Public health project management in VUCA contexts: hybridmethodology, Scrum and ETET based on Ecosalud and One Health

" Public health project management faces increasing challenges in environments characterized by volatility, uncertainty, complexity, and ambiguity (VUCA). This article proposes an integrative approach that combines VUCA principles with the Ecosalud methodology, the One Health framework, Agile methodologies, specifically Scrum, and the territorial experience of the Territorios Tricolor project in Colombia. This initiative focuses on strengthening community, social, and environmental assets to promote healthy aging. The research adopted the Desk-Territory-Desk-Territory (ETET) model, an iterative methodology that integrates technical analysis with local knowledge through co-creation and participatory validation processes. This approach enabled a comprehensive examination of biopsychosocial, environmental, and zoonotic determinants in rural settings, while also challenging the limitations of top-down public policies lacking territorial focus. The results demonstrate how this methodological convergence strengthens local capacities, promotes territorial governance, and facilitates social appropriation of knowledge. Innovative strategies were identified to improve primary health care management, reduce inequities, and generate culturally relevant, sustainable solutions. The article thus outlines a more adaptive, ethical, and transformative model for public health project management, aligned with territorial dynamics and responsive to the complexities and uncertainties of today’s world. Keywords: VUCA; Scrum; Public health; Ecohealth; Territorial governance; Tricolor territories"