Strengthening One Health implementation at the national and subnational levels in the Democratic Republic of Congo: A 5-step implementation framework.

Introduction: The Democratic Republic of the Congo (DRC) institutionalized the One Health approach over a decade ago to address complex challenges at the human-animal-environment interface. This study assessed the level of knowledge integration achieved through One Health implementation at national and subnational levels and identified key challenges and actions for sustainable implementation. Methods: We applied the framework and tool developed by the Network for Evaluation of One Health (NEOH) to evaluate knowledge integration across six dimensions: Systems Thinking, Planning, Transdisciplinary Working, Sharing, Learning, and Systemic Organization. The tool was translated into French and used by trained interviewers to collect data from stakeholders involved in One Health activities. For analysis, we aggregated the data according to participant characteristics (site, sector, gender) and calculated dimension scores, as well as the One Health Index (OHI) and the Ratio (OHR), which compares operational aspects (Thinking, Planning, Transdisciplinary working) with infrastructure dimensions (Learning, Sharing, Systemic Organization). We used data from multisectoral participatory workshops to identify challenges and activities to sustainable One Health implementation across governance levels. Results: A total of 138 stakeholders were interviewed across eight sites, including national, provincial (Kinshasa, Équateur, Haut-Katanga, Kasaï-Oriental, Kwilu, Kwango), and communal levels. Participants represented human (45%), animal (38%), and environment (17%) health sectors. The findings reveal limited knowledge integration capacity with variation across governance levels with encouraging performance for operational dimensions (Planning, Thinking and Transdisciplinary working). However, the infrastructure (Sharing, Learning and Systemic Organization) to sustain this collaboration is limited or inexistent. The Thinking dimension scored highest nationally (0.75), while Systemic Organization was strongest in Kwango (0.70). Conclusion: We propose a 5-step implementation framework starting from sector-specific capacity development to the development of a common vision as part of a multisectoral coordination backed by political commitment and funding.