Operationalising the One Health Approach in a Fragile State: A Framework for Sustainable Health Security in Somalia  

Operationalising the One Health Approach in a Fragile State: A Framework for Sustainable Health Security in Somalia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Operationalising the One Health Approach in a Fragile State: A Framework for Sustainable Health Security in Somalia Abdulrazaq Yusuf Ahmed This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7018674/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Somalia, a quintessential fragile and conflict-affected state (FCAS), grapples with a poly-crisis where protracted conflict, extreme climate vulnerability, and profound health system weaknesses create a self-reinforcing cycle of instability and disease. The One Health (OH) approach, which integrates human, animal, and environmental health, is globally recognized as critical for health security, yet its operationalization in such complex environments remains poorly understood and documented. This paper aims to analyze the current OH landscape in Somalia and propose a context-engineered framework for building sustainable health security. A scoping review of peer-reviewed and grey literature published between 2010 and 2025 was conducted, supplemented by a qualitative policy analysis of national and international strategic documents. The systematic search included academic databases such as PubMed, Web of Science, and Scopus, alongside repositories of key organizations including the World Health Organization (WHO), Food and Agriculture Organization of the United Nations (FAO), World Organisation for Animal Health (WOAH), United Nations Environment Programme (UNEP), World Bank, and International Livestock Research Institute (ILRI). Data were systematically charted and synthesized using a thematic framework aligned with core OH operational domains: governance, finance, surveillance, human resources, and community engagement. The reporting of this scoping review adheres to the principles of the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines to ensure methodological transparency. The analysis reveals a landscape of nascent OH structures hindered by systemic gaps. Governance is fragmented by political divisions and the absence of a legally-backed national OH strategy. The health sector is over 90% dependent on donor funding, undermining sustainability and national ownership. Critical infrastructure for integrated surveillance, laboratory diagnostics (particularly for animal and environmental health), and data sharing is largely non-existent. A persistent "brain drain" and lack of standardized OH training depletes human capital. However, the analysis also identified significant opportunities, including a strong economic case for OH based on protecting the livestock sector (which contributes 60% of GDP), the high degree of legitimacy and functionality of traditional community governance systems (Xeer), and innovative community-based service delivery models. Key threats include a severe burden from prioritized zoonoses (e.g., Rift Valley Fever, brucellosis), an unchecked "silent pandemic" of antimicrobial resistance (AMR), and the cascading impacts of climate change on health and livelihoods. Operationalizing One Health in Somalia requires a paradigm shift from a top-down, donor-driven model to a nationally-owned, community-governed system. This paper proposes an innovative five-pillar framework focused on: (1) institutionalizing governance by integrating traditional structures; (2) building financial resilience through economic framing and diversified funding; (3) creating an integrated intelligence and response system; (4) investing in cross-sectoral human capital, including a new cadre of Community Environmental Workers; and (5) empowering communities as the foundation of resilience, with cross-cutting integration of mental health and gender equity. This systems-thinking approach aims to disrupt the poly-crisis cycle, offering a potential roadmap for achieving sustainable health security in Somalia and other FCAS. One Health Somalia Health Security Zoonoses Fragile and Conflict-Affected States (FCAS) Governance Intersectoral Collaboration Antimicrobial Resistance Climate Change Community Engagement Health Systems Strengthening Full Text Additional Declarations No competing interests reported. Supplementary Files OperationalisingtheOneHealthApproachinaFragileStateSupplementaryMaterialsforSustainableHealthSecurityinSomalia.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7018674","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":490366480,"identity":"dbbae161-322e-4166-b8f1-156a16ea1120","order_by":0,"name":"Abdulrazaq Yusuf Ahmed","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4ElEQVRIie3RsQrCMBCA4ROhXY52vYL4DJWCOPksVwKd4hMoKhQcOxd8CR+hUGyX4hzQQX0CQRAnMXZzaTsK5p9ycB8kBMBk+sUyYDgDDFyqRxp0IwyAXgq9tSbYhUBNfFUTaCfOMbvceDHF4BiXV7WYINj5ftdEvAML4kLg+FSEsSz0xTCKVBPxK2Biq49jJUextDQhfW4h4smvFQbph7y6kYjCTY4+aTLbdCCeJpMwKZFUFG5nCaHV9hanQqFuj/nQTUV2l4/l0LXzopHoj+Dv2Wpe/2Rn7Tsmk8n0370BaydIB64drHYAAAAASUVORK5CYII=","orcid":"","institution":"Demartino Public Hospital","correspondingAuthor":true,"prefix":"","firstName":"Abdulrazaq","middleName":"Yusuf","lastName":"Ahmed","suffix":""}],"badges":[],"createdAt":"2025-07-01 09:38:13","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7018674/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7018674/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88306165,"identity":"97023cf3-2bf5-455b-a251-48d91e15a534","added_by":"auto","created_at":"2025-08-05 05:54:00","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":468282,"visible":true,"origin":"","legend":"","description":"","filename":"OperationalisingtheOneHealthApproachinaFragileStateAFrameworkforSustainableHealthSecurityinSomalia.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7018674/v1_covered_eaf81dda-3006-4270-8f70-d9fe3b62c7a8.pdf"},{"id":87659201,"identity":"cc35993e-d015-4354-b10c-2819d89e305e","added_by":"auto","created_at":"2025-07-27 08:49:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":179085,"visible":true,"origin":"","legend":"","description":"","filename":"OperationalisingtheOneHealthApproachinaFragileStateSupplementaryMaterialsforSustainableHealthSecurityinSomalia.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7018674/v1/22a7cd4986ef07ef445afcf3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Operationalising the One Health Approach in a Fragile State: A Framework for Sustainable Health Security in Somalia ","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"One Health, Somalia, Health Security, Zoonoses, Fragile and Conflict-Affected States (FCAS), Governance, Intersectoral Collaboration, Antimicrobial Resistance, Climate Change, Community Engagement, Health Systems Strengthening","lastPublishedDoi":"10.21203/rs.3.rs-7018674/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7018674/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eSomalia, a quintessential fragile and conflict-affected state (FCAS), grapples with a poly-crisis where protracted conflict, extreme climate vulnerability, and profound health system weaknesses create a self-reinforcing cycle of instability and disease. The One Health (OH) approach, which integrates human, animal, and environmental health, is globally recognized as critical for health security, yet its operationalization in such complex environments remains poorly understood and documented. This paper aims to analyze the current OH landscape in Somalia and propose a context-engineered framework for building sustainable health security. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA scoping review of peer-reviewed and grey literature published between 2010 and 2025 was conducted, supplemented by a qualitative policy analysis of national and international strategic documents. The systematic search included academic databases such as PubMed, Web of Science, and Scopus, alongside repositories of key organizations including the World Health Organization (WHO), Food and Agriculture Organization of the United Nations (FAO), World Organisation for Animal Health (WOAH), United Nations Environment Programme (UNEP), World Bank, and International Livestock Research Institute (ILRI). Data were systematically charted and synthesized using a thematic framework aligned with core OH operational domains: governance, finance, surveillance, human resources, and community engagement. The reporting of this scoping review adheres to the principles of the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines to ensure methodological transparency. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe analysis reveals a landscape of nascent OH structures hindered by systemic gaps. Governance is fragmented by political divisions and the absence of a legally-backed national OH strategy. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe health sector is over 90% dependent on donor funding, undermining sustainability and national ownership. Critical infrastructure for integrated surveillance, laboratory diagnostics (particularly for animal and environmental health), and data sharing is largely non-existent. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA persistent \"brain drain\" and lack of standardized OH training depletes human capital. However, the analysis also identified significant opportunities, including a strong economic case for OH based on protecting the livestock sector (which contributes 60% of GDP), the high degree of legitimacy and functionality of traditional community governance systems (Xeer), and innovative community-based service delivery models. Key threats include a severe burden from prioritized zoonoses (e.g., Rift Valley Fever, brucellosis), an unchecked \"silent pandemic\" of antimicrobial resistance (AMR), and the cascading impacts of climate change on health and livelihoods. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOperationalizing One Health in Somalia requires a paradigm shift from a top-down, donor-driven model to a nationally-owned, community-governed system. This paper proposes an innovative five-pillar framework focused on: (1) institutionalizing governance by integrating traditional structures; (2) building financial resilience through economic framing and diversified funding; (3) creating an integrated intelligence and response system; (4) investing in cross-sectoral human capital, including a new cadre of Community Environmental Workers; and (5) empowering communities as the foundation of resilience, with cross-cutting integration of mental health and gender equity. 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