Integrating One Health governance in China: Assessing structural implementation and operational entry points.

Background: In China, despite the establishment of a top-level One Health framework to address the interconnected risks of zoonotic diseases, antimicrobial resistance (AMR), and environmental degradation, significant challenges persist in translating this vision into effective implementation. The country's large agricultural sector, dense population, and diverse ecosystems require coordinated governance across human, animal, and environmental health sectors. However, gaps remain in resource allocation, cross-sector coordination, and policy integration. This study evaluates China's One Health governance through four structural domains-Monitoring & Evaluation, Intervention & Response, Surveillance & Early Warning, and Capacity Building-and four operational entry points-Technology, Information, Human Resources, and Finance. The aim is to identify strengths, gaps, and provide actionable recommendations for improvement. Methods: A qualitative approach was employed, involving 41 in-depth expert interviews, policy document analysis, and a systematic literature review. Interviews were conducted with stakeholders from public health, veterinary services, and environmental agencies, focusing on key domains of the One Health implementation. Data were thematically coded using NVivo 12.0 and analyzed using Grounded Theory. The results were cross-checked through intercoder reliability testing to provide actionable recommendations. Results: While regular reporting mechanisms exist for Monitoring & Evaluation across human, animal, and environmental health sectors, real-time assessments remain insufficient, limiting timely, multisectoral responses to emerging health risks. A tiered emergency system supports Intervention & Response, but inefficiencies in cross-sector resource allocation and coordination hinder its effectiveness. In Surveillance & Early Warning, fragmented data collection and interdepartmental silos across different health domains impede comprehensive and integrated risk monitoring. Despite existing Capacity Building programs, large-scale interdisciplinary exercises and continuous skill development opportunities remain scarce. Operationally, diagnostic technologies like polymerase chain reaction (PCR) and geographic information system (GIS) are available but unevenly distributed. Data-sharing mechanisms exist, but bureaucratic delays and inconsistent standards hinder integration. Workforce gaps, an aging cohort, and insufficient multidisciplinary training threaten the sustainability of the One Health framework. Operational budgets and personnel incentives remain inadequate, limiting the impact of financial investments. Conclusion: Despite progress in policy and infrastructure, China faces critical gaps in One Health implementation, particularly in real-time monitoring, cross-sectoral coordination, data integration, workforce capacity, and financial support. Addressing these gaps is crucial for enhancing One Health governance and offers valuable lessons for other regions with similar challenges in integrating human, animal, and environmental health.