Cross-Sectoral Zoonotic Disease Surveillance in Western Kenya: Identifying Drivers and Barriers Within a Resource Constrained Setting.

Jonathan Rushton,Lian Francesca Thomas,Eric M. Fèvre,Salome A. Bukachi,Olivia Howland,Laura C. Falzon

doi:10.3389/fvets.2021.658454

Abstract

Background: Collaboration between the human and animal health sectors, including the sharing of disease surveillance data, has the potential to improve public health outcomes through the rapid detection of zoonotic disease events prior to widespread transmission in humans. Kenya has been at the forefront of embracing a collaborative approach in Africa with the inception of the Zoonotic Disease Unit in 2011. Joint outbreak responses have been coordinated at the national level, yet little is currently documented on cross-sectoral collaboration at the sub-national level.Methods: Key informant interviews were conducted with 28 disease surveillance officers from the human and animal health sectors in three counties in western Kenya. An inductive process of thematic analysis was used to identify themes relating to barriers and drivers for cross-sectoral collaboration.Results: The study identified four interlinking themes related to drivers and barriers for cross-sectoral collaboration. To drive collaboration at the sub-national level there needs to be a clear identification of “common objectives,” as currently exemplified by the response to suspected rabies and anthrax cases and routine meat hygiene activities. The action of collaboration, be it integrated responses to outbreaks or communication and data sharing, require “operational structures” to facilitate them, including the formalisation of reporting lines, supporting legislation and the physical infrastructure, from lab equipment to mobile phones, to facilitate the activities. These structures in turn require “appropriate resources” to support them, which will be allocated based on the “political will” of those who control the resources.Conclusions: Ongoing collaborations between human and animal disease surveillance officers at the sub-national level were identified, driven by common objectives such as routine meat hygiene and response to suspected rabies and anthrax cases. In these areas a suitable operational structure is present, including a supportive legislative framework and clearly designated roles for officers within both sectors. There was support from disease surveillance officers to increase their collaboration, communication and data sharing across sectors, yet this is currently hindered by the lack of these formal operational structures and poor allocation of resources to disease surveillance. It was acknowledged that improving this resource allocation will require political will at the sub-national, national and international levels.

Highlights

Global awareness of zoonotic disease emergence and the risks these pose both to human health and our global economy has been growing steadily over the last two decades and has been thrown into sharp relief by the ongoing COVID19 pandemic
Additional probing questions were included on the flow of information both vertically and horizontally, the prioritisation process for surveillance activities and strengths and weaknesses of the surveillance systems in general, to gain a greater overview of the workings of the system
The particular examples of common objectives appear to be closely linked to the available “operational structures” we identified from our study, which are discussed

Summary

Introduction

Global awareness of zoonotic disease emergence and the risks these pose both to human health and our global economy has been growing steadily over the last two decades and has been thrown into sharp relief by the ongoing COVID19 pandemic. Identifying zoonoses within the animal host prior to transmission to or between humans has the potential to mitigate outbreaks at source, saving lives and potentially large economic burdens [1]. Routine surveillance activities within humans, animals and food products, with interoperable data sharing between sectors, can assist in the monitoring for presence and trends of pathogen occurrence and identification of risk factors, allowing for appropriate allocation of resources to mitigate the burden of zoonoses and foodborne disease [4, 5]. Collaboration between the human and animal health sectors, including the sharing of disease surveillance data, has the potential to improve public health outcomes through the rapid detection of zoonotic disease events prior to widespread transmission in humans. Joint outbreak responses have been coordinated at the national level, yet little is currently documented on cross-sectoral collaboration at the sub-national level

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