T3 COHESA Malawi One Health Key Informant Interviews Report 12092022 - Catherine Wood

T3 COHESA Malawi One Health Key Informant Interviews Report 12092022

Introduction 

Background: The world is facing unprecedented, interconnected threats to human, animal, and environmental health; addressing these threats necessitates cross-sectoral, systems-wide approaches. This is encapsulated in the One Health concept, which acknowledges the interdependence of humans, animals, plants, and their shared environment. COVID-19 and its origins as a zoonotic pathogen are a particularly relevant example, but One Health also addresses many of today's major threats, including climate change and disease emergence, antimicrobial resistance, ecosystem destruction with loss of biodiversity, and the fragility of food and feed systems. In a globalised world, all nations and societies must improve their management of One Health. We hope to build One Health capacity in Eastern and Southern Africa through this project.

Overview of the project: The project aims to create an inclusive Research & Innovation ecosystem, facilitating rapid uptake, adaptation, and adoption of solutions to issues that can be addressed using a One Health (OH) approach, with the OH concept embedded across society in Eastern and Southern Africa (ESA), working for healthy humans, animals, and environments.

Objectives

1. Increased relevance of OH research and policies in Eastern and Southern Africa (ESA). 
2. Enhanced national and subregional cross-sectoral collaboration between government entities with OH mandates and OH stakeholders across society. 
3. Educational and research institutes equipped to train the next generation workforce in tackling OH issues. 
4. Increased capacity of government and non-governmental stakeholders trained by the intervention to identify and deliver OH solutions to key problems of final beneficiaries.

Purpose and objectives of the Study 

The aim of the study was to help COHESA project better understand: (1) Individual, institutional, and countrywide understanding of the One Health situation inclusive of strengths and weaknesses. (2) Greater understanding and awareness of the One Health Landscape in Eastern and Southern Africa. The International Research Ethics Committee of ILRI and the Malawi Research and Ethics Committee provided ethical clearance.

The purpose of the study was to understand the following about One Health in Malawi:

1. One Health challenges, gaps and capacities within Malawi 
2. Current One Health Research and Innovation within Malawi
3. One Health performance, capacity, and bottlenecks within Malawi

Methods 

The study was conducted on behalf of the COHESA project, which was administered by ILRI (International Livestock Research Institute), ISAAA AfriCenter, and CIRAD (Centre de coopération internationale en recherche agronomique pour le développement (French Agricultural Research Centre for International Development)).

Participants were purposefully selected based on their expertise and experience in the field of One Health. One participant withdrew owing to scheduling conflicts, while the majority of those chosen volunteered to participate. All participants consented to participate for the key informant interview. Several participants expressed concerns about the confidentiality of the information they shared during the interview. All KII participants were reassured that all information given by participants would be kept confidential and that personal information would not be recorded alongside responses, implying that data would be stored and used in a way that would preserve anonymity through data encryption, anonymization, and restricting access. A 15-page questionnaire was administered to the participants.  Several participants expressed dissatisfaction with the length of the questionnaire. The interview took about 1 ½ hours on average. Each interview was audio recorded, transcribed, and handwritten notes were also taken.

Institutions

The following institutions were represented research (Centre for Ticks and Tick-borneDiseases (CTTBD) and Malawi Liverpool Wellcome Trust (MLW)), the Government of Malawi (Department of National Parks and Wildlife (Government), Department of Animal Health and Livestock Development (DAHLD)), academia (Lilongwe University of Agriculture And Natural Resources (LUANAR)), two nongovernmental organisations (Lilongwe Wildlife Trust (NGO), Lilongwe Society for the Protection and Care of Animals (LSPCA) and Action for Environmental Sustainability (AfES)), Central Veterinary Laboratory (CVL) and  two  international organisations (Food and Agriculture Organization (FAO),World Bank).

Findings

The following components were used in the analysis: 

1. Demographics 
2. Institutional capability and effectiveness 
3. Collaboration and Coordination 
4. Gender and Power Imbalances 
5. One Health Definition 
6. One Health Understanding, Knowledge, and Attitude
7. One Health Implementation
8. One Health Benefits
9. Research and Innovation
10. Collaboration and Coordination
11. Interdisciplinary Competency

1. Demographics

There were 17 males and eight females, with the youngest being 26 years old and the oldest being 62 years old. Most of the participants have a tertiary education. Eight of the participants held senior management positions, four were junior managers, one was the dean of the school, one was a graduate student and one was a National Professional Officer. One participant was affiliated to the government, academia, and a parastatal; one from a UN Specialised agency, and one from a US Government Agency; six from the academia/government, one from academia, and one from a research institution.Two participants identified as international non governmental organisation and one as non governmental organisation.

The interview lasted at most one and a half hours and was recorded. One participant had worked for just 1 year and one had over 30 years there with your current organisation. There were ten (10) participants with expertise in human medicine/health, eight (8) with expertise in public health, six (6) with laboratory expertise, seven (7) with expertise in policy, six (6) with expertise in data analysis, three (3) in environmental sciences, one (1) in social sciences, three (3) in biological sciences, five (5) in project management, and two (2) in virology.

One participant specialised in ecology, data analysis, animal health, biological sciences, and natural sciences, while the other two specialised in data analysis, three veterinary/animal health, one biological sciences, two natural sciences, one policy, one economics, and one environmental science.

The participants described their day- to -day responsibilities as follows: Disease programming policies, guidelines, and norms; resource mobilisation. Acting dean; managing academic affairs; managing finances; managing human resources; clinical work; taking classes; administrative work. Project coordination, antimicrobial resistance project in human and animal health; ensuring activities are carried out; connecting stakeholders; reporting. Overseeing the management of health programs, specifically COVID-19, tuberculosis, and malaria; clinical services; and partnership strengthening (MOH and stakeholders). Policy development, oversight, study formulation, technical guidance, resource mobilisation, quality assurance mobilisation, and monitoring and evaluation. Two lines: pandemic management (via the National Microbiology Laboratory; diagnostic capacity; early pandemic response) and microbiological resistance implementation.  Disease outbreak monitoring; prepared response; data analysis; program event-based surveillance. Management of staff, management of partnerships, hands-on research and research supervision, hands-on clinical (veterinary), assessment of existing projects (govt and private), teaching, community outreach and data management.

Other participants reported the following: Attend to resident sick animals to ensure their health and well-being, as well as train new volunteers who are externs coming into the centre in the afternoon. Management of various livestock-related projects, as well as the focal point for all livestock activities at this institution, including the planning, implementation, and monitoring of all livestock-related activities in all FAO projects. Coordinate college programs and ensure that they run smoothly. Coordination of environmental management issues, pollution control, and waste management. Teaching and course planning. Head of the department, listen to and respond to subordinates, and attend meetings with college management. Supervisor of subordinates, academician, researcher. Writing research project proposals

2. Institutional Capability and Effectiveness

15. What is the mandate and/or responsibilities of your organisation?

• Some of the  participants described their organisation mandates as follows: National leadership; multisectoral; disease control; national leader; respond to public health emergencies; provide landscape for public health leadership; development assistance for health, socioeconomic growth, public health, education, democracy; project management on behalf of the Government of Malawi; support government in the field of antimicrobial resistance; produce health professionals. Others described their mandates as follows: research, vaccine manufacture, coordination of veterinary field services, zoonotic and OIE reportable disease surveillance and response, animal health/food security policy, management majority veterinary diagnostics for Malawi.  Providing diagnostic capacity for veterinary research (mostly private or academic), education of veterinary students, developing veterinary research capacity, research and outreach pertaining to human health, support of CoM, advise ministry of health on policy, promotion of animal welfare, UN financing of LMIC countries and promotion of environmental awareness in Malawi, community outreach projects. 
• Other participants reported the following mandates: Observe and manage wildlife in and out of protected areas, as well as regulate their use. Rescue and rehabilitation of injured, orphaned, and sick animals ensures that the animals are healthy before being released back into their natural habitat. Work toward better crop or livestock production, production promotion, and better nutrition; additionally, the organisation trains farmers in the best agricultural conservation practices for the sake of environmental improvement. The college also has an artificial insemination centre and livestock farms, and it trains para-vet professionals up to the diploma level. Coordinate the country's overall environmental management issues. Leading agricultural training institution producing excellent and innovative graduates

16. What is the organisational structure of your organisation? (You can attach an organisational chart or draw one below)

17. Does your organisation have any influence (direct or indirect) on animal health? If so, how?

• Some participants stated that their organisations had an indirect impact on international health regulations, food safety, laboratory services, neglected tropical diseases, and antimicrobial resistance, the relationship between animal health and tuberculosis. Other organisations exerted direct influence through both human and animal health, project implementation, served as a reference laboratory, for human and animal health, legislation, oversight for all activities, particularly the antimicrobial coordination centre, and information sharing on zoonoses One participant stated that there was no influence.
• One participant said: “I would say indirect such that if we feel that human health is affected by animal health, then we make recommendations on what should be done in the animal health area, noting that we are not experts in animal health, but if we do find that the disease is emanating from animals, then we may provide recommendations’”.
• Other participants stated that they had a direct influence on national policy, disease outbreak intervention (desire to do more research but limited resources), tick-borne disease prevention (TBD), screening animal disease, education veterinarians (desire to do more research but limited resources), and organisational mandate to improve animal welfare in Malawi. One institution had an indirect impact through zoonotic disease research, while the other two had no influence.

18. Does your organisation have any influence (direct or indirect) on human health? If so, how?

• Some participants reported that their organisations had an impact on human health, either directly or indirectly. One participant noted that, while they were not implementers and had no physical presence in the facilities, they were responsible for policy development. Other participants noted that their organisations directly contributed to policy, trained medical students, and participated in HIV, tuberculosis, malaria, and COVID-19 research. Others collaborated closely with MOH and, through the human disease control mandate, served as a multisectoral reference laboratory for human and animal health, with oversight for all activities, particularly the antimicrobial coordination centre.
• Other participants reported that their organisations had influence on toxicology screening diagnostics for zoonotic diseases, coordination with the public health institute of Malawi on select zoonotic disease outbreaks, that their entire mandate is to improve human health in Malawi and support to the Medical College, rabies mitigation, ensuring environmental health (water quality, flood control) that affects human populations and environmental and community health, that their entire mandate is to improve human health in Malawi and support to the Medical College. One institution had no influence at all.

19. Does your organisation have any influence (direct or indirect) on environmental health? If so, how?

• Some participants stated that their organisations had a direct impact on environmental health because zoonotic diseases were not well managed at the environmental level. Some organisations were involved in climate change, water, sanitation, and hygiene programs, while others ran environmental laboratory samples, health system strengthening, environmental health officers, and collaborated with the Environment Department, particularly in disaster situations. Three participants reported that their organisations had influence through other departments, projects where the role was to assess environmental effects on institution projects, - promotion of sound environmental policy, and community education. Two participants stated that the influence was present but limited, while five stated that they had no influence at all.

21. Does your organisation explicitly aim to integrate animal, human, and environmental health (One Health)? If so, how – explain an example from your organisation. COLLECT any One Health policies from respondents that apply to their work/workplace (can be policies from your workplace or outside of your workplace that apply to you – for example government policy or signed bilateral agreements, etc.

• When asked if their organisations explicitly aim to integrate animal, human, and environmental health, some of the participants stated that this has already occurred because of donor funding for GOM capacity building and international health regulation. They use the One Health approach to antimicrobial resistance and to monitor antibiotic resistance because animals use antibiotics and some people feed antiretrovirals to their chickens. Although the connection is tenuous, they are aware of the need to integrate. Other participants stated that they do not actively advocate for integration in medical schools, even though they do deal with antibiotic use to some extent. One participant mentioned that they received global health security funding to assist in the development of shared policies for detecting, responding to, and preventing zoonotic diseases. Another participant stated that, while their organisation did not have a strong one-health approach, they were very intentional in their AMR response. They are collaborating on a One Health strategy as well as other documents that will aid in disease surveillance, provide guidelines, capture, and report facility-level data at a central data warehouse.
• The department of animal health and livestock development is working with Malawi's public health institute to strengthen One health initiatives such as policy, zoonotic disease response, and research. A One Health task force has been formed, but its specific mandates and roles are unknown at this time. Because neither institution has yet approved the draft document describing the task force, it is not yet available to the public. The MLW has a number of ongoing research projects that, while not explicitly stated, address one or more health concerns. The trust is likely to review policies in the future to include one health. All participants stated that their institution's explicit goal was not to integrate animal, human, and environmental health.

22. Has your institute/workplace changed their mandate on One Health over the last 10 years? If so, describe

• Some participants expressed concern about whether and how their mandate has changed and adapted over time. Others stated that their mandates have not changed because they do not have direct influence, but other departments may. Some participants lacked information. A few participants reported that their mandates were evolving and about to change in the future, and that some projects may have contributed to the need for that change.

The majority of participants declined to respond because their institutions lacked a health policy. Nonetheless, the department of animal health and livestock diseases is obviously revising their one health policy. The MLW anticipates developing a formal One Health policy. 

23. What time scale does your institute/workplace concern themselves with? For example, do they work with plans for centuries ahead, decades ahead, years ahead, others? Please specify if this varies by different One Health issues. 

• Some participants reported having, 1to 2 years experience, others had 5 to 10 years while others had 10 years strategic plans for animal health, human health, and agriculture. Some stated that they have multi year work plans that are guided by the health sector plan, general program of work, and extract plans to quarterly and implemented projects in cycles. One participant mentioned that they have a multi-decade plan in place.

3. Collaboration and Coordination

24. What type of economies your institute/workplace is concerned with? For example, global, national, regional, other?

• All organisations collaborate on plans to integrate human, animal, and environmental health; currently, no formal one-health policy exists; however, stakeholder collaboration occurs. A recent example was the management of the Anthrax and FMD outbreaks, in which the Department of Animal Health and Livestock Development (DAHLD) collaborated with the Public Health Institute of Malawi and the Department of National Parks and Wildlife to identify and contain the disease's spread. The stakeholders work to implement government policies, which typically have a five-year timeframe. The policies are then reviewed to take into account emerging issues. The types of economies involved range from regional to global, depending on the area of need.The benefits of cross-disciplinary thinking include encouraging resource stewardship across sectors and ensuring rapid response to emergencies.The difficulties; the process of bringing people together can take a long time, and the varying focus of different sectors can slow progress.
• Three participants stated that they are national, while six others stated that they are both national and regional. One participant stated that they have a large mandate and thus enjoy economies around antimicrobial resistance for Malawi; data transmission to the national level and beyond Malawi, which contributes to global AMR mapping. Some participants were unsure about the nature of the economies in which their organisations were involved. Some participants reported that member states required annual subscriptions.One participant reported that they national and regional economies.

25. What level of networking/collaboration does your institute/workplace do? For example, only within your organisation, working with other closely related institutes, across sectors, other? Please provide examples of the other institutes/workplaces you work with and how much you collaborate or network with them?

• Most participants reported some form of collaboration with other institutes and universities outside of Malawi health institutions. One participant stated that their organisation serves as a convenor of various stakeholders as well as a technical advisor. Others assisted the GOM by providing resources to implement policies and strengthen the systems. Most of the collaborations were with network institutions. According to one participant, they primarily collaborate with their implementing partners, with WHO and FAO serving as funding channels. They also work with the LUANAR on the socioeconomic and nutrition components, as well as the National Health Cluster and COVID-19 vaccine taskforce. Other participants work with various GOM departments, primarily in human resources in the ministries of health, police, defence, immigration, and water. Because HIV is a disease, some collaborate with 10 health sectors that contribute to SDG achievement, but rarely engage with all the sectors. Positive collaborations were reported by one participant in academics, practicums, and shared project implementation at learning institutions. Some participants reported collaboration with  private research, other academic institutions, the ministry of health, other departments in the ministry of agriculture,  college of medicine, animal welfare organisations in the country and internationally.
• The following institutions collaborated: ECSA, WHO, US CDC, Africa CDC, ASLM, QMP, REACT and ICAS Project, Malawi Liverpool Wellcome Trust, CHAM, FAO, OIE, UNICEF.

26. What are the benefits and challenges of cross-disciplinary thinking and working with those from outside your field/institute?

• Some of the most notable benefits were idea cross-pollination and learning from one another, division of labour, and reliance on other departments. A more comprehensive understanding of resistance patterns in animal and human health, networking and knowing who is doing what where to address gaps and avoid duplication, and resource leveraging and pooling. Participants also mentioned the following challenges: It is difficult to understand why One Health is important, and there is little input from the animal health sector. One participant stated that priorities differ by sector, that some sectors are not proactive, and that there is a lack of coordination. There are also some unmet expectations, and one participant mentioned that working within government budgets was difficult. Biassed implementation targets and minimal investments in bacteriology.
• Multiple participants believed that cross-disciplinary thinking and collaboration facilitated the cross-pollination of ideas and coordinated policy. One participant reported that collaboration across disciplines allowed for rapid response to zoonotic disease outbreaks. Several animal health professionals expressed their belief that human health professionals viewed veterinary and animal sciences as inferior. Due to a lack of resources, animal health professionals believed they could not perform at the same level as human health professionals. Several respondents felt they had no contact with environmental health professionals.

4. Gender and Power Imbalances

27. Are there power imbalances (academic or disciplinary) or gender imbalances within your organisation which lead to bias? For example, are women excluded from decision making? Are only senior staff involved in decision making? Are certain ethnicities or social classes excluded? Do power imbalances lead to conflicts?

• Most participants agreed that there are power and gender imbalances, particularly at the senior and leadership and decision-making levels, but one participant expressed concern that despite the existence of gender imbalances, no firm action has been taken. One participant believed that their organisation had strict policies in place to discourage imbalances, and that they were experiencing more interpersonal differences, conflicts, and tensions at work. One participant mentioned that they have policies and guidelines in place that prioritise equal opportunity employment. Another participant observed that decision making is, to some extent, a male-dominated domain in which gender is not a key issue of discussion. One participant stated that the leadership at their organisation is predominantly female, with no gender imbalances and that there are strong policies in place. One participant did mention that ethnicity is a source of concern.
• One participant said: “Our institution subscribes to national laws, promoting gender equality and gender balance, both in terms of admitting students but also in higher staff. I must say that in terms of gender policies, imbalances are there…the institution is what subscribes to policies that ensure gender equality. In terms of faculty, there's still a big gender gap, that most of us are males. There are fewer females that are represented in our organisation. And I do feel that their academic progression is not that fast. Because obviously they have to care for their families. They have to take maternity leave. And maybe we don't have good strategies to ensure that females are supported to move quickly like we men move up the ladder. So that's the reality in terms of gender imbalance”. 
• When asked whether there was exclusion from decision making a participant said: “On decision making they're not excluded, but they are underrepresented in our decision-making committees. Therefore, indeed, I can't speak for them, but maybe that our committees are male dominated. And if you don't have powerful women, maybe gender issues or issues that affect women are not highlighted. So, they are not excluded, but they are underrepresented in decision making committees”.
• Another participant said: “I don't see strong women within governance, within power, within the Ministry. We talk about gender equality, but it is not implemented. So, it's just lip service”.
• Several participants reported no bias or imbalance within their organisation. Several participants noted the lack of women in higher leadership positions. Other participants also noted that decisions were made without the input of junior staff. However, to some participants there were  no gender imbalances, and ethnicity played no role in the hierarchy setting. They also reported that women have been excluded from some positions due to the nature of the work. For example, the position of wildlife officers, which is field based, is openly advertised during vacancy, but the majority of individuals who apply and are hired are men.

28. What are the other key institutes/organisations that your institution works with? Provide details of 4 key partner institutions in question.

5. One Health Definition

29. How do you, as a respondent, personally define One Health? 

• The definition of One Health was interpreted differently by the participants. The following are some of the terms that were used: A platform/discipline where we must coordinate resources to implement action for human, animal, and environmental health. It is about the close relationship between humans, animals, and the environment; acknowledging that addressing challenges in human health is insufficient and that we must go to the source of the problem. There are connections between various aspects of health, such as animal health, human health, and environmental health; all these aspects must be coordinated for a good response on health outcomes in these sectors. An approach that encourages global communication. Intersection of animal health, human health, and environmental health. It refers to the ability to interact with animals.
• One participant said:  “I don't have a textbook definition but basically, my understanding is that human health is influenced by a lot of things, including things that happen to animals, and also animals’ health is influenced by what happens to humans.  So, it's the internal relatedness between human and animal health and how they influence each other”.
• Another participant stated: “I think it's a discipline. It's a platform where we have to collaboratively coordinate implementation of public health emergencies because most of these affect both platforms, they affect animal health, they affect human health and the environment. So, a platform where we are pulling together all these resources, and all the investment to come together and implement for action”. 

6. One Health Understanding, Knowledge, and Attitude

32. What are the most important elements of One Health?

• Most participants stated that all elements are important. They also offered additional information to back up their claims: Elements that promote the integration of animal, human, and environmental health to protect the health of all entities. Those who address current health threats, form partnerships and coordinate efforts across all sectors, and have a good understanding of coordination. Some participants stated that collaborating with the environmental health sector was difficult and that coordination was a major challenge.
• One participant said: “All of them. You want me to pick? Why do you want to pick one? Every element there has its own importance. It's not like something is more important than the other. The way I'm looking at it. How can you think of inter sectoriality and then, and then leave out participation? Leave out sustainability? How can I think of systems thinking and yet it’s not sustainable. And no one is participating. That’s my thinking. You cannot participate in something that cannot be sustained”. 

33. What are the most important elements of Ecohealth (systems thinking, inter-sectoriality, sustainability, participation)?

• The following were identified as the most important elements: stakeholder participation and sustainability issues. Because most initiatives are donor-funded and partner-driven, government ownership is essential. There was a need for clear terms of reference that defined the members' and each sector's roles and responsibilities. One participant also stated that inter-sectoriality, system delivery system strengthening thinking and prioritisation are important but are not well integrated into programs, and that participation is also important. One participant lacked the confidence to respond to the question.

34. How important is Environment health to One Health? (circle one)

• Most respondents indicated that this is of high importance.

35. How important is Animal Health to One Health? (circle one)

• Most respondents indicated that this is of high importance.

36. How important is Human Health to One Health? (circle one)

• Most respondents indicated that this is of high importance.

37. Briefly explain your scoring from the last three questions, focus on explaining why they were or were not equally weighted in importance?

• Participants elaborated on the scoring decisions they had reported. Some individuals believed that the environmental health sector was not enthusiastic and did not fully comprehend the notion of One Health. Others stated that it was due to their knowledge in human health and the fact that when we mismanage human health, it has a ripple effect on animal health and environmental health. Some researchers have observed that human activity has destabilised the environment. According to some, all components are essential for our survival, which is dependent on the human, animal, and environmental health sectors. Most respondents weighted the above equally and expressed that the above cannot be considered separately. A few participants felt that environmental health was more important than animal and human health.

7. One Health Implementation

38. What is the level of implementation of One Health in your country? (circle one)

• Most participants reported that One Health implementation in Malawi was low to moderate.

39. How many years of experience (work/education/projects) do you have on One Health?

• Most  participants had 1-5 years of experience, two had 1 year of experience, and two had more than 10 years of experience.

40. Thinking about your profession – How does it contribute to One Health? (select one)

• Most participants reported that their profession had made a moderate to large contribution to One Health. Two participants indicated that their profession had made a negative contribution to One Health. 

41. On a scale of 1-10, how much is your institute/workplace focus on the environment? (circle one)

• Majority of the participants reported that their institution has no or moderate focus on the environment.

42. On a scale of 1-10, how much is your institute/workplace focused on animal health? (circle one)

• Four participants reported that their institution has a high focus on animal health.Majority of the participants reported that their institution has no or moderate focus on animal health.

43. On a scale of 1-10, how much is your institute/workplace focus on human health? (circle one)

• Majority of the participants reported that their institution has a high focus on human health.

8. One Health Benefits

44. Which of the following do you see as benefits of the One Health /One Health Approach? (select all that apply) 

• Most  participants stated that One Health: promotes trans and multidisciplinarity (where different disciplines collaborate on health issues) and efficiency, promotes system thinking, participation, and health system resilience/sustainability (it is easier to deal with health issues). The approach also emphasises that One Health is complex, but that complex issues should not be avoided, and it defines the roles of each sector while saving resources.

45. What is the main benefit of One Health (select one)

• According to the participants, One Health promotes trans and multidisciplinarity (where different disciplines collaborate on health issues) and efficiency, as well as system thinking. The Approach emphasises that One Health is complex, but that complex issues should not be avoided, and it defines the roles of each sector and evaluates the benefits of One Health.One Health saves resources (it is economical).

9. Research and Innovation

46. How would you rate the following initiatives in terms of improving One Health (please tick one per initiative, where one is not important, and ten is Highly important to improve One Health)?

• Most participants rated the following as highly important: Managing emerging zoonotic diseases (for example, sars-cov-2),  managing neglected zoonotic diseases (for example, rabies), antimicrobial resistance, and the development of new therapies (drugs and vaccines), foodborne illness disease, landscape health management, and wildlife/protected areas interface (for example: fisheries collapse, desertification). Plant health, forages, and feeds (for example, efficiently feeding humans and animals, (promote sustainable agriculture, mycotoxins, pesticides) were moderately important. Other One Health initiatives and Laboratory services and capacity improvement were identified as critical.

47. What type of training on One Health your institute/workplace provided in the last 12 months? Please only include courses with One Health in the title OR where at least 20% of the material is One Health related. 

• Six participants reported that their institutions provided training as part of their mandate over the last 12 months. Nurses, clinicians, veterinarians, and laboratory personnel received in-service training. Antimicrobial resistance, antimicrobial stewardship master's program, integrated disease surveillance and response for undergraduate students. Some participants reported that they provided short courses in zoonotic disease training, that many BSc courses have a One Health component (BVet, natural resources, environmental engineering, animal health, crop sciences, public health), that many MSc's and PhD's are in areas related to the overlap between human and animal health and human and environmental health, and that community sensitization is important. Eleven  participants stated that their organisations did not provide any training in the previous year. Participants also discussed three short courses for tertiary students: one health for development Summer School, wildlife medicine, and laboratory diagnostic skills. Graduate satisfaction is measured and the number of graduates per course ranges from 85 to 100.

48. Give the name of up to three One Health related training you are familiar with from your institute (One Health in name of training or >20% content is on One Health). For each training, please list and provide details

• The participants listed antimicrobial resistance (animal health), Laboratory Practices, and Dynamics of Disease Stewardship (Master of Public Health, Global Health) as three training methods familiar to their institution. The number of graduates in each course (not broken down by gender) was as follows: Disease surveillance 100/year, Laboratory technicians 50/year, Medics 30/year, and Pharmacists 50-60/year. Although participants stated that the change in graduate knowledge, attitudes, and behaviours was examined, the graduate satisfaction was not assessed. The effects of the training on the health of humans, animals, and the environment were not assessed. Some participants were unsure of the total number of people who had received training at the time of the interview, while one participant reported hundreds, two reported dozens, and one participant did not have specific One Health training.

49. Do you believe the use of One Health as an adjective (a conceptual way of approaching One Health issues) rather than as a noun (Doing One Health) is beneficial or harmful for accomplishing using One Health in your country?

• Some participants agreed that using One Health as a concept and an approach to reflect collective teamwork and implementation is beneficial.Others had no opinion on One Health as a concept. Other participants stated that using one health as a concept was beneficial.

50. Do you feel there are any gaps in One Health education in your institute? If your answer is yes, where are these gaps?  What topic would you choose for a One Health training to take now?

• One participant stated that their institution has many gaps in One Health knowledge. They proposed zoonotic and environmental health management as potential One Health topics. Other participants reported that the environment is undervalued in one health education, with more emphasis placed on human and animal health.

10. Collaboration and Coordination

51. Thinking about how you work with professionals in the One Health sector (animal, human, and environment), please fill in how you work together (including how you work with people in your own field).

• Participants indicated that they communicate and collaborate, and that they have shared policies about how they collaborate, that they make decisions together, and that they share a budget for the work they do together on animal health, human health, and environmental health. A few participants stated that they do not work with animal health or environmental health but do share a budget with environmental health. In general, participants reported working with others in their respective fields, including conversing, exchanging policies, making decisions, and sharing budgets. Professionals in animal health reported sharing policies and decision-making with those in human health. There was a glaring lack of collaboration between environmental health professionals and other fields, according to reports.

52. Thinking about how you work with professionals in the One Health sector (animal, human, environment), please fill in how you work together (including how you work with people in your own field).

• All participants who identified as government indicated that they communicate and collaborate with one another, that they have shared policies about how they collaborate, that they make decisions together, and that they share a budget for the work they do together. Most participants who identified as private sector, Academia/Education and Development/NGO/INGO, CHAI, and World Bank indicated that they, too, communicate and collaborate with one another, that they have shared policies about how they collaborate, that they make decisions together, and that they share a budget for the work they do together. Some participants who identified as private sector stated that they do not have shared policies regarding how they collaborate, and that they do not make decisions for the work they do together. Some participants identified as Academia/Education and Development/NGO/INGO, CHAI, World Bank stated that they do not make decisions for the work they do together. One participant who identified as Academia/Education stated that they do not share a budget for the work they do together. In general, government participants reported collaboration between government institutions, including shared policy decision making, but no shared budget. Government participants also reported collaboration with the private sector and NGOs (discussions and policy development). Participants from academic institutions reported collaboration (discussions and decision-making) with the government, the private sector, and other NGOs, but minimal collaboration between academic institutions. NGOs reported collaborating with the government and with one another. Private institutions reported policy and academic collaboration with the government (varying degrees of collaboration).

11. Interdisciplinary Competency

53. Self-assessment of interdisciplinary competence

53. A. The participants strongly agreed on the following interdisciplinary competences:

• Skills:  Due to their mutual influence, they value reading about issues outside of their field. They delight in contemplating how several fields and disciplines handle the same topic in different ways. That not all One Health problems have exclusively technical solutions, and that while resolving One Health issues, they frequently consult experts from other academic disciplines. Given knowledge and ideas from several domains, they can determine what is necessary to solve a One Health issue. They recognize connections between concepts in their subject and concepts from other fields, such as the humanities and social sciences. They can synthesise concepts from beyond their discipline in ways that enhance their understanding. They can apply their knowledge from one field to another setting.
• Reflective behaviour: They frequently pause and evaluate their thoughts to determine whether they are overlooking anything. They constantly consider where they may be going wrong or right when attempting to solve a problem.
• Recognizing disciplinary perspectives: They know the kind of evidence upon which various academic disciplines rely. They are adept at identifying the omissions made by specialists in various domains while describing a problem/solution. 

53. B. The participants agreed on the following interdisciplinary competences:

• Skills:  Due to their mutual influence, they value reading about issues outside of their field. They delight in contemplating how several fields and disciplines handle the same topic in different ways. That not all One Health problems have exclusively technical solutions, and that while resolving One Health issues, they frequently consult experts from other academic disciplines. Given knowledge and ideas from several domains, they can determine what is necessary to solve a One Health issue. They recognize connections between concepts in their subject and concepts from other fields, such as the humanities and social sciences. They can synthesise concepts from beyond their discipline in ways that enhance their understanding. They can apply their knowledge from one field to another setting.
• Reflective behaviour: They frequently pause and evaluate their thoughts to determine whether they are overlooking anything. They constantly consider where they may be going wrong or right when attempting to solve a problem.
• Recognizing disciplinary perspectives: If asked, they could identify the kind of information and ideas that are unique to fields of study. They know the kind of evidence upon which various academic disciplines rely. They are adept at identifying the omissions made by specialists in various domains while describing a problem/solution. 

53. C. The participants neither agreed nor disagreed on the following interdisciplinary competences:

• Skills:  They value reading about issues outside of their field. That not all One Health problems have exclusively technical solutions, and that while resolving One Health issues, they frequently consult experts from other academic disciplines.
• Reflective behaviour: They constantly consider where they may be going wrong or right when attempting to solve a problem.
• Recognizing disciplinary perspectives: If asked, they could identify the kind of information and ideas that are unique to fields of study. 

54. D. The participants disagreed on the following interdisciplinary competences:

• Skills:  That while resolving One Health issues, they frequently consult experts from other academic disciplines.
• Recognizing disciplinary perspectives: If asked, they could identify the kind of information and ideas that are unique to fields of study. They know the kind of evidence upon which various academic disciplines rely. They are adept at identifying the omissions made by specialists in various domains while describing a problem/solution.

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