A Systems Approach to Evaluate One Health Initiatives

TLDR

One Health initiatives tackle complex, intertwined human, animal, and ecosystem challenges that arise from wicked problems with intricate structures and dynamics. The authors propose a systems‑theory based evaluation framework to assess One Health initiatives as subsystems within their broader context. The framework comprises four elements—initiative definition, theory of change, process evaluation of One‑Health‑ness, and outcome association—implemented via mixed methods, semi‑quantitative scoring (OH‑index and OH‑ratio), conventional metrics, and multi‑criteria decision analysis, with ready‑to‑use Excel tools for elements 1 and 3. The framework enables evaluation, comparison, and learning across One Health activities, and its application in eight case studies provides initial OHI and OHR data, validating the approach and illustrating when One Health initiatives add value over conventional health initiatives.

Abstract

Challenges calling for integrated approaches to health, such as the One Health (OH) approach, typically arise from the intertwined spheres of humans, animals and ecosystems constituting their environment. Initiatives addressing such wicked problems commonly consist of complex structures and dynamics. As a result of the EU COST Action (TD 1404) "Network for Evaluation of One Health" (NEOH), we propose an evaluation framework anchored in systems theory to address the intrinsic complexity of OH initiatives and regard them as subsystems of the context within which they operate. Typically, they intend to influence a system with a view to improve human, animal and environmental health. The NEOH evaluation framework consists of four overarching elements, namely: (1) the definition of the initiative and its context, (2) the description of the theory of change (TOC) with an assessment of expected and unexpected outcomes, (3) the process evaluation of operational and supporting infrastructures ("the One Health-ness"), and (4) an assessment of the association(s) between the process evaluation and the outcomes produced. It relies on a mixed methods approach by combining a descriptive and qualitative assessment with a semi-quantitative scoring for the evaluation of the degree and structural balance of "One-Health-ness" (summarised in a OH-index and OH–ratio, respectively) and conventional metrics for different outcomes in a multi-criteria-decision-analysis. Here we focus on the methodology for Elements (1) and (3) including ready-to-use Microsoft Excel spreadsheets for the assessment of "the One-Health-ness". We also provide an overview of Element (2), and refer to the NEOH handbook for further details, also regarding Element (4) (http://neoh.onehealthglobal.net). The presented approach helps researchers, practitioners and evaluators to conceptualise and conduct evaluations of integrated approaches to health and facilitates comparison and learning across different OH activities thereby facilitating decisions on resource allocation. The application of the framework has been described in eight case studies in the same Frontiers research topic and provide first data on OHI and OHR, which is an important step towards their validation and the creation of a dataset for future benchmarking, and to demonstrate under which circumstances OH initiatives provide added value compared to disciplinary or conventional health initiatives.