Putting Health and Community at the Center of One Health in Bangladesh
It’s often said that it takes a village to raise a child. We’re going to use the following 900 words to highlight why it takes a community to truly operationalize One Health. The One Health approach gained traction in the early 2000s, during the widespread outbreaks of highly pathogenic avian influenza H5N1. The approach acknowledges that the well-being of human beings, animals (domestic and wild), plants and the larger environment (including ecosystems) are intricately connected and dependent upon one another.
The potential of the One Health paradigm to improve the health of all species and ecosystems and reduce pandemic risk is increasingly recognized at national and global (including by both the G7 and the G20 forums) levels. To date, most of the One Health discussions have taken place in high-level meeting rooms in global organizations, national capitals and universities. These meetings have been essential to bring the various sectors and disciplines together to discuss how best they can combine efforts to, for instance, reduce infectious disease risk and deliver sustainable and safe food systems.
However, for One Health to sustainably deliver on its design, the active engagement of local communities is essential. After all, it is in communities that the action and inaction of the various health sectors is most sharply felt. Indeed, the application of One Health approaches are highly effective at the community level, where they are implemented and monitored by local, invested members who ensure the benefits of good health are equitably distributed across the community, covering people, animals and ecosystems.
Communities are microcosms of global One Health small, tight-knit units composed of humans living with animals and plants within their local environment. Local communities are on the frontline in terms of detecting changes and managing their One Health, and they have much to offer broader One Health efforts. Communities have a grounded understanding of what can feasibly be done to improve health outcomes for all, something crucial to achieving sustainable development goals.
An important feature of local communities is that they often have well-developed communication networks among themselves. People know who to contact when issues arise. This results in a rapid sharing of information, which can support timely, tailored responses when dealing with issues for which communities have agreed protocols in place. Economists should rejoice at the efficiency and effectiveness of community-based One Health efforts. Many of the redundancies typically observed with sectoral and siloed institutions are dramatically reduced at the community level.
Thanks to the Feed the Future Bangladesh Livestock and Nutrition Activity, a newly funded, community-level pilot project in Cox’s Bazar is capitalizing on existing linkages across government, private sector and civil society entities to strengthen livestock productivity, disease surveillance and household well-being. The pilot project started with a One Health mapping exercise to identify all relevant stakeholders. Bangladeshi livestock farmers at union and village levels then took a synergistic approach to build on existing, trusted communication channels used by the community partners in One Health, including the Union Disaster Management Committee (UDMC), Ministry of Health and Family Welfare, Department of Livestock Services, Ministry of Disaster Management and Relief, and Ministry of Environment and Climate Change.
Many members of the UDMC have dual roles as community health workers, livestock field assistants, livestock service providers or members of local farmers’ organizations. This broad representation of relevant sectors and responsibilities within the UDMC means that committee members have multiple options for communicating concerns and implementing actions.
Effective One Health coordination brings together stakeholders from the public and private sectors and civil society, representing all societal groups and levels of administration. The pilot in Cox’s Bazar is improving information sharing, for instance, on livestock diseases among key stakeholders with a physical presence at the community level (i.e., livestock producers and public and private livestock services) as well as numerous government entities.
The Ministry of Health and Family Welfare supports community health clinics and has trained field attendants in all unions nationwide. The Department of Livestock Services supports livestock field assistants and artificial insemination technicians in many unions.
This community-managed activity is moving from an initial sole focus on disease (e.g., infectious disease reporting) to one with a strong focus on preventive health. In addition to reporting cases of animal disease, community participants also coordinate their requests for preventive animal health services, such as the timely control of vaccine-preventable diseases. This step is important because, in many upazillas, or counties, in Bangladesh — as in too many rural areas across the world — the number of animals benefiting from regular vaccination is a small percentage of the total livestock population. If mortality and morbidity rates in livestock can be reduced through effective vaccination campaigns, then detecting the outbreak of a new disease becomes a much easier proposition.
The pilot project in Cox’s Bazar is an exciting opportunity to behold and learn from community-level implementation. The One Health community team will assess if improved sharing of consistent, situation-appropriate messages will support more timely animal disease control and reporting through in-person communication and tailored online applications. If successful, improved livestock productivity will yield multiple benefits, including improved household nutrition and livelihoods, particularly for children, and more sustainable use of local environmental resources. Most compellingly, if this pilot project is successful, it could be scaled up to benefit people, animals and the environment across communities in Bangladesh, demonstrating the effectiveness of cross-sectoral One Health approaches at the local level.