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One Health: The Evolving Paradigm to Boost India’s Healthcare Infrastructure

One health

The World Health Organization, in collaboration with Food and Agriculture Organization (FAO), World Organization for Animal Health (OIE), United Nations Children’s Fund (UNICEF), United Nations System Influenza Coordination, and the World Bank developed the framework on 'One Health' in 2008 - to decrease the drastic impact of new diseases, and the ones that re-emerged.

One Health is an interdisciplinary solution - bolstered by government infrastructure, adequate healthcare financing and administration of the healthcare system.  It is based on the integration of several agencies that are managed by different ministries, across both central and state governments. The establishment of a 'National Institute for One Health' is the tipping point for the initiative to elucidate the human health perspective into the manifesto of economically focused, socially adept and ecologically sustainable development.  

In a joint endeavor by the Ministry of Health and Family Welfare, the Ministry of Agriculture and the Wildlife Institute of India, Government of India - the Roadmap to Combat Zoonoses in India (RCZI) initiative was established in June 2008. The framework highlights the need to measure the morbidity, mortality, and economic burden of zoonotic diseases and emphasizes the rationale for adopting a 'One Health' framework. It sheds light on the promotion of collaborative research to provide evidence, capacity building and health promotion. It also focuses on the need for an evidence-based forum to rightfully utilize existing data and for contacting relevant people with expertise in their subjects. 

The Union Budget of 2021 specifically allocates a portion for 'One Health'. The Department of Biotechnology’s National Institute of Animal Biotechnology (NIAB), at Hyderabad, launched the Centre for One Health on November 3, 2020 with the manifesto “Animal health for Human Welfare”. The Indian Council of Medical Research has started out partnerships with agricultural universities.

Laboratory capacity is being increased throughout the country, expanding from the block level, to enable district level surveillance of microbial infections using the One Health methodology.

The OHCs can be visualized to evolve through three critical phases:

(i) history of 'One Health' activities in each individual state -- their strengths and limitations;

(ii) environment -- resource shortcomings and provisions for the stakeholders; and

(iii) relationship dynamics -- leadership of the endeavors and the stakeholders framing the problems. 

Implementing a 'One Health' system consists of emphasizing the intersections of humans, domestic and wild animal populations as well as plants and ecosystems. A National Expert Group on One Health as a multi-sectoral transdisciplinary collaborative group, a National Institute of One Health at Nagpur, Maharashtra and Integrated Public Health Laboratories are the three contemporary policy initiatives responsible for popularizing 'One Health' in India. The logistical step forward for India to make the 'One Health' strategies functional will be the framing of One Health Committees (OHCs) at state and district levels with representation from district administration, public health including clinical medicine, veterinary and wildlife institutions as well as environmental health and private (including corporate) stakeholders.

The primary objectives of OHCs should include promotion of integrated disease surveillance for contagious and non-contagious conditions, prevention and response in terrestrial and aquatic animals including at intersections of domestic and wild species, humans, agriculture, animal husbandry and aquaculture and setting up a social determinant approach towards 'One Health'. It is important that attention is paid to the improvement of service programs for researchers and practitioners, constitution of policies on socio-economic determinants such as land use, water access, pollution, urban planning, industrial and domestic waste management and deforestation.

A comprehensive approach needs to be institutionalized through frontline/community health workers (ANMs and ASHAs), community-based animal health workers (para-veterinarians), forest officers and rangers, and farmers and domestic animal owners of all communities. Financial support and human resources ought to be provided through the National Health Mission (NHM) and the Prime Minister’s Atmanirbhar Swasth Bharat Yojana (PM-ASBY) schemes. A National Standing Committee on Zoonoses (NSCZ) coordinated by the Ministry of Health and Family Welfare is necessary to facilitate collaboration. 

This article has been authored by Paridhi Puri.