How are large-scale One Health initiatives targeting infectious diseases and antimicrobial resistance evaluated? A scoping review

Abstract

While One Health initiatives are gaining in popularity, it is unclear if and how they are evaluated when implementation at scale is intended. The main purpose of this scoping review was to describe how One Health initiatives targeting infectious diseases and antimicrobial resistance at a large scale are evaluated. Secondary objectives included identifying the main facilitators and barriers to the implementation and success of these initiatives, and how their impacts were assessed. Twenty-three studies evaluating One Health initiatives were eligible. Most studies included the human (n = 22) and animal (n = 15) sectors; only four included the environment sector. The types of evaluated initiative (non-exclusive) included governance (n = 5), knowledge (n = 6), protection (n = 17), promotion (n = 16), prevention (n = 9), care (n = 8), advocacy (n = 10) and capacity (n = 10). Studies used normative (n = 4) and evaluative (n = 20) approaches to assess the One Health initiatives, the latter including impact (n = 19), implementation (n = 8), and performance (n = 7) analyses. Structural and economic, social, political, communication and coordination-related factors, as well as ontological factors, were identified as both facilitators and barriers for successful One Health initiatives. These results identified a wide range of evaluation methods and indicators used to demonstrate One Health's added values, strengths, and limitations: the inherent complexity of the One Health approach leads to the use of multiple types of evaluation. The strengths and remaining gaps in the evaluation of such initiative highlight the relevance of comprehensive, mixed-method, context-sensitive evaluation frameworks to inform and support the implementation of One Health initiatives by stakeholders in different governance settings.

Keywords: AMR, antimicrobial resistance; Evaluation; Global health; Infectious diseases; Multisectoral; NEOH, Network for Evaluation of One Health; OH, One Health; OHHLEP, One Health High Level Expert Panel; One health; Participatory; WFPHA, World Federation of Public Health Associations.

Graphical abstract

Fig. 1

PRISMA flowchart (obtained from Covidence®) for the scoping review “How are large-scale One Health initiatives targeting infectious diseases and antimicrobial resistance evaluated? A scoping review”.

Fig. 2

Geographical distribution of the One Health (OH) initiatives of the 23 studies included in a scoping review exploring the evaluation of OH initiatives. Each highlighted country is mentioned in at least one study. As some studies involved multiple countries, the choropleth scale was calculated by continent. * The study mentioning a OH initiative in Mexico also involved central and south American countries, so Mexico was counted along with this group instead of North America.

Fig. 3

Types of evaluation of One Health (OH) initiatives identified in 23 studies included in a scoping review exploring the evaluation of OH initiatives in a context of intersectoral collaborations (i.e., involving at least two stakeholders among human health, animal health, and environmental health). Studies could use more than one type of evaluation. The types of evaluation were classified as normative assessment, or evaluative research (including impact analysis, implementation analysis, and performance analysis) [35]. The types of evaluation are presented for studies including the human and animal stakeholders, and for studies including the human and environment stakeholders. * One study included the human, animal, and environment stakeholders and was not included in the graphs. The type of evaluation conducted in this study was an impact analysis [37].