Community first: One Health projects collaborate with communities to respond to epidemics
Globally, there are over 200 infectious diseases that can spread from animals to humans. Some of these, like Ebola, are deadly. As humans put increasing pressure on the environment by cutting down forests, farming more livestock and hunting wildlife to trade and eat, the risk of these diseases spreading increases. Climate change adds to the problem: warming temperatures and shifting weather patterns cause both humans and animals to migrate, resulting in more human-animal interactions and opportunities for diseases to pass between species. This intersection between human, animal and environmental health is known as One Health.
The COVID-19 pandemic showed how rapidly viruses can spread in a globalized world, with no regard for international borders. More recently, the World Health Organization declared the outbreak of Mpox — a disease caused by a virus found in rats, monkeys and humans — a global health emergency, a further reminder of the need for a coordinated response to epidemics.
Researchers are examining the complex relationships between the health of humans, animals and the environment using the One Health approach. Many hotspots for diseases that spread from animals to humans, known as zoonotic diseases, are found in low- and middle-income countries. In these zoonotic disease hotspots, it is crucial to involve local communities in monitoring and reporting diseases to prevent and detect outbreaks. This philosophy is at the heart of IDRC’s Collaborative One Health Research Initiative on Epidemics (COHRIE).
Initiated in 2021, COHRIE is funding four research projects in nine countries in sub-Saharan Africa and Latin America. In line with One Health principles, the projects are structured around the connections between human, animal and environmental health. COHRIE promotes collaboration across sectors and the implementation of policies and systems to enable the early detection of diseases and a coordinated response to epidemics.
In September 2024, COHRIE research teams met in Cape Town, South Africa, for a workshop to share insights and lessons from their fieldwork ahead of the World One Health Congress. The workshop included three key sessions:
- a thematic knowledge exchange on key lessons learned from project successes and challenges
- a session on how to communicate findings to drive changes in One Health policy, practice and research
- an exploration of priorities for future research
Collaborating with communities from the start
One overarching theme that emerged from the discussions was the imperative to work with and for communities in One Health implementation. The research teams highlighted the value of building on existing community knowledge, systems and ongoing initiatives, while providing training and support to communities to equip them to identify infectious disease symptoms. Researchers also discussed using innovative approaches, such as mobile phone technology, for reporting.
Researchers with the West Africa One Health Actions project are focusing on the impacts of COVID-19, Ebola and Lassa fever in Guinea, Liberia, Nigeria and Sierra Leone. The researchers trained a diverse cross-section of community One Health volunteers who form part of a community action network (CAN) to identify and report zoonotic diseases and environmental threats using the mobile messaging platform WhatsApp, integrated with an artificial intelligence application called InfraNodus. This system analyzes text messages, images, audio and video recordings reporting disease systems to uncover patterns and trends that inform prompt public health interventions.
Prior to the CAN training, many communities across the project sites lack structured systems for real-time disease surveillance, zoonotic disease awareness and environmental hygiene. Following the training, communities are changing their practices. For example, there is improved hygiene in animal slaughtering. Volunteers are reporting disease symptoms sooner, which allows for a coordinated response to new cases, signifying a shift towards community-driven health and hygiene practices. An example of this in action was the recent outbreak of Mpox in Liberia, where CAN communities reported via the project WhatsApp platform in the very early stages, helping to stimulate a timely government response.
Continuous engagement with community volunteers while leveraging existing structures for sustainable change is important. In Uganda, the project trained 127 community One Health volunteers to collect data and report on diseases in the country’s cattle corridor, which is home to about 60% of the nation’s livestock. The volunteers were selected based on their existing roles as community health workers, animal health workers and wildlife officers. Weekly meetings during which the volunteers share experiences and learn from one another are key to the success of the volunteer groups.
Collaboration with communities helps ensure that traditional knowledge is valued and included in One Health approaches. For example, the One Amazon project is working with Indigenous communities to co-develop community-based health surveillance programs. In Ecuador, community elders trained young people on the use of traditional medicine, and the research team trained local Indigenous researchers to use an early-warning system for disease. Each of the One Amazon project teams uses a fair compensation approach, paying Indigenous elders, monitors or researchers the same rate as public university professors for their contributions.
The project team in Guinea and the Democratic Republic of the Congo has also involved communities in the development of context-specific integrated disease control strategies based on the One Health approach. The research team has drawn on the data regarding causes of emerging and re-emerging diseases, while focusing research on the consequences felt in communities, community perceptions of control measures, as well as perceptions of decision-makers, to improve the overall implementation of disease surveillance and control.
The experiences of the COHRIE teams show that engaging communities from the start and involving them in project design and implementation while valuing local and traditional knowledge are critical steps to building trust and ensuring ownership of One Health initiatives. The teams emphasized that researchers and funders should aim to prioritize this community-first approach in future One Health initiatives.
National One Health policies are needed to ensure effective coordination and response
Important observations and recommendations emerged from the research teams’ discussions.
- Community systems, as developed with COHRIE support, play a vital role in national disease surveillance and reporting. However, communities can become discouraged if the government does not offer a coordinated response when they raise an alert or when there is an outbreak.
- There is a need for national One Health policies to strengthen cooperation and coordination between government sectors and departments. Existing One Health platforms are typically housed within a single sector, such as the Ministry of Health, instead of at a higher, cross-cutting level. This limits the collaboration required for coordinated One Health responses.
- Governments should allocate a dedicated budget for One Health activities once they put a national One Health policy or platform in place, instead of directing funds to the different sectors involved in One Health. Also, a shared One Health vision and clear goals across sectors are essential to supporting collaboration and identifying funding priorities.
From research to action: One Health solutions at work
Results from the COHRIE research work are already being used to shape policy. For example, in Guinea, the research team was invited to contribute to developing the national One Health policy. In 2023, the West African team held a multistakeholder conference attended by ministers and senior government officials from each project country, along with civil society and non-governmental organizations. The discussions provided valuable inputs for all participating countries, notably Sierra Leone, which is in the process of revising its One Health Governance Manual and One Health Strategic Plan.
In Latin America, the One Amazon project has made significant progress toward the recognition of Indigenous practices to prevent and treat diseases. Together with representatives from government health ministries, the project has opened spaces for proposals linked to Indigenous autonomy and intercultural dialogue.
The impacts of the COVID-19 pandemic are still reverberating today as new outbreaks of diseases, such as Mpox and Marburg, continue to emerge and rise, hitting African countries the hardest. At this pivotal time, the experiences of COHRIE researchers have important implications for developing policies and practices that put communities at the forefront of fighting existing and emerging infectious diseases.
Recommendations
- Define One Health priorities and goals across relevant sectors — such as health, agriculture and the environment — along with a common vision and understanding of objectives to align efforts and funding.
- Develop and implement national One Health policies. These must be backed by an act of parliament or high-level political commitment to ensure that resources are allocated to One Health activities, government agencies are incentivized to collaborate, and One Health approaches are institutionalized within decision-making and budgeting processes.
- Engage communities from the start of One Health research projects and involve them in the design and implementation process, incorporating local and traditional knowledge. Doing so helps build trust and ownership of One Health initiatives at the local level and contributes to project sustainability.
- Collaborate with community members — such as community health workers, animal health workers and environmental stewards — to establish effective surveillance and response systems. For these systems to be effective, there needs to be two-way communication and accountability from government agencies responsible for responding to outbreaks.
Learn more about the COHRIE projects
- Surveillance, control and prevention of neglected zoonotic diseases in Uganda
- West African One Health actions for understanding, preventing and mitigating outbreaks
- Decentralize and operationalize the One Health platforms in Guinea and the Democratic Republic of Congo
- One Amazon: A One Health assessment of emerging epidemic threats and resilience among Amazonian Indigenous peoples