Pathways to strengthen one health systems in the PanEuropean Region for integrated prevention and preparedness strategies and one health security

Multisectoral approaches, such as One Health (OH), have been recognized as the best approaches for the prevention and preparedness of threats emerging at the human-animalenvironment interface to support health security. In practice, the operationalization of the OH approach at national, regional and global level is challenging since it requires the consolidation of OH systems that work in synergy between different sectors and actors at different levels and within and beyond country borders. Therefore, implementation research should identify successful ways to operationalize the OH approach to strengthen national OH systems through practical examples and the identification of enabling factors. This implementation research study aimed at highlighting pathways to strengthen OH systems in the Pan-European Region by adopting a building blocks approach for the functional operationalization of OH strategies to support one health security, and provide evidence in the form of enabling factors to support decision-makers with OH operationalization. First, a OH system building blocks (OHBBs) framework was developed starting from a OH conceptual framework and its piloting in Armenia and Montenegro. Then, the OHBBs framework guided the identification of country and multi-country practices in the PanEuropean Region and their and enabling factors. Finally, the enabling factors were summarized in a OH systems strengthening (OHSS) model to suggest potential pathways for the strengthening of OH systems in the Region at country and multi-country level to ensure One Health Security. The OH systems strengthening pathways would guide decision-makers in the Pan-European Region at national and regional level, leveraging practical case studies and enabling factors to support OH operationalization for integrated prevention and preparedness and finally enhance national and regional health security.