Harnessing One Health for Avian Influenza Response in Cambodia: A Collaborative Inquiry into Surveillance, Preparedness, and Policy Reform

In 2023, after nearly a decade of silence, Cambodia was again confronted by a familiar adversary: the highly pathogenic avian influenza virus H5N1. Sixteen human infections were confirmed, five of them fatal. These cases were not just statistics—they were lived realities for families in rural villages, poultry handlers, and overstretched local health officers. It was against this backdrop that our team, supported by the SEAOHUN One Health Research and Training (OHRT) Awards Program, launched a deep investigation into how Cambodia could better prepare for and respond to zoonotic outbreaks.

Project Implementation Journey

With support from the SEAOHUN One Health Research and Training (OHRT) Awards Program, the team embarked on a qualitative journey. The project was not a traditional top-down study, but rather a qualitative exploration shaped by community voices and practitioner experiences. We set out to conduct a situational analysis using the One Health framework, which calls for multisectoral collaboration across human, animal, and environmental health. Our main goals were to evaluate existing response systems, identify intersectoral gaps, and recommend practical improvements. To do this, we conducted 13 in-depth interviews with key informants at the national level—including officials from health and agriculture ministries, NGOs, and international partners—as well as two comprehensive focus group discussions with 22 frontline responders from Prey Veng and Takeo provinces. These provinces were chosen because they had been recent hotspots of H5N1 activity, making them critical lenses through which to understand both the risks and the responses.

Insights from the Frontlines

Our data revealed both commendable efforts and serious shortcomings. Nationally, an inter-ministerial committee exists on paper to guide One Health collaboration—but in practice, operational planning remains disjointed. Surveillance systems are active in both human and animal sectors, yet they function largely in silos. Animal health officers often lacked timely access to human case data, and vice versa. There was no unified outbreak dashboard or routine cross-sector data sharing protocol. Most notably absent was the environmental health sector, which remains under-resourced and poorly integrated despite its essential role in zoonotic risk mapping and mitigation.

On-the-Ground Realities

At the provincial and community levels, our focus groups painted a picture of dedication under strain. Health workers and veterinary officers in Prey Veng and Takeo recounted experiences of responding to suspected poultry outbreaks with minimal protective gear and inconsistent communication from the capital. Rapid Response Teams were activated but lacked adequate support to maintain investigations and community education. Village chiefs, often the first to receive outbreak rumors, spoke of confusion and fear among residents, especially when poultry culling policies changed mid-response. Subnational actors often improvised their own coordination systems—texting their counterparts, meeting informally, or relying on personal relationships to plug operational gaps.

Overcoming Barriers, Building Trust

Before these voices could be documented, we had to navigate our own challenges. The ethical approval process was complicated by shifting institutional affiliations, and securing permission from local health departments took weeks of follow-up and face-to-face visits. High-level informants were cautious, some requiring multiple reassurances before agreeing to speak candidly. Yet, these early hurdles became foundational moments. They allowed us to build rapport, explain our purpose clearly, and clarify that our goal was not criticism but co-learning. As trust grew, so did the depth of our findings. Officials began sharing internal reports, field officers offered their own logs and maps, and students helped facilitate dialogues that might not otherwise have happened.

Cultivating New Leadership

One of the most promising outcomes of the project was the inclusion of five public health and agriculture students as volunteer researchers. They didn’t just take notes—they coordinated logistics, helped moderate discussions, cleaned transcripts, and participated in thematic coding of the data. For many of them, this was their first field experience, and the One Health lens became more than theory. One student remarked, 'I never knew how many sectors had to come together until I saw how hard it was for them to even meet.' These students are now preparing their own mini-projects and theses rooted in the One Health paradigm.

From Dialogue to Curriculum and Policy

The lessons from this fieldwork are now being translated into formal education and policy recommendations. A case study drawn from our project will be presented in the upcoming outbreak investigation training for public health professionals in July 2025. In addition, elements from our findings are being incorporated into the Master of Health and Community Development (MHCD) course at the National Institute of Public Health. Policy briefs—focused on data sharing, environmental monitoring, and subnational workforce development—are in draft, with dissemination planned through inter-ministerial working groups and academic seminars.

Looking Ahead

Cambodia’s One Health system, like many in the region, is a work in progress. But this project underscores that real change is possible—not just through major reform, but through deep listening, capacity building, and iterative action. Our key recommendations include decentralizing outbreak response authority, integrating environmental health actors more fully, and piloting a shared zoonotic data platform at the provincial level. We also propose a formal mentoring pipeline for students to engage with live outbreak investigations under supervision, ensuring both learning and sustainability.

Conclusion

From policy corridors in Phnom Penh to poultry farms in Prey Veng, this project journeyed through the full spectrum of Cambodia’s One Health ecosystem. Supported by SEAOHUN, it was more than an academic exercise—it was a catalyst for practical insights, cross-sector conversations, and human-centered learning. The road ahead remains long, but with each interview, each shared lesson, and each empowered student, the foundation for a stronger, more integrated health system continues to grow.

Team Leader:

Mr. Ngor Chamnab – National Institute of Public Health, Royal University of Agriculture

Team Members:

Mr. Chansovannara Soputhy – National Institute of Public Health

Ms. Ban Naiheak – Royal University of Agriculture