Multi-sectoral health system analysis for zoonotic diseases management: An application of Parsons' Social System Action Theory to improve One Health practice for rabies control in Burkina Faso.

BACKGROUND

Rabies is a deadly infectious disease that affects humans and animals. Human cases are preventable through vaccination and rabies can be eliminated by applying the One Health approach to build integrated, operational and innovative health systems. However, in the context of Burkina Faso, animal and human rabies systems are not properly inter-connected. Despite several initiatives conducted in Burkina Faso for decades by animal health and human health stakeholders (including vaccination of domestic carnivores, post-exposure prophylaxis (PEP), awareness raising), the country is still facing human cases.

METHOD: To unravel the factors that hinder the control of rabies and to support locally-tailored strategic planning, this qualitative study applies the framework of Parsons' Social System Action Theory (PSSAT) to assess the functioning of multi-sectoral efforts for rabies prevention and control. The qualitative data obtained from semi-structured interviews were analyzed using a thematic approach. The identified themes were then grouped in light of the functional dimensions of PSSAT, in order to structure the understanding of the system.

RESULTS

The stakeholders mapping showed the diversity of entities and stakeholders involved in the rabies control system. In addition, the constraints related to the system's capacities were analyzed considering factors related to adaptation, fundamental goal achievement, operational processes for expected services delivery as well as organizational culture. In total, 39 function-related challenges and 22 alignment-related challenges were described.

CONCLUSION

The framework proved useful in the analysis of this complex multi-sectoral health system, hence constituting a potential tool for the implementation of One Health in different contexts. Indeed, if the identified challenges are comprehensively converted into forward-looking actions, this can enable the development of locally-tailored strategies for effective domestic carnivore-transmitted human rabies control.