Is it feasible to develop a one health surveillance system in a fragile state? The case of Guinea-Bissau.

Background: Guinea-Bissau is a fragile state marked by political instability, weak governance, and fragmented institutions. Despite these challenges, recent international support and policy initiatives have promoted a growing interest in adopting a One Health (OH) approach to integrated human, animal, and environmental health surveillance. Objectives: To explore the feasibility of developing a national One Health surveillance (OHS) system in Guinea-Bissau through stakeholder insights into governance, system integration, and technological and community factors. Methods: A qualitative study, specifically a focus group discussion with seven purposively selected professionals from human, animal, and environmental health sectors, was conducted. Participants were experienced stakeholders from national institutions, non-governmental organizations, and international agencies. Discussions were guided by a pre-tested script, recorded in Creole, transcribed into Portuguese, and analyzed using inductive Thematic Analysis. Results: Key barriers identified included: (1) political instability and lack of legal frameworks undermining long-term governance; (2) fragmented and uncoordinated health programs with limited territorial reach; (3) poor integration of surveillance systems and technological infrastructure; and (4) insufficient funding and training. However, participants highlighted opportunities, such as leveraging digital technologies (e.g., drones, artificial intelligence, big data), public-private partnerships, and increasing international engagement. Emphasis was placed on developing inclusive, interoperable platforms across different sectors and ensuring ethical data governance. Community involvement and tailored capacity building were deemed essential to system resilience and effectiveness. Discussion: Findings align with regional and global evidence on the structural and operational barriers to OH implementation in fragile contexts. Despite major challenges, a phased, multisectoral strategy supported by legal reforms, sustainable financing, technological adaptation, and inclusive stakeholder engagement could enable Guinea-Bissau to build a functional OHS system. Conclusion: Developing a OHS system in Guinea-Bissau is feasible if supported by institutional reforms, digital integration, sustained funding, capacity building, and strong community and civil society participation. Strategic coordination across sectors, grounded in ethical and equitable frameworks, is essential for long-term success.