The Need for Regional Capacity in One Health System Mapping and Analysis

Training in the use of the One Health–Systems Mapping and Analysis Resource Toolkit™ ignites huge interest in government managers and academics.

As major infectious disease outbreaks continue to emerge throughout Africa, agencies need to ensure effective prevention, detection and response to these threats by integrating multi-sectoral approaches. A new systems mapping tool, developed by the University of Minnesota and the U.S. Department of Agriculture, is an operational tool that maps out key organizations’ involvement in outbreak preparedness and response teams. Workshops that train health stakeholders on how to use and train others on the tool are now being implemented around the world.

A total of 42 participants from eight countries representing universities within the One Health Central and Eastern Africa (OHCEA) network and from partner government agencies were trained on the use of the One Health-Systems Mapping and Analysis Resource Toolkit™ (OH-SMART™) mapping tool and planned for its use, among other tools, in supporting country workforce planning and strengthening in the region during a workshop on 13–17 February 2017 in Kampala, Uganda. The workshop also featured training on the OIE PVS tool, the CDC Zoonotic Disease Prioritization Tool (ZDPT), and the USAID Preparedness & Response project-supported One Health National Platforms tools. This training addresses a key capacity area in operationalizing One Health, improving cross-sectoral coordination and collaboration among agencies and assessing workforce needs and collaboration gaps for the development of a One Health workforce.

Response to emerging threats requires strong institutions that meet government-identified workforce needs by supporting the development of an ‘in-service’ and ‘pre-service’ workforce through improved education and training opportunities and enhanced partnerships. In the African region, this capacity is still largely weak.

One Health Central and Eastern Africa, working with the USAID One Health Workforce project’s US University partners, University of Minnesota and Tufts University, organized the regional OH-SMART™ implementer training and workforce planning workshop targeting senior faculty, and senior government representatives from Cameroon, Senegal, Rwanda, Uganda, Kenya, Tanzania, Ethiopia, and DRC. The workshop also leveraged partnerships that have complementary tools and systems that can benefit workforce and government planning for infectious disease prevention, detection and response. These partners included U.S. Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), the Food and Agriculture Organization of the United Nations Emergency Centers for Transboundary Animal Disease (FAO-ECTAD) and the USAID Preparedness and Response (P&R) project.

All workshop trainees are involved in the implementation of One Health programs and activities in their respective countries and institutions. This mix of participants greatly enriched the discussions and impacted the outcome of the highly participatory and practical training. A key result of the workshop included the development of action plans for all eight countries to synthesize national action plans to identify cross-sectoral workforce skill gaps and needs for improving country prevention, detection and response that universities can address.

The OH-SMART™ Tool:

The OH-SMART™ tool provides a standardized process for strengthening agency and stakeholder interactions around prevention, detection and control of infectious disease threats including antimicrobial resistance. Traditionally, evaluation and assessment of government efficacy has focused on individual agency processes and workforce issues, and rarely considered systems and activities that do (or should) cut across agency lines. The tool enables practitioners to analyze how existing collaborations are perceived within the multi-agency network, how the inter-agency collaborations actually work, and identifies discrepancies and opportunities to fill gaps and build best practices to strengthen multi-agency collaboration.

The training created understanding of the tool and built capacity in leadership and facilitation skills for the participants to be able to conduct the same training and support outcome processes in their own countries. It also equipped the participants with other tools that can enable them to identify cross-sectoral systems and identify workforce and operational gaps and challenges.

The first three days of the training were dedicated to understanding the 6-step OH-SMART™ process of mapping and analyzing a One Health system or process in a specific setting and knowing how to implement the OH-SMART™ process with a network at the state/country/regional level.

The last two days were reserved for a Workforce Planning Meeting with the objectives of reviewing the One Health Workforce project’s Transformation Strategy, establishing a baseline of existing national/ international workforce assessments conducted in the countries, and discussing challenges and opportunities for workforce planning at country-level. Country teams then created a plan for implementing OH-SMART™ and workforce planning in their respective countries.

Participants came to the training with expectations, a number of them fitting nicely in the training objectives. One participant expected to “learn how the tool can enable them to strengthen stakeholder engagement in One Health and in workforce development”. Another hoped to “learn how the tool can be applied to support response capacity for emerging infectious disease threats”, especially how the various agencies can collaborate more effectively with each other in managing these threats.

There was also anticipation that the training would provide insight into “how the tool can be used to bridge the gap between government and academia in order to more effectively plan for workforce development”.

Dr. Monica Musenero Masanza, former Deputy Commissioner in the Uganda Ministry of Health gave an opening statement for the training that spoke to the great need for One Health approaches in managing infectious disease risks, like Ebola. “Developing a One Health workforce requires insight and foresight that determines ahead what the graduates being trained will be confronted with in the future; this involves universities and employing agencies working together to determine the nature of workforce required for future needs. Graduates often fail to fit in the government system because there is an engagement gap between the universities that train the workforce and the government that employs them. Universities embraced One Health, but have not engaged well with the employers of the graduates (government). The graduates, once well trained, should be taken up in government and improve the system”. Dr. Masanza spoke from a lot of experience, having supported many processes in West Africa during and after the Ebola outbreak. One cannot help but pay keen attention to this observation.

During the training, participants were taken through the six steps of the OH-SMART™ and as country teams, worked their way through the steps to better understand how agencies interact around infectious diseases, and identifying actionable steps to improve the system. Building facilitation skills for participants was an integral component of the training to equip implementers with skills needed to facilitate a OH-SMART™ workshop and process.

The Six Steps of OH-SMART™ Toolkit

As participants were going through the steps, they were able to link what they were learning to the challenges they face while performing their work in their respective countries. From the systems mapping exercise, a participant noted, “There exists a variety of models of collaboration and communication in the different countries especially during outbreak responses”. However, across the board, participants also noted that in most of the countries communication across the partners came out as a major challenge.

“Using the tool in this workshop, we have seen the disconnections between the trainers and the consumers of the human resource trained. There is need to match training programs and approaches with the capacity/competence needs”, remarked one participant from Uganda.

While going through an exercise on stakeholder interviews, “We realised [there are] gaps in One Health human resources in Uganda. For example, when there is a zoonotic outbreak and the Ministry of Agriculture, Animal Resources and Fisheries invites CDC on board, CDC will not respond until invited by the Ministry of Health”, noted Dr. Monje, a Ugandan participant.

To many participants, especially from government agencies, the tool is a godsend. “This tool is fabulous; approaching other sectors has been a nightmare in my mind, but now I feel comfortable in approaching them. When I go back, I just want to see that the Ministry of Higher Education is leading the training component”, Professor Franscisca Monebenimp, Ministry of Higher Education, Cameroon, stated during the training.

As part of the workforce planning session, partners from WHO, CDC, FAO, and P&R presented various international and national tools and assessments done in country including:

  • International Health Regulations; an international set of regulations to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide. The tool uses several sources of information and is validated by the countries.
  • The Joint External Evaluation tool (JEE) is a voluntary, collaborative, and multi-sectoral tool that includes both self-assessment and assessment by external committee. It is a data-gathering instrument designed to evaluate a country’s capacities for health security, including all IHR and GHSA-relevant capacities across all relevant sectors at a national level.
  • The CDC Zoonotic Disease Prioritization Tool is a five-step zoonoses prioritization process. The process leads to prioritized list of at least five endemic/ emerging zoonotic diseases agreed upon by all stakeholders and later approved by all ministries representing core voting members and discussion of next steps for prioritized zoonoses including identifying areas for multi-sectoral engagement in developing control and prevention strategies.
  • National One Health Platforms were presented as an opportunity to enhance government and university engagement. These platforms are operational in six of the OHCEA countries — Cameroon, Ethiopia, Kenya, Rwanda, Tanzania, and Uganda.

Working in sector-specific groups (government, university, and external partners), participants discussed challenges and opportunities in effective government/university engagement.Some of the challenges that participants identified as affecting engagement between academia and government included:

  • The disconnect between universities and government, with universities focusing on scientific products while governments are focusing on data for planning. As a result, while universities are continually publishing, governments are using outdated data for planning.
  • Also of note is the fact that in some settings, there are already existing formal and informal structures and frameworks for university-government collaboration, which are not taken advantage of.

Several recommendations were made, key among them:

  • Establishment of coordination mechanisms involving university-government partnerships that can bridge government human resource needs into university (OH) training programs
  • Governments have an opportunity to take key roles in the leadership and development of programs. They cited the example of curricula that could be evaluated by governments before implementation. It was also suggested that governments should oversee the monitoring and evaluation of in-service trainings to enable them to map out qualifications and competencies in the country.
  • Participants recommended the creation of linkages between government and universities to craft needs-based programs, with government supporting regular national workforce needs assessments. They recommended regular and periodic high-level meetings between government and university leadership to review priorities.

The interaction enabled participants to share experiences on the different best practices in their own countries that others may consider implementing in their own countries. One participant shared an experience while still in her country’s Ministry of Livestock when they would engage universities and challenge faculty to give students research areas to work on real issues/problems in the field. Through such initiatives collaboration improves while the country’s capacity needs are addressed.

Easy to implement initiatives identified for engagement included the use of existing platforms, structures and frameworks that are currently not being utilized much, as well as needs assessments that have been conducted in several countries, but have not been discussed by the key agencies, including government and universities.

At the end of the five-day workshop, participants from each country developed an action plan on how they plan to use the knowledge and tools in workforce planning while partnering with the organizations present. Key country steps include plans to synthesize completed national workforce needs assessments to identify workforce training and skills gaps that can be addressed by universities. The expectation is that, as a result of these processes, workforce development initiatives and plans will be harmonised and relevant to the countries’ needs.

About the Author

Milly Nattimba is the Head, Communications for the One Health Central and Eastern Africa (OHCEA), a network supported by the USAID One Health Workforce project.