Integrating One Health Into Health Systems: A Systematic Review and Narrative Synthesis of Implementation Challenges,...

Area of Science:

• Global Health
• Public Health Policy
• Interdisciplinary Studies

Background:

• The One Health (OH) approach emphasizes coordinated action across human, animal, and environmental health sectors.
• Despite global recognition, OH integration into national health systems is inconsistent.
• A unified definition of OH was established in 2022.

Purpose of the Study:

• To synthesize global evidence on challenges and opportunities for embedding the One Health approach within health system structures.
• To identify strategic directions for sustainable OH integration.

Main Methods:

• Systematic review following PRISMA 2020 guidelines.
• Searches conducted in major databases (Scopus, PubMed, Web of Science, ProQuest) for studies published between June 2013 and April 2025.
• Narrative synthesis of findings from 17 included studies.

Main Results:

• Key challenges include weak governance, limited policy support, inadequate financing, workforce constraints, and sectoral fragmentation.
• Opportunities arise from increased awareness of zoonotic threats and antimicrobial resistance, institutional support, and multisectoral coordination.
• Included studies spanned Africa, Europe, Asia, Australia, and multi-country settings.

Conclusions:

• Sustainable integration of the One Health approach requires embedding it within existing governance, financing, and service delivery systems.
• Parallel initiatives are less effective for long-term OH implementation.
• Strategic directions focus on systemic integration rather than standalone programs.