Introduction: In 2013, an estimated 2.1 million adolescents (age 10–19 years) were living with HIV globally. The extent to which health facilities provide appropriate treatment and care was unknown. To support understanding of service availability in 2014, Paediatric‐Adolescent Treatment Africa (PATA), a non‐governmental organisation (NGO) supporting a network of health facilities across sub‐Saharan Africa, undertook a facility‐level situational analysis of adolescent HIV treatment and care services in 23 countries.Methods: Two hundred and eighteen facilities, responsible for an estimated 80,072 HIV‐infected adolescents in care, were surveyed. Sixty per cent of the sample were from PATA's network, with the remaining gathered via local NGO partners and snowball sampling. Data were analysed using descriptive statistics and coding to describe central tendencies and identify themes.Results: Respondents represented three subregions: West and Central Africa (n = 59; 27%), East Africa (n = 77, 35%) and southern Africa (n = 82, 38%). Half (50%) of the facilities were in urban areas, 17% peri‐urban and 33% rural settings. Insufficient data disaggregation and outcomes monitoring were critical issues. A quarter of facilities did not have a working definition of adolescence. Facilities reported non‐adherence as their key challenge in adolescent service provision, but had insufficient protocols for determining and managing poor adherence and loss to follow‐up. Adherence counselling focused on implications of non‐adherence rather than its drivers. Facilities recommended peer support as an effective adherence and retention intervention, yet not all offered these services. Almost two‐thirds reported attending to adolescents with adults and/or children, and half had no transitioning protocols. Of those with transitioning protocols, 21% moved pregnant adolescents into adult services earlier than their peers. There was limited sexual and reproductive health integration, with 63% of facilities offering these services within their HIV programmes and 46% catering to the special needs of HIV‐infected pregnant adolescents.Conclusions: Results indicate that providers are challenged by adolescent adherence and reflect an insufficiently targeted approach for adolescents. Guidance on standard definitions for adherence, retention and counselling approaches is needed. Peer support may create an enabling environment and sensitize personnel. Service delivery gaps should be addressed, with standardized transition and quality counselling. Integrated, comprehensive sexual reproductive health services are needed, with support for pregnant adolescents.

Small towns lag behind cities in drinking water and sanitation access globally. Closing this gap requires developing service models for areas with both urban and rural characteristics. This study assessed Bushenyi-Ishaka, a municipality in Uganda situated at the rural–urban transition, with a focus on service ladder indictors. Data sources included household interviews (n = 500) and water quality samples from sources and storage containers. Households in more urban (as compared to rural) cells were more likely to use improved water sources (including piped water on-premises), make regular payments for water, rely on shared sanitation facilities, and make use of manual sludge emptying services. Most households (72%) used an unlined pit latrine not intended for emptying and reuse. These findings suggest that small town servicing models should prioritize non-sewered sanitation management, including incentives for safe excreta containment and disposal opportunities. This study also highlights a need for integrated services models to expand rural–urban water and sanitation coverage.

Antimicrobial resistance (AMR) is a global health crisis that affects all life on Earth. In 2015, the World Health Organization developed guidance to combat AMR in accordance with a One Health framework considering human, animal, and environment sectors of planetary health. This study reviewed global guidance and 25 National Action Plans to evaluate thematic priorities in One Health AMR approaches using a novel framework that additionally facilitated the identification of water-related stewardship gaps, as water resources are recognized as the primary environmental AMR reservoir and dissemination pathway. This review found that global and national stewardship primarily focuses on mitigating antibiotic use in the human and animal sectors, overlooking environmental drivers, particularly diverse environmental waters. The findings of this study highlight the need to broaden the scope of water-related AMR concerns beyond water, sanitation, and hygiene (WASH) infrastructure for water supply and wastewater treatment, and account for environmental waters in AMR development and dissemination, particularly in low-income countries where half a billion people rely on environmental waters to meet daily needs. Equitably accounting for water environments, supplies, and waste in AMR prevention, mitigation, surveillance, and innovation can significantly enhance the integration of environmental objectives in One Health AMR stewardship.

Capetonians have relied on dams to meet their needs for over a century. Extremely limited rainfall between 2015–2018, however, forced the City to impose a 50-litres per capita per day water restriction on its four million residents to avoid supply cut-offs. Cape Town’s water crisis highlights the importance of moving away from past infrastructural practices. South Africa needs a new water paradigm that embeds water sustainability and resilience in day-to-day practices that, inter alia, protects the natural water systems and ensures a sustainable water supply through reducing the environmental footprint of a growing population and developing alternative supply systems to dam infrastructure. To accomplish this, government, the private sector and consumers need to work together to develop and implement a water sensitive approach that will transform water planning, supply and demand at scale.

Antimicrobial resistance (AMR) is a pervasive global health threat linked to human antimicrobial misuse and abuse, food production, and broader environmental contamination. While global agencies promote a multi-sectoral One Health system approach to equitably combat human, animal, and environmental health AMR risks, it is widely acknowledged that the human and animal sectors dominate discussions. Given this disproportionate focus, identification of critical research gaps is needed to develop stewardship plans that equitably address One Health AMR threats. This review used natural language processing and term frequency algorithms to classify 12,638 records from 1990–2020 thematically in order to highlight sectoral prioritization and gaps. It also specifically assessed water-related gaps as water is recognized as both a primary environmental dissemination pathway and key means of intervention. Drawing from systemic health and integrated water management lenses, this review found that themes related to plant, wildlife, and environmental-related AMR threats—in particular, the role that environmental (ambient) waters play in AMR development, transmission, and spread—are under-prioritized as compared to human and food animal health concerns regardless of geographic region or income level. Further prioritization of these themes is needed to strengthen the environmental dimension of One Health AMR responses and systemically protect global health.