Balancing duty and risk: Ethical dimensions of community-based one health surveillance among frontline health workers in Mombasa, Kenya

Abstract

One Health, which integrates human, animal, and environmental health, is vital for detecting and managing emerging health threats. Yet, its implementation through community-based surveillance poses significant ethical challenges for frontline health workers (FLHWs), who must balance informed consent, confidentiality, community trust, and competing stakeholder priorities. This qualitative study explored ethical dilemmas encountered by FLHWs engaged in One Health surveillance across six sub-counties in Mombasa, Kenya. Between October and November 2024, twenty FLHWs—including community health promoters, health assistants, public health officers, veterinarians, laboratory personnel, and surveillance officers—participated in semi-structured interviews. Data were analyzed thematically using a hybrid inductive–deductive approach, guided by utilitarian, deontological, care ethics, and virtue ethics frameworks. Participants reported recurring ethical challenges, including threats to personal safety, conflicts in duty of care, ambiguity in institutional responsibilities, exclusion from decision-making, religious influences on reporting practices, gender-related disparities, and difficulties responding to One Health incidents. These dilemmas undermined their effectiveness and strained trust with communities. Community-based One Health surveillance requires more than technical capacity; it demands ethical preparedness. Strengthening policy guidance, institutional support, and inclusive decision-making can equip FLHWs to navigate ethical dilemmas, safeguard trust, and balance their dual obligations to duty and personal risk. This study contributes to advancing ethically sound approaches to community-level One Health implementation.