Attachments
EXECUTIVE SUMMARY
Public health systems have critical and clear relevance to the World Bank’s twin goals of poverty eradication and boosting shared prosperity. In particular, they are impacted by, and must respond to, significant threats at human-animal-environment interface. Most obvious are the diseases shared between humans and animals (“zoonotic” diseases), which comprise more than 60 percent of known human infectious pathogens; but also aspects of vector-borne disease, food and water safety and security, and antimicrobial resistance.
Zoonotic diseases account for more than one billion cases and a million deaths per year. The high costs of emerging and pandemic diseases are well appreciated, as seen with local and global multi-sectoral economic impacts from SARS, H1N1, and Ebola virus. At the same time, endemic diseases contribute to persistent disease and economic burden through impacts on health and livelihoods, as well as on agricultural production and ecosystems. The occurrence and impact of known and novel disease outbreaks are likely to increase with continued wide-scale changes in land use, transformation of agricultural practices without adequate biosecurity, climate and weather, trade and travel, urbanization and other factors that can facilitate the risk of spillover and spread of diseases. At the same time, many of these pressures are having other wide-ranging impacts on health of humans, animals and environment (from air pollution, nutrition deficiencies, vulnerability to natural and biological hazards, and more). Targeting these drivers may generate shared benefits.
Public health systems must therefore be resilient and prepared to face existing and future disease threats at the human-animal-environment interface. This Operational Framework provides a practical reference toward achieving that aim, with the following key objectives:
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Provide operational guidance to directly address the need for targeted investments that prevent, prepare, detect, respond to and recover from issues like diseases with endemic, emerging and pandemic potential, including antimicrobial resistance;
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Showcase opportunities for targeting disease threats upstream (prevention at the source, or via early detection and effective response) to help reduce the frequency and impact of emergencies the system has to react to;
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Jointly yield long-term gains (and consider trade-offs) in human health, animal production and environmental management, ultimately improving overall health of the planet and the lives, livelihoods and well-being of people;
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Outline activities and interventions with a starting point at the human-animal-environment interface, highlight proposed methods of institutional and technical implementation, and enable mechanisms of coordination and partnership to build more collaborative public health systems.
In its entirety, the Operational Framework provides a strong orientation to One Health to assist users in understanding and implementing it, from rationale to concrete guidance for its application. Six core chapters are included, supported by annexes diving deeper into operational tools and recent World Bank alignment with One Health topics, and a glossary that explains key terms, including interpretations specific to the Operational Framework.
Chapter 1 presents background on the need and scope for One Health, showing how it is inclusive of and can be useful in addressing a broad range of priorities for human and animal health and environment sectors. Chapter 2 reviews the economic argument for One Health for the global and local public good – both through more effective disease prevention and control, as well as operational efficiencies at country and project level. Chapter 3 showcases relevant tools and initiatives for One Health that support capacity for human, animal and or environmental health sectors, bringing them together and articulating possible connections as well as identifying priority areas for further development to aid in successful One Health operations, with additional examples provided in the Annex.
Chapters 4-6 present specific applications of One Health. Examples of entry points for One Health thinking are shown in Chapter 4, including determining relevance of different sectors for involvement based on the specific context. Chapter 5 outlines the building blocks for embedding One Health approaches to prepare for endemic, emerging and pandemic threats, all the way from disease prevention to recovery. Finally, noting the challenge of monitoring progress across sectors, Chapter 6 outlines possible pathways for monitoring and upscaling, showcasing indicators from relevant Bank projects.
Ideally, projects will be designed with One Health intent from the onset, allowing Task Team Leaders (TTLs) to align their tools, investments and indicators to yield added value from One Health.
The Operational Framework is intended as a guide for One Health operations, from project and program scoping and identification stages to design and implementation, including monitoring and evaluation, to help optimize investments. Examples are provided in each section to assist sectors in identifying relevant points for participation; each sector will likely identify additional relevance and ideas for operationalizing One Health in reviewing the examples, as well as in the course of developing One Health programs (or in attempting to integrate One Health into existing programs). It opens the door for genuine collaboration and shared gains to address pressing issues central to the World Bank’s focus — noting that public health systems will only be stronger by integrating humans, animals and the environment.
There is no one-size-fits-all approach for One Health implementation. Yet this precise fact presents ample opportunities for action based on country context and demand and disease or program-specific objectives to achieve the added value One Health approaches can bring. Use of this Framework is envisioned as iterative, with lessons learned and case studies informing its current and future refinement and collective benefits to multiple sectors. Practitioners — whether from the World Bank, other development and technical agencies, or partners from government authorities in client countries — are encouraged to consider themselves partners in shaping the utility of One Health resources and approaches to optimize collective benefits across sectors and countries to better tackle disease threats at the human-animal-environment interface.
This Operational Framework is designed to provide a comprehensive overview of the One Health concept and operational guidance for One Health application (what, why and how). It is envisioned for use in existing and future projects undertaken by the World Bank and its client countries and technical partners.
Certain sections (e.g. chapters 1-2) are more relevant to the preparation of background sections or policy documents, given their emphasis on the human-animal-environment interface, whereas others (e.g. chapters 3-6) provide particular tools, entry points and steps that can be extracted and used in the development and function of projects and programs.
The Operational Framework presents key available instruments, approaches, tools and guidance developed so far by a range of leading technical and/or development agencies and institutions. It helps understand the links between animal, human and environmental health interventions that are typically overlooked when a disease threat is addressed from any one of these perspectives. Based on extensive experience, the Operational Framework also offers guidance on phasing and sequencing interventions so that considered incremental steps can be taken to develop comprehensive and sustainable interconnected, coordinated public health systems.
Practitioners can select the tools and approaches that are most relevant to their situation. Several components can be bundled together and implemented jointly. Alternatively, where capacity and resources are limited, interventions can be undertaken and tools applied separately — where initial activities (e.g. system diagnostics and assessment) lay the foundations for the next phase of work (e.g. investments, policy reform). Zoonotic disease prioritization (see Chapters 3 and 5) is another example of this approach, as applying One Health approaches to disease-specific contexts may serve as a foundation for upscaling to address other known and unknown hazards (see Chapter 5).
This document is primarily directed to World Bank staff (particularly TTLs), working on health, agriculture and environment sector projects and programs. As a cross-cutting discipline, One Health issues are relevant to projects in many disciplines. However, the document has value beyond this institution as client countries, other development banks, bilateral aid agencies and communities are tackling common issues (and many of these groups have highlighted One Health as a priority). Tools and approaches here can be applied in many of these contexts.
Policy makers and managers likely will find this document useful as it provides strong context for opportunities to strengthen public health systems to inform higher-level dialogue and decision-making.
Operational teams should find value in the specific tools and approaches here that can be integrated within development lending programs. The many examples should also provide useful context for all readers and show the breadth of topics where applying One Health may have utility. Building on the World Bank’s “People, Pathogens and Our Planet” reports (2010 and 2012) that provide the rationale for One Health, this more robust document aggregates prior work from the World Bank and its partners, including lessons from World Bank programs, providing an inventory of relevant operational tools and steps.
All dollar figures in U.S. dollars, unless otherwise noted.