One health strategic planning: multi-criteria decision analysis to prioritize rabies interventions in Burkina Faso

Rabies is recognized among the top five priority zoonotic diseases in Burkina Faso. As in other endemic countries around the world, implementing the One Health approach is a best way towards rabies control. In 2022, Burkina Faso adopted a national strategic plan (NSP) with the aim of advancing collaborative efforts towards the elimination of domestic dog-mediated human rabies by 2030. The first two years following the adoption of this strategic plan were characterized by a low level of commitment from involved stakeholders and unsuccessful implementation due to a wide range of constraints that those stakeholders are facing.

To review the ongoing strategy with these stakeholders, a multi-criteria decision analysis (MCDA) approach has been proposed to establish a prioritization of interventions. Participatory workshops joined relevant 45 institutional and community stakeholders (22 participants for human health group, 23 participants in animal health group, 45 participants for the plenary session) involved in animal and human rabies control, as well as actors from other sectors or civil society. The method was applied in parallel in two groups centred around sectoral participants from human and animal health, then combined through discussions in plenary sessions.

Overall, 41 interventions were selected, related to data collection and analysis, prevention and control, laboratory diagnosis, dog population management, advocacy and public awareness, and cross-cutting issues. Seven analysis criteria were defined by the stakeholders, related to rabies elimination, strategic and operational aspects, One Health capacity development, and social impact. The results revealed distinct prioritization between the sectoral groups. However, a relative agreement could be highlighted on the importance ascribed to a set of cross-sectoral interventions, including harmonization of procedures for surveillance, data sharing as well as prevention and control. Accordingly, interventions perceived as sector-specific were attributed with the lowest scores.

The results of the study inform decision-makers regarding the interventions that are best supported by implementing stakeholders, hence showing the potential for increased their ownership, commitment, and eventually efficacy.