Whose health, whose voice? : asymmetries in a One Health program in Rwanda

This dissertation critically examines the implementation of One Health (OH) programs at the intersection of global frameworks and local realities, through a case study of the Gorilla Conservation Employee Health Program (GCEHP) in Rwanda. Grounded in a constructivist paradigm and informed by critical theories of power, the study investigates how OH initiatives that are designed with the intention to improve health outcomes, are experienced on the ground. It challenges common explanations for program shortcomings that focus solely on structural, technical, or resource-based constraints, especially in a postcolonial ecotourism setting. The research employs a qualitative case study approach, drawing on secondary data originally collected for an evaluation of the GCEHP. This includes semi-structured interviews, a focus group discussion, field observations, and program documents. Data were analyzed through iterative thematic analysis and interpreted using theories from fields addressing collaborative health, community engagement, health equity and relational power dynamics. Two primary stakeholder groups were engaged: One Health Experts (OHEs) including program designers, managers, and global actors, and Local Experts (LEs) comprising frontline staff and community members. Findings reveal a sharp divergence in perspectives. OHEs emphasized structural and institutional barriers such as inefficiencies, limited resources, and governance challenges. In contrast, LEs highlighted relational concerns, particularly issues of trust, respect, and the lack of meaningful participation in program decision-making. These contrasting views illuminate deeper asymmetries in knowledge valuation and reveal whose voices and interests are prioritized in OH operations. This dissertation contributes to OH scholarship by offering an equity-centered analysis of program implementation. It argues that without deliberate attention to power relations, local agency, and epistemological diversity, OH programs risk perpetuating the very hierarchies current scholarship and institutional narratives seek to dismantle. By advancing decolonial and pluralistic approaches, this study provides both conceptual and practical insights for designing more accountable and equitable OH interventions in postcolonial, human–animal health interface, and ecotourism contexts.