Practical experiences of an NGO implementing One Health initiatives in the Albertine Ecosystem, Hoima, South Western Uganda
Lawrence Mugisha1,2,3,&, Dominic Travis2, Katharine Pelican2
1Conservation and Ecosystem Health Alliance (CEHA), P.O. Box, 34153, Kampala, Uganda, 2Ecosystem Health Initiative, Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, 3College of Veterinary Medicine, Animal Resources & Biosecurity (COVAB), Makerere University, P.O. Box 7062, Kampala, Uganda
Lawrence Mugisha, Makerere University, Department of Wildlife and Animal Resources Management (WARM), Conservation & Ecosystem Health Alliance (CEHA), P.O. Box 34153, Kampala, Uganda
The One Health concept, recognized as a multi-disciplinary, multi-sectoral approach to addressing grand challenges in health, is increasingly being utilized in the control and management of infectious diseases at human-wildlife-livestock interface. Recently, a number of One Health initiatives have emerged, including several university networks, international One Health conferences, workshops and trainings as well as several agencies endorsing One Health approaches. However, the One Health concept is not appreciated, sometimes confusing, and remains largely theoretical at the local/community level.
Conservation & Ecosystem Health Alliance (CEHA), a local Non-Governmental Organisation (NGO), has implemented One Health approaches since the year 2012 at community level in the Albertine Ecosystem, Hoima, Uganda. Joint identification and prioritisation of local health challenges with District Local Government leadership and technocrats was undertaken.
One Health initiatives, such as One Health leadership trainings, joint field attachments, joint planning, research and workshops were implemented in the three districts of Hoima, Kibaale and Kasese of the Albertine Ecosystem. This involved a number of international students/researchers working with national students/researchers and community representatives from various discipline since 2012 at One Health demonstration sites. Districts have prioritised the diseases requiring the One Health approach followed by a number of zoonotic diseases studies.
our preliminary observations and experience reveal that health related NGOs play an important role in domesticating One Health at local governments and communities. This approach is highly desired in the planning and implementation of health related challenges in communities.
One Health has been universally recognised internationally as the most practical and feasible approach to deal with infectious zoonotic diseases and health challenges at the interface of humans, animals and ecosystems [1,2]. The concept has been broadly defined, and in most cases, to reflect the missions of the various organisations, as a collaborative, multidisciplinary and multi-sectoral effort of multiple health related professionals from various institutions working together locally, national, regionally and globally to address complex health challenges at human, animal and ecosystem interface [3, 4]. One Health has evolved overtime and has gained more insight and attention more recently with outbreaks of various zoonotic diseases including highly pathogenic organisms such as severe acute respiratory syndrome (SARS), highly pathogenic avian influenza strains like H1N5, Nipa Virus, Hendra, coronavirus, ebola, Marburg, among others [3, 5]. This trend has sparked a number of initiatives in the last one decade including the adoption of 12 Manhattan Principles published by Wildlife Conservation Society in 2004 , launch of the One Health Initiative) in 2007, launch of One Health initiative website in 2008 (http://www.onehealthinitiative.com/), to the most recent launch of ‘One Health Global Think Tank for Sustainable Health and Wellbeing- 2030’ (GHW 2030) to contribute to of the UN Sustainable Development Goals (SDGs) . In addition, several endorsements of One Health by several international agencies and professional associations is well documented . By 2017, a record of 1046 of organisations/institutions/associations and prominent individuals was available on One Health initiative website as One Health supporters and endorsers . We are increasingly observing the application of One Health concept in the zoonotic disease investigation and outbreak response as a proof of concept [6, 10]. One Health continues to make a landmark in media press, newsletters, websites and scientific publications including specific journals for One Health . Several university networks have also emerged mainly for capacity building of the One Health workforce . Despite of the break record advancement of One Health concept globally, its application and appreciation at local community levels remains scanty. Non-governmental organisations usually play a critical role in public health at community level but currently only a few are actively involved in One Health for various reasons . Hence, Conservation & Ecosystem Health Alliance (CEHA) has taken the mantle to demonstrate the role of nongovernmental organisations in the implementation of One Health initiatives in Uganda.
This section describes processes, systems and projects undertaken by CEHA from inception in 2012 to date in the foundation and implementation of the One Health initiatives. Several meeting consultations with stakeholders and partners were held face to face and by teleconferencing. Working documents were developed, and memorandum of understanding (MOU) /contractual agreements signed. Projects and activities for implementation were identified through a participatory process involving all stakeholders. Public awareness and sensitization and training of technical personnel in one health were undertaken using media and training workshops. One health research on zoonotic diseases was conducted by multidisciplinary team of researchers and students drawn from national and international universities.
CEHA project location
: CEHA’s projects and activities are located in the Murchison- Semliki Landscape of the Albertine Rift Ecosystem that lies between two National Parks: Murchison Falls National Park (North of Budongo Forest Reserve) and Queen Elizabeth National Park (South of Bugoma Forest Reserve) as shown in Figure 1
. This landscape part of the Albertine Rift is the most biodiverse region in Africa and an important corridor for wildlife movements with high endemism of the threatened species. Moreover, the Albertine Rift Ecosystem falls under one of the areas that have been identified by the United States Agency for International Development (USAID) as “hot spots” where emerging and re-emerging infectious diseases originate globally. This biodiverse ecosystem is however undergoing various threats mostly human induced that have resulted in a high level of forest fragmentation. These fragments are inhabited by small populations of chimpanzees and other primates and surrounded by dense human communities engaged in a myriad of agricultural-related activities. The co-existence is threatened by several human-wildlife conflicts emanating from crop-raiding and different forms of damage from wildlife on community land mainly baboons, bush pigs, elephants, monkeys and chimpanzees. As the human population has grown, subsequent clearing of forests for agriculture has increased the level of wildlife-human interaction, significantly impacting conservation efforts and increasing the potential risk of transmission/emergence of infectious diseases. To date, conservations efforts in this region have concentrated on forest destruction/fragmentation mitigation measures and improving human livelihoods. However, no efforts were being taken to address the impact of habitat changes and interactions on disease dynamics and transmission between humans, non-human primates and livestock. Hence, the role of CEHA in establishing One Health demonstration sites in these areas to implement One Health initiatives in order to improve human, animal and ecosystem health.
CEHA rabies awareness campaign and vaccination
: CEHA implemented the first One Health activity by conducting rabies prevention awareness campaign in April, 2012. The campaign was undertaken in conjunction with the Hoima District Veterinary and District Health Departments and mobilised the communities within Hoima Municipality for vaccination of dogs against rabies. 200 dogs were brought to the local CEHA office in Hoima for vaccination against rabies and treatment against ecto and endo-parasites. In addition, 20 female dogs were spayed and 20 males castrated to manage the uncontrolled breeding as well as capacity building of local veterinarians in surgical skills. CEHA launched a veterinary services clinic in partnership with Hoima District Veterinary Department.
CEHA One Health training in Hoima
: CEHA organised the first One Health sensitisation workshop in Hoima on 8th
August 2013 that brought together technical personnel from health related and planning departments at the District and Sub-county Local Governments. Sixty (60) participants: Veterinarians, Health officers, Health inspectors, Environmental Officers, District Planners, Chief Administrative Officers (CAO), District LC V Chairperson, students and One Health resident fellows were enrolled for the workshop. The purpose of the workshop was to provide opportunities for: 1) sharing experiences on One Health approaches in Uganda and elsewhere 2) providing updates to all stakeholders on the One Health Approach in Hoima; 3) providing guidance for developing District One Health strategic plan and 4) CEHA One Health activities to the Hoima District technical and political teams. In addition, the workshop updated participants on the One Health implementation status in the Country. Pre-and post evaluation questionnaires were administered to the participants to assess their knowledge of One Health pre and post workshop.
One Health in-service leadership training
: CEHA organised the One Health in-service leadership training of technical personnel from health related departments of 5 Districts in South-Western Uganda from 17th
February 2014 in Hoima District. The training was part of the One Health Central and Eastern Africa (OHCEA) leadership capacity building that targeted 180 participants from six countries of Rwanda, Uganda, Ethiopia, DR Congo, Kenya and Tanzania supported by USAID and implemented by CEHA. The 48 participants were selected from 5 districts prone to emerging and re-emerging infectious diseases which included: Hoima, Kibaale, Bundibunyo, Kasese and Luwero districts. In addition, 5 line ministries relevant to the implementation of One Health were selected to participate in the training. The ministries selected included: Ministry of Health (MoH), Ministry of Agriculture, Animal Industry and Fisheries (MAAIF), Ministry of Education, Ministry of Water and Environment and Office of the Prime Mister (OPM). Training facilitators were drawn from various disciplines with diverse experience in One Health from Makerere University, CEHA, Ministry of Health, USAID RESPOND, University of Minnesota and Hoima District Local Government. The participants were trained in 4 cornerstones of One Health competencies; 1) Visionary and Strategic Management, 2) Team Building 3) Communication and 4) Change Management. The highly partcipatory and competence based training involved a series of group discussions, expereince sharing, oral presentaions and field trip to Kabwoya Wildlife Reserve, oil exploration sites and fish landing sites along Lake Albert. The participants also visited community based safe food handling and bulking project that was intiated to help communiteis supply food to the oil componies for economic benefits.
CEHA research and capacity building in the region
: CEHA established EcoHealth Research Group (EHRG) in 2012 to coordinate One Health research under a project entitled: Development of EcoHealth Research and Training Capacity in Uganda. This initiative was implemented in partnership with University of Minnesota, USA and Makerere University to link universities to communities in the implementation of One Health under One Health demonstration site model.
Joint One Health Field Attachment
: CEHA conducted a 4 week Joint One Health Field Attachment (JOHFA) held from 14th
June, 2014 to 10th
July 2014 in Bwera sub-County, Kasese District. This project was undertaken with financial support from Healthy Foods, Health Lives Institute, University of Minnesota
under the project: Innovation collaboratives: a University-Community Partnership to Sustainably Improve Food Safety and Security in Uganda
This initiative was collaboration between the UMN, Mak and CEHA- as the lead non-governmental organisation. The team of student comprised of 3 UMN students and 9 Makerere University students drawn from various disciplines, including: nursing, veterinary medicine, environment health sciences, public health, agriculture, economics and housing, food science and technology. The student teams worked under the mentorship and guidance of the One Health residents, faculty supervisors from Mak and UMN coordinated and supervised by CEHA field operational team. JOHFA had components of social entrepreneurship to enable teams assess community needs with the lens of entrepreneurship for sustainable community project interventions. The students were organised into multidisciplinary teams and paired with community representatives and One Health residents and supervised by faculties for the period of 4 weeks in the field. All teams were taken through principles of One Health and practically exposed to tools and techniques
of community entry; community needs assessment, identification and prioritisation of community challenges, project development and implementation, project evaluation and result dissemination.
One Health summer course
: CEHA participated in the design and implementation of the annual College of Veterinary Medicine, Animal Resources and Biosecurity (COVAB) summercourse under “Capacity Building in Integrated Management of Transboundary Animal Diseases and Zoonoses (CIMTRADZ)
” in East and Central Africa (ECA) since 2012. The participants for the 6 week summer course were recruited annually from Veterinary colleges in ECA and USA mainly and academic staff at the beginning of their careers. The 6-week program is sub-divided into four sections: 3-4 days of lectures at COVAB, 16 days of field and hands-on exposure to production systems in small holding settings and livestock disease control (Eastern Route) and wildlife and ecosystem health experiences (Western Route), 2-3 days of International Cultural Boma and 2 days of International Conference for sharing of scientific outputs.
CEHA One Health advocacy
: CEHA promoted advocacy One Health at community, national, regional and international level through workshops and conferences.
In this section, we describe, present and discuss the processes, activities and achievements attained by CEHA in advancing, promoting and implementing One Health initiatives at community level in One Health demonstration sites;
CEHA was registered as a Non-Governmental Organisation (NGO) incorporated in USA (Ref: 6773-205-7: EIN number 611648348) in 2011 and locally registered in Uganda under Uganda NGO Registration Board in 2012. This was followed by the establishment of One Health demonstration sites in the Albertine Rift with Hoima, Kibaale and Kasese as pilot districts. The Memorandum of Understanding (MoUs) was signed with Hoima and Kibale District Local Governments as a foundation for One Health working framework. Projects and activities implemented under established One Health framework include:
Rabies prevention and awareness campaign was conducted in Hoima Municipality where 200 dogs were vaccinated against rabies and treated for ectoparasites. In addition, 40 dogs (20 males and 20 females were castrated and spayed as part of capacity building of 5 local veterinarians in clinical and surgical skills.
One Health training was held on 8th August, 2013 in Hoima district trained more than 50 participants including veterinarians, medical officers, clinical officers, nurses, natural resources officers, planners and politicians. The participants were equipped and updated with approaches to the One Health.
One Health In-service Leadership Training held in February 2014 trained 48 technical personnel from 5 districts in the Albertine ecosystem. The participants were trained in four cornerstones of the One Health competencies; Visionary and Strategic Management; Team Building; Communication and Change Management in the period of one week.
One Health pre-service capacity building: 30 students from Makerere University and University of Minnesota, USA, drawn from different health related programs. They were trained together under the One Health Joint Field Attachment in Bwera sub-countyin Kasese Distict for 4 weeks. One Health research focused on neglected tropical zoonotic diseases has been implemented under the project entitled: “Development of EcoHealth Research and Training Capacity in Uganda”. This was implemented under a collaborative partnership with College of Veterinary Medicine, University of Minnesota. Short-term, MSc and PhD research projects have been undertaken under this program. We hosted international students from Colorado State University, University of Minnesota, John Hopkins University, Georgia University including students with fellowship support mainly Fogarty Fellowship and Duke Doris Fellowship. Research was conducted in the Albertine ecosystem on neglected tropical zoonotic diseases at wildlife-livestock and
human interface. The major diseases studied brucellosis, leptospirosis and bovine tuberculosis in multidisciplinary teams of national and international students and fellows. The research outputs include both published and unpublished data, accepted and presented abstracts in various national international conferences and result dissemination to areas of operation.
CEHA organised and participated in the implementation of the three annual summer courses in partnership with College of Veterinary Medicine, Animal Resources and Biosecurity (COVAB) under “Capacity Building in Integrated Management of Transboundary Animal Diseases and Zoonoses (CIMTRADZ)
” in East and Central Africa (ECA) since 2012. This was supported by United States Agency for International Development (USAID) through Higher Education for Development (HED). In addition, CEHA developed One Health modules and instituted One Health summer course as part of continuous capacity building. CEHA registered as a member of the Global Education Exchange in Medicine and the Health Professions (GEMx) (http://www.gemxelectives.org/uganda-kampala/ceha/) for internationalisation of the developed One Health modules and summer course.
Oral presentations and abstracts were submitted and presented to national and international conferences, workshops and seminars to promote One Health as summarised in Table 1
CEHA registration as Non-Governmental Organisation (NGO) incorporated in USA and local registration Uganda under Uganda NGO Registration Board provided framework for international and national collaboration. To fulfil its registration purpose of promoting One Health capacity building and research as well as biodiversity conservation at wildlife-livestock and human interface across Africa, One Health demonstration field sites were established in Hoima, Kibaale and Kasese Districts. The registration status facilitated the process of collaboration by signing Memorandum of Understanding (MoU) with Hoima and Kibaale District Local Governments. Hence, mechanism of collaboration was agreed upon and achieved through multidisciplinary collaboration with various universities and local governments in the implementation of One Health research and capacity building at human, animal and ecosystem interface. The established framework facilitated the process participatory planning, needs assessment, project identification and prioritisation of the one health actions as implemented by CEHA in the period from 2012 to 2016.
Rabies is well documented disease that affects both animals and humans and provides a good example of using one health approach. Hence CEHA used the case of rabies to demonstrate the importance of One Health approaches. Rabies campaign for rabies awareness and prevention was held in Hoima Municipality in April 2012 in collaboration with Hoima District Veterinary and Health Departments. As a result, 200 dogs were brought to the local CEHA office in Hoima and vaccinated against rabies and treated for ecto and endoparasites. Dog owners were sensitised on rabies control and encouraged to present their dogs for vaccination annually. Each dog was tagged and issued with a vaccination certificate. In addition, 20 female dogs were spayed and 20 males castrated to manage the uncontrolled breeding as well as capacity building of local veterinarians in surgical skills. With this 1st successful operation, CEHA launched a veterinary services clinic in partnership with Hoima District Veterinary Department to provide the much needed veterinary service and to continue with advocacy of eliminating rabies from the human population.
One Health remains unappreciated at community level hence, CEHA organised the first One Health sensitisation workshop in Hoima on 8th August 2013 to raise awareness. The workshop brought together technical personnel from health related and planning departments at the District and Sub-county Local governments. It was attended by 60 participants who included Veterinarians, Health officers, Health inspectors, Environmental Officers, District Planners, Chief Administrative Officers (CAO), District LC V Chairperson, students and One Health resident fellows. The majority of the workshop participants acknowledged that they were interfacing with term One Health for the first time and were not sure of its application and importance. During the workshop, the participants gained knowledge and information on definition of One Health, its needs and relevance in the disease outbreak investigations and responses and other health related interventions. The participants learnt of the on-going One Health initiatives in the country and globally for them to appreciate the importance of One Health. Some of the One Health experiences shared with participants included; One Health Competencies, Vetcap program in Karamonja, One Health Residence Program at Makerere University, USAID Pandemic Threats Program, One Health Central and Eastern Africa (OHCEA), Farm to Table concept, CEHA One Health demonstration site plan and CEHA internship and research program. During the workshop, one of the CEHA research intern under Doris Duke International Clinical Research Fellow from Johns Hopkins University School of Medicine in the USA provided his personal experience and perspective of One Health and his One Health research activities with CEHA. His physical participation and presentation provided a living life example that was critical to conceptualisation and understanding of One Health approaches. This provided a good background to understanding of One Health and participants were able to brainstorm and discuss challenges, constraints and gaps likely to inhibit implementation of One Health approaches.
Recognition and implementation of One Health approaches requires several competencies including leadership competence as has been documented [14
]. In recognition of the need, CEHA led and coordinated the One Health in-service leadership training of technical personnel from health related departments of 5 Districts in South-Western Uganda from 17th
February 2014 in Hoima District. The 5 day training workshop on One Health Leadership was attended by 48 participants drawn from 5 districts majorly in the Albertine Ecosystem prone to emerging and re-emerging infectious diseases which included: Hoima, Kibaale, Bundibunyo, Kasese and Luwero plus representatives from 5 line ministries and four One Health Resident Fellows. The participants were trained in 4 cornerstones of One Health competencies: 1) Visionary and Strategic Management, 2) Team Building 3) Communication and 4) Change Management. The participants of the training acquired skills and knowldege on One Health leadership compentecies and were able to develop One Health strategic plans road maps for thier respective district during the training period. Each district developed a vision and generated all components of the strategic plans highlighted here by selected few extracts of the vision: Kibaale
– “A district of excellence in the provision of effective and sustainable One Health approaches
” and Luwero
- “A healthy and productive human and animal population in a sustainable environment
”. While giving concluding remarks, the Deputy Chief Administrative Officer of Hoima said “One Health approach should be adopted by government especially in the handling of all epidemics
”. This is a clear evidence of the need to extend One Health leadership training to all District Local Governments and other institutions and organisations working at community level.
One Health provides unique opportunity to conduct research using multidisciplinary teams from various disciplines to understand the current challenges of zoonotic diseases and changing ecosystems. CEHA established EcoHealth Research Group (EHRG) in 2012 to lead the One Health research in 2013 under the project entitled: Development of EcoHealth Research and Training Capacity in Uganda
. The primary focus of the EHRG was to undertake One Health research understanding the dynamics of the zoonotic diseases especially brucellosis, bovine tuberculosis, leptospirosis among others and develop practical approaches of disease prevention at human-animal and ecosystem interface. Several research studies have been undertaken that involved international students from Colorado State University, University of Minnesota, John Hopkins University, Georgia State University some as National Institute of Health (NIH) Fogarty Global Health Fellows and Duke Doris Fellows working together with students from Makerere University and technical personnel for local government to implement zoonotic disease research studies under the coordination of CEHA. We have worked as One Health research teams in design, data collection, analysis, manuscript preparation and generated published and unpublished data on various zoonotic diseases using limited resources [15-19
]. The unpublished data is being prepared for publication and importantly, we have built capacity for One Health research carders at different levels with ability to work in multidisciplinary teams in low income settings.
As part of One Health capacity building, we have conducted Joint One Health Field Attachment (JOHFA) as a pre-service training for national and international students from nursing, veterinary medicine, environment health sciences, public health, agriculture, economics and housing, food science and technology. The 4 week Joint One Health Field Attachment (JOHFA) held from 14th
June, 2014 to 10th
July 2014 in Bwera sub-County, Kasese District. The students were organised into multidisciplinary teams and paired with community representatives and One Health residents and supervised by faculties for the period of 4 weeks in the field. All teams were trained in principles of One Health and practically exposed to tools and techniques of community entry; community needs assessment, identification and prioritisation of community challenges, project development and implementation, project evaluation and result dissemination. The One Health student teams were able to identity community challenges, prioritised the projects and implemented a project in terms of data collection, analysis, documentation and result dissemination within the 4 weeks (unpublished data, 2014). In addition, each team identified and developed an enterprising community project and presented in a joint group workshop and evaluated for possible funding. The Joint One Health Field Attachment was very effective in One Health capacity building and a practical approach to establishing the multidisciplinary teams and preparing students to face the community challenges.
Furthermore, the efforts to building One Health workforce was delivered by organising the One Health summer course and One Health modules. The annual summer course at College of Veterinary Medicine, Animal Resources and Biosecurity (COVAB) trained participants in integrated management of transboundary animal diseases and zoonoses. The course uses a mixture of unique tools including lectures, field trips, cultural boma and conference to train students from diverse backgrounds in order to learn and understand production systems in small holding settings, livestock diseases and their control, wildlife and ecosystem health challenges. Through this experience, CEHA has further developed One Health modules and instituted One Health summer course as part of continuous capacity building. The summercourse and modules have been made available internationally through a membership platform with Global Education Exchange in Medicine and the Health Professions (GEMx): (http://www.gemxelectives.org/uganda-kampala/ceha/). CEHA provides practical evidence and opportunities for developing One Health workforces highly required for addressing health challenges within changing ecosystems.
In order to achieve and tap into the benefits of the One Health approaches, mechanisms/processes are required to advocate and disseminate information to different target audiences. As such CEHA is engaged in promoting One Health at community, national, regional and international level in terms of organising/participating in a number local workshops and to international conferences to publications as reported and summarised in Table 1
This paper demonstrates with practical examples the need and role of non-governmental organisations in promoting and advocating for One Health at community, national, and global level. We organised and implemented One Health projects and activities ranging from pre-and in-service trainings, research to advocacy at community level working in multidisciplinary teams and provide successful cases for One Health lessons. We successfully established networks and linked universities to communities thereby providing opportunities for joint learning, faculty and student exchanges, training and research benefiting both national and international students needed for One Health approaches.
What is known about this topic
- Non-governmental organisations play a significant role in community development.
What this study adds
- Information, including case studies, on the need and
role of non-governmental organisations in promoting and
advocating for One Health at community, national and global
The authors declare no competing interest.
Lawrence Mugisha, Travis Dominic and Katharine Pelican contributed to development and design of the paper, writing the article, and intellectual content. All authors approved the version to be published.
We thank the Hoima, Kibaale, and Kasese District Local Governments for opportunity and administrative support for our One Health initiatives and hosting our research students. We thank University of Minnesota for the great partnership and financial support for the CEHA One Health initiatives and research. One Health Central and Eastern Africa (OHCEA) for financial support for the One Health Leadership Training.
Table and figure
summary of One Health events implemented by Conservation & Ecosystem Health
Figure 1: a map of
Murchison-Semliki landscape showing location of Conservation & Ecosystem Health
Alliance (CEHA) project activities
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