Implementing One Health as an integrated approach to health in Rwanda

Nyatanyi, Thierry; Wilkes, Michael; McDermott, Haley; Nzietchueng, Serge; Gafarasi, Isidore; Mudakikwa, Antoine; Kinani, Jean Felix; Rukelibuga, Joseph; Omolo, Jared; Mupfasoni, Denise; Kabeja, Adeline; Nyamusore, Jose; Nziza, Julius; Hakizimana, Jean Leonard; Kamugisha, Julius; Nkunda, Richard; Kibuuka, Robert; Rugigana, Etienne; Farmer, Paul; Cotton, Philip; Binagwaho, Agnes

Known as 'the land of 1000 hills', Rwanda has a northsouth mountain range, various water sheds, rain forests and grazing lands. The nation confronts various challenges: energy sustainability, natural gas extraction from beneath Lake Kivu, a growing population, land degradation, crop raiding, wildlife poaching 6 ; a loss of biodiversity, conversion of forests to farm land and the risk of soil overexploitation; and climate change resulting in an increasingly variable rainfall. In addition, Rwanda is one of the most densely populated (415 people/square mile) countries in the world, 7 where One Health disasters can quickly affect large populations. Further, areas with high population density are more prone to food insecurity, soil erosion, decreased grazing lands, and forest degradation, which in turn leads to increased food insecurity and other measures of poor health. 8 9 The eastern part of Rwanda is home to pastoral communities, which move from place to place in search of water and pastures to feed their animals. Movement is not limited to the national borders, thus pastoralists are at risk of picking up animal pathogens that can be disastrous to the livestock population in Rwanda such as foot and mouth disease and contagious bovine pleural pneumonia, both of which have become endemic. 10 11 These diseases have high mortality and thus affect food security and the economic well-being of these nomads. Contagion between animals (wild and domestic) and humans does not happen in only one direction. In 2011, one of the mountain gorillas, which provide large eco-tourism revenue for Rwanda, succumbed to a human virus (human meta-pneumovirus) passed on by a tourist. 12 Through these experiences, Rwanda has learned that the eradication of hunger through initiatives such as Girinka (one cow per family (see online supplementary appendix B)), improvements in public health indicators (eg, improved maternal health, reduction in HIV, reducing malaria and other vector borne illnesses), and environmental sustainability all depend on interdependent systems, shared responsibility, involvement of the community, and collaboration across government agencies, content specialists and policies-all ideas embodied by One Health, a burgeoning global approach to integrated health. The government of Rwanda has therefore framed policies and priorities to drive toward an integrated, holistic-system approach to promoting health. Moreover, it has led to the adoption of the One Health approach by the East African Community, and Rwanda is also working with its neighbours to address regional issues that recognise the inextricable connection between the health of the country's people, animals and environment and the importance of this interconnection in development. The concept and approach of One Health provides an opportunity for the Rwandan government to expand its reforms to address important interdisciplinary, intersectoral health problems and work to meet the Sustainable Development Goals. Rwanda has therefore set out to achieve, in policy and practice, what has yet to be implemented across any nation-an evidence-based, interconnected system to address One Health problems. 13