Kenya is intensifying the creation of County One Health Units (COHUs) as part of the country's strategies to prepare all 47 counties to respond to the emergence and transmission of diseases between animals and humans, the rise of antimicrobial resistance, and the safety and security of food and water.
The units prioritise communication between the healthcare and livestock industries to monitor and report zoonotic diseases and consequently facilitate swift collaborative investigations.
The country's One Health coordinating body, the Zoonotic Diseases Unit (ZDU), reported that there were functional and trained units in 31 counties in 2017. Working with the health departments in the counties, ZDU supports the counties to have skills that characterise a successful response to zoonoses. These skills include the ability to detect the outbreak using established surveillance systems, including event-based reporting and adequate laboratory capability to confirm the pathogen responsible for the disease.
Mathew Muturi, a field epidemiologist and co-lead at ZDU, said: ‘The ultimate goal of having COHUs is to minimize the adverse effects of disease outbreaks by expanding and improving the approach for all potentially zoonotic outbreaks, understanding, preventing, and controlling the endemic zoonotic diseases in the counties.’
The project Capacitating One Health in Eastern and Southern Africa (COHESA) will support ZDU in the preparation of training modules, which is part of Kenya's One Health strategy. Apart from the COHUs, the country’s strategy also tasks ZDU to establish the procedures that promote One Health, sensitise the policymakers and advocate for the appointment of One Health focal leads in the counties. ZDU will also hold regional review meetings to evaluate the progress of the One Health activities.
However, it has not been fully implemented at the subnational administrative levels due to concerns over sustainability, shortage of funding, and other competing priorities in the counties.
COHESA Lead at the University of Nairobi, Salome Bukachi, said establishing the COHUs is especially critical since health is now devolved, and all 47 counties are responsible for responding to diseases that break out in their counties, especially after years of systemic neglect by the national government.
In a 2017 paper, Bukachi and her colleagues detailed how the arid counties in the North of Kenya suffered the most economic and human effects during the 1997 and 2006 Rift Valley Fever Outbreaks, which resulted in 27,500 human infections and 170 deaths. While the 2006/07 Rift Valley outbreak was more geographically widespread, it had better coordination and timely diagnosis and resulted in 700 suspected human cases and 90 deaths.
Bukachi said, ‘When counties are capable of initiating and implementing their responses to diseases, from clinical activities like surveillance to health education and community engagement, we see fewer deaths in livestock and people and less negative economic impact.’
The ZDU will support the establishment of more COHUs because they have seen the impact of the working COHUs in counties like Isiolo, which has coordinated outbreaks through WhatsApp groups to coordinate outbreak response and communication pathways within the animals and human health departments in the counties.