Summary: Implementing One Health governance approaches to mitigate antimicrobial resistance across institutional, social, economic and political contexts: a scoping review

Publication: Implementing One Health Governance Approaches to Mitigate Antimicrobial Resistance Across Institutional, Social, Economic, and Political Contexts
Authors: Chloe Clifford Astbury, Taylor Hecker, Jaskeerat Singh, Suzanne Garkay Naro, Lauren Wallace, Geneviève Boily-Larouche, Mathieu J. P. Poirier, Yahaya Ali Ahmed, Anand Balachandran, Zlatina Dobreva, Walter Fuller, Laetitia Gahimbare, Yidnekachew Degefaw Mazengiya, Bassem Zayed, and Arne Ruckert.

Why did we do this research?  

Antimicrobial resistance (AMR) threatens our ability to treat infectious diseases in humans, animals, plants, and the environment around the world. To address this issue, we must take a One Health approach, which promotes collaboration across human, animal, plant, and environmental health sectors. Specifically, One Health governance is the structures, processes, and mechanisms that enable and support the coordination and collaboration between these sectors, as well as with actors outside of the government, such as the private sector, academic experts, health professionals, and civil society.  

Current literature highlights important factors for successful One Health governance, meaning it provides possible mechanisms that will support successful collaboration between sectors and intervention implementation. However, existing literature does not differentiate between different country contexts (i.e., income levels, government types) and how this may impact or result in barriers to certain mechanisms. Therefore, we performed this research through a context-specific lens.  

What were we trying to find out? 

We aimed to:

• Map the range of One Health governance mechanisms implemented across contexts and identify the actors involved; 
• Examine how the performance of One Health governance is interpreted and measured; 
• Identify key barriers and facilitators to implementation of One Health governance across diverse contexts. 

How did we do it?

We systematically conducted a scoping review of peer-reviewed and grey literature. A total of 171 articles and documents were included from over 50 different countries across all income levels and regions. Most studies focused on Sub-Saharan Africa, East Asia and the Pacific, and South Asia, and main topic focus of the studies included general One Health governance, AMR, zoonoses, and other infectious diseases.  

To analyse results, we built on contextual aspects and themes that have been published in existing literature, including factors such as formal aspects of governance (political structure) informal aspects like power dynamics and informal relationships, and wider governance or country contexts, like economic drivers.   

What did we find? 

We identified six core governance dimensions as relevant to One Health governance success: participation, leadership, coordination, decision-making, resourcing, and accountability. These dimensions were implemented in diverse ways across contexts and were strongly influenced by existing governance structures and broader country factors/conditions.  

• Participation: Examined who was involved, their formal or informal roles, and their level of engagement. One Health governance should involve participation by a wide range of actors, including national and sub-national governments, intergovernmental organisations, donors, private actors, researchers, civil society, and communities.  
  • Actors identified, and their roles, varied across the literature/contexts, but national governments often played the central roles with sub-national governments, private sector, and academic experts being involved as key actors. There was often limited meaningful engagement of non-state actors and the general public in many contexts.  

• Leadership: Can be both formal and informal. Formal leadership is typically when leadership is held by institutions (i.e., human health ministries commonly lead multisectoral coordinating mechanisms). Informal leadership comes from individuals acting as policy champions, building momentum and facilitating bottom-up approaches (approaches that come from the community instead of the government). 
  • Leadership concentrated in a single sector can lead to disengagement from others while shared/rotating or higher-level political leadership (e.g., prime ministerial offices) may improve coordination but can present implementation challenges. 

• Coordination: The processes and mechanisms that help actors to work together. This could include surveillance coordination or multisectoral coordination mechanisms that are general (One Health) or focused on specific topics (e.g., AMR, avian influenza, food safety) and may be permanent or established in response to a disease outbreak.  
  • Coordination is commonly stronger at national than subnational levels, and integration across sectors – particularly in surveillance systems – remains uneven. 

• Decision-making: Includes any approach across the policy process, such as technical working groups, who help incorporate evidence into decision-making, or consultations with stakeholders outside of government (i.e., private sector, civil society groups). Power imbalances between sectors and actors often shape whose perspectives are prioritized and uptake of evidence into policy is not always consistent.  

• Resourcing: Includes where resources come from, the amount of resources available, and how the resources are used and divided. In high income countries, these resources often come from domestic sources, in contrast, lower-middle income countries often relied more heavily on donors and development partners, which threatened the sustainability of interventions. 

• Accountability: The processes and mechanisms in place to keep stakeholders accountable to the One Health commitments made through clear roles and responsibilities for stakeholders. Examples include public reporting of data or progress, establishing legal requirements, and designating specific accountability bodies to monitor activities.   
  • These mechanisms are often weak, under-implemented, or treated as procedural exerrcises rather than drivers of performance.  

Evidence Gaps

• Few studies provide robust evaluations of governance effectiveness. Available evidence is often qualitative, anecdotal, or based on outbreak response. While some cases suggest improved coordination and response, there is limited causal evidence linking governance models to specific outcomes 

• There is a lack of rigorous, context-specific evaluations of One Health governance, particularly in LMICs. Standardized measures of performance are lacking, and long-term outcomes are rarely assessed. Therefore, there is a need for more case studies and empirical evidence. 

What are the limitations? 

Due to language capacities of the research team, we restricted our scope to documents in English or French. This may have limited our results, as many policy documents and implementation frameworks are produced only in national or official languages.

Therefore, we could have an underrepresentation of national level mechanisms not represented in Anglo- or Francophone peer-reviewed and grey literature. Additionally, our grey literature search was performed on global and regional organisation websites for feasibility, which may have limited our insights into national level specifics. We recommend that future research projects expand their search to include national-level documents and multiple languages.   

What does this mean and what happens next?  

Recommendations  

1. Develop Context-sensitive governance strategies: Governments and international partners should design One Health governance approaches tailored to institutional, political, and economic contexts rather than applying uniform models. 

2. Strengthen evaluative evidence: There is a need for more rigorous and comparative evaluations of governance approaches, including the use of mixed methods and context-sensitive performance metrics.  

3. Clarify and standardize performance frameworks: Our work contributes to establishing clearer definitions and indicators of One Health governance, including both process and outcome measures.  

4. Enhance sustainable resourcing: Countries, particularly LMICs, should develop strategies to reduce reliance on external funding and ensure long-term sustainability, including domestic financing and innovative funding mechanisms.  

5. Improve coordination & institutionalisation: Formalize coordination mechanisms across sectors and levels of governance, including subnational systems, and integrate One Health into existing institutional structures.  

6. Promote inclusive participation and ownership: Strengthen engagement of non-state actors, including communities and civil society, and ensure equitable participation across sectors to build legitimacy and effectiveness.