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Rev. Sci. Tech. Off. Int. Epiz., 2019, 38 (1), 71–89
Synergising tools for capacity assessment
and One Health operationalisation
doi: 10.20506/rst.38.1.2942
K. Pelican (1)*, S.J. Salyer (2)**, C. Barton Behravesh (2)**, G. Belot (3)**,
M. Carron (4)**, F. Caya (4)**, S. de La Rocque (3)**, K.M. Errecaborde (1),
G. Lamielle (5)**, F. Latronico (5)**, K.W. Macy (1), B. Mouillé (5)**,
E. Mumford (3)**, S. Shadomy (2, 5)**, J.R. Sinclair (2, 4)** & T. Dutcher (6)
(1) University of Minnesota, College of Veterinary Medicine, 1954 Gortner Avenue, St Paul, MN 55108,
United States of America
(2) One Health Office, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease
Control and Prevention (CDC), 1600 Clifton Road, NE 30329, Mail-Stop H-16-5, Atlanta, GA 30329,
United States of America
(3) World Health Organization (WHO), Health Emergency Programme/Country Health Emergency Preparedness
& International Health Regulations, 20 Avenue Appia, CH–1211 Geneva 27, Switzerland
(4) World Organisation for Animal Health (OIE), 12 rue de Prony, 75017 Paris, France
(5) Food and Agriculture Organization of the United Nations (FAO), Viale delle Terme di Caracalla, 00153 Roma,
Italy
(6) United States Department of Agriculture (USDA), Animal and Plant Health Inspection Services, Veterinary
Services, 100 Bridgepoint Drive Suite 180, South St Paul, MN 55075, United States of America
*Corresponding author: pelicank@umn.edu
**The views and opinions expressed in this article are those of the author/s and are not necessarily the official
views of the Centers for Disease Control and Prevention, Food and Agriculture Organization of the United
Nations, World Organisation for Animal Health, United States Department of Agriculture or World Health
Organization
Summary
Multisectoral, One Health collaboration is essential for addressing national
and international health threats that arise at the human–animal–environment
interface. Thanks to the efforts of multiple organisations, countries now have
an array of One Health tools available to assess capacities within and between
sectors, plan and prioritise activities, and strengthen multisectoral, One Health
coordination, communication, and collaboration. By doing so, they are able to
address health threats at the human–animal–environment interface, including
emerging zoonotic and infectious diseases, more efficiently. However, to ensure
optimal outcomes for the countries using these One Health tools, the partners
responsible for implementation should regularly collaborate and share information
such as implementation timelines, results and lessons learned, so that one
process can inform the next. This paper presents a consensus framework on how
commonly implemented One Health tools might align to best support countries in
strengthening One Health systems. Twelve One Health tools were selected based
on their high implementation rates, authors’ experience with these tools and their
focus on multisectoral, One Health coordination. Through a four-step process, the
authors: a) jointly carried out a landscape analysis of One Health tools, using a Cloud-
based spreadsheet to share the unique characteristics and applications of each
tool; b) performed an implementation analysis to identify and share implementation
dynamics and identify respective outcomes and synergies; c) jointly created a
consensus conceptual model of how the authors suggest the tools might logically
work together; and d) extrapolated from steps 1–3 an agreed-upon overarching
conceptual framework for how current and future One Health tools could be
categorised to best support One Health system strengthening at the national
level. Highlighted One Health tools include the States Parties Annual Reporting
Tool under the International Health Regulations (IHR), the World Organisation
for Animal Health Performance of Veterinary Services (PVS) Pathway, the Joint
External Evaluation process, IHR/PVS National Bridging Workshops, the Centers
for Disease Control and Prevention One Health Zoonotic Disease Prioritization
Tool, the Food and Agriculture Organization (FAO) Laboratory Mapping Tool, the
FAO Assessment Tool for Laboratories and Antimicrobial Resistance Surveillance
72 Rev. Sci. Tech. Off. Int. Epiz., 38 (1)
Systems, the FAO Surveillance Evaluation Tool, the One Health Systems Mapping
and Analysis Resource Toolkit, the National Action Plan for Health Security, and
IHR Monitoring and Evaluation Framework tools for After Action Reviews and
Simulation Exercises. A new guidance document entitled, Taking a Multisectoral,
One Health Approach: A Tripartite Guide to Addressing Zoonotic Diseases in
Countries was also included as a framework that provides guidance to support
the implementation of the outputs of the tools described.
Keywords
Capacity assessment – Infectious disease – Multisectoral – One Health – One Health
tools.
Introduction
Countries around the world are increasingly committed
to taking a multisectoral, One Health approach to address
complex health threats at the human–animal–environment
interface, such as zoonotic and emerging infectious
diseases and antimicrobial resistance (AMR). Recognition
of challenges or gaps in national mechanisms for taking
a One Health approach – whether based on national
experience with the negative impacts of outbreaks or the
results of internal or external reviews and assessments – has
prompted countries to explore options for improvement.
In addition, countries recognise that taking such an
approach is critical to meeting their obligations under
multiple global frameworks, including the requirements
of the International Health Regulations (IHR, 2005) and
the standards of the World Organisation for Animal Health
(OIE). The One Health approach is also vital for making
progress towards achieving the United Nations Sustainable
Development Goals (1, 2, 3, 4).
In the experience of the authors, practical implementation
of a One Health approach can be challenging, especially in
low-resource settings or where sector-specific structures
are well established. Many international agencies, bilateral
technical partners, development partners and donors have
provided technical and financial support to countries, using
available One Health tools to promote the operationalisation
of a multisectoral, One Health approach. The intent of this
capacity-building work is to assist and maximise the results
of national efforts in addressing complex health threats at
the human–animal–environment interface by engaging and
mobilising resources more effectively across One Health
sectors. Decision-makers in many countries are now being
offered a wide variety of initiatives, tools and projects that
are intended to build sector-specific, disease-specific and/or
multisectoral, One Health capacity (5). This paper examines
a number of these One Health tools and processes, all of
which have the potential to advance the implementation of
One Health approaches at the national level.
The Tripartite (OIE, the Food and Agriculture Organization of
the United Nations [FAO] and the World Health Organization
[WHO]), in collaboration with international experts and
country representatives, have developed an operational
guide entitled, Taking a Multisectoral, One Health Approach:
A Tripartite Guide to Addressing Zoonotic Diseases in Countries
also referred to as the Tripartite Zoonoses Guide or TZG (6).
This guide builds on a 2008 WHO guide, Zoonotic Diseases:
A Guide to Establishing Collaboration between Animal and Human
Health Sectors at the Country Level (7) and on a rich array of
global One Health initiatives and experiences from different
countries (5, 8, 9, 10). The TZG is designed to support
countries in providing guidance to build multisectoral,
One Health capacity to address zoonoses and other health
threats at the human–animal–environment interface. This
includes building capacity in aligned surveillance, joint
outbreak response, preparedness, One Health workforce
development, and development of multisectoral coordination
mechanisms. As the TZG is launched, it will be important
that countries understand how best to use the guidance to
operationalise plans and use the outputs from the many
One Health tools and processes already being implemented
at the national level, as described in this article.
Tool origins and selection process
In 2010, an international meeting, ‘Operationalizing
One Health: A Policy Perspective’, was held in Stone
Mountain, Georgia, the United States of America (USA)
(11). Attendees identified specific projects to advance the
implementation of the One Health approach around the
world, creating working groups on One Health capacity
building, needs assessment and training, among other issues.
Discussions during and following the meeting highlighted
the importance and value of convening experts working in
the One Health realm (intergovernmental organisations,
government agencies, academia and other partners) to
share information, details of progress and ideas. These
discussions also created a shared commitment to harmonise
efforts and build tools designed to address specific aspects
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Rev. Sci. Tech. Off. Int. Epiz., 38 (1)
of strengthening and assessing multisectoral, One Health
coordination/implementation mechanisms within a country.
Over the last eight years, the authors have worked both
independently and collaboratively to develop a series of tools
to further One Health at the operational level. Each tool and
associated process was developed to address specific aspects
of assessing and/or strengthening One Health capacity.
Each was also independently implemented and piloted
by the various authors and their organisations in the field.
A number of publications describe these efforts (4, 12, 13,
14, 15, 16, 17, 18, 19, 20, 21, 22).
As work on these various tools progressed, the authors
began sharing results with partners, inviting observation and
participation in implementation and training workshops,
and exploring potential opportunities for collaboration
and for synergising outputs. The collaborative engagement
in developing the TZG during 2017–2018 provided
further opportunity for the authors to identify specific
tools that encourage and support the implementation of a
multisectoral, One Health approach at the national level, as
described in the guide. This prompted tool developers to
discuss methods for highlighting the complementarity of
these One Health tools and how they could assist countries
in implementing the guidance in the TZG. As a first step,
they collaborated to host a symposium at the annual meeting
of the American Society for Tropical Medicine and Hygiene
in 2017 (23). The pre- and post-symposium activities led to
the creation of a multi-step process to review tools together,
share the outcomes of tool implementation, with country
permission, and establish synergies.
Additionally, as part of the TZG development effort, the
Tripartite, with input from other organisations, including
the Centers for Disease Control and Prevention (CDC),
developed a review document that summarises and links
existing One Health-related processes and activities (e.g.
regulations, standards, guidance, manuals, tools, assessments,
evaluations and conventions) (internal document available
upon request). This review encompasses approximately
50 tools, processes and activities that the Tripartite authors
broadly considered One Health-related. This comprehensive
list served as a resource to the authors in determining tools
for inclusion in this paper and building a conceptual model
of how these tools could work together more effectively.
While much progress has been made in developing and
implementing various One Health tools and processes, to
date there has been limited effort in sharing lessons learned
and best practices on how to synergise or link these for
maximal benefit at the national level (5). The tools and
processes presented in this paper are voluntary, but multiple
countries have chosen to use them to advance their own
goals related to global health security, trade of animals and
products of animal origin, and to prevent, detect, respond
to, and control zoonotic diseases. Although not exhaustive,
the information presented in this paper should help
countries to gain a clearer understanding of the One Health
tools that are available, how and when tools and processes
can be applied for maximal benefit, and how these tools
can be used to support national and international standards
and goals for One Health, including goals concerning
preparedness, planning, response, operations, workforce
development and other capacity-building activities.
While previous efforts have brought partners together to
promote collaboration and describe specific One Health
tools (5, 23), this paper seeks to provide information on
how selected tools might be used together for greatest
effect and better outcomes. This paper also presents a
more in-depth review of the unique characteristics and
applications of operational tools that have been used
to assist countries and regions. It focuses specifically
on tools that authors have personal experience with,
have high ‘implementation rates’, i.e. have been used in
multiple countries and regions (12, 24), and emphasise
multisectoral, One Health coordination and collaboration.
The descriptions in this paper are not meant to present the
only potential context and application for each tool, as each
tool has its own context, requirements and applications that
are independent of how they might be used in synergy to
advance One Health.
The overall goals for this work were to review synergies
and possible overlaps, clarify expected country outputs,
and elucidate options for how countries can use these tools
to maximal benefit in the context of both their individual
use as well as their use together or in sequence. Specific
objectives of this project were to:
a) jointly conduct a landscape analysis of One Health
tools, using a Cloud-based spreadsheet application (Google
sheets) to share unique characteristics and applications of
each tool online
b) perform an implementation analysis to identify and share
implementation dynamics and identify respective outcomes
and synergies
c) jointly create a consensus conceptual model of how the
authors feel the tools might logically work together
d) extrapolate from steps 1–3 an agreed-upon overarching
conceptual framework for how current and future
One Health tools could be categorised to best support
countries to strengthen their One Health systems.
Methods
Criteria for tool inclusion
This paper does not provide an exhaustive list of all the
One Health tools available, but it provides examples of
74 Rev. Sci. Tech. Off. Int. Epiz., 38 (1)
some of the tools that national decision-makers could find
useful when developing their strategy for implementing
One Health approaches in their countries. A more
comprehensive list of tools is available in other publications
(5). Each of the tools included in this analysis met all of the
following criteria:
a) The tool helps support a multisectoral, One Health
approach to preventing, detecting, responding to and
controlling zoonotic diseases or other health threats at the
human–animal–environment interface.
b) The tool has been implemented at the national level in at
least five countries.
c) One or more authors was involved in developing the tool
and has/have supported implementation of the tool at the
national level.
The one exception was the TZG. This is a new tool that was
in development during the preparation of this analysis and
has not yet been implemented in any country. The authors
included this tool because they predict that the TZG will be
used by countries to address gaps in One Health capacity
and operationalise the plans developed through the
application of the One Health tools described in this paper.
Landscape analysis
The authors identified 12 tools that met the above inclusion
criteria and jointly conducted a landscape analysis in order to
collectively establish a cohesive understanding of these tools
and analyse key aspects of their role, scope and application.
This analysis allowed authors to directly compare the key
characteristics of the tools and identify the main differences
between them. Authors worked collaboratively on the group
document to establish the variables and other information
to be collected. A consensus-driven iterative review process
was used to select the following descriptive variables:
– tool name
– organisation of origin
– scope or category
– description
– reason for development
– implementation process
– example applications
– key outputs
– an Internet link, if available.
The authors then filled in the required information for their
tool(s) individually into the Cloud-based spreadsheet.
Country implementation analysis
The authors worked with agency and institutional teams
involved in implementation to document where, when and
how the included One Health tools had been used since
development. The authors compared the implementation
date of each tool with that of every other tool so as to
determine the order in which they were used. This analysis
of temporal directionality was visualised in a matrix showing
the percentage number of times one tool followed another
to demonstrate any commonly seen implementation
patterns. For each tool comparison, if one tool preceded
the other more than 50% of the time, it was marked in grey,
indicating a stronger tendency to be implemented before
the other tools.
In addition, authors worked with their respective
implementation teams to answer a set of questions regarding
sharing and use of tool outcomes for implementation in
countries where at least four tools were implemented. The
authors chose countries with a high rate of tool use, as there
are more opportunities to evaluate the number of data-
sharing events between the tools. Questions included:
a) Did you share your tool outcomes with other tool-
implementing partners in this table prior to their
implementation?
b) Did you receive other tool outcomes listed in this table
prior to your implementation?
c) If you received other tool outcomes prior to
implementation, did those outcomes inform your tool
implementation?
Authors were asked to respond in one of four ways: ‘yes’,
‘no’, ‘don’t know’ or ‘not applicable’, and all data were
collected into the cloud-based spreadsheet. Tool outcomes
could be received in a multitude of ways: published online,
direct from the authors involved in implementation, or
shared by a country partner.
Linking the tools: developing the conceptual
model and the overarching conceptual
framework
Once the tools were identified and the implementation
spreadsheet developed, the authors began sharing a series
of diagrams to understand how tools might logically
be applied to strengthen One Health approaches at the
national level. Authors shared information on what
did and did not work when tools were implemented in
countries by highlighting themes from repeated or piloted
implementation, particularly in cases where tools were
used in a series or together, and lessons learned from those
experiences. After iterative review and revision of proposed
tool sequencing and relationships, a conceptual model
diagram was developed representing a consensus of how
the authors believe the tools might maximally inform each
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Rev. Sci. Tech. Off. Int. Epiz., 38 (1)
other. The conceptual model was designed to describe when
tools might be used, what the expected outputs were, and
how those outputs might be used in a synergistic manner.
As the authors worked through the landscape analysis and
conceptual model, the tools were categorised into groups.
The authors worked iteratively on an overarching conceptual
framework, starting with identifying the tool categories. A
graphical representation was generated and agreed to by
author consensus to represent overarching categories that
multiple tools might fit into and countries might use.
Results
Landscape analysis
The iterative landscape analysis identified 12 tools that met
all criteria, as follows:
– IHR After Action Review (AAR)
– FAO Assessment Tool for Laboratories and Antimicrobial
Resistance Surveillance Systems (FAO–ATLASS)
– FAO Laboratory Mapping Tool (FAO–LMT)
– FAO Surveillance Evaluation Tool (FAO–SET)
– IHR Joint External Evaluation (JEE) Tool
– WHO National Action Plan for Health Security (NAPHS)
– OIE Performance of Veterinary Services (PVS) Pathway
– IHR/PVS National Bridging Workshop (NBW)
– One Health Zoonotic Disease Prioritization Tool
(OHZDP), developed by the CDC
– One Health Systems Mapping and Analysis Resource
Toolkit (OH–SMARTTM), developed by the University of
Minnesota and the US Department of Agriculture
– WHO Simulation Exercises (SimEx)
– WHO States Parties Annual Reporting (SPAR) Tool.
(Annual reporting is mandatory, but use of the SPAR Tool is
not; countries can choose to submit their reports in another
format if they prefer.)
In addition, the TZG was included as guidance to support
the implementation of the outputs from the highlighted
One Health tools.
Full descriptions of these tools are provided in the complete
landscape analysis in Table I. Of these tools, a number fit
in multiple categories. Eight were categorised as assessment
tools, three as prioritisation tools, two as action planning
tools, one as an implementation tool and four as monitoring
tools (Table I).
Country implementation analysis
Implementation data were collected for nine of the 12 tools
that met the inclusion criteria, namely: OIE PVS Pathway,
JEE, NBW, OHZDP, FAO–LMT, FAO–ATLASS, FAO–SET,
OH–SMART and NAPHS. The AAR, SimEx, and SPAR were
not assessed in this analysis as implementation data were
not readily available for review. The nine tools assessed were
implemented in a median of 20 (range 13–134) countries
representing four WHO regions (Africa, the Eastern
Mediterranean, South-East Asia and the Western Pacific
region). There were 30 countries which had implemented
≥4 of the tools assessed (Table II). There were only
three countries (Ethiopia, Senegal and Tanzania) where all
nine tools had been implemented.
For the temporal directionality of implementation
analysis, the authors found that the OIE PVS Pathway and
FAO–LMT were implemented before other tools 98% and
80% of the time, respectively. Conversely the FAO–SET,
NBW and NAPHS more frequently followed the
implementation of all other tools (Table III). This pattern is
most likely influenced by the date of tool creation and the total
number of countries where the tool has been implemented
with other tools. Specific directional relationships regarding
tools like the OIE PVS Pathway, JEE, NBW and NAPHS,
where one tool output is needed to initiate or inform the
other, were the most frequent scenarios seen. However, the
authors found that there was still some flexibility regarding
the temporality of the implementation of these tools (i.e.
one country completed a JEE prior to an OIE PVS Pathway
evaluation; one country implemented an NAPHS prior to a
JEE; and two countries completed NBWs prior to or during
a JEE) (Table III).
For the 30 countries where the authors assessed sharing
and use of tool outcomes for implementation, completed
questionnaires were obtained for only seven of the
nine tools (OIE PVS Pathway, JEE, NBW, FAO–SET,
OHZDP, OH–SMART and NAPHS). Of all the tools,
OH–SMART used information from the most tools (OIE PVS
Pathway, JEE, NBW, OHZDP and NAPHS) and with more
frequency than any other tool. This was, in part, because
OH–SMART was used to support multisectoral zoonotic
disease workforce planning and National AMR Action
Planning, using protocols that explicitly required the
synthesising and processing of outcomes and outputs from
these other tools. In fact, in some cases, OH–SMART imple-
mentation was delayed to allow for prior use of the OHZDP.
76 Rev. Sci. Tech. Off. Int. Epiz., 38 (1)
Table I
Landscape analysis and comparison of the 12 One Health tools that met the inclusion criteria
Tool Organisation(s) Scope/Category Tool description Reason for development
FAO Assessment
Tool for Laboratories
and Antimicrobial
Resistance
Surveillance Systems
(FAO–ATLASS)
FAO Assessment and
prioritisation
FAO–ATLASS maps the national antimicrobial resistance
(AMR) surveillance systems along five pillars (laboratory
capacity and network, epidemiology unit, governance,
communication and sustainability). The tool consists of
two modules – laboratory and surveillance – which include
features of FAO–LMT and FAO–SET, focusing on AMR.
FAO–ATLASS provides recommendations for improvement of
the systems, measures progress relative to the FAO Global
AMR Action Plan, and provides evidence for action and
advocacy
To assist countries in evaluating
their AMR surveillance systems
and building their capacity
FAO Laboratory
Mapping Tool
(FAO–LMT)
FAO Assessment and
monitoring
Standardised, semi-quantitative toolkit used to determine
gaps in laboratory functionality and define mechanisms and
targets for capacity building. The core assessment tool
(FAO–LMT–Core) assesses the veterinary laboratories’
general functionality through 108 questions. The FAO–LMT
family was further expanded in 2016 with the release of a
separate module for assessing laboratory safety
(FAO–LMT–Safety). This module uses 98 questions to provide
a standardised assessment of the environmental safety of
veterinary laboratories and occupational risks
To allow veterinary laboratories
to visualise their performance as
compared to national, regional
and global networks and thereby
further encourage them to
improve their capacity
FAO Surveillance
Evaluation Tool
(FAO–SET)
FAO Assessment and
monitoring
Comprehensive and standardised evaluation of national
animal/zoonotic disease surveillance systems along
90 indicators organised in 19 categories, including aspects
of intersectoral cooperation between Veterinary Services,
Public Health Services and Wildlife Services. FAO–SET
provides Veterinary Services with a 360º assessment of their
surveillance network, which is used to develop a locally
relevant action plan for capacity building of national animal
disease surveillance
To respond to countries’ requests
for an evaluation and work
planning tool to specifically
enhance capacities of national
animal disease surveillance
systems
IHR/PVS National
Bridging Workshops
(NBWs)
WHO and OIE Assessment Reviews current collaboration gaps across human and animal
health in 15 key technical areas and supports development
of a joint roadmap of corrective measures and strategic
investments
To improve the prevention,
detection and control of health
threats at the animal–human
interface
International Health
Regulations (IHR)
Monitoring and
Evaluation Framework:
After Action Review
(AAR) and Simulation
Exercises (SimEx)
WHO Monitoring Two of the four components of the IHR Monitoring and
Evaluation Framework. These processes allow a qualitative
review of national operational capacity for responding to
events, either proactively (SimEx) or retrospectively (AAR)
SimExes can be used to test specific aspects of a system (e.g.
collaboration among partners) under a hypothetical scenario,
whereas AARs review the actual functioning of the system
during a real event involving hazards as described in the IHR
(2005), as well as for other natural and human-made disasters
To allow countries to identify
best practices and gaps in
operational functioning of the
national preparedness and
response to emergency events
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Rev. Sci. Tech. Off. Int. Epiz., 38 (1)
How applied/Process Example applications Key outputs Website, if available
Five-day assessment carried out by fully
trained FAO–ATLASS assessors. The
first assessment is always carried out
by external assessors, while follow-up
assessments may be carried out by
national assessors, or by an FAO–ATLASS
Focal Point. Evaluations include:
1) a preparatory phase where all relevant
documents are gathered; 2) meetings with
all national authorities and stakeholders
for the assessment of the whole AMR
surveillance system; and
3) the evaluation of each laboratory that is
already included or is to be included in the
national AMR surveillance system
To date, 19 countries have conducted
FAO–ATLASS assessment missions
(Africa: 8; Asia: 8; Europe: 3). Seventeen
missions involved the full assessment
with laboratory and surveillance
modules, two were laboratory module
only. FAO–ATLASS results can support
JEE missions, and since the tool includes
components that link to other sectors,
such as public health and environment,
they may also help to address AMR
under the One Health approach
Outputs of FAO–ATLASS evaluations
include:
1) A final report summarising the outcome
of the assessment including a description
of findings and recommendations for
the gradual improvement of the AMR
surveillance system
2) For each laboratory: FAO–LMT AMR and
progressive improvement pathway (PIP)
scoring are generated
3) For the National AMR surveillance
system: the PIP scoring identifies and
prioritises the areas of intervention
for five pillars of an AMR surveillance
system (laboratory capacity and
network, epidemiology unit, governance,
communication and sustainability)
www.fao.org/antimicrobial-
resistance/resources/tools/
atlass/en/
The tool automatically generates graphical
outputs and a profile which can be followed
over time to evaluate the evolution of
laboratory capacities, guide capacity
building and develop strategic plans that
correspond to individual laboratory needs,
addressing all key elements required for an
operational laboratory
The FAO–LMT–Core has been used in
117 individual facilities in 42 countries
in Africa and Asia since 2010 and yearly
follow-up assessments have monitored
progress. Outputs from the FAO–LMT
evaluations can be used as a resource
during JEE missions. The tool can also
be used to characterise laboratory
functionality together with results from
assessments such as a PVS Laboratory
Mission or FAO–SET
The tool automatically generates
graphical outputs and a profile which can
be followed over time to evaluate the
evolution of laboratory capacities, guide
capacity building and develop strategic
plans that will correspond to individual
laboratory needs, addressing all key
elements required for an operational
laboratory
www.fao.org/ag/againfo/
programmes/en/empres/
news_130514.html
Teams of five to ten people (FAO staff and
National Focal Points from the Veterinary
Services) conduct an initial evaluation to
provide baseline information on the animal
disease surveillance system. Missions may
last between 10 and 12 days, during which
time stakeholders are interviewed at all
levels of the system (central, intermediate,
field). Information collected is entered into
FAO–SET and outputs are automatically
generated, allowing the evaluation team
to develop an action plan for improvement
with specific, measurable, attainable,
relevant and prioritised recommendations
Subsequent evaluations may take place
every three to five years thereafter
To date, 13 countries in West, Central
and East Africa have used the tool,
leading to the development of locally
relevant action plans to improve their
animal disease surveillance systems.
Decision-makers can use FAO–SET to:
1) directly evaluate their national animal
disease surveillance capacity; 2) carry
out a targeted evaluation following
more general evaluations such as the
JEE or PVS, if this aspect is identified as
weakness; or 3) monitor progress during
follow-up evaluations
Visual outputs generated by the tool
include: 1) scores for each of the
surveillance capacities evaluated (core
capacities); 2) spider graphs indicating
the progress of the surveillance system
relative to ten different performance
attributes, e.g. sensitivity, flexibility; and
3) scores for the JEE indicators related
to animal disease surveillance, which
may differ from the scores obtained
during the JEE itself. A final evaluation
report is generated with evaluation
results and a locally relevant action plan
for improvement of the national animal
disease surveillance system
www.fao.org/ag/againfo/
programmes/en/empres/
tools_SET.html
In countries that have performed a PVS and
(ideally) a JEE. Implemented as a workshop
in seven steps over three days:
1) setting the scene; 2) case studies and
diagnosis of the levels of collaboration
for 15 key technical areas; 3) IHR and
PVS tools and mapping of the identified
gaps on the IHR–PVS matrix; 4) extraction
and compilation of results from previous
assessments; 5) development of a joint
roadmap (objectives and activities);
6) fine-tuning of the roadmap; 7) way
forward and linkages with other
mandated plans
15 countries have implemented an NBW.
Results of the IHR/PVS NBWs can feed
into the development of the National
Action Plan for Health Security (NAPHS)
or other national One Health plans
1) A diagnosis of the strengths and
weaknesses of the current collaboration
between animal health and human health
services (based on five priority zoonotic
diseases)
2) A better understanding of the regulatory
frameworks and capacity assessment tools
from both sectors and how their results
can be complementary and synergetic
3) A roadmap of joint activities that both
sectors commit to implementing in order to
improve their collaboration at the animal–
human–environment interface
https://extranet.who.int/sph/
ihr-pvs-bridging-workshop
Duration, scope, focus, structure, and
partners vary according to the event or
scenario. These voluntary processes are
carried out by countries with support from
WHO as needed
Out of the 35 AARs conducted since
2016, 17 were associated with zoonotic
or food safety events. Out of the 73 WHO
simulation exercises conducted since
2016, 41 had a multisectoral, One Health
component related to a zoonotic disease
Identification and documentation of the
strengths and gaps in the functional,
operational aspects of implementation
of IHR capacities in the specific scope
reviewed or tested through exercises
www.who.int/ihr/publications/
WHO-WHE-CPI-2017.10/en/
https://extranet.who.int/sph/
simulation-exercise
https://extranet.who.int/sph/
after-action-review
https://extranet.who.int/sph/
ihrmef
www.who.int/ihr/procedures/
monitoring/en/
Table I (cont.)
78 Rev. Sci. Tech. Off. Int. Epiz., 38 (1)
Table I (cont.)
Tool Organisation(s) Scope/Category Tool description Reason for development
Joint External
Evaluation (JEE)
WHO Assessment and
monitoring
Evaluation of national capacity – particularly infrastructural
capacity – in 19 technical areas that cover the scope of
IHR core capacities. Includes evaluation of capacity for
collaboration across sectors for public health outcomes. One
of the four components of the IHR Monitoring and Evaluation
Framework
To provide expert assessment of
country capacities under IHR and
to identify strengths and areas
for strengthening and priority
actions to be taken in each of
the 19 technical areas being
evaluated. Allows continual
strengthening of capacities
for the implementation of the
IHR and, through iterative
evaluations, monitoring of
progress
National Action Plan
for Health Security
(NAPHS)
WHO Action planning Country Planning for Health Security is an activity of Member
States that enables them to develop their NAPHS, with
the support of WHO. The activity includes coordinating and
collaborating on different areas of health security, defining
national stakeholders’ roles and responsibilities, and
consolidating the information into a single comprehensive
national action plan. The principles of Country Planning for
Health Security are country ownership, active partnerships,
and WHO leadership
To plan and monitor the
strengthening of activities
required for compliance with
the IHR
One Health Systems
Mapping and Analysis
Resource Toolkit
(OH–SMART)
University of
Minnesota
Assessment,
action planning
and prioritisation
The OH–SMART process includes six steps and is designed
to map and analyse complex One Health challenges such as
zoonotic disease outbreaks or antimicrobial resistance.
The six OH–SMART steps are:
1) Identify stakeholder network
2) Interview stakeholders
3) Map the system
4) Analyse the system
5) Identify improvement opportunities
6) Develop an action plan
The tool is targeted to
government Ministries,
coordination mechanisms/
platforms and organisations
looking to:
1) improve One Health
collaboration in practice by
moving from relationship-based
systems to institutionalised
approaches that maximise
resources and effort and provide
mutual benefit
2) identify practical and targeted
interventions at specific points
across the system
3) provide One Health leaders
with a suite of tools for
stakeholder engagement,
advocacy and ongoing
collaboration
One Health Zoonotic
Disease Prioritization
(OHZDP) Process
Centers for
Disease Control
and Prevention
Prioritisation The OHZDP process uses a multisectoral, One Health
approach to prioritise endemic and emerging zoonotic
diseases of major public health concern that should be jointly
addressed by national human, animal, and environmental
health sectors and other relevant partners
The OHZDP tool is flexible in scale and can be applied at the
regional, national or sub-national level. The process uses a
standardised, mixed-methods approach and is implemented
by trained facilitators
The OHZDP process was
developed to focus the use
of limited resources to build
capacity and reduce the impact
of prioritised zoonoses using
a One Health approach. The
OHZDP process is a transparent
process that involves all of the
relevant One Health sectors and
partners working together and
providing equal input, which
helps to enhance and strengthen
One Health networks
OIE Performance of
Veterinary Services
(PVS) Pathway
(PVS Evaluation,
Evaluation Follow-
Up, Gap Analysis,
Legislation mission,
Laboratory mission,
veterinary education
support, public–private
partnerships, etc.)
OIE Assessment Voluntary, multi-staged, continuous process which uses a
set of complementary tools designed to assist Veterinary
Services in improving their capacity to undertake their animal
health, veterinary public health and other regulatory functions
in closer compliance with the international standards of the
OIE Codes.(a) The OIE PVS Pathway has a strong systems
approach and supports the strengthening of the cross-sectoral
capacities that are needed for the control of zoonoses, food
safety and AMR
To promote the strengthening
of Veterinary Services and
improve their compliance with
the international standards in the
OIE Codes(a)
79
Rev. Sci. Tech. Off. Int. Epiz., 38 (1)
Table I (cont.)
How applied/Process Example applications Key outputs Website, if available
Voluntarily undertaken every four to
five years by a country, in two stages, using
the JEE tool. 1) An initial self-evaluation
conducted by the country; and 2) an
in-country evaluation conducted jointly
by a multisectoral external team and a
team of national experts from all relevant
sectors. Normally initiated by Ministry
of Health; WHO supports logistics and
implementation; OIE and FAO are generally
invited as external experts
As of 6 November 2018, 86 countries
have completed a JEE
Final report prepared by the external team
in collaboration with the multisectoral
national team and validated by the
national government. The report includes,
for each of the 19 technical areas, a
review of capacity in that technical
area, including strengths and areas for
strengthening, priority actions, and scores
for each of the indicators. The report is
posted on the WHO website once cleared
by the national government
https://extranet.who.
int/sph/sites/default/
files/document-library/
document/9789241550222-
eng.pdf
https://extranet.who.int/sph/
ihrmef
WHO supports countries in the process
of collecting information, planning and
conducting the workshop, and developing
the plans
As of 6 November 2018, 38 countries
have developed an NAPHS
A costed plan to improve the national
health system and national and global
health security
https://extranet.who.int/sph/
country-planning
OH–SMART is best applied to complex
challenges that require a multisectoral
and multidisciplinary approach to improve
system efficiency and effectiveness.
Examples:
1) Pro-actively, to develop surveillance
plans, investigation and response plans,
workforce development plans and
other action plans or simply to improve
understanding of the current system around
a One Health challenge
2) Retroactively, to analyse an actual
system response to a One Health challenge
and develop a plan for improving future
responses
3) Just in time, during an outbreak or other
crisis, to analyse and improve response
systems as they are being implemented
A total of 17 countries have used
OH–SMART to strengthen One Health
systems for prevention, detection and
response to infectious disease threats.
1) National AMR Action Planning in
South-East Asia; 2) Development of
National Zoonotic Disease Workforce
Plans in Africa; 3) Action planning for
multisectoral coordination mechanisms
in Africa and Asia; 4) After Action
Review of zoonotic disease outbreaks
in the USA; 5) development of action
plans for prioritised zoonotic diseases in
South-East Asia, the USA and Europe;
6) strengthening zoonotic disease
surveillance and communication plans in
South-East Asia
1) Mapping and analysis of multisectoral
agency systems
2) Improvement in agency coordination
and collaboration around a specific crisis,
outbreak or other complex challenge
3) Multisectoral systems improvement
through pro-active planning, retroactive
analysis of events and/or just-in-time
response using actionable implementation
plans developed during the OH–SMART
Workshop
4) Development of a consensus action plan
to advance systems strengthening across
sectors
www.vetmed.umn.edu/
centers-programs/global-
one-health-initiative/one-
health-systems-mapping-and-
analysis-resource-toolkit
The OHZDP process is conducted upon
the request of a country, region, or other
jurisdiction and consists of an in-person
workshop that gathers relevant One Health
Ministries and partners to prioritise
zoonotic diseases of greatest national
concern for One Health collaboration.
The OHZDP workshop consists of five
steps. Step 1 (Preparation and Logistics) is
completed prior to the workshop.
Steps 2–5 (Criteria Development, Question
Development, Ranking and Scoring the
Zoonoses, and Next Steps and Action
Planning) occur throughout the multi-day
workshop
The OHZDP Process has been used at
regional, national, sub-national, and local
levels. The process has been used in over
20 locations around the world in various
regions and languages
Prioritised list of zoonotic diseases that
are agreed upon by all stakeholders by the
end of the workshop
Discussions about next steps and action
plans for prioritised zoonoses and
One Health implementation
Workshop summary, available shortly after
the workshop so governments can begin to
work collaboratively to address the newly
prioritised zoonoses
Final workshop report that is reviewed
and approved by all relevant One Health
sectors that can be shared with potential
funding partners and collaborators
www.cdc.gov/onehealth/
global-activities/prioritization.
html
www.ghsagenda.org/
packages/p2-zoonotic-disease
OIE PVS Evaluation: Conducted upon
country request by certified OIE PVS
Pathway experts; evaluation focuses on
four Fundamental Components:
1) Human, physical and financial resources
2) Technical authority and capability
3) Interaction with interested parties
4) Access to markets
As of 1 October 2018, 135 PVS
Evaluations, 96 PVS Gap Analysis
missions, 51 PVS Evaluation Follow-Up
missions, 62 PVS Veterinary Legislation
missions, and 14 PVS Laboratory
missions have been implemented.
The PVS Evaluation is one of the two
background documents used in the IHR/
PVS National Bridging Workshops. The
OIE PVS Gap Analysis report and costing
of the key veterinary public health
activities can feed the development and
costing of the WHO National Action Plan
for Health Security
OIE PVS Evaluation: comprehensive
assessment of the country’s animal health
system, providing a complete overview
of the Veterinary Services’ organisational
structure, animal health, food safety and
regulatory activities, their weaknesses and
strengths
www.oie.int/en/solidarity/pvs-
pathway/
80 Rev. Sci. Tech. Off. Int. Epiz., 38 (1)
Table I (cont.)
Tool Organisation(s) Scope/Category Tool description Reason for development
States Parties Annual
Reporting under the
International Health
Regulations (2005;
SPAR)
WHO Assessment Self-assessment of national core public health capacities,
particularly infrastructural capacity, as required under the IHR
(2005), to prevent, detect, and rapidly respond to public health
threats, whether occurring naturally or due to deliberate
or accidental events. Includes evaluation of capacity for
collaboration across sectors for public health outcomes. Is
one of four components of the IHR Monitoring and Evaluation
Framework
To provide information on
capacity and progress towards
achieving IHR core capacities
both to WHO and to the country
itself
Taking a Multisectoral,
One Health Approach:
A Tripartite Guide to
Addressing Zoonotic
Diseases in Countries
(Tripartite Zoonoses
Guide/TZG)
WHO, OIE and
FAO
Implementation The TZG provides standard, practical guidance for countries
in taking a multisectoral, One Health approach to zoonotic
diseases and other health threats at the human–animal–
environment interface. It covers the following topics:
multisectoral coordination; understanding national
context and priorities; strategic planning and emergency
preparedness; surveillance for zoonotic diseases and
information sharing; coordinated investigation and response;
joint risk assessment for zoonotic disease threats; risk
reduction, risk communication, and community engagement;
and workforce development
To provide practical, standard
guidance from the Tripartite
so that countries can involve
all relevant sectors to more
effectively address issues at the
human–animal–environment
interface using a multisectoral,
One Health approach
FAO: Food and Agriculture Organization of the United Nations
FAO–ATLASS: FAO Assessment Tool for Laboratories and Antimicrobial Resistance
Surveillance Systems
FAO–LMT: FAO Laboratory Mapping Tool
FAO–SET: FAO Surveillance Evaluation Tool
IHR: International Health Regulations
JEE: Joint External Evaluation
NAPHS: National Action Plan for Health Security
NBW: IHR/PVS National Bridging Workshop
OH–SMART: One Health Systems Mapping and Analysis Resource Toolkit
OHZDP: One Health Zoonotic Disease Prioritization Tool
OIE PVS Pathway: World Organisation for Animal Health Performance of Veterinary Services
Pathway
a) Only countries where four or more tools had been implemented were included in this
analysis. Users wishing to obtain information about how these tools had been used previously
could access it from publicly available reports or by obtaining reports from earlier users. For
example, the JEE tool used results from the OIE PVS Pathway in 25 countries. All questionnaire
responses and analysis reflect data available as of 2 November 2018
b) Questionnaires not completed for the FAO–LMT and FAO–ATLASS tools; blank cells indicate
that no data were available for analysis, either because reports or tool outcomes were not
available for other partners to reference prior to their tool implementation (e.g. OIE PVS
Pathway, NAPHS, etc.) or because questionnaires were not completed regarding specific tools
(FAO–LMT and FAO–ATLASS); 17 of 19 FAO–ATLASS missions involved the full assessment
with laboratory and surveillance modules, two were laboratory module only
FAO: Food and Agriculture Organization of the United Nations
WHO: World Health Organisation
a) The OIE Terrestrial Animal Health Code and Aquatic Animal Health Code
Table II
Overview of country implementation and other tool outcome use, categorised by tool, for nine multisectoral, One Health tools
Tool Year
developed
Total no. of
countries
where tool
implemented
No. of countries
where tool was
implemented
with >3 other
One Health
tools/plans
Percentage of times the below tools were used as input for tools listed in the first column
(no. of opportunities to use tools)(a)
OIE PVS
Pathway JEE NBW FAO–
SET
FAO–
LMT(b)
FAO–
ATLASS(b) OHZDP OH–
SMART NAPHS
OIE PVS
Pathway 2006 134 30 (22.40%) 50% (2) 100% (1)
JEE 2016 84 30 (35.70%) 83% (30) 88% (8)
NBW 2013 14 11 (78.60%) 100% (11) 100% (10) 100% (5) 100% (6)
FAO–SET 2017 13 13 (100.00%) 100% (8) 100% (11) 100% (11) 100% (8)
FAO–LMT(b) 2010 38 26 (68.40%)
FAO–ATLASS(b) 2017 19 13 (68.42%)
OHZDP 2014 20 17 (85.00%) 0% (15) 100% (9) 100% (1) 100% (1)
OH–SMART 2015 17 15 (88.20%) 100% (8) 100% (14) 50% (2)
100% (10)
100% (4)
NAPHS 2016 36 21 (58.30%) 100% (11)
81
Rev. Sci. Tech. Off. Int. Epiz., 38 (1)
Table I (cont.)
How applied/Process Example applications Key outputs Website, if available
Obligatory annual self-assessment,
information reported to the World Health
Assembly, provided to the secretariat of
IHR in WHO by the IHR National Focal
Point. SPAR is the format proposed by
WHO but countries are free to use another
format for their reporting
State Party annual reporting to the IHR
Secretariat in WHO is mandatory
Annually updated information on national
capacities under IHR
https://extranet.who.int/sph/
ihrmef
www.who.int/ihr/procedures/
monitoring/en/
A tool that countries can use as appropriate
to fill multisectoral gaps identified through
various assessments or experiences, and to
operationalise national plans. Operational
tools (e.g. terms of reference, templates,
standard processes) are being developed
for each of the included topics
None to date (released 11 March 2019) Operationalisation of One Health
approaches
www.oie.int/
tripartitezoonosesguide
https://extranet.who.int/sph/
sites/default/files/document-
library/document/Tripartite-
Guidance-EN-web%20
single%20page.pdf
www.fao.org/3/ca2942en/
ca2942en.pdf
Table III
Temporal directionality of the implementation of nine One Health tools
Numbers indicate, from left to right, the number of times both tools were used by the same country, and the number of times and the percentage of
times tools in columns preceded tools in rows. Cells shaded in grey indicate where tools in columns precede tools in rows more than 50% of the time.
For example, OIE PVS Pathway and JEE were both used in 88 countries, the OIE PVS Pathway preceded the JEE 87 out of 88 times, or 98.9% of the time
Questionnaire responses and analysis reflect data available as of 2 November 2018
Tool
OIE PVS
Pathway
(precedes)
FAO–LMT
(precedes)
OHZDP
(precedes)
JEE
(precedes)
FAO–
ATLASS(a)
(precedes)
OH–SMART
(precedes)
FAO–SET
(precedes)
NBW
(precedes)
NAPHS
(precedes)
OIE PVS
Pathway
(follows)
36, 5, 13.9% 19, 0, 0% 88, 1, 1.1% 16, 0, 0% 16, 0, 0% 13, 0, 0% 12, 0, 0% 54, 0, 0%
JEE (follows) 88, 87, 98.9% 35, 35, 100% 19, 9, 47.4% 17, 9, 52.9% 16, 5, 31.2% 13, 0, 0% 10, 2, 20% 59, 1, 1.7%
NBW (follows) 12, 12, 100% 9, 9, 100% 7, 5, 71.4% 10, 8, 80% 5, 3, 60% 6, 5, 83.3% 6, 4, 66.7% 8, 5, 62.5%
FAO–SET
(follows)
13, 13, 100% 13, 13, 100% 11, 10, 90.9% 13, 13, 100% 4, 2, 50% 7, 4, 57.1% 6, 2, 33.3% 12, 3, 25%
FAO–LMT
(follows)
36, 31, 86.1% 15, 1, 6.7% 35, 0, 0% 12, 0, 0% 14, 0, 0% 13, 0, 0% 9, 0, 0% 27, 0, 0%
FAO–ATLASS
(follows)
16, 16, 100% 12, 12, 100% 6, 4, 66.7% 16, 7, 43.8% 9, 3, 33.3% 4, 2, 50% 5, 2, 40% 13, 3, 23.1%
OHZDP (follows) 19, 19, 100% 15, 14, 93.3% 19, 10, 52.6% 6, 2, 33.3% 11, 1, 9.1% 11, 1, 9.1% 7, 2, 28.6% 16, 3, 18.8%
OH–SMART
(follows)
16, 16, 100% 14, 14, 100% 11, 10, 90.9% 16, 10, 62.5% 9, 5, 55.6% 7, 2, 28.6% 6, 1, 16.7% 15, 4, 26.7%
NAPHS
(follows)
54, 54, 100% 27, 27, 100% 16, 13, 81.2% 59, 58, 98.3% 13, 10, 76.9% 15, 11, 73.3% 12, 9, 75% 8, 3, 37.5%
Compared to all
others
254, 248, 97.6% 161, 129, 80.1% 104, 52, 50.0% 256, 107, 41.8% 82, 31, 37.8% 94, 29, 30.6% 79, 18, 22.8% 63, 12, 19.0% 204, 19, 9.3%
FAO: Food and Agriculture Organization of the United Nations
FAO–ATLASS: FAO Assessment Tool for Laboratories and Antimicrobial Resistance
Surveillance Systems
FAO–LMT: FAO Laboratory Mapping Tool
FAO–SET: FAO Surveillance Evaluation Tool
IHR: International Health Regulations
JEE: Joint External Evaluation
NAPHS: National Action Plan for Health Security
NBW: IHR/PVS National Bridging Workshop
OIE PVS Pathway: World Organisation for Animal Health Performance of Veterinary
Services Pathway
OHZDP: One Health Zoonotic Disease Prioritization Tool
OH–SMART: One Health Systems Mapping and Analysis Resource Toolkit
a) 17 of 19 FAO–ATLASS missions involved the full assessment with laboratory and
surveillance modules, two were laboratory module only
82 Rev. Sci. Tech. Off. Int. Epiz., 38 (1)
The outcomes of the OHZDP were not always available
prior to the implementation of other tools but, when they
were, countries almost always took the opportunity to
use them. For example, there were eight occasions when
OHZDP outcomes were available to use as a reference for
assessing established zoonotic disease surveillance capacity
in the JEE, and they were used on seven of those occasions
(7/8, 88%). Similarly, OHZDP outcomes were used to
inform the implementation of OH–SMART exercises
(10/10, 100%), the FAO–SET tool (8/8, 100%), and the
disease-specific group work conducted as part of the
NBW (5/5, 100%) (Table II). The JEE outcomes were used
by the most tools assessed (NBW, NAPHS, OHZDP and
OH–SMART). The JEE (25/30, 83%) and NBW
(11/11, 100%) relied heavily on the OIE PVS Pathway
for implementation. The OIE PVS Pathway, being one
of the earliest tools implemented of those analysed, did
not have many opportunities to use other tools during
implementation; however, in the two opportunities where
the OIE PVS Pathway could have been informed by another
tool, it did reference two other tools (JEE and FAO–SET).
Not all tool outcomes were readily available for immediate
reference by other tool implementers, either due to
restrictions on sharing reports broadly, limited ability to
access outcomes, delays in report processing, or lack of
awareness of other concurrent work on the part of authors
(Table II).
Conceptual model and overarching conceptual
framework
A conceptual model was generated representing the
authors’ consensus on the links and synergies between the
12 tools for advancing One Health implementation (Fig. 1).
This flow diagram depicts one way in which tools and their
outputs might be used to inform and strengthen outputs
from other, subsequently or concurrently, implemented
IHR Self
Assessment
• Progress toward
M&E indicators
• Sector-specific
gaps and needs
PVS
Assessment
JEE
• Multisectoral
One Health gaps
and needs
IHR/PVS
National
Bridging
Workshop
AAR & SimEx
• National Action
Plan for Health
Security with
costing
OH–SMART
NAPHS
Workshop
OHZDP
• Joint plans to
strengthen One
Health systems
and address
priority zoonotic
diseases
• Sector-specific
surveillance and
lab gaps
• Disease-specific
plans for One
Health capacity
building
• Prioritised list of
zoonotic diseases
of greatest
concern
• Action plan to
improve
multisectoral One
Health
coordination and
collaboration
across sectors
FAO–SET
FAO–ATLASS
FAO–LMT
Assessment
Prioritisation
Action planning
Monitoring
Implementation
SYSTEM STAGES
Tools
Outputs
CATEGORIES
• Promotion and
review of
multisectoral One
Health
coordination
• Multisectoral
matrix of gaps and
needs
• Roadmap to
address One
Health gaps
• Strengthened One
Health zoonotic
disease systems
TZG
AAR: After Action Review
FAO–ATLASS: Food and Agriculture Organization (FAO) Assessment Tool for Laboratories
and Antimicrobial Resistance Surveillance Systems
FAO–LMT: FAO Laboratory Mapping Tool
FAO–SET: FAO Surveillance Evaluation Tool
IHR: International Health Regulations
JEE: Joint External Evaluation
M&E indicators: Indicators of the IHR Monitoring and Evaluation Framework
NAPHS: National Action Plan for Health Security
OH–SMART: One Health Systems Mapping and Analysis Resource Toolkit
OHZDP: One Health Zoonotic Disease Prioritization Tool
PVS Assessment: World Organisation for Animal Health (OIE) Performance of Veterinary
Services Evaluation +/– PVS Gap Analysis
SimEx: Simulation Exercises
TZG: Taking a Multisectoral, One Health Approach: A Tripartite Guide to
Addressing Zoonotic Diseases in Countries
Fig. 1
Conceptual model
83
Rev. Sci. Tech. Off. Int. Epiz., 38 (1)
tools. In addition, the model can help countries to select
appropriate tools according to the specific output they
seek to strengthen. As the conceptual model was being
developed, the tools fell into five categories: Assessment,
Prioritisation, Action Planning, Implementation and
Monitoring. Together they created an implementation cycle
that fits an overarching conceptual framework that could
inform future tool use (Fig. 2).
Discussion
This paper presents, for the first time, a summary of key
tools and processes that have supported One Health
assessment and implementation globally. It also proposes
a model and framework for how these tools could
potentially complement each other and be implemented in
a coordinated fashion when used in countries to strengthen
the implementation of a One Health approach.
The conceptual model is not intended to be prescriptive,
but rather to highlight a potential approach to linking and
coordinating the implementation of these One Health tools
for maximal benefit and impact for countries. While this
should be seen as one potential approach among the many
opportunities available to countries working to strengthen
One Health, the results represent a consensus among diverse
partners as to the importance of promoting the sharing of
outcomes among partners and working collaboratively as
they plan the implementation of additional One Health tools.
Lessons learned
Unique to this paper was the focus on One Health tools
that have been implemented extensively in the field
(>5 countries), have already been implemented
cooperatively using a One Health approach, and focus
specifically on strengthening multisectoral, One Health
systems. This paper and resulting suggestions have drawn
extensively on the authors’ own personal experiences
in implementing these tools across many countries. The
authors also drew on their experiences in working with
many partners to coordinate the implementation of those
One Health tools to best support countries. Although the
coordination of these tools in countries has been field-tested
through ad hoc collaborations and communications during
implementation, there is a need for a more systematic
way to share timelines and objectives as well as to share
outputs and lessons learned. Sharing experiences more
systematically would greatly strengthen countries’ ability
to select the most relevant tools for greatest impact and
would also help to maximise outcomes. Operationalising
One Health remains challenging, as it is often driven by
funding timelines and organisational priorities, but certain
practices can help make the benefit more sustainable. It
would be beneficial to consider mechanisms to coordinate
One Health efforts more systematically, including following
guidance, such as that provided by the TZG, on a) mapping
the current national One Health infrastructure and context,
b) establishing multisectoral coordination mechanisms
to formalise coordination and communication across all
relevant sectors, and c) implementing technical activities
using a multisectoral, One Health approach. Ensuring the
timely, transparent and wide release of results and outcomes
from One Health tools and processes through a variety of
media, including websites, reports and publications, would
further maximise countries’ ability to share successes,
lessons learned and best practices to help to strengthen
One Health. Improving information and knowledge flow
among implementing partners on tool use and outcomes
will greatly strengthen country One Health implementation
and improve a country’s ability to drive change and
strengthen One Health processes. Where possible, funders
and implementers should support countries in advancing
their abilities to facilitate coordination, collaboration,
communication and information sharing through known
means; for example, individual countries can support
multisectoral coordination mechanisms, establish sharing
platforms, including portals and websites, and enhance
their own coordination efforts.
The authors found that in almost all instances where
outcomes were made available to tool implementers, by
direct sharing or through open-sourced online reports,
outcomes were used to inform the implementation of
other tools. Similarly, tool implementation was most
effective when it was coordinated and supported a planned
national effort to strengthen One Health across the partners
supporting that goal. There are numerous examples of when
the outcomes of the implementation of one tool can be used
to inform the implementation of another, for example:
Fig. 2
Overarching conceptual framework
A
S
S
E
S
S
M
E
N
T
P
R
I
O
R
I
T
I
S
A
T
I
O
N
A
C
T
I
O
N
P
L
A
N
N
I
N
G
I
M
P
L
E
M
E
N
T
A
T
I
O
N
M
O
N
I
T
O
R
I
N
G
One Health
System
84 Rev. Sci. Tech. Off. Int. Epiz., 38 (1)
– In many countries, implementation of the JEE led to
increased awareness of the gaps in the country’s One Health
capacity, and this then allowed countries to adapt other
tools (NBW, OHZDP, OH–SMART) to target their efforts to
prioritise these gaps.
– The outcomes of an OHZDP, which requires human
and animal health and environmental agencies and other
relevant partners to work together to identify the zoonoses
of greatest concern, have been used to help to focus
surveillance evaluations (FAO–SET) and inform disease-
specific mapping exercises (NBW and OH–SMART). The
outcomes of an OHZDP are also important for obtaining
high scores when carrying out a JEE or using the WHO SPAR
Tool. For example, for a country to obtain a capacity score
of 2 or greater for indicator P.4.1 (Coordinated surveillance
systems in place in the animal health and public health
sectors for zoonotic diseases/pathogens identified as joint
priorities), animal and public health sectors must have
jointly prioritised zoonotic diseases using input from all
relevant sectors (25).
– The planned use of outputs from the IHR SPAR, OIE
PVS Pathway, JEE, and OHZDP for OH–SMART-based
Zoonotic Disease Workforce Planning and National AMR
Action Planning. Through these planned implementation
strategies, action plans were developed specifically to
build on information and outputs generated during prior
implementation of the IHR annual reporting, OIE PVS
Pathway evaluation, JEE and OHZDP. This yielded a
much more informed and targeted workforce action plan
than would have resulted from an isolated workforce
planning effort. This kind of planned sequencing, where
tool implementation protocols explicitly link to outputs or
synergies of other tools, should be encouraged.
When multiple One Health tools have been implemented,
and there is coordination among the implementers, the
authors have noted better targeted and strengthened
assessments, plans and analyses for a country. This
provides continuity and clarity for the countries in terms of
integrating One Health tool outputs and outcomes to help
them to meet their country goals. However, this kind of
coordination has not always occurred and, in fact, most often,
the implementation has not followed the conceptual model
presented. Information is not communicated that might
have been valuable to tool implementation. In developing
the conceptual model and temporal analysis, the authors
realised that lack of coordination and communication
resulted in missed opportunities to strengthen the outcomes
(plans, assessments, analyses) of their own tools by building
on previous tool implementation efforts in the countries.
It is also clear, based on this review, that there has been
a disproportionate emphasis placed on building tools and
processes for assessment, rather than tools that support
One Health prioritisation, action planning, implementation
or monitoring. Implementation of the One Health approach
is greatly facilitated by tools and guidance that can
support countries in implementing sustainable day-to-day
One Health operations and functions on the ground, e.g. the
TZG, its associated operational tools, and disease-specific
tools (e.g. Stepwise Approach to Rabies Elimination [26]).
It is also critical to continually improve implementation
and the system as a whole through ongoing prioritisation,
action planning and monitoring and evaluation. This helps
countries to establish a multisectoral, One Health approach
to building and sustaining functional multisectoral health
systems which, in turn, helps them to achieve optimal
health outcomes for people and animals and their shared
environment.
Best practices for future implementation
As the authors developed the conceptual model, a flexible
conceptual framework emerged that could help countries
in implementing One Health tools at the national level in a
more systematic way to maximise outcomes and impact. This
framework places tools into one (or more) of five operational
categories of work: Assessment, Prioritisation, Action
Planning, Implementation and Monitoring. This conceptual
framework is intended to inform tool implementation and
support country One Health mechanisms to ensure strong
synergy and that the outputs of tool implementation are
used effectively to support the achievement of overall
country goals. And, encouragingly, the results from the
directionality and outcome use analyses both show that
what has been implemented to date, though somewhat ad
hoc, also aligns with this suggested conceptual model and
framework.
The tools the authors evaluated and listed in the conceptual
model only reflect those that met the inclusion criteria;
however, there are currently many tools that are at varying
stages of development (from those that are fully developed
and implemented to those that are in the early stages
of planning [5, 24]) that could be used by a country.
Moving forward, countries can consider the elements of
the framework when implementing One Health and in
developing One Health or other multisectoral coordination
tools and approaches in their countries. In the experience
of the authors, each tool works best when it is supported,
targeted and informed by the other categories of tools.
The authors recommend that this framework be used to
identify where there may be a need to develop new tools in
a particular category and determine how best to coordinate
data sharing among other existing One Health tools.
Possibly the most important best practice that the authors
identified lies in the use of One Health tools themselves.
Tools that provide an opportunity to jointly improve
coordination and collaboration among diverse sectors
and stakeholders produce specific outputs that support
85
Rev. Sci. Tech. Off. Int. Epiz., 38 (1)
Créer des synergies entre les outils d’évaluation des capacités
en vue de de l’opérationnalisation d’Une seule santé
K. Pelican, S.J. Salyer, C.B. Behravesh, G. Belot, M. Carron, F. Caya,
S. de La Rocque, K.M. Errecaborde, G. Lamielle, F. Latronico, K.W. Macy,
B. Mouillé, E. Mumford, S. Shadomy, J.R. Sinclair & T. Dutcher
Résumé
La collaboration multisectorielle suivant l’approche Une seule santé est essentielle
pour répondre aux menaces sanitaires survenant à l’interface homme–animal–
environnement à l’échelle nationale et internationale. Grâce aux efforts conjugués de
nombreuses organisations, les pays disposent désormais d’une gamme d’outils Une
seule santé permettant à la fois d’évaluer les capacités intra et intersectorielles, de
planifier et prioriser les activités, et de renforcer la coordination, la communication
et la collaboration multisectorielles suivant cette approche. Grâce à ces outils, les
pays sont mieux armés pour faire face avec efficacité aux menaces sanitaires à
l’interface homme–animal–environnement, en particulier celles liées aux maladies
zoonotiques et infectieuses émergentes. Néanmoins, pour optimiser les retombées
pour les pays du recours aux outils Une seule santé, les partenaires chargés de leur
assessment, prioritisation, action planning, implementation
and monitoring of One Health tools and processes.
Additionally, coordinating the use of these tools results
in stronger outputs for each, and a stronger One Health
system over all. However, one less obvious outcome that
the authors feel is actually crucial to advancing One Health
is that the use of these tools builds relationships and trust
among One Health partners. In implementing these tools,
it is clear that One Health is most functional and most
active when the different sectors understand and trust
each other regardless of other factors in the system. This
kind of understanding and trust can only exist where
there are shared priorities and ongoing collaboration.
These tools provide the kind of continuing collaboration
and coordination that make a multisectoral, One Health
approach operational and functional.
Conclusions
Over the last decade, global recognition of the inherent value
of linking human health, animal health, the environment,
and other relevant sectors has been increasing. Similarly,
there has been growing awareness of the need to take a
multisectoral, One Health approach to health threats existing
or arising at the human–animal–environment interface (27).
Additionally, the authors have seen increasing recognition
of the shared roles and responsibilities of the human health
and animal health sectors in many countries (12, 24), and
a trend towards growing recognition of the environmental
health and wildlife sectors as key partners in One Health.
Moreover, recognition that other sectors and disciplines,
notably finance, education, civil society and communities,
and the security sector, also play key roles in the successful
application of a One Health approach. One Health partners
in countries are requesting an expansion of tools designed
to evaluate and strengthen One Health approaches. In
response, a number of additional One Health tools have
been developed and are currently under development
(5, 24). The best approach to implementation of this
growing array of One Health tools is not always clear to
countries which are generally offered support for different
tools on a case-by-case basis, which may result in an
ad hoc approach to tool implementation. Ideally, countries,
funding partners and those developing and supporting
countries in the implementation of tools could – and should
– play a role in ensuring the alignment of One Health tool
implementation for maximum impact. The intention of this
paper is to highlight the complementary nature of a series of
One Health tools by providing a concise conceptual model
for the most commonly used tools and an overarching
conceptual framework to inform the implementation of
these and other tools. The authors’ goal in providing this
model and framework is to enhance the operationalisation
of One Health at the national level.
Acknowledgements
The authors gratefully acknowledge the contributions
of Kendra McCormack Grahl and Benjamin Blair to the
manuscript, tables and figures.
86 Rev. Sci. Tech. Off. Int. Epiz., 38 (1)
Creación de sinergias entre distintas herramientas de evaluación
de capacidades para hacer efectiva la puesta en práctica
de Una sola salud
K. Pelican, S.J. Salyer, C.B. Behravesh, G. Belot, M. Carron, F. Caya,
S. de La Rocque, K.M. Errecaborde, G. Lamielle, F. Latronico, K.W. Macy,
B. Mouillé, E. Mumford, S. Shadomy, J.R. Sinclair & T. Dutcher
Resumen
La colaboración multisectorial en clave de Una sola salud es esencial para responder
a las amenazas sanitarias de dimensión nacional e internacional que surgen en la
mise en œuvre devraient régulièrement collaborer et partager leurs informations,
notamment le calendrier de mise en œuvre, les résultats obtenus et les enseignements
tirés, afin que chaque processus contribue à l’amélioration des suivants. Les auteurs
présentent un cadre consensuel sur la manière dont les outils Une seule santé les plus
courants peuvent converger afin d’aider le mieux possible les pays à renforcer leurs
systèmes basés sur cette approche. Douze outils ont été choisis en fonction de leur
fréquence d’utilisation, de l’expérience acquise par les auteurs et de l’accent mis sur
la coordination multisectorielle Une seule santé. Les auteurs ont ensuite procédé à un
examen en quatre étapes, comme suit : a) analyse générale des outils sélectionnés,
au moyen d’un tableur sur serveur dématérialisé permettant de saisir et de partager
les caractéristiques et les applications spécifiques de chaque outil ; b) analyse de
la mise en œuvre des outils, visant à déterminer et à partager la dynamique et les
caractéristiques de mise en œuvre, ainsi que les résultats respectifs et les synergies
qui en ressortent ; c) création d’un modèle conceptuel consensuel contenant les
propositions des auteurs en vue d’une convergence raisonnée des fonctionnalités de
ces outils ; d) à partir des trois étapes précédentes, conception d’un cadre conceptuel
transversal destiné à catégoriser les outils Une seule santé actuels et futurs afin
d’apporter un soutien optimal au renforcement des systèmes Une seule santé à
l’échelle des pays. Parmi les outils examinés figurent l’Outil d’autoévaluation pour
l’établissement de rapports annuels par les États Parties de l’Organisation mondiale de
la santé (OMS), qui concerne l’application du Règlement sanitaire international (RSI) ;
le Processus sur les Performances des Services vétérinaires (PVS) de l’Organisation
mondiale de la santé animale (OIE) ; le processus d’Évaluation extérieure conjointe ;
les ateliers nationaux de liaison RSI/PVS ; l’outil Une seule santé de priorisation des
maladies zoonotiques des Centres pour le contrôle et la prévention des maladies
(CDC) ; l’Outil de cartographie des laboratoires de l’Organisation des Nations Unies pour
l’alimentation et l’agriculture (FAO) ; l’Outil d’évaluation de la FAO pour les laboratoires
et les systèmes de surveillance de l’antibiorésistance ; l’Outil d’évaluation de la FAO
sur la surveillance ; la Boîte à outils cartographiques et analytiques sur les systèmes
Une seule santé ; les Plans d’action nationaux de sécurité sanitaire ; et enfin les outils
d’examen après action et protocoles de simulation du Cadre de suivi et d’évaluation du
RSI. Le document d’orientation récemment publié sous le titre Taking a multisectoral
One Health approach: a Tripartite guide to addressing zoonotic diseases in countries
[Adopter une approche multisectorielle Une seule santé : Guide tripartite pour lutter
contre les maladies zoonotiques] est également présenté, en tant qu’il fournit un cadre
directeur en appui de la mise en œuvre des résultats des outils d’évaluation ci-dessus.
Mots-clés
Évaluation des capacités – Maladie infectieuse – Multisectoriel – Outils Une seule santé – Une
seule santé.
87
Rev. Sci. Tech. Off. Int. Epiz., 38 (1)
confluencia de personas, animales y medio ambiente. Gracias al trabajo de numerosas
organizaciones, los países disponen ahora de un repertorio de herramientas
concebidas desde la óptica de Una sola salud para evaluar las capacidades existentes
dentro de los sectores y entre ellos, planificar y jerarquizar actividades y potenciar
las labores de coordinación, comunicación y colaboración multisectoriales en
clave de Una sola salud. Gracias a todo ello, los países están en condiciones de
luchar más eficazmente contra las amenazas sanitarias en la interfaz de personas,
animales y medio ambiente, en particular las enfermedades infecciosas y zoonóticas
emergentes. No obstante, para que los países obtengan resultados óptimos del uso
de estas herramientas de Una sola salud es preciso que los distintos colaboradores
encargados de aplicarlas colaboren e intercambien información periódicamente, por
ejemplo sobre plazos de ejecución, resultados obtenidos y enseñanzas extraídas, de
tal manera que un proceso pueda alimentar el siguiente. Los autores presentan un
conjunto de principios consensuados sobre el modo en que cabría armonizar entre
sí las herramientas de Una sola salud utilizadas con frecuencia para que los países
cuenten con un apoyo idóneo a la hora de fortalecer los sistemas de Una sola salud.
Ante todo, los autores seleccionaron doce de esas herramientas atendiendo a su
(elevado) nivel de utilización, la experiencia de los propios autores con ellas y la
medida en que privilegian la coordinación multisectorial en clave de Una sola salud.
Después, siguiendo un proceso en cuatro etapas: a) efectuaron colectivamente un
análisis general de las herramientas existentes, empleando una hoja de cálculo situada
en la «nube» para poner en común las características y aplicaciones únicas de cada
herramienta; b) analizaron la utilización práctica de esas herramientas de Una sola salud
para dilucidar y poner en común la dinámica de aplicación de cada una y determinar
sus respectivos resultados y sinergias; c) elaboraron de forma concertada un modelo
teórico del modo en que, a su juicio, sería lógico que las herramientas funcionaran
conjuntamente; y d) a partir de los pasos 1 a 3, extrapolaron consensuadamente un
marco teórico global con el que se podrían clasificar las herramientas de Una sola
salud, actuales y futuras, para prestar un apoyo idóneo al fortalecimiento del sistema
de Una sola salud en cada país. Las herramientas de Una sola salud seleccionadas
son: el instrumento de evaluación para la presentación anual de informes de los
Estados Partes que forma parte del Reglamento Sanitario Internacional (RSI); el
proceso PVS (Prestaciones de los Servicios Veterinarios) de la Organización Mundial
de Sanidad Animal (OIE); la herramienta de evaluación externa conjunta del RSI; los
talleres nacionales de coordinación RSI-PVS; la herramienta de jerarquización de
enfermedades zoonóticas en clave de Una sola salud de los Centros para el Control y
la Prevención de Enfermedades (CDC); la herramienta de inventario de laboratorios de
la Organización de las Naciones Unidas para la Alimentación y la Agricultura (FAO); la
herramienta de evaluación de laboratorios y sistemas de vigilancia de las resistencias
a los antimicrobianos de la FAO; la herramienta de evaluación de la vigilancia de la
FAO; el juego de herramientas y material de análisis y cartografía de los sistemas de
Una sola salud; los planes de acción nacional de seguridad sanitaria de la OMS; las
herramientas del marco de seguimiento y evaluación del RSI para la realización de
exámenes posteriores a la acción y ejercicios de simulación. También se incluyó una
nueva guía de la Tripartita para combatir las enfermedades zoonóticas en los países
desde la lógica multisectorial de Una sola salud (Taking a multisectoral One Health
approach: a Tripartite guide to addressing zoonotic diseases in countries), en el cual se
ofrecen pautas para secundar la aplicación en la práctica de los resultados obtenidos
con las citadas herramientas.
Palabras clave
Enfermedad infecciosa – Evaluación de capacidades – Herramientas de Una sola salud –
Multisectorial – Una sola salud.
88 Rev. Sci. Tech. Off. Int. Epiz., 38 (1)
References
1. Wernli D., Haustein T., Conly J., Carmeli Y., Kickbusch I.
& Harbarth S. (2011). – A call for action: the application
of the International Health Regulations to the global threat
of antimicrobial resistance. PLoS Med., 8 (4), e1001022.
doi:10.1371/journal.pmed.1001022.
2. Griggs D., Stafford-Smith M., Gaffney O., Rockström J.,
Ohman M.C., Shyamsundar P., Steffen W., Glaser G., Kanie N.
& Noble I. (2013). – Sustainable Development Goals for
people and planet [Policy]. Nature, 495 (7441), 305–307.
doi:10.1038/495305a.
3. Sachs J.D. (2012). – From Millennium Development Goals
to Sustainable Development Goals. Lancet, 379 (9832),
2206–2211. doi:10.1016/S0140-6736(12)60685-0.
4. World Organisation for Animal Health (OIE) (2019). – PVS
Pathway, 10 years together to improve Veterinary Services.
Available at: www.oie.int/for-the-media/press-releases/detail/
article/pvs-pathway-10-years-together-to-improve-veterinary-
services/ (accessed on 14 February 2019).
5. Berthe F.C.J., Bouley T., Karesh W.B., Le Gall F.G.,
Machalaba C.C., Plante C.A. & Seifman R.M. (2018).
– Operational framework for strengthening human,
animal and environmental public health systems at their
interface. World Bank, Washington, D.C., United States of
America, 152 pp. Available at: http://documents.
worldbank.org/curated/en/703711517234402168/
Operational-framework-for-strengthening-human-animal-
and-environmental-public-health-systems-at-their-interface
(accessed on 14 February 2019).
6. World Health Organization (WHO), World Organisation for
Animal Heath (OIE) & Food and Agriculture Organization of
the United Nations (FAO) (2019). – Taking a multisectoral,
One Health approach: a Tripartite guide to addressing zoonotic
diseases in countries. WHO, Geneva, Switzerland; OIE, Paris,
France; & FAO, Rome, Italy, 166 pp. Available at: www.oie.
int/tripartitezoonosesguide (accessed on 29 March 2019).
7. World Health Organization (WHO) (2008). – Zoonotic
diseases: a guide to establishing collaboration between animal
and human health sectors at the country level. WHO, Geneva,
Switzerland, 20 pp. Available at: https://apps.who.int/iris/
handle/10665/207731 (accessed on 14 February 2019).
8. Travis D.A., Chapman D.W. […] & Rwego I.B. (2014). –
One Health: lessons learned from East Africa. Microbiol. Spectr.,
2 (1), OH–0017–2012. doi:10.1128/microbiolspec.OH-
0017-2012.
9. Rwego I.B., Babalobi O.O., Musotsi P., Nzietchueng S.,
Tiambo C.K., Kabasa J.D., Naigaga I., Kalema-Zikusoka G.
& Pelican K. (2016). – One Health capacity building in sub-
Saharan Africa. Infect. Ecol. Epidemiol., 6, 34032. doi:10.3402/
iee.v6.34032.
10. Sukumaran A. & Pradeepkumar A.S. (2015). – One Health
approach: a platform for intervention in emerging public
health challenges of Kerala State. Int. J. One Hlth, 1, 14–25.
doi:10.14202/IJOH.2015.14-25.
11. National Center for Emerging and Zoonotic Infectious
Diseases, Division of High-Consequence Pathogens and
Pathology, Centers for Disease Control and Prevention (CDC)
(2011). – Operationalizing ‘One Health’: a policy perspective –
taking stock and shaping an implementation roadmap. CDC,
Atlanta, Georgia, United States of America, 24 pp. Available
at: www.cdc.gov/onehealth/pdf/atlanta/meeting-overview.pdf
(accessed on 14 February 2019).
12. Salyer S.J., Silver R., Simone K. & Barton Behravesh C.
(2017). – Prioritizing zoonoses for global health capacity
building – themes from One Health zoonotic disease
workshops in 7 countries, 2014–2016. Emerg. Infect. Dis.,
23 (Suppl. 1), S55–S64. doi:10.3201/eid2313.170418.
13. Food and Agriculture Organization of the United Nations
(FAO) (2019). – Emergency Prevention System for Animal
Health (EMPRES–AH). Available at: www.fao.org/ag/againfo/
programmes/en/empres/tools_SET.html (accessed on
14 February 2019).
14. Food and Agriculture Organization of the United Nations
(FAO) (2019). – FAO to release laboratory mapping tool on the
Web. Available at: www.fao.org/ag/againfo/programmes/en/
empres/news_130514.html (accessed on 14 February 2019).
15. Food and Agriculture Organization of the United Nations
(FAO) (2018). – FAO regional training aims to improve access
to new tool for assessment of laboratories and AMR surveillance
systems. Available at: www.fao.org/asiapacific/news/detail-
events/en/c/1129839/ (accessed on 14 February 2019).
16. World Health Organization (WHO) (2014). – WHO–OIE
Operational Framework for Good Governance at the Human–
Animal Interface. WHO, Geneva, Switzerland, 103 pp.
Available at: www.who.int/ihr/publications/WHO-OIE_
Operational_Framework/en/ (accessed on 14 February 2019).
17. World Health Organization (WHO) (2016). – IHR (2005)
Monitoring and Evaluation Framework. Joint External
Evaluation Tool: International Health Regulations (2005).
Joint External Evaluation Tool and process overview. WHO,
Geneva, Switzerland, 7 pp. Available at: http://apps.who.
int/iris/bitstream/handle/10665/252755/WHO-HSE-GCR-
2016.18-eng.pdf?sequence=1&isAllowed=y (accessed on
14 February 2019).
18. World Organisation for Animal Health (OIE) (2019). – The
OIE Tool for the Evaluation of Performance of Veterinary
Services (OIE PVS Tool). Available at: www.oie.int/solidarity/
pvs-evaluations/oie-pvs-tool/ (accessed on 14 February 2019).
89
Rev. Sci. Tech. Off. Int. Epiz., 38 (1)
19. World Organisation for Animal Health (OIE) (2019). – PVS
gap analysis. Available at: www.oie.int/solidarity/pvs-gap-
analysis/ (accessed on 14 February 2019).
20. World Health Organization (WHO) (2013). – WHO/HSE/
GCR/2013.2. International Health Regulations (2005). IHR
core capacity monitoring framework: checklist and indicators
for monitoring progress in the development of IHR core
capacities in States Parties. WHO, Geneva, Switzerland,
53 pp. Available at: www.who.int/ihr/checklist/en/ (accessed
on 14 February 2019).
21. Errecaborde K.M., Pelican K.M., Kassenborg H.,
Prasarnphanich O.O., Valeri L., Yuuzar E., Fauzi R.P.S.,
Budayanti N.S., Suwandono A., Artama W.T., Adisasmito W. &
Dutcher T. (2017). – Piloting the One Health Systems Mapping
and Analysis Resource Toolkit in Indonesia. Ecohealth, 14 (1),
178–181. doi:10.1007/s10393-017-1207-3.
22. Centers for Disease Control and Prevention (CDC) (2018).
– One Health Zoonotic Disease Prioritization Workshop.
Available at: www.cdc.gov/onehealth/global-activities/
prioritization-workshop.html (accessed on 14 February 2019).
23. Barton Behravesh C., Dutcher T., Salyer S.,
Riviere Cinnamond A., Pelican K. & Nel L.H. (2017). –
Papers presented at the Symposium ‘Operationalizing One
Health: One Health Tools in the Context of Global Health
Security’, held during the 66th Annual Meeting of the American
Society of Tropical Medicine and Hygiene, 5–9 November,
Baltimore, Maryland, United States of America. Available at:
www.abstractsonline.com/pp8/#!/4395/session/12 (accessed
on 14 November 2018).
24. Machalaba C.C., Salerno R.H. […] & Wannous C. (2018)
– Institutionalizing One Health: from assessment to action.
Hlth Secur., 16 (Suppl. 1), S37–S43. doi:10.1089/
hs.2018.0064.
25. World Health Organization (WHO) (2018). – International
Health Regulations (2005): State Party Self-Assessment Annual
Reporting Tool. WHO, Geneva, Switzerland, 34 pp. Available
at: www.who.int/ihr/publications/WHO-WHE-CPI-2018.16/
en/ (accessed on 13 February 2019).
26. Lembo T. & Partners for Rabies Prevention (2012). – The
Blueprint for Rabies Prevention and Control: a novel
operational toolkit for rabies elimination. PLoS Negl. Trop. Dis.,
6 (2), e1388. doi:10.1371/journal.pntd.0001388.
27. Häsler B., Cornelsen L., Bennani H. & Rushton J. (2014). –
A review of the metrics for One Health benefits. In One
Health (W.B. Karesh, ed.). Rev. Sci. Tech. Off. Int. Epiz., 33 (2),
453–464. doi:10.20506/rst.33.2.2294.
