Enablers and barriers influencing district-level One Health policy implementation in four districts of western Uganda

Background Translating national One Health policies into routine decentralized action remains challenging, and evidence on subnational institutionalization in Uganda is limited. This study assessed the implementation status, enablers, and barriers of the One Health approach across four districts in Western Uganda. Methods A quantitative cross-sectional study was conducted among 49 stakeholders in Mbarara, Kabale, Ibanda, and Kiruhura districts using a structured questionnaire and a scorecard across six domains (governance, collaboration, surveillance, workforce, community engagement, and financing). Domain indicators were scored (0–5 scale) to create a composite implementation index. Perceived enablers and barriers were assessed using Likert scales and summarized as medians and interquartile ranges, with cross-district differences analyzed by Kruskal-Wallis test. Results One Health implementation was weak in Mbarara (38.5%) and Kabale (35.4%), and very weak in Ibanda (9.2%) and Kiruhura (9.2%). Major gaps occurred in routine coordination, surveillance integration, workforce training, community engagement, and financing, with zero districts possessing dedicated One Health budgets. Across all districts, resource availability, networks, community engagement, workforce capacity, planning, and communication were consistently perceived as barriers rather than enablers (p > 0.05). Conclusions National One Health structures have not translated into functional district-level operationalization in Western Uganda. Strengthening decentralized implementation requires integrating One Health priorities into local planning and budgeting, establishing functional coordination mechanisms, building workforce capacity, and unifying surveillance systems.