One Health Strategic Plan for the Prevention and Control of Zoonotic Diseases in Kenya (2021-2025)

1.1 Overview 1

1.2 Process of developing this strategic plan 1 2 Situational Analysis 2

2.1 Country profile 2 Burden of zoonotic diseases 2

2.2 Surveillance of zoonotic diseases in Kenya 3

2.2.1 Surveillance in humans 3

2.2.2 Surveillance in animals 4

2.3 One Health Approach 4

2.4 The Kenya One Health strategic plan 2012-2017 5

2.4.1 Key Achievements 5

2.4.2 Main challenges 6

2.4.3 Lessons Learnt 6

2.5 Institutional framework 6

2.6 Policy and legal frameworks 8

2.7 Stakeholder analysis 9

2.8 PESTEL and SWOT Analysis 9

2.9 Approach to this strategic plan 11 3 The Five-Year Strategic Plan 2021-2025 15

3.1 Vision, Mission and Goal 15

3.2 Core values and guiding principles 15

3.4 Financing the strategic plan 29

3.5 Monitoring and Evaluation 29 Appendix 1. List of contributors 31 Appendix 2. Management and Response Structure for Zoonotic Diseases 33 Appendix 3. Detailed Stakeholder Analysis 36 References 41 i List of Tables Table 1. PESTEL Analysis results for the OH strategic plan for prevention and control of zoonotic diseases in Kenya 9 Table 2. SWOT Analysis for the prevention and control of zoonotic diseases in Kenya using a One Health approach from 2021 to 2025. 11 Table 3. Strategic framework for the prevention and control of zoonotic diseases in Kenya using a One Health approach from 2021 to 2025 18 Table 4. Summary budget for implementation of the strategic plan for prevention and control of zoonotic diseases in Kenya using a One Health approach from 2021 to 2025 29 List of Figures Figure 1: Current organizational structure of ZDU/ZTWG 7 Figure 2: Proposed new organizational structure of ZDU/NZTC 8 ii List of Abbreviations ACDC Africa Centers for Disease Control IDSR Integrated Disease Surveillance and AfDB African Development Bank Response AFROHUN Africa One Health University Network IDU Infectious Diseases Unit AMR Antimicrobial Resistance IFAW International Fund for Animal Welfare ANAW African Network for Animal Welfare IFRC International Federation of Red Cross APHOK Association of Public Health Officers and Red crescent Societies Kenya IHR International Health Regulations of the ARIS Animal Resources Information System World Health Organization ASAL Arid or semi-arid land ILRI International Livestock Research ASTG Agricultural Sector Transformation Institute and Growth Strategy 2019-2029 IMCAPI International Ministerial Conferences AU-IBAR African Union InterAfrican Bureau for on Avian and Pandemic Influenza Animal Resources IPR Institute of Primate Research AWF African Wildlife Foundation JEE Joint External Evaluation CBD Convention for Biological Diversity JKUAT Jomo Kenyatta University of CCM Comitato Collaborazione Committee Agriculture and Technology (medical collaboration committee) KABS Kenya Animal Bio surveillance System CDC Centers for Disease Control and KALRO Kenya Agricultural and Livestock Prevention Research Organization CDH County Director of Health KEFRI Kenya Forestry Research Institute CITES Convention on International Trade in KEMRI Kenya Medical Research Institute Endangered Species KEPSA Kenya Private Sector Alliance COG Council of Governors KFS Kenya Forestry Services COHUs County One Health Units KHP Kenya Health Policy CP3 Community Pandemic Preparedness KHSSP Kenya Health Sector Strategic Plan Project KLWSS Kenya Livestock and Wildlife DALY Disability-Adjusted Life Year Syndromic Surveillance system DHIS District Health Information System KMA Kenya Medical Association DMS Directorate of Medical Services KNH/IDU Kenyatta National Hospital/ Infectious DPT Digital Pen Technology Disease Unit DSER Division of Disease Surveillance and KTB Kenya Tourist Board Epidemic Response KU Kenyatta University DSRU Disease Surveillance and Response KVA Kenya Veterinary Association Unit KVP Kenya Veterinary Policy DVS Director of Veterinary Services KWS Kenya Wildlife Service ECTAD Emergency Centre for Transboundary MALFC Ministry of Agriculture, Livestock, Animal Diseases Fisheries and Cooperatives EOC Emergency Operation Centre MERS-CoV Middle East Respiratory Syndrome EPT Emerging Pandemic Threats Coronavirus FAO Food and Agriculture Organization of MOEF Ministry of Environment and Forestry the United Nations MOH Ministry of Health FELTP Field Epidemiology and Laboratory MoI&CNG Ministry of Interior and Coordination Training Program of National Government GDP Gross Domestic Product MOLD Ministry of Livestock Development GHSA Global Health Security Agenda MOTW Ministry of Tourism and Wildlife HMIS Health Management Information MPHS Ministry of Public Health and System Sanitation ICIPE International Centre of Insect MPT Mobile Phone Technology Physiology and Ecology MTP Medium Term Plan HPAI H5N1 Highly Pathogenic Avian Influenza NAPHS National Action Plans for Health H5N1 Security iii NASIC National Antimicrobial Stewardship WHO World Health Organization of the Interagency Committee United Nations NCCG Nairobi City County Government WHO-AFRO World Health Organization Africa ND1 Notifiable diseases form 1 Region NDMU National Disaster Management WSU Washington State University Unit WWF World Wide Fund for Nature NIT National Influenza Taskforce ZDU Zoonotic Disease Unit NMK National Museums of Kenya ZTWG Zoonoses Technical Working Group NOHO National One Health Office NPHI National Public Health Institute NPHL National Public Health Laboratory NRECC National Rabies Elimination Coordination Committee NZTC National Zoonotic Disease Technical Committee NTD Neglected Tropical Diseases OH One Health OHCEA One Health Eastern and Central Africa OHTC One Health Technical Committee OHW One Health Workforce OIE Organization Internationale des Epizooties (World Organization for Animal Health OWOH ‘One World, One Health’ P&R Preparedness and Response PHEIC Public Health Emergencies of International Concern PHEIUE Public Health Events of Initially Unknown Etiology PZD Priority zoonotic diseases RRTs Rapid Response Teams RVF Rift Valley Fever SARS Severe Acute Respiratory Syndrome SCVOs Sub County Veterinary Officers SME Subject matter experts SOPs Standard Operating Procedures UHC Universal Health Coverage UNICEF United Nations International Emergency Children’s Fund UoL University of Liverpool UoN University of Nairobi USAID United States Agency for International Development VEES Veterinary Epidemiology and Economics Section VERU Veterinary Emergency Response Unit VSF Vétérinaires Sans Frontières WAHIS World Animal Health Information System WAP World Animal Protection WB World Bank WDMMS Wildlife Disease Management and Monitoring Strategy iv Foreword Foreword The burden of zoonotic diseases has increased globally over the last few decades, raising concern among governments. Zoonoses are transmitted through interactions between animals, humans and their shared environments. Zoonoses such as Brucellosis, Anthrax and Rift Valley fever lead to increased health care costs, loss of human lives, loss of income from livestock trade and loss of endangered and rare wildlife biodiversity, among many other negative impacts. The factors contributing to the increasing burden of these diseases include but not limited to human and animal population expansion, wildlife habitat degradation, international travel and trade, changing farming systems, urbanization, cultural practices, poverty and climate change. The successful prevention and control of zoonotic diseases require a One Health approach, which involves a multisectoral collaboration of the human, animal and environmental health sectors, among madHDŬUPstep other stakeholders. Kenya made a firm firm towards implementing the One Health approach since 2011 when the Zoonotic Disease Unit (ZDU) was established.The ZDU is a collaborative platform shared between the ministries responsible for human and animal health. It serves as Kenya’s One Health office and secretariat to the Zoonoses Technical Working Group (ZTWG). Ŭrst first strategic plan for implementing One Health in Kenya (2012-2017) strengthened collaboration The first SpeciŬc Specific outputs were produced, such as the among multiple sectors to prevent and control zoonoses. Specific prioritization of zoonotic diseases in Kenya and their inclusion in the Integrated Disease Surveillance and Response (IDSR) system. This has led to better preparedness and response, and the rapid containment of the recent Rift Valley fever outbreak of 2018 is a case in point. These achievements are a good argument for further efforts to institutionalize the lessons learnt through sustainability and scaling out, within the context of devolution of public services. Successful implementation of the One Health strategic plan for the prevention and control of zoonotic diseases in Kenya from 2021 to 2025 will contribute to a reduced burden of zoonotic diseases; enhancement of universal health coverage; food and nutritional security; enhanced conservation of wildlife biodiversity and better rural livelihoods, among other benefits. benefits. This strategic plan represents our continued beneŬWs. commitment to strengthening collaboration between our ministries to prevent zoonotic diseases at the human-animal-environment interfaces. Hon. Peter Munya, EGH Sen. Mutahi Kagwe, EGH Cabinet Secretary Hon. Peter Munya, EGH Cabinet Secretary Sen. Mutahi Kagwe, EGH Ministry of Agriculture, Livestock, Fisheries and Cabinet Secretary Ministry of Health Cabinet Secretary Co-operatives Ministry of Agriculture, Livestock, Fisheries and Ministry of Health Co-operatives v Acknowledgements This One Health strategic plan for the prevention and control of zoonotic diseases in Kenya was developed through This One aHealth consultative strategicprocess plan forwith subject matter the prevention experts and control of from human, zoonotic environmental diseases in Kenya wasand animal developed health sectors, through a researchers consultative andwith process policy formulators subject matter at the from national experts and county human, levels. The environmental evelopment and animal of health this plan is in line with the priorities outlined in the National Action Plan for Health Security sectors, researchers and policy formulators at the national and county levels. The development of this plan(NAPHS). These priorities is in line with thewere derived outlined priorities from JointinExternal Evaluation the National Action(JEE) Planconducted for Healthin Security 2017 and (NAPHS). Performance of These Veterinary Services (PVS) conducted in 2019. priorities were derived from Joint External Evaluation (JEE) conducted in 2017 and Performance of Veterinary Services (PVS) conducted in 2019. The Zoonotic Disease Unit (ZDU) coordinated this consultative process by anchoring on the existing multisectoral The Zoonotic Zoonoses Technical Disease Unit (ZDU) Working Group coordinated this(ZTWG), drawing consultative membership process from on by anchoring the the Ministry of existing Agriculture, multisectoralLivestock, Zoonoses Fisheries Technicaland Co-operatives Working (MALF),drawing Group (ZTWG), Ministry of Health (MOH), membership Kenya from the Wildlife Ministry of Service (KWS), universities and research organizations. The Zoonotic Disease Unit (ZDU) led the drafting Agriculture, Livestock, Fisheries and Co-operatives (MALFC), Ministry of Health (MOH), Kenya Wildlife process. Service (KWS), universities and research organizations. The Zoonotic Disease Unit (ZDU) led the drafting process. To prepare this national strategy, Food and Agricultural Organization (FAO-Kenya) facilitated the entire process with To prepare thisfinancial nationalsupport strategy,from USAID the Food andGlobal HealthOrganization Agricultural Security Agenda (GHSA)provided (FAO-Kenya) initiativetechnical and the USAID P&R project. Specific acknowledgement is to the institutions DQGŬQDQFLDOVXSSRUWWKURXJKWKH86$,'*OREDO+HDOWK6HFXULW\$JHQGD and financial support through the USAID Global Health Security Agenda *+6$listed below whose representatives (GHSA) initiative and LQLWLDWLYHDQGWKH86$,' the USAID participated in developing and validating this strategy. A complete list of contributors P&R project. We appreciate this support. We acknowledge the institutions listed below whose and organizations has been provided representatives in Annex in participated 1: developing and validating this strategy. A complete list of contributors and organizations has been provided in Annex 1: • Zoonotic Disease Unit (ZDU) Food • Food and and Agriculture Agriculture Organization Organization (FAO) (FAO) United States Agency for International Development Œ8QLWHG6WDWHV$JHQF\IRU,QWHUQDWLRQDO'HYHORSPHQW • United States Agency for International Development (USAID) (USAID) 86$,' Centers for • County Disease Control and Prevention-Kenya Governments Chemonics • Field Epidemiology and Laboratory Training Program (FELTP) • Core Group Polio Program Global Health,/5, Œ,QWHUQDWLRQDO/LYHVWRFN5HVHDUFK,QVWLWXWH International Livestock Research Institute Security (ILRI) • Kenya CP3 Medical Œ.HQ\D0HGLFDO5HVHDUFK,QVWLWXWH Research Institute .(05, (KEMRI) County • Centers Governments for Disease Control and Prevention-Kenya (CDC-K) FieldVeterinary • Kenya Epidemiology and Laboratory Association (KVA) Training Program (FELTP) • Kenya Global Implementation Solutions (GIS) Œ.HQ\D9HWHULQDU\9DFFLQHV3URGXFWLRQ,QVWLWXWH Veterinary Vaccines Production Institute .(9(9$3, (KEVEVAPI) International • Kenya Livestock Wildlife Service Research Institute (ILRI) (KWS) Kenya Medical • Neglected TropicalResearch DiseasesInstitute Programme (KEMRI) Kenya of Veterinary • University Association Liverpool- (KVA) HORN project Kenya of Veterinary • University Vaccines Production Institute (KEVEVAPI) Nairobi (UoN) • Kenya Wildlife Washington State Service (KWS) University (WSU) Neglected • Zoonotic Tropical Disease Diseases Programme Unit (ZDU) • PREDICT • University of Liverpool- HORN project • University of Nairobi (UoN) • Washington State University (WSU) • VSF-Germany and -Suisse • World Animal Protection Mr. Harry Harry Kimtai, Kimutai, Kimutai,CBS CBS CBS Susan Mochache, CBS Principal Secretary Principal Secretary State Department of Livestock Ministry of Health Mr. Harry Kimutai, CBS Susan Mochache, CBS Ministry of Agriculture, Livestock and Fisheries Principal Secretary Principal Secretary and Co-operatives State Department of Livestock Ministry of Health Ministry of Agriculture, Livestock, Fisheries and Co-operatives vi Executive Summary The current COVID-19 pandemic has reinforced the relevance of implementing One Health principles in Thethe globalCOVID-19 current preparedness, detection pandemic and response has reinforced the to emerging relevance infectious diseases. of implementing One Health 7KHFXUUHQW&29,'SDQGHPLFKDVUHLQIRUFHGWKHUHOHYDQFHRILPSOHPHQWLQJ2QH+HDOWKSULQFLSOHVLQ The Tripartite principles in (WHO, the FAO,OIE) global fact finding preparedness, mission detection andtoresponse identify to theemerging zoonotic origins of the infectious SARS-CoV-2 diseases. The , the route Tripartite (WHO,of introduction to FAO,OIE) )$22,( the human fact-finding population, mission to including identify the the possible zoonotic originsrole of of intermediate the SARS-CoV-2 hosts ledto , led to genomic IDFWŬQGLQJPLVVLRQWRLGHQWLI\WKH]RRQRWLFRULJLQVRIWKH6$56&R9OHGWRJHQRPLFDQGgenomic and epidemiological epidemiological evidence that the coronaviruses most highly related to SARS-CoV-2 may have “spilled evidence that the coronaviruses most highly related to SARS-CoV-2 may have “spilled over“ from over“ from mammalian mammalianreservoirs reservoirs as suchbats and and as bats pangolins at the pangolins Chinese at the wildlife Chinese wet wet wildlife markets. markets. The The recurrent recurrent Ebola Ebola outbreaks outbreaks exemplify exemplify the the threat threat from from zoonotic zoonotic diseases. diseases. Ebola Ebola outbreaks outbreaks in Guinea, Guinea, Liberia, Sierra Liberia, Sierra Leone Leone and and DRC DRC between between 2014 2014 and and 2021, 2021, which which led led to to heavy heavy human human fatalities fatalities and and widespread widespread socio- socio- economic disruption in economic disruption in the the four four countries countries and and beyond beyond warrants warrants heightened heightened joint joint national national and and assessment and regional risk assessment andsurveillance surveillanceof ofzoonoses zoonosesusing usingone onehealth healthapproach. approach. Kenya is Kenya is at at high high risk risk from from zoonoses zoonoses and and other other trans-boundary trans-boundary diseases diseases due due toto her her geographical geographical location, location, growing human population, human population, closeclose livestock-wildlife-human livestock-wildlife-human interactions interactions, and and porous porous borders. borders. The burden burden of zoonotic diseases in Kenya is estimated to cause a loss of Ksh. 618 billion attributed of zoonotic diseases in Kenya is estimated to cause a loss of Ksh. 618 billion annually, attributed toto Brucellosis, Bovine tuberculosis Brucellosis, Bovine and non-typhoidal tuberculosis Salmonella every and non-typhoidal year. Recurrent Salmonella. Recurrent outbreaks outbreaks of of diseases such as diseases such as Rift Valley fever 5)9 5LIW9DOOH\IHYHU fever (RFV) and (RFV) andAnthrax Anthraxhave havecaused causedsignificant significant socio-economicimpacts impactsandandthreatened threatened DQG$QWKUD[KDYHFDXVHGVLJQLŬFDQWVRFLRHFRQRPLFLPSDFWVDQGWKUHDWHQHGUDUH socio-economic to rare rare and and endangered endangered wildlife wildlife species. species. To To mitigate mitigate the the risk risk from from zoonotic zoonotic diseases, diseases, the the Ministry Ministry of of Health Health (MOH) (MOH) and and the the Ministry Ministry ofof Agriculture, Agriculture, Livestock, Fisheries and Cooperatives (MALF) have established joint disease surveillance and response response systems within the frameworks frameworks of the World World Health Health Organization’s Organization’s International International Health Regulations [WHO V\VWHPVZLWKLQWKHIUDPHZRUNVRIWKH:RUOG+HDOWK2UJDQL]DWLRQŋV,QWHUQDWLRQDO+HDOWK5HJXODWLRQV>:+2 IHR (2005)]@ and ,+5  DQG the WKHWorld the :RUOGAnimal World $QLPDO Health Animal +HDOWK Organization’s Health 2UJDQL]DWLRQŋV (OIE) Organization’s 2,(  Terrestrial 7HUUHVWULDO and DQG Aquatic $TXDWLF Animal $QLPDO Health +HDOWK Codes. Further, Codes. Further, Kenya adopted a One Health One Health approach in 2011 by establishing the ZDU, a collaborative by establishing the ZDU, a collaborative office RŴFH shared VKDUHG between EHWZHHQ the WKH MOH 02+ and DQG MALF. 0$/) This MALF. 7KLV synergistic This V\QHUJLVWLF arrangement synergistic DUUDQJHPHQW will ZLOO be EH strengthened VWUHQJWKHQHG and DQG expanded within expanded within the the current planning period current planning period toto better better integrate integrate the the wildlife wildlife and and environment sectors in environment sectors in and controlling preventing and controllingzoonotic zoonoticdiseases, diseases,ininline linewith withglobal globalbest bestpractices. practices. The ZDU implemented the first first One Health strategic plan from 2012 to 2017, which focused on establishing 7KH='8LPSOHPHQWHGWKHŬUVW2QH+HDOWKVWUDWHJLFSODQIURPWRZKLFKIRFXVHGRQHVWDEOLVKLQJ active collaboration active collaboration atat the the animal-human-ecosystem animal-human-ecosysteminterface interface,forforbetter better prevention prevention andand control control of of zoonotic, ]RRQRWLF zoonotic, emerging emerging HPHUJLQJ DQGand and re-emerging re-emerging UHHPHUJLQJ diseases. GLVHDVHV 7KHThe diseases. The SODQ planplan led WR to OHGled to unified XQLŬHG unified E\ by efforts HųRUWV efforts by MOH, 02+ MOH, MALF, non- MOALFC, 02$/)& QRQ governmental actors, and governmental actors, and multiple multiple professional professional disciplines disciplines towards towards addressing addressing zoonotic zoonotic disease disease outbreaks outbreaks in in the the country. country. This This is is demonstrated demonstrated by by improved improved joint joint rapid response to rapid response to the the Rift Rift Valley Valley fever fever (RVF) (RVF) and and anthrax outbreaks in 2018 and 2019, respectively. Through the first first strategic plan, zoonotic diseases were DQWKUD[RXWEUHDNVLQDQGUHVSHFWLYHO\7KURXJKWKHŬUVWVWUDWHJLFSODQ]RRQRWLFGLVHDVHVZHUH prioritized and evidence-based prioritized and strategies, notably evidence-based strategies, notably the the rabies rabies elimination strategy, were elimination strategy, were developed developed and and implemented. Further, implemented. Further, the the One One Health Health approach approach waswas incorporated incorporated in in training curricular and training curricular and sectoral sectoral Although the policies. Although the ZDU ZDU was was established established toto manage manage zoonotic zoonotic diseases, diseases, itit has played a broader broader coordination role and has partnered with other One Health Health players in other other areas areas such such as as antimicrobial antimicrobial resistance (AMR) resistance (AMR) and and food food safety. safety. The One Health Strategic Plan for the Prevention and control of Zoonotic Diseases in Kenya (2021-2025) 7KH2QH+HDOWK6WUDWHJLF3ODQIRUWKH3UHYHQWLRQDQGFRQWURORI=RRQRWLF'LVHDVHVLQ.HQ\D   was developed through a consultative process involving a wide range of stakeholders was developed through a consultative process involving a wide range of stakeholders from National from National and and County County governments, governments, non-governmental non-governmental institutions institutions and and development development partners. partners. The The planplan builds builds on on achievements, achievements, DFKLHYHPHQWV challenges, FKDOOHQJHV challenges, lessons OHVVRQV lessons EHVWbest DQGand learnt OHDUQW learnt and best practices practices SUDFWLFHV drawn drawn GUDZQ fromfrom IURP WKHthe the 2012-2017  2012-2017 ZLOOwill ,W It plan. SODQ plan. It will EH be be implemented through close collaboration across the MOH, MALF, the Ministry of implemented through close collaboration across the MOH, MALFC, the Ministry of Environment and Environment and Forestry (MOEF), Forestry (MOEF), Ministry Ministryof ofTourism TourismandandWildlife Wildlife(MOTW) (MOTW)and and other other stakeholders, stakeholders, with with coordination coordination by by ZDUZDU andand thethe Zoonoses Zoonoses Technical Technical Working Working Group Group (ZTWG). (ZTWG). vii vii The current strategic plan conforms with the Constitution of Kenya 2010 and is aligned to sectoral, sectoral, regional and global globalstrategies strategiesandandpolicies. policies.The strategic The strategicplan planallows domestication allows domestication by by County governments County for their governments, for XVHLQWKHŬJKWDJDLQVW]RRQRWLFGLVHDVHV7KHJRDORIWKHSODQLVWRUHGXFHWKHEXUGHQRI]RRQRWLFGLVHDVHV use in the fight against zoonotic diseases. The goal of the plan is to reduce the burden of their use in the fight against zoonotic diseases. The goal of the plan is to reduce the burden of zoonotic zoonotic diseases in Kenya,in diseases which Kenya,will be will which achieved be through achievedthree strategic through objectives, namely: three strategic objectives, namely: 1. To strengthen implementation of the One Health approach at the national and county levels 1. To strengthen implementation of One Health approach at the national and county levels The current strategic plan conforms with theresponse Constitution and of Kenyaof2010 and iszoonotic aligned to sectoral, regional 2. To 2. To strengthen strengthen prevention, prevention, surveillance, surveillance, response and control control of priority priority zoonotic diseasesdiseases in both and globalhumans in both strategies andand policies. The strategic plan allows domestication by County governments for their animals humans and animals. XVHLQWKHŬJKWDJDLQVW]RRQRWLFGLVHDVHV7KHJRDORIWKHSODQLVWRUHGXFHWKHEXUGHQRI]RRQRWLFGLVHDVHV 3. To promote applied research using the One Health approach in Kenya, which will be achieved through three strategic objectives, namely: 7RSURPRWHDSSOLHGUHVHDUFKXVLQJWKH2QH+HDOWKDSSURDFK 3. To promote applied research using the One Health approach Effective implementation of this strategic 1. To strengthen plan willof implementation contribute towards the One Health Universal approach Health at the Coverage national (UHC),levels and county improved livelihoods, food and nutritional security, improved biodiversity conservation and enhanced (ųHFWLYHLPSOHPHQWDWLRQRIWKLVVWUDWHJLFSODQZLOOFRQWULEXWHWRZDUGV8QLYHUVDO+HDOWK&RYHUDJH Effective implementation of this strategic plan will contribute towards Universal Health Coverage 8+& (UHC), animal and human2. To welfare. It will thus strengthen contribute to prevention, the realising surveillance, response the Vision and 2030 control of and the zoonotic priority government’s diseases in both improved livelihoods, food and nutritional security, improved biodiversity conservation and enhanced “Big Four” Agenda. Potential funding humansIt and sources for the implementation of the strategic plan are the National will animals. DQLPDODQGKXPDQZHOIDUH,WZLOOWKXVFRQWULEXWHWRWKHUHDOLVLQJWKH9LVLRQDQGWKHJRYHUQPHQWŋVō%LJ animal and human welfare. thus contribute to the realising the Vision 2030 and the government’s “Big and County governments, and implementing partners. Four” Agenda. Potential funding sources for the implementation of the strategic plan are the National and County governments 7RSURPRWHDSSOLHGUHVHDUFKXVLQJWKH2QH+HDOWKDSSURDFK and implementing partners. (ųHFWLYHLPSOHPHQWDWLRQRIWKLVVWUDWHJLFSODQZLOOFRQWULEXWHWRZDUGV8QLYHUVDO+HDOWK&RYHUDJH 8+&  improved livelihoods, food and nutritional security, improved biodiversity conservation and enhanced DQLPDODQGKXPDQZHOIDUH,WZLOOWKXVFRQWULEXWHWRWKHUHDOLVLQJWKH9LVLRQDQGWKHJRYHUQPHQWŋVō%LJ Four” Agenda. Potential funding sources for the implementation of the strategic plan are the National and Dr. Obadiah N. Njagi, County PhD, OGW governments and implementing partners. Dr. Patrick Amoth, EBS Director of Veterinary Services Ag. Director General for Health State Department of Livestock Ministry of Health Ministry of Agriculture, Livestock and Fisheries and Co-operatives Dr. Obadiah N Njagi, PhD, OGW Dr. Patrick Amoth, EBS Director of Veterinary Services Ag. Director General of Health Ministry of Agriculture, Livestock, Fisheries and Ministry of Health Co-operatives Dr. Obadiah N. Njagi, PhD, OGW Dr. Patrick Amoth, EBS Director of Veterinary Services Ag. Director General for Health State Department of Livestock Ministry of Health Ministry of Agriculture, Livestock and Fisheries and Co-operatives Dr. Obadiah N. Njagi, PhD, OGW Dr. Patrick Amoth, EBS Director of Veterinary Services Ag. Director General for Health State Department of Livestock Ministry of Health viii Ministry of Agriculture, Livestock and Fisheries Glossary of Terms Biodiversity: Biodiversity is the variability among living organisms and the ecological complexes of which they are part; this includes diversity within species, between species, and ecosystems. DALY: The Disability-Adjusted Life Year (DALY) is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death Disease Surveillance: Disease surveillance is an ongoing process that involves the systematic collection, analysis, interpretation, and dissemination of information regarding the occurrence of diseases in defined populations for public health action to reduce morbidity and mortality Emerging Infectious Diseases: An infectious disease that has newly appeared in a population or that has been known for some time but is rapidly increasing in incidence,geographic range, or is appearing in a new species Endangered Species: An endangered species is an animal or plant that is considered at risk of extinction Endemic Zoonotic Diseases: Zoonotic diseases that are constantly present in the population to a greater or lesser extent, such as brucellosis and salmonellosis, are referred to as endemic Epidemics: An epidemic is an unusual increase in the number of cases of infectious disease cases that already exist in a specific region or population. It can also refer to the appearance of a significant number of cases of an infectious disease in a region or population that is usually free from that disease. Infectious Diseases: A disease caused by the entrance into the body of pathogenic agents or microorganisms such as bacteria, viruses, protozoa, or fungi that grow and multiply there. One Health: An approach to designing and implementing programmes, policies, legislation and research in which multiple sectors communicate and work together to achieve better public health outcomes. Pandemics: A pandemic is an outbreak of a disease that occurs over a wide geographic area and affects an exceptionally high proportion of the population such as over several continents or even worldwide Public Health Emergencies of International Concern (PHEIC): Defined in the IHR (2005) as “an extraordinary event which is determined, as provided in these regulations: i. To constitute a public health risk to other States through the international spread of disease; and ii. to potentially require a coordinated international response”. This definition implies a situation that : is severe, unusual or unexpected; carries implications for public health beyond the affected State’s national border; and may require immediate international action. Re-emerging Infectious Diseases: Re-emerging infectious diseases are diseases that once were major health problems globally or in a particular country, and then declined dramatically, but are again becoming health problems for a significant proportion of the population. Zoonotic Diseases: These are diseases that can be transmitted from animals to people and vice versa. ix ©FAO/Luis Tato 1 Introduction

1.1 Overview Over 60% of all human infections and over 75% of emerging and re-emerging infectious diseases are zoonotic, meaning that they can be transmitted from animals to humans and vice versa1. Zoonotic diseases have the potential to spread rapidly across nations to cause pandemics. Over the last several decades, it is estimated that new zoonotic diseases have emerged at an average rate of one zoonosis per year . A WHO-Africa Region (WHO-AFRO) report in 2012 indicated that 25% of the Public Health Emergencies of International Concern (PHEIC) reported from the region were zoonotic3. Studies further indicate that endemic zoonotic diseases account for an estimated 20% of all illnesses and deaths in the poorest countries and cause about 2.4 billion cases of human illness and 2.7 million deaths per year in lower- income countries. 4, 5 The regional threat from zoonotic diseases was demonstrated by the Ebola outbreaks in Guinea, Liberia, Sierra Leone from 2013 to 2015 and in the Democratic Republic of Congo in 2019. 6,7 By the end of 2015, the epidemic had caused a total of 28,639 cases, 11,316 deaths and 17,300 orphaned children in the three western Africa countries. This was accompanied by widespread disruption of socio-economic activities, combined GDP losses of US$ 2.2 billion and outbreak response costs amounting to US$ 3.6 million in the three countries. The Ebola shock caused Kenya Airways over Ksh 10 billion in losses due to suspended flights to western Africa and led to reduced tourism arrivals across all African destinations.8 The Ebola outbreak in DRC has (as of August 2019) resulted in a confirmed 2892 cases and caused 1998 deaths, translating to a case fatality rate of 67%. By October 2021, the COVID 19 pandemic in Kenya had led to 253000 cases and almost 5263 deaths with high costs in treatment and disproportionate economic impacts due to livelihood disruption, closure of businesses and reduced tourism. Kenya is at high risk of zoonotic diseases as evidenced by constant presence and recurrent outbreaks of anthrax, Rift Valley fever (RVF), rabies, brucellosis, non-typhoidal salmonellosis and bovine tuberculosis, among other zoonoses. Zoonoses disproportionately affect poor communities causing increased household health-care costs, reduced labour productivity, loss of incomes from animal resources and increased malnutrition among other impacts.5 They also pose a significant threat to the country’s rare and endangered wildlife biodiversity. It is against this backdrop that Kenya adopted a One Health approach that enables the MOH, MALF, MOEF, MOTW, County governments and other stakeholders to reduce the burden of zoonotic diseases and attain optimal health for humans, their animals and the environment.

1.2 Developmental Process Development of the current strategic plan was informed by an end-evaluation of the 2012-2017 One Health strategic plan that was undertaken from January to March 2018. In October 2018, the ZDU convened a stakeholders’ meeting to discuss the evaluation findings and guide the development of the new plan. In April 2019, a consultative workshop was convened to identify priorities for the new One Health strategic plan, based on the findings of the 2012 to 2017 plan, and the outputs of the Pan-Afric meeting. Subsequently, in May 2019, a team of seven technical experts drawn from MOH, MALF, KWS and partner organizations drafted the new plan based on the stakeholders consultations. The draft was reviewed internally by technical experts from the listed ministries and later presented to a validation workshop in September 2019. Based on feedback from the validation workshop, the plan was then finalized. 1 1 2 Situational Analysis This section highlights the context in which the One Health strategic plan will be implemented.

2.1 Country Profile Kenya is situated on the East Coast of Africa, between latitudes 5°N and 5°S and longitudes 34°E and 43°E. Kenya borders Ethiopia (North); South Sudan (Northwest), Uganda (West), Tanzania (South) and Somalia (East). Kenya is about 587,000 km2 of which 80% is arid or semi-arid land (ASAL). According to the 2019 census, the total population of Kenya is 47,564,296, with an annual population growth rate of 1.69% and an urbanization rate of 4.15%. 9, 10 The Gross Domestic Product (GDP) of Kenya is estimated at Ksh 4.8 billion in 2018 with an annual GDP growth rate of 6.3%, driven mainly by the sectors of agriculture, services and manufacturing. 11 Agriculture accounted for 34.2 % of the total GDP, 12.1% of wage employment and 47.7% of export earnings in 2018. According to the same survey by the Kenya Bureau of Statistics, animal production contributed 4.1% to GDP, and 12% of Agricultural GDP. About 60% of the country’s livestock is raised in the ASALs, employing nearly 90% of the population. 12 Wildlife is the backbone of the tourism sector in Kenya, and tourism is a major economic driver in the country. The country is a regional hub for trade and travel, with millions of people transiting through its airports, seaports and land crossing sites annually. The tourism industry was ranked third largest in sub- Saharan Africa in 2018 growing at 5.6% per year, contributing Ksh 790 billion to the Kenyan economy and creating 1.1 million jobs. 13, 14 An estimated 8% of Kenya’s landmass is covered by 65 state-protected areas, in form of national parks, reserves and sanctuaries, while a further 12% is under 160 non-state protected areas, in form of private or community conservancies 15, 16. However, over 70% of the wildlife in Kenya is domiciled in community lands where they share scarce natural resources with humans and their domestic animals. Kenya has made significant reforms over the last decade to build a globally competitive economy and achieve high standards of life for her citizens. In 2008, the country launched the Vision 2030, a blueprint to “transform Kenya into a newly industrialized, middle-income country, providing a high quality of life to all its citizens in a clean and secure environment by 2030”. In 2018, Kenya launched the “Big Four Agenda” as a medium- term action plan towards the realization of the Vision 2030. The agenda has four priorities; food security, affordable housing, manufacturing and universal and affordable healthcare. Therefore, effective control and prevention of zoonotic diseases is a necessary constituent of Vision 2030, and activities to curb zoonoses will contribute to health prioritization in the Big Four agenda. Following the enactment of the Constitution of Kenya 2010, the country has two inter-dependent levels of governance: the National Government, and 47 semi-autonomous Counties. Delivery of health care and veterinary services were devolved, in line with the 2010 constitution; by devolution, these services became the responsibility of County governments. In general, the national government focuses on policy, coordination, capacity building, standards, international agreements and related functions, while most of the implementation functions take place at the county level. 2 2 The burden of Zoonotic Diseases Several factors place Kenya at high risk of transmission of emerging, and re-emerging zoonotic diseases. Kenya is situated astride the Equator and has a tropical climate, favoring many pathogens and vectors, in addition to its close proximity with the Congo Basin, a global hotspot of emerging pathogens. Kenya’s position as a hub for tourism, trade and travel, coupled with its porous borders puts the country at risk of transmission of diseases occurring elsewhere in the world. Furthermore, human population expansion, wildlife habitat destruction, increased human-wildlife-livestock interactions, changing farming practices, poor biosecurity measures, and climate change, provide opportunities for new diseases to emerge. The numerous water bodies of the Rift Valley of Kenya serve as suitable wintering spots for migratory birds of the Eurasian flyway, increasing the risk of occurence of zoonotic influenzas in Kenya. Compounding these risks,zoonoses have historically been neglected in surveillance strategies,and the burden of zoonoses has therefore not been systematically documented. There is growing evidence, that zoonotic diseases cause significant socio-economic impacts in Kenya. A recent study indicates that brucellosis, bovine tuberculosis and non-typhoidal Salmonella alone cost the country over Ksh 600 billion (USD 6 billion Purchasing Power Parity), corresponding to 3.9 % of the national GDP.18 A 2006/2007 study on the socio-economic impact of the RVF outbreak indicated costs to control RVF in Kenya reached nearly Ksh 3 billion and the public health burden of of RVF was 3.4 Disability Adjusted Live Years (DALYs) per 1000 people, with per capita household costs of Ksh 11,800 for every reported human case. 19 It is estimated that about 2000 rabies related human deaths occur annually in Kenya and these may be underestimated due to inadequacies in the current surveillance systems.20 In Kenya, the average cost of post-exposure treatment for rabies is USD 85 per patient, and is higher when the psychological trauma and the financial hardships are fully accounted for.19 Additionally, frequent anthrax outbreaks pose a deadly threat to domestic livestock and humans and a significant threat to rare and endangered wildlife species . For instance, outbreaks of the disease have resulted in high mortalities of herbivore species including buffalo, white and black rhinoceros, Rothschild giraffe, elands, impalas, Thompson gazelles, warthog, waterbuck and Grevy’s zebras, among other wild species 21, 22, 23, 24, 25. As part of efforts to mainstream zoonotic diseases into surveillance strategies, the ZDU prioritised zoonotic diseases in the country using a comprehensive set of criteria. The criteria included the severity of illness in humans, epidemic potential, socio-economic impact, prevalence or prevalence, or incidence of disease, and potential for effective intervention. Anthrax, trypanosomiasis, rabies, brucellosis, Rift Valley fever, echinococcosis, non-typhoidal salmonellosis, Q-Fever, mycobacterium species and influenza pandemics were the top ten diseases in order of rank. 26

2.2 Surveillance of Zoonotic Diseases in Kenya

2.2.1 Surveillance in Humans Disease surveillance in the human health sector is mainly done through the Integrated Disease Surveillance and Response System, (IDSR) and the District Health Information System 2 (DHIS 2). The IDSR is a WHO–AFRO regional surveillance and response strategy adopted by member states in 1998 to strengthen national disease surveillance systems in Africa. Disease reporting using the IDSR is health facility-based. Local health facilities report human diseases to sub-counties where data is entered into a web-based database. The data is captured using designated forms, classified and reported based on the WHO’s International Statistical Classification of Diseases and Related Health Problems (ICD 10th Edition)27. The reporting frequency for health facilities is weekly for outbreak prone diseases, and monthly for other diseases. These reports are fed into the DHIS2 which is linked to the overall Health Management Information System (HMIS). In 2011 the Kenya IDSR strategy was revised to include more zoonotic and neglected tropical diseases. 3 3

2.2.2 Surveillance in Animals The Directorate of Veterinary Services (DVS) is mandated to conduct surveillance for notifiable diseases in the animal health sector. Using designated Notifiable Disease (ND1) forms, Sub County Veterinary Officers (SCVOs) routinely fill and submit reports to the County Director of Veterinary Services who in turn transmits to the Veterinary Epidemiology and Economics Section (VEES) at the DVS national level. In addition, meat inspectors carry out food-borne disease surveillance at slaughterhouses and notify the DVS of suspect cases of notifiable diseases. With regard to wildlife, the Kenya Wildlife Services (KWS) undertakes opportunistic surveillance by investigating morbidity and mortality events in wildlife across the country. KWS compiles these data and reports these events to the DVS. The types of reports submitted include monthly narrative reports, notifiable and OIE-listed disease reporting forms, radio and telephone calls and rumor logs. The sources of data include farms, slaughter houses and markets, among others. Reporting from the field is enhanced by using electronic reporting systems that employ mobile phone technology (MPT). A Kenya Livestock and Wildlife Syndromic Surveillance system (KLWSS) packaged as a mobile application called the Kenya Animal Biosurveillance (KABS) - is currently being piloted to counties to enable web-based real-time animal disease reporting. The DVS reports notifiable diseases to 1) the OIE through the World Animal Health Information System (WAHIS) and, 2) to the African Union- InterAfrican Bureau for Animal Resources (AU-IBAR) through the Animal Resource Information System (ARIS2).

2.3 One Health Approach Following the emergence of highly pathogenic avian influenza (HPAI H5N1) in Hong Kong in 1997, its rapid spread and pandemic potential caused the global community to realize the weakness of disjointed approaches in addressing emerging infectious diseases. In 2004, global experts formulated the 12 Manhattan Principles that called for the international community to adopt a holistic, multisectoral approach to combat threats to health under the banner ‘One World, One Health (OWOH)’.28 The call to adopt this holistic One Health approach was advocated through a series of International Ministerial Conferences on Avian and Pandemic Influenza (IMCAPI) and global congresses which the Hanoi IMCAPI Declaration unanimously adopted in 2010. In 2008, the United Nations Food and Agriculture Organization (FAO), the World Animal Health Organization (OIE), the United Nations World Health Organization (WHO), the United Nations System Influenza Coordination (UNSIC), the United Nations International Children’s Emergency Fund (UNICEF) and the World Bank (WB) jointly developed a framework for reducing risks of infectious diseases at the animal-human-ecosystem interface based on the OWOH principles.29 In 2010, FAO, OIE and WHO established a Tripartite agreement on the One Health approach.30 Since then, global initiatives such as the Global Health Security Agenda (GHSA) and World Bank One Health programs have assisted countries to institutionalize and operationalize the One Health approach.31, 32 In 2017, the heads of states and governments of the African Union (AU) established the African Union Centre for Disease Control and Prevention (ACDC) anchored on the principles of a One Health approach. The Africa CDC and the InterAfrican Bureau for Animal Resources (AU-IBAR), two AU specialized technical agencies, have jointly developed continental One Health frameworks. Similarly, the East African Community (EAC) and the Economic Community of West African States (ECOWAS) have institutionalized the One Health approach among other regional economic communities. In 2006, Kenya formed a multi-sectoral National Influenza Taskforce (NIT), responding to the HPAI H5N1 pandemic threat originating from Southeast Asia. Though set up to address HPAI H5N1, Kenya was not affected by the pandemic at the time, and the NIT was utilized as a One Health platform to mount a rapid coordinated response to a severe Rift Valley fever (RVF) outbreak in Kenya, Somalia and Tanzania in 2006-2007. After the RVF outbreak, the NIT was re-named the Zoonoses Technical Working Group 4 4 (ZTWG), to address other emerging outbreaks of zoonoses. In 2011, the Director of Public Health and Sanitation [Ministry of Public Health and Sanitation (MOPHS)] and Director of Veterinary Services [Ministry of Livestock Development (MOLD)] signed a memorandum of understanding establishing the ZDU as a One Health Office nested between the two ministries. The ZDU was operationalized in 2012 with support from the US Government (Biosecurity Engagement Program of the US Department of State, the Cooperative Biological Engagement Program of US Department of Defense, and the Centers for Disease Control and Prevention). The ZDU developed its first strategic plan to implement the One Health approach in Kenya (2012 to 2017). The ZDU reviewed its strategic plan in 2013 to account for the newly devolved governance system of Kenya. In March 2017, Kenya underwent the WHO Joint External Evaluation (JEE) to assess IHR core competencies, including One Health coordination mechanisms and zoonotic diseases. The evaluation identified the establishment of ZDU as a major strength in multisectoral coordination using a One Health approach. Subsequently, Kenya has developed a National Action Plan for Health Security (NAPHS) to address gaps identified by JEE. Kenya is a permanent steering committee member of the GHSA, a global partnership that supports countries to detect, prevent and respond to health security threats using a One Health approach. The country has also developed a National Antimicrobial Stewardship interagency committee (NASIC) to address AMR through a multisectoral One Health approach and is a member of the universities One Health network, namely One Health Central and East Africa(OHCEA) which transitioned to Africa One Health University Network (AFROHUN).

2.4 The Kenya One Health Strategic Plan 2012-2017 The Kenya One Health strategic plan 2012-2017 sought to establish active collaboration at the animal- human-ecosystem interface towards better prevention and control of zoonotic, emerging and re-emerging diseases. The plan had three objectives, namely: 1) To strengthen Kenya’s capacity for zoonotic disease prevention and control; 2) To enhance collaboration between the animal health, human health and environment sectors in areas of common interest, and 3) To conduct applied research at the interface. The key achievements, challenges and lessons learnt from the previous plan are highlighted in this section.

2.4.1 Key Achievements The Kenya One Health strategic plan (2012-2017) unified efforts of line ministries, professional disciplines and non-governmental actors to address zoonotic, emerging and re-emerging diseases. Significant progress was realized towards institutionalizing the One Health approach such as, incorporating clear statements on One Health in the veterinary and livestock policies, and integrating of the One Health approach in medical, nursing and veterinary curricula at universities through AFROHUN. Further, One Health champions were deployed in different positions through mentorship programs for graduate interns and Field Epidemiology and Laboratory Training Programme (FELTP) fellows. A major milestone was the prioritization of zoonotic diseases in the country. Based on this, the country’s IDSR guidelines were reviewed to incorporate zoonotic diseases and evidence-based prevention and control interventions for zoonoses were formulated. Notable examples are the Rabies elimination strategy, the Kenya Livestock and Wildlife Syndromic Surveillance system (KLWSS), and Anthrax and Brucellosis studies, culminating in control strategies for the two diseases. Through the 2012-2017 OH strategy plan, the country’s preparedness and response capacity for zoonotic diseases was strengthened. This was partly achieved through the development or revision and testing of contingency plans for priority zoonotic diseases (RVF and HPAI) and Public Health Events of Initially Unknown Etiology (PHEIUE). The plan galvanized joint responses to zoonotic disease outbreaks by the ministries responsible for human and animal health. 5 5 The ZDU played a significant role in coordinating issues of One Health nature beyond zoonotic diseases. The ZDU was, for instance, designated the focal point for the Global Health Security Agenda and the unit coordinated the WHO Joint External Evaluation of the country’s IHR competencies.

2.4.2 Main Challenges The devolution of health and veterinary services under the new constitution made it necessary to establish County One Health Units (COHUs) in some piloted counties and there are efforts to cover all the 47 counties. However, the wide diversity of county administrations, high staff turnovers and the lack of a One Health devolution strategy slowed down progress in institutionalizing COHUs. The One Health approach is new, and there is a low level of awareness of the approach among senior government officials at both national and county levels. Furthermore, the high staff turnover among senior officials requires sustained sensitization to ensure buy-in, support and institutionalization of One Health initiatives. The ZDU did not obtain a budget line from respective ministries to implement the 2012-2017 One Health strategic plan. Notwithstanding, the ZDU attracted support to implement the One Health strategic plan from partners notably, CDC, DTRA, FAO, OIE, USAID, WHO and WSU. Sustainability of the outcomes of the previous plan in the absence of government support remains a major challenge. Furthermore, the ZDU is understaffed, and the two government staff on its payroll are inadequate for effective coordination and implementation. The absence of expertise on the environment, ecology and knowledge management in the ZDU imposes additional constraints to implement the strategy. Although the ZDU is the country’s One Health office, the mandate of ZDU is confined to zoonotic diseases; as such,separate coordination mechanisms have evolved to address other One Health concerns , such as antimicrobial resistance and food safety.

2.4.3 Lessons Learnt The (2012–2017) OHSP played a significant role in institutionalising the One Health approach in Kenya, enabling the development of evidence-based programs for prevention and control of zoonotic diseases leveraging partner support for implementation. The current strategic plan builds on past achievements while working towards making ZDU sustainable through government buy-in and support.

2.5 Institutional Framework The One Health strategic plan for the prevention and control of zoonotic diseases will be implemented by the MOH and MALF in close collaboration with the Ministry of Environment and Forestry (MOEF) and the Ministry of Tourism and Wildlife (MOTW). The coordination of the implementation will be anchored on the existing ZTWG and ZDU as its Secretariat. The ZTWG will be transitioned to the National Zoonoses Technical Committee (NZTC), a permanent One Health coordination forum for the prevention and control of zoonotic diseases. The Director General of Health (DGH) forum to prevent and control zoonotic diseases. The Director General for Health and the Director of Veterinary Services (DVS) will alternately Chair the NZTC and provide oversight to ZDU through relevant departments under their director. At County and sub-county levels, One Health Units will work through County and sub-County Coordinating Committees to implement the plan. Two epidemiologists jointly lead the ZDU, each seconded by respective line ministries. The unit is in the Department of Disease Surveillance, Epidemics and Response (DSER) under the Directorate of Preventive and Promotive in the DMS. In the DVS, the unit is under the Veterinary Epidemiology and Economics Section (VEES) in the Division of Disease Surveillance, Vector regulation and Zoological services. The current strategic plan foresees stronger integration of ecosystem and environment expertise into the ZDU to enhance the impact of the One Health approach. The Directorate of Wildlife in the Ministry of Tourism and Wildlife and the KWS Veterinary Department (KWSVD) are members of the ZTWG. The KWSVD also actively participates in joint wildlife health investigations with ZDU and reports wildlife disease events to the DVS as a statutory requirement. To implement the current One Health strategic 6 6 plan, the MoU forming ZDU will be reviewed and the management structure revised, to enhance MOEF involvement. The current structure of ZDU/ZTWG and the proposed new organizational structure of ZDU/NZTC are presented below in (Figures 1 & 2). The NZTC will provide technical guidance to line ministries and other stakeholders on the prevention and control of zoonotic diseases using a One Health approach. Its membership will include ministries and agencies responsible for human health, livestock, wildlife and environment; County governments; representatives of the private sector; semi-autonomous government agencies, non-governmental organizations, research institutions, academia, and international partners. Management and response to zoonotic disease outbreaks, including public health events of initially unknown etiology (PHEIUE), will be coordinated by the ZDU/NZTC working closely with the Public Health Emergency Operation Centre (PHEOC), other EOCs and disaster units using the proposed management and response structure presented in Figure 3 under Appendix 2 The current One Health strategic plan will establish stronger coordination between ZDU/NZTC and other committees concerned with antimicrobial resistance and food safety. To this end, the ZDU/NZTC will play a pivotal role to establish an over-arching National Coordination Platform to addresse current and emerging One Health initiatives. Further, the ZDU will establish stronger collaborative links with local universities through AFROHUN Kenya in One Health workforce development and related capacity building activities. Figure 1: Current organizational structure of ZDU/ZTWG 7 7 Figure 2: Proposed new organizational structure of ZDU/NZTC

2.6 Policy and Legal Frameworks At the global level, the One Health Strategic plan (2020-2024) aligns with the Sustainable Development Goals (SDG) 2, 3 and 15, the revised WHO IHR (2005) and IDSR technical guidelines, the OIE Terrestrial and Aquatic Animal Health code, the Global Health Security Agenda (2024) and the Sendai Framework for Disaster Risk Reduction (2015-2030). The plan also aligns with the African Union Agenda 2063 and other relevant disease prevention and control strategies (such as the African Union Agenda 2063 and other relevant disease prevention and control strategies).. At the national level, the One Health Strategic Plan (2020-2024) plan conforms with the 2010 Kenya Constitution, Vision 2030, the Big Four Agenda, as well as sectoral policies and strategies here listed: the Kenya Health Policy (2010-2030), the Kenya Health Sector Strategic and Investment Plan (2019-2023), the revised National Livestock Policy (2019), the Kenya Veterinary Policy 2015 (draft), the National Wildlife Policy 2011 (draft), the Agricultural Sector Transformation and Growth Strategy (ASTG, 2019-2029), National Action Plan for Health Security (NAPHS, 2019-2023), The National Wildlife Strategy (2030), Health strategic plan (2015-2030) and the Directorate of Veterinary Services Strategic Plan (2018-2022). Since health and veterinary services are devolved functions, county governments will play a vital role in the prevention of zoonotic diseases using a One Health approach. The current One Health strategic plan has been developed in consultation with county stakeholders and is customizable to strategies and policies of county governments.. 8 8 The plan is supported by several laws that are relevant to the prevention and control of zoonotic diseases in Kenya such as the the Animal Diseases Act (Cap 364), the Meat Control Act (Cap 356), the Public Health Act (Cap 242), Fisheries Act (Cap 378), Kenya Veterinary Vaccines Production Institute Order (1990), Kenya Medical Supplies Authority Act (2013), Medical Practitioners and Dentists Act (Cap 253); Nurses Act (Cap 257); Veterinary Surgeons and Veterinary Para-Professionals Act (Rev. 2014,2011); Medical Laboratory Technicians and Technologies Act (Rev. 2012, 1999); Food, Drug and Chemical Substances Act (Cap 254), Rabies Act (Cap 365), the Health Act (2017), Wildlife Conservation and Management Act (cap 376) and the Intergovernmental Relations Act (2012).

2.7 Stakeholder Analysis A stakeholder analysis is essential to guide the development of a One Health strategic plan. The outputs of a stakeholder analysis feed into activities of planning, implementation and synthesis of an effective communication strategy, among others. The professionals developing this strategic plan analyzed the stakeholders in the country with respect to their roles, attitude, and implementation of the One Health approach. The analysisalso considered methods to engage various stakeholders in One Health, the key messages to be used and the champions to be targeted. Details of the stakeholders analysis are in Table 5 under Appendix 3.

2.8 PESTEL and SWOT Analysis The prevailing Political, Economic, Social, Technological, Legal and Environmental factors (PESTLE) that would impact the implementation of the One Health strategy to prevent zoonotic diseases in Kenya were analyzed. Furthermore, One Health implementation’s strengths, weaknesses, opportunities, and threats (SWOT) were identified. These analyses informed the development of this strategic plan and are presented below in (Tables 1 & 2) Table 1. PESTEL Analysis results for the OH strategic plan for prevention and control of zoonotic diseases in Kenya PESTLE Factors Impact on OH implementation Recommendation for OHSP Political Devolution of public service Inadequate coordination and • Continued engagement with counties delivery divergent priorities between • Participation in inter-governmental national and county medical and relations forums veterinary services Frequent changes in the senior Weakens political buy-in and • A sustained approach to sensitize high leadership of ministries involved slows the momentum of the One level ministry officials on One Health in One Health Health approach and zoonotic diseases Political Absence of a One Health Policy Negatively impacts buy- • Advocate the development of a OH in,political support and funding policy and inclusion of statements on OH in sectoral policies • Lobby relevant government ministries and stakeholders to implement a One Health policy Economic Competition for funding with Negatively impacts budgetary • Increase collaboration with other national priorities allocation to zoonotic disease development partners prevention programs • Develop resource mobilization proposals • Develop annual budgetary estimates and lobby for more budgetary allocation Social Cultural values and practices Increased zoonotic disease risks • Capacity development and consultation that hinder good animal health, with counties to use appropriate production, welfare and public extension delivery systems,; community health empowerment • Develop OH communication plan to implement information, education and behavioral change using culture- responsive information Low literacy levels Hinder One Health knowledge • Use most accepted approaches for transmission and enhance communication to various target transmission of zoonotic diseases communities • Use of appropriate information dissemination platforms 9 9 PESTLE Factors Impact on OH implementation Recommendation for OHSP Technology Rapid development and change Inability to keep up with the Staff capacity development; continued in ICT technologies required changes professional development Use of ICT applications in OH Possibility for Improved disease Invest in most result-oriented and user- implementation surveillance, prevention and friendly technology in zoonotic disease response using technology prevention and control activities Environmental Climate change Extreme weather pattern shifts • Enhance resilience, disaster and shocks associated with preparedness and management increased incidence of zoonotic • Streamline close collaboration with disease outbreaks Metrological department Environmental Environmental degradation and Increased incidence of diseases Involve environmental experts and Pollution authorities in implementation of the one health strategic plan Increased human-wildlife Increased incidences and burden • Develop and issue guidelines on Land interactions and conflict of emerging and re-emerging use planning in collaboration with zoonotic diseases Environmental and Planning • Develop and disseminate guidelines on sustainable energy source Globalization Increased propagation and trans- Collaborate with regional and global Environmental degradation boundary spread of zoonotic actors in addressing regional and global diseases health agendas Legal Competition with other priorities Delay in debate and passing of Lobby the appropriate parliamentary in parliamentary calendar veterinary medical policies and committees bills Inadequate legislative framework Gaps in existing laws may hinder Advocate for review of laws to support One Health implementation implementation of one Health in prevention and control of zoonotic diseases 10 10

2.9 Consultative Approaches This strategic plan was developed through a participatory consultative process involving a broad range of stakeholders from sectors involved with zoonotic disease prevention and control using a One Health approach. The plan builds on the lessons learnt from the previous strategic plan (2012 to 2017). This strategic plan is guided by international best practices and guidelines for the control of zoonotic diseases, in particular the FAO, OIE and WHO tripartite guidelines. It also conforms to the Kenya Constitution (2010), Vision 2030, the “Big Four” Agenda and existing sectoral polices and strategies. Table 2. SWOT Analysis for the prevention and control of zoonotic diseases in Kenya using a One Health approach from 2021 to 2025. Thematic area Strengths Weaknesses Zoonotic disease prevention, •Disease surveillance structures exist at County • Weak enforcement of disease control strategies surveillance, response and and sub-County levels for both animal and human • Some priority zoonotic diseases do not have national control health. control plans • A revised IDSR strategy that incorporates zoonotic •Limited coverage of electronic reporting in animal diseases is being implemented in line with IHR health (2005) • Limited diagnostic capacity for zoonotic diseases in • The country has comprehensively prioritized humans and wildlife zoonotic diseases •Lack of laboratories specialized in wildlife disease • Strategies, programs and guidelines are in place for diagnosis and lack of validated laboratory tests for some priority zoonotic diseases, such as for rabies wildlife diseases elimination • Inadequate reporting structures for wildlife disease • Syndromic surveillance system for livestock and surveillance wildlife is being implemented through an electronic • Absence of a structured surveillance for neglected reporting platform zoonotic diseases e.g. echinococcosis, hydatidosis, • Regional labs and one Central Veterinary q-fever, rickettsial fevers Laboratories is in place with some diagnostic • Limited human capacity at National and County and capacity a high turnover of surveillance officers • The country has a good network of human • Weak sample referral system, especially in the animal diagnostic laboratories and good capacity for health laboratories confirmatory diagnosis at the national reference • Laboratories have weak capacity to diagnose laboratories at KEMRI and NPHL zoonotic diseases • The Disease Surveillance and Response Unit • Test kits commonly used for zoonotic disease (DSRU) in the MOH produces and disseminates a diagnosis are not validated e.g. brucellosis weekly epidemiological bulletin on human diseases • Limited access to human and animal laboratory • The VEES produces and disseminates quarterly services in arid/semi-arid counties bulletins on animal diseases • Veterinary investigation laboratories are not adequate • Existing curriculum on One Health for training for the country (only seven currently) institutions at various levels • Inadequate human health and animal health • Trained human and animal health personnel specialists • Contingency plans available • Sub-optimal involvement of private practitioners in • Applied epidemiology training program in place disease reporting in both humans and animals • Challenges in reporting:- timeliness, data quality, sensitivity • Existence of legal and policy framework e.g. • Lack of county-specific contingency plans for Animal Diseases Act, Public Health Act, National outbreak response, and absence of rapid outbreak Livestock Policy, National Wildlife Policy response teams • Existence of disease surveillance guidelines e.g. • Weak institutional structures for sharing of resources IDSR/IHR (2005), OIE, FAO between the animal and human health agencies • Existence of contingency plans for some diseases • Culture of working in silos e.g. RVF, HPAI • Lack of intersectoral laboratory sharing policy • Multiple zoonotic disease challenges e.g. anthrax • Lack of harmonized disease community surveillance guidelines • Lack of a National One Health policy • Inadequate human resource at national and subnational levels • Inadequate information sharing (between sectors) • Lack of integrated SOPs and guidelines for zoonotic diseases • Inadequate surveillance data feedback (between sectors and farmers/livestock keepers) • Porous borders and inadequate cross-border collaboration among neighbouring countries One Health coordination and • The ZDU is institutionalized in the MOH and • Weak Involvement of the Ministry responsible for collaboration MAL&F to coordinate zoonotic disease as a One Environment in the One Health approach Health platform 11 11 Thematic area Strengths Weaknesses One Health coordination and • A Zoonotic Technical Working Group (ZTWG) is • Inadequate ZDU staff to effectively implement the collaboration in place to provide technical guidance in prevention One Health mandate and control of zoonotic diseases • Weak county-level mechanisms for One Health • The country has One Health champions some of coordination and collaboration whom have been mentored by ZDU through FELTP • Limited Government funding for zoonotic disease residencies and graduate internships prevention and control • ZDU promotes multisectoral collaboration • Inconsistent monitoring and evaluation of the One • Other multisectoral collaboration efforts e.g. Health activities AMR, food safety are present in the country • Weak linkages between ZDU and new One Health • One Health approach is explicitly spelt out initiatives that address other thematic areas beyond in veterinary and livestock policies which can zoonotic diseases (e.g AMR,) positively impact buy-in and support by key • Dependence on donor funding could hinder decision makers sustainability • Some human and animal health training • Duplication of efforts with no framework to institutions address One Health at pre-service level harmonize activities by different institutions • A clear MoU defining the obligations, roles and • Lack of interoperable data reporting and sharing responsibilities of each of the line ministries under the OH Platform is in place • Quarterly OHTWG and monthly ZTWG meetings are already ongoing Operational Research • The ZTWG provides a multisectoral platform • Weak linkage with environmental health experts to discuss both operational research and basic limits the scope of research agenda research agenda using the One Health approach • Weak information technology infrastructure limits • An existing list of priority zoonotic diseases is the capacity for establishment of databases at national available to guide the research agenda and county levels • The ZDU has enhanced capacity to undertake • Absence of a research information sharing system zoonotic disease outbreak investigations and • Institutions conduct research in isolation associated operational research by the parent • Inadequate information sharing among institutions ministries. on One Health research • Participating institutions are conducting relevant • Duplication of research by different institutions and reliable research related to One Health • Output of One Health research is not used to inform • Existence of multidisciplinary and multisectoral appropriate policies research experts • National research agendas do not address One Health • Political will on importance of research e.g. multi- issues disciplinary research funds through the National • Research Fund • Availability of basic infrastructure and resources for research • Existence of rich and diverse natural resources for use in research Zoonotic disease prevention, • Prevention and control of zoonotic diseases • Outbreaks of emerging and re-emerging zoonotic surveillance, response and including emerging pandemic threats is a priority in diseases such as Ebola, RVF and HPAI control global health security priority and the SDGs • Insecurity in parts of the country decreases access to • A national action plan for health security (NAPHS, essential health and veterinary services 2019-2023) is in place to strengthen IHR (2005) core • Porous borders with neighbouring countries makes capacities that include zoonotic diseases enforcement of border controls difficult, increasing • There are continental and regional initiatives from the risk of incursion of zoonotic diseases multiple global partners • There is increasing global threat of bioterrorism • Kenya has good information and communication • Climate change with extreme weather pattern technologies (enhanced mobile phone and email shifts could exacerbate the emergence and spread of communication and internet accessibility) can be zoonotic diseases harnessed for improved surveillance • Environmental degradation and pollution could • Devolved governance could improve funding for increase the emergence and vulnerability to zoonotic zoonotic disease prevention and control across the diseases country • Globalization enhances emergence and rapid spread • There is a One Health communication strategy of zoonotic diseases (draft) • Changing priorities in global health funding • There is potential to expand delivery of existing • International travel. curriculum on One Health to more training • Difficulty defining the right environmental experts institutions • Political interfering with disease control efforts. • Establishment/strengthening of county-based • Some cultural beliefs, practices and diets predispose veterinary investigation laboratories in all the 47 communities to risks particular OH problems counties • insufficient or lack of compelling evidence of • Greater involvement of private practitioners in advantages of One Health to the policy makers disease reporting in both humans and animals • Conflicting political interests • Existence of various surveillance tools and • Conflicting and/competing interests on priority platforms setting and resource allocation • Presence of potential donors to support disease • Fragmented chain of command surveillance and prevention 12 12 Thematic area Opportunities Threats One Health coordination and • Strong global technical support and advocacy • The presence of devolved governance may create collaboration for the One Health approach through FAO, OIE, power struggles with the national goverment WHO and World Bank among other international organizations • Presence of a vibrant private sector that provide opportunity Public-Private partnership for One Health implementation • Presence of Devolved governance as an opportunity for One Health collaboration Operational Research • There is global interest in research on emerging • Potential shifts in global research agenda and re-emerging diseases • Many research projects are not demand driven • ZDU has networks and linkages that favour • Lack of availability of renewable material resources research activities by international partners • Global economic crisis • Occurrence of emerging/re-emerging pandemic • Competing priorities of the donor and local threats institutions • Baseline information on One Health exists in • Diversity of one health group formulation different collaborating institutions • Lack of government commitment after donor • Existence of external funding agencies withdrawal • Interest of development partners and innovation • Inadequate communication between researchers and • Existence of EAC One Health forum policy makers • Existence of fora (e.g. KMA, KVA, conferences) • Customs and culture that can be used to disseminate policy briefs 13 13 ©FAO/Luis Tato 14 14 3 The Five-Year Strategic Plan (2021-2025) This section presents the vision, mission, goals, core values and guiding principles of the five-year strategic plan. In addition, the detailed strategic framework, financing, and monitoring and evaluation aspects of the plan are described.

3.1 Vision, Mission and Goal Vision: Elimination of zoonotic disease threats to ensure well being of humans, animals and the environment in the country Mission: To establish and strengthen multi-sectoral collaborations through the One Health approach to effectively prevent and control zoonotic diseases at national and county levels. Goal: To reduce the burden of zoonotic diseases through a One Health approach.

3.2 Core Values and Guiding Principles Core Values The following are the core values that will guide the implementation of this strategic plan: • Collaboration – To promote engagement, close working relationships, collaboration among stakeholders and disciplines to achieve full benefit and synergy for all. • Adaptability – Flexibility, innovativeness and responsiveness, to meet evolving county, national, regional and international One Health requirements. • Excellence – Promote the highest standards of performance across the One Health scope,to realize quality and continuous improvement at all levels. • Transparency – Strive for open and interactive communications with and among members, partners, staff, and other stakeholders to create the highest level of ethics throughout its work. • Integrity – Strive for absolute scientific confidence through all communications, resources, and programs to ensure our work’s credibility and the importance and value of the One Health approach. • Leadership – Serve with a visionary responsibility for the future, instilled with the highest level of trust to develop and implement an integrated strategy for improved health in Kenya, regionally and globally. • Stewardship – Maintain responsible management practices, to uphold the highest standards of accountability regarding our work and the use of our funds. Guiding Principles The following principles will guide the implementation of this plan: 1. Prevention and control of zoonotic diseases is a public good and requires strong political and financial commitment for sustainability at national and county levels . 2. Regional and international collaboration is necessary for the control of zoonotic, emerging and re-emerging diseases. 3. Use of multi-sectoral and multi-disciplinary approach to realize technical, political and regulatory frameworks required to manage zoonotic diseases and other emerging One Health priorities. 15 15 4. Adaptation to emerging information and communication technologies for effective One Health implementation. 5. Adaptation to emerging zoonotic disease trends. 6. Community engagement in the prevention and control of zoonotic diseases. 7. Prevention is the most cost-effective way to reduce the burden of disease. 8. Respect for cultural diversity and gender inclusivity is important to overcome access barriers to health. 9. Public health policy and practice should be evidence-based.

3.3 Strategic Framework This strategic plan will be implemented through three objectives and eleven strategies as outlined below. Strategic Objective 1: Strengthen Implementation of One Health Approach at National and County Levels Reducing the burden of zoonotic diseases, including emerging and re-emerging ones, requires coordination and collaboration mechanisms between ministries responsible for human, animal (livestock and wildlife) and environmental health, alongside other stakeholders. This plan will employ the four strategies outlined below to establish coordination and collaboration mechanisms at the national and county levels. 1.1: Strengthen OH Co-ordination Mechanisms at National and County Levels This strategy will involve strengthening operations and structures of the ZDU, including enhancing the involvement of the environmental sector in ZDU; establishment and operationalization of COHU; strengthening the coordination mechanism for zoonotic disease management at national level; updating the database of ZTWG stakeholders and sensitizing the Council of Governors on the One Health approach. 1.2: Strengthen Collaborative Mechanisms for OH Initiatives This will entail reviewing and disseminating the One Health communication strategy, strengthening linkages with regional and international platforms and coordinating the establishment of an over- arching national One Health Platform to link different OH thematic areas for synergy and coherence. 1.3: Strengthen OH Policy and Legal Frameworks This strategy will focus on improving the policy and legislative environment for implementation of the OH approach through evidence-based advocacy with policymakers at both national and county levels. 1.4: Support Capacity Building for OH Workforce This strategy will involve in-service training of personnel from human, animal, environmental and other relevant sectors on zoonotic diseases and One Health approach; advocating for inclusion of One Health modules in training institutions; and mentoring ZDU interns and post-graduate residents on the OH approach. This strategy will be implemented in collaboration with OHCEA/ Africa One Health University Network (AFROHUN) Kenya. Strategic Objective: 2. Strengthen Prevention, Surveillance, Response and Control of Priority Zoonotic Diseases in both Humans and Animals Data-driven prevention, response and control strategies are necessary to establish and reduce the burden of zoonotic diseases, which depend on strong disease surveillance systems. While medium to long-term building efforts are ongoing, there will be a need to respond to emergencies arising from outbreaks of known zoonotic diseases, and those of unknown etiology. This objective will employ the five strategies outlined below. 16 16

2.1 Strengthen Surveillance for Zoonotic Diseases at the National and County level This strategy will involve reviewing and updating the list of priority zoonotic diseases and the associated risk maps; conducting risk assessment for priority zoonotic diseases; updating existing surveillance tools and guidelines by the different sectors; and strengthening surveillance for zoonotic diseases among other interventions.

2.2 Enhance, Prevention and Control of Priority Endemic Zoonotic Diseases This strategy will focus on developing and updating prevention and control plans for priority endemic zoonotic diseases such as rabies, Rift Valley fever, brucellosis and anthrax.

2.3 Enhance Preparedness and Response to Zoonotic Disease Outbreaks and Public Health Events of Initially Unknown Etiology This strategy will review and develop preparedness and response plans for zoonotic and potentially zoonotic emerging diseases and disseminate a One Health Joint Response Plan to zoonotic and potentially zoonotic emerging disease outbreaks; coordinate joint outbreak response activities; and review and develop disease-specific risk and crisis communication plans.

2.4 Support Strengthening of National, Regional and County Laboratories for Diagnosis of Priority Zoonotic Diseases This strategy will involve conducting diagnostic laboratory needs assessment for priority zoonotic diseases, developing protocols for sample referral, and establishing and enhancing diagnostic capacity for priority zoonotic diseases.

2.5 Strengthen Early Warning Systems for the Detection of Emerging and Re-emerging Zoonotic Diseases and Public Health Events of Initially Unknown Etiology This strategy will entail supporting the establishment of sentinel human, wildlife and livestock surveillance sites to enhance early detection of pathogens of public health interest. It will also entail supporting community based zoonotic disease surveillance. Strategic Objective 3: Promote Applied Research using the OH Approach Applied research provides required evidence for interventions and policy directions with regard to zoonotic diseases prevention and control. This objective will employ the two strategies outlined below:

3.1 Develop zoonotic and emerging infectious diseases research agenda for Kenya This will entail convening stakeholders from the different One Health sectors to discuss and agree on research priorities for zoonotic diseases in Kenya.

3.2 Conduct Applied Research to Inform Evidence-Based Strategies and Policies on Priority Zoonotic Diseases This strategy will focus on supporting epidemiological, ecological, socioeconomic and cross-sectoral studies; reviewing literature periodically to guide updating of strategies; and promoting citizen science’s application in zoonotic disease prevention and control among other interventions. The detailed strategic framework is presented in the matrix below in (Table 3) outlining the objectives, strategies, activities, sub-activites, expected outputs, indicators, timelines, and budget for implementing the activities. The ZDU will be responsible for implementation. 17 17 Table 3. Strategic framework for implementation of One Health approach (2021 - 2025) Timeframe Strategy Activities Sub-activities Outputs Indicators Budget (Ksh) 2021 2022 2023 2024 2025 Strategic Objective 1: Strengthen implementation of One Health approach at national and county levels 1.1 1.1.1: Strengthen 1.1.1.1 Update Optimal staff ZDU staff x x 0.00 Strengthen OH operations and optimal staff requirement of ZDU establishment coordination structure of the requirement for established report mechanisms at ZDU ZDU national and

1.1.1.2 Review and MOU revised and A signed MoU x 480,000 county levels sign the MOU that signed establishes ZDU

1.1.1.3 Advocate for Staff deployed Number of staff x x x x x 0.00 deployment of staff deployed against in the ZDU the establishment

1.1.1.4 Review terms TOR reviewed Reviewed TOR x of reference (TOR) available for zoonotic disease unit

1.1.2 Strengthen 1.1.2.1 Establish Disease ecologist A deployed x x 0.00 the involvement of a position for a position established disease ecologist the environmental disease ecologist and officer deployed sector in ZDU at ZDU and lobby the responsible ministries to deploy the officer

1.1.2.2 Establish Environment officer A co-opted x x 0.00 position for an position established environment environmental and officer co-opted officer officer and lobby on a need basis responsible ministry to co-opt on a need basis 1.1.3: Support 1.1.3.1 Establish Guidelines (SOPs) Number of SOPs x x 1,332,000 establishment and procedures to available operationalization promote One Health of county One approach at the Health platform county

1.1.3.2 Sensitize Sensitization Number of x x 10,230,000 County policy meetings for County sensitization makers on One policy makers meetings held Health conducted

1.1.3.3 Form and County COHUs TORs of COHUs x x x 5,000,000 train County formed and trained Minutes/ One Health Units proceedings (COHUs)

1.1.3.4 Advocate for County OH focal Number of x x 500,000 appointment of OH persons appointed focal persons focal persons by and working appointed Counties Number of counties with focal persons

1.1.3.5 Sensitize the County OH focal Number of x x x x 1,026,000 County OH focal persons sensitized focal persons persons sensitized

1.1.3.6 Hold annual Meetings held Number of x x x x 25,000,000 regional review meetings held meetings for COHUs 18 18 Timeframe Strategy Activities Sub-activities Outputs Indicators Budget (Ksh) 2021 2022 2023 2024 2025 1.1.4: Strengthen 1.1.4.1 Transform NZTC in place Minutes of x 3,000,000 the coordination ZTWG to a meetings mechanism for National Zoonotic zoonotic diseases Disease Technical management Committee (NZTC)

1.1.4.2 Identify/ Formally nominated Letters of x x 0.00 formally nominate NZTC members in appointment members from the place human, animal and environment sectors to the NZTC

1.1.4.3 Form NZTC NZTC sub- Minutes/reports x x x x x 3,000,000 sub-committees committees formed and operational

1.1.4.4 Hold Quarterly meetings Minutes of x x x x x 5,320,000 Quarterly meetings conducted meetings for the NZTC 1,1,4,5 Hold a Biennial zoonotic Proceedings of x x 2, 500,000 biennial zoonotic conference held the conference disease conference to involve national, county and other OH stakeholders to share best practices and experiences

1.1.5 Update 1.1.5.1 Request for List of SME Number of SME x x 0.00 database of nomination of nominees in place nominees subject matter Subject matter experts (SME) on experts from priority zoonotic relevant institutions diseases

1.1.5.2 Convene a Experts database A database of x 2,000,000 meetings of the updated experts NZTC to review and approve SME nominees

1.1.6 Engage COG 1.1.6.1 Develop Advocacy material Advocacy x 2,000,000 to get support for advocacy material developed materials OH approach

1.1.6.2 Convene a Meetings with the Meeting report/ x 720,000 meeting with CoG CoG held minutes

1.1.5.3 Convene two Meeting with CECM/ Number of x x 2,500,000 meetings with the Cos convened meetings relevant CECM/COs Minutes of meeting

1.2 Establish 1.2.1 Review and 1.2.1.1 Hold 2 Communication A reviewed x x 2,760,000 collaborative disseminate OH workshops strategy reviewed communication mechanisms for Communication to review strategy OH initiatives Strategy communication Number of strategy workshops held

1.2.1.2. Disseminate Communication Number of x 1,220,000 strategy to strategy sensitization stakeholders disseminated meetings through 2 sensitization Number of meetings and platforms used electronic platforms

1.2.1.3 Develop Communication Number of x x x 1,618,000 and disseminate messages shared to messages messages to target audiences developed audiences

1.2.1.4 Update the ZDU electronic Updated x x x x x 1,000,000 ZDU electronic footprint current electronic footprint (website and up-to-date footprints and twitter) regularly 19 19 Timeframe Strategy Activities Sub-activities Outputs Indicators Budget (Ksh) 2021 2022 2023 2024 2025 1.2.2: Strengthen 1.2.2.1 Participate in Cross-border Number of cross- x x x x x 1,120,000 linkages with 5 cross border One meetings attended border meetings regional and Health meetings attended international OH platforms reports

1.2.2.2 Participate Regional OH Number of x x x x x 2,240,000 in 3 regional OH meetings attended regional OH platform meetings meetings attended Reports

1.2.2.3 Participate International Number of x x x x x 3,360,000 in 3 international conferences international conferences attended conferences attended Proceedings/ reports 1.2.3: Coordinate 1.2.3.1Identify OH One Health Thematic areas x x 1,020,000 the establishment thematic areas and thematic areas and stakeholders of the national OH stakeholders and stakeholders report platform identified

1.2.3.2 Develop TORs and TORs and x x 1,020,000 TORs and Organizational Organizational organization structure for structure structure for national OH the national OH platform developed coordination platform 1.2.3.3Sensitize Stakeholders and Number of x x 2, 360,000 stakeholders Counties sensitized stakeholders and Counties on on One Health and Counties national One Health platform sensitized platform

1.2.4.4 Coordinate Biannual meetings Number of x 5,360,000 biannual meeting held biannual of the national OH meetings held platform

1.3 Strengthen 1.3.1 Identify gaps 1.3.1.1 Conduct Policy and legislative Policy and x x 2,220,000 OH policy in policies and a policy and scan conducted legislative scan and legal legislations with legislative scan to report frameworks regard to OH identify gaps in approach existing policies and legislations

1.3.2 Disseminate 1.3.2.1 Prepare policy Policy briefs Number of policy x x 1,000,000 evidence-based briefs prepared briefs policy advocacy

1.3.2.2 Convene Policy dialogue Number of x x x 1,600,000 materials to policy policy dialogue meetings convened policy dialogue makers at national through NZTC meetings and county level convened

1.3.2.3 Prepare and Newspaper articles Number of x x x 500,000 publish newspaper prepared and newspaper articles published articles prepared and published

1.4 Support 1.4.1 Develop 1.4.1.1 Conduct Training needs Training needs x 500,000 Capacity and implement training needs assessment assessment building for OH training modules assessment on conducted report workforce on zoonotic priority zoonotic diseases and diseases and One One Health for Health human, animal and environmental health professionals 20 20 Timeframe Strategy Activities Sub-activities Outputs Indicators Budget (Ksh) 2021 2022 2023 2024 2025

1.4.1.2 Develop Training modules Number Training x x x x x 440,000 training modules developed modules for priority zoonotic diseases and One Health

1.4.1.3 Conduct two Trainings conducted Number of x x x x x 22,016,000 trainings annually trainings on the priority conducted zoonotic diseases and One Health 1.4.2: Advocate for 1.4.2.1 Conduct Annual advocacy Number of x x x x 1,360,000 inclusion of One annual advocacy meetings held advocacy Health modules meetings to meetings held in training promote curriculum institutions for review in training animal, human institutions to and environmental incorporate One health Health modules

1.4.2.2 Conduct Advocacy meeting Number of x x x x 1,360,000 advocacy meetings held advocacy with professional meetings held regulatory bodies to accredit One Health modules as part of continuous professional development

1.4.3 Provide 1.4.3.1 Provide Trainees mentored Number x x x x x 1,500,000 mentorship mentorship to on the One Health of trainees to interns and interns and post- approach mentored post-graduate graduate residents residents on the OH approach Strategic Objective: 2. Strengthen prevention, surveillance, response and control of priority zoonotic diseases in both humans and animals

2.1 Strengthen 2.1.1 Review 2.1.1.1 Review Existing data Number of tools x x 2,220,000 surveillance for existing sector- existing zoonoses collection tools reviewed zoonoses at the based surveillance data collection tools reviewed National and data collection Report County levels tools to include relevant zoonotic diseases information

2.1.2 Coordinate 2.1.2.1 Develop Guidelines on Guidelines x x 5,220,000 data exchange guidelines on information sharing between human, information sharing developed animal and for priority zoonotic environmental diseases at the health sectors national and county at National and level County levels

2.1.2.2 Develop data Data sharing MoUs Signed MoUs x x 500,000 sharing agreements developed and between the sectors signed

2.1.2.3 Develop Protocol for A protocol x x 500,000 a protocol for immediate for immediate immediate notification notification of notification of developed zoonotic diseases zoonotic diseases between multiple sectors

2.1.2.4 Convene Information sharing Number of fora x x x x x 4,600,000 biannual fora convened convened information sharing fora among stakeholders 21 21 Timeframe Strategy Activities Sub-activities Outputs Indicators Budget (Ksh) 2021 2022 2023 2024 2025 2.1.3: Review 2.1.3.1 Review Surveillance Reviewed x 2,220,000 zoonoses zoonoses guidelines in surveillance surveillance surveillance animal, human guidelines guidelines guidelines and and environmental opportunities health reviewed for integrated surveillance in animal, human and environmental health sectors

2.1.4 Collate, 2.1.4.1 Prepare Quarterly zoonotic Number of x x x x x 1,000,000 analyze and and disseminate disease bulletin bulletins share updates on quarterly zoonotic disseminated disseminated zoonotic disease disease bulletin events in Kenya

2.1.4.2 Organize Public dissemination Number of public x x x x x 2,500,000 public fora on need-basis fora organized dissemination fora (during an outbreak)

2.1.5 Strengthen 2.1.5.1 Develop Community- Validated x 1,250, 000 community- and disseminate based surveillance community- based syndromic guidelines for guidelines developed based surveillance community-based and disseminated surveillance surveillance guidelines

2.1.5.2 Develop lay Lay case definitions Lay case x x 4,440,000 case definitions and and syndromes definition and syndrome manuals developed syndrome on priority zoonotic manuals diseases

2.1.5.3 Disseminate Case definitions and Number of x 5,220,000 case definition and syndrome manuals manuals syndrome manuals disseminated to 15 disseminated to piloted counties Number of counties with manuals

2.1.5.3 Support Community event Number of x x x 11,532,000 implementation based surveillance counties of the community system in place community event based event based syndromic surveillance surveillance in zoonotic hotspots 2.1.6: Review and 2.1.6.1 Identify Disease Adopted tool x 1,380,000 update list of all available prioritization tool priority zoonotic tools and adopt adopted diseases suitable disease prioritization tool

2.1.6.2 Conduct desk Database on Database on x 1,380,000 review on selected zoonotic diseases zoonotic diseases zoonotic diseases to available at National inform prioritization and County Number of at National and zoonotic diseases County reviewed

2.1.6.3 Convene Prioritization Number of x 1,380,000 prioritization workshop convened workshops workshops to review and update Priority zoonoses list Priority zoonoses priority list developed list

2.1.6.4 Disseminate Zoonotic disease list 1. Number of x 500,000 zoonotic diseases disseminated meetings held priority list to and stakeholders stakeholders reached. 2. Proportion of counties to which list is disseminated 22 22 Timeframe Strategy Activities Sub-activities Outputs Indicators Budget (Ksh) 2021 2022 2023 2024 2025 2.1.7: Develop 2.1.7.1 Develop Risk maps developed Number of risk x x 2,220,000 and review risk risk maps for maps developed maps for priority brucellosis, anthrax zoonotic diseases and other priority zoonotic diseases

2.1.7.2 Review Risk maps reviewed Number of x 1,380,000 existing risk maps reviewed risk for rabies, RVF maps and other priority zoonotic diseases

2.1.7.2 Develop risk Risk profiles Number of risk x x 1,380,000 profiles for priority developed profiles ZDs

2.1.8 Build 2.1.8.1 Conduct Risk assessment Number of risk x 5,152,000 capacity for risk two trainings on trainings conducted assessment assessment of risk assessment at trainings priority zoonotic national and county conducted diseases levels per year

2.1.8.2 Conduct one Joint risk Number of joint x x x 6,440,000 joint risk assessment assessments risk assessments of zoonotic disease conducted conducted outbreaks, including public health events of initially unknown etiology (PHEIUE) per year

2.1.9 Enhance 2.1.9.1 Develop Tools and training Number of tools x x x 4,140,000 surveillance at tools and training modules developed and training slaughter houses modules for modules for neglected surveillance developed endemic zoonoses of Bovine TB, (Bovine TB, echinococcosis, echinococcosis, cysticercosis) cysticercosis)

2.1.9.2 Train Slaughter-house Number of x x x 7,728,000 slaughter-house personnel trained personnel trained personnel on the use of the surveillance tools for bovine TB, echinococcosis and cysticercosis

2.1.9.3 Develop a Reporting system Reporting system x x x 1,720,000 reporting system and database and database and database for developed slaughter house surveillance

2.1.9.4 Create Slaughterhouse and Databases x x 1,720,000 linkages between existing surveillance interoperable the slaughterhouse system linkage and existing animal developed surveillance systems

2.1.9.5 Advocate Advocacy meetings Number of x x x 540,000 for inclusion held advocacy of slaughter meetings house zoonoses surveillance and reporting in curriculum of Meat Training Institute (MTI) 23 23 Timeframe Strategy Activities Sub-activities Outputs Indicators Budget (Ksh) 2021 2022 2023 2024 2025

2.2 Enhance 2.2.1: Develop 2.1.1.1 Conduct table 1. Eight simulation 2. Three x x x x 17,760,000 preparedness and review top simulation exercises conducted contingency and response contingency exercises to update for HPAI,RVF, plans updated to zoonoses plans for priority existing contingency PHEIUE outbreaks zoonotic diseases plans (HPAI,RVF, 2. Number of and public PHEIUE) contingency health events plans updated of initially

2.2.1.2 Conduct one One field simulation Simulation x 2,244,000 unknown field simulation exercise conducted exercise report etiology exercise for HPAI

2.2.1.3 Develop a Contingency plan Number of x 1,430,000 CP for any other developed contingency emerging zoonotic plans developed disease based on risk assessment

2.2.2 Develop, 2.2.2.1 Develop a OH joint response One Health joint x 2,220,000 disseminate and One Health joint plan developed response plan test one health response plan for joint response zoonotic disease plan to zoonotic outbreaks disease outbreaks

2.2.2.2 Disseminate One Health joint 1. Number of x 250,000 the plan to response plan meetings held stakeholders disseminated 2. Proportion of counties with the plan

2.2.2.3 Conduct two Two joint table-top Number of x 2,769,000 table-top simulation simulation exercises simulation exercises for joint conducted exercises response plan conducted

2.2.3 Coordinate 2.2.3.1 Conduct RRTs trained Number of RRTs x x x x 5,000,000 joint outbreak training for joint at National and trained response activities rapid response Counties for zoonotic teams (National and Proportion of diseases County) Counties with JRRTs

2.2.3.2 Develop Repository for Zoonotic disease 500,000 a repository and zoonotic disease repository database for all outbreaks created zoonotic disease outbreak and response reports

2.2.3.3 Conduct After action reviews Number of after x x x x 2,220,000 after action review conducted action reviews for major zoonotic conducted outbreaks

2.2.3.4 Participate Participation Number of cross- x x x x x 200,000 in cross –border in cross-border border simulation zoonotic disease zoonoses outbreak exercises simulation exercises simulation exercise participated in 2.2.4: Review 2.2.4.1 Review Disease specific Number of plans x 2,220,000 or develop existing disease risk and crisis reviewed disease-specific specific (HPAI and communication risk and crisis RVF) risk and crisis plans reviewed communication communication plans plans 2.2. 4.2 Develop Communication Number of x 2,220,000 risk and crisis plans for other communication communication zoonotic diseases plans developed plans for 4 other developed priority diseases 24 24 Timeframe Strategy Activities Sub-activities Outputs Indicators Budget (Ksh) 2021 2022 2023 2024 2025 2.2.4: Review 2.2.4.3 Disseminate Risk communication Number of x 250,000 or develop disease-specific plans disseminated dissemination disease-specific risk and crisis workshops risk and crisis communication s Proportion of communication plans counties with plans plans

2.3 Enhance, 2.3.1: Develop 2.3.1.1 Finalize Rabies elimination 1. Number x 2,172,000 prevention and update rabies elimination guidelines of rabies and control prevention and guidelines finalized guidelines of priority control plans finalized endemic for endemic 2.3.1.2 Develop Anthrax prevention Anthrax x x 2,172,000 zoonoses zoonotic anthrax prevention and control plan prevention and diseases and control plan developed control plan

2.3.1.3 Develop Brucellosis Brucellosis x x 2,172,000 brucellosis prevention and prevention and prevention and control plan control plan control plan developed

2.3.1.4 Develop Prevention and Number of x x 4, 344, 000 prevention and control plans for plans control plans for other priority 2 other priority zoonotic diseases zoonotic diseases developed 2.3.1.5Disseminate Anthrax, 1. Number x 696,000 anthrax, brucellosis, of plans brucellosis and and other PZDs disseminated other PZDs prevention and prevention and control plans 2. Number of control plans and disseminated counties with rabies elimination Rabies elimination plans guidelines guidelines disseminated

2.3.1.6 Train National 1. Number x 12,432,000 national and and County of counties county technical personnel trained with trained personnel on on anthrax, personnel implementation brucellosis and of brucellosis other PZDs 2. Number and anthrax plans and rabies of national prevention and guidelines and county control plans and personnel rabies elimination trained guidelines

2.4 Support 2.4.1: Conduct 2.4.1.1 Conduct Capacity needs A capacity x 2,500,000 strengthening diagnostic laboratory assessment need of National, laboratory diagnostic conducted assessment regional needs capacity needs report and County assessment assessment for laboratories priority zoonotic for diagnosis diseases at of priority national, county zoonotic level and KWS diseases diagnostic laboratory

2.4.1.2 Support Trainings Number x 2,470,000 trainings based undertaken of training on the need conducted assessments Number of trainees 25 25 Timeframe Strategy Activities Sub-activities Outputs Indicators Budget (Ksh) 2021 2022 2023 2024 2025

2.4 Support 2.4.2: Develop 2.4.2.1 Develop Protocols Number of x 5,130,000 strengthening protocols for protocols developed protocols of National, animal health for specimen developed regional sample referral referral, including and County for priority referrals across laboratories zoonotic sectors for PZDs for diagnosis diseases 2.4.2.2 Train both Animal health Number of staff x x x x 8,288,000 of priority human and animal laboratory and trained zoonotic health laboratory frontline workers diseases staff and frontline trained workers on the sample referral protocols.

2.4.3 Enhance 2.4.3.1 Establish Rabies diagnostic Rabies diagnostic x 546,000 laboratory rabies diagnostic capacity established facility at NPHL diagnostic capacity at the capacity for NPHL priority zoonoses

2.4.3.2 Expand Rabies diagnostic Number of x x x x 2,310,000 rabies diagnostic capacity established RVILs with capacity to all in all RVILs rabies diagnostic RVILs capacity

2.4.3.3 Support Brucellosis Number of RVILs x 1,638,000 establishment Confirmatory with brucellosis of confirmatory diagnostic capacity confirmatory diagnostic tests for available at NPHLS diagnosis brucellosis at the and all RVILs NPHLS & RVILs Diagnostic capacity at NPHLS

2.4.3.4 Advocate for Advocacy meetings Number of x x x 1,500,000 equipping of labs held meetings held according to results of laboratory needs assessment

2.4.3.5 Support Trainings carried Number of x x x 1, 250,000 county labs out laboratory staffs on sample trained collection and basic laboratory diagnostics

2.5 Strengthen 2.5.1: Support 2.5.1.1 Identify Priority ZDP List of PZD for x 2,260,000 early warning establishment of priority zoonotic identified wildlife and systems for the sentinel wildlife pathogens for livestock sentinel detection of and livestock wildlife and surveillance emerging and surveillance sites livestock sentinel re-emerging surveillance zoonoses

2.5.1.2 Map partners Stakeholder Database of x x 300,000 and stakeholders mapping stakeholders working in wildlife health and disease ecology

2.5.1.3 Identify Establishment of Number of sites x 2,760,000 and support sentinel surveillance establishment of sites sentinel sites with stakeholders in priority areas for targeted sentinel surveillance 26 26 Timeframe Strategy Activities Sub-activities Outputs Indicators Budget (Ksh) 2021 2022 2023 2024 2025

2.5 Strengthen 2.5.1: Support 2.5.1.4 Support Surveillance Number of x 2,220,000 early warning establishment of collection, collation information reports reports systems for the sentinel wildlife and analysis of data detection of and livestock from wildlife and emerging and surveillance sites livestock sentinel re-emerging sites zoonoses

2.5.1.5 Disseminate Wildlife surveillance Number of x x x x 200,000 wildlife and reports decimated reports livestock sentinel surveillance reports periodically Strategic objective 3: To promote applied research using the OH approach

3.1 Develop 3.1.1: Map out Stakeholder Stakeholder x 1.000,000 zoonoses and stakeholders mapping report in mapping report emerging carrying out place infectious research in the diseases human, animal research and environment agenda for sectors to Kenya promote research collaborations on zoonotic diseases 3.1.2: Convene Priority research Priority research x 1,380,000 key stakeholders agenda report agenda report meeting to identify priority research areas at the human-animal- environmental interface 3.1.3: Prepare Concepts and Number of x x x 0.00 concept notes proposals concept notes and proposals to prepared and proposals conduct applied prepared research in the identified areas

3.2 Conduct 3.2.1 Conduct Cross-sectional Number of x x 10,000,000 applied cross-sectional studies conducted diseases with research studies for baseline data to inform baseline data Baseline data evidence- on zoonotic available Number based diseases of studies strategies conducted and policies 3.2.2 Conduct Pathogen search Number of x x x 1,500,000 on priority studies in wildlife studies done pathogen search zoonotic to detect zoonotic studies diseases and potentially zoonotic pathogens.

3.2.2 Promote Citizen science Number of x x 1,500,000 application of studies conducted citizen science citizen science studies to support prevention and control of PZDs

3.2.3 Identify and Potential hotspots Number of x x 1,500,000 map potential for EIDs identified hotspot maps emerging and mapped infectious disease hotspots in the country 27 27 Timeframe Strategy Activities Sub-activities Outputs Indicators Budget (Ksh) 2021 2022 2023 2024 2025

3.2 Conduct 3.2.4 Conduct Linked studies Number of x x x 1,500,000 applied linked studies conducted linked studies research on transmission conducted dynamics of to inform priority zoonotic evidence- diseases at the based animal-human strategies interphase and policies

3.2.5 Conduct Studied conducted Number x x x 1,500,000 on priority operational of studies zoonotic research studies conducted diseases to support and evaluate implementation of anthrax, brucellosis and rabies strategies

3.2.6 Carry out Literature review Number of x x 1,380,000 biennial review report literature review of literature to reports update burden, prevention and control measures for priority zoonoses

3.2.7 Conduct Socio-economic Number x x x 1,500,000 socio-economic impact studies of studies impact studies to conducted conducted inform policies on zoonotic disease prevention and control and the One Health approach

3.2.8 Promote 3.1.6.1 Establish an Expert working An expert x 1,380,000 ecological studies expert working group established working group to understand group with drivers of environmental zoonoses sector subject emergence and matter experts re-emergence

3.1.6.2 Conduct one Studies conducted Number x x x x 1,500,000 study per year on of studies ecological drivers of conducted disease emergence and disseminate findings

3.2.9 Prepare and Scientific Number of x x x x 240,000 submit scientific publications and scientific publications reports submitted publications and and reports for reports submitted journals, books and conference proceedings 3.2.11:Create Repository created Number of x x 300,000 a repository articles for scientific publications and reports on zoonotic diseases in Kenya 28 28

3.4 Financing the Strategic Plan The strategic plan for the prevention and control of zoonotic diseases using a one Health approach will cost Ksh 313,577,000 as shown in the breakdown below (Table 4). These financial resources are expected to come from the government of Kenya, county governments, other governmental agencies and implementing partners. The ZDU will develop a resource mobilization strategy for implementing this strategic plan. Table 4. Summary budget for implementation of the strategic plan Strategic Objective Budget (Ksh) Strategic Objective 1: Strengthen implementation of One Health approach at national and county levels

1.1 Strengthen OH coordination mechanisms at national and county levels 79716000

1.2 Establish collaborative mechanisms for OH initiatives 22,378,000

1.3 Strengthen OH policy and legal frameworks 3,454,000

1.4 Support Capacity building for OH workforce 25,396,000 Subtotal 130,944,000 Strategic Objective: 2. Strengthen prevention, surveillance, response and control of priority zoonotic diseases in both humans and animals

2.1 Strengthen surveillance for zoonotic diseases at the National and County levels 69,274,000

2.2 Enhance preparedness and response to zoonotic disease outbreaks and public health events of initially 39,039,000 unknown etiology

2.3 Enhance, prevention and control of priority endemic zoonotic diseases 24,268,000

2.4 Support strengthening of National, regional and County laboratories for diagnosis of priority zoonotic 24,672,000 diseases

2.5 Strengthen early warning systems for the detection of emerging and re-emerging zoonotic diseases 7,740,000 Subtotal 164,993,000 Strategic objective 3: To promote applied research using the OH approach

3.1 Develop zoonotic and emerging infectious diseases research agenda for Kenya 2,340,000

3.2 Conduct applied research to inform evidence-based strategies and policies on priority zoonotic 15,300,000 diseases Subtotal 17,640,000 GRAND TOTAL 348,577,000

3.5 Monitoring and Evaluation The ZDU/ZDTWG will develop a monitoring and Evaluation (M&E) plan for this strategic plan. Monitoring will focus on routine and continuous tracking of zoonotic disease prevention and control activities including efficiency and effectiveness. Evaluation will provide a periodic assessment of how well ZDU and its stakeholders meet their objectives. The mid-term evaluation will inform any changes that may be necessary to put implementation back on track and end-evaluation will document learning from the implementation of the strategic plan to inform the next steps. 29 29 ©FAO/Luis Tato 30 30

Appendix 1. List of contributors List of contributors to the development of the One Health strategic plan for the prevention and control of zoonotic diseases in Kenya from 2021-2025 Name Organization 1. Aggrey Lugendo MOH-Kakamega County 2. Ahmed Arale CORE group 3. Ahmed Ogwel World Bank 4. Allan Azegele DVS 5. Alessandro Guarino CCM 6. Allan Ogendo MOALFC 7. Andrew Kitua USAID P&R 8. Andrew Thaiyah USAID 9. Angela Mukami ZDU 10. Athman Mwatondo ZDU 11. Augusta Kivunzya Kitui County 12. Benard Bett ILRI 13. Caroline Nasimiyu ZDU 14. Charles Kibui MOH 15. Daniel Lang’at MOH 16. David Mutonga USAID P&R 17. David Soti MOH-Africa CDC 18. Davis Ikiror VSF Suisse 19. David Mwangangi DVS 20. Dennis Okundi MALFC 21. Edward Kiema COG 22. Emily Mudoga WAP 23. Emmanuel Okunga DSRU-EOC 24. Eric Fevre UoL/ILRI 25. Eric Osoro WSU 26. Erick Maitha MOH-Kilifi county 27. Evans M. Tenge FAO 28. Francis Gakuya KWS 29. Getrude Kusa NCCG- Food safety 30. Githui Kaba Nakuru County 31. Harry Oyas Deputy Director DVS 32. Hesbon Awando DVS 33. Isaac Lekolool KWS 34. Isaac Ngere WSU 35. Jack Omolo ZDU 36. Jane Githuku FELTP 37. Jane Lwoyero OIE 38. Jeremiah Akumu VSF German 39. John Mwita MOTW 40. Julius Kimitei MOH/ZDU 41. Kelvin Momanyi WAP 42. Konongoi Limbaso KEMRI 43. Lian Thomas ILRI/UoL 44. Lisa Kramer USAID 45. Lydia Njaramba Nyeri County 46. Malega S.K Kilifi County 47. Mark Nanyingi University of Liverpool/UoN/FAO-ECTAD 31 31 48. Mark Obonyo FAO- ECTAD 49. Martin Mboloi Makueni County 50. Mathew Mutiiria ZDU 51. Matthew Muturi ZDU 52. Michael Otieno NCC 53. Michael O. Mitoko Nairobi County 54. Moses Olum KALRO 55. Mwatha Stephen NTD-MOH 56. Nazaria Wanja Nyaga KVA 57. Omolo Jada ZDU 58. Peninah Munyua CDC 59. Peter Kinyanjui NHPL 60. Peter M.Wamai CDH-NYERI 61. Philip Ngene MOH-DSRU 62. Rinah Siawa FAO-ECTAD 63. Robert Miheso Mulembani DVS-BUSIA 64. Romona Ndayi DVS 65. Ruth Njoroge ZDU 66. Samuel Kadivane Nairobi County 67. Solomon Njenga KNH/ IDU 68. Stella Kiambi FAO ECTAD 69. Stephen Manen’gene MOTW 70. Susan Mubichi KEPSA 71. Susan Scribner USAID P&R 72. Thomas Manga DVS 73. Thomas Manyibe Nyariki USAID P&R and FAO ECTAD 74. Thumbi Mwangi WSU-KEMRI 75. Titus Kaitho KWS 76. Titus Wanjala Consultant USAID P&R 77. U.S Adano Intra Health 78. Victor Okoth Afya Ugavi 79. Wande Alimi Africa CDC 80. Zelalem Tedesse FAO- ECTAD 32 32

Appendix 2. Management and Response Structure for Zoonotic Diseases Figure 3: Proposed management and response structure for zoonotic diseases and PHEIUE. 33 33 The various offices and entities on the coordination structure are defined as follows; 1. The Presidency The office of the presidency 2. National Disaster Executive Committee (NDEC) The Cabinet secretaries’ committee 3. National Disaster Coordinating Committee (NDCC) These are the Principal Secretaries 4. Environment This will be the Ministry responsible for environment currently, Ministry of Environment and Forestry (MOEF) 5. Livestock The Ministry responsible for agriculture, livestock, fisheries, irrigation and research, currently the Ministry of Agriculture, Livestock, Fisheries and Cooperatives(MALF) 6. Interior This will be the Ministry responsible for interior and coordination of National government (MoICNG) 7. Health This will be the Ministry responsible for human health, currently Ministry of Health (MOH) 8. Wildlife This will be the Ministry responsible for Wildlife, currently Ministry of Tourism and Wildlife (MOTW) 9. Governors These are the 47 governors representing counties within the Republic of Kenya 10. Council of Governors This is the official county platform for consultation, information sharing, capacity building, performance management, and dispute resolution 11. National disaster management agencies a. National Disaster Operations Centre (NDOC) i.e. the National coordinating agency b. National Disaster Management Unit (NDMU) i.e. safety, security and incidence command c. National Youth Service (NYS) d. Kenya Wildlife Service (KWS) e. Kenya Forest Service (KFS) f. National Police Service (NPS) g. Kenya Defense Forces (KDF) h. Government Chemist i. Radiation Protection Board (RPB) j. Kenya Nuclear Energy Board (KNEB) k. Emergency and Disaster Risk Management (EDRM) l. Public Universities and research agencies 12. Partners – public and private actors a. Kenya Red Cross Society (KRCS) b. St. John Ambulance c. UN Agencies d. Kenya Private Sector Alliance (KEPSA) e. Bilateral partners f. OHCEA/AFROHUN KENYA g. Other relevant NGOs 13. National One Health Technical Committee (NOHTC) The NOHTC comprises technical teams such as Ministries responsible for Human health, Animal health, Environment and other line ministries under One Health approach. 34 34 14. Director of Veterinary Service Disaster Unit (DVSDU) The DVSDU coordinates emergencies in the animal health sector 15. Public Health Emergency Operation Centre (PHEOC) The PHEOC coordinates emergencies in the human health sector 16. Other Relevant Emergency Operations Centers (OREOCs) The OREOCs coordinates emergencies within other line ministries/sectors 17. National Rapid Response Teams (NRRT) The NRRT is a multi-sectoral team that responds to emergencies at the national Level 18. County Coordinating Committee (CCC) and Emergency Operations Centre (CEOCs) The CCC manages emergencies using the CEOCs as the operational organ 19. Sub-County Coordinating Committee (SCCC) and Emergency Operations Centre (CEOCs) The SCCC manages emergencies using the CEOCs as the operational organ 20. County Rapid Response Teams (CRRTs) The CRRTs responds to emergencies at the county level 21. Sub-County Rapid Response Teams (SCRRTs) The SCRRTs responds to emergencies at sub-county level 22. Community Rapid Response Teams (CoRRTs) The CoRRTs responds to emergencies at wards, village and local health facility levels. 35 35 Appendix 3. Detailed Stakeholder Analysis

Appendix 3. Detailed Stakeholder Analysis Table 5: Stakeholder Analysis for the One health strategic plan for the prevention and control of zoonotic diseases in Kenya Table 5: from Stakeholder Analysis for the One health strategic plan for the prevention and control of zoonotic diseases in Kenya 2021-2025 from 2021-2025 Current How? Attitude Current to Role What we How? Important One Health Attitude to When? Role wouldwe What Tactics or Stakeholder or Important approach; One Health Key Messages When? Champion Why they are engage would specificities Tactics or Stakeholder Influential? Favorable, or approach; Key Messages [Timeline] Champion Important? Why they are engageon? them to engaging specificities Unfordable, Influential? Favorable, [Timeline] Important? them on? tothem engaging Resourceful, Unfordable, them Resourceful, Government ministries Government ministries MALF Line ministry Both Favorable & Leadership, Animal resources In policy Always DVS MALF onLine ministry matters Both Favorable & resourceful Leadership, expertise, Animal resources productivity, Inand policy as key Always DVS on animalmatters health, resourceful expertise, resource productivity, welfare, and and as key driver of animal vet publichealth, health, resource allocation, welfare, and to contribution driver the OHof vet public food safety, health, allocation, policy contribution public healthto the OH strategy food safety, zoonosis policy formulation public health and social strategy zoonosisAMR, response, formulation and social welfare response, monitor AMR, ports of welfare monitor ports of entry entry MOH Line ministry Both Favorable & Leadership, Universal In policy Always DGH MOH Line ministry Both Favorable & Leadership, Universal In policy Always DGH on matters resourceful expertise, Health and as key on matters resourceful expertise, Health and as key human health, resource Coverage and driver of human health, resource Coverage and driver of public health, allocation, the goal to eliminate the OH public health, allocation, the goal to eliminate the OH food safety, policy communicable strategy food safety, policy communicable strategy zoonosis zoonosis formulation formulation diseases diseases response, response,AMR, AMR, monitor monitorports ports ofofentry entry MOTW MOTW Line Lineministry ministry Both Both Favorable, Favorable, Leadership, Leadership, Wildlife Wildlife InInpolicy policy Always Always Director Director ininwildlife wildlife resourceful resourceful expertise, expertise, management management and and of Wildlife of Wildlife management management&& resource resource andcc and Involved Involved Conservation Conservation eco ecosystem system allocation, allocation, onservation onservation from from andand health health policy ofrare of rareand and conception conception Management Management formulation formulation endangered endangered toto species species implementation implementation ofofthe thestrategic strategic plan plan MOEF MOEF Lineministry Line ministry Both Both Favorable, Favorable, Leadership, Leadership, Ecosystem Ecosystem InInpolicy policy Always Always Director of of Director inin resourceful resourceful expertise, expertise, services, services, and and environment environment environmental environmental resource resource environmental environmental Involved Involved issues issues allocation, allocation, protection protection from from policy policy conception conception toto formulation formulation implementation implementation ofofstrategic plan strategic plan County County Implementers Implementers Both Both Favorable & Favorable & Advocacy, Advocacy, County County Involved from Involved from Always Always Chair- Council Chair- Council governments governments ofofdevolved devolved resourceful resourceful implementation, implementation, Development Development conception conception toto of Governors of Governors functions functions resource resource implementation implementation allocation allocation ofofthe the strategic plan strategic plan MoI&CNG-law Security, Important Favorable, Enforcement – National In planning and Occasional Accounting MoI&CNG-law Security, Important Favorable, Enforcement – National In planning and Occasional Accounting enforcement enforcement, resourceful border points, Security response to officers enforcement enforcement, resourceful border points, Security response to officers agencies immigration quarantine etc. disease agencies immigration quarantine etc. disease outbreaks outbreaks National Response Important Favorable, Epidemic National In planning and Always Director National disaster Response Important Favorable, resourceful Epidemic emergency Nationalrisk Disaster In planning response to and Always Director disaster management resourceful emergency response Disaster risk management response to disease management agencies response management disease outbreaks agencies outbreaks Local Beneficiaries Both Favorable Planning, Health, In surveillance Always All key players Local communities Beneficiaries of their Both Favorable Others – lack Planning, implementation, Health, livelihoods In surveillance and response Always All key players communities of their program. Others – of lack information implementation, feedback livelihoods and social and response program. Their of information feedback and social welfare Their participation welfare participation and acceptance and acceptance of the concept of isthe concept key is key 36 36 36 36 Current How? Attitude to Role What we Important One Health When? would Tactics or Stakeholder or approach; Key Messages Champion Why they are engage specificities Influential? Favorable, [Timeline] Important? them on? to engaging Unfordable, them Resourceful, Government agencies KWS Wildlife both Favorable, Expertise, Wildlife In policy, Always Director management, resourceful resources, conservation and conception to general, health, management implementation head of vet surveillance of the strategic services etc. plan KFS Forest both Favorable, Expertise, Forest cover, In policy, Always Director management, resourceful resources, water catchment conception to Forest etc. protection implementation services of the strategic plan NMK – Vector, both Favorable, Expertise, Preservation of In policy, Always Director reservoir resourceful resources, national heritage conception to research implementation activities of the strategic plan KTB- Tourism both Favorable, Expertise, Development and In policy On a needs Director promotion resourceful resources, protection of the basis tourism industry Research Bodies KEMRI Human health both Favorable, Expertise, Collaborative One In operational Always CEO research, resourceful resources, Health research research and KEMRI outbreak response investigation support and response ILRI Animal health both Favorable, Expertise, Collaborative One In operational Always Director research resourceful resources, Health research research and response support KALRO Animal and both Favorable, Expertise, Collaborative One In operational Always Director plant health resourceful resources, Health research research and research response support KEFRI Plant both Favorable, Expertise, Collaborative One In operational Always Director research resourceful resources, Health research research and response support ICIPE Vector ecology both Favorable, Expertise, Collaborative One In operational Always Director research resourceful resources, Health research research and health, response support surveillance etc. IPR Non-human both Favorable, Expertise, Collaborative One In operational Always Director primate resourceful resources, Health research research and research response support International agencies World bank Funding and both Favorable, Expertise, Socio-economic In resource On needs Country technical resourceful resources, development, mobilization, basis representation support impact of pandemic advocacy and threats technical support AfDB Funding and both Favourable Expertise, Socio-economic In resource On needs Country technical resources, development, mobilization, basis representation support impact of pandemic advocacy and threats technical support WHO Funding and both Favorable, Expertise, Global Health In resource On needs Country technical resourceful resources, security, mobilization, basis representation support on compliance to advocacy and human health International Health technical support Regulations (IHR, 2005) 37 37 37 Current How? Attitude to Role What we Important One Health When? would Tactics or Stakeholder or approach; Key Messages Champion Why they are engage specificities Influential? Favorable, [Timeline] Important? them on? to engaging Unfordable, them Resourceful, FAO Funding and both Favorable, Expertise, Global food In resource On needs Country technical resourceful resources, security, mobilization, basis representation support on production, advocacy and animal health productivity, technical support welfare and public health CDC Funding and both Favorable, Expertise, Global Health In resource On needs Country technical resourceful resources, Security, mobilization, basis representation support on Research in One advocacy and human and Health technical support animal health and research USAID Funding and both Favorable, Expertise, Global Health In resource On needs Country and technical resourceful resources, Security, mobilization, basis Regional support on development advocacy and representation human and technical support animal health WSU Funding and both Favorable, Expertise, Research in One In resource On needs Country technical support resourceful resources, Health mobilization, basis representation on research advocacy and technical support DTRA Funding and both Favorable, Expertise, Global Health In resource On needs Country technical resourceful resources, Security, mobilization, basis representation support on Research in One advocacy and research Health technical support OIE Funding and both Favorable, Expertise, Animal Health, In resource On needs Regional technical resourceful resources, Productivity mobilization, basis representation support on Welfare and advocacy and animal health compliance to the technical support Terrestrial and Aquatic Animal Health Codes AU-IBAR Funding and both Favorable, Expertise, Animal Resources In resource On needs Director technical resourceful resources, productivity and mobilization, basis support on health for economic advocacy and animal health development and technical support social welfare in Africa Non-governmental organizations IFAW Animal welfare, both Favourable Expertise, Animal welfare In resource On needs Director advocacy, resources mobilization, basis community advocacy and outreach technical support WWF Wildlife both Indifferent Create Conservation of In resource On needs Director conservation, awareness endangered species mobilization, basis advocacy, advocacy and community technical support outreach AWF Wildlife both Indifferent Create Conservation of In resource On needs Director conservation, awareness endangered species mobilization, basis advocacy, advocacy and community technical support outreach WAP Animal welfare, both Favourable Expertise, Animal welfare In resource On needs advocacy, Resources mobilization, basis community advocacy and outreach technical support ANAW Animal welfare, both Favourable Expertise, Animal welfare In resource On needs Director advocacy, Resources mobilization, basis community advocacy and outreach technical support 38 38 38 Current How? Attitude to Role What we Important One Health When? would Tactics or Stakeholder or approach; Key Messages Champion Why they are engage specificities Influential? Favorable, [Timeline] Important? them on? to engaging Unfordable, them Resourceful, IFRC, Disaster and both Favourable, Expertise, Emergency and In resource On needs Country Kenya Emergency Resourceful Resources disaster response mobilization, basis Director Red Cross response, advocacy and community technical support outreach World Vision Community both Somewhat Create Sustainable In resource On needs Country development favorable more development of mobilization, basis Representative and outreach through awareness marginalized advocacy and involvement in communities technical support GHSA VSF-Germany Animal Health, both Favourable’ Expertise Animal health, In resource On needs Country community Resourceful and resources welfare and mobilization, basis Representative outreach in productivity, advocacy and cross border community technical support Counties and development ASALs VSF-Suisse Animal Health, both Favourable, Expertise Animal health, In resource On needs Country community Resourceful and welfare and mobilization, basis Representative outreach in cross resources productivity, advocacy and border community technical support Counties and development ASALs AFROHUN Capacity building, Both Favorable Leadership Transformational In One Health Always Deans in KENYA at in-service and & Resourceful on One change for Communication. respective pre-service Health Core continuous In policy One Health levels, of a Competencies, improvement of formulation. institutions Multidisciplinary Communication, health & Conception & One Health One Health well-being of implementation of Workforce ready Multidisciplinary humans, strategic plan. to identify, detect, Expertise, animals and In planning & prevent and Collaboration environment response to respond to & Partnerships, through One disease outbreaks. emerging Systems Health principles In surveillance pandemic Thinking, & approaches to and response. threats. Resources, research, In research & Awareness training innovations. creation, & community Technical support. Training & service. Training & Capacity capacity building. building, One Development Health Policy of One Health & Advocacy, Programs & Research & Modules. Innovations, Integration of One Health Modules in Curriculums. Universities- Training, both Favorable, Expertise, Inculcating Integration of One Always DVC, Deans, UON, curriculum resourceful resources, professional Health approach student MOI, Egerton. development, competences in to curriculum professional JKUAT, inculcating the training Pre-service and associations/ MT. Kenya, One Health institutions that in-service clubs KU concept early meet needs of training industry Professional and Farmer associations Professional Membership/ both Favorable, Expertise, The welfare of In outreach, Always Respective associations- outreach resourceful resources, members and surveillance leadership/ KVA, KMA, capabilities continued and provide secretariats APHOK professional surge capacity in development response Media owners Dissemination of both Indifferent Create Matters of Communication On a need Directors or association, various messages awareness public interest at all stages of basis Chairpersons editors guild to the public implementation of the strategic plan 39 39 39 Current How? Attitude to Role What we Important One Health When? would Tactics or Stakeholder or approach; Key Messages Champion Why they are engage specificities Influential? Favorable, [Timeline] Important? them on? to engaging Unfordable, them Resourceful, Kenya Dissemination of both Favourable Expertise, Improved communication On a needs Respective livestock messages to their resources production at all stages of the basis chairpersons associations members and productivity strategic plan of animal resources Regulatory Oversight, both Favorable, Expertise, Upholding In policy matters Always Respective bodies – membership, resourceful resources, professional leaderships KMPDB, continuous standards and KVB, development ethics KEBS 40 40 40 References 1. WHO. Neglected zoonotic diseases. https://www.who.int/neglected_diseases/diseases/zoonoses /en/ . Last accessed 11 May 2019 2. World Bank 2018. One Health: operational framework for strengthening human, animal, and environmental public health systems at their interface (pp 4 of 138) 3. Zoonotic Disease Unit: National One Health Strategic Plan 2012- 2017. 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