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As antimicrobial resistance (AMR) continues to threaten global health, 91��ɫ researchers are examining whether governments have the tools and systems needed to address it.

“AMR, which is often described as a ‘silent pandemic’, threatens our ability to effectively treat infectious diseases in humans, animals, plants and the environment around the world,” says Arne Ruckert, director of research at the ’s (GSL) AMR Policy Accelerator.

In response, international health organizations and policymakers have increasingly turned to a framework known as One Health, which recognizes that the health of people, animals and ecosystems is interconnected. The approach calls for an equally interconnected response.

“One Health governance is comprised of the structures, processes and mechanisms that enable and support coordination and collaboration between these sectors, as well as with actors outside government, such as the private sector, academic experts, health professionals and civil society,” says Taylor Hecker, research fellow at GSL, which is headquartered at 91��ɫ and the University of Ottawa.

But recognizing the need for collaboration is only the first step. While One Health has gained widespread support among governments, international organizations and public health experts, less is known about how those collaborations should be organized, managed and evaluated, or how policymakers can determine whether they are achieving their intended goals.

To address that gap in knowledge, GSL worked with colleagues from the World Health Organization.

“We wanted to synthesize what is known about One Health governance globally, and especially how its mechanisms have been implemented in different institutional, social, economic and political contexts,” says Ruckert, adding the team also wanted to understand how success has been defined and measured, and what barriers and facilitators influence implementation.

The researchers reviewed studies and policy documents exploring how governments and organizations were putting One Health into practice. These included national AMR plans, disease surveillance systems, cross-sector coordination bodies and responses to infectious disease outbreaks. After screening more than 3,000 records, the team examined 171 documents representing more than 50 countries.

A key aspect of the review was its focus on how local context shapes the design and implementation of coordination systems.

“Existing literature and guidance often does not differentiate between different country contexts and how this may impact or result in barriers to certain mechanisms,” Hecker says. “Therefore, we approached and performed this research through a context-specific lens as there is no one-size-fits-all solution to support effective One Health governance.”

That analysis identified six dimensions that consistently inform One Health governance: participation, leadership, coordination, decision-making, resourcing and accountability. Together, these factors determine who is involved, who is responsible for leading efforts, how information is shared, how priorities are set, how activities are funded and how progress is monitored.

Despite differences in political structures, funding models and government institutions, several barriers appeared repeatedly across the literature. These include challenges coordinating action across multiple levels of government, dependence on donor funding, siloed departments and weak information-sharing. The review also found that while disease outbreaks often created momentum for cross-sector cooperation, many countries struggled to maintain those partnerships once the immediate crisis had passed.

The researchers say the goal was to catalogue the challenges countries face and identify approaches that could help policymakers design more effective and sustainable systems for AMR policy implementation.

“As the first phase of a broader , this article also provides a conceptual foundation for how governance approaches can be implemented going forward, as well as how they can be assessed across different contexts,” says Ruckert.

Among the factors associated with stronger adoption were political commitment, clear coordination mechanisms and effective systems for sharing information across sectors. Successful initiatives foster a sense of shared ownership, with participants viewing One Health as a collective responsibility rather than the domain of a single department or sector. Previous disease outbreaks, meanwhile, sometimes helped build support for these approaches by demonstrating the value of sustained cross-sector collaboration.

The review calls for more rigorous evaluation of One Health initiatives so policymakers can understand what works, where and why. As countries continue searching for ways to slow the spread of AMR, researchers suggest that building stronger evidence around governance may be just as important as developing new policies.

Effective approaches must account for the political, institutional and economic realities of individual countries, say researchers. Governments also need to move beyond outbreak-driven collaboration and establish lasting structures capable of addressing long-term challenges such as AMR.

“We hope that this review encourages researchers and policymakers to look beyond one-size-fits-all approaches of One Health governance and pay attention to how context shapes what is feasible, effective and sustainable during AMR policy implementation,” says Ruckert.

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