The Fleming Fund is working with Uganda’s health care system to break down the barriers to disease surveillance by strengthening laboratory and diagnostic capacity in antimicrobial resistance (AMR) - leveraging in-country infrastructure and sustainability - for global health security.
Common elements of good practice for supporting One Health
How does the Fleming Fund’s approach to One Health reflect good practice? How can One Health be evaluated? These are questions being considered by the Fund’s independent evaluator, Itad. The evaluation team looked to the literature on One Health and multisector collaborations to identify any common elements of good practice.
Why One Health?
One Health refers to multiple sectors coming together to achieve better health outcomes. One Health discussions generally refer to collaborations among animal, environment, and public health sectors. The concept of One Health is a fairly new concept, but one which builds upon a strong tradition of linking animal, human and ecological health together. Researchers have advanced different arguments in favour of One Health, such as efficiency and effectiveness of multisector partnerships. Most convincing argument possibly being there is no other option. Complex policy challenges such as zoonoses and antimicrobial resistance (AMR) are referred to as ‘wicked problems’ – meaning these cannot be fully understood by a single perspective and even the fragmented understandings different sectors have tends to be dynamics and change with circumstances.
For instance, AMR could be framed as a problem of health protection, access to health, inappropriate prescriptions, food production and export standards for livestock production. No single sector has the understanding or capacity to address these issues on their own. However, despite the above arguments and repeated calls for One Health collaborations from international platforms, implementation of One Health remains a challenge at global and national levels.
How to make One Health work?
The challenges faced by those implementing One Health are similar to other multisector collaborations, such as social determinants of health, food systems, and ecological conservation. Itad, working with the Institute of Development Studies, conducted a literature review on complex multisector collaborations to inform the Fleming Fund’s approach to supporting One Health approaches, and how the evaluation can assess its impact in this field. The review demonstrates that multisector partnerships are complex enterprises whose structures and chances of success are rooted in local political and administrative contexts. Collaborations come in all shapes and sizes, and important factors to consider include:
Informality, relationships and local political dynamics are important drivers
- Most collaborations will have elements that are formal AND informal.
- One is not necessarily better than the other. The degree of formality is likely to be a response to the administrative cultures in a country, and likely to represent what is most feasible at the current stage.
Actors come to collaborations in pursuit of their (different) institutional agendas: no shared vision
- Fractured contexts: Collaborating partners have different agendas and approaches. They do not come together willingly but come together only when the situation at hand is beyond their individual sector’s control.
- Interdependence: Instead of a common vision, individual partners are more likely to be pursuing institutional agendas. Therefore, successful collaborations are likely to consist of complementary aims and strengths and this allows each to pursue their individual organisational aims, while drawing upon each other’s' strengths.
Multisector collaborations are often not easy to identify: therefore likely to require a flexible approach
- Adaptation takes place when boundaries are fluid: In order to allow partnerships / collaborations to be sustained, there should be some room for them to manoeuvre and adapt in response to partner needs or changing circumstances.
The above insights raise the question – what is meant by a successful collaboration? Given the short half-lives of many collaboration initiatives, could we label those collaborations that sustain themselves over a long period of time and are responsive to local needs as ‘successful’? Alternatively, should our focus be on those collaborative enterprises that deliver in the short term on the immediate project aims? It is possible that these two definitions are not mutually exclusive. However, since collaborations are likely to represent a mix of agendas rather than a single shared vision among members, asking this question early would be helpful.
Implications for the Fleming Fund
The findings of the review shared above highlight the need to avoid standardised approaches. Instead we should examine more closely the different understandings around One Health issues held by different actors. The precise nature, and structure of One Health partnerships might take different forms at country level – as they seek to best incorporate One Health collaborations within their existing institutional and political cultures.
Even as the Fleming Fund aims to strengthen capacities and the evidence base for AMR surveillance in different countries, it will need to continue tailoring the approach at the country level. Importantly, the Fleming Fund can use its convening power to provide visibility to different actors in the sphere of AMR and facilitate cross-sector conversations across formal and informal spaces – with the understanding that formal institutional collaborations are a reflection of the informal, interpersonal networks underlying these.