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In this Series paper, we review the contributions of One Health approaches (ie, at the human–animal–environment interface) to improve global health security across a range of health hazards and we summarise contemporary evidence of incremental benefits of a One Health approach. We assessed how One Health approaches were reported to the Food and Agricultural Organization of the UN, the World Organisation for Animal Health (WOAH, formerly OIE), and WHO, within the monitoring and assessment frameworks, including WHO International Health Regulations (2005) and WOAH Performance of Veterinary Services. We reviewed One Health theoretical foundations, methods, and case studies. Examples from joint health services and infrastructure, surveillance–response systems, surveillance of antimicrobial resistance, food safety and security, environmental hazards, water and sanitation, and zoonoses control clearly show incremental benefits of One Health approaches. One Health approaches appear to be most effective and sustainable in the prevention, preparedness, and early detection and investigation of evolving risks and hazards; the evidence base for their application is strongest in the control of endemic and neglected tropical diseases. For benefits to be maximised and extended, improved One Health operationalisation is needed by strengthening multisectoral coordination mechanisms at national, regional, and global levels.

The need for resilient health systems is recognized as important for the attainment of health outcomes, given the current shocks to health services. Resilience has been defined as the capacity to “prepare and effectively respond to crises; maintain core functions; and, informed by lessons learnt, reorganize if conditions require it”. There is however a recognized dichotomy between its conceptualization in literature, and its application in practice. We propose two mutually reinforcing categories of resilience, representing resilience targeted at potentially known shocks, and the inherent health system resilience, needed to respond to unpredictable shock events. We determined capacities for each of these categories, and explored this methodological proposition by computing country-specific scores against each capacity, for the 47 Member States of the WHO African Region. We assessed face validity of the computed index, to ensure derived values were representative of the different elements of resilience, and were predictive of health outcomes, and computed bias-corrected non-parametric confidence intervals of the emergency preparedness and response (EPR) and inherent system resilience (ISR) sub-indices, as well as the overall resilience index, using 1000 bootstrap replicates. We also explored the internal consistency and scale reliability of the index, by calculating Cronbach alphas for the various proposed capacities and their corresponding attributes. We computed overall resilience to be 48.4 out of a possible 100 in the 47 assessed countries, with generally lower levels of ISR. For ISR, the capacities were weakest for transformation capacity, followed by mobilization of resources, awareness of own capacities, self-regulation and finally diversity of services respectively. This paper aims to contribute to the growing body of empirical evidence on health systems and service resilience, which is of great importance to the functionality and performance of health systems, particularly in the context of COVID-19. It provides a methodological reflection for monitoring health system resilience, revealing areas of improvement in the provision of essential health services during shock events, and builds a case for the need for mechanisms, at country level, that address both specific and non-specific shocks to the health system, ultimately for the attainment of improved health outcomes.

Background There are several definitions of resilience in health systems, many of which share some characteristics, but no agreed-upon framework is universally accepted. Here, we review the concept of resilience, identifying its definitions, attributes, antecedents and consequences, and present the findings of a concept analysis of health system resilience. Methods We follow Schwarz-Barcott and Kim’s hybrid model, which consists of three phases: theoretical, fieldwork and final analysis. We identified the concept definitions, attributes, antecedents and consequences of health system resilience and constructed an evidence-informed framework on the basis of the findings of this review. We searched PubMed, PsycINFO, CINAHL Complete, EBSCOhost-Academic Search and Premier databases and downloaded identified titles and abstracts on Covidence. We screened 3357 titles and removed duplicate and ineligible records; two reviewers then screened each title, and disagreements were resolved by discussion with the third reviewer. From the 130 eligible manuscripts, we identified the definitions, attributes, antecedents and consequences using a pre-defined data extraction form. Results Resilience antecedents are decentralization, available funds, investments and resources, staff environment and motivation, integration and networking and finally, diversification of staff. The attributes are the availability of resources and funds, adaptive capacity, transformative capacity, learning and advocacy and progressive leadership. The consequences of health system resilience are improved health system performance, a balanced governance structure, improved expenditure and financial management of health and maintenance of health services that support universal health coverage (UHC) throughout crises. Conclusion A resilient health system maintains quality healthcare through times of crisis. During the coronavirus disease 2019 (COVID-19) epidemic, several seemingly robust health systems were strained under the increased demand, and services were disrupted. As such, elements of resilience should be integrated into the functions of a health system to ensure standardized and consistent service quality and delivery. We offer a systematic, evidence-informed method for identifying the attributes of health system resilience, intending to eventually be used to develop a measuring tool to evaluate a country’s health system resilience performance.

ObjectivesThis study elucidates the status of public health governance, defines the concept and synthesises the evidence to guide stakeholders in enhancing governance for the delivery of essential public health functions (EPHFs).DesignA scoping review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines.Data sourcesA systematic search of peer-reviewed literature was performed using PubMed and Embase for English-language publications from 2000 to April 2025, supplemented by a grey literature search.Eligibility criteriaWe included literature addressing public health governance and institutional arrangements. We excluded documents focusing solely on disease-specific and clinical governance, and governance at supranational level.Extraction and synthesisData from 177 included documents were extracted and analysed to identify definitions, components, actors, enablers and principles relevant to public health governance. Findings were complemented by WHO’s experiences to develop an operational definition and framework.ResultsFindings revealed the absence of a standardised definition of public health governance and highlighted the diversity of actors within and across health and allied sectors. Findings identified strategy and policy development, oversight, partnership, legal authority, resource stewardship, and monitoring and evaluation as key components of public health governance; legislation, financing, institutional structures and political will as key enablers; and integration, comprehensiveness with equity and shared responsibility as key principles. Four institutional models were identified: autonomous public health bodies, semi-autonomous bodies under health ministries, public health departments within ministries and interministerial platforms without a designated institute.ConclusionDespite differences in institutional structures, successful delivery of the EPHFs depends on clearly defined roles and effective coordination across sectors. Government-led reviews and reforms are needed urgently to strengthen public health governance through institutional clarity, sustained investment and cross-sectoral collaboration for building resilient, trusted and equitable systems.

National public health institutes and WHO collaborating centres, and their global networks, are a key resource to support public health system strengthening with essential public health functions and generate evidence for health policy central to national health and socioeconomic development. The COVID-19 pandemic has laid bare global inequities in public health capacities, made urgent the need to examine sources of global knowledge and understand how to better invest in and use public health institutes and their capacities. This analysis paper incorporates experiences and perspectives from the WHO and International Association of National Public Health Institutes including the ongoing pandemic and work conducted in the UK-WHO ‘Tackling Deadly Diseases in Africa Programme’. We acknowledge geographical disparities in public health capacities both within and across countries and regions, provide examples of novel ways of working for global health actors, and define the challenging environment in which public health authorities operate. We identify four incentives for all countries to invest in public health and strengthen institutions: (1) transparency and trust; (2) socioeconomic dividends; (3) collective health protection and (4) knowledge sharing and equity. By pursuing shared priorities; enabling voices from low-resource settings to be more equitably heard; facilitating collaboration and learning within and across regions, we articulate actionable next steps to develop and better harness public health institutes and international networks.

Background The COVID-19 pandemic exposed weaknesses in health systems globally, highlighting chronic underinvestment, fragmentation, and a lack of preparedness with catastrophic impact on public health, economies and societies. Lessons learned reconfirmed the necessity to build health systems resilience, integrating efforts to achieve Universal Health Coverage (UHC) and health security in tandem. Results This study identified 63 global and regional policies, collaborations, and investments (collectively termed “initiatives”) that came out post-COVID-19 and reviewed them in reference to their focus on integration of UHC and health security through the lens of WHO’s seven policy recommendations for building resilient health systems. The findings indicate that while efforts to align UHC and health security are evident at global and regional levels, they vary in depth and coherence. 81% of initiatives align with at least four of the seven WHO policy recommendations. While there is emphasis for health security preparedness, focus on primary care and health promotion is less pronounced. Policy initiatives show stronger alignment with WHO policy recommendations compared to Collaborations or Investments, indicating synergies between policies, while apparently a gap between policy and practice. Multilateral groups, including UN agencies, and government-affiliated organizations show greater alignment with the WHO policy recommendations too, while there is less alignment with those from non-governmental and other entities. Conclusions This review shows that while post COVID-19 policies increasingly articulate visions for integrated health systems strengthening, existing collaborations and investments have not demonstrated comparable commitment to the implementation of these visions. This underscores a prevailing disconnect among global health actors and the mostly reactive and short-term nature of external investments and partnerships. In low-income and fragile health system contexts, this misalignment risks the inefficient use of global support and may perpetuate foundational weaknesses in health systems. Moreover, this is particularly problematic given worsening fiscal constraints from reductions in overseas development assistance and country-level economic contractions. By (re)orienting global health policies, collaborations, and investments toward more unified approaches to achieving UHC and health security, the international community can more effectively support countries in building health systems capable of withstanding future crises, maintaining essential health services and safeguarding gains in health equity.

Humanitarian needs are escalating globally, with around 300 million people requiring assistance—over half in Africa. These crises are increasingly driven by conflict, climate-related disasters and emergencies and economic instability, all severely impacting public health and disrupting health systems. A new approach is essential to address root causes of humanitarian crises and develop durable solutions. In response to this need, the WHO developed a framework for health in the humanitarian–development–peace nexus (HDPN) in Africa. This framework was informed by literature reviews and consultations with key stakeholders across UN and wider humanitarian sector (including the African Union bodies, WHO offices and relevant non-governmental organisations). The framework presents a structured method for countries to integrate health across the HDPN, emphasising policy alignment, the need for sustainable financing, strong monitoring systems and adaptable governance. It defines clear roles for WHO, the African Union Commission, regional economic communities and authorities in countries as applicable. Key areas for operationalising the framework include health sector development planning, budgeting, financing, intersectoral coordination, services delivery and monitoring and evaluation. It also recommends integrated strategic actions focusing on health across humanitarian, development and peacebuilding efforts, emphasising synergy and co-benefits from this nexus approach. With a growing number of countries facing humanitarian crises, fragility and conflict, urgent implementation of this framework is vital to build resilience and improve health outcomes across Africa and beyond.

The COVID-19 pandemic exposed vulnerabilities in many health systems worldwide with profound implications for health and society. The public health challenges experienced during the pandemic have highlighted the importance of resilient health systems, that can adapt and transform to meet the population’s evolving health needs. Essential public health functions (EPHFs) offer a holistic, integrated and sustainable approach to public health by contributing to achieving several health priorities and goals. In recent years, there has been a focused effort to conceptualise and define the EPHFs. In this paper, we describe the collaborative approach undertaken by the WHO Eastern Mediterranean Region (EMR) and UK Health Security Agency and present the findings and results of the revised EPHFs, in view of lessons learnt from the COVID-19 pandemic and the current priorities for countries across the EMR. This included conducting a desktop review, a gap and bottleneck analysis and stakeholder consultation to arrive at the revised EPHF model including four enablers and nine core functions, including a new function: public health services. The EPHFs will offer countries a complementary and synergistic approach to strengthen health systems and public health capacities and contribute to the region’s ability to effectively respond to future health challenges and emergencies. By focusing on the EPHFs, countries can work towards ensuring health security as an integral goal for the health system besides universal health coverage, thus strengthening and building more resilient and equitable health systems.