b. Challenges in the implementation of OS into One Health at National level
i. Barriers to cross-sectoral collaborations
According to Abbas et al.18, the concept of multisectorality in the OH approach consists of different agendas aligned towards a common goal. The definition of sectors can vary, from different disciplines or institutions18. During the 12th five-year plan, the Department of Health and Family Welfare, India launched a scheme to strengthen inter-sectoral coordination for the prevention and control of zoonotic diseases in 2012. The objectives of this program included establishing coordination, communication, laboratory, capacity building, and awareness for effective prevention and control19.
However, Mckenzie et al.20 in their critical review mentions that without effective surveillance mechanisms and information sharing between sectors, forming a complete picture becomes challenging. Although multisectoral committees have been established, collaborative research and policy formulation are yet to be implemented effectively. The authors suggested that joint education and training of professionals from various sectors can help build understanding, trust, and break down barriers between different disciplines20.
Besides, a mixed-method study by Asaaga et al.21, revealed several barriers to cross-sectoral collaborations such as communication and information gaps, differences in disciplinary training, and institutional challenges like bureaucratic hurdles, perceived mistrust, ego clashes, differing mindsets, insufficient funding, and coordination issues. Additionally, contextual factors such as hierarchies and regional capacity disparities were also seen as constraints. The authors stressed the importance of effective communication between all sectors and levels for promoting cross-sector engagement. According to Asaaga et al.21, the hierarchical structure of the health system often gives national-level agencies significant powers, potentially weakening support for local health priorities. This can lead to a shift in focus from local priorities to those dictated by central government, particularly in cases where state-level health departments lack adequate funding. The rigid hierarchy leads to weak self-feedback mechanisms within the health system, inhibiting effective communication and feedback from ground-level workers to their superiors21.
State government agencies encounter human resource and logistical challenges, with varying administrative cultures across different states in India. The disparities in administrative practices and the lack of skilled personals slow down collaborative actions. This makes the officials transfer the tasks to other authorities21. Participants in the study conducted by Asaaga et al.21 also expressed a lack of willingness to engage in collaborative actions across sectors due to time constraints and increased administrative burden. They emphasized the need to sensitize all actors about the importance and benefits of such collaborations. State and district level actors reported feeling overwhelmed by competing demands, making it difficult to balance their responsibilities.
During outbreak events, veterinarians and medical professionals collaborate and develop mutual respect and trust. Short-term collaborations during outbreaks are more likely than long-term systematic collaborations, as the latter requires formalized understanding between different institutional bureaucracies21. Collaboration is only emphasized when deficiencies are found within the respective sector or when services are required from other sectors. Top-down directives drive collaborations during outbreaks, leading to power issues in non-outbreak situations. Additionally, collaborations are perceived as burdens rather than benefits, leading to further challenges22.
There is also a discrepancy in shared responsibilities between central and state governments, making inter-sectoral merging difficult23. Time constraints and additional administrative burdens further affect collaboration, with state and district-level actors feeling overwhelmed especially during disease outbreaks. Balancing clinical and administrative responsibilities is particularly challenging during such crises, impacting their capacity to engage in cross-sectoral efforts, which is a key aspect of OS.
Challenges in data sharing
When researchers open up their data, they make it possible for others to check their work, reproduce their results, and build new ideas to what is already known. This kind of openness breaks down barriers between disciplines and sectors, helping people solve problems together. It also saves time and money by preventing researchers from collecting the same data repeatedly.
In 2019, Bhat et al.24 conducted a mixed-method study to evaluate the existing surveillance system for Kayasanur Forest Disease (KFD) in Shivamogga, Karnataka, India. According to the authors, the global policy on the OH approach focuses on combining the health of humans , animals, and the environment. This requires collaboration, cooperation, and data sharing among stakeholders and different departments24,25. The KFD study revealed that the existing surveillance system had questionable practices regarding timeliness and quality of reporting data. The authors stress about the importance of reporting data that is easily understandable to all. There is also a great need to establish a robust data sharing mechanism between animal husbandry and forest department staff to enhance the comprehensiveness of the surveillance system24. For scientists in low-resource settings, access to open data can be a lifeline, giving them tools they couldn’t otherwise afford. Therefore, design and development of simple surveillance tools based on stakeholder feedback would be helpful to effectively utilize field data, capture quality data, and take appropriate actions26,27.
Dasgupta et al.28 in their review article in 2021, expressed the need to visualize the OH concept beyond the scope of zoonotic diseases. According to the authors, the challenges in OH issues in South Asian countries point towards the need for productive engagement between medical, laboratory, and social scientists. While OH has been institutionalized in some South Asian countries, further intersectoral institutional changes are needed to strengthen OH research and training28. Globally, there are several OH initiatives in progress, but the Indian approach has primarily been focused on developing solutions during disease outbreaks, rather than fostering sustained, proactive research and preparedness28. Integrating OS principles such as open data, collaborative platforms, and transparent sharing of research findings into India’s OH approach could help build a more resilient system. By encouraging ongoing collaboration between human, animal, and environmental health sectors, OS can shift the focus from crisis response to continuous innovation and prevention.
According to Dahal et al.29, Bangladesh and India have made progress towards OH approach but struggle to bring the governmental sector and stakeholders together for joint action. This could be due to organizational structure, staff attitudes, or cultural and perception issues that require behavioural changes among professionals28,29. Barriers to sustaining cross-sectoral action include mistrust, differences in mindsets, and ego clashes. Public health experts often view themselves as primary leaders in cross-sectoral collaborations, while experts in the animal health and environment sectors perceive that the public health experts take charge of recognitions from cross-sectoral efforts. There is also a belief that each sector has its own mandate and does not necessarily have to implement policies or guidelines from other sectors21,30,31. According to Sironi et al.32, the OH approaches may be challenging for many countries, as the new framework requires greater investment and can be more expensive to implement. In summary, there is a need for improved collaboration and understanding among sectors in South Asian countries to effectively address OH issues. This requires overcoming cultural and perception issues, behavioral changes, and better intersectoral communication and engagement. Moreover, when the public has funded the research, sharing the data is a way to give back to society, ensuring that knowledge serves everyone, and not just a few.
Limited guidelines for collaboration
According to Asaaga et al.21, there were limited guidelines on fostering, managing, and sustaining cross-sectoral collaborations. Key sectoral policies lacked clear formal guidelines or frameworks to support cross-sectoral action, which constrained sustained coordination efforts outside of outbreaks. The authors emphasized a great need for operationalization guidelines specifying roles in disease control efforts across relevant departments. Without structured guidelines, the OH actors felt collaboration was not possible, and they could not visualize collaboration during non-outbreak periods.
However, most collaborations were based on specific instructions from top authorities during outbreaks22. The study by Asaaga et al. also highlights that implicit hierarchies exist within the social setting and professional relationships, particularly in contexts where career sensitivities are prominent. These barriers to cross-sectoral collaboration extend beyond technical aspects and are deeply rooted in the dynamics of collaboration. Creating an environment where professionals from different disciplines come together and have mutual respect is a significant challenge. One potential solution could be incorporating transdisciplinary modules in the curriculum to expose students to the value of interdisciplinarity. The authors also stressed on the need for context-specific cross-sectoral collaboration21.
Dasgupta et al.28, argue that the absence of a policy framework that officially recognizes the OH approach in development and health policies hinders efforts to eradicate poverty and poverty-related diseases28. Prejith et al.14 note that there are still no validated guidelines for quantitatively measuring OH activities14. Mckenzie et al.20 express a significant need for well-coordinated and well-designed research programs on zoonotic diseases within a OH framework to develop effective integrated disease control policies for both humans and animals20. Limited cross-sector engagement exists for most zoonotic diseases due to the lack of an integrated OH policy. Effective implementation of OH requires a framework that includes policy formation, program implementation, financial support, interdepartmental collaboration, capacity building, and local-level participation21,33.
However, the actors involved in cross-sectoral collaboration range from administrative policymakers and program implementers at the highest level to community actors such as village leaders and health workers at the lowest level. To facilitate collaboration, Raut et al.23 in their narrative review suggest robust methodological tools like transdisciplinary multicriteria analysis and a health management system thinking approach have been proposed. Additionally, the Checklist for Reporting of OH Epidemiological Evidence (COHERE) has been employed to combine knowledge from the animal, human, and environmental sectors23.
Lack of inter-ministerial collaboration
One major challenge in implementing OH initiatives is the difficulty in achieving inter-ministerial collaboration to establish a common funding strategy28. The participants in the study by Asaaga et al.21 stated that fragmentation and disparate sectoral affiliations make it difficult to achieve cross-sectoral collaborations in India, as different ministries and departments have different goals and power21,34. Besides, there is a lack of comprehensive guidelines on coordinating between sectors and departments, leading to political decision-making rather than technical decision-making. The nature of government agencies in different disciplines hamper cross-sectoral collaboration. Each department believes that all expertise lies within itself, further contributing to the challenge21, which poses a major obstacle to promote OS.
Additionally, the compartmentalization of the human health and animal health departments under different ministries contributes to bureaucratic competition and affect the implementation of cross-sector initiatives. While formal collaborative mechanisms were established in South Asian countries to address emerging disease threats, the sustainability of these collaborations for managing endemic zoonoses during non-outbreak periods has been inconsistent. Some countries have made progress in building a strong OH network and institutionalizing OH, while others rely on individual advocates and donor funding for collaboration. Bangladesh stands out as a leading example, having signed the OH Strategic Framework in 2012 and making consistent progress in implementation20. India also initiated multisectoral collaboration in response to the H5N1 influenza outbreak and formalized it through an Inter-Ministerial Task Force and Joint Monitoring Group35. However, coordination among ministries such as Health, Agriculture, Wildlife, and Environment remains challenging due to differing objectives and priorities.
To enhance the Indian health system, robust and integrated OH and OS initiatives beyond outbreaks are required. The Department of Biotechnology under the Ministry of Science and Technology has taken steps toward establishing an inter-ministerial OH task force, which could help bring essential ministries under its umbrella. However, institutional and administrative problems continue to hinder collaboration across ministries, making the operationalization of OH challenging17.
Lack of interdisciplinary collaboration
According to Asaaga et al.21, the wildlife sector has had limited involvement in health policy deliberations compared to the human health and veterinary sectors in India. This lack of representation from the wildlife sector is evident in committees such as the National Standing Committee on Zoonoses. Besides, there is a longstanding perception among veterinarians that they are considered less prestigious compared to human doctors, which creates a competitive dynamic between the two professions. However, there is potential for collaboration between veterinarians and doctors during disease outbreaks, as illustrated by their cooperation in cases of dog bites and rabies21. In fact, Veterinary institutes are essential for OH research and diagnostics. During the Covid-19 pandemic, they demonstrated their capability in supporting human disease outbreaks by providing diagnostics, screening, and logistical support15. Therefore, there is a need to strengthen the health care system by promoting knowledge translation, exchange, and other activities between the veterinary and medical health sectors36.
Lack of coordinated One health research programmes
According to Mckenzie et al.20, several significant initiatives have been undertaken in India to address zoonotic diseases. This includes the establishment of a National Standing Committee on Zoonoses in 2005, responsible for advising on policies, operational research, and inter-sectoral collaboration for zoonotic disease control. Additionally, in 2010, the U.S. Centers for Disease Control and Prevention (CDC) and the National Center for Disease Control in India together agreed to setup the India Global Disease Detection Regional Center. Nevertheless, this partnership aimed to enhance epidemic intelligence services, surveillance, preparedness and response to outbreaks, laboratory safety, and zoonotic disease investigation and control. Despite these efforts addressing potential pandemic threats, they have yet to fully institutionalize a OH approach supporting coordinated research programs and effective integrated policies for controlling zoonotic diseases20.
However, the emergence of avian influenza H5N1 in the year 200637 helped highlight the need for multisectoral collaborations in India between human health, animal health, and wildlife sectors. Institutionalized efforts included the establishment of an Inter-Ministerial Task Force and Joint Monitoring Group at the national level, with coordination mechanisms extending down to the district level. To address these challenges, a national-level OH Consortium was established by the Department of Biotechnology - National Institute of Animal Biotechnology. This comprises 27 organizations including medical, veterinary, and wildlife sectors. Additionally, efforts towards establishing a National Institute of One Health in India have received joint support from the Indian Council of Medical Research (ICMR) and the Indian Council of Agricultural Research (ICAR)21.
Although, the opportunity created by these initiatives has not been fully utilized, and there is a need to expand their scope to address zoonoses and other issues at the human-animal-wildlife interface21. OS, with its emphasis on transparency, data-sharing, and interdisciplinary cooperation, aligns well with these objectives, offering a pathway to strengthen OH implementation.
Ii. Challenges in practicing Citizen science
Citizen Science plays a vital role in advancing OS by involving the public in scientific research, data collection, and knowledge production. By bridging the gap between professional scientists and communities, Citizen Science democratizes science, enhances transparency, and fosters wider access to scientific processes and outcomes. In a diverse country like India, the potential for Citizen Science to contribute to sustainable development, informed policy-making, and community empowerment is immense. However, as Namdeo et al.38 highlights, there is a shortage of Citizen Science projects, publications, and participants in India when compared to the country's capacity. Current volunteers mostly come from the educated middle class, representing only a small portion of the population. Addressing the challenges and opportunities associated with Citizen Science in India is the need of the hour. With South India having the highest number of projects, uneven geographic and thematic distribution of projects is a major issue38. Secondly, the data quality from Citizen Science projects in India is often questionable due to personal biases and lack of trained volunteers, leading to concerns among researchers.
As a result, there is mistrust among scientists regarding data collected by volunteers or communities. Financial stability, particularly for community-driven projects, is also a concern26,38. Nevertheless, issues of data ownership, usage, privacy, and accessibility are also the major challenges in the Citizen Science approach38. Kullenberg and Kasperowski39 in their scientometric meta-analysis located public participation in epidemiological research under the Citizen Science umbrella39. In a scoping review by Hansen et al. in Denmark40, the challenges in the research data management by citizen science is enormous, such as- difficulties in the identification of the data of citizen science origin, sharing of data by the citizen scientists before the publication of the findings, and challenges in reusability of data.
The authors also stress upon lack of databases and publishing platforms for citizen science. In addition, the authors state that most of the citizen scientists are considered “Research Assistants” and not research participants, due to which the Institutional Review Boards (IRBs) do not assess the risks and benefits of the citizens. In our study, we explored a group of community health workers in India called Accredited Social Health Activists (ASHAs). They act as a bridge between the community and the health service providers39. There are about 9,00,000 ASHAs in rural and 64,000 in urban areas working under the National Health Mission (NHM), India41. According to Ghanekar et al.41, there are several gaps in research on Community Health Worker (CHW) programs, and the published literature often fails to discuss essential health system considerations, such as program governance, community voice and engagement, and collaboration between the community and CHWs. According to Rajbangshi et al.42, displacement of ASHAs in conflict-hit areas has significantly affected the living conditions and perception of security risks among ASHAs42. Disparities in social access between urban and rural ASHAs have also been observed, emphasizing the need for greater social inclusion in urban ASHA programs41.
They are extensively involved in various public health programs and interventions, demonstrating their multidisciplinary working culture43. They also collaborate with schoolteachers and participate in mass sanitation campaigns. However, the incentive-based payment system poses a significant challenge, as workers may not receive financial incentives due to non-completion of tasks or unavailability of data. Additionally, there is dissatisfaction with the lack of fixed work schedules and disparities in incentive distribution among workers. Despite their extensive efforts, there is a lack of equal compensation, particularly during outbreaks, which impacts their motivation and financial stability44–46. There is a need for formal policies to address these challenges, as well as the provision of incentives and recognition14.
Additionally, factors such as training, supervision, and security are crucial for engaging community health workers in research. In a case study by Yasobant et al.46 in 2021, the ASHAs expressed a strong desire to represent themselves as OH activists, if relevant incentives and recognitions are given to them. They also expressed a need for proper training in the field of OH. Proper training and sensitization of these multipurpose healthcare workers could enhance their ability to work on zoonoses prevention effectively22.
