Assessing health systems in Guinea for prevention and control of priority zoonotic diseases: A One Health approach

Abstract

To guide One Health capacity building efforts in the Republic of Guinea in the wake of the 2014-2016 Ebola virus disease (EVD) outbreak, we sought to identify and assess the existing systems and structures for zoonotic disease detection and control. We partnered with the government ministries responsible for human, animal, and environmental health to identify a list of zoonotic diseases - rabies, anthrax, brucellosis, viral hemorrhagic fevers, trypanosomiasis and highly pathogenic avian influenza - as the country's top priorities. We used each priority disease as a case study to identify existing processes for prevention, surveillance, diagnosis, laboratory confirmation, reporting and response across the three ministries. Results were used to produce disease-specific systems "maps" emphasizing linkages across the systems, as well as opportunities for improvement. We identified brucellosis as a particularly neglected condition. Past efforts to build avian influenza capabilities, which had degraded substantially in less than a decade, highlighted the challenge of sustainability. We observed a keen interest across sectors to reinvigorate national rabies control, and given the regional and global support for One Health approaches to rabies elimination, rabies could serve as an ideal disease to test incipient One Health coordination mechanisms and procedures. Overall, we identified five major categories of gaps and challenges: (1) Coordination; (2) Training; (3) Infrastructure; (4) Public Awareness; and (5) Research. We developed and prioritized recommendations to address the gaps, estimated the level of resource investment needed, and estimated a timeline for implementation. These prioritized recommendations can be used by the Government of Guinea to plan strategically for future One Health efforts, ideally under the auspices of the national One Health Platform. This work demonstrates an effective methodology for mapping systems and structures for zoonotic diseases, and the benefit of conducting a baseline review of systemic capabilities prior to embarking on capacity building efforts.

Keywords: Capacity building; Guinea; Health systems assessment; One Health; Zoonotic disease.

Fig. 1

(A) Timeline for the steps taken in the assessment process, with key events indicated (timeline is not to scale). (B) Step-wise methodology for collaborative zoonotic disease systems assessment.

Fig. 2

Systems map for rabies case identification, diagnosis, and reporting in Guinea, from the community level (top) to the international level (bottom). MOH = Ministry of Health; MOL = Ministry of Livestock; MOE = Ministry of Environment; IDSR = Integrated Disease Surveillance and Response; DPS = Prefectural Health Directorate; LCVD = Central Veterinary Diagnostic Laboratory; WHO = World Health Organisation; OIE = World Organisation for Animal Health.

Fig. 3

Systems map for brucellosis case identification, diagnosis, and reporting in Guinea, from the community level (top) to the international level (bottom). MOH = Ministry of Health; MOL = Ministry of Livestock; MOE = Ministry of Environment; DPS = Prefectural Health Directorate; DPE = Prefectural Livestock Directorate; LCVD = Central Veterinary Diagnostic Laboratory; OIE = World Organisation for Animal Health.

Fig. 4

Systems map for avian influenza case identification, diagnosis, and reporting in Guinea, from the community level (top) to the international level (bottom). MOH = Ministry of Health; MOL = Ministry of Livestock; MOE = Ministry of Environment; ACSA = Community Animal Health Agent; IDSR = Integrated Disease Surveillance and Response; DPS = Prefectural Health Directorate; DPE = Prefectural Livestock Directorate; DPEn = Prefectural Environment Directorate; LCVD = Central Veterinary Diagnostic Laboratory; OGUIPAR = Guinean Office for Parks and Reserves; DNEF = National Directorate for Waters and Forests; WHO = World Health Organisation; OIE = World Organisation for Animal Health.