Analyzing countries’ needs to improve multisectoral collaboration against health threats at the human-animal-environment interface: a study of 51 National Bridging Workshop Roadmaps

Abstract

Background

The devastating effects of global health threats at the human-animal-environment interface have highlighted the continued need to improve collaboration between the human, animal, and environment health sectors. The National Bridging Workshop (NBW) Program contributes to this effort, gathering representatives from relevant sectors to assess their collaborative capacities and to develop a joint Roadmap to strengthen them.

Methods

We conducted NBWs in 58 countries and 51 Roadmaps are publicly available. A document analysis of these Roadmaps was conducted using a hybrid inductive-deductive coding approach. Roadmap activities were coded, categorized, and quantified for descriptive analysis. Hierarchical clustering (HCA) and principal component analysis (PCA) were applied to examine co-occurrence and variability across countries and activities. Jaccard index was used to assess inter-country alignment and regional trends were evaluated.

Results

The analysis identified 60 distinct activity types (codes), grouped into six key themes, describing 2028 activities, providing unique and meaningful insight into how countries plan to improve their One Health capacity. Of these 60 activity types, 37 were present in a third of Roadmaps or more. The HCAs revealed an absence of clustering between activities or countries and the PCA confirmed a high degree of variability. The highest Jaccard similarity score between two countries was 0.64, and intra-regional (0.34) and inter-regional (0.32) average similarity scores were almost identical.

Conclusions

The activity needs, and their frequency, can help streamline international efforts to support countries in building their multisectoral collaborative capacities. With no dominant patterns of activity inclusion identified across countries or regions, our results offer concrete evidence for the need to tailor the One Health approach to countries’ national contexts. The findings support the growing body of literature that emphasizes the absence of a “one-size-fits-all” approach. They also demonstrate that the NBW method supports this needed flexibility.

This study is the first to investigate One Health needs from such a broad range of countries, based on a common, standardized tool. Our findings offer critical insights into national and, by extension, global priorities for One Health collaboration, that can guide the development of tools and strategies that align with the specific needs articulated by countries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s44263-025-00193-3.

Background

Threats originating at the human-animal-environment interface (HAEI) have had devastating impacts on health, livelihoods and economies, highlighting the continued need to strengthen collaboration between the human, animal and environment health sectors to safeguard global health [1]. Addressing these shared threats effectively, including emerging and re-emerging zoonoses, foodborne diseases, and antimicrobial resistance (AMR), requires a multisectoral approach [1–5].

Changing global conditions impact certain drivers of zoonotic spillover, increasing pressure on the environment and altering the nature and frequency of contact between humans, animals (be they pets, livestock, or wildlife), and their environment. Thus, understanding what countries need to strengthen their multisectoral collaboration to effectively address them is essential [6, 7].

The National Bridging Workshop (NBW) Program—Capitalizing on the International Health Regulations (IHR) and Performance of Veterinary Services (PVS)—contributes to this effort. The Program is jointly managed by the World Health Organization (WHO), the World Organisation for Animal Health (WOAH), and the Food and Agriculture Organization of the United Nations (FAO) [8]. The Program begins with conducting the NBW, followed by various in-country follow-up activities [Supplementary material 1: National Bridging Workshop Factsheet].

The NBW brings together representatives from the animal health, human health, and environment sectors and creates an enabling environment for them to evaluate and discuss their level of collaboration. The workshop culminates in the development of a joint, consensual, and operational Roadmap to pragmatically improve this collaboration [3, 9, 10].

This study aims to systematically analyze the NBW Roadmaps, to identify and interpret patterns in the activities included within them. These documents provide unique and meaningful insight into how countries plan to improve their capacity to apply a comprehensive One Health approach to address health challenges that span the interconnected domains of human, animal, and environmental health. Comparative analyses of One Health needs across countries are notably scarce, with no studies to date drawing on data generated through a standardized methodology applied consistently across such a broad range of countries. In this study, we compile, analyze, and discuss the contents of these 51 NBW Roadmaps to better understand national and, by extension, global priorities for operationalizing One Health collaboration. A French translation of the abstract is provided in Supplementary material 2.

Methods

Conducting National Bridging Workshops

Following three pilots that did not produce Roadmaps, we conducted NBWs in 55 additional countries, between May 2017 and March 2024, using the method described by Belot et al. [3]. Of the 55 NBW Roadmaps, 51 had been validated and endorsed by national authorities at the time of the study (Table 1) and could be included in this analysis.

Table 1.

List of countries having completed a National Bridging Workshop, organized by geographic region

Country Roadmaps analysed in this study (n = 51)
Africa	Americas	Asia	Europe
Benin	Belize	Bangladesh	Albania
Cameroon		Bhutan	Armenia
Central African Republic		Cambodia	Georgia
Chad		Indonesia	Republic of Moldova
Congo		Kazakhstan	North Macedonia
Côte d’Ivoire		Kyrgyzstan	Romania
Ethiopia		Lao People’s Democratic Republic	Serbia
Gabon		Lebanon
The Gambia		Mongolia
Ghana		Myanmar
Guinea		Nepal
Kenya		Pakistan
Liberia		Philippines
Mali		Sri Lanka
Mauritania		Thailand
Morocco		Viet Nam
Niger
Nigeria
Senegal
Sierra Leone
Somalia
South Africa
Togo
Tunisia
Uganda
United Republic of Tanzania
Zambia
Countries whose Roadmap was unavailable at the time of analysis (n = 7)
Africa	Americas	Asia	Europe
Democratic Republic of the Congo	Costa Rica	Bahrain	Azerbaijan
		Jordan	Ukraine
		Malaysia

The NBW is a structured seven-session process, held over 3 days, to enhance collaboration among the human, animal, and environmental health sectors. Typically involving 50–120 participants, the workshop begins with Session 1, which introduces the One Health concept and fosters cross-sectoral understanding. In Session 2, participants engage in fictional outbreak scenarios to assess their level of collaboration across 15 key technical areas for 4–6 priority threats at the human-animal-environment interface. Sessions 3 and 4 involve mapping these collaboration scores onto global health frameworks (State Party Annual Report/Joint External Evaluation and Performance of Veterinary Services) and extracting key insights from existing national assessments. In Session 5, participants begin developing, from scratch and in their own words, joint activities to address identified gaps. Session 6 focuses on refining these activities into a detailed and prioritized NBW Roadmap through structured planning and peer review. Finally, Session 7, facilitated by national stakeholders, solidifies the Roadmap, ensuring national ownership, alignment with existing plans, and defining next steps for implementation [11].

All validated NBW Roadmaps are publicly available on WHO’s Strategic Partnership for Health Security and Emergency Preparedness (SPH) Portal (https://extranet.who.int/sph/nbw/activities).

Coding of Roadmap activities

A document analysis was performed on all 51 NBW Roadmaps to describe their contents and identify patterns in the information recorded within them [12–15]. We compiled the complete contents of these 51 Roadmaps in a Microsoft Excel file, where they were first coded and then categorised into themes, following the methodology described below.

Codebook development and application

A codebook [Supplementary material 3: Codebook and Coded Roadmaps] was developed, through inductive and deductive qualitative data coding techniques, to facilitate systematic coding of the Roadmaps’ contents [16, 17]. Inductive coding first generated codes from the Roadmaps themselves.

To ensure codes were anchored to expert consensus on zoonotic disease management, deductive codes were developed from relevant principles detailed in each activity chapter of the Tripartite publication, Taking a Multisectoral, One Health Approach: A Tripartite Guide to Addressing Zoonotic Diseases in Countries [1], known more commonly as the Tripartite Zoonoses Guide (TZG). The TZG “provides principles, best practices and options to assist countries in achieving sustainable and functional collaboration at the HAEI” [18]. It addresses primarily zoonoses, but its principles are flexible enough to be applied to other HAEI health threats [1, 5].

Expert-agreed principles and language from the TZG were also used to develop descriptions, and inclusion and exclusion criteria of inductive and deductive codes. A glossary of relevant terms used in the development of these codes are included in Supplementary material 4: Glossary.

This inductive/deductive approach provided the flexibility necessary to capture the diverse and emerging information in the NBW Roadmaps, anchored to the scientific rigor of an established global framework developed by zoonotic disease experts (i.e., the TZG) [1, 19].

Roadmap coding and code theming

All 51 Roadmaps were read thoroughly before commencing coding. All Roadmaps follow a standard structure, recording the objectives under the technical areas identified During the NBW, the activities needed to achieve the objective, and the process that will be followed to accomplish those activities. For more information, see Supplementary material 3: Codebook and Coded Roadmaps.

Codes were attributed to the NBW Roadmap activities, when contents met code descriptions, and inclusion and exclusion criteria [16] detailed in the codebook [Supplementary material 3: Codebook and Coded Roadmaps]. During coding, some activities were split when different parts of the activity corresponded to different codes.

The other Roadmap information, though not coded, provided additional context to inform the meaning of activities. Inductive codes were attributed, as necessary, to emerging concepts during coding. Codes were reviewed periodically, and deductive and inductive codes with conceptual similarity were merged, or added to the codebook as a separate code [12, 16].

After coding all 51 Roadmaps, the accuracy of codes assigned to each activity was reviewed by two authors. Any differences in opinion were discussed, and a consensus was reached on the appropriate code for each disputed action.

Codes were then grouped into categories and themes that reflect their role in strengthening multisectoral collaborative capacity to address health threats at the HAEI.

Analytical considerations

Some codes generated through qualitative interpretation were excluded from quantitative analyses and a justification is provided in Supplementary material 5: Justification for codes excluded from analyses. For example, codes for activities included in two or fewer Roadmaps were excluded due to their low representation (< 4% of Roadmaps).

Dataset

The curated dataset was a matrix displaying the 60 activities in rows and the 51 countries in columns. Values were binary, with 1 meaning that the country has planned this activity in its Roadmap and 0 meaning that it has not.

Descriptive data analysis

Code quantification

After attributing codes to all activities, the appearance of each code was counted once per Roadmap across the 51 NBW Roadmaps to account for differences in length and granularity. Codes were then ranked by frequency, revealing the most frequently identified activities for improving multisectoral collaboration.

Heatmap

A heatmap was developed to visually represent the presence or absence of specific activities across the 51 Roadmaps.

Statistical methods

The geographic classification from Table 1 was used to group countries during related statistical analyses.

Cluster analysis of activities

A hierarchical clustering analysis (HCA) was performed to group the activities based on their occurrence across the 51 Roadmaps, ordered by theme. The clustering was performed using Ward’s method to minimize variance within clusters and Euclidean distance was employed as the distance metric. The analysis and visualization were carried out using Python 3.13 [20] with the Scipy library [21] for clustering and the Matplotlib [22] library for plotting the dendrogram.

Cluster analysis of countries

An HCA to group countries based on their activities was performed using Ward’s method. Euclidean distance was again used as the distance metric. The HCA was executed using Python’s Scipy library [20, 21] for clustering and the Matplotlib library [22] for plotting the dendrogram.

The elbow method was used to identify the optimal number of clusters. For each clustering option, a Chi-squared test was used to check if the distribution of countries across clusters was statistically significant by region. Average inter-regional and intra-regional distances were computed and compared with a t test. An alternative clustering method was also attempted with k-means clustering to investigate the regional distribution in a similar manner.

Association analysis

A Jaccard similarity analysis was conducted to examine the overlap in activity implementation between countries based on their NBW Roadmaps. The analysis was performed using Python’s Scikit-learn library [20, 23] to compute the Jaccard similarity score for each pair of countries, measuring the proportion of shared activities between them. To explore regional trends, countries were grouped by region (Africa, Asia, Europe, and Americas), and average intra-regional (within the same region) and inter-regional (from different regions) similarities were calculated.

Dimensionality reduction

A principal component analysis (PCA) was performed to explore patterns in the implementation of activities across countries’ NBW Roadmaps, using the PCA function from Python's Scikit-learn library [20, 23], with five components selected to capture the key dimensions of data variance.

Results

Code frequencies and themes

The 51 analyzed Roadmaps comprised a total of 1728 activities. Due to splitting of activities during coding (see section Roadmap coding and code theming), the final number of coded data points was 2028. A total of 60 codes were defined and included in the exploratory and association analyses.

Table 2 highlights the 35 codes that appeared in at least one third of the analyzed Roadmaps.

Table 2.

Code frequencies across the 51 analysed NBW Roadmaps

Ranking	Code short title	Frequency (out of 51)	% of NBW roadmaps
1	Conduct simulation exercises	46	90.2
	Develop electronic data sharing platform
3	Develop guidelines/SOPs for joint investigation/response	41	80.4
4	Establish national level coordination committee	40	78.4
	Conduct training for joint investigation/response
6	Conduct training for joint risk communication	35	68.6
7	Conduct training for joint laboratory functions	33	64.7
	Develop guidelines/SOPs for joint surveillance
9	Establish (rapid) investigation/response teams	32	62.8
	Develop guidelines/SOPs for multisectoral coordination
11	Conduct training on joint surveillance	31	60.8
	Develop joint plan(s) for investigation/response
13	Develop joint risk communication messages	30	58.8
14	Develop guidelines/SOPs for joint laboratory functions	27	52.9
15	Establish joint risk communication (sub)committees	26	51.0
16	Conduct training on joint risk assessment	25	49.0
	Develop joint plan for risk communication
18	Establish subnational level coordination committee	24	47.1
	Develop One Health legislation
	Engage non-state stakeholders in joint activities
21	Develop guidelines/SOPs for joint risk communication	23	45.1
22	Develop guidelines/SOPs for joint risk assessment	22	43.1
	Establish local level coordination committee
	Establish joint routine funding mechanisms
25	Establish joint surveillance (sub)committees	21	41.2
	Map workforce availability and competencies
27	Establish joint investigation/response (sub)committee	20	39.2
	Develop list of priority HAEI health threats
	Develop platforms for risk communication/community engagement
30	Conduct joint risk assessment	19	37.3
31	Conduct general training on the One Health concept	18	35.3
	Develop joint surveillance systems
33	Conduct One Health advocacy for policy-makers	17	33.3
	Develop joint risk communication strategy
	Establish joint laboratory network
	Develop laboratory quality management system
	Develop joint surveillance systems

SOPs standard operating procedures

Figure 1 depicts the categories and themes into which coded activity types were grouped. Categories group various activity types related to a similar topic [16, 24]. Resulting themes thus reflect the role of the coded activity types in strengthening multisectoral collaborative capacity to address health threats at the HAEI [16].

Fig. 1.

Depiction of code grouping into themes

Figure 2 presents the distribution of the 60 codes (ordered by theme) across the 51 analyzed Roadmaps, providing a visual representation of the activity types included in each country’s Roadmap.

Fig. 2.

Heatmap of activities in 51 NBW Roadmaps

Strategic planning

This theme grouped Roadmap activities that combined strategic goals, outlined in overarching strategies, with the technical and operational activities and plans required to address zoonoses and other HAEI health threats [1] (Fig. 1).

Developing joint plans for investigation and response to zoonoses and joint strategies for risk communication were mentioned in 60.8% and 33.3% of Roadmaps, respectively (Table 2). Joint plans or strategies for other joint technical areas (such as surveillance or workforce development), were also mentioned, but in fewer than one third of Roadmaps (Fig. 1).

Joint operational procedures

This theme grouped activities to develop guidelines or operational procedures detailing how to perform the practical tasks needed during joint technical activities [1] (Fig. 1).

Guidelines and standard operating procedures (SOPs) for joint investigation and response (JIR) were the most frequently mentioned type of operational procedures (80.4%), followed by procedures for joint surveillance (64.7%), multisectoral coordination (62.8%), laboratory functions (52.9%), risk communication and community engagement (RCCE) (45.1%), and joint risk assessment (JRA) (41.2%) (Table 2).

Technical coordination and governance

Grouped under this theme were activities to establish multisectoral coordination mechanisms (MCMs) at any administrative level and multisectoral focal points or working groups to coordinate joint technical activities.

Activities to establish MCMs at national, subnational, and local level were included in 40, 24, and 22 Roadmaps, respectively (Fig. 1). Thirteen countries included establishing MCMs at only one level (nine at national, one at subnational, and three at local level) (Fig. 2). Fifteen countries’ Roadmaps included activities to establish MCMs at national and either subnational or local level, while eleven countries aimed to establish MCMs at all three levels.

Establishing multisectoral committees for joint technical activities were also frequently included Roadmap activities. These include establishing field-level multidisciplinary response and investigation teams (62.8%) as well as committees to coordinate joint RCCE (51.0%), surveillance (41.2%), and JIR (39.2%) (Table 2).

Enabling environment

This theme grouped Roadmap activities contributing to creating the regulatory, financial, and material conditions necessary to facilitate effective multisectoral collaboration (Fig. 1).

One Health legislation and regulations, and formal agreements between sectors, contribute to creating an enabling environment in which multisectoral collaboration can take place. Activities to develop or amend One Health legislation or regulations were included in 47.1% of analyzed Roadmaps (Table 2).

Also contributing to this enabling environment, thirteen countries further supported the establishment of these MCMs by signing Memoranda of Understanding for multisectoral collaboration between sectors to address zoonoses and other health threats at the HAEI (Fig. 1).

Developing interoperable electronic platforms to share data and information collected During technical activities to address shared health threats, including zoonoses, were the second most frequently included Roadmap activities, present in 88.2% of Roadmaps (Table 2). Establishing joint surveillance systems and laboratory networks, integrating laboratories from different sectors, and jointly interpreting data to assess the risk of shared health threats were included in 35.3%, 33.3%, and 37.3% of Roadmaps, respectively.

Key RCCE activities identified in over one-third of Roadmaps included developing risk communication messages for the public (58.8%), developing web-based or telecommunications platforms to communicate these messages (39.2%), and engaging non-state actors during joint technical activities (47.1%) (Table 2). Activities to advocate for the use of the One Health approach to decision- and policy-makers also contributed to the enabling environment and were included in 33.3% of Roadmaps.

Technical knowledge and capacity building

This theme grouped activities that enhanced the technical knowledge of zoonoses and other shared threats at the HAEI and enabled relevant personnel to acquire the competencies necessary to address them.

Training on JIR was the most frequently included type of training and was the fourth most frequently included Roadmap activity overall (Table 2). Training on joint RCCE, joint laboratory functions, coordinated surveillance, and JRA were included in 68.6%, 64.7%, 60.8%, and 49.0% of Roadmaps, respectively. Conducting general training on the One Health concept was mentioned in 35.3% of Roadmaps.

Mapping existing human resources in relevant sectors, and the knowledge, skills, and attitudes possessed by these professionals also contributed to this theme (Fig. 1). This activity type was included in 41.2% of Roadmaps (Table 2). Activities to incorporate One Health concepts into pre- and post-graduate academic degrees were also included, though were less frequent (Fig. 1).

Testing capacity

The final theme grouped activities to test national capacity to address zoonoses and other health threats at the HAEI. This includes planning and conducting simulation exercises, and Intra and After-Action Reviews [25] (Fig. 1).

Activity clustering and association

Hierarchical cluster analysis by activity

Figure 3 shows the dendrogram organizing activities based on their co-occurrence, helping to identify groups of activities commonly included together across Roadmaps.

Fig. 3.

Hierarchical clustering dendrogram of activities in the 51 NBW Roadmaps

Activities that tend to be included together across many countries’ Roadmaps are clustered together at shorter distances. For example, activities to develop guidelines or SOPs for joint outbreak investigation and response and conducting simulation exercises often appear together (Fig. 3).

However, despite many pairwise connections of logically linked activities, such as the example above, the dendrogram shows a clear absence of clustering.

Principal component analysis

The purpose of the PCA is to simplify complex datasets by reducing the number of variables (dimensions) while still retaining most of the information (variability) present in the original data. It does this by identifying new variables, called principal components, that are combinations of the original variables. These components are arranged in order of importance based on how much variance they explain in the data.

In this analysis, the first five principal components had an explained variance ratio of 0.070, 0.069, 0.065, 0.054, and 0.051. The first principal component only captures 7.0% of the variance observed in the data meaning that no single direction (or combination of variables) strongly dominates the data’s structure or variability.

Clustering analysis by country

Figure 4 shows the dendrogram organizing countries based on their Roadmap activities when conducting the HCA.

Fig. 4.

Hierarchical clustering dendrogram of countries

The dendrogram does not reveal distinct, well-separated clusters, suggesting a continuous variation in activity patterns rather than sharply defined groupings. To explore potential regional patterns, hierarchical clustering was forced into 6, 7, 8, and 9 clusters, yielding chi-square test results of 29.36 (p = 0.015), 30.34 (p = 0.034), 32.44 (p = 0.053), and 35.70 (p = 0.059), respectively. In comparison, K-means clustering for the same number of clusters produced chi-square values of 26.14 (p = 0.037), 28.24 (p = 0.058), 22.10 (p = 0.40), and 38.13 (p = 0.034).

These results indicate varying levels of statistical significance across different clustering methods and cluster numbers, showing no clear regional clustering pattern. The average inter-regional and intra-regional distances were 4.89 and 4.81 respectively, suggesting a very minor, although statistically significant (t test, p = 0.00052), impact of geographical factors.

Jaccard between countries

Among the 1275 possible pairwise comparisons between the 51 Roadmaps, none had a similarity score above 0.7, and only 2 (0.16%) had a similarity score above 0.6 (Bangladesh/Vietnam 0.64 and Myanmar/Zambia 0.61). Further, only 28/1275 (2.2%) pairwise comparisons had a similarity score of 0.5 or above.

The proximity between the intra-regional (0.34) and inter-regional (0.32) average Jaccard similarity score indicates that approximately one-third of Roadmap activities are shared between countries, regardless of their regional proximity.

Discussion

This study presents a comprehensive analysis of 51 NBW Roadmaps, detailing activities government stakeholders have identified to strengthen their collaboration to jointly address health threats at the HAEI, including zoonoses [3]. Coded activity types were grouped into six themes (Fig. 1). Code frequencies revealed a greater number of countries prioritizing operational procedures, capacity building and enabling environments over strategic planning and capacity testing. To focus on common trends, this discussion concentrates on activities included in at least one third of Roadmaps (Table 2). The lack of clear clustering between activities (Fig. 3) and countries (Fig. 4), indicate varying national priorities for improving multisectoral collaboration at the HAEI. Roadmap activities, therefore, seem to primarily reflect the country’s individual context and stage of One Health implementation.

Strategic planning is the process that combines a strategic goal with the technical and operational activities required to reach that goal, usually performed by high-level decision- and/or policy-makers [1]. Only three activities contributing to this theme were included in over one third of Roadmaps (Table 2). The relatively low frequency of strategies and plans being included in the Roadmaps may indicate that countries already possess such documents, or that these were not seen as suitable or pragmatic solutions for improving national multisectoral collaboration. The higher relative frequency of operational procedures for joint technical activities suggests a greater need for strengthening multisectoral collaboration at the operational and field-level, rather than at high-level. Fostering multisectoral ownership of operational-level activities and adopting a bottom-up approach to addressing health threats at the HAEI have been identified as important enablers of effective multisectoral collaboration in various settings [26, 27].

Establishing national, subnational, and local level MCMs were also frequently included Roadmap activities (Table 2). National level MCMs, the most frequently included among countries aiming to establish such a mechanism at a single level (Fig. 2), may be considered a good starting point for countries that do not already have one established in their government [28–30]. Nevertheless, most countries that included MCM-establishing activities included them across multiple levels (Fig. 2).

Countries that included activities to establish MCMs only at subnational or local level may already have a national One Health coordination mechanism. This is the case of Ethiopia, for example, who established their National One Health Steering Committee in 2017 [31]. Ethiopia’s Roadmap, developed in 2018, therefore included an activity to establish a local level MCM only.

This example illustrates how the absence of certain activities from a Roadmap does not necessarily mean that these are not useful for improving multisectoral collaboration. The country may already have had the outcome of these activities in place when developing their Roadmap. Thus, activities reflect, and are tailored to, the country’s stage of One Health approach implementation.

Establishing committees for joint technical activities were popular among countries (Table 2). Of these technical subcommittees, 39.2% countries included activities to establish JIR coordination committees, while 62.7% included establishing a system of multidisciplinary investigation and response teams to be deployed at national or subnational level. This would suggest that operational-level teams were the preferred option to improve national JIR capacity.

During acute health events, particularly emergencies, sectors default to a siloed management approach as health systems are overwhelmed [32, 33]. To implement an effective One Health approach, collaboration mechanisms and networks should be established in advance. As an illustration, developing and amending One Health legislation and regulations, included in 47.1% of Roadmaps, is a process that is not easily done during a health emergency. Such regulations create a strong enabling environment in which to collaborate to address those shared threats. Furthermore, gaining commitment from decision- and policy-makers further contributes to the sustainability of national multisectoral activities [1].

Conducting simulation exercises was one of two most frequently included activities, present in 90.2% of Roadmaps, reflecting its central role in strengthening multisectoral collaboration (Table 2). This prominence can be attributed to the fact that simulation exercises are a logical step for testing the efficacy of several other critical activities, such as the development of operational guidelines and procedures for JIR (highlighted by the very strong Jaccard similarity score of 0.81 between these two activities), the creation of joint response plans, or the establishment of joint response teams [34–37].

Activities to develop interoperable electronic platforms were also included in 90.2% of Roadmaps (Table 2). The emphasis on intersectoral zoonotic disease data sharing in NBW Roadmaps aligns with existing research, which both underscores its importance and highlights persistent challenges [38–40]. Countries also included actions to establish joint surveillance systems and multisectoral laboratory networks to collect this data, and methodologies and mechanisms for JRA. These elements enable sectors to jointly detect zoonotic events, evaluate their potential risk to humans, animals, or the environment, and jointly determine appropriate management measures [5].

Activities to engage in effective joint RCCE on shared health threats were frequently included (Table 2). Though many pathogens are shared between humans and animals, feasible and effective risk reduction and management interventions will differ between the two populations. Risk communication materials, effectively tailored for their target audience, therefore, must be developed jointly to provide people with accurate and holistic information on how to protect themselves and promote compliance to break transmission chains [1, 41, 42].

Developing and conducting trainings on joint technical activities and the One Health approach were among the most frequently included Roadmap activities (Table 2). Mapping the availability and competency of the country’s workforce was also a priority. This focus on technical training and workforce capacity building is consistent with previous literature reviews, which identified weaknesses in technical knowledge and capacity as major barriers to multisectoral collaboration [38, 43, 44].

The HCA by Roadmap activity highlights the strategic emphases adopted by multiple countries. The lack of clustering reveals significant variability in how they choose to strengthen multisectoral collaboration (Fig. 3). Countries at different stages of implementing the One Health approach logically prioritize a unique set of activities. This may contribute to the lack of observable activity clusters and highlights the Roadmaps’ tailoring to individual national circumstances.

This observation is further supported by the PCA results, where the low explained variance of the first five principal components underscores the diversity in countries’ Roadmaps. Thus, while certain activities may be broadly recommended, it is important their implementation be based on specific national contexts and challenges.

When HCA is performed by country, the absence of clear clustering suggests that there are no strongly distinct groups based on their planned activities (Fig. 4). Instead, the data shows a continuous variation, where countries exhibit overlapping patterns rather than forming well-defined categories. This lack of distinct clusters highlights the diversity and complexity of country responses to zoonotic diseases and multisectoral collaboration. It also suggests that countries tailor their approaches to their unique contexts, making it difficult to identify a consistent set of activities across clusters. This reflects the complexity of One Health and the fragmented implementation of One Health strategies, aligning with broader trends in the literature that emphasize context-specific adaptations rather than a standardized set of activities [45, 46].

Despite some possible facilitator-induced bias (since NBWs in the same region are typically led by the same facilitators), the HCA by country found no strong regional clustering patterns. The difference between inter-regional and intra-regional distances was minimal (4.81 vs. 4.89), indicating that geographic proximity is not a primary cluster-inducing factor. Countries in the same region may be at different stages of developing their public health infrastructures and One Health approaches. For example, countries in Africa may have different priorities and capacities, leading to different sets of activities in their Roadmaps, despite geographic proximity. This highlights the diversity of approaches, within and across regions, when dealing with zoonotic diseases and other health threats at the HAEI.

The similarity between the intra-regional (0.34) and inter-regional (0.32) Jaccard scores further supports the idea that geography alone does not play a dominant role in shaping the similarities in NBW activities between countries. This suggests that factors other than geographic proximity play a more substantial role in determining how countries identify and implement their One Health activities.

Our results support the findings of Amuasi et al. [47], Rüegg et al. [48], and Destoumieux-Garzón et al. [49], which emphasize that global frameworks, national capacities, and international collaborations play a more significant role than geography in shaping the implementation of the One Health approach. While other research identifies the influence of geographical and regional factors on One Health implementation [50–52], the absence of significant regional clustering in our analysis suggests that these factors may be secondary to other influences.

Lastly, the uniqueness of each country’s NBW Roadmap is reinforced by the fact that the highest pairwise Jaccard similarity score was 0.64. However, there is an interesting contradiction. While only 2.2% of all country pairs had a similarity score of 0.5 or higher, these pairs collectively involve 31 countries. This suggests that while most countries have distinct approaches, a significant proportion (60.8%) share at least 50% of their Roadmap activities with at least one other country, despite the overall low similarity scores across all country pairs. Countries with high Jaccard similarity scores could leverage this overlap to collaborate, share resources, exchange expertise, and learn from each other’s experiences in implementing similar activities. This kind of cross-country collaboration is actively encouraged by the NBW Catalyst program developed by WHO, WOAH, and FAO. Catalysts are nationally nominated One Health experts who support Roadmap implementation and participate in a global community of practice to share experiences, discuss challenges, and promote mutual learning. Catalysts’ experiences, highlighting areas for potential expertise and resource sharing, are further documented in the report Implementing National Bridging Workshop Roadmaps for One Health Collaboration: Successes and Challenges from 17 Countries [53].

Having access to the complete set of documents is a key quality concern for document analysis [13, 14]. The Roadmaps are outputs of the standardized and internationally endorsed NBW methodology. They are developed and validated by national stakeholders [3], enhancing their quality and suitability for comparison and analysis [14]. All 51 available Roadmaps were analyzed, making it one of this study’s strengths.

Inherent similarities between Roadmaps could be expected, as they arise from the same standardized methodology, and often facilitated by the same international NBW experts. Particularly, NBWs within the same geographic region are also usually facilitated by the same regional representatives. Nevertheless, comparable intra- and inter-regional similarity between Roadmaps suggests no regional facilitator-induced convergence in Roadmap activities. While workshop facilitators guide participants during activity development, they do not provide a predefined list of activities from which participants must choose. Rather, national stakeholders develop Roadmap activities entirely from scratch, identifying and formulating activities based on the specific gaps and priorities they uncover during the workshop. This iterative process, while essential for tailoring outcomes to each country’s context, added significant complexity to the analysis. The structured qualitative approach used in this study made it possible to capture this complexity, while ensuring activities were systematically classified using the developed codebook [12, 14, 16, 54].

Despite this structured approach, applying the codebook required some flexibility to accommodate cultural and linguistic differences in how activities were expressed [19, 54]. In some countries, Roadmaps are compiled in the national lingua franca and translated into English or French in the report, potentially altering their original meaning. Researchers’ interpretations may, therefore, differ from those of the stakeholders who compiled the Roadmap. To address this, researchers used the context provided by the rest of the Roadmaps’ contents, discussing any ambiguous activities until consensus on their meaning was reached.

The presence of key stakeholders, and their equitable representation across sectors and administrative levels, are essential for the methodology to generate appropriate and comprehensive solutions to improve multisectoral collaboration to address HAEI health threats [3]. Achieving equal and meaningful participation from all relevant stakeholders has been noted as a challenge to collaboration in other reviews [44].

Engaging the environment sector during NBWs has proven particularly challenging. The NBW method, initially being designed to focus mainly on human and animal health sector professionals (while still involving other relevant sectors such as environment and wildlife), contributes to this challenge. The absence of an overarching regulatory framework in the environment sector, like WHO’s IHR or WOAH’s Terrestrial Animal Health Code, and assessment tools, like the State Party Annual Report, the Joint External Evaluation, or the Performance of Veterinary Services Evaluation, further contributes to these difficulties [3]. More recently, UNEP’s increased involvement in the planning and execution of NBW workshops, since joining the One Health Quadripartite in 2022 [55], has strengthened engagement of the environment sector in NBWs.

Finally, this study does not assess the extent to which the observed variability in included Roadmap activities arises due to differing stages of national One Health approach implementation. Further research, to identify collaborative capacity strengthening activities implemented prior to the NBW, and how these are complemented by activities identified in the Roadmaps, could reveal a standard set of activities needed to establish effective multisectoral collaboration. Such a study would also enhance understanding of the status of national and, by extension, global adoption and implementation of the One Health approach.

Conclusions

This in-depth and systematic analysis of the 51 available NBW Roadmaps provides unique insight into the activities over a quarter (26.3%) of WHO and FAO Member States and (27.9%) of WOAH Members have identified to improve their multisectoral collaboration to address zoonotic diseases and other HAEI health threats.

The findings from the analysis align with the growing body of literature that emphasizes the absence of a “one-size-fits-all” approach in implementing the One Health concept. Previous authors have highlighted that the variability in ecological, social, political, and economic contexts across countries requires flexibility in applying One Health frameworks [48, 49] and have underscored the importance of tailoring interventions to national circumstances [47, 56].

Our results offer concrete evidence for the need to tailor the One Health approach to a country’s national context. They also demonstrate that the NBW, designed to help countries tailor One Health activities to their specific needs and capacities, supports this needed flexibility [3].

To the authors’ knowledge, this analysis is the first to investigate One Health needs from such a broad range of countries, based on the outputs of a common, standardized tool. Due to the high variability of activities, the descriptive interpretation of the most frequently included NBW Roadmap activities offers valuable information on the concrete actions needed to improve how health threats at the HAEI are addressed using a One Health approach in diverse national contexts.

The NBW is the first step along a stepwise approach to improving health security at the HAEI [57]. The activities outlined in the Roadmaps, and their frequency, can help streamline international efforts to support countries in building their collaborative capacity to address zoonoses and other shared HAEI health threats, based on priority areas countries themselves have identified.

Abbreviations

AMR

Antimicrobial resistance

FAO

Food and Agriculture Organization of the United Nations

HAEI

Human-animal-environment interface

HCA

Hierarchical cluster analysis

IHR

International Health Regulations

JIR

Joint investigation and response

JRA

Joint risk assessment

MCM

Multisectoral coordination mechanism

NBW

National Bridging Workshop

PCA

Principal component analysis

PVS

Performance of Veterinary Services

RCCE

Risk communication and community engagement

SOP

Standard operating procedure

SPH

Strategic Partnership for Health Security and Emergency Preparedness (Portal)

UNEP

United Nations Environment Programme

WHO

World Health Organization

WOAH

World Organisation for Animal Health

Authors’ contributions

CSAD and GB designed the work, compiled, analysed and interpreted the raw data contained in the NBW Roadmaps, and were the major contributors to the writing of the manuscript. SLR also made substantial contributions to the design of the work and drafting and revising the manuscript. GB, FC and SLR designed the NBW methodology, used to generate the raw data analysed in this study. CM played a critical role in the design and roll-out of the NBW Program during the study period. GB, SLR, TT, BL, ASk, DMon, SD, JKL, YG, KD, LW, AF and MIA played a critical role in the organization of NBWs in various global regions and led the facilitation of NBWs to collect the data used in this study. DMor and ASa led the facilitation of NBWs to collect the data used in this study. BA, JNL, JP, HM, PSH, GG played a critical role in the organization of NBWs in various global regions, enabling the collection of the data used in this study. All authors read and approved the final manuscript.

Funding

The National Bridging Workshops that generated the Roadmaps analysed in this study were funded by a wide range of partners and donors, including the European Commission (DG DEVCO), the United States of America (USAID and DTRA), the World Bank, the United Kingdom of Great Britain and Northern Ireland (DFID/FCDO), Germany (BMG, BMZ, and GIZ), Australia, France, the Russian Federation, Canada, Japan, the Republic of Korea, the People’s Republic of China, Indonesia, the Bill & Melinda Gates Foundation, the International Livestock Research Institute (ILRI), the World Health Organization (WHO), the World Organisation for Animal Health (WOAH), and the Food and Agriculture Organization of the United Nations (FAO).

Data availability

The datasets generated and analysed for the current study are available within the paper and its Supplementary Information. The NBW Roadmaps from which these datasets was generated can be found on the Strategic Partnership for Health Security and Emergency Preparedness Portal, in the NBW Activities Tab (https://extranet.who.int/sph/nbw/activities).

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.