"One Health" is an approach that addresses human, animal and ecosystem health together. We founded Conservation Through Public Health (CTPH) in 2003 because we were concerned about disease transmission from people to gorillas, an issue that we identified as a threat to the gorillas when setting up the Uganda Wildlife Authority (UWA) veterinary unit from 1996 to 2000. In 1996, I led a team that investigated the first scabies skin disease outbreak in the critically endangered mountain gorillas that was traced to people living around the park who have limited access to basic health care and other social services.

In 2000, we held a meeting with gorilla conservation partners and a recommendation was made by International Gorilla Conservation Programme (IGCP) to start educating local communities about basic health and hygiene, where I was tasked to lead this initiative. This was when my "One Health" journey began by developing brochures in English and the local language about the risk of human-gorilla disease transmission. This was also my first introduction to community education where together with the UWA Community Conservation warden and rangers and subcounty health assistant, we spoke to over 1,000 people in 8 villages at greatest risk from human-gorilla conflict.

We thank the Gorilla Journal for supporting CTPH since being founded in 2003 as a Ugandan registered NGO and US registered non-profit. CTPH promotes biodiversity conservation by enabling people, wildlife and livestock to coexist through improving their health and livelihoods in and around protected areas in Africa. We envision people and gorillas living in balance, health and harmony with local communities acting as stewards of their environment. CTPH's three integrated programs are wildlife conservation, community health and alternative livelihoods.

In the wildlife conservation program, we set up a long-term gorilla health-monitoring program as an early warning system for disease outbreaks between people, gorillas and livestock. We train park staff to recognize and report clinical signs in gorillas and to collect monthly fecal samples from the night nests and trails; when the dung is abnormal from all habituated gorilla groups and during the gorilla census, which occurs every five years. We regularly analyze fecal samples from gorillas to prevent and control cross disease transmission between people, gorillas and livestock, where we also conduct comparative analysis with livestock and people.

We also work with community volunteers from the Human-Gorilla Conflict Resolution (HuGo) team set up by UWA and IGCP to safely chase gorillas back to the park. We train HuGo to monitor the health of gorillas when they forage on community land, a time when they are most likely to pick up diseases from people. Results from the analyses are shared with UWA, local NGO partners, local health centres and local veterinary offices for timely action and to guide health management. Sample analysis was first carried out at a Gorilla Research Clinic built in 2005 at Buhoma, Bwindi's main tourist site, with funding from the MacArthur Foundation and it was later upgraded to a permanent Gorilla Health and Community Conservation Centre, with funding from Tusk Trust. We also promote the use of energy saving cook stoves through our Village Health and Conservation Teams (VHCTs) to reduce deforestation and destruction of the gorillas' habitat.

In the community health program, we strengthen community based health care where we started off by consolidating Community Based Direct Observation of Treatment Short course therapy (CBDOTS) for Tuberculosis and then later added community based family planning though the formation of Village Health and Conservation Teams (VHCTs) in 2007. When we started to expand the program from Kanungu to Kisoro district, the Ministry of Health had started to recognize the Village Health Teams (VHTs) made up of community volunteers and we subsequently trained the most active VHTs to become VHCTs. Each VHCT is in charge of 50 households in their village. They promote good hygiene and sanitation, infectious disease prevention and control, family planning and good nutrition and refer suspected TB, HIV and scabies patients as well as those with diarrhea to the nearest health centres. They also promote gorilla and forest conservation, and report homes that are visited by gorillas, which reduces the response time of the HuGo and park staff.

In the alternative livelihoods program, we support VHCTs with group income generating livestock projects for each parish, where the money generated helps to sustain their volunteer activities and meet basic household needs. The VHCTs later reinvested the funds into Village Saving and Loan Associations, doubling their income. The VHCTs have continued to promote health and conservation beyond donor funding, where we have had no volunteer dropouts for 10 years. The VHCT and VSLA model led CTPH to win the first prize of the 2012 Global Development Network, Japanese most Innovative Development Project Award for scaling social service delivery. In 2016, we used the same approach to make the HuGo community volunteer groups financially stable by giving them group livestock projects that bring them together and help them earn an income from livestock enterprises.

In 2015, with support from WWF Switzerland we founded Gorilla Conservation Coffee as a social enterprise of CTPH that trains farmers and buys good coffee from them at a premium price to reduce their dependence on the national park to meet basic needs for food and fuel wood. A donation from every coffee bag sold is given to continue CTPH's health work with the gorillas and local communities of Bwindi.

Interventions Based on the Work

Within the first year of setting up the gorilla health monitoring program, we discovered that gorillas from Nkuringo gorilla group that were spending over 50 % of the time on community land had the highest parasite burden. This together with the increased human-gorilla conflict prompted UWA to recruit more HuGo members in the southern sector of Bwindi.

We conducted fecal antigen ELISA tests on people, gorillas and livestock to test for Giardia and Cryptosporidium and found that there was a high incidence of Giardia in people admitted with diarrhea at the hospital. This promoted us to recruit an additional VHCT community volunteer in a larger village that had the most Giardia cases and poorest living conditions, and also where the gorillas often ranged in community land. The hospital also educated their patients to collect water from protected water sources.

When we conducted baseline surveys we also found that over 50 % of homes collect water from unprotected water sources and those who did were more likely to drink water from dirty containers. Though we found Cryptosporidium in the gorillas, people and livestock, they were not showing clinical signs. This made us increase our effort to prevent the gorillas from getting Giardia, which is much more pathogenic. UWA put the activity of monthly gorilla fecal sample collections by rangers and trackers in the annual operational plan for Bwindi.

Because of the behaviour change communication of VHCTs and additional encouragement from UWA, Bwindi community members around the park, particularly in the southern sector started to build pit latrines.

We started to conduct joint One Health research through memorandums of understanding with the Kanungu and Kisoro District local governments and the NGO missionary hospital - Bwindi Community Hospital.

Outcomes and Impact

• reduced disease incidences in the gorillas
• reduced human-gorilla conflict
• improved conservation attitudes evidenced by increase in sustainable agriculture practices and use of energy saving cook stoves, a silverback gorilla receiving more protection in community land, and preventing reduced poaching and illegal forest offtake, which is currently being measured through social impact evaluation research conducted with funding from the Darwin Initiative
• increased use of family planning methods from 20 to 60 %, above the 30% national average
• men getting more involved in family planning and women and youth more involved in conservation
• 50 % increase in hand washing facilities, anal cleansing material, clean water storage containers and drying racks
• significant increase in patients suspected to have TB, HIV and scabies referred to health centres

Measuring our Impact

In 2016, CTPH teamed up with researchers from Oxford University and the International Institute of Environment and Development (IIED) to conduct a social impact evaluation study to determine how health investments we have made over the past 10 years have contributed to outcomes for conservation and sustainable development. Recommendations from this study will be used to improve our programs and scale the model to additional parishes around Bwindi, in Mpungu subcounty and other protected areas. These include Budongo Forest led by the Jane Goodall Institute working closely with Budongo Forest Conservation Station and Mount Elgon National Park led by UWA working closely with District Environmental Officers.

Future Plans

We plan to intensify research through partnerships with universities and other research institutions to measure and improve the effectiveness of our innovative One Health model and to scale our approach through implementing new programs in new locations in Uganda and other countries in Africa where we started a project at the Virungas. We also want to spread our impact by training others to implement our approach and influencing others through advocacy.

Gladys Kalema-Zikusoka

We are very grateful to many donors and partners who have supported our work over the past 14 years.