IN A NUTSHELL
Author's Note



Climate change, emerging infectious diseases, environmental degradation, and unequal access to essential health services create interconnected risks that conventional, sector-specific health policies struggle to address. Although One Health has gained international recognition, its practical integration into national decision-making, emergency-care delivery, and health financing remains a critical implementation challenge. We propose a One Health architecture for Zambia and other African countries that connects climate intelligence, multisectoral surveillance, emergency-care readiness, equitable service delivery, and accountable financing. The framework's original contribution is to position these components as a single governance pathway, linking early warning to clinical action and measurable health-system performance. Rather than creating additional institutional structures, countries should strengthen coordination among existing institutions, define decision-making responsibilities, and establish indicators that measure both preparedness and equitable access to care. Zambia offers a relevant setting in which to examine this approach through research linking climate variability, disease patterns, and institutional response. The framework requires empirical testing, local stakeholder validation, and alignment with national priorities. Its central proposition is that health security and health equity are mutually reinforcing foundations of resilient African health systems

By Dr Kalolo Charles Chitembo

Crisis Expert/ Emergency Medicine Specialist/ Health Economist/ Global Health Advocate/ Climate and ONE HEALTH Researcher

University of Lusaka, Zambia

From Crisis to Resilience: a One Health Architecture for Equitable Health Security in Zambia and Africa

 

By the same Author on PEAH: HERE

 

The resilience gap

The central challenge facing health systems is not simply the emergence of new threats, but the difficulty of managing risks that cross institutional and disciplinary boundaries. Climate-sensitive disease transmission, ecological disruption, population mobility, and health-system vulnerability interact in ways that cannot be adequately addressed through isolated programmes.

The World Health Summit 2026, held in Berlin under the theme From Crisis to Resilience: Innovating for Health, provides a timely context for reconsidering how global commitments can translate into national capability. However, international declarations and preparedness investments do not automatically produce coordinated action at the point where risks emerge or patients require care.

Recent global assessments of pandemic preparedness have highlighted the need for sustained investment, stronger coordination, and more effective accountability. Meanwhile, the Lancet Countdown’s emerging Africa initiative emphasises the importance of locally relevant evidence and the integration of climate-related health risks into policy and essential services. These developments reinforce a fundamental question: how can African countries connect environmental intelligence, disease surveillance, clinical response, and equitable access within a coherent national system?

We argue that health-system resilience should be designed as an integrated governance function, rather than treated as a collection of separate preparedness programmes.

One Health as an operational architecture

The Lancet One Health Commission provides a substantive foundation for understanding the interdependence of human, animal, and environmental health, while emphasising the need for equitable and sustainable socioecological systems. The policy challenge is to translate this understanding into operational arrangements that influence decisions, resource allocation, and service delivery.

We propose a One Health architecture comprising five interconnected functions.

First, climate and environmental intelligence should identify changes relevant to disease risk and health-service demand. Meteorological observations, environmental indicators, and appropriate geographical information systems can inform risk assessments, provided that their limitations and uncertainty are acknowledged.

Second, integrated surveillance should connect human health information with relevant veterinary and environmental data. The objective is not indiscriminate data aggregation, but the timely exchange of information needed to assess specific risks and determine appropriate action.

Third, emergency-care readiness should translate verified warnings into clinical preparedness. Emergency departments, district hospitals, referral networks, and public-health teams require clear escalation pathways, appropriate staffing, essential supplies, and reliable communication arrangements.

Fourth, equitable service delivery should ensure that early warning and response capacity reach populations facing the greatest barriers to care. Rural communities, underserved districts, and households with limited financial resources must not remain systematically disadvantaged by the distribution of preparedness investments.

Fifth, accountable financing and governance should connect responsibilities and resources to measurable outcomes. Institutions need agreed decision rights, defined response thresholds, costed plans, and mechanisms for reviewing performance after an alert or emergency.

These functions form a proposed architecture, not an established or validated intervention. Their value lies in making the relationships between surveillance, decision-making, clinical response, equity, and financing explicit and testable.

Why Zambia matters

Zambia provides a relevant setting for examining this architecture because climate variability, infectious-disease risks, livelihoods, and access to health services intersect across different ecological and socioeconomic contexts.

My proposed doctoral research, The Impact of Climate Change on Zoonotic and Vector-Borne Disease Transmission in Zambia: A One Health Approach, offers a potential empirical pathway for investigating these relationships. Analysis of temperature, rainfall, humidity, and relevant disease records could identify associations requiring further epidemiological investigation. Interviews with public-health officials, veterinary personnel, environmental experts, and affected communities could then explore how institutions interpret risk and coordinate responses.

The distinction between association and causation is essential. Climate–disease relationships can be influenced by land use, population movement, vector ecology, diagnostic access, reporting practices, and other contextual factors. A robust research programme must account for these influences rather than assume that climatic change alone explains observed disease patterns.

The policy contribution would extend beyond identifying disease associations. It would examine whether relevant information reaches decision-makers, whether institutional responsibilities are clear, and whether health services can respond when risks increase.

This approach could support the development of geographically targeted preparedness priorities and practical indicators for evaluating the performance of existing systems. It would also help identify where additional investment is justified and where better coordination may improve the use of existing resources.

Equity is a condition of resilience

Health-system resilience is often discussed in terms of continuity, preparedness, and the capacity to recover after disruption. These are important measures, but they do not establish whether a system protects populations fairly.

A service may remain operational while rural patients face prolonged referral delays, low-income households cannot afford transport, or vulnerable communities receive warnings without access to effective care.

Research and policy on strengthening primary healthcare in a changing climate support the need to integrate climate adaptation into the systems responsible for delivering essential services. For African health systems, this means connecting preparedness with primary care, community engagement, referral capacity, and financial protection.

An equitable One Health architecture should therefore measure not only whether warnings are generated and responses initiated, but also who receives timely information, who reaches appropriate care, and which populations continue to experience preventable barriers.

This perspective changes the policy objective. Equity is not an additional benefit to be pursued after resilience has been achieved; it is one of the conditions by which resilience should be judged.

From architecture to implementation

The proposed framework generates three immediate priorities for policymakers.

First, map existing institutional responsibilities and information flows. National authorities should identify how health, veterinary, environmental, meteorological, and disaster-management institutions currently exchange information and make decisions. The priority is to identify operational gaps before establishing additional structures.

Second, link preparedness investments to measurable outcomes. Countries should develop costed plans that connect surveillance, emergency-care readiness, workforce capacity, and essential services. Indicators could include alert-verification time, facility readiness, referral performance, continuity of essential services, and differences in access across population groups. Indicator selection should be guided by available baseline data and local priorities.

Third, establish a research-to-policy feedback loop. Surveillance findings, implementation evaluations, and community experience should inform periodic revisions to preparedness plans. African research institutions and policymakers should lead this process, supported by equitable regional and international collaboration.

Implementation should proceed through stakeholder consultation, assessment of existing capacity, and staged evaluation. Research involving human participants or identifiable health records must obtain the relevant ethical and regulatory approvals. Any proposed national framework should also align with existing policies and institutional mandates.

Conclusion

The transition from crisis response to resilience requires more than new technologies or additional preparedness expenditure. It requires governance arrangements that connect early warning to timely action, ensure that frontline services can respond, and distribute the benefits of preparedness equitably.

A One Health architecture offers a framework for examining and strengthening these connections in Zambia and across Africa. Its contribution is to bring climate intelligence, multisectoral surveillance, emergency medicine, health equity, and accountable financing into a single operational model.

The next step is empirical: to determine which institutional arrangements work, which investments produce measurable improvements, and whether these improvements reach the populations most exposed to risk.

A resilient health system should not merely detect threats earlier. It should convert that knowledge into timely, effective, and equitable protection for the people it serves.

 

Disclaimer: The proposed architecture represents the author's policy analysis and has not been presented as an officially adopted framework of the Government of Zambia, WHO, or the World Health Summit.