Table I.

Landscape analysis and comparison of the 12 One Health tools that met the inclusion criteria

Tool	Organisation(s)	Scope/Category	Tool description	Reason for development	How applied/Process	Example applications	Key outputs	Website, if available
FAO Assessment Tool for Laboratories and Antimicrobial Resistance Surveillance Systems (FAO–ATLASS)	FAO	Assessment and prioritisation	FAO–ATLASS maps the national antimicrobial resistance (AMR) surveillance systems along five pillars (laboratory capacity and network, epidemiology unit, governance, communication and sustainability). The tool consists of two modules – laboratory and surveillance – which include features of FAO–LMT and FAO–SET, focusing on AMR. FAO–ATLASS provides recommendations for improvement of the systems, measures progress relative to the FAO Global AMR Action Plan, and provides evidence for action and advocacy	To assist countries in evaluating their AMR surveillance systems and building their capacity	Five-day assessment carried out by fully trained FAO–ATLASS assessors. The first assessment is always carried out by external assessors, while follow-up assessments may be carried out by national assessors, or by an FAO–ATLASS Focal Point. Evaluations include: 1) a preparatory phase where all relevant documents are gathered; 2) meetings with all national authorities and stakeholders for the assessment of the whole AMR surveillance system; and 3) the evaluation of each laboratory that is already included or is to be included in the national AMR surveillance system	To date, 19 countries have conducted FAO–ATLASS assessment missions (Africa: 8; Asia: 8; Europe: 3). Seventeen missions involved the full assessment with laboratory and surveillance modules, two were laboratory module only. FAO–ATLASS results can support JEE missions, and since the tool includes components that link to other sectors, such as public health and environment, they may also help to address AMR under the One Health approach	Outputs of FAO–ATLASS evaluations include: 1) A final report summarising the outcome of the assessment including a description of findings and recommendations for the gradual improvement of the AMR surveillance system 2) For each laboratory: FAO–LMT AMR and progressive improvement pathway (PIP) scoring are generated 3) For the National AMR surveillance system: the PIP scoring identifies and prioritises the areas of intervention for five pillars of an AMR surveillance system (laboratory capacity and network, epidemiology unit, governance, communication and sustainability)	www.fao.org/antimicrobial-resistance/resources/tools/atlass/en/
FAO Laboratory Mapping Tool (FAO–LMT)	FAO	Assessment and monitoring	Standardised, semi-quantitative toolkit used to determine gaps in laboratory functionality and define mechanisms and targets for capacity building. The core assessment tool (FAO–LMT–Core) assesses the veterinary laboratories’ general functionality through 108 questions. The FAO–LMT family was further expanded in 2016 with the release of a separate module for assessing laboratory safety (FAO–LMT–Safety). This module uses 98 questions to provide a standardised assessment of the environmental safety of veterinary laboratories and occupational risks	To allow veterinary laboratories to visualise their performance as compared to national, regional and global networks and thereby further encourage them to improve their capacity	The tool automatically generates graphical outputs and a profile which can be followed over time to evaluate the evolution of laboratory capacities, guide capacity building and develop strategic plans that correspond to individual laboratory needs, addressing all key elements required for an operational laboratory	The FAO–LMT–Core has been used in 117 individual facilities in 42 countries in Africa and Asia since 2010 and yearly follow-up assessments have monitored progress. Outputs from the FAO–LMT evaluations can be used as a resource during JEE missions. The tool can also be used to characterise laboratory functionality together with results from assessments such as a PVS Laboratory Mission or FAO–SET	The tool automatically generates graphical outputs and a profile which can be followed over time to evaluate the evolution of laboratory capacities, guide capacity building and develop strategic plans that will correspond to individual laboratory needs, addressing all key elements required for an operational laboratory	www.fao.org/ag/againfo/programmes/en/empres/news_130514.html
FAO Surveillance Evaluation Tool (FAO–SET)	FAO	Assessment and monitoring	Comprehensive and standardised evaluation of national animal/zoonotic disease surveillance systems along 90 indicators organised in 19 categories, including aspects of intersectoral cooperation between Veterinary Services, Public Health Services and Wildlife Services. FAO–SET provides Veterinary Services with a 360° assessment of their surveillance network, which is used to develop a locally relevant action plan for capacity building of national animal disease surveillance	To respond to countries’ requests for an evaluation and work planning tool to specifically enhance capacities of national animal disease surveillance systems	Teams of five to ten people (FAO staff and National Focal Points from the Veterinary Services) conduct an initial evaluation to provide baseline information on the animal disease surveillance system. Missions may last between 10 and 12 days, during which time stakeholders are interviewed at all levels of the system (central, intermediate, field). Information collected is entered into FAO–SET and outputs are automatically generated, allowing the evaluation team to develop an action plan for improvement with specific, measurable, attainable, relevant and prioritised recommendations Subsequent evaluations may take place every three to five years thereafter	To date, 13 countries in West, Central and East Africa have used the tool, leading to the development of locally relevant action plans to improve their animal disease surveillance systems. Decision-makers can use FAO–SET to: 1) directly evaluate their national animal disease surveillance capacity; 2) carry out a targeted evaluation following more general evaluations such as the JEE or PVS, if this aspect is identified as weakness; or 3) monitor progress during follow-up evaluations	Visual outputs generated by the tool include: 1) scores for each of the surveillance capacities evaluated (core capacities); 2) spider graphs indicating the progress of the surveillance system relative to ten different performance attributes, e.g. sensitivity, flexibility; and 3) scores for the JEE indicators related to animal disease surveillance, which may differ from the scores obtained during the JEE itself. A final evaluation report is generated with evaluation results and a locally relevant action plan for improvement of the national animal disease surveillance system	www.fao.org/ag/againfo/programmes/en/empres/tools_SET.html
IHR/PVS National Bridging Workshops (NBWs)	WHO and OIE	Assessment	Reviews current collaboration gaps across human and animal health in 15 key technical areas and supports development of a joint roadmap of corrective measures and strategic investments	To improve the prevention, detection and control of health threats at the animal–human interface	In countries that have performed a PVS and (ideally) a JEE. Implemented as a workshop in seven steps over three days: 1) setting the scene; 2) case studies and diagnosis of the levels of collaboration for 15 key technical areas; 3) IHR and PVS tools and mapping of the identified gaps on the IHR–PVS matrix; 4) extraction and compilation of results from previous assessments; 5) development of a joint roadmap (objectives and activities); 6) fine-tuning of the roadmap; 7) way forward and linkages with other mandated plans	15 countries have implemented an NBW. Results of the IHR/pVs NBWs can feed into the development of the National Action Plan for Health Security (NAPHS) or other national One Health plans	1) A diagnosis of the strengths and weaknesses of the current collaboration between animal health and human health services (based on five priority zoonotic diseases) 2) A better understanding of the regulatory frameworks and capacity assessment tools from both sectors and how their results can be complementary and synergetic 3) A roadmap of joint activities that both sectors commit to implementing in order to improve their collaboration at the animal–human–environment interface	https://extranet.who.int/sph/ihr-pvs-bridging-workshop
International Health Regulations (IHR) Monitoring and Evaluation Framework: After Action Review (AAR) and Simulation Exercises (SimEx)	WHO	Monitoring	Two of the four components of the IHR Monitoring and Evaluation Framework. These processes allow a qualitative review of national operational capacity for responding to events, either proactively (SimEx) or retrospectively (AAR) SimExes can be used to test specific aspects of a system (e.g. collaboration among partners) under a hypothetical scenario, whereas AARs review the actual functioning of the system during a real event involving hazards as described in the IHR (2005), as well as for other natural and human-made disasters	To allow countries to identify best practices and gaps in operational functioning of the national preparedness and response to emergency events	Duration, scope, focus, structure, and partners vary according to the event or scenario. These voluntary processes are carried out by countries with support from WHO as needed	Out of the 35 AARs conducted since 2016, 17 were associated with zoonotic or food safety events. Out of the 73 WHO simulation exercises conducted since 2016, 41 had a multisectoral, One Health component related to a zoonotic disease	Identification and documentation of the strengths and gaps in the functional, operational aspects of implementation of IHR capacities in the specific scope reviewed or tested through exercises	www.who.int/ihr/publications/WH0-WHE-CPI-2017.10/en/ https://extranet.who.int/sph/simulation-exercise https://extranet.who.int/sph/after-action-review https://extranet.who.int/sph/ihrmef www.who.int/ihr/procedures/monitoring/en/
Joint External Evaluation (JEE)	WHO	Assessment and monitoring	Evaluation of national capacity – particularly infrastructural capacity – in 19 technical areas that cover the scope of IHR core capacities. Includes evaluation of capacity for collaboration across sectors for public health outcomes. One of the four components of the IHR Monitoring and Evaluation Framework	To provide expert assessment of country capacities under IHR and to identify strengths and areas for strengthening and priority actions to be taken in each of the 19 technical areas being evaluated. Allows continual strengthening of capacities for the implementation of the IHR and, through iterative evaluations, monitoring of progress	Voluntarily undertaken every four to five years by a country, in two stages, using the JEE tool. 1) An initial self-evaluation conducted by the country; and 2) an in-country evaluation conducted jointly by a multisectoral external team and a team of national experts from all relevant sectors. Normally initiated by Ministry of Health; WHO supports logistics and implementation; OIE and FAO are generally invited as external experts	As of 6 November 2018, 86 countries have completed a JEE	Final report prepared by the external team in collaboration with the multisectoral national team and validated by the national government. The report includes, for each of the 19 technical areas, a review of capacity in that technical area, including strengths and areas for strengthening, priority actions, and scores for each of the indicators. The report is posted on the WHO website once cleared by the national government	https://extranet.who.int/sph/sites/default/files/document-library/document/9789241550222-eng.pdf https://extranet.who.int/sph/ihrmef
National Action Plan for Health Security (NAPHS)	WHO	Action planning	Country Planning for Health Security is an activity of Member States that enables them to develop their NAPHS, with the support of WHO. The activity includes coordinating and collaborating on different areas of health security, defining national stakeholders’ roles and responsibilities, and consolidating the information into a single comprehensive national action plan. The principles of Country Planning for Health Security are country ownership, active partnerships, and WHO leadership	To plan and monitor the strengthening of activities required for compliance with the IHR	WHO supports countries in the process of collecting information, planning and conducting the workshop, and developing the plans	As of 6 November 2018, 38 countries have developed an NAPHS	A costed plan to improve the national health system and national and global health security	https://extranet.who.int/sph/country-planning
One Health Systems Mapping and Analysis Resource Toolkit (OH–SMART)	University of Minnesota	Assessment, action planning and prioritisation	The OH–SMART process includes six steps and is designed to map and analyse complex One Health challenges such as zoonotic disease outbreaks or antimicrobial resistance. The six OH–SMART steps are: 1) Identify stakeholder network 2) Interview stakeholders 3) Map the system 4) Analyse the system 5) Identify improvement opportunities 6) Develop an action plan	The tool is targeted to government Ministries, coordination mechanisms/platforms and organisations looking to: 1) improve One Health collaboration in practice by moving from relationship-based systems to institutionalised approaches that maximise resources and effort and provide mutual benefit 2) identify practical and targeted interventions at specific points across the system 3) provide One Health leaders with a suite of tools for stakeholder engagement, advocacy and ongoing collaboration	OH–SMART is best applied to complex challenges that require a multisectoral and multidisciplinary approach to improve system efficiency and effectiveness. Examples: 1) Pro-actively, to develop surveillance plans, investigation and response plans, workforce development plans and other action plans or simply to improve understanding of the current system around a One Health challenge 2) Retroactively, to analyse an actual system response to a One Health challenge and develop a plan for improving future responses 3) Just in time, during an outbreak or other crisis, to analyse and improve response systems as they are being implemented	A total of 17 countries have used OH–SMART to strengthen One Health systems for prevention, detection and response to infectious disease threats. 1) National AMR Action Planning in South-East Asia; 2) Development of National Zoonotic Disease Workforce Plans in Africa; 3) Action planning for multisectoral coordination mechanisms in Africa and Asia; 4) After Action Review of zoonotic disease outbreaks in the USA; 5) development of action plans for prioritised zoonotic diseases in South-East Asia, the USA and Europe; 6) strengthening zoonotic disease surveillance and communication plans in South-East Asia	1) Mapping and analysis of multisectoral agency systems 2) Improvement in agency coordination and collaboration around a specific crisis, outbreak or other complex challenge 3) Multisectoral systems improvement through pro-active planning, retroactive analysis of events and/or just-in-time response using actionable implementation plans developed during the OH-SMART Workshop 4) Development of a consensus action plan to advance systems strengthening across sectors	www.vetmed.umn.edu/centers-programs/global-one-health-initiative/one-health-systems-mapping-and-analysis-resource-toolkit
One Health Zoonotic Disease Prioritization (OHZDP) Process	Centers for Disease Control and Prevention	Prioritisation	The OHZDP process uses a multisectoral, One Health approach to prioritise endemic and emerging zoonotic diseases of major public health concern that should be jointly addressed by national human, animal, and environmental health sectors and other relevant partners The OHZDP tool is flexible in scale and can be applied at the regional, national or sub-national level. The process uses a standardised, mixed-methods approach and is implemented by trained facilitators	The OHZDP process was developed to focus the use of limited resources to build capacity and reduce the impact of prioritised zoonoses using a One Health approach. The OHZDP process is a transparent process that involves all of the relevant One Health sectors and partners working together and providing equal input, which helps to enhance and strengthen One Health networks	The OHZDP process is conducted upon the request of a country, region, or other jurisdiction and consists of an in-person workshop that gathers relevant One Health Ministries and partners to prioritise zoonotic diseases of greatest national concern for One Health collaboration. The OHZDP workshop consists of five steps. Step 1 (Preparation and Logistics) is completed prior to the workshop. Steps 2–5 (Criteria Development, Question Development, Ranking and Scoring the Zoonoses, and Next Steps and Action Planning) occur throughout the multi-day workshop	The OHZDP Process has been used at regional, national, sub-national, and local levels. The process has been used in over 20 locations around the world in various regions and languages	Prioritised list of zoonotic diseases that are agreed upon by all stakeholders by the end of the workshop Discussions about next steps and action plans for prioritised zoonoses and One Health implementation Workshop summary, available shortly after the workshop so governments can begin to work collaboratively to address the newly prioritised zoonoses Final workshop report that is reviewed and approved by all relevant One Health sectors that can be shared with potential funding partners and collaborators	www.cdc.gov/onehealth/global-activities/prioritization.html www.ghsagenda.org/packages/p2-zoonotic-disease
OIE Performance of Veterinary Services (PVS) Pathway (PVS Evaluation, Evaluation Follow-Up, Gap Analysis, Legislation mission, Laboratory mission, veterinary education support, public–private partnerships, etc.)	OIE	Assessment	Voluntary, multi-staged, continuous process which uses a set of complementary tools designed to assist Veterinary Services in improving their capacity to undertake their animal health, veterinary public health and other regulatory functions in closer compliance with the international standards of the OIE Codes.(a) The OIE PVS Pathway has a strong systems approach and supports the strengthening of the cross-sectoral capacities that are needed for the control of zoonoses, food safety and AMR	To promote the strengthening of Veterinary Services and improve their compliance with the international standards in the OIE Codes(a)	OIE PVS Evaluation: Conducted upon country request by certified OIE PVS Pathway experts; evaluation focuses on four Fundamental Components: 1) Human, physical and financial resources 2) Technical authority and capability 3) Interaction with interested parties 4) Access to markets	As of 1 October 2018, 135 PVS Evaluations, 96 PVS Gap Analysis missions, 51 PVS Evaluation Follow-Up missions, 62 PVS Veterinary Legislation missions, and 14 PVS Laboratory missions have been implemented. The PVS Evaluation is one of the two background documents used in the IHR/ PVS National Bridging Workshops. The OIE PVS Gap Analysis report and costing of the key veterinary public health activities can feed the development and costing of the WHO National Action Plan for Health Security	OIE PVS Evaluation: comprehensive assessment of the country’s animal health system, providing a complete overview of the Veterinary Services’ organisational structure, animal health, food safety and regulatory activities, their weaknesses and strengths	www.oie.int/en/solidarity/pvs-pathway/
States Parties Annual Reporting under the International Health Regulations (2005; SPAR)	WHO	Assessment	Self-assessment of national core public health capacities, particularly infrastructural capacity, as required under the IHR (2005), to prevent, detect, and rapidly respond to public health threats, whether occurring naturally or due to deliberate or accidental events. Includes evaluation of capacity for collaboration across sectors for public health outcomes. Is one of four components of the IHR Monitoring and Evaluation Framework	To provide information on capacity and progress towards achieving IHR core capacities both to WHO and to the country itself	Obligatory annual self-assessment, information reported to the World Health Assembly, provided to the secretariat of IHR in WHO by the IHR National Focal Point. SPAR is the format proposed by WHO but countries are free to use another format for their reporting	State Party annual reporting to the IHR Secretariat in WHO is mandatory	Annually updated information on national capacities under IHR	https://extranet.who.int/sph/ihrmef www.who.int/ihr/procedures/monitoring/en/
Taking a Multisectoral, One Health Approach: A Tripartite Guide to Addressing Zoonotic Diseases in Countries (Tripartite Zoonoses Guide/TZG)	WHO, OIE and FAO	Implementation	The TZG provides standard, practical guidance for countries in taking a multisectoral, One Health approach to zoonotic diseases and other health threats at the human–animal–environment interface. It covers the following topics: multisectoral coordination; understanding national context and priorities; strategic planning and emergency preparedness; surveillance for zoonotic diseases and information sharing; coordinated investigation and response; joint risk assessment for zoonotic disease threats; risk reduction, risk communication, and community engagement; and workforce development	To provide practical, standard guidance from the Tripartite so that countries can involve all relevant sectors to more effectively address issues at the human–animal–environment interface using a multisectoral, One Health approach	A tool that countries can use as appropriate to fill multisectoral gaps identified through various assessments or experiences, and to operationalise national plans. Operational tools (e.g. terms of reference, templates, standard processes) are being developed for each of the included topics	None to date (released 11 March 2019)	Operationalisation of One Health approaches	www.oie.int/tripartitezoonosesguide https://extranet.who.int/sph/sites/default/files/document-library/document/Tripartite-Guidance-EN-web%20single%20page.pdf www.fao.org/3/ca2942en/ca2942en.pdf

FAO: Food and Agriculture Organization of the United Nations

WHO: World Health Organisation

^a)The OIE Terrestrial Animal Health Code and Aquatic Animal Health Code