Toward One Health Institutionalization: harnessing stakeholder network as leverage to strengthen health security in Libya

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Background: The institutionalization of the One Health approach is critical for addressing complex health threats at the human-animal-environment interface. In Libya-a state affected by prolonged political conflict, the growing impact of climate change, and weak intersectoral coordination-such an approach is critical to address zoonotic diseases, antimicrobial resistance (AMR), and climate-related health threats. This study aimed to map and analyze stakeholder networks to inform the development of a national One Health governance framework in Libya. Methods: We employed a mixed-methods approach integrating participatory Net-Map stakeholder mapping, social network analysis (SNA), and SWOT analysis during a national consultation workshop (September 2024) with 42 multisectoral experts. SNA metrics (degree, betweenness, eigenvector centrality, modularity) were computed using R software to analyze a network of 11 core institutions and 102 directed ties across four interaction modalities: coordination, collaboration, capacity building, and advocacy. Results: The network was structurally cohesive (reciprocity = 0.857; average path length = 2.05) but functionally siloed into three clusters: (1) an Operational One Health Interface comprising the National Center for Disease Control (NCDC), National Center for Animal Health (NCAH), Environmental Sanitation Affairs (ESA), and Ministry of Environment (MoE); (2) an Agricultural and Livestock Governance Cluster including the Ministry of Agriculture (MoA), Food and Agriculture Organization of the United Nations (FAO), Ministry of Local Government (MoLG), and World Organization for Animal Health (WOAH); and (3) a Public Health and Regulatory Cluster consisting of the Ministry of Health (MoH), Food and Drug Control Center (FDCC), and World Health Organization (WHO). NCAH and NCDC emerged as central hubs, while MoA served as the key broker (betweenness centrality = 0.334). SWOT analysis identified strong technical expertise and centralized infrastructure as key strengths but highlighted fragmented coordination, limited funding, and political instability as major constraints. Conclusion: These evidence-based insights directly informed Libya's first national One Health Memorandum of Understanding (MoU), establishing a formal governance framework signed by the MoH, MoA, MoLG, MoE, and FDCC, and endorsed by NCDC, the NCAH, and ESA. The study demonstrates that even in fragile contexts, network-informed stakeholder engagement can catalyze sustainable, multisectoral health governance-offering a replicable model for One Health institutionalization in similar settings as a catalyst for health security. It highlights practical lessons learned from the COVID-19 pandemic, underscoring how integrated governance across human, animal, and environmental health sectors can enhance prevention, preparedness, response, and resilience against future threats.

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