One Health in Sub-Saharan African Medical Curricula

Background: There is an urgent need to adapt health systems to consider the interface between
human, animal and ecosystem health, which converge in the One Health (OH) approach. Today,
there are numerous global health challenges, including climate change, biodiversity loss, the
globalization of disease spread, and food insecurity. These events negatively affect human health.
Thus, medical doctors, particularly in Sub-Saharan Africa (SSA), should know about OH-related
factors and the social determinants of health so that they can provide more holistic patient care.
However, there is little research about OH awareness among medical practitioners in SSA. This
study was thus completed to identify if and how medical education institutions from SSA integrate
OH into their medical curricula.
Methods: This mixed methods, cross-sectional study used purposive sampling to explore the
comprehensiveness of OH integration into the curricula of SSA medical education institutions.
Participants were sampled from accredited SSA medical education institutions and were either
Deans, Administrators, or Faculty members with self-reported knowledge about their institutions’
medical curricula. Two data collection tools, survey questions and an interview guide, were used
to gather participants’ insights. Questions focused on OH topics and competencies integrated into
medical curricula, how they were integrated, the sufficiency of OH topic and competency
integration, and associated benefits and challenges. Survey information was gathered using an
online QualtricsXM survey and phone or online calls. To test for associations among quantitative
variables, logistic regression and odds ratios were used, and thematic analysis was used for
qualitative data. A comprehensiveness checklist guided the categorization of institutions’ OH
content into “very sufficient,” “sufficient,” and “room for improvement” groups.
Results: A total of 61 participants from 27 SSA countries completed the survey. Among these
participants, 23 also completed a semi-structured interview. The overall response rate was 28.1%.
The most common OH topic reportedly integrated into medical curricula was epidemiology (n=56,
93.3%). Regarding OH competencies, ethics and values were the most common (n=40, 66.7%).
Interviewees commonly linked zoonotic/vector-borne diseases, collaboration, and research with
OH. Based on the comprehensiveness checklist, most participants’ institutions (N=43) fall under
the category of having “room for improvement” (N=37, 86.0%). The most commonly cited
benefits of OH were “holistic patient care” and “provision of better health care services for all.”
For the participants that integrated OH (N=43) and those that didn’t (N=18), they cited “not enough
time” (n=23, 53.3%) and “lack of faculty knowledge” (n=16, 88.9%) as the biggest barriers to
integrating OH, respectively.
Conclusion: This study demonstrated gaps in OH integration into SSA medical curricula. Animal
and environmental health experts are insufficiently involved in medical curricula development,
and medical students still study in silos. This has contributed to having medical doctors who are
not sufficiently prepared to address current global health issues affecting human health. Thus, there
is an imminent need to train both medical teaching staff and future medical doctors to provide
holistic patient care using the OH approach.