T3 COHESA Malawi One Health Focused Group Discussion Report 11282022 - Priscah Wawire

T3 COHESA Malawi One Health Focused Group Discussion Report 11282022

Introduction:

We held a one-day FGD at the Center for Tick and Tick-Borne Diseases, on Tuesday, November 8 in Lilongwe to facilitate communication between and among the diverse One Health stakeholders and to understand the participants perspectives which are critical to determining how and why people react to One Health concerns in the way they do and to facilitate an interactive discussion of One Health topics by all participants and facilitators as one group in one location. The FGD was used to investigate Malawians' comprehension, interpretation, and legitimization of the One Health and One Health Malawi idea and strategy.

The participants shared their perceptions to better understand their creation, conceptions, and understanding of One Health. The FGD also gave insights into the meeting's variances based on organizational and individual representation to gather local expertise on the One Health idea. These encompassed aspects of animal, human, and environmental health.

The FGD was useful in examining the confluence of knowledge from the government, research, academia, the commercial sector, and non-governmental organizations (NGOs) and traditional scientific understanding on One Health subjects and priorities. Participants came from the government, the commercial sector, research, academia, and non-governmental organizations. The facilitators ensured that no unnecessary information was included, and that consensus was reached at the end of each session

Methodology (agenda) See appendix 7

We applied the Ethics-approved COHESA FGD questionnaire in this FGD. We created a list of questions (from the questionnaire) to guide each session of the focus group discussion

• Session 1: Questions 3, 4, 5, 6, 7, 8, 9, 10, 11, 13, 14, 15, 16, 21, 24
• Session 2: Questions 12, 17, 18, 19, 20, 22, 23

We identified volunteers from the previous individual interviews to ensure we had the necessary group dynamics and synergistic ties among participants, to collect data on One Health. Purposive sampling was utilized to guarantee that participants had the ability and capacity to submit meaningful information on One Health.

The facilitator expressed appreciation for the participants' participation in the focus group discussion and encouraged everyone to talk freely, share their professional experiences, and participate actively, adding that there are no "correct" or "incorrect" responses to the questions. The collected data would be used to provide and inform targeted help for Malawi to achieve its One Health objectives and goals. Participants were also urged to talk openly and truthfully as individuals or representatives of their respective organizations. The facilitators took notes for reporting purposes and created an audio recording of the interview to ensure that the information from our discussion was accurately presented. The facilitators further promised the participants that all information acquired would be kept confidential and utilized solely for the purposes of the research. The responses of the participants would not be shared with anyone within their organizations, households, or communities. The facilitator began the conversation after describing the FGD procedure to the participants.

There were fourteen participants, and the moderators divided the group into smaller groups to address different equations before bringing them back to the plenary to share their own discussions.

The analysis of the FGD was under the following five (5) major themes:

1. Education, training, and capacity development
2. Collaborations 
3. Participation and Intersectoriality
4. Sustainability
5. Priorities

1. Education and Training

This theme was addressed by five questions (9, 16, 17,18, 23)

9.  Do you think there is a broad enough spectrum of disciplines and fields of expertise currently working on One Health in your country? Why or why not?

• In the opinion of all participants, Malawi lacks a sufficient range of disciplines and fields of competence. Many highlighted the fact that the concept is very new and in its infancy as the cause. There are no well-established governance frameworks through which this expertise can be utilized and fostered. Little understanding across fields that may be implicated in OH. Additionally, there are little training possibilities in OH to advance the specialties and fields.

16. Is formal training in One Health important? Why or why not?

• Most participants believed that formal training in One Health is crucial because it provides a pool of experts who can conduct OH mandates throughout time. It is also vital to provide students with opportunities to collaborate across disciplines early in their careers to prevent silos in their later professional endeavors. Additionally, formal education reinforces the concept and practice of One Health in professional employment.

17. What type of One Health training is available in your country? 

• The participants noted that primary and secondary schools lack access to One Health training. One training has just begun in other tertiary institutions, which offer cross-cutting training across the three components, but not as an integrated One Health course. MUST provide complete training in One Health. One Health in its entirety. On-board modules for One Health, Environmental Health, and Animal Health were included on purpose. Previously, only Environmental Science (ecotoxicology, studying the environmental ecological footprint, and waste management at the human health level) College of Medicine possessed a master's degree for the One Health components: Animal Health, Public health (human side of One Health). LUANAR-offers public health training for One Health Training, which focuses on animal interaction and One Health. KUHES provides students with One Health training.
• Currently, Malawi's One Health training is limited to higher education institutions, of which less than three (and even fewer courses) offer OH training. Currently, MUST offers master’s and Doctoral programs in Ohio. However, participants highlighted that student demand for OH training and courses is considerable. (The given course information is listed in appendix 6) The participants were uncertain as to whether there was a course for skill enhancement for food system actors. 

18. Do you feel there are any gaps in One Health education in your country? If your answer is yes, explain where these gaps are. 

• In elementary and senior schools, there is a dearth of training in One Health. Instead of emphasizing all three facets of One Health, tertiary institutions stress only one. Despite the enormous demand, few institutions of higher education offer One Health courses. Participants noted deficiencies in one health education, noting that One Health has not been incorporated into elementary and secondary school curricula. There is no lower education program that includes health education. They also emphasized that higher education in One Health is only available at a handful of universities, including MUST, and that it begins at the master's level rather than the undergraduate level. Several respondents said that insufficient research has been conducted to determine One Health educational requirements. Numerous participants concurred that present courses that are delivered in fragments and focus on a single field are not comprehensive.

23. Please rank the following One Health training needs for tertiary education students in your country – 1 is most important, and five is least important

• RANK 1: Resource mobilization for One Health
• RANK 2: Use of One Health in delivery of curative and preventative health services
• RANK 3: Use of One Health in surveillance, risk assessment and preparedness
• RANK 4: Use of One Health in research
• RANK 5: One Health theory
• RANK 6: Personal and group skills for One Health work
  

2. Collaborations

4. Which of your organizations/institutes belong to external One Health structures/working groups? Please list these external structures. 

• DAHLD and PHIM working to create a One Health platform for the Government of Malawi.  The mandates remain in draft form.
• LUANAR Department of Animal Science is a key member of the Innov8 4Health Initiative, established in 2022. This is a collaboration with University of Hohenems, Germany.
• CTTBD is a participant in African Union One Health Forums, last held 2019.
• MUST has ongoing disucssions with Addis Ababa University, Georgetown University, and other international academic partners to strengthen the One Health MSc and PhD programmes and research initiatives at MUST. 

12. Please list all the groups and disciplines you know to be working on One Health in your country.

• PHIMWHOMUBASMLWEADEnvironmental health assoc.CDCFAODNPWKuHeSLSPCALiverpool trustMUSTDAHLDWESMMOHWaterAidDept of fisheriesLUANARUSAIDLWTBSPCAAll creaturesOne Health task force

3. Participation and Intersectoriality

 7. Does your workplace/institute have power imbalances? Across gender, disciplines, sectors, ethnicities, and social class? How does this impact work in One Health? 

• All participants believed that power disparities existed at their place of employment. Most work environments were dominated by men, and few women participated in the decision-making process. It was emphasized, however, that women were not excluded from decision-making per se, but because fewer women held leadership positions. Those already in positions of authority actively participated in decision-making. Some individuals remarked that ethnicity was not heavily considered but could be a factor in some workplaces.

8. Do you work face to face with people who work on One Health in your institute? Across disciplines? Nationally? Why or why not? And how does this impact your work

• Many participants disagreed with this assumption, stating that One Health is still a new concept in Malawi and that there is no specific coalition of individuals working on one health concern. A few participants admitted that, while working in the field of environmental health, this is the first time they have heard of One Health and that they have never collaborated with colleagues working in the OH sector. They were uncertain as to how this would affect their work. Nonetheless, a number of participants partially acknowledged that they do communicate with colleagues from other disciplines but noted that this was not a regular occurrence and that they only did so to solve a health issue that required a multidisciplinary team. When there was an anthrax outbreak among wildlife and a multidisciplinary team was assembled to manage the problem, this is a good illustration.

10. How are people selected to work on One Health? How are different disciplines involved? 

• One Health in Malawi is still in its infancy, but a One Health Task Force was established a year ago to address multidisciplinary health issues. This task force has not legally passed the institutionalization procedure that authorizes it to operate on behalf of the government (creation of TOR, Ministerial ascension, and launch). Instead, it functions as a consultative platform for specialists in one health space. Consequently, this is still a work in progress, and individuals join One health at various times.
• A member of the group remarked that this gathering felt like an introductory session for one health actor to initiate further conversation.
• Currently, it is believed that One Health is dominated by Veterinary practitioners and other experts from the Animal health sector, with considerable interactions with specialists from the Human health sector, but with minimal participation from environmental health professionals.

13. Are non-scientific disciplines/actors involved in One Health in your country?

• The community players have been the major non-scientific actors who have been prominently involved in one health effort. Over time, these individuals have been involved in all elements of outbreak investigations. Notably, cholera and anthrax were discussed previously.

4. Sustainability

6. Does your workplace/institutes approach One Health in a way that aligns with National Priorities? Global Priorities? Why or why not?

The participants could not agree on what national priorities were; some said there were no channels to reach out to the environment, while others said there were imbalances that needed to be addressed, such as human health receiving and having a larger budget while animal health receiving a smaller or no budget. Given that climate change can be addressed through forestry, forestry is underrepresented as a One Health component. It is also necessary to comprehend the scope of forestry. Some participants noticed poor resource coordination, such as cholera management, and that teams were working in silos, as well as a lack of support for human resources for health, which are crucial to addressing the critical parts of One Health. The team recognized that there was a need to deepen One Health coordination to ensure that well-funded human health can support the other areas, as well as to examine options for resource shifting in the future. There was discussion that the lack of coordination needed to be addressed at the policy level, and while the human and animal health teams spoke with one another, the environmental team was left behind and was rarely included in the One Health implementation.

14. Does your country have a common One Health plan/objectives to guide One Health work? Do you follow it?

• Malawi has no existing One Health policy or strategic plan to guide OH work, although such a policy is currently being drafted. 
• There are several One Health initiatives that have stand alone plans that guide activities, notably, the AMR strategic plan.

5. Priorities

19. What are the priorities for building One Health capacity in your country? (Education; Policy Research; Implementation Collaboration; Financial resource)

• Research and collaboration received the highest priority areas for building momentum of OH in Malawi. Participants strongly felt that OH needs are not well articulated now. A well-researched landscape needs to be established to define the OH needs of the country. Creating a collaborative environment also came out as a high priority, recognized as a pillar for moving the OH agenda in the country. Policy and multisectoral coordination and collaboration was thought to be the foundation for creating an enabling environment for OH.

Other themes that came out as priority included:

• Human resource capacity
• Infrastructure support
• Laboratory capacity
• Research
• Public awareness
• Education- all levels integration of OH issues at all levels of education
• Data management and sharing
• Surveillance

20. What are One Health priority topics in your county? options from one being most important to seven being least important 

• RANK 1: Managing emerging zoonoses
• RANK 2: Antimicrobial resistance and discovering new therapies
• RANK 3: Foodborne illness and diseases 
• RANK 4: Feeds, forages, and plant health 
• RANK 5: Managing neglected zoonotic diseases 
• RANK 6: Landscape health management and the interface of wildlife/protected areas

Non ranked free-form answers in addition to the above, included:-

• loss of biodiversity
• fish and fisheries  health
• waste management, and
• occupational health

22. Please provide three suggestions for improving the capacity of the future One Health workforce.

Priority activities for COHESA Malawi: Workshops on:

• Governance structures
• Awareness
• Review existing governance structures
• Try to produce national structure
• Communication of existing government policies
• Workshops for OH in higher education and line ministries and private sector stakeholders

Conclusions of the COHESA Malawi Focused Group Discussion Report - 28.11.2022

Overall impressions by the research team.

• Across sectors, there is a high level of enthusiasm for One Health as a concept, good understanding of potential benefits of One Health approaches,  and recognition of the need for formalized collaboration in research, education, emergency response, disease surveillance/public health.  Such collaboration is unlikely to happen without outside impetus and development of formalized structures; such structures could be at national or institutional levels.  
• Particularly in the animal health sector, there is concern for lack of consistent funding.  All sectors support an increased role of PPP to further One Health initiatives.
• Consistent with other baseline assessment activities, there was limited participation from the environmental health sector, although the importance of the environmental sector is well recognized by the human-health and animal-health sectors. 

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