From evidence to action: a narrative literature review to inform cross-border one health implementation in the Kavango-Zambezi region

Introduction Despite growing commitment to One Health, there is limited operational guidance for implementing cross-border approaches in transboundary regions. The Kavango-Zambezi Transfrontier Conservation Area (KAZA-TFCA), spanning the Southern African countries of Angola, Botswana, Namibia, Zambia, and Zimbabwe, faces interconnected challenges at the human-animal-environment interface, including zoonotic disease risks, food insecurity, environmental change, and complex governance. This study synthesises evidence to identify barriers and opportunities for operationalising One Health across KAZA.Theory This narrative review is informed by the One Health framework, which recognises the interdependence of human, animal and environmental health, and draws on a systems perspective to examine cross-border governance, multisectoral collaboration, and community participation in transboundary settings.Method A narrative review, following the PRISMA-ScR guidelines, was conducted of studies published between 2010 and 2024 across nine databases. Thirty-eight studies were thematically synthesised and analysed across six domains: animal health, food security, environmental health, governance, community perceptions, and health and veterinary services.Results Findings show that challenges are driven by cross-border policy fragmentation, disjointed surveillance coordination, unequal resource access, and limited community inclusion in decision-making. Environmental pressures such as climate variability, land-use change, and water scarcity exacerbate vulnerabilities across sectors. Community trust and participation are central to effective implementation but remain under-addressed.Discussion An evidence-informed framework is proposed for cross-border One Health implementation that is centred on policy harmonisation, integrated planning, inclusive governance, and meaningful community engagement. These insights are relevant to other transboundary regions facing similar challenges and highlight the need for coordinated, equity-focused strategies to translate policy into action.