The application of the One Health approach in the management of five major zoonotic diseases using the World Bank domains: A scoping review

The international authorities, such as the Food and Agriculture Organization of the United Nations, World Health Organization, World Organization for Animal Health, United Nations Environment Programme, and World Bank, have endorsed the One Health concept as an effective approach to optimize the health of people, animals, and the environment. The One Health concept is considered as an integrated and unifying approach with the objective of sustainably balancing and optimizing the health of people, animals, and ecosystems. Despite variations in its definitions, the underlying principle remains consistent – recognizing the interconnected and interdependent health of humans, animals, and the environment, necessitating interdisciplinary collaboration to optimize health outcomes. The One Health approach has been applied in numerous countries for detecting, managing, and controlling diseases. Moreover, the concept has found application in various areas, including antimicrobial resistance, food safety, and ecotoxicology, with a growing demand. There is a growing consensus that the One Health concept and the United Nations Sustainable Development Goals mutually reinforce each other. The World Bank has recommended five domains as foundational building blocks for operationalising the One Health approach, which includes: i) One Health stakeholders, roles, and responsibilities; ii) financial and personal resources; iii) communication and information; iv) technical infrastructure; and v) governance. The domains provide a generalised overview of the One Health concept and guide to its application. We conducted a scoping review following the five-staged Arksey and O’Malley's framework. The objective of the review was to map and synthesise available evidence of application of the One Health approach to five major zoonotic diseases using the World Bank domains. Publications from the year 2004, marking the inception of the term ‘One Health,’ to 2022 were included. Information was charted and categorised against the World Bank domains identified as a priori. We included 1132 records obtained from three databases: Embase, Medline, and Global Health; as well as other sources. After excluding duplicates, screening for titles and abstracts, and full text screening, 20 articles that contained descriptions of 29 studies that implemented the One Health approach were selected for the review. We found that included studies varied in the extent to which the five domains were utilised. Less than half the total studies (45%) used all the five domains and none of the studies used all the sub-domains. The environmental sector showed an underrepresentation in the application of the One Health approach to zoonotic diseases as 14 (48%) studies in 10 articles did not mention it as a stakeholder. Sixty two percent of the studies mentioned receiving support from international partners in implementing the One Health approach and 76% of the studies were supported by international donors to conduct the studies. The review identified disparate funding mechanisms employed in the implementation of the One Health approach. However, there were limited discussions on plans for continuity and viability of these funding mechanisms in the future.


Introduction
The concept of One Health was officially launched in 2004 as 'One World, One Health' in a conference held by the Wildlife Conservation Society in the United States [1].One Health is considered as an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals, and ecosystems [2].Despite availability of various definitions of One Health concept [2][3][4][5][6][7][8][9], (Supplementary file 1) its principle revolves around recognizing the interconnectedness of human, animal, and environmental health and using a collaborative, interdisciplinary approach to address complex health challenges at this intersection.The concept has been endorsed by major international authorities including the Food and Agriculture Organization of the United Nations (FAO), World Health Organization (WHO), World Organization for Animal Health (WOAH), World Bank, United States Agency for International Development (USAID) and Centres for Disease Control and Prevention (CDC) to promote effective, multisectoral and multidisciplinary collaboration [10][11][12].A Quadripartite memorandum of understanding that was signed between FAO, WHO, WOAH, and United Nations Environment Programme (UNEP) in March 2022 offers a legal and formal framework to address the challenges at the human, animal, and ecosystem interface using an integrated and coordinated approach [13].
There is a growing consensus on the mutually reinforcing relationship between the One Health concept and the United Nations Sustainable Development Goals (SDGs) [49].The One Health approach facilitates meeting the SDGs [50].Six of the SDGs directly address the One Health approach: SDG3 (Good Health and Wellbeing); SDG6 (Clean water and sanitation, SDG11 (Sustainable cities and communities); SDG13 (Climate action); SDG14 (Life below water); and SDG15 (Life on land) [51].Most SDGs are interconnected and requires a paradigm based on inter-sectoral integration and collaboration, thereby providing a unique opportunity for One Health approaches [52].
The World Bank has provided an operational framework [8] to allow operationalisation of One Health both for target countries and the donors [53,54].The five domains in the framework are the foundational building blocks of One Health [8], comparable to the health building blocks of the World Health Organization [55,56] and with adaptability to be employed across diverse contexts [8,56].These domains are: i) One Health stakeholders, roles, and responsibilities; ii) financial and personal resources; iii) communication and information; iv) technical infrastructure; and v) governance.
Many studies have highlighted the application of One Health approaches to specific diseases or a program [17,[57][58][59][60].However, there apprears to be inconsistencies and disparities in fully implementing the domains of One Health, which will impact the effectivess of the approach.
To date, no systematic or scoping review has been conducted to map and synthesise available evidence to highlight best practice or explore gaps in the implementation of One Health using the World Bank domains.The aim of this scoping review was to map and synthesise available evidence describing the implementation of One Health approach against five major zoonotic diseases globally using the World Bank domains.

Methods
We followed the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis [61] which was built from the original framework of Arksey and O'Malley [62] later enhanced by Levac et al. [63] The framework consists of five sequential stages: identifying the research question, identifying relevant studies, study selection, charting the data and collating, summarising, and reporting results.Optional stage six, 'consultation,' was not conducted as validation of the results are not necessary in the context of a scoping review.The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) [64] checklist was used for reporting the review (Supplementary file 2).

Objectives and scope
The aim of this scoping review was to map and synthesise available evidence describing the application of the One Health approach against five major zoonotic diseases globally using the World Bank domains.

Identification of relevant studies
We used the population, concept, and context (PCC) framework from the JBI Manual for Evidence Synthesis [61] to develop inclusion and exclusion criteria (Supplementary file 3).Population: The population included all animal, human and environment population to which the One Health approach was implemented.Concept: Operationalisation of One Health approach with application of one or more of the World Bank domains to at least one of anthrax, brucellosis, avian influenza, rabies, and scrub typhus [35][36][37].Context: Studies from any geographic location were included whereby the intention of the study was interpreted as to inform surveillance, response, control of zoonotic diseases.
A three-step search process was conducted.First, an initial search was conducted on the Global Health database to identify index terms, medical subject headings (MeSH) and synonyms of the diseases in titles and abstracts.As the objective of the search was to retrieve papers describing the implementation of the One Health approach, the term "One Health" in combination with the selected zoonotic diseases was identified as one of the key index terms in the search strategy.In the second step, a search using all key concept terms and disease synonyms was undertaken across Embase, Medline and Global Health because of their wide scope of publications and multidisciplinary contents [65].Boolean, truncations, and wild cards were used in various combinations with these keywords and index terms.A librarian from the Faculty of Health Sciences, Curtin University was consulted for designing the search strategy (Supplementary file 4).Third, a search was conducted using the Google search engine and Google Scholar for non-indexed studies on webpages of WHO, WOAH, FAO, and One Health Commission and reference lists of studies initially retrieved.

Study selection
A total of 1132 records were identified, of which 1117 records were identified through the database search and 15 records through the search on web pages and from references of initially selected papers.After removing 602 duplicate records, 530 eligible records were selected for title and abstract screening.GP, GAT and LF screened 30 papers with queries regarding selection, and the rest of the papers were screened by BDR.We removed 420 records after title and abstract screening leaving 110 records for full text screening.Ninety records not meeting the inclusion criteria were removed after full text screening leaving 20 records for analysis.The results of screening process were recorded using the PRISMA flow diagram.

Data charting
Distinct components, equivalent to sub-domains, were identified under each domain based on findings from other relevant studies (Table 1).This approach was employed to ensure a clear and focused assessment of the literature under each domain.The information charted were standard bibliographic information that included the author(s), year of publication, aims and purpose of the studies, countries where the studies were conducted, diseases against which One Health was operationalised, and any information encompassing domains and B.D. Rai et al. subdomains (Supplementary file 5).An iterative process of screening and extracting data was undertaken, discussed, and reviewed by coauthors.In cases of articles that were inconclusive, research team members discussed to reach a decision.

Collating, summarising, and reporting results
The extracted information from the included articles were presented in a tabular form and synthesised.Articles that contained more than one One Health operationalisation study or One Health operationalisation to more than one zoonoses were identified and enumerated.Information from individual studies described in each article were tabulated and organised along the World Bank domains and subdomains identified a priori.Frequency counts of the articles, individual studies described in each article, geographical regions, zoonotic diseases to which the One Health approach was utilised, and types and frequencies of discussions on World Bank domains and sub-domains were tabulated and analysed.

Stakeholders, roles, and responsibilities
In the review, all the selected articles described a range of One Health stakeholders which included community members at the lowest level to international organisations at the highest level (Table 3).Stakeholders described were either government institutions, nongovernment organisations or private parties with varying backgrounds.Private sector vaccine manufacturers, private clinicians/physicians/veterinarians, private poultry corporation were mentioned by three articles [68,73,83].All studies mentioned stakeholders from animal and human health sectors, and 14 (48%) studies in 10 articles did not mention the environmental sector as a stakeholder [60,67,68,70,74,[77][78][79]82].Apart from animal, human and environmental health sectors, other stakeholders included finance, regulatory, academic and research, government administrative units, social sectors, and volunteers and were stated by 15 articles in 21 (72%) studies [ 60,66-69, 71,72,74-76,78-81,83].Thirty four percent of studies contained in six articles mentioned international organisations as stakeholders [66,68,69,71,73,75].The roles played by national stakeholders were based on their institutional mandates.For example, stakeholders from animal health sectors, human health sectors and administrative units were involved in surveillance of animal populations, human populations and providing administrative support, respectively.The international organisations main roles were to provide technical and financial support.

Financial and personal resources
Partial/full national funding mechanisms were acknowledged in only 6 (21%) of the studies in five articles [60,69,71,74,77,79].For example, a study from Indonesia reported availability of fund for avian influenza outbreaks through the national disaster management agency [69] and a study from Canada reported reinvestment of the revenue generated from licensing dog ownership to promote One Health activities for rabies and dog-bites control [77].There were 18 (62%) studies in 10 articles that indicated funding and/or technical support from various donors and international partners [34,60,66,68,69,71,73,75,76,80].For example, a study from Thailand reported technical and financial support from FAO, WHO, USAID and US CDC for One Health process against avian influenza [69].Three articles referred to the sustainability of the funding mechanisms in various terms.One study explicitly described about the sustainability of the funding [74], one recommended a sustained funding [73] and the other mentioned lack of sustained funding as a challenge [34].Nine studies (31%) in eight articles did not mention funding or the financial sustainability of the One Health implementation [67,70,72,78,79,[81][82][83].Five (17%) and 14 (48%) studies in 10 articles stated low capacity of staff and staff insufficiency respectively, as a challenge to operationalising One Health.[34,60,66,[72][73][74]76,80,81,83] Eleven articles described trainings in 16 (55%) studies.[34,60,[68][69][70][71]73,75,78,79,81] Eleven of these studies revealed that some sort of training was imparted whereas five expressed the need for training.

Communication and information
We identified 23 (79%) studies in 16 articles that referred to this domain [34,[66][67][68][69][70][71][72][73][74][75][76][77]79,81,83].Use of both formal and informal means of communication was highlighted in the selected articles.Meetings were means of sharing information in six of the studies described in three articles [66,68,73].Five studies in three articles mentioned the importance of informal methods of information sharing for One Health operationalisation [66,67,73].Electronic applications were used to share information on a real-time basis in six (21%) of the studies that were described in five articles [66,[70][71][72][73].These applications included bespoke applications for smartphones through social platforms.For example, users WhatsApp [84] (cross-platform messaging and Voice over IP service owned by Facebook, Inc.) groups were utilised for communication between government ministries, international organisations, health institutes, and medical and veterinary officials of regions and districts for anthrax control in Tanzania [66].
Awareness about zoonotic diseases or concepts of One Health among communities and stakeholders were discussed in the studies.A total of 21 (72%) studies in 14 articles reported on awareness of either One Health approaches (27%) or zoonotic diseases (45%) [34,[66][67][68][69]71,72,[74][75][76][77]79,81,83].From the total studies that reported on awareness, 48% mentioned lack of awareness of One Health concept and diseases among communities, 33% mentioned conduct of awareness programs on rabies and animal rights targeted for communities, school and general public and 19% mentioned plans and recommendations to conduct awareness programs on One Health concepts, dog bites and diseases among stakeholders and public.

Technical infrastructure
Eighteen (62%) of the studies in 12 articles referred to the Technical infrastructure domain [34,66,[68][69][70][71][72][73]75,[80][81][82].Ten studies (35%) in six articles provided descriptions and functions of the health system set-up in either the animal or human sectors [34,66,[68][69][70]82].For example, district hospitals provided rabies post-exposure prophylaxis in Tanzania and livestock posts confirmed the rabies status of the dogs in human dog bite cases in Republic of Guinea.More than half of the total studies (52%) in nine articles stated the names of the laboratories and partly their set-up [34,66,68,[70][71][72][73]80,81].The types and levels of laboratories mentioned depended on the scale of One Health operationalisation and ranged from community to national levels.All the studies referring to the Technical infrastructure domain, 18 (62%) highlighted limited capacity of laboratories either in terms of logistics or human resources.For example, a study from Sri Lanka reported lack of infrastructure to collect and submit samples in wildlife for rabies control program [80]and a study from India reported lack of designated laboratory staff for diagnosis of anthrax [81].

Discussion
This is the first review to assess evidence of One Health operationalisation in zoonotic diseases prevention and control, guided by the World Bank domains.
Overall, this review found that studies have described the World Bank domains to varying degrees, with the majority of studies lacking detail on One Health operationalisation along the domains.Less than half the total studies described all the domains and none of the studies described all the sub-domains.

Stakeholders, roles, and responsibilities
Our review identified that the Stakeholder domain was relatively well-described among the five domains.This finding can be partially attributed to the inherent nature of any zoonotic disease control program whereby stakeholders and their roles are the drivers.The evolving concept of intervention and expansion of implementation of One Health To review surveillance data and assess need and potential of One Health approach for surveillance of rabies.
To identify gaps and challenges in zoonotic disease prevention and control procedures.

Republic of Guinea
Rabies Anthrax Brucellosis Avian Influenza

Lushasi et al., 2020 [70]
To assess feasibility and possible impact of Integrated Bite Case Management for rabies surveillance in Tanzania.

Yasobant et al., 2020 [83]
To identify and categorize stakeholders for control and prevention of zoonotic diseases at the human-animal health system interface and identify challenges in intersectoral collaboration during outbreak and peace time.

India Avian Influenza (zoonoses as general)
Zuhriyah et al., 2020 [75] To identify the factors required for control of the rabies in Domphu, Indonesia.

Dargantes et al., 2021 [74]
To assess the integration of Rabies management information system into the rabies prevention and control Philippines Rabies

Table 3
Extracted information along the domains and their sub-domains.has broadened the range of stakeholders beyond those directly involved with animal, human and environmental health [85].This expansion was evident in the studies we reviewed which involved a range of stakeholders including non-government organisations, finance, regulatory, academic and research sectors, government administrative units, social sectors, and volunteers.A more concerning result was that the environmental sector, crucial to the control of zoonotic disease, was not mentioned in about half of the reviewed articles, which was consistent with other studies that reported under-representation of environmental sector [54,86].
International organisations are important stakeholders for One Health operationalisation.This is because, these international organisations provide financial and human resources that are interdisciplinary in nature including human, animal health, environment, and other relevant stakeholders [87].
The development and utilisation of various toolkits have proven to be useful in mapping and analysis of One Health stakeholders [88,89], and there is need for development of similar tool kit or a checklist for reporting One Health operationalisation utilising a standard set or components of One Health.

Financial and personal resources
Our study found that majority of the reviewed studies did not discuss this domain extensively.This could be partly attributed to technical focus and varying objectives of the reviewed studies.Nevertheless, it was clear that international organisations play an important role in providing financial support to One Health processes, especially in LMICs.Similar findings were reported in other studies [90,91].This trend is likely to continue because of emergence and re-emergence of zoonotic diseases [92,93] and establishment of several One Health initiatives [21].However, to sustain and expand the application of One Health to fields beyond zoonotic diseases like antimicrobial resistance, food safety and ecotoxicology, a reliable and sustained financing are required [90].The information on financing in the literature and involvement of external funders in several One Health operationalisations makes it difficult to judge the sustainability and future of One Health operationalisation described in the selected papers.We conclude that there is need to generate more research evidence in this domain to inform on different financing models and their likely outcomes in One Health operationalisation in zoonotic diseases.This will benefit both the institutions implementing the One Health approaches and the donors in terms of ensuring sustainability of such initiatives in the future.

Communication and information
Sharing of surveillance data and disease information between stakeholders will enable planning and enhance response to public health events [94].Despite diverse contexts of One Health operationalisation in the selected papers, a majority of them described Communication and information domain to a great extent demonstrating its significance in the context of zoonotic diseases prevention and control.Elements of information and communication can also be found incorporated into the evaluation frameworks for One Health [95] and a review identified communication as one of the factors that support successful One Health collaboration and response to health events [96], further demonstrating its significance.Both formal and informal communication was found to be contributing to success of One Health.There is a consensus that response to health emergencies is more effective when formal and informal relationships are established [96].
Domination by discussion on awareness in the studies mentioning this domain demonstrated its significance, supporting similar findings by other authors [97][98][99].Knowledge and awareness are proposed as one of the themes of the updated core competencies for One Health [100,101] The fact that infectious diseases outbreaks often appear at the community level, which often lacks basic health services, warrants innovative communication approaches to collect near-to real-time information, and has proven to be successful [102].Therefore, One Health implementations should prioritise harness of the power of electronic media at local levels and link them to global One Health networks [103] in parallel with building capacity of stakeholders to collaborate across disciplines at a global level [104].

Technical infrastructure
Effective laboratory systems are essential for an efficient surveillance of zoonoses [105].Despite the development of sophisticated and highly efficient laboratory technologies worldwide, challenges remain at the local community level, where the risk of zoonotic diseases is often higher [106].Discussions on challenges and limitations have dominated the studies that have mentioned laboratory systems in this review.While there is an abundance of literature focussing on limitations and challenges of laboratories, there is a dearth of publications that provide insights into their set-up and networking.Therefore, there is need for more literature offering lessons on laboratory systems set-up and alignment for the purpose of successful One Health processes in the context of disease surveillance and monitoring in animals, humans, and environment.Appropriately established laboratory systems can reduce expenditures and response times through One Health via sharing of information and physical resources [107].
Further, laboratory assessment tools, such as the Laboratory Mapping Tool [108] has been used by more than 30 countries [109] to evaluate and develop laboratory systems in animal health sectors.Similar tools such as WHO-Laboratory Assessment Tool [110] and Assessment Tools for Laboratory Services [111] are available for human health sector.Utilisation of such tools and reporting their outcomes will help in assuring quality laboratory systems are in place for successful One Health operations.

Governance
Governance with capacity to prepare for complex challenges and multi-sector responses are required for successful implementation of the One Health approach [112].It also requires processes, rules, and institutions to enable policy and practice to be co-managed and codelivered [113].We found that national policies and One Health platforms are critical components of successful One Health processes.These improve coordination and integration of activities and programs across sectors [12].The platforms and networks facilitate integrated engagements of multiple disciplines beyond zoonotic diseases such as antimicrobial resistance, food safety, non-communicable diseases, and climate changes [114].Our study also found that majority of the publications emphasised the importance of the governance and mentioned the relevant policies that impact the One Health process.Although the selected literature described operationalisation of One Health within diverse government settings, the importance of governance, supporting policies and formation of appropriate One Health platforms for successful One Health processes were consistently implemented.

Limitations
This review was limited to the studies that described the implementation of the One Health approach in the context of the five zoonotic diseases with relevance to One Health approach globally.Therefore, we cannot confirm that findings and discussions presented in this study are generalisable to studies on all zoonotic diseases.However, the One Health approach and its principles are applicable to all zoonotic disease, including to emerging and re-emerging diseases of recent times.
The review was guided by the domains of the World Bank, aligning to the fundamental principles of the One Health approach.The subdomains were extracted from other relevant studies and do not constitute all the components discussed in the World Bank operational framework.Therefore, the findings from this review should be applied with due consideration of these limitations.

Conclusion
Despite limiting the review to the five zoonotic diseases, this study has revealed some significant findings regarding the reporting of One Health operationalisation across the domains.Overall, the lack of evidence on operationalisation across the domains discovered by this review indicates either that such One Health operationalisation is not sufficiently prioritised and that there is no standardised framework for reporting One Health implementation across the five domains of the World Bank.

Table 1
Domains and subdomains with their sources.
* Domains extracted from: The World Bank.Operational Framework for Strengthening Human, Animal, and Environmental Public Health Systems at their Interface.2018 [8].B.D. Rai et al.

Table 2
Characteristics of the selected studies.