Crossing institutional boundaries: mapping the policy process for improved control of endemic and neglected zoonoses in sub-Saharan Africa.

The recent adoption of the World Health Assembly Resolution 66.12 for neglected tropical diseases (NTDs) in May 2013 is an important turning point for advocacy regarding a number of endemic zoonotic infections, defined by the World Health Organization as the neglected zoonotic diseases (NZDs). In addition to NTD-listed zoonoses such as rabies, echinococcosis (hydatid disease), leishmaniasis, Human African trypanosomiasis (sleeping sickness) and Taenia solium cysticercosis, the NZDs also include important bacterial zoonoses such as anthrax, bovine tuberculosis and brucellosis. To date, analysis of the processes that prioritize, develop and deliver zoonoses control programmes in many low- and middle-income countries is lacking, despite its potential to highlight significant evidence gaps and institutional constraints to the intersectoral approach required for their control. Policy process analysis was conducted via a series of semi-structured interviews with key policy actors within various ministries and institutes in Uganda and Nigeria. The study concluded that despite the rhetoric around 'linear' models of health policy development promoting consultation with a wide range of national stakeholders, the decision-making process for zoonotic disease control appears instead overtly influenced by the external political economy of trending pandemic threats, often overlooking national and regional zoonoses priorities. The inclusion of political systems remains a key factor in the zoonoses analysis matrix, enhancing our understanding of the intersectoral and transdisciplinary approaches required for their control. The authors consider policy process analysis to be a fundamental first step of any attempt to holistically strengthen human and animal health systems in a development context, particularly regarding the promotion of integrated control policies for regionally important zoonoses under the growing One Health movement.