Pastoralists in sub-Saharan Africa have limited access to public services due to their mobile lifestyle, economic and political marginalization, and the limited health infrastructure that is common to arid and semi-arid lands (ASALs) where they primarily reside. This often results in poor health outcomes, including increased rates of maternal, neonatal, and under-5 mortality. One Health approaches that integrate human and animal health service delivery can help to improve pastoralists’ health through increased vaccine coverage and improved access to services. Kenya has institutionalized One Health at the national level; however, progress at the subnational level has been limited due to sustainability concerns, competing priorities, and insufficient coordination platforms. To address this gap, this paper presents a One Health framework (OHF) to aid in the implementation of integrated human and animal health policies in Turkana County, which can act as a model for other ASALs. Utilizing a grounded theory design, we conducted semi-structured interviews and focus group discussions with human health, animal health, and pastoralist stakeholders. Inadequate engagement with the public sector was identified as a major limitation by community members. Factors that contributed to this include distance to health facilities and restricted department capacities such as availability of vehicles, personnel, and cold chain maintenance. Our proposed OHF harnesses the existing structure of service delivery in Turkana and establishes an official coordination mechanism to implement One Health activities, through the form of mobile “One Health Huduma Centres”, offering a range of public services. This innovative framework is supported by stakeholders in Turkana and can improve service delivery constraints thereby improving the health of Turkana pastoralists.

中文翻译：

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肯尼亚图尔卡纳县提供综合服务的单一卫生框架

撒哈拉以南非洲地区的牧民由于其流动的生活方式，经济和政治边缘化以及他们主要居住的干旱和半干旱土地（ASAL）所共有的卫生基础设施有限而无法获得公共服务。这通常会导致健康状况不佳，包括增加孕产妇，新生儿和5岁以下儿童的死亡率。结合人类和动物健康服务提供的一种健康方法可以通过增加疫苗覆盖率和改善获得服务的方式来帮助改善牧民的健康。肯尼亚在国家一级将“一种保健”制度化；但是，由于对可持续性的关注，相互竞争的优先事项以及不足的协调平台，国家以下各级的进步受到了限制。为了弥补这一差距，本文提出了一个单一健康框架（OHF），以帮助在图尔卡纳县实施人与动物健康综合政策，该政策可以作为其他ASAL的典范。利用扎实的理论设计，我们与人类健康，动物健康和牧民利益相关者进行了半结构化访谈和焦点小组讨论。社区成员认为与公共部门的接触不足是主要的限制。造成这种情况的因素包括与医疗机构的距离以及部门能力的限制，例如车辆的可用性，人员和冷链维护。我们提议的OHF利用Turkana的现有服务提供结构，并建立正式的协调机制来实施One Health活动，通过移动“ One Health Huduma中心”的形式，提供一系列公共服务。这一创新的框架得到了土库曼斯坦利益相关者的支持，可以改善服务提供的约束，从而改善土库纳牧民的健康状况。