IHR-PVS National Bridging Workshops, a tool to operationalize the collaboration between human and animal health while advancing sector-specific goals in countries

Collaborative, One Health approaches support governments to effectively prevent, detect and respond to emerging health challenges, such as zoonotic diseases, that arise at the human-animal-environmental interfaces. To overcome these challenges, operational and outcome-oriented tools that enable animal health and human health services to work specifically on their collaboration are required. While international capacity and assessment frameworks such as the IHR-MEF (International Health Regulations—Monitoring and Evaluation Framework) and the OIE PVS (Performance of Veterinary Services) Pathway exist, a tool and process that could assess and strengthen the interactions between human and animal health sectors was needed. Through a series of six phased pilots, the IHR-PVS National Bridging Workshop (NBW) method was developed and refined. The NBW process gathers human and animal health stakeholders and follows seven sessions, scheduled across three days. The outputs from each session build towards the next one, following a structured process that goes from gap identification to joint planning of corrective measures. The NBW process allows human and animal health sector representatives to jointly identify actions that support collaboration while advancing evaluation goals identified through the IHR-MEF and the OIE PVS Pathway. By integrating sector-specific and collaborative goals, the NBWs help countries in creating a realistic, concrete and practical joint road map for enhanced compliance to international standards as well as strengthened preparedness and response for health security at the human-animal interface.


Introduction
In recent decades, the world has seen increasing emergence of infectious zoonotic diseases,

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With these observations, the One Health concept, loosely defined as "the collaborative efforts of 72 multiple disciplines working locally, nationally, and globally, to attain optimal health for people, 73 animals, and our environment"(10), has gained great momentum over the past two decades as it 74 becomes clear that collaboration between the different sectors can help countries to better face 75 current and upcoming health threats (11)(12)(13)(14).

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The benefits of One Health go beyond emerging infectious diseases. It is also a much needed 77 approach for other major global health challenges such as antimicrobial resistance (  188 In the post-workshop survey, participants once again asked for a longer workshop with more time for 189 discussion and group exercises. They also felt that there were too many presentations and found the 190 working group sessions to be the most productive ones.

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Costa Rica (2016) (60 national experts, 2.5 days) 192 The third pilot incorporated a number of critical changes, including an increase to two-and-a-half 193 days total duration, the reduction of the number of presentations, the replacement of some 194 presentations by videos and the addition of a working group exercise using short outbreak scenarios 195 (Table 1) to allow stakeholders to self-assess their level of collaboration for 15 key technical areas.

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This exercise resulted in the mapping of strong and weak areas in the collaboration, which 197 participants used to draft the outline of a strategy to improve their inter-sectoral work.

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When presented with simple scenarios, participants could more easily identify the strengths and 199 weaknesses of their current collaboration and the conceptualization of joint activities was better 200 facilitated.
201 Table 1. The five short disease scenarios used during the NBW Pilot in Thailand.

Disease Scenario
Rabies A case of rabies, which has been confirmed in a dairy cow recently inseminated and regularly milked, generates panic in the population H7N9 avian influenza H7N9 was confirmed in a vet who returns from a conference in China and lives in the northern part of Thailand

Anthrax
Nine people showed identical anthrax-like lesions reported in a district hospital close to a border post. One is working in village slaughterhouse Streptococcus suis An exporting country suspects that a shipment of piglets to Thailand was contaminated with Streptococcus suis and entered into the market Unknown disease

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The overall duration was increased to three days to optimally facilitate these changes.

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The whole set of material, which included videos, activity cards and posters, was revised and The first session serves as an introduction, with short videos (S1 and S2 Videos) presenting the that should be conducted to fill the identified gaps and to improve the collaboration between the 295 two sectors in their technical area of focus. The NBW roadmap starts to take shape.

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The sixth session is about structuring and going further into the description of the activities to make 297 them as operational as possible. Groups are given Activity cards that they must fill for each activity.

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The card asks for a detailed description of the activity, who will be leading its implementation, what  (Fig 2).

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The NBW method has been summarized in a video (S5 Video) available at www.bit.ly/NBWMethod.

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In an increasingly complex and globalized world, with competing priorities, the One Health approach 452 is becoming more and more relevant. As national governments seek to strengthen their capacity for 453 zoonotic disease prevention, detection and response, they need tools to both diagnose needs and 454 existing gaps, as well as develop action plans to support collaboration across sectors. The NBW 455 process, as developed through a series of pilots, supports countries to link their inter-sectoral goals