Describing the one health approach: a case study of anthrax outbreak investigation in Arua district, February-May 2018.
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Uganda has made some strides in implementation of the One Health approach in responding to and managing public health events, including outbreaks of zoonotic diseases. From February to May 2018, an outbreak of anthrax occurred in Arua district. Multi-sectoral agencies investigated and managed this outbreak using the platform of One Health approach. The objectives of this study were: 1) To describe the process of anthrax outbreak investigation and response in order to identify in roles and contributions of the various actors, and 2) To identify and document modifiable challenges encountered during investigation and management of anthrax outbreak in Arua district in 2018. The study involved two parts: 1) Content analysis of sector reports of the outbreak, and 2) Semi-structured interviewing of selected respondents from institutions and agencies that participated in the outbreak. Documents reviewed and contents analyzed included field situational reports, laboratory reports and outbreak investigation reports prepared by the response teams. A total of 14 purposively selected respondents were interviewed. The findings revealed that the key multi-agency actors in the investigation and response to anthrax outbreak were: MAAIF, MoH, CDC, NOHP, UWE, UWA, FAO, IDI, Government Veterinary Officers in Arua District, Uganda Police Force, private clinics and private veterinarians practicing in Arua district. The roles and contributions of the One Health actors were majorly in terms of funding, personnel, technical support and equipment. The major challenges in effectively actualizing the One Health approach included: 1) Insufficient policy prioritization and funding that constrained planning meetings among line ministries and partners. For example, the CAH/CVO was not directly involved and thus difficulty in coordination and access to financial resources from MAAIF, 2) Donors preferred independent involvement and reporting, 3) Arua district leadership felt that were not wholly in-charge of the processes, and claimed the investigation and response were too centralized, 4) There were delays in response due to meetings and coordination. The study concluded that challenges exist and persist for implementing OH approach in Uganda. Therefore, solving these challenges represents the “unfinished agenda” of OH approach in Uganda.