Strengthening one health systems: A readiness assessment across Croatia, Ghana and Nigeria.

Background: Despite widespread endorsement, many countries continue to face challenges operationalizing One Health. Existing assessment tools are often fragmented and limited in scope, focusing on specific technical functions (e.g., surveillance, coordination, or prioritization) or diseases (e.g. AMR, zoonotic disease) and rarely integrate governance, environmental health, evidence-informed policymaking and strategic prioritization within a single systems assessment. The Knowledge- to-Policy (K2P) One Health System Readiness Assessment (KOHSRA) tool addresses this gap by integrating a comprehensive systems-level readiness assessment across the human-animal-environment interface with structured priority setting, enabling countries to translate assessment findings into strategic priorities for policy and implementation. Methods: Within the One Health-Evidence-Informed Policy Approaches (OH-EVI) project, we piloted KOHSRA in Croatia, Ghana and Nigeria. The tool employed a standardized, facilitated national self-assessment process, comprising two phases: Assessment and Prioritization. The assessment phase combined documentary review, stakeholder mapping and multisectoral consensus workshops across five components: (1) One Health system foundation; (2) One Health risk profile; (3) Policy coherence and One Health integration; (4) Evidence-informed policymaking for One Health; and (5) One Health stakeholder landscape. The prioritization phase synthesized assessment findings into country-specific SWOT profiles, which informed the identification of strategic priorities for policy and implementation. Results: All three countries demonstrated foundational One Health capacities including sectoral institutions, technical expertise, surveillance arrangements and coordination mechanisms, but these remained insufficiently institutionalized within routine national systems and varied in maturity. Common cross-country gaps included fragmented governance and multisectoral coordination, the absence of dedicated domestic financing, weak surveillance interoperability, limited environmental integration, and insufficient mechanisms for evidence synthesis and knowledge translation. The prioritization phase translated these findings into context-specific strategic priorities, with recurring themes including strengthened institutional governance and multisectoral coordination, integrated surveillance across the human-animal-environment interface, sustainable financing, workforce development and One Health education, AMR control, and climate resilience. Conclusions: KOHSRA represents a practical framework that can support countries in assessing national One Health system readiness and identifying context-specific priorities for policy and implementation. Its application in Croatia, Ghana, and Nigeria identified common system readiness gaps and context-specific priorities for strengthening national One Health systems. Future applications in additional countries and formal validation studies are warranted to strengthen the evidence base supporting its broader applicability.