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Implementing the One Health approach in Palestine: Reviewing and mapping ministerial mechanisms for reporting and controlling zoonotic diseases and inter-sectoral collaboration

Occupied Palestine territory | Public Health, Environment

Picture from a workshop organized during the project in 2023

Swiss partners

  • Universität Basel – Swiss Tropical and Public Health Institute Swiss TPH: Jakob Zinsstag-Klopfenstein (main applicant), Said Abukhattab

Partners in the MENA region

  • Birzeit University, Palestine: Niveen Me Abu-Rmeileh (main applicant)

Presentation of the projet

Zoonotic diseases (ZDs) significantly impact global health, particularly in low and middle-income countries (LMICs) with weaker health systems. The World Health Organization (WHO) estimates
that 60% of human infectious diseases and 60-75% of emerging diseases are zoonotic, spreading rapidly due to environmental factors, human activities, and close contact between humans and
animals. Annually, ZDs cause approximately 2.4 billion illnesses and 2.7 million deaths, with economic losses exceeding $220 billion from 2000-2010. Despite their impact, ZDs are often neglected in LMICs but are preventable. The One Health approach, an integrated and unifying approach, aims to balance and optimize the health of people, animals, and ecosystems. This approach is essential for effective control, as it relies on multidisciplinary collaboration. However, One Health adoption is limited by lack of understanding, financial resources, and institutional support. In Palestine, political, socio-economic, and environmental challenges further hinder One Health implementation. Effective ZD management requires coordinated efforts across sectors,
mapping national infrastructure, legislation, and resources. Prioritizing ZDs and understanding their national burden is crucial for efficient resource allocation. This study reviews the Palestinian Ministry of Health (MoH) and Ministry of Agriculture (MoA) structures in ZDs detection, control, and intersectoral collaboration, identifying communication and decision-making gaps.

The study used a mixed-methods approach approved by the ethics review committee at the Institute of Community and Public Health in Birzeit University. Local authorities were involved and informed about the project. Participants were assured of confidentiality and voluntary participation.

Initially, a list of ZDs was developed from WHO reports and relevant literature. Palestinian infectious diseases experts were targeted to determine ZD prevalence. A transdisciplinary workshop with key stakeholders prioritized ZDs using the U.S. Centers for Disease Control and Prevention (CDC) One Health ZDs Prioritization tool based on epidemiological profile, disease severity, availability of intervention, potential transmission, and economic impact.

A Knowledge, Attitudes, and Practices (KAP) survey examined these aspects related to prioritized ZDs among human and animal healthcare providers in the West Bank, Palestine. The survey targeted primary healthcare clinics at the MoH and veterinary departments at the MoA across various sectors using a comprehensive questionnaire.

A case study evaluated existing structures regarding zoonotic disease reporting and control. Frameworks were developed to map strengths and gaps in the reporting system through round table
discussions with subject matter experts. The discussions aimed to enhance communication and coordination between ministries and within each ministry. The regional offices of WHO and Food and Agriculture Organization (FAO), along with published literature, identified 52 zoonotic ZDs relevant to the region. A survey of 25 Palestinian infectious disease experts found that 43 of these diseases are endemic in Palestine. In a workshop with 43 stakeholders, participants prioritized these ZDs. The analysis identified 23 high-priority pathogens, with Brucella, Avian influenza, and Rabies ranking highest due to their severe impacts and economic burdens.

The KAP survey targeted public health professionals and veterinarians across 43 health facilities in the West Bank. Participants responded to questions concerning seven zoonotic diseases:
Brucellosis, Avian Influenza, Rabies, Listeria, Q Fever, Leishmania, and Echinococcus. The survey revealed that Brucellosis was the most recognized disease, with 95.7% of participants being
knowledgeable about it. Post-qualification training positively influenced knowledge and confidence in managing ZDs.

Brucellosis was chosen for a detailed case study. A workshop with representatives from the Ministry of Health (MoH) and the Ministry of Agriculture (MoA) mapped existing structures for reporting and managing Brucellosis, identifying strengths and gaps. Key weaknesses included limited health education for farmers, inconsistent training, and poor inter-sectoral communication. Stakeholders recommended establishing a One Health committee, enhancing education, and creating dedicated Rapid Response units.

More on this project

Story on the Swiss TPH website (2022)