The presentations summarized the main achievements of NEOH. The workshop participants had the opportunity to confront the One Health initiatives they designed with the rationale of a One Health evaluation, through the framework, the protocols, and the tools proposed by NEOH, and to approach a One Health economic assessment. The conference programme can be downloaded here. The summer school programme can be downloaded here. Dr Anastasios Saratis, local organiser and moderator warmly welcomed participants and presented the programme for the day.
Barbara Haesler set the scene for the workshop by talking about some of the origins and history of One Health and describing some key milestones in the One Health community. She then raised the question of the value of monitoring and evaluation and challenges associated with the evaluation of complex activities that can produce multiple outcomes that may be difficult to attribute to the initiative. She observed that in the evaluation of complex initiatives it may be equally relevant to look at the quality of the initiative instead of aiming to focus solely on the outcomes.
Dr Haesler finalised her talk with the question whether benchmarking with the NEOH tools would be possible given the large heterogeneity of contexts, settings and epistemiologies. She mentioned the lack of an established national One Health support system in Greece, with both the medical and veterinary services working apart, with some exceptions related to significant outbreaks such as the West Nile Fever outbreak.
A first attempt in this direction was the establishment of the Hellenic Scientific Society of One Health.
They had notices that medical services and veterinary services were both focusing on unusual clinical signs, history taking, sample collection, diagnosis confirmation, but there was no link across animal and human species. Based on that joint PhD theses with other institutions started e.
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They have also a signed agreement with the major water companies for the surveillance of surface, drinking and waste waters for microbial and parasitic infections. They also participate in a large project by HAO Demeter on the safety of surface waters assigned by the Ministry of Environment and Energy. Examples of parasites mentioned were Giardia and Cryptosporidia with the aim to estimate prevalence in different animal species and humans, characterise the zoonotic potential of those species and identify possible risk factors associated with infection, taking an interdisciplinary approach into account.
During the Q-fever outbreak in it became evident that communication and collaboration across sectors was difficult, which set in motion a commissioned analysis that identified the need for a more systematic approach of sharing and assessing signals. As a result, there was a recommendation to improve early warning and control of re- emerging zoonoses. Consequently, an integrated human-veterinary risk analyses structure for efficient signalling, risk-assessment and control of emerging zoonoses in the Netherlands was established.
It consists of an integrated structure Signalling Forum Zoonoses SOZ that assesses normal and urgent signals every month supported by a response team, outbreak management team, and an expert forum zoonoses when needed. Examples of Schmallenberg virus, Seoulvirus and Brucella suis were used to illustrate how the integrated risk analysis structure successfully picks up new events and enables investigations, risk assessments and response.
It was pointed out that institutional memory is crucial. A key success factor of the risk analysis structure is the long-term funding commitment from the Netherlands in combination with the associated official mandate. While the structure is functioning and funded under the ministries, for signalling collection it depends on the wider surveillance system and disease reporting by all health professionals, laboratories, and authorities, among others.
Hence, its success is also greatly supported by the established surveillance infrastructure. It aims to collect and analyse surveillance and outbreak data on foodborne zoonoses and capacity building within and between EU countries. He pointed out that One Health focuses on the health of people, animals and ecosystems, which differentiates it from other interdisciplinary collaborations. He presented several public health organisations in Slovenia that use a One Health approach to address cases of disease. The work is performed according to a yearly plan for monitoring of the agro-food chain, approval and registration of establishments including laboratories.
The National Veterinary Institute is part of the Veterinary Faculty and has all duties of such an institute, including designated laboratories, national reference laboratories, pathomorphological diagnostics and veterinary-hygienic services, review of the health status and treatment of fish and bees. The NDCC brings together specialists from public and animal health sectors for this task. Slovenia has also established a cross-sectoral zoonotic unit that meets annually.
There is a good One Health collaboration along humans health —animals health — safer environment supported by some legislation zoonosis, drugs, residues , and research individual level. A gap was identified at the educational level, as integrated education opportunities are scarce. The project Public Health in the Western Balkans — was established to promote communication among disciplines and build a One Health based educational master programme in Western Balkan countries to create One Health experts with graduates from various disciplines who have a global version of health problems, and who can learn a common language to establish public health plans and to solve problems from a OH points of view.
This Tempus funded project included six institutions in six countries supported by higher education bodies with the aim to create nationally accredited programmes. The Advanced Master Training course gained accreditation in two countries and is on offer in Sarajevo and Pristina; it covers survey and surveillance systems, public health regulation and risks analysis, emergency preparedness and food security and food safety, decision-making, zoonotic and emerging diseases. For each subject, there is staff from the veterinary and medical sectors.
The courses have generally been well received by students who claim that the study was useful for them and that they were happy to get involved in it, but they think also that it included too much obligations for 2 semester study. He talked about implementing One Health in Romania, the lessons learned so far and institutionalisation of One Health.
He adressed factors influencing success or failure, highlighting the importance of context and local factors, such as tradition, beliefs, social structures, and history. Historically, medicine and health was one of the five pillars on which Romanian Society was built on. For example, Victor Babes, Nicolaeu Paulescu, Ioan Cantacuzino, Ion Poenaru, and Vladimir Capatana were critical pioneers in health who made crucial contributions to the field of medicine.
So far, over 20 public and private legal entities from various domains have joined the NGO with over individual members. Barriers in academia are the lack of One Health publications and the associated lack of research income. Some members are in the process of developing a One Health master education curricula, but there are no dedicated One Health funds and there is no training of future generations in One Health.
Authorities are slowed down in progress by political and economic constraints as well as political instability, with conflicts of interest legal system, social history. Once a believer, the public buys into the concept and very willingly shares it further.
While NGOs are supportive and interested they are the main promotor of the concept , they are often constrained by the lack of funds and bad publicity due to ill intent of some and hidden agenda. Alexandru Supeanu concluded that Romania is on a positive, albeit slow track and is hoping for major breakthroughs with the support of the authorities and the creation of One Health opportunities for students.
She outlined the objectives of this working group, the selection of case studies, and the general approach used including the use of NEOH networking tools such as short term scientific missions and training schools that helped to learn how to use the NEOH tools. Because the majority of evaluators were not familiar with such evaluations, the learning curve was perceived to be very steep and the work intense.
The evaluations in all case study teams were rather time consuming, but Dr Savic thought that it was worth it: She concluded that the new tools to measure One Healthness work and that they allow generating relevant and useful information on One Health initiatives. Afifah Rahman-Shepherd then gave a presentation on evaluating One Health initiatives reporting on One Health networks that they evaluated and their key findings and recommendations.
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It was found that there is no normative definition of how to operationalise One Health and that there is a dearth of monitoring and evaluation reports. Chatham House had elaborated a theory of change with activities, outcomes and impact; these elements were then discussed by international experts in Chatham House roundtable event. Following the presentation, Afifah Rahman-Shepherd facilitated a discussion on the lack of One Health governance and operationalisation and how this could be addressed by the international One Health community.
Other people observed that several international powerhouses have acknowledged One Health, but that this did not lead to funding for countries which can be a barrier in resource-scarce settings. One participant observed that convincing stories are needed to get support for One Health.
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He explained the services they offer in the laboratory and mentioned the good collaboration with the University hospital in Thessaloniki and other hospitals that require specific diagnostic testing for parasites. They also work with suspected cases with clinical signs that require testing for parasitic diseases such as leishmaniosis, toxoplasmosis, or toxocara. Often, healthy individuals are also subjected to testing, for example when health certificates are needed e. Papadopoulos believes that Greece makes use of a wide range of One Health opportunities and mechanisms, but that it is very often based on personal contact networks and the initiative taken by individuals.
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The driving force behind the establishment of the Society were local champions in local networks. A key preceding event was the organisation of a workshop in that demonstrated big interest for a more formal structure that would span many different areas, sectors and disciplines.
The mission of the new society is the implementation of the principles of One Health in Greece through scientific and social activities towards health professionals, decision-makers, government and public. Dr Dimitrios Arvanitis observed that the trend in medicine is towards holistic medicine and that One Health is an essential aspect of this. Financial pressures and lack of funding is a constant challenge. It is an early collaboration, but they are willing to extend collaborations and learn from other specialisations.
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The private sector has been approached too in order to attract funding. He then explained the bigger funding picture of funding and highlighted the importance of the project producing results, dissemination and use, and generating impact that would then once again influence policy and the funding structure and calls. He explained the different programmes, thematic categories and beneficiaries and pointed out suitable calls and programmes, e. After meeting end a dinner was organised at Panellinion restaurant to round up a successful and interesting workshop.
In the evening, the group enjoyed an excellent dinner in a local, traditional restaurant. The very fruitful day finished with suggestion for optional diner and networking between participants.
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