Applying the One Health approach to study the policy and institutional determinants to control and prevent zoonoses in a low-resource setting.

BACKGROUND: Zoonoses - diseases transmitted between animals and people - disproportionally affect low-resource countries (LRCs). The complex nature of zoonoses adds substantial barriers to implementing multisectoral policies to address them. Research on the policy process could help illuminate the significant factors influencing policy change among the complex systems involved in managing zoonoses. We applied the One Health (OH) approach to describe the policy process among the systems involved in preventing and controlling zoonoses in Peru. The study's purpose is to (1) describe the priority-making process and the driving or limiting factors, (2) describe the process for selecting policy solutions and (3) describe perspectives about organizations' role in zoonoses management and authority in policy-making. METHODS: We applied a case study with a qualitative research approach. We conducted semistructured interviews with policy-makers and experts integral to zoonoses programs in the Ministry of Health, Agriculture and Environment at Peru's national and subnational levels. The final analytical sample was 59. We used a rapid qualitative method to analyse the data. RESULTS: Limited surveillance systems do not capture regional endemic zoonoses. Influenced by funding structures, local activities are focused on addressing national priorities instead of local zoonoses. Policies are developed at the national level through multidisciplinary work teams and multisectoral regional meetings, incorporating feedback from experts' opinions. Local policies that regulated roles in multisectoral activities were described as more accessible solutions to address zoonoses. Hierarchical structures deter local policy-making and adaptations, and unclear rules in zoonosis management among animal and environmental systems were reported as barriers to multisectoral work. OH implementation barriers could be prevented by engaging local leaders in national priority and policy-making, as well as training and empowering local experts and technicians to propose policy changes or adaptations. Future research should focus on evaluating OH implementations over time to improve program effectiveness and sustainability. CONCLUSIONS: By applying the OH approach, we captured the perspectives of various public organizations, including the local government, involved in preventing and controlling zoonoses in Peru. We found that structural barriers, such as national priorities surpassing local priorities, prevented addressing local issues. Hierarchical norms were also reported to hinder policy adaptations at the regional level. This study found that zoonosis management requires a multisectoral and intergovernmental approach. The empowerment of local technicians and experts was recommended to sustain multisectoral work and policy adaptations. More comprehensive research on the rules-in-use of policy-making is needed to provide recommendations for future multisectoral collaborations to address zoonoses in LRCs.