Abstract Background One Health approaches are vital for zoonotic disease control, yet its effective implementation requires fundamental health system reforms for successful multisectoral coordination. Evidence on operational-level barriers and system requirements is urgently needed. This pre-implementation study examined One Health implementation barriers in Ghana across human, animal, and wildlife health sectors, using structured intersectoral dialogue to prioritise barriers and develop collective solutions for policy development. Methods A two-phase mixed-methods study was conducted in Ghana’s three largest metropolitan areas. Phase 1 involved interviews with 101 frontline and national stakeholders, with data analysed using reflexive thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR). Phase 2 convened a participatory workshop ( n = 16) for individual ranking, collective voting and consensus dialogue to prioritise barriers and formulate policy recommendations. Data were analysed using framework analysis, supported by descriptive statistics, and triangulated across phases. Results Ten implementation barriers were identified. Critically, eight (80%) reflected Outer Setting determinants (e.g. policy gaps, system structure, and workforce architecture), while two represented Outer–Inner Setting interactions; no barriers were purely organisational. Initially, sectoral priorities (human: leadership; animal: finance; wildlife: service delivery) converged through dialogue. Participants reframed financial constraints as symptoms of a weak system structure, establishing this as the root barrier. Extreme workforce imbalances (e.g. three wildlife officers nationally) emerged as critical constraints, representing a health service planning failure that makes conventional coordination models operationally infeasible. Participants jointly recommended coordination frameworks with clear mandates and interoperable data systems, subsequently acknowledging workforce gaps as a priority omission. Conclusions This study illustrates how participatory cross-sectoral dialogue can shift stakeholder perspectives from sector-specific constraints to systemic governance reform. Findings indicate that sustainable One Health implementation requires addressing both governance fragmentation and workforce architecture across ministerial boundaries, challenging assumptions that organisational capacity alone suffices. These insights directly inform Ghana’s national One Health policy development and offer methodological and empirical guidance for multisectoral health system reforms in low- and middle-income countries facing similar implementation challenges.
Dsani et al. (Fri,) studied this question.