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One Health prevention and preparedness to vector-borne diseases: how should we deal with a multisectoral, multilevel and multigroup governance?

One Health Outlook volume 6, Article number: 21 (2024) Cite this article

Abstract

Introduction

Multifactorial determinants of vector presence, distribution and ability of transmitting diseases, demand holistic approaches that consider eco-biosocial factors, such as One Health (OH), and engage institutions and communities to reduce vulnerability to vector-borne diseases (VBDs). Although the importance of multisectoral, multilevel and multigroup collaboration for prevention and preparedness to VBDs has been promoted by international guidance, evidence about practical experiences adopting a OH approach needs to be gathered and enabling factors for a successful governance highlighted.

Methods

This study included a rapid literature review coupled with a stakeholder consultation process.

Results

The peer-reviewed literature search identified 1674 articles and 13 articles were finally included in the review. The collaboration and coordination of different sectors and stakeholders allowed to focus resources, and share knowledge and perspectives. To support coordination and collaboration among the stakeholders synergistic interaction mechanisms were created, such as working groups and committees, and connection agents emerged as the main link between institution and communities. These synergies allowed to target the multidimensional drivers of VBDs, supported transversal capacity building and an holistic monitoring evaluation framework, and improved effectiveness and sustainability of the interventions.

Conclusion

A OH model highlighting enabling factors for multisectoral, multilevel and multigroup interventions for VBDs prevention and preparedness was developed to support decision-makers and key stakeholders to deal with a OH governance.

Introduction

Vector-borne diseases (VBDs) account for more than 17% of all infectious diseases, causing more than 700,000 deaths annually worldwide and devastating socio-economic consequences [1]. 80% of the world population live in areas at risk for at least one major VBD, mostly in low resource settings [2]. Climate, environmental and global changes are expanding and shifting the distribution of VBDs, and, on top of that, disease programs budgetary and personnel constraints and insecticide resistance are hampering VBDs prevention and preparedness interventions coverage and impact, urging to find cost-effective and sustainable solutions [3]. Multifactorial determinants of vector presence, distribution and ability of transmitting diseases, demand holistic approaches, such as One Health (OH), which considers the complexity of eco-biosocial drivers and promotes multisectoral and multistakeholder collaborations to maximise the available human and financial resources and enhance the effectiveness and the sustainability of the interventions [4,5,6,7]. Multisectoriality, as recognized by the WHO guidance framework “Multisectoral approach to the prevention and control of vector-borne diseases”, involves collaboration between different sectors (human health, animal health, environmental health etc.) and stakeholders (government, public and private institutions and organizations, civil society, communities etc.) to achieve public health outcomes [5]. The WHO Global Vector Control Response 2017–2030 (GVCR) includes as its foundational pillars, strengthening inter- and intra-sectoral action and collaboration, community engagement and mobilisation, surveillance, monitoring and evaluation of interventions, and the integration of different approaches [8]. The World Health Assembly resolution WHA70.16 called member states to align with the GVCR by adopting the OH approach across all sectors and levels of government, including municipality and local administrative structures, and with the engagement and mobilization of community actors [9]. As a matter of fact, vectors live within communities and their ecology is strongly influenced by local environmental, social and behavioural factors, therefore the engagement of households and communities has a prominent role in controlling vector presence and distribution and reduce the vulnerability to VBDs. Communities usually engage themselves, though informally, in vector control strategies. However, transforming these informal actions into organised activities communicating with the formal institutional system is essential to enhance prevention and preparedness actions (Fig. 1) [10, 11].

Fig. 1
figure 1

The formal and informal systems engaged in VBDs prevention and preparedness

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The OH approach should be adopted both within the formal system (government, research institutions, healthcare system) and its different levels (national, regional/district, municipal), and within the informal system and its groups (communities, civil society, private sector) to ensure the sharing of resources, knowledge and information. However dealing with a multisectoral, multi-level and multi-group governance is challenging and examples of practical experiences are rare in the literature.

This research aimed at gathering recent evidence about successful OH VBDs prevention and preparedness interventions supported by a multisectoral, multi-level and multi-group governance and highlighted enabling factors for its operationalisation.

Methods

Overview and aim

The study included a rapid literature review coupled with a stakeholder consultation process to explore enabling factors of successful multisectoral, multilevel and multigroup interventions for VBDs prevention and preparedness to guide decision-makers with the design and implementation of effective OH governance mechanisms.

Definitions for the scope of the research

  • Sector: Disciplinary sector.

  • Multisector: Including at least two sectors.

  • Community: Groups of people that may or may not be spatially connected, but who share common interests, concerns or identities [12].

  • Prevention: Regulatory and physical measures to ensure that emergencies are prevented, or their effects mitigated [13].

  • Preparedness: Activities that aim at preventing, mitigating and preparing for emergencies [13].

  • Formal: Referring to the institutional system.

  • Level: Different tiers of the formal system (national, regional/district, municipal)

  • Multilevel: Including more than one level.

  • Informal: Referring to the non-institutional system.

  • Group: Different actors supporting the informal system (citizens, NGOs, religious associations, private sector etc.)

  • Multigroup: Including more than one group.

Rapid Review

We chose a rapid review to produce timely and actionable information to be shared within the context of the MediLabSecure Project (https://www.medilabsecure.com/), that aims to mitigate the risk associated with VBDs in the Mediterranean, Balkans, Black Sea, Maghreb and Sahel regions. The rapid review followed the Cochrane guidance to conduct rapid reviews [14].

Search strategy

The peer-reviewed literature search was performed in PubMed® and Cochrane Central. The final search string was: (("Vector Borne Diseases"[Mesh]) AND ("prevention and control" [Subheading] OR "Communicable Disease Control"[Mesh]) AND ("Community Participation"[Mesh] OR community)). We decided not to us ethe term One Health and proceed during the screening phase to select only the records adopting a OH approach. The retrieved records were imported in the systematic review software Rayyan© [15].

Eligibility criteria

Inclusion criteria

  1. i.

    Documents describing multisectoral interventions (at least two sectors involved) for VBDs prevention and preparedness engaging community members (any group) and members of the formal system (at any level), and showing a positive impact on entomological indices, disease rates, cost-effectiveness.

  2. ii.

    Documents published in English with full-text available.

  3. iii.

    Documents published from the 1st of January 2017 to the 31st of December 2022. We chose this timeframe to explore recent evidence in the context of the 2017 GVCR [8].

  4. iv.

    Any type of document.

Exclusion criteria

  1. i.

    Documents that do not answer the research objectives.

  2. ii.

    Documents in other languages than English.

  3. iii.

    Documents with no full-text available.

  4. iv.

    Documents published before the 1st of January 2017 or after the 31st of December 2022.

Quality assessment of included literature

We minimised the risk of bias by following specific guidance for rapid reviews [14]. Two researchers were involved in all the steps of the research and were supported by a third researcher in case of disagreement. We followed a check-point approach, with regular exchange of information with the research team and definition of the next steps. The use of a software for systematic reviews during the screening phase helped to manage the high volume of articles.

Evidence extraction and analysis

After automatic duplicates removal, the articles titles and abstracts first and then the full-texts were screened according to the eligibility criteria using the software Rayyan© [15]. Finally the information related to the included articles was reported in an inclusion matrix with the support of a Microsoft Excel spreadsheet. The evidence obtained was synthetised through a multi-step process. First a descriptive analysis summarised the main features of the included studies, then a two-stage thematic analysis (first inductive according to the study objectives, then deductive to highlight emerging themes) outlined enabling factors of successful multisector, multilevel and multigroup interventions for VBDs prevention and preparedness. The preliminary results guided the stakeholder consultation process.

Stakeholder consultation

Five stakeholders were consulted through open-ended online interviews (through video communication platforms) to refine the results of the rapid review. The stakeholders were identified through a web search for experts in community engagement, VBDs prevention and control, vector ecology and public health and contacted through email. They were working for research institutions, international organisations and donors.

Results

Rapid review

Selection of source of evidence

The peer-reviewed literature search identified 1674 articles. Finally 13 articles were included in the review (Fig. 2).

Fig. 2
figure 2

Flow of information through the different phases of the rapid review

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Characteristics of literature included

The majority of the included articles targeted Aedes spp. (7) in the region of the Americas (Central and South America) (6), and they were implemented in rural settings (9). The interventions included different sectors (entomology, public health, social sciences, animal health, environmental sciences, laboratory sciences, education), coming both from the formal system (governmental institutions, research institutions, healthcare system) and its different levels (municipal, regional, national), and from the informal system and its different groups (community members, community leaders, community networks and platforms, associations, non-governmental organisations). Community engagement activities for VBDs prevention and preparedness ranged from awareness and education campaigns to community members being actively involved in vector prevention and control strategies (e.g. water containers removal, spraying of insects, early warning, etc.) (see supplementary material for a description of the interventions). A description of the type of threat, region, and setting of the included studies is reported in Table 1.

Table 1 Description of the type of threat, region, and setting of the included studies
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Enablers of a multisectoral, multilevel and multigroup interventions governance

Results from the rapid review

The active collaboration and coordination of different actors allowed to create synergies to focus resources and efforts, and share information and knowledge [19, 22, 24]. To support coordination and collaboration among sectors, levels and groups, synergistic interaction mechanisms were created, like ad-hoc committees [22] or established working groups, that were engaged for the specific scope of the interventions [19, 22].

In India (Kerala) steering committees were organised with members of the local government, of the healthcare system and other governmental institutions, and community representatives, and played a crucial role for the coordination and collaboration of different sectors and actors [19]. In Uruguay intersectoral partnership and community engagement was supported by an executive group made of members of the Ministry of Social Development, municipalities, academia, and community representatives and its coordination was crucial to tackle Aedes-transmitted diseases multifactorial determinants [22]. In southwestern Ethiopia community engagement and mobilisation for malaria prevention relied on community-based platforms established years before within an integrated vector management program and included government officers (administrators), village health extension workers, village agricultural development agents, community elders, youth organisers and community members [24].

The synergistic approach of the interaction mechanisms was ensured by connection agents, local leaders recognized both from the formal and informal systems as trustable and knowledgeable figures who could bring together all the stakeholders and support collaboration and coordination (Table 2). The connection agents played various roles, including providing access to communities, mobilization and training of community members, supported logistics and implementation of the activities, data collection and monitoring activities, and fostered the exchange of knowledge and data between the formal and informal systems [17, 18, 21, 27, 28]. This allowed extensive data collection within time and space and helped to plan effective prevention and preparedness actions ahead of time [18]. The synergistic interaction mechanisms supported also horizontal interventions, by adopting the same strategies to target different threats with common characteristics and drivers, [16, 19], and the sharing of financial resources, contributing to the effectiveness and sustainability of the interventions [22].

Table 2 Connection agents main activities and categories
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The coordination and collaboration of different sectors, levels and groups allowed to characterize the multidimensional drivers of VBDs and the engagement of community actors, fostered hyper-localisation of strategies and approaches and the use of local innovation [17,18,19]. Moreover, it allowed to explore local knowledge about VBDs, map community assets and resources, identify at-risk groups, and understand what level of effort was reasonable to expect from community members [16,17,18,19, 21, 22, 24, 27].

The synergistic interaction mechanisms supported transversal capacity building activities, targeting all the different components of the interventions from vector ecology and control, to environmental management and communication strategies [26, 28]. In Cambodia the lessons-learnt were integrated into the National Health Education Curriculum to provide a continuous education opportunity [17]. The synergistic governance supported also an holistic monitoring and evaluation of the activities and outcomes, including feedback from all the involved sectors and actors, to consolidate the functionality and effectiveness of the interventions. Participatory approaches were used to gather observations also from community members during workshops and periodic meetings with key stakeholders [16, 18, 19, 27]. Data gathered from volunteers and community members were also used for monitoring activities [18].

Stakeholder consultation

The stakeholder consultation sessions were analysed with an inductive thematic analysis that allowed to highlight enablers of multisectoral, multilevel and multigroup VBDs prevention and preparedness interventions, that complemented the results of the rapid review (Table 3).

Table 3 Main themes that emerged from the stakeholder consultation process
Full size table

A multisectoral, multilevel and multigroup governance model for VBDs prevention and preparedness

The enabling factors that emerged from the review and the stakeholder consultations supported the refinement a OH multisectoral, multilevel and multigroup governance model for VBDs prevention and preparedness (Fig. 3).

Fig. 3
figure 3

The OH model for multisector, multilevel and multigroup VBDs prevention and preparedness interventions

Full size image

The OH model proposes an in-between approach, where the top-down approach of the formal system and the bottom-up approach of the informal system meet to create synergistic interaction mechanisms liaised by connection agents and regulated by agreed alignment frameworks, that define roles, responsibilities, sharing of resources and data. Synergistic interaction mechanisms supported the sharing of resources, the targeting of multidimensional drivers, multisectoral capacity building and monitoring and evaluation, including data and knowledge from communities, and finally the effectiveness and sustainability of the interventions.

Discussion

Multisectoral and multistakeholder approaches, including the engagement of communities are recommended by international guidance for prevention and preparedness to VBDs and evidence showed their effectiveness [5, 29]. Previous reviews investigated community intervention for VBDs, however a multisectoral OH approach wasn’t specifically included [30]. This review explored VBDs interventions adopting a multisectoral, multilevel and multigroup OH approach, and pointed out enabling factors of an effective governance to support decision-makers with the design and implementation of these interventions. Finding effective and sustainable strategies for VBDs prevention and preparedness is fundamental in the context of climate, environmental and global changes [31]. This study emphasised that a OH approach including multiple sectors, levels and actors is “sine qua non” for effective and sustainable VBDs prevention and preparedness, particularly through the creation of synergies regulated by an alignment framework. Collaboration and coordination among sectors and stakeholders of the formal and informal systems were supported by connection agents, who linked the different actors and sectors, also by promoting data sharing. Oftentimes data at institutional level are not shared among the different sectors and the information collected outside the formal system is perceived of questionable quality and validity. In Nicaragua the question of perceived low quality of the data collected by community members was solved by comparing data collected by the community with the data obtained by professional external entomological inspections [18]. The connection agents fostered also co-development, co-implementation and co-evaluation of the interventions, and by doing so, promoted effectiveness and sustainability [16, 18, 19, 24].

These results could support decision-makers with the design and implementation of multisectoral, multilevel and multigroup interventions for VBDs prevention and preparedness and their governance mechanisms. Further research would need to better describe the sustainability of the interventions in the long-term, the impact on human epidemiological indices, the specific contribution of the different sectors and actors and define integrated indicators to evaluate the added value of the OH approach. Finally, a prototype of an alignment framework to regulate coordination and collaboration of synergistic interaction mechanisms would need to be developed.

Limitations

The studies retrieved with the review included only few vector species and countries and didn’t always describe carefully the contribution of the different actors and sectors.

Conclusion

The main conclusions from the study are the importance of multisectoral, multilevel and multigroup approaches to VBDs prevention and preparedness and the need to create synergies between the formal and informal systems to support effectiveness and sustainability of the interventions. This implies that stakeholders from the formal system would need to be open to collaborate and facilitate an enabling policy and investment framework and community actors would need to understand the importance of their role. The model developed is an useful tool to support decision-makers with the governance of  OH interventions for VBDs prevention and preparedness, that engage different sectors, levels and actors from institutions and communities.

Availability of data and materials

Not applicable.

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Acknowledgements

The study was performed within the framework of the MediLabSecure (MLS) project (www.medilabsecure.com), an EU-funded multisectoral network of experts which aims at strengthening OH prevention and preparedness for VBDs across 22 countries of the Mediterranean, Black Sea and Sahel Regions. We acknowledge MLS coordination, partners and beneficiaries for their constant support. The design of the this research was presented as a poster at the World One Health Congress 2022.

Authors’ information

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Funding

The MediLabSecure project, coordinated by Institut Pasteur, receives financial support from the European Union ( FPI/2021/427–564). Its contents are the sole responsibility of the authors and do not necessarily reflect the view of the European Commission.

Author information

Authors and Affiliations

  1. Istituto Superiore Di Sanità (Italian National Institute of Health), National Center for Global Health, Rome, Italy

    Claudia Robbiati, Alessia Milano, Silvia Declich & Maria Grazia Dente

  2. Public Health and Infectious Diseases Department, Sapienza University of Rome, Rome, Italy

    Claudia Robbiati & Alessia Milano

Authors
  1. Claudia Robbiati
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  2. Alessia Milano
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  3. Silvia Declich
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  4. Maria Grazia Dente
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Contributions

CR, MGD, AM, SD: Conceptualisation, methodology—CR, AM, MGD, SD: Investigation, data curation, formal analysis, writing- Original draft preparation: CR, MGD, AM, SD: Writing- Reviewing and Editing.

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Correspondence to Claudia Robbiati.

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Robbiati, C., Milano, A., Declich, S. et al. One Health prevention and preparedness to vector-borne diseases: how should we deal with a multisectoral, multilevel and multigroup governance?. One Health Outlook 6, 21 (2024). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s42522-024-00114-8

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s42522-024-00114-8

Keywords

One Health Outlook

ISSN: 2524-4655