The increase in global health challenges is linked to the close interaction between humans, animals and the environment (1). This close interaction is often precipitated by population pressure, urbanization, advances in transport, trade and animal industry, deforestation, climate change, and encroachment on wildlife habitats, and has led to an increase in the transmission of emerging and re-emerging infectious diseases, including Coronavirus disease (COVID-19), and hemorrhagic fevers such as Ebola virus disease (EVD) and Marburg (2, 3). Other factors contributing to the emergence and re-emergence of infectious diseases include increased exposure of humans to disease vectors and reservoirs, antimicrobial resistance, weak surveillance systems and limited laboratory diagnostic capacity (4, 5).
The emergence and re-emergence of pandemics such as severe acute respiratory syndrome virus (SARS), the H1N1 influenza pandemic, EVD and COVID-19 has had reverberating economic and social consequences, both locally and at global level (6). Most notably, these pandemics have led to a loss of livelihoods consequently leading to poverty and inequalities, weakening of the healthcare systems, and loss of lives (7). For instance, the 2003 SARS outbreak led to 8,098 cases and 774 deaths, the 2009 H1N1 led to 151,700-575,400 deaths, the 2014-2016 EVD led to 28,616 cases of EVD and 11,310 deaths, while the current COVID-19 pandemic has so far claimed 4,690,186 lives globally (8–11). Uganda is a hotspot and has experienced several emerging and re-emerging infectious disease outbreaks (5, 12–17). In addition to the current COVID-19 pandemic that has resulted in 122,405 cases and 3,132 deaths as of September 2021(18), the 2000 EVD outbreak in Uganda resulted in 425 cases and 224 deaths (19). These outbreaks have had a high case fatality rate. The case fatality rate has been as high as 75% for EVD (13, 19), 100% for Marburg (15) and 36% for Crimean-Congo hemorrhagic fever (20). The increasing number of global health challenges has made the application of the one health (OH) approach to health promotion and protection inevitable (1, 21–24).
The OH approach, defined as a collaborative, multisectoral, and transdisciplinary approach in which stakeholders at local, regional, national, and global levels work together to achieve optimal health for humans, animals and their shared environment (25), is increasingly vital in the prediction, detection, prevention and response to global health challenges (26). The OH approach strives to improve global health security by building a multidisciplinary health workforce. Such a workforce requires knowledge and critical skills to counter infectious disease threats and eliminate the current global barriers that exist because of disciplinary silos (27, 28). The OH approach brings together public health professionals, veterinarians, agricultural scientists, anthropologists, economists, educators, engineers, entomologists, epidemiologists, hydrologists, microbiologists, nutritionists, physicians, and sociologists among other cadres to work collaboratively to attain human, animal and environmental health (21).
The multidisciplinary and transdisciplinary, and collaborative nature of OH requires knowledge, skills and competencies, processes and institutions that facilitate policy and operations to be co-managed and co-delivered across jurisdictions (29). Although vital, OH competencies required to build successful teams and programs are often overlooked. Most of the discussion on developing the OH workforce focuses on creating cross-disciplinary awareness and technical skills (29) rather than soft skills such as leadership, communication and informatics, systems thinking and management among others (30–33). To address this challenge, the Africa One Health University Network (AFROHUN) (formerly One Health Central and Eastern Africa (OHCEA), through its One Health Workforce (OHW) and One Health Workforce next generation projects undertook competence-based training to enhance the knowledge and skill set of the pre- and in-service workforce in its network of 9 member countries and 18 universities (1, 2).
AFROHUN uses a more integrative and dynamic education system to match global health needs and to produce a workforce that can effectively and efficiently predict, detect and respond to complex global health challenges (27). To achieve this, AFROHUN developed 16 training modules that aim to address the training needs of different sectors and disciplines (34). The modules emphasize teamwork, community engagement, research and effective communication across disciplines (34). The one health trainings incorporate both theoretical and experiential learning with the view of equipping the workforce with the basic technical and non-technical skills and competencies that can complement their specific areas of expertise necessary for One Health practitioners, regardless of discipline (27).
In order to build a more sustainable workforce, AFROHUN together with partner institutions of higher learning provides scholarships, graduate fellowships and residencies. AFROHUN, through the OH clubs, provides students with an opportunity to engage in outbreak investigation. In addition, through the OH Institute, it conducts OH field placements in which students of the various disciplines live and work together in small multidisciplinary teams in the community (27). Together with the different professionals in the field, supervisors and community members, the multi-disciplinary team of students once placed, embarks on community assessments to identify key health problems in the communities of placement (35). This is followed by the implementation of activities aiming at solving these challenges as well as routine monitoring and evaluation.
While numerous OH programs/trainings and research activities have been carried out among academic, non-academic, government, corporate, and non-profit entities (36), there has been little progress in understanding the extent of acquisition and application of the OH competencies. This tracer study was based on Kolb’s experiential Learning Cycle (37) and the systems theory framework (STF) of career development (38) to establish the extent to which the AFROHUN-Uganda alumni acquired and applied the OH competencies. Kolb’s cycle suggests that effective learning is achieved when a participant obtains a concrete experience of the subject matter followed by (2) observation of and reflection on that experience which leads to (3) the formation of abstract concepts (analysis) and generalizations (conclusions) which are then (4) used to test hypothesis in future situations, resulting in new work experiences. The STF of career development suggests that career development is a dynamic process, depicted through its process influences, change over time and chance (39).