One health approach: Unleashing Sudan's potential for better human, animal, and environmental health outcomes

The adoption of a One Health approach in Sudan has the potential to create more resilient and integrated solutions to address the nexus of health, environmental and economic challenges, particularly in the aftermath of the current conflict situation. The One Health approach recognizes the interconnectedness of human, animal, and environmental health and emphasizes the collaboration between multiple sectors to address health issues that affect all three domains. We recently published the landmark study, Towards a One Health Approach in Sudan: Understanding the Nexus of Climate Change, Land Use, Zoonotic Diseases, and Human Health that gains its significance as the first of its kind to be carried out under the One Health perspective in Sudan, spotlighting a unified path to health in harmony with nature.

The idea for this study emerged as part of the Sudan Sustainable Natural Resources Management Project (SSNRMP) implemented in 2014-2023. Our goal was to expand cost-effective, integrated solutions and enhance the project's goal of adopting sustainable land and water management practices to increase community resilience against climate change. Our study refers to previous scholarly reports that documented land-use changes, such as deforestation, as major contributors to over 30% of emerging diseases since 1960. Therefore, understanding these relationships is crucial for developing effective strategies to prevent and control disease outbreaks. The study supports the One Health approach promoted by the World Bank and other development partners, which encourages collaboration across sectors for better health outcomes.

The One Health approach could address government's concern that inadequate institutional coordination, limited capacity, and readiness had weakened and delayed the country's response to multiple earlier disease outbreaks with catastrophic human, health, and economic effects. Through the assessment of risks, vulnerabilities, and disease patterns, this study provides evidence-based data that will help inform Sudan’s policy decisions and guide new business development concerning the influence of land-use practices and climate change on zoonotic diseases.

Our findings hold relevance not only for Sudan, but also for the sub-region. They apply to other areas with similar economic and ecological contexts as well. Moreover, the study aligns with the World Bank’s growing focus on the One Health approach to prepare and respond to zoonotic diseases - those transmitted from animals to humans through direct contact or via food, water, and the environment. Over 70% of emerging infectious diseases (EIDs) - transmitted from human to human - are newly recognized in a population or have existed but are rapidly increasing in incidence or geographic range, posing recurring risks to global health and the economy. Despite operating in Sudan's challenging context—characterized by fragility, conflict, volatility, and scarcity of data— we overcame these hurdles by performing a comprehensive literature review of scholarly publications and publicly available government records that was further reinforced by exclusive interviews with ten subject matter experts in addition to feedback from World Bank experts. This allowed us to gain deeper understanding of the transmission of zoonotic diseases in Sudan's specific context related to the human-livestock-wildlife interface.

Our research findings offered valuable insights into the significant transmission pathways in areas where various drivers such as land use change, agricultural expansion, intensification of livestock production, encroachment into wildlife habitats, implications of changing climate, vulnerable food systems, and armed conflict and fragility, contribute to the emergence and transmission of zoonotic diseases in Sudan.

We found that the risk of disease emergence is elevated in specific hotspots of rainfed and irrigated agricultural lands and during rainy seasons and heavy floods. These phenomena significantly affect human health and the country’s economy and large livestock sector, which contributes about 20 percent to Sudan’s gross domestic product (GDP) and is predominantly reliant on climatically vulnerable rangelands.

We identified specific risk factors, such as land degradation, poor disaster-risk management, lack of understanding of disease patterns, and fragility, armed conflict, and displacement, which can exacerbate the occurrence and outbreak of diseases. For instance, putting policies in place to reduce disease frequency is hampered by poor understanding, mapping, and forecasting of the potential risk of zoonotic diseases. Another example, it is key to understand which geographical areas of Sudan are most vulnerable to the negative impacts of rangeland practices, erratic weather patterns, and a shortage of veterinary care services, aids in pinpointing the areas that will benefit most from interventions. These results allow more targeted preventative actions and proactive surveillance approaches to be put into practice.

Our study’s recommendations revolve around the One Health concept, grounded in the simple idea that the health of humanity depends on the health and livability of the planet and the health of other species.

• There is urgent need to bolster Sudan's One Health practices through supporting the One Health Platform (under formation) to facilitate cross-sectoral coordination, extending beyond human and animal health sectors, to include, among others, environment, land and water management agencies.
• The country should embrace medium -and long- term strategies, including adopting coordinated policies and research methods, implementing reforms, strengthening institutional capacity, and upgrading surveillance and usage of early warning systems, remote sensing, geographic information system (GIS), and laboratory capabilities.