Working Title: Operationalization of multi-sectoral collaboration in One Health: A health system study in Ahmedabad, India
Research country: India
Research Themes: Health System and Policy Research (HSPR), Systems thinking, Zoonotic diseases

Abstract:
The One Health approach is receiving increasing attention globally and some countries have taken efforts for putting it into practice. Effective implementation of One Health oriented policies/solutions require multi-sectoral collaboration. However, there is a dearth of evidence available on factors affecting the degree of collaboration between sectors and strategies. This complexity is further multiplied by the health system structure and its degree of resilience to different disease burdens. With the dynamic changes of health system resilience and destabilization at the interfaces of human, animal, and environmental health, the operationalization of multi-sectoral collaboration is becoming mercurial. Therefore, this study attempts to understand the health system complexity to facilitate operationalization of multi-sectoral collaboration with the help of system thinking principles, which focuses on how the units influence one another within a complete entity or larger system. It also takes into account the structures, patterns of interaction, events and organizational dynamics as components of larger structures, helping to anticipate rather than react to events, and to better prepare for emerging challenges.

This was a mixed-method health system and policy research conducted between July 2018 and September 2019 in Ahmedabad, India. Data from three (i.e. managerial, provider and community) levels of the health system were captured through qualitative and quantitative methods. The qualitative data consists of key informant interviews, participatory workshop, vignette and modified policy Delphi method, in order to prioritize diseases, understand the current degree of collaboration and explore what factors influence collaboration at the managerial and provider level. The quantitative data consists of cross-sectional surveys among the providers and at community level to identify the first contact person for One Health. Software like Atlas.Ti version 7 for qualitative data, R version 3.4.1 for quantitative data, UCINET 6 for network data and Sensitivity Model of Vester to explore the system factors were used.  

There are multiple actors responsible for the operationalization of the One Health at the managerial, provider and community level of the health system. The interest-influence matrix indicates the clustering of the actors with minimal influence on one another. The network analysis reveals higher strength only during outbreaks and no or only minimal interactions during other health situations. The overall study finding is expressed in the form of a multi-sectoral collaboration sensitivity model with its factors. The potential One Health entry points identified for each level of the health system would facilitate the operationalization of a One Health in the city. Establishing a better understanding of the challenges and facilitators for multi-sectoral collaboration in the local setting of the health system provides a comprehensive picture and points to ways to enhance multi-sectoral collaboration.

Supervisor(s):

PD Dr. Walter Bruchhausen (MHI)

Publications:

1. Yasobant S, Saxena D, Bruchhausen W, Memon F, Falkenberg T. (2019). Multi-sectoral prioritization of zoonotic diseases: One health perspective from Ahmedabad, India. PLoS ONE, 2019; 14(7):e0220152. (PMID: 31361782)
2. Yasobant S, Bruchhausen W, Saxena D, Falkenberg T. (2019). One health collaboration for a resilient health system in India: Learnings from global initiatives. One Health, 8:1-10. (PMID: 31304229)
3. Yasobant S, Bruchhausen W, Saxena D, Falkenberg T. (2018). Convergence model for effectual prevention and control of zoonotic diseases: A health system study on  ‘One Health’ approach in Ahmedabad, India. Health Research Policy and Systems, 16 (1): 124. (PMID: 30567599)