Operationalizing One Health in Saudi Arabia: a mixed-methods framework for national implementation

The One Health (OH) approach is a method of integrating animal, environmental, and human health. Recently, there has been an international response to addressing zoonotic infections, antimicrobial resistance (AMR) and ecological hazards. The OH system in Saudi Arabia is in a positive position, though it still faces challenges in policy integration. The study aims to examine OH awareness, collaboration, implementation, and institutional roles, and to propose a national framework for OH implementation in Saudi Arabia.

The study used an explanatory sequential mixed-methods design. A cross-sectional survey (n = 400) was administered to assess awareness of OH, collaboration, and implementation among health-related professionals and students. Chi-square tests, regression and Cohen's kappa reflected the relationships and the degree of consensus on study variables. After that, semi-structured interviews were conducted to explore systemic aspects of barriers and facilitators. This support the establish of the proposed national OH operational structure.

The survey revealed relatively low OH awareness (81% had no prior knowledge), low collaboration (mean = 0.51; range = 0-4), and poor concurrence regarding the institutional roles of zoonotic diseases (κ = -0.13 to -0.10, all p < 0.001). Implementation was also correlated with OH awareness level (R ² = 0.167, p < 0.001). Age, higher levels of education, and profession influence awareness levels, according to regression analysis. Qualitative themes pointed to collaboration within the Saudi health system, with challenges reflected in government silos, gray routes in data, and institutional dispersion. All this, combined, led us to a multi-level OH framework, comprising national coordination, cross-sector functions and quantifiable program outputs.

OH, in Saudi Arabia, is underdeveloped due to a lack of awareness, institutional misalignment, and integrated governance. We have a logical operational model, shaped by mixed-methods evidence and based on OH principles, that can inform policy, foster intersectoral collaboration, and streamline national implementation plans of action.