Submission ID 130552
| Issue/Objective | Community-based One Health surveillance is central to early detection of zoonotic and environmental health threats in low- and middle-income countries. However, its implementation increasingly relies on frontline health workers (FLHWs) operating within fragile health systems characterized by weak governance, inadequate institutional support, and inequitable resource distribution. Evidence from Mombasa, Kenya, shows that FLHWs face disproportionate occupational risks including exposure to infectious diseases, environmental hazards, and unsafe working conditions while navigating complex ethical dilemmas related to duty of care, personal safety, and community trust. This study aims to examine how structural determinants particularly governance gaps, power asymmetries, and policy failures shape ethical challenges in community-based One Health surveillance. It contributes to the conference theme by interrogating how systemic inequities undermine global health commitments and shift risk onto vulnerable health workers. |
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| Methodology/Approach | An exploratory qualitative study was conducted across six sub-counties in Mombasa, Kenya, between October and November 2024. Twenty FLHWs (including community health promoters, public health officers, veterinarians, laboratory personnel, and surveillance officers) participated in semi-structured key informant interviews. Data were analyzed using an inductive thematic approach supported by NVivo. A normative ethical analysis framework drawing on utilitarianism, deontology, care ethics, virtue ethics, and principles of justice and reciprocity was applied to interpret how systemic and structural factors shape ethical decision-making and risk distribution in frontline practice. |
| Results | Findings reveal that ethical challenges experienced by FLHWs are structurally produced rather than individual in nature. Key themes include: Disproportionate exposure to risk: FLHWs face recurrent exposure to zoonotic diseases, environmental hazards (e.g., sewage, waste, chemical pollutants), and infectious outbreaks without adequate protection. Inadequate institutional support: Persistent shortages of personal protective equipment (PPE), weak infrastructure, and delayed emergency responses force workers to compromise safety or use personal resources. Power and governance gaps: Exclusion from decision-making, weak cross-sectoral coordination, and political interference undermine effective surveillance and ethical practice. Moral distress and duty conflicts: Workers navigate tensions between professional obligation and self-protection, often prioritizing community needs at personal risk. Knowledge and system inequities: Limited One Health training and fragmented systems reduce workers' capacity to respond safely and ethically. These findings demonstrate that risks are inequitably distributed, with frontline workers bearing the burden of systemic failures. |
| Discussion/Conclusion | This study highlights that achieving global health equity requires addressing upstream determinants embedded in governance, policy, and institutional design. Ethical challenges in One Health surveillance are rooted in systemic inequities that shift responsibility and risk onto frontline workers while limiting their agency and protection. Restoring commitment to global health equity demands: Strengthening ethical governance frameworks and accountability mechanisms Ensuring equitable resource allocation and occupational protections Promoting inclusive decision-making that recognizes frontline workers as key stakeholders Investing in One Health training and cross-sectoral coordination Scaling these interventions can transform community-based surveillance into a more just, resilient, and sustainable system. By centering the experiences of FLHWs, this work advances the call to collectively reclaim global health equity and address the structural drivers of injustice in fragmented health systems. |
| Presenters and Affiliations | Ahmed Adam Department of Health Services County Government Mombasa Joseph Nguta niversity of Nairobi ,Department of Public Health, Pharmacology and Toxicology, Bernadette Kina Kombo d e Department of Community Health Sciences, University of Manitoba Sabina Odero Institute for Human Development, Aga Khan University |
