Inter-Sectoral Silence in One Health Antimicrobial Resistance Governance: A Qualitative Multi-Professional Study from Southwest Ethiopia

Background: Antimicrobial resistance (AMR) is a major cause of death across sub-Saharan Africa, where One Health  governance—integrating human, animal, and environmental health—is internationally endorsed but rarely operationalised. Evidence on how professional stakeholders in resource-constrained settings understand and enact One Health  AMR governance remains sparse. We addressed this gap through a qualitative, multi-professional study of One Health  AMR knowledge, practices, and health-system factors in Jimma, southwest Ethiopia.

Methods: We conducted 33 semi-structured key informant interviews across three professional groups: human/public health (n=17), veterinary/animal health (n=11), and environmental health (n=5). Data were analysed thematically and interpreted through five complementary frameworks: the WHO Health Systems Building Blocks, the COM-B behavioural model, the One Health Framework, Ostrom's Socio-Ecological Systems Framework, and Diffusion of Innovations theory.

Findings: Six themes and 18 sub-themes emerged: fractured AMR knowledge, with no shared priority pathogen list and a clinical blind spot to environmental pathways; One Health understanding that was aspirational in discourse but nascent in practice; a permissive environment sustained by empirical prescribing and unregulated drug markets; universal absence of inter-sectoral data sharing; layered institutional, material, and governance barriers; and AMR research and training that were active but disconnected from surveillance. No formal cross-sectoral data-sharing mechanism existed, and five senior human-health professionals had never encountered the One Health concept.

Interpretation: Barriers to One Health AMR governance in Jimma are structural rather than motivational. Effective responses require institutional redesign: cross-ministerial policy mandates with legal enforcement, a co-produced cross-sectoral priority pathogen list, institutionalised surveillance functions independent of donor funding, and mandatory One Health content in postgraduate curricula.