*4.2.3 Implementation of the one health approach in Africa under current socioeconomic and political conditions*

Strong social, economic and political commitments are key elements in successful schistosomiasis control, which requires persistent efforts and a systematic step-bystep approach with increasingly ambitious targets to reach elimination [35]. The disease context is complex, with the interplay of social, economic, political and cultural factors [20, 27] that may affect the attainment of the goals of the NTD 2021–2030 road map [28]. Concurrent treatment of zoonotic *Schistosoma* reservoirs, at least in terms of livestock hosts in Africa, is likely to be imperative for successful disruption of the transmission of human disease [15]. However, a key problem for the treatment of many zoonotic infections in livestock reservoirs is that, while the costs of treatment fall largely on the agricultural sector, the benefits of reduced transmission to humans are felt largely by the public health and medical sectors [15]. Therefore, motivating the sustainable involvement of livestock authorities and producers, who may have other disease priorities, could be difficult.

Given the potential impact of schistosomiasis on animal health and productivity, a One Health economic evaluation of extending treatment to animal hosts in Africa appears warranted, and requires data to be gathered on the costs and benefits to both the animal and human health sectors. To assess the economics of One Health interventions, the impacts on both sectors need to be integrated so that decision-makers in both sectors can assess and interpret outcomes in a way that is meaningful both to their sector and to society [74]. In light of these challenges, there is a need to revisit the current approach to schistosomiasis control among African countries irrespective of the level of endemicity.
