Conceptualizing One Health governance for leptospirosis control through a bivariate spatial analysis of risk factors in East Java province, Indonesia

Objective: Effective management requires a One Health strategy integrating epidemiological and environmental data to guide intersectoral coordination. This study aimed to analyze local spatial associations between leptospirosis and risk factors using the Bivariate Local Indicator of Spatial Association (BiLISA) and to develop a One Health Cooperation Map for targeted control.Methods: An ecological cross-sectional study was conducted across 38 regencies/cities in East Java using 2024 data. Variables included leptospirosis incidence, climate, flooding, agriculture, and socio-demographics. Global Moran’s I and BiLISA were used to identify spatial clusters. Significant clusters were mapped to construct a governance framework assigning intervention responsibilities to relevant non-health sectors.Results: Global spatial autocorrelation was weak, but BiLISA revealed significant local heterogeneity. The analysis distinguished "hotspots" (High-Low) from critical "silent risk" areas (Low-High)-regions where low reported cases coexist with high environmental vulnerability (e.g., Sidoarjo, Lamongan). Nineteen priority regencies were identified. These findings were translated into a One Health Governance Map, explicitly linking specific spatial risks to mandated actions for agencies such as Public Works and Housing.Conclusion: Leptospirosis in East Java exhibits distinct local clustering driven by specific determinants. By translating statistical evidence into a practical governance tool, this study operationalizes One Health. This shift from siloed approaches to determinant-led collaboration enables policymakers to prioritize "silent risk" areas and implement targeted infrastructure-based prevention strategies.