One Health in Tunisia: Towards an Integrated Governance Framework Linking Human, Animal and Environmental Health
Department of Research and Strategic Studies 15-10-2026; Research and writing: Khawla Klahchi, Journalist and Researcher in Law, Political Science and Communication
Public health in the twenty-first century is no longer confined to hospitals, physicians and medicines. It is closely interconnected with environmental quality, food safety, animal health, climate change and the capacity of state institutions to coordinate their efforts and respond effectively to health risks. Against this background, the concept of One Health has emerged as an integrated approach linking human, animal and environmental health, with the aim of preventing risks before they develop into health, social and economic crises.
In Tunisia, this approach raises a question that extends beyond improving healthcare services: does the country have an integrated system capable of anticipating and managing health risks, or do policies relating to public health, the environment, agriculture and food safety continue to operate within fragmented institutional frameworks?
This question is particularly relevant in the context of water scarcity, pollution, climate change, zoonotic diseases and the need to strengthen food safety monitoring and address the inappropriate use of antimicrobial agents. Consequently, adopting the One Health approach is not merely a scientific choice; it may also provide an opportunity to rethink health governance and public policy in Tunisia.
1. What Does One Health Mean in Practice?
The One Health approach is based on a fundamental principle: human health cannot be safeguarded independently of animal health and the integrity of ecosystems. The World Health Organization (WHO) and its international partners have adopted this approach as a framework for cooperation between human healthcare, veterinary medicine, environmental protection and agriculture, particularly in addressing zoonotic diseases, antimicrobial resistance and food safety risks.
The relationship between these areas can be illustrated through several examples.
First, zoonotic diseases. Controlling rabies, for instance, requires coordination between animal vaccination programmes and medical care for people exposed to infection, including the involvement of the Pasteur Institute, the monitoring of stray animals and public awareness campaigns in schools and secondary educational institutions.
Second, food safety. Veterinary services play an essential role in monitoring the quality and safety of food of animal origin and identifying infectious diseases that may be transmitted to humans. However, foodborne disease prevention cannot be limited to final-stage health inspections. It begins with animal husbandry, the use of veterinary medicines, agricultural production, storage, transportation and distribution.
Third, the environment and climate change. Water scarcity, pollution and changes in temperature and rainfall patterns can affect the distribution of certain diseases, the quality of food and water, and the capacity of healthcare systems to respond effectively.
One Health does not mean merging all institutions into a single ministry. Rather, it requires sustainable mechanisms for data sharing, coordinated decision-making and clearly defined
responsibilities, ensuring that gaps between sectors do not become vulnerabilities that threaten public health.
2. Tunisia Faces the Challenge of Implementation
Tunisia provides an important case study for examining both the potential and the limitations of the One Health approach. The central issue is not an absence of awareness of interconnected health risks, but the extent to which institutions can transform sectoral cooperation into an integrated, measurable public policy.
2.1. Health Security and the One Health Approach
According to information published by the World Health Organization, Tunisia is working to develop the One Health approach, including through a national roadmap and cooperation among the health, agriculture and environmental sectors. With support from international partners, the authorities have also undertaken initiatives to strengthen pandemic preparedness, surveillance systems, laboratory capacities and early-warning mechanisms.
Rabies provides a concrete illustration of the importance of this approach. In 2024, Tunisia strengthened training programmes that reached 591 health professionals across all 24 governorates, while awareness-raising activities reached more than 1,500 people.
These figures indicate that practical efforts are underway. However, they also highlight the need for continuous evaluation of animal vaccination coverage, the effectiveness of medical care for people exposed to infection, the sustainability of coordination between relevant institutions and public awareness of the risks associated with rabies.
Tunisia’s challenges extend beyond epidemics. Water scarcity, pollution, climate change, food safety and antimicrobial resistance are all areas involving the mandates of several institutions. Addressing each issue in isolation may therefore produce only partial solutions, even when individual sectoral interventions remain necessary.
The decisive question is whether Tunisia has a national system capable of collecting human, veterinary and environmental health data, analysing them jointly and translating the findings into clear, publicly communicated decisions. The effectiveness of such a system also depends on identifying the institution responsible for coordination, allocating an appropriate budget, defining performance indicators and establishing accountability mechanisms.
Efforts to strengthen coordination and surveillance capacities, supported through cooperation involving the Food and Agriculture Organization of the United Nations (FAO), the World Bank and the World Health Organization, aim to improve prevention, preparedness and response capacities. These efforts include the development of an integrated surveillance system known as SATURN.
This national strategy reflects a shift away from responding to health emergencies only after they occur and towards prevention and early anticipation. This emerging governance framework involves establishing a permanent coordination and monitoring mechanism across three key sectors: the Ministry of Health, the Ministry of Agriculture and the Ministry of the Environment.
The objective is to overcome fragmented sectoral approaches, harmonise early-warning mechanisms and improve the response to zoonoses, or diseases transmissible between animals and humans. It also seeks to address antimicrobial resistance (AMR), which threatens health security and food security in Tunisia.
2.2. Veterinary Professionals: A First Line of Defence for Public Health
Veterinary practice constitutes one of the essential lines of defence for public health in Tunisia. Its importance is particularly evident in rabies control, which requires sustained coordination between human healthcare services, veterinary authorities, local authorities and environmental stakeholders.
Veterinarians play a central role in animal surveillance, the investigation of suspected cases, sample collection and referral to specialised laboratories, preventive vaccination campaigns, and the provision of epidemiological data needed to identify infection hotspots and monitor disease transmission.
The available figures illustrate the scale of this work. According to the World Organisation for Animal Health (WOAH), Tunisia’s 2025 vaccination campaign covered approximately 500,000 dogs and 70,000 cats through 197 vaccination centres, supplemented by mobile teams. Veterinary services also reportedly process more than 1,900 animal samples annually for rabies diagnosis.
A scientific study published in January 2026, covering the period from 1994 to 2023, identified 6,920 confirmed animal cases and 90 human cases in the dataset analysed by the researchers. The study also found that dogs accounted for 61.4% of confirmed animal cases, while canine vaccination coverage remained below the recommended benchmark of 70% in most years.
These findings highlight the importance of Tunisian veterinarians’ professional expertise and fieldwork, despite material constraints, limited veterinary equipment and the difficulties of accessing certain rural areas.
The challenges include securing adequate resources, vaccines, transport and diagnostic facilities; expanding vaccination coverage; and improving reporting systems and the geographical tracking of cases. Recognising the contribution of veterinary teams must therefore go beyond counting vaccinated animals or samples analysed. Their effectiveness
should also be assessed in terms of their ability to detect infection hotspots early, reduce transmission among animals and improve coordination with public health services to protect people at risk.
Supporting veterinarians is not simply an investment in animal health. It is a fundamental pillar of national health security and a prerequisite for embedding the One Health approach in public policy. It also enables a shift from reactive interventions after a threat emerges towards proactive prevention and effective forward-looking strategies.
3. International Experiences: Lessons for Developing Health and Environmental Policies in Tunisia
Comparing Tunisia with France and the Netherlands helps illustrate the difference between recognising the importance of One Health and translating it into organised public policy. This comparison does not suggest that foreign models can be transferred wholesale to Tunisia. Rather, it helps identify approaches that could be adapted to the Tunisian context.
3.1. France: Coordination Across Ministries and Local Institutions
France has adopted national environmental health plans and pursued stronger coordination across government sectors. One practical example is a national platform for animal health surveillance established in 2011, bringing together public and private institutions, laboratories, representatives of livestock farmers and veterinarians.
This institutional structure facilitates the exchange of expertise and information on risks affecting animals that may also threaten human health.
Tunisia could draw on this experience by developing a permanent national mechanism bringing together representatives of the health, agriculture and environmental sectors, alongside laboratories and universities. Such a mechanism would require clearly defined responsibilities and deadlines for information sharing, enabling faster communication of findings and more effective responses.
It could also strengthen statistical monitoring through real-time data collection, documentation, archiving and the digitalisation of results and outputs.
3.2. The Netherlands: Antimicrobial Resistance as a Shared Responsibility
The Netherlands has adopted a national action plan for 2024–2030 to combat antimicrobial resistance, linking interventions across human health, animal health and the environment. Implementation involves several government portfolios, including health, agriculture, nature, food quality, infrastructure and water management.
Antimicrobial resistance is particularly relevant to Tunisia when considering the environmental implications of industrial activity, notably the operations of the Gafsa Phosphate Company and the Tunisian Chemical Group. Mining and industrial processing activities raise concerns relating to water, soil and air quality, as well as the management of industrial waste.
Environmental pollution does not necessarily imply the presence of antimicrobial resistance. However, inadequately treated wastewater and industrial waste may, depending on the nature of the contaminants and local conditions, contribute to the spread of resistant bacteria or the environmental dissemination of antimicrobial resistance genes.
This makes a scientifically integrated approach essential. It should include monitoring water, soil and sediment quality; testing for antimicrobial-resistant bacteria in wastewater treatment facilities and around industrial sites; and monitoring antimicrobial use in livestock farming and animal production.
The state has a key responsibility in this area. Its role includes strengthening environmental and public health oversight, ensuring that industrial facilities comply with treatment and discharge standards, funding independent studies to assess actual risks, and publishing the findings regularly.
Cooperation between the ministries responsible for health, agriculture and the environment, together with universities, veterinary laboratories and microbiology laboratories, is also necessary to prevent antimicrobial resistance from being treated as an exclusively medical issue disconnected from other public policies.
Protecting the effectiveness of antimicrobial medicines therefore begins well beyond hospital settings. It requires monitoring sources of pollution and strengthening environmental and veterinary surveillance within the framework of One Health.
Comparative Overview: Policy Priorities in Tunisia, France and the Netherlands
This comparison concerns announced policies and institutional instruments. It is not a ranking of national healthcare system performance, which would require harmonised indicators and comparable data across countries.
|
Criterion |
Tunisia |
France |
The Netherlands |
|
Main area of focus |
Pandemic preparedness and rabies control |
Coordination of health and environmental policies, and animal surveillance |
Combating antimicrobial resistance |
|
Institutional instrument |
One Health roadmap and joint initiatives |
National plans and multi-stakeholder platforms |
Multisectoral action plan for 2024–2030 |
|
Key lesson for Tunisia |
Sustaining coordination, resources and data sharing |
Structuring cooperation between institutions |
Integrating antimicrobial resistance surveillance across sectors |
4. One Health in Tunisia: Governance Challenges and Implementation Requirements
The World Health Organization identifies several challenges to implementing One Health in Tunisia, including limited human and financial resources, insufficient familiarity with the approach among some stakeholders, and difficulties in ensuring the participation of all relevant parties.
A closer analysis requires distinguishing between three levels of challenge.
First, governance. Responsibilities may be distributed across ministries and institutions with different legal mandates, without always being supported by continuous operational coordination. Announcing intersectoral cooperation is not enough. It is necessary to identify which institution leads the response when a shared health threat emerges and which bodies are responsible for monitoring and evaluation.
Second, data availability, accessibility and quality. Health data cannot fulfil their potential if they remain fragmented across institutions or cannot be exchanged in a timely manner. Tunisia needs to develop a surveillance system capable of linking human, veterinary and environmental indicators while safeguarding personal data and ensuring data quality.
Third, prevention and territorial equity. Health risks are not distributed evenly across Tunisia’s regions. Areas facing environmental pressures or inadequate infrastructure may experience challenges that differ significantly from those encountered elsewhere. National policies must therefore account for regional disparities in veterinary vaccination, health monitoring, access to safe water and emergency response capacity.
These considerations shift the debate from the traditional question of how much the state allocates to the health sector towards a broader question: how can public resources be distributed to prevent risks that might otherwise develop into substantial healthcare and economic burdens?
5. Towards a National One Health Policy in Tunisia
Developing the One Health approach in Tunisia could be guided by five practical priorities.
1. Establish permanent national coordination. Create a clear institutional framework bringing together the health, agriculture, environment, water and higher education sectors, with the participation of municipalities and civil society where appropriate.
2. Develop a shared early-warning system. Link data on human and animal diseases, food and water safety, and environmental factors that may signal emerging health risks.
3. Adopt and publish performance indicators. These could include the speed of information exchange, animal vaccination coverage against rabies, food safety monitoring results, trends in antimicrobial use and resistance, and response times following health alerts.
4. Strengthen preventive funding and scientific research. Support laboratories, universities and multidisciplinary research, while incorporating assessments of the economic costs of prevention in comparison with the costs of responding to health emergencies.
5. Engage citizens and the media. Disseminate reliable health information, explain how to prevent zoonotic and other shared health risks, and make public data accessible so that journalists and researchers can evaluate policies and hold the relevant authorities accountable.
These priorities are consistent with the joint guidance developed by the World Health Organization, the Food and Agriculture Organization and their international partners. The guidance recommends assessing the national situation, establishing or strengthening coordination mechanisms, identifying resources and priorities, and evaluating implementation while sharing lessons learned. The overall objective is to move from crisis management towards effective risk governance.
The real challenge for Tunisia is not simply to adopt the term One Health, but to turn it into a permanent operating principle for public health governance.
International experiences demonstrate that integrated approaches can take different forms: institutional coordination and animal health surveillance in France, a multisectoral action plan on antimicrobial resistance in the Netherlands, and efforts to strengthen surveillance and pandemic preparedness in Tunisia.
The success of Tunisia’s approach cannot be measured by the number of strategies announced or agreements signed. It must be assessed according to its ability to reduce risks, improve response times, expand preventive measures and ensure that services reach all regions.
One Health is therefore a test of the state’s capacity to work beyond traditional administrative boundaries and connect health policy with environmental, agricultural and water policies in a
coherent manner. It is also a test of governance and accountability: who controls the data? Who coordinates decision-making? Who finances prevention? And who bears responsibility when early-warning mechanisms fail?
Ultimately, public health does not begin at the hospital entrance. It begins with the environment in which people live, the animals with which they interact, the food they consume, the water they use and the policies that govern these relationships.
One Health offers an integrated framework for protecting human health while strengthening food, water, environmental and animal health security. Its effectiveness in Tunisia will depend on the state’s ability to translate this vision into coordinated institutions, evidence-based policies, sustained prevention and transparent accountability.
Key References
- World Health Organization (WHO), One Health.
- World Health Organization, Tunisia country profile: WHO Results Report 2024–2025.
- Food and Agriculture Organization of the United Nations (FAO), Project supporting Tunisia in pandemic prevention, preparedness and response through the One Health approach.
- French Government, National Environmental Health Plan.
- Government of the Netherlands, Dutch Action Plan for the Reduction of Antimicrobial Resistance 2024–2030.
- World Organisation for Animal Health (WOAH), One Goal, One Health, Zero Rabies Deaths: Supporting Africa’s Fight Against Rabies.
- Kalthoum et al., “Rabies in Tunisia: A 30-Year Retrospective Study (1994–2023),” Frontiers in Tropical Diseases, 6 January 2026. Full scientific article.
- World Health Organization, Decline in Rabies-Related Mortality in Tunisia During 2025.
