believe that ecological governance is an activity with the government as the main executioner, and ordinary people have neither professional knowledge nor the ability to participate in it.…”