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Objectives Antimicrobial resistance (AMR) poses a serious threat across human, animal and environmental health. The One Health approach emphasises multisectoral collaboration and is critical in addressing AMR. While One Health governance has gained recognition from international organisations, there remains limited understanding of how it can be effectively implemented across institutional, social, economic and political contexts. This scoping review aims to explore the design and implementation of One Health governance across contexts.Design Scoping reviewData sources We searched PubMed, Scopus, Web of Science and grey literature sources in December 2024, updating our search in March 2026.Eligibility criteria Eligible sources included empirical and conceptual work on One Health governance.Data extraction and synthesis We searched for and screened documents and extracted data following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. We then applied qualitative analysis to examine governance mechanisms; implementation contexts; conceptualisations of effectiveness; evidence of effectiveness and key barriers and facilitators.Results We included 171 documents from over 50 countries. We explored six dimensions of One Health governance: participation, leadership, coordination, decision-making, resourcing and accountability. Existing governance structures and wider aspects of country context shaped One Health governance. While there was broad agreement on the goals of One Health governance—namely, to support disease prevention, detection and response—empirical evidence on effective approaches was relatively limited. Facilitators included strong political will and crisis-driven momentum, while barriers included siloed systems, sectoral dominance, limited accountability, inadequate funding and lack of institutionalisation.Conclusions This review highlights the range of approaches to One Health governance that exist and outlines how context may shape the design and implementation of One Health governance. Evaluative research should further explore which approaches to One Health governance are most effective in specific contexts. These insights are particularly relevant for AMR, where sustained cross-sectoral governance beyond outbreak-driven responses is essential to counter the ‘silent pandemic’.