Antimicrobial Resistance National Action Plan 2018-2023

REPUBLIC OF UGANDA Antimicrobial Resistance National Action Plan 2018-2023 “Prevent, slow down, and control the spread of resistant organisms” ACKNOWLEDGMENTS The Government of Uganda (GoU) wishes to acknowledge, with gratitude, the Uganda National Academy of Sciences (UNAS) through its standing committee on antimicrobial resistance with the following members: Prof. Denis K. Byarugaba (Chair), Donna A. Kusemererwa (Co-Chair), Aziz A. Maij, Charles B. Rwabukwali, Connie Cleona Kyarisiima, Eric Wobudeya, Florence Najjuka MD, Frederick Byarugaba, George Mukiibi-Muka, Michael Romeo Mutyaba, Richard Odoi Adome, and Victoria Katawera. The committee coordinated the development of this National Action Plan (NAP) on Antimicrobial Resistance (AMR) with support from the Center for Disease Dynamics, Economics & Policy (CDDEP) under the Global Antibiotic Resistance Partnership (GARP) and the World Health organization Uganda Country office. UNAS undertook this work on behalf of the Ministry of Health (MOH), the Ministry of Agriculture, Animal Industry, and Fisheries (MAAIF), and the Ministry of Water and Environment. The process received invaluable technical support from the World Health Organization (WHO), the Food and Agriculture Organization (FAO), the World Animal Health Organization (OIE), the US Centers for Disease Control and Prevention (CDC), the Infectious Diseases Institute (IDI), and the Uganda AMR Surveillance Task Force. The GOU also wishes to thank all those individuals who provided additional expert opinions and invaluable comments as they reviewed this document. All these contributions ensured that Uganda developed a plan that will guide efforts towards slowing down the threat of antimicrobial resistance and its attendant impact on public, animal, and environmental health and on sustainable development in Uganda and the world at large. FOREWORD Antimicrobial resistance (AMR) is a global One Health—human, animal, and environmental health concern. AMR has reduced the ability of antimicrobial agents to effectively control infectious diseases caused by bacteria, parasites, viruses, and fungi impacting negatively on global health security, healthcare, global trade, agriculture, and the environment. The consequences of AMR threaten the attainment of the Sustainable Development Goals recently agreed upon by UN member countries. It has been recognized that AMR is accelerated by misuse of antimicrobial agents and aggravated by a host of other factors. These include self-medication, unrestricted access to medicines and both proper and improper use of medicines that allow drug resistant organisms to flourish. Sites with high concentrations of antimicrobials, such as pharmaceutical industries, healthcare facilities and agriculture, can discharge antimicrobial residues and resistant bacteria into the environment. The current trend in AMR in Uganda and globally is rising and calls for immediate action. The 71 st UN General Assembly (UNGA), the 68th World Health Assembly, and organizations including the World Health Organization (WHO), the Food and Agriculture Organization (FAO), and the World Organization for Animal Health (OIE), have agreed on a set of actions that member countries such as Uganda are committed to implement. The Government of Uganda (GOU) has put in place a framework through this National AMR Action Plan to address the threat AMR poses to the welfare of the peoples of Uganda. The Action Plan sets out a coordinated and collaborative One Health approach involving key stakeholders in government and other sectors to confront the threat and shall be coordinated by the National Antimicrobial Resistance Sub Committee (NAMRSC). The Government will also work together with other governments, international organizations, and partners to address this global threat from AMR. Although AMR cannot be eradicated, it can be reasonably slowed down and contained. The Ugandan Government is confident that this plan will help respond to the threats of AMR. The Government urges all stakeholders to develop specific plans of action in their respective institutions and sectors and to coordinate with the national effort to prevent, detect, and respond to the threat posed by AMR pathogens so that the people of Uganda are not subjected further to the burden of drug-resistant infections. Dr. Henry G. Mwebesa Director General Health Services Ministry of Health Dr. Juliet Sentumbwe Director Animal Resources Ministry of Agriculture Animal Industry & Fisheries Mr. Collins Oloya Ag. Director Environmental Affairs Ministry of Water & Environment Mr. Sam Mwandha Executive Director Uganda Wildlife Authority Ministry of tourism, Wildlife & Antiquities ABBREVIATIONS AND ACRONYMS AMR Antimicrobial Resistance ASP Antimicrobial Stewardship Programme BS/S Bio-safety/bio-security CDC The US Centers for Disease Control and Prevention CHEWS Community Health Extension Workers CDDEP Center for Disease Dynamics, Economics & Policy CPHL Central Public Health Laboratories CSO Civil Society Organization FAO Food and Agriculture Organization GAP Global Action Plan GARP Global Antibiotic Resistance Partnership GHSA Global Health Security Agenda GOU Government of Uganda IDI Infectious Diseases Institute INH Isoniazid IPC Infection Prevention and Control LMICs Low- and Middle-Income Countries M&E Monitoring and Evaluation MAAIF Ministry of Agriculture, Animal Industry and Fisheries MDAs Ministries, Departments and Agencies MDR TB Multi-drug resistant Tuberculosis MING Ministry of Information and National Guidance MoES Ministry of Education and Sports MOH Ministry of Health MoLG Ministry of Local Government MoSTI Ministry of Science, Technology, and Innovation NAP National Action Plan NOHP National One Health Platform NEMA National Environment Management Authority NWSC National Water and Sewage Corporation NAMRSC National Antimicrobial Resistance Sub-Committee OIE World Organization for Animal Health PSU Pharmaceutical Society of Uganda TWC Technical Working Committee UNAS Uganda National Academy of Sciences UNBS Uganda National Bureau of Standards UNCST Uganda National Council for Science and Technology UNGA UN General Assembly UPDF Uganda People’s Defense Force UPF Uganda Police Force URSB Uganda Registration Services Bureau WHA World Health Assembly WHO World Health Organization XDR-TB Extensively Drug-Resistant Tuberculosis TBD To Be Determined BUBU Buy Uganda Build Uganda Table of Contents Executive Summary ....................................................................................................................... 1 1.0 Introduction ............................................................................................................................. 1 1.1 Background ......................................................................................................................... 1 1.2 Antimicrobial Use and Resistance in Uganda .................................................................. 2 1.3 Principles of Approach of the NAP ................................................................................... 4 1.4 Goals and Strategic objectives ........................................................................................... 5 2.0 Governance Mechanisms ........................................................................................................ 6 2.1 Uganda National AMR Committee Composition ............................................................ 7 2.2 Terms of Reference for the NAMRSC .............................................................................. 7 3.0 Strategic Interventions............................................................................................................. 9 3.1 Strategic Objective 1: Promote Public Awareness, Training and Education ............... 9 3.2 Strategic Objective 2: Improve Infection Prevention and Control .............................. 11 3.3 Strategic Objective 3: Promote Optimal Access and Use of Antimicrobials............... 13 3.4 Strategic Objective 4: Surveillance ................................................................................. 16 3.5 Strategic Objective 5: Research and Innovation ........................................................... 17 4.0 Implementation Plan ............................................................................................................. 16 4.1 Introduction ...................................................................................................................... 16 4.2 Objective ............................................................................................................................ 16 4.3 Structural Framework ..................................................................................................... 16 4.4 Implementation Plan Matrix ........................................................................................... 19 5.0 Monitoring and Evaluation ................................................................................................... 61 5.1 Introduction ...................................................................................................................... 61 5.2 Goal and Objectives of the M&E Plan............................................................................ 61 5.3 Structural Framework ..................................................................................................... 61 5.4 Methodology ...................................................................................................................... 61 5.5 Monitoring and Evaluation Framework Matrix ........................................................... 63 References .................................................................................................................................... 75 Appendix 1: Detailed Monitoring and Evaluation Matrix ......................................................... 76 Uganda National Action Plan for Antimicrobial Resistance 1 Executive Summary The impact of antimicrobial resistance will likely be greater in poorer countries that already have a high burden of infectious diseases associated with poor healthcare systems, inadequate sanitation, limited access to safe water and resource constraints. This, in turn, imposes even more urgency for those countries to put in place plans to confront the problem of antimicrobial resistance. AMR cuts across different sectors—particularly health, agriculture and the environment—and is a global problem requiring a global response. It will therefore be important to implement a One Health approach to ensure that each of these sectors clearly understands and plays an appropriate role. The AMR National Action Plan (NAP) is intended to be a guide for Ugandan stakeholders contributing to efforts to confront and contain the problem. The NAP is aligned with the WHO Global Action Plan’s strategic objectives and proposes actions aimed at focusing government and partner efforts in the following strategic areas: • Raising awareness and understanding of the AMR problem and containment options, • Improving prevention, detection and control of infectious agents, • Optimizing the use of antimicrobial medicines, • Generating knowledge and evidence through surveillance • Research and innovation. The implementation of this plan will be coordinated and overseen by a Uganda National Antimicrobial Resistance Committee that will also monitor the progress of the interventions. While successful implementation relies heavily on the government’s commitment, it is expected that the private sector, civil society organizations and the general public will play a significant role, not only in supporting government efforts but also in implementing some of the proposed interventions. 1.0 Introduction 1.1 Background The problem of antimicrobial resistance in infectious agents has been rising, and there is global concern that in the absence of interventions to reverse these trends, the means to treat infectious diseases will be limited and out-of-reach for many, especially those living in low- and middle income countries (LMICs). Resistance to antimicrobial drugs is a natural phenomenon that has been observed since the first antibiotics were discovered. Resistance has increased in recent years with the growing global population and concordant increasing use of antimicrobials. This has exerted selection pressure on microbes and resulted in increased populations of antimicrobial resistant strains of pathogenic organisms. Unfortunately, the upward trend of AMR has not been matched by the development of new antimicrobial agents to treat the emerging resistant pathogens. The consequences of infection with antimicrobial-resistant organisms can be severe. A recent report commissioned by the UK government estimated that AMR could lead to 10 million deaths a year by 2050 and could result in a USD $100 trillion economic loss if no action is taken. In accordance with the 68th World Health Assembly resolution on the Global Action Plan of 2015, the OIE Strategy on Antimicrobial Resistance and the Prudent Use of Antimicrobials 2016 and the FAO Global Action Plan of 2016, together with similar commitments by the Heads of State at the 2016 UN General Assembly and the Global Health Security Agenda, Uganda has developed this NAP as a guiding framework for implementation of these global commitments at the country level. This National Action Plan for Antimicrobial Resistance operates in conjunction with preexisting programmes currently being undertaken by the Government of Uganda and various elements of policy and regulation. Both the WHO GAP and the FAO GAP include five strategic objectives that are aimed at slowing down the emergence and spread of AMR and prolonging the efficacy of existing antimicrobial agents. 1.2 Antimicrobial Use and Resistance in Uganda The Uganda National Academy of Sciences (UNAS) recently undertook a situational analysis on antimicrobial resistance in Uganda under the auspices of the Global Antibiotic Resistance Partnership (GARP)-Uganda (UNAS, 2015). The report found increasing trends in antimicrobial resistance. According to the MOH Annual Health Sector Performance Report for the financial year 2014/2015, microbial infections, including pneumonia, tuberculosis, and sepsis, accounted for 18.4 percent of hospital-based mortality. Of those, pneumonia was the biggest contributor at 9.7 percent. Additionally, microbial infections were responsible for 37 percent of all hospital admissions. Resistance to the most commonly-used antimicrobials (e.g. penicillins, tetracyclines, cotrimoxazole) was in some cases above 80 percent. Of particular concern was the report of the high prevalence of multi-drug resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase (ESBL)-producers. Multi-drug resistant infections restrict treatment options to fewer and often more expensive drugs. In healthcare settings, the prevalence of MRSA varied from as low as 2 percent to as high as 50 percent, while ESBL prevalence ranged from 10 to 75 percent among isolates analyzed. In addition, increasing resistance ranging from 4 to30 percent was reported among gram negative enterobacteria against carbapenems, a last-line treatment. Although the high prevalence of MRSA, ESBL-producers, and carbapenem resistant bacteria may reflect the emergence and growth of resistance, it may also reflect challenges related to the quality of data being generated. To provide more reliable data, quality assurance is needed for sampling, laboratory assays, and related processes. Since these isolates are often recovered from treatment-failed cases, the spread of such bacteria within healthcare settings and into the community poses serious challenges to public health. The UNAS report also highlighted the impact of the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), malaria and tuberculosis (TB) on human health in Uganda. By 2015, about 1.5 million Ugandans were living with HIV, a prevalence of 7 percent, with 83,000 new infections, 28,000 AIDS-related deaths and about 800,000 people on antiretroviral therapy (ART). With an increasing proportion of all ART-eligible people living with HIV that require antiretroviral treatment, resistant HIV infections are likely to increase. Resistance in TB is equally worrying. In 2010, Uganda was ranked 16th out of the 22 countries with the highest TB burden worldwide. In that year, the prevalence of TB was 193 cases/100,000 persons/year. Treatment for TB is based on the WHO recommendations although there are limited Uganda National Action Plan for Antimicrobial Resistance 2 data on the incidence of drug resistance in Uganda. Some studies show varying resistance levels of resistance to first-line treatments (5-20 percent resistance to isoniazid; 0.5-5 percent to rifampicin; to streptomycin 5-20 percent, to 0.5-10 percent; and MDR-TB, 0.5-10 percent) with most cases co infected with HIV (50-80 percent). Among the subset of MDR isolates, 83 percent were resistant to ethambutol, 50 percent to pyrazinamide, 48 percent to streptomycin, 16 percent to ethionamide, 6 percent to ofloxacin, and 2 percent to kanamycn, with increasing extensively drug-resistant TB reported as well (Source: National Tuberculosis Reference Laboratory). Anti-parasitic resistance is also threatening the control of malaria, a major cause of morbidity and mortality in Uganda. Uganda has abandoned the use of chloroquine, while sulfadoxine pyrimethamine (SP) and the current artemisinin-based treatments are also threatened with resistant strains in other parts of the world. The report noted a similar situation in animal health, with a high burden of bacterial diseases whose treatment is compromised by resistant organisms. A broad range of bacteria show high resistance (over 50 percent in many cases) to commonly used antimicrobials, and there is high resistance in parasitic infections. Nationally aggregated data on the amount of antimicrobials used in either animals or humans are limited; the National Drug Authority (NDA) keeps records of all antimicrobials imported into the country and periodically collates them, but they are not currently widely shared. Misuse of antimicrobials in both humans and animals was well noted with dispensing over the counter, in unlicensed drug stores and in open vans in markets. The transmission of common bacteria such as Enterobacteriaceae and staphylococci between humans, animals and the environment in the same settings has been reported, and when these bacteria are resistant they cause a problem that requires collaborative action between all sectors to address. Despite all the above threats, there is limited awareness among the public, policy makers, prescribers and other professionals about the problem of AMR and its consequences. For the successful mitigation of AMR in Uganda and the world, a series of comprehensive health, political and social strategies will need to be implemented. While there is limited awareness, Uganda has made strides to address many issues related to AMR through guidelines and policies. In relation to infection prevention and control, Uganda maintains National Infection Prevention and Control Guidelines (2013). These guidelines continue to be implemented across the country, with Infection Prevention and Control Committees established in most tertiary healthcare facilities. There is further need to strengthen the committees through facilitation, establishing the required infrastructure, and providing supplies in order to implement committee recommendations in addition to the regular review and monitoring of their performance. Optimal access and use of antimicrobials in the public and private sectors remains a primary responsibility of the National Drug Authority (NDA). Their mandate is enshrined in the National Drug Policy and Act and is complemented by several guidelines including the National Treatment Guidelines and the National Clinical Guidelines, both of which provide guidance on the usage of antimicrobials in treatment of infectious diseases. In an effort to monitor the state of AMR and the effectiveness of these documents in changing antimicrobial access and usage, a Supervision Uganda National Action Plan for Antimicrobial Resistance 3 Performance Assessment and Recognition Strategy (SPARS) is being implemented at a district level to examine the application of these guidelines in human health facilities. Surveillance of antimicrobial resistance is increasing overall within Uganda. As noted within the Joint External Evaluation (JEE) of 2017 for Uganda, 25 human health facilities are regularly performing Antimicrobial Susceptibility Testing (AST). In addition, regular reports are provided to the National Animal Disease Diagnostic and Epidemiology Center (NADDEC) on a monthly basis regarding AMR (JEE 2017). At the same time, a Technical Working Group on AMR Surveillance has also produced a National Antimicrobial Resistance Surveillance Plan which is in the process of being approved and implemented. Furthermore, research and innovation on AMR within Uganda is a growing priority area with opportunities for further improvement. The establishment of the Ministry of Science, Technology, and Innovation (MoSTI) has signaled government interest in further supporting research on areas inclusive of AMR. In addition, there are several strong research institutions such as the National Chemotherapeutics laboratories, higher institutions of learning, as well as research organizations that undertake research on AMR although coordination remains an area for improvement. While there are substantial challenges for Uganda, the opportunity is ripe for a multi-sectoral and multi-disciplinary approach to strengthen Uganda’s animal and human health sectors. This recognition shall require substantial political and technical will to ensure that this plan mobilizes the financial resources necessary to continue the task of building national frameworks and structures that Ugandan stakeholders collectively own. By using this NAP-AMR to guide Uganda’s efforts, the global goal of managing AMR can be sustainably achieved. 1.3 Principles of Approach of the NAP The guiding principles for this NAP conform to the guidance from the WHO/OIE/FAO Action Plans that require integrated and well-coordinated actions globally, regionally, nationally as well as at local government and institutional levels. The principles are as follows: a) Whole-of-society engagement including a One Health approach. Antimicrobial resistance arises from collective actions including animal production, terrestrial livestock and aquaculture, crop agriculture, human and environmental activities. Therefore, it requires a One Health approach (defined as ‘...the collaborative effort of multiple disciplines— working locally, nationally, and globally – to attain optimal health for people, animals and our environment. The implementation of this plan will require concerted efforts from all in accordance with the above principle. b) Prevention first Prevention is the most effective, affordable way to reduce risk for and severity of resistant infections. This entails disease prevention and health promotion in general to reduce the use of Uganda National Action Plan for Antimicrobial Resistance 4 antimicrobial agents—the single most important driver of resistance. Infection prevention and control is, therefore, a critical element of slowing down resistance and preserving antimicrobial agents. c) Access Access to effective antimicrobial agents is essential in slowing down development of resistant infections. This requires not only equitable access but also optimal use of antimicrobial agents, which also requires adequate access to health care facilities and services, health care professionals, veterinarians and preventive technologies as well as to diagnostic tools and information. d) Sustainability Containment of AMR will require long-term sustained efforts that will progressively provide visible impacts. Sustainability of the proposed interventions and activities is therefore critical and will require political commitment and international collaboration to sustain the required resources to support these interventions. e) Incremental targets for implementation The operational plan will clearly define the strategies for implementation and define immediate, medium-term and long-term interventions contained in the NAP. Clear definition of these incremental actions is critical for countries with resource constraints to ensure sustained progress towards the ultimate goal of containing AMR. 1.4 Goals and Strategic objectives 1.4.1 Goal The goal of this NAP is to prevent, slow down, and control the spread of resistant organisms while ensuring the continuous availability of safe, effective, efficacious and quality-assured antimicrobials and their optimal use. This can be achieved only through collaborative actions between partners in human health, agriculture, the food industry, environment, teaching and research institutes, civil societies and associations, the pharmaceutical industry, and global stakeholders to synergize efforts and resources. This action plan was developed in line with the guiding principles and the strategic objectives of relevant global action plans to ensure alignment with global efforts. In all relevant sectors, One Health approaches will be used to implement actions and harness synergies that are needed to successfully combat AMR. The plan proposes focus areas based on the principle that AMR requires a multi-sectoral approach comprising effective communication, coordination, and collaboration between the different sectors, Ministries, Departments and Agencies, both locally and globally. The plan will exploit the respective strengths of the public sector, the private sector, civil society, academia and research partners. The plan also focuses on strengthening national systems by utilizing existing structures within the national system, while avoiding the creation of new parallel institutions for Uganda National Action Plan for Antimicrobial Resistance 5 implementation. The following strategic objectives are the general categories for the strategies and objectives contained in the Strategic Plan: 1. To promote public awareness and understanding on antimicrobial use, resistance prevention, and containment through effective communication and training. 2. To improve infection prevention and containment of resistant microorganisms in human health care, community and animal health through individual and environmental sanitation, hygiene and infection prevention and biosecurity measures. 3. To optimize the use of antimicrobial drugs in human and animal health-care settings through effective stewardship practices. 4. To strengthen the knowledge and evidence base of antimicrobial use and antimicrobial resistance through One Health surveillance to inform policy. 5. To invest in research and innovations to inform policy and implementation science. 2.0 Governance Mechanisms For this plan to be successfully implemented, political, technical and financial commitment shall be sustained both nationally and internationally. Global political commitments, evidenced by the recent UN declaration on AMR and high-level meeting on AMR at the 2016 UNGA, are necessary and this commitment must be reflected at the country level where the actions are implemented. The increasing movements of people, animals, food and other products, as well as medical tourism, have facilitated the transmission of resistant microorganisms. Local action alone will not be sufficient to bring about the desired change. Concerted and coordinated national and international efforts are needed to influence opinion, obtain support, mobilize action, harness expertise and resources available in different sectors, and improve governance. A multi-sectoral committee to oversee and provide overall coordination of the implementation of this AMR National Action Plan (AMR-NAP) will be put in place by the Government of Uganda and shall be known as the National Antimicrobial Resistance Sub-Committee (NAMRSC). In line with the recognition of the importance of a One Health Approach, the National Action Plan shall be coordinated by the National One Health Platform (NOHP). The NOHP is a collaboration between the Ministry of Health, Ministry of Agriculture Animal Health and Fisheries, the Ministry of Water and Environment and the Uganda Wildlife Authority through a Memorandum of Understanding with the objective of coordinating joint efforts to address health issues that affect all the sectors. This committee will be chaired by an independent expert conversant with AMR both nationally and globally. In addition, the committee will have representatives from key line Ministries, Departments and Agencies (MDAs), national and international organizations, academia and civil society organizations. The committee will act as an oversight mechanism with support from international technical agencies in health, agriculture and animal health sector such as the WHO, OIE, and FAO. The NAMRSC will establish Technical Working Committees (TWCs) to support and oversee the implementation of each of the strategic objectives. These TWCs will be composed of technical experts from MDAs, public and private institutions and the civil society with expertise in those areas. Uganda National Action Plan for Antimicrobial Resistance 6 Uganda National Action Plan for Antimicrobial Resistance 7 2.1 National AMR Sub-Committee Composition The NAMRC will include representatives of the following MDAs, organizations and institutions: 1. Ministry of Health (MoH) 2. Ministry of Agriculture Animal Industry, and Fisheries (MAAIF) 3. Ministry of Water and the Environment (MoWE) 4. Uganda Wildlife Authority (UWA) 5. National Drug Authority (NDA) 6. Uganda National Academy of Sciences (UNAS) 7. Public and Private Universities and Post-Secondary Teaching Institutions 8. National Medical Stores (NMS) 9. Research Institutions (Uganda National Health Research Organization, National Agricultural Research Organization, Uganda Virus Research Organization) 10. Professional Societies (Uganda Medical Association, Uganda Veterinary Association Pharmaceutical Society of Uganda, Uganda Allied Health Sciences) 11. Uganda Consumer Society 12. National Water and Sewerage Corporation (NWSC) 13. National Environment Management Authority (NEMA) 14. International agencies (WHO, OIE, FAO etc.) 15. Uganda National Council of Science and Technology (UNCST) 16. Uganda Police Force/Uganda People’s Defense Force 2.2 Terms of Reference for the NAMRSC 1. Oversee the implementation of the NAP 2. Provide overall strategic guidance on the NAP-AMR implementation and monitoring 3. Coordinate mobilization of resources for the implementation of the strategy within the sectors and international collaborations 4. Monitor and provide strategic advice necessary changes to achieve the goals outlined in the NAP- AMR 5. Provide a platform to harmonize and establish consensus on implementation advice between private and public stakeholders 6. Support the mainstreaming of the national antimicrobial resistance action plan activities into related sector activities and international programmes 7. Review the knowledge and experiences generated on a regular basis to assess the performance and effects of interventions and provide updates to all stakeholders 8. Revise and/or update the NAP every five years to provide a strategic policy framework for AMR 9. Strengthen international collaborations to improve knowledge and understanding of AMR 10. Coordinate actions with other regional and international plans, including the African Union, WHO, FAO and OIE 11. Maintain national and international political support for action. 12. Collaborate in the development and consistent use of international standards to support evidence- based interventions and evaluation mechanisms for their effectiveness 13. Ensure sustainable coalitions, management and governance arrangements at all levels to bring together different sectors Uganda National Action Plan for Antimicrobial Resistance 8 Strategic Interventions 3.0 Strategic Objective 1: Promote Public Awareness, Training and Education Previous reports have indicated that most Ugandans are not aware of the growing problem of AMR. This is not limited to the public but also pertains to human and animal health professionals. For this plan to be successfully implemented, it is critical that all stakeholders understand what is at stake. Understanding of antimicrobial use, resistance prevention and containment can be achieved only through raising awareness, effective communication, coordination, collaboration, education and training. Social engagement is needed to ensure a critical change in behavior in the way antimicrobials are used and to take action and promote best practices necessary for slowing the problem of AMR. Tuberculosis, HIV and malaria already have their own national control programs, and these efforts will focus specifically on antibiotic resistance awareness. The following priority strategies are proposed: 3.0.1 Improve Public Awareness Promote public awareness, education and empowerment for antimicrobial use and resistance prevention and containment 1. Develop and disseminate a comprehensive communication strategy for AMR for various stakeholders. 2. Develop core communication materials and tools for use by different stakeholders for different communication channels and/or platforms. 3. Conduct regular public awareness campaigns on antimicrobial use and resistance to change general practices and influence behavioral change. 4. Undertake awareness raising activities in primary, secondary and tertiary schools and other training institutions using specialized materials 5. Collaborate with non-governmental organizations (NGOs), Civil Society Organizations (CSOs), the private sector, international organizations, law enforcement and the media to deliver messages on antimicrobial use. 6. Engage and train the media to report on AMR. 7. Engage groups and engage/develop networks for the dissemination of information on antimicrobial use and resistance. 8. Enhance public awareness through the quick and efficient dissemination of relevant research findings as they are published. The goal of this intervention is to create public awareness and understanding and improve education on antimicrobial use, resistance prevention, and containment in humans, animals and the environment. Uganda National Action Plan for Antimicrobial Resistance 9 3.0.2 Support Education and Training of Human, Animal, Plant and Environmental Health Professionals Promote knowledge and skills in human, animal and environmental professionals on prudent antimicrobial use and resistance prevention. 1. Create AMR courses for undergraduate and postgraduate health professionals (human, animal and environment) on AMR prevention and containment. 2. Incorporate courses on antimicrobial stewardship, infection prevention and control, biosecurity and AMR into the continuous professional development curricula for all health, agriculture, animal and environmental professionals with a system of ensuring accountability. 3. Develop and/or review prescribing guidelines and promote responsible-use practices, including effective dissemination of guidelines. 4. Facilitate continued education and training to promote responsible prescribing practices, dispensing and administering principles for antimicrobials. 3.2 Strategic Objective 2: Improve Infection Prevention and Control In order to prevent the spread of resistant infections, it is important to implement infection prevention programs across human and animal communities and health care settings through individual and environmental sanitation and hygiene, as well as through biosecurity measures throughout the entire value chain from farm to plate. Infection prevention and control (IPC) measures in healthcare facilities as well as immunization and sanitation and hygiene in the community reduce the risk of transmission of infections and minimize the need for and use of antimicrobials. The following interventions are proposed: 3.2.1 Strengthen Infection Prevention and Control Programs in Healthcare Facilities 1. Maintain up-to-date infection prevention guidelines and standards of professional practice and ensure their availability in all healthcare facilities. 2. Institute/strengthen and support minimum standards for infrastructure in healthcare facilities that promote IPC. 3. Institute/strengthen and support proper functioning of IPC committees in all healthcare facilities. 4. Create and promote specific guidelines for limiting the spread of multidrug-resistant organisms. 5. Support availability and proper use of infection prevention materials and supplies. 6. Encourage timely diagnosis and treatment of drug-resistant microorganisms. 7. Promote hand hygiene and other hygienic practices and behaviors that prevent transmission of infectious diseases. 8. Promote campaigns for infection control at healthcare facilities. The goal of this intervention is to reduce the burden of infectious diseases. 9. Institute systems of incentives or rewards that uphold and monitor good IPC practices. 10. Promote safe waste disposal and waste treatment practices in healthcare facilities. 11. Create and strengthen coordinating entities at all levels from local level facilities to the Ministry of Health for IPC. 12. Improve human resource systems, education, and commitment to professionalism. 3.2.2 Promote Infection Prevention and Control Practices in Communities 1. Develop and disseminate tools for information, education and communication/behavior change communication on IPC in communities, including schools and public places. 2. Promote food hygiene practices in all public places and communities. 3. Improve access to safe and clean water and sanitation throughout the country. 4. Promote safe waste disposal and waste treatment practices at all levels. 5. To promote public awareness and understanding on antimicrobial use, resistance prevention, and containment through effective communication and training. 3.2.3 Promote Farm Biosecurity Measures in Agriculture 1. Develop and disseminate farm biosecurity guidelines to different categories of animal farms, abattoirs and aquaculture facilities. 2. Promote hygiene, sanitation and infection prevention practices on farms. 3. Promote food safety campaigns and programs. 4. Promote good IPC practices in the agricultural, livestock and animal production industries. 5. Ensure minimum standards for infrastructure in animal and agricultural facilities that promote IPC. 6. Ensure availability and proper use of infection prevention materials and supplies in agricultural and animal facilities. 7. Promote safe waste disposal and waste treatment practices from agricultural and animal facilities. 3.2.4 Increase and Optimize Use of Vaccines to Prevent Infectious Diseases 1. Strengthen vaccination programs in human and animal health. 2. Improve coverage of vaccination programs across the country for vaccine preventable diseases in humans and livestock. 3. Increase the range of vaccines and their availability across the country. 3.3 Strategic Objective 3: Promote Optimal Access and Use of Antimicrobials The major modifiable driver of AMR is the use of antimicrobial agents. Promotion of prudent use of these agents is therefore critical in prolonging their efficacy and curtailing acceleration of AMR. This will involve ensuring access and appropriate use of safe and effective antimicrobials, both in the human, animal and agricultural sectors. Achieving optimal antimicrobial use will require strengthening technical and regulatory frameworks, ensuring availability of appropriate medicines and changing behavior among prescribers, dispensers and consumers. Antimicrobial Stewardship Programs (ASPs) involve coordinated interventions designed to measure and improve the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug Uganda National Action Plan for Antimicrobial Resistance 10 Uganda National Action Plan for Antimicrobial Resistance 11 regimen, including dose, duration of therapy and route of administration. They seek to achieve optimal clinical outcomes related to antimicrobial use, minimize toxicity and other adverse events, reduce the costs of health care for infections and limit the selection for antimicrobial resistant strains. This strategic objective is cognizant of the existing regulatory and policy framework in Uganda to promote access and use of effective antimicrobial agents and diagnostics. In addition to this Uganda National AMR strategy, their implementation will be anchored in the following regulatory and policy instruments: i) The National Drug Policy and Authority act and its subsequent revisions. The act establishes the NDA with a mandate to ensure the availability, at all times, of essential, efficacious and cost effective drugs and diagnostics for human and animal health in Uganda. This aspiration is further emphasized in the Uganda National Medicine Policy. ii) Regulations that establish each health profession in Uganda and their subsequent revisions or amendments, such as the pharmacy and drugs act, the veterinary surgeon’s act, the medical and dental practitioners act, allied health professionals statute. These laws provide the basis for control of their professional practice, specifically and of relevant to this AMR strategy, the use of antimicrobial agents and diagnostics in their routine practice. iii) The National Medicine Policy 2015 and the national pharmaceutical sector strategic plan 2015-2020, where measures to control antimicrobial resistance are incorporated in the wider appropriate medicine use intervention area. The cross-cutting nature of these objectives is a deliberate attempt to add value to these existing systems, sector specific strategic plans and programs and not to supplant them. As a guiding principle, efforts to facilitate and provide synergy will create efficiency and embed sustainability to the Uganda National AMR strategy 2018-2028. The following interventions are proposed: 3.3.1 Optimize Access to Effective Antimicrobial Medicines and Diagnostics in Human Health 1. Ensuring availability of affordable and accurate diagnostic tools to all health facilities 2. Enhance systems for financing access to diagnostics and antimicrobial medicines. 3. Enhance and strengthen the distribution mechanisms for provision of antimicrobials to human health providers in a timely and efficacious way. 4. Improve the supply chain for antimicrobials by creating a coordinating mechanism to manage the storage, pricing, selection and procurement of appropriate antimicrobials at the national, regional and local levels in order to reduce the costs, wastage and inappropriate selection of antimicrobials. 5. Where funding is available, enhance capacity and support for local producers of antimicrobials. The goal of this intervention is to preserve the effectiveness and efficacy of antimicrobial agents for human and animal health through controlled access, effective antimicrobial stewardship, and appropriate use. 6. Regulate over-the-counter availability and self –medication with antimicrobial medicines. 3.3.2 Promote Optimal Prescribing, Dispensing and Use in Humans 1. Regularly update and ensure availability of prophylactic and treatment guidelines and protocols for infectious diseases in human health. 2. Institute/strengthen and support proper functioning of drug and therapeutics committees in all health care facilities. 3. Support the development and dissemination of antimicrobial stewardship working manuals and procedures. 4. Support implementation of antimicrobial stewardship through training, supervision, and monitoring. 5. Provide up-to-date and unbiased medicine information services to health providers. 6. Strengthen supervision of prescribing and dispensing outlets. 7. Initiate incentives and reward systems for excellence in adherence to best practices and standards. 3.3.3 Promote access to and prudent use of antimicrobials and diagnostics in Agriculture and Veterinary Medicine 1. Develop and disseminate prescription guidelines for improving appropriate use of antimicrobials in agriculture and veterinary medicine. 2. Promote antimicrobial stewardship programs in veterinary practice and educational programs. 3. Restrict broad or generalized use of antimicrobials as growth promoters or as feed additives. 4. Strengthen regulation and oversight for the supply chain and use of antimicrobials in agriculture and veterinary medicine. 5. Establish regular programs for monitoring antimicrobial residues in foods. 3.3.4 Promote Use of Quality, Safe and Efficacious Antimicrobial Agents 1. Strengthen licensing, approval, regulation and oversight over the antimicrobial supply chain (pharmaceutical manufacturers, distributors, importation, wholesalers and retailers). 2. Support capacity for regular quality assessment of antimicrobial agents in the NDA quality laboratories. 3. Support supervision of pharmacies and ensure adherence to Good Pharmacy Practices in all pharmacy outlets. 4. Strengthen regulation of the pharmaceutical companies and adherence to Good Manufacturing Practices 5. Regulate pharmaceutical and antimicrobial waste. 3.4 Strategic Objective 4: Surveillance Evidence-based public policy and practices informed by good data, analytical skills and political support are essential for the successful implementation of public health programs. Surveillance (of antimicrobial resistance and use) data help identify program elements and practices capable of improving outcomes. AMR surveillance is essential to detect and monitor changes in antimicrobial use Uganda National Action Plan for Antimicrobial Resistance 12 Uganda National Action Plan for Antimicrobial Resistance 13 and resistance, provide early warnings and indications of emerging and reemerging problems and monitor the impacts of interventions. It thus helps guide management of infectious diseases and informs policy and updates to treatment guidelines, infection control practices, antimicrobial use and essential medicines lists. The following interventions are proposed: 3.4.1 Support Surveillance of AMR 1. Support the implementation of a national AMR surveillance programme to generate actionable data. 2. Develop Standard Operating Procedures (SOPs) and methodologies for surveillance of AMR in humans, food, agriculture, veterinary medicine, environment and wildlife consistent and harmonized with international standards. 3. Strengthen and support improvement of laboratory infrastructure, human resources, access to laboratory supplies and equipment for microbiological testing and quality data reporting platforms. 4. Support the routine generation and use of microbiological culture and sensitivity tests on prioritized microorganisms and antimicrobials in health facilities and on farms? 5. Support mechanisms for quality assurance systems and supervision to improve availability and reliability of routine microbiology laboratory testing. 6. Analyze, disseminate and share surveillance data and information to facilitate decision making on diagnoses and treatments in clinical public health, veterinary practice, environment and wildlife laboratories and food technologies. 7. Support One Health networks for data sharing at national and regional levels as well as systems for linking microbiology data to clinical and pharmaceutical data to support decisions for AMR prevention and control. 8. Establish an early warning system and monitor trends to determine the risk factors and drivers of resistance, resistance burden and impacts on public and animal health and the economy. 9. Utilize data generated, including all regions of the country and hard-to-reach areas, to evaluate and improve intervention outcomes. 10. Ensure the inclusion of AMR as a priority in the risk register, MDA plans, and any other mechanisms as needed. 3.4.2 Support Surveillance of Antimicrobial Use 1. Design and implement a national antimicrobial use surveillance plan that defines surveillance activities and the roles consistent with international surveillance standards. 2. Develop and implement procedures and methodologies for monitoring antimicrobials imported, used and disposed of in Uganda. 3. Monitor prescribing practices, dispensing practices, client/community use and consumption patterns in health care settings, veterinary health practice, agriculture, aquaculture, traditional The goal of this intervention is to generate the knowledge and evidence needed through surveillance for identifying emerging and re-emerging AMR issues and informing best practices for slowing down AMR and guiding policy using the One Health approach. Uganda National Action Plan for Antimicrobial Resistance 14 herbalists (indigenous technical knowledge groups) and communities. 4. Support collection and sharing of data to evaluate and monitor interventions aimed to improve appropriate use and access to antimicrobials. 3.4.3 Support Surveillance for Antimicrobial Drug Residues in Foods 1. Design and implement a national surveillance plan for monitoring antimicrobial residues in foods and animal feeds. 2. Support the use of standard procedures in accordance with international standards including the WHO/FAO Codex Alimentarius for monitoring antimicrobial residues in foods. 3. Collaborate with the WHO/FAO Codex Alimentarius and other international efforts to generate and share actionable data. 3.4.4 Foster Collaboration and Partnerships 1. Collaborate with the WHO, OIE, FAO and other national, regional and international efforts focused on the development and implementation of harmonized surveillance and capacity to detect and monitor antimicrobial use and resistance in prioritized pathogens. 2. Participate in mechanisms for national, regional and international communication of critical events that may signify new resistance trends with global One Health implications. 3. Use national, regional and international quality assurance standards for generation of quality data. 3.5 Strategic Objective 5: Research and Innovation The increasing prevalence and geographic distribution of AMR threatens to undermine decades of progress in effective prevention and control of infectious diseases. Major challenges include MDRTB, artemisinin resistance in malaria, HIV resistance to HAART and antimicrobial resistance in the most common bacterial agents causing pneumonia, diarrheal disease, neonatal sepsis, enteric fever, sexually transmitted diseases, maternal infections and other syndromic infections. Uganda must invest in research and innovations for tackling AMR including in areas such as the development of new diagnostics, preventives, therapeutic products and innovative ways of minimizing transmission of infectious agents and preventing infection. The following interventions are proposed: 3.5.1 Promote Innovations in the Search for Alternative Treatments and Drug Discovery 1. Facilitate and support the Natural Chemotherapeutics Laboratories to expand their antimicrobial product development. 2. Support establishment of and international collaboration in high-throughput screening of antimicrobial compounds. 3. Support academia and other researchers in product development. The goal of this intervention is to stimulate innovations aimed at finding technologies to slow down the emergence and spread of AMR. Uganda National Action Plan for Antimicrobial Resistance 15 4. Support the development of alternative treatments for infections that do not rely on antimicrobials. 5. Link the indigenous technical knowledge (ITK) groups to the product development system. 3.5.2 Promote Innovations in Diagnostic Technology 1. Support investments and collaborations and strengthen capacity for research, development and testing of innovative diagnostic technologies for detection of resistance in real time. 2. Support evaluation of point-of-care diagnostics for detection of infectious diseases and detection of resistance, including linkage to testing sites and the NDA. 3. Create linkages and support for Ugandan scientists to take leadership roles in international research partnerships targeting AMR. 3.5.3 Collaborate with International Partners in Basic Intervention Research 1. Promote research to identify high-risk and high-burden resistant strains, their resistance mechanisms and their transmission. 2. Promote innovations for new antimicrobial drug development, vaccines, and other innovative therapies. 3. Invest and support collaboration in high-throughput genomics and sequencing technologies that have the potential to enhance product development. 4. Support research on the burden of AMR and its interventions to inform policy for investment in interventions. 5. Establish a research innovation fund to support innovations that slow down AMR. 3.5.4 Enhance Operational and Health Systems Research at the Local Level 1. Support local research on resistance and transmission pathways between the environment, humans, animals and food supply chain. 2. Promote local research on antimicrobial use patterns with the goal of producing more context specific stewardship approaches. 4.0 Implementation Plan 4.1 Introduction This implementation plan presents a detailed, realistic, and costed implementation plan with specific activities and proposed resources required to carry out priority activities to operationalize the strategic plan. Given the complexity of the AMR threat and the response, it is essential that every stakeholder is clear about their contribution to combating AMR in Uganda, both within their own mandate as well as in the context of others. Ownership of the strategy by all stakeholders under the leadership of the Government of Uganda is critical to move forward and yield the desired results. This plan is important in presenting what needs to be done to prevent the emergence and re-emergence of AMR, to contain its spread, and to outline how Uganda fits into regional and global efforts to combat resistance. The Government of Uganda, through the National One Health Platform, will establish the NAMRSC according to the recommended composition and representation outlined within the Strategic Plan. The NAMRSC will be responsible for overseeing the implementation of the strategic plan with the support of technical working groups in each area. The Committee will provide overarching strategic direction and recommendations for action as necessary to all stakeholders engaged in combating AMR. 4.2 Objective The objective of the implementation plan is to provide clarity on particular actions that need to be undertaken in line with each of the strategies outlined above. By providing guidance on the particular actions, suggested costs, and outputs, stakeholders can understand and act to provide support where needed and where their resources allow them to do so. As a result, the Implementation Plan can be both sufficiently flexible to adjust to contextual needs while maintaining a solid foundation that promotes accountability and transparency. 4.3 Structural Framework The structural framework of the Implementation Plan is built on the foundation of evidence and data coming from the grassroots upwards with the NAMRSC providing guidance back to implementing stakeholders. The NAMRSC, with its multi-sectoral and multi-disciplinary composition, can provide comprehensive and thorough advice back to the Government of Uganda and other stakeholders on how to better improve the actions being undertaken to address AMR. The NAMRSC will be able to make comprehensive and thorough feedback through independent Technical Working Committees (TWCs), which will comprise multi-disciplinary local experts, who will gather evidence from local level implementers to be able to provide an impartial, objective, and balanced view of the realities on the ground. This structure allows for collective ownership of both the evidence, advice, and at the same time driving accountability and action in response to failures and success of the NAP-AMR. The TWCs primary role will be to provide the technical knowledge and guidance necessary for action. Their actions are not limited to but may include baseline studies, consolidation and analysis of data, and/or identification of areas requiring improvement. Throughout the lifetime of this plan, the TWCs will continue to refine interventions and implementation strategies as well as M&E Uganda National Action Plan for Antimicrobial Resistance 16 Uganda National Action Plan for Antimicrobial Resistance 17 mechanism aimed at improving the outcomes of each strategic objective. By accumulating and documenting the evidence gathered over the lifetime of the NAP-AMR, the following NAP-AMR can be strengthened based off of the lessons learned and evidence gathered. In order to promote greater accountability and ownership of the NAP-AMR, experts from the Government of Uganda and/or implementers may be called upon to serve on the TWCs in order to provide the evidence for deliberation and evaluation. Since these Government of Uganda stakeholders will be supporting the District Health Teams in the planning and implementation of the plan at the sub-national and peripheral levels, their active participation will allow financial resources and technical expertise to be provided directly. Combining their expertise and participation in the development of technical advice, successful implementation of these proposed interventions will be more directly incorporated into the broader strategy of improving both animal and human health. At the community level, social mobilization through the Community Health Extension Workers (CHEWS) and other relevant animal health entities will be used as a means of promoting local participation and action. Gender specific strategies will be developed to ensure that both men and women are involved in the prevention and control of communicable diseases. At the national level, the Department of National Disease Control (MOH) and the Department of Livestock health and Entomology (MAAIF) in collaboration with other departments will be key focal points in providing data and information to the TWCs as well as key recipients of the NAMRSC’s strategic guidance. The NAMRSC and relevant departments will provide technical supervision and support to District Directors of Health Services and District Veterinary and Environment Offices. Together with the NAMRSC, the technical working groups and the government departments will co-ordinate with the private sector on the establishments of standards and regulations affecting the program, and for monitoring the performance of the plan. The district level, information will be fed into the national data capture system through the national reporting structures. The implementation organizational structure is presented in Fig 1 while the details of the plan are presented in the implementation matrix table. Fig 1. Organization Structure National Antimicrobial Resistance Sub-Committee (NAMRSC) Public Awareness, Training and Education (PATE) TWC Infection Prevention and Control (IPC) TWC Antimicrobial Stewardship Optimal Access and Use (ASO) TWC Surveillance (SURV)TWC Research and Innovation (RI) TWC One Health Platform Uganda National Action Plan for Antimicrobial Resistance 18 4.4 Implementation Plan Matrix The implementation matrix was made basing on the WHO guidance and template for ease of harmonization with the M&E matrix. By using this approach, this table format allows for easier comparison of plans between members of the World Health Assembly. The table outlines activities and sub-activities to be taken under each proposed intervention in the strategic plan and defines the unit of measure, the targeted quantities, the timeline within which the activities are expected to be implemented, the location or place where the stated activities will be undertaken, the lead or responsible entity (in most cases these will be technical MDAs). The table also includes an estimate of the costs for the activity based on the unit and quantities proposed for the activity and propose possible sources of funds. It is anticipated that the TWCs will continuously review the targets and provide a more accurate estimation of the costs based on the baseline surveys and what can be realistically achieved within the timeframe. SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING Strategic Objective 1: Improve Public Awareness, Training and Education Intervention 1: Improve Public Awareness 1.1 Support mechanisms for coordinated communication and public awareness on AMR 1.1.1 Establish a Technical Working Group (TWC) on public awareness, training, and education ( PATE TWC) PATE TWC 20 Year1 National NAMRSC 458 Government /Partners 1.2 Develop and disseminate a comprehensive communication strategy for AMR for various stakeholders 1.2.1 Conduct a needs assessment of communications needs AMR communications needs 1 Year1 Countrywide Communications department of MOH, MAAIF, and MWE 30,000 MOH/MAAI F/ Partners 1.2.2 Disseminate needs assessment to stakeholders Number of Stakeholders reached 80 Year 1 National Communications Department of MoH, MAAIF, and MWE 3000 MoH/MAAIF / Partners 1.2.3 Develop a communications strategy for the AMR NAP Communication Strategy 1 Year1 National/ District level Communications department of MOH and MAAIF 10,486 MOH/MAAI F/ Partners Uganda National Action Plan for Antimicrobial Resistance 19 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 1.2.4 Print and distribute strategy Copies of the strategy 5,000 Year1 National/ District level Communications department of MOH and MAAIF 27,778 MOH/MAAIF/ Partners 1.2.5 Disseminate strategy among stakeholders MOH/MAA IF, CSO, FBO, Dev-partners 100 Sep 2018 National/ District level Communications department of MOH and MAAIF 3,643 MOH/MAAIF/ Partners 1.3 Develop core communication materials and tools for use by different stakeholders for different communication channels and/or platforms. 1.3.1 Develop core communication messages for different stakeholders Communication messages 10 Year 1 National Communications department of MOH and MAAIF, faith based organizations, CSO 10,486 MOH/MAAIF/ Partners 1.3.2 Print and/or distribute materials and tools Copies 5,000 Year 1 National/ District level Communications department of MOH and MAAIF, faith based organizations, CSO 27,778 MOH/MAAIF/ Partners 1.3.3 Disseminate materials and tools among stakeholder s MOH/MAA IF, CSO, FBO, Dev-partners 100 Year 1 National/ District level Communications department of MOH and MAAIF, faith based organizations, CSO 556 MOH/MAAIF/ Partners 1.4 Conduct regular public awareness campaigns on antimicrobial use and resistance to change general practices and influence behavioral Change through annual events. 1.4.1 Conduct ToT for district health educators and veterinary officers District health educators and veterinary officers 242 Year 1 National Communications department of MOH and MAAIF, faith based organizations, CSO 40,525 MOH/MAAIF/ Partners 1.4.2 Conduct district-level communications training sessions for health and veterinary workers on AMR Health and veterinary workers 726 Year 1 Regional Level Communications department of MOH and MAAIF, faith based organizations, CSO 54,210 MOH/MAAIF/ Partners 1.4.3 Organize activities to raise awareness during the World Antibiotic Awareness Week Awar eness activit ies 5 Year 1 National/ District level Communications department of MOH and MAAIF, faith based organizations, CSO 15,000 MOH/MAAIF/ Partners Uganda National Action Plan for Antimicrobial Resistance 20 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 1.4.4 Set up billboards along major travel routes Billboards 50 Year 1 Countrywide Communications department of MOH and MAAIF, faith based organizations, CSO 41,667 Gov’t/Partners/ Private sector 1.4.5 Print and distribute awareness- raising Leaflets/fliers Leaflets and Flyer 25,00 0 Year 1-5 National/ District level Communications department of MOH and MAAIF, faith based organizations, CSO 13,889 MOH/MAAIF/ Partners 1.4.6 Air radio/TV segments with key messages TV/Radio segments/qu arter 14 Year 2-5 National/ Regional/Distric t s Communications department of MOH and MAAIF, faith based organizations, CSO 19,444 MOH/MAAIF/ Partners 1.4.7 Conduct public dramas (at major national events— Independence Day, Labor Day Etc.) Public Drama per year 5 Year 2-5 National/ Regional/Distric t s Communications department of MOH and MAAIF, faith based organizations, CSO 6,944 MOH/MAAIF/ Partners 1.5 Undertake awareness raising activities in primary, secondary and tertiary schools and other training institutions using specialized materials 1.5.1 Identify existing school health programs and determine integration of AMR messages into these. School health programs 5 Year 1 National Communications department of MOH, MOES and MAAIF, faith based organizations, CSO 10,486 MOH/MAAIF/ Partners 1.5.2 Train focal persons at different levels and sectors of the education system AMR focal persons 5,000 Year 2 National Communications department of MOH, MOES and MAAIF, faith based organizations, CSO 305,625 MOH/MAAIF/ MOES/Partners 1.5.3 Disseminate materials and tools to focal persons School AMR focal persons 5,000 Year 2 National/ District level Communications department of MOH, MOES and MAAIF, faith based organizations, CSO 27,778 MOH/MAAIF/ Partners 1.5.4 Train relevant education partners Education partners 1,000 Year 2 National Communications department of MOH, MOES and MAAIF, 20,071 MOH/MAAIF/ Partners Uganda National Action Plan for Antimicrobial Resistance 21 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING faith based organizations, CSO 1.6 Collaborate with non-governmental organizations (NGOs), Civil Society Organizations (CSOs), Faith Based Organizations (FBOs) the Private sector, international organizations, law enforcement and the media to deliver messages on antimicrobial use. 1.6.1 Disseminate training materials and tools to partners Partners 1,000 Year 2 National/ Regional/Distric t s Communications department of MOH and MAAIF 5,556 MOH/MAAIF/ Local Government/ Partners 1.7 Engage and train the media to report on AMR. 1.7.1 Train media on AMR reporting Journalist/ communication experts 200 Year 2 National Communications department of MOH and MAAIF 3,958 MOH/MAAIF/ Local Government /Partners 1.7.2 Distribute communication materials and tools to the media Package of materials 200 Year 2 National/ Regional/Distric t s Communications department of MOH and MAAIF 1,111 MOH/MAAIF/ Local Government/ Partners 1.8 Engage groups and develop networks for the dissemination of information on antimicrobial use and resistance. 1.8.1 Conduct a survey to identify pre-existing networks to assist with dissemination of materials and tools to key Survey Report with lists of gaps 1 Year 1 National Communications department of MOH and MAAIF 5,000 MOH/MAAIF/ Partners 1.8.2 Design messages for social media networks for AMR awareness Messages 10 Year 2 National Communications department of MOH and MAAIF 5,000 MOH/MAAIF/ Partners 1.8.3 Include AMR data in weekly epidemiological reports for MoH/MAAIF Epidemiologic al reports 104 Year 2-5 National Communications department of MOH and MAAIF 5,000 MOH/MAAIF/ Partners 1.9 Enhance public awareness through quick and efficient dissemination of relevant research findings as they are published. 1.9.1 Identify stakeholders (national and global) conducting research on AMR Researchers unlimited Year 1 National and internationa l PATE TWC/ Universities Uganda National Action Plan for Antimicrobial Resistance 22 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 1.9.2 Periodically review research findings and translate them into popular versions Popular versions of research reports unlimited Year 2-5 National PATE TWC/Universities 5,000 1.9.3 Share latest research with relevant policymakers Policy makers 100 Year 2-5 National PATE TWC/Universities 2,292 MOH/MAAIF/ Partners Objective 2: Support Education and Training of Human, Animal and Environmental Health Professionals 2.1 Create AMR courses for under graduate and postgraduate health professionals (human, animal and environment) on AMR prevention and Containment. 2.1.1 Conduct a needs assessment of AMR related gaps in the professional education system at different levels Needs assessment Report 1 Year 1 Countrywide Universities, health and veterinary professionals councils 5,000 Professional councils/boards 2.1.2 Disseminate the needs assessment findings to relevant educational and curriculum-approval bodies Educational and curriculum review bodies 100 Year 1 National Universities, health and veterinary professionals councils 556 Professional councils/boards 2.1.3 Review and update curriculums based on gaps identified in needs assessment New or updated curriculum 100 Year 2 National Universities, health and veterinary institutions and professionals councils 16,871 Universities, health and veterinary professionals councils 2.1.4 Train professional educators at different levels on AMR issues Health professional teacher/educators/lect urers 200 Year 2 National Universities, health and veterinary institutions and professionals councils 33,529 Universities, health and veterinary professionals councils 2.1.5 Train health/veterinary professionals on AMR Health/veteri nary professional 2,000 Year 3 National Universities, health and veterinary institutions and professionals councils 333,357 Universities, health and veterinary professionals councils 2.1.6 Conduct a consultative workshop identifying factors Health, veterinary, and traditional 250 Year 4 National Universities and traditional health 10,000 Universities, health and veterinary Uganda National Action Plan for Antimicrobial Resistance 23 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING Contributing to usage of alternative medicines consortiums or organizations Health professionals professional councils Strategic Objective 2: Infection Prevention and Control Objective 3: Strengthen Infection Prevention and Control Programs in Healthcare Facilities Strengthen coordinated mechanisms for infection prevention and control 1.1.1 Establish a Technical Working Group (TWC) on Infection Prevention and Control (IPC TWC) with TORs IPC TWC 20 Year 1 National NAMRSC 458 Government/ Partners 3.1 Maintain and disseminate up-to -date National infection prevention and control manuals including guidelines and standards of professional practice 3.1.1 Update the IPC policy IPC Policy 1 Year 1 National NAMRSC 10,486 Government/ Partners 3.1.2 Revise IPC manual for infection prevention control IPC guidelines 1 Year 1 National Departments of Clinical services (MOH), Quality assurance (MOH), Nursing Associations and Licensing Councils 10,486 Government/ Partners 3.1.3 Print and distribute IPC Guidelines Copies 4,000 Year 2 National Departments of Clinical services (MOH), Quality assurance (MOH) 22,222 Government/ Partners 3.1.4 Disseminate IPC and standards of professional practice guidelines at all healthcare facilities Health care workers 5,000 Year 2 Facility Level Departments of Clinical services (MOH), Quality assurance (MOH), MoLG 27,778 Government/ Partners 3.2 Institute/strengthen and support minimum standards for infrastructure in healthcare facilities that promote IPC. 3.2.1 Under take an assessment of the current status and needs of IPC in health facilities Health care facilities 3,584 Year 1 Health facility level Departments of Clinical services (MOH), planning (MOH), QA (MoH), MoLG 20,000 Government/ Partners Uganda National Action Plan for Antimicrobial Resistance 24 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 3.2.2 Update guidelines for health care facility infrastructure that support minimum IPC standards IPC compliant Infrastruc ture Guideline s 1 Year 1 National Departments of Clinical services (MOH), planning (MOH) 10,486 Government/ Partners 3.2.3 Disseminate the guidelines Stakeholders 500 Year 1 National Departments of Clinical services (MOH), planning (MOH), MoLG 2,778 Government/ Partners 3.2.4 Under take support supervision to support implementation of IPC at health facility level Hea lth faci litie s 3,584 Year 2-5 health facility level Departments of Clinical services (MOH), planning (MOH) 961,929 Government/ Partners 3.3 Institute/strengthen and support proper functioning of IPC committees in all healthcare facilities. 3.3.1 Setup functional IPC committees with TORs committees 3,584 Year 2-5 Facility Departments of Clinical services (MOH), Quality assurance (MOH) and Livestock Health and Entomology (MAAIF) 10,000 Government/ Partners 3.3.2 Train IPC committee members on their functions IPC members 3,584 Year 2-5 National Directorate of Clinical services (MOH), QA (MoH) 69,758 MOH/Partners 3.3.3 Regularly undertake performance monitoring and mentoring of the IPC committee members Mentoring sessions for IPCs 3,584 Year 2-5 Facility Directorate of Clinical services (MOH), QA (MoH) 641,193 MOH/Partners 3.4 Create and promote specific guidelines for limiting the spread of multidrug-resistant (MDR) organisms. 3.4.1 Update guidelines for prevention and control of MDR organisms MOP 1 Year 1 National Departments of Clinical services (MOH), Quality assurance (MOH) 10,486 Government/ Partners Uganda National Action Plan for Antimicrobial Resistance 25 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 3.4.2 Print and distribute the MDR control Guidelines Copies 4,000 Year 2 National Departments of Clinical services 22,222 Government/ Partners (MOH), Quality assurance (MOH) 3.4.3 Train health care workers at facility level on the control of MDR Health care workers 2,000 Year 2 Facility Level Departments of Clinical services (MOH), Quality assurance (MOH) 38,958 Government/ Partners 3.5 Support availability and proper use of infection prevention materials and supplies. 3.5.1 Update lists of IPC products, including equipment and supplies List of IPC materials and supplies 20 Year 1 National IPC TWC 458 Government/ Partners 3.5.2 Procure and distribute in a timely manner IPC supplies and equipment at health care facilities Materials Assorted Year 2-5 National Departments of Clinical services (MOH), Quality Assurance (MOH) 4,000,00 0 Government/ Partners 3.6 Encourage timely diagnosis and treatment of drug-resistant microorganisms. 3.6.1 Procure and timely distribute tools for rapid diagnosis of drug resistant organisms Materials assorted Year 1-5 Facility Level Planning (MOH), NMS, CPHL 2,000,00 0 Government/ Partners 3.6.2 Train health care workers at facility level on the treatment and management of patients with MDR infections Health care workers 2,000 Year 1-5 Facility Level Departments of Clinical services (MOH), Quality assurance (MOH), MoES, MAAIF 38,958 Government/ Partners 3.6.3 Procure and timely distribute drugs for treatment of MDR Drugs assorted Year 1-5 Facility Level Departments of Clinical services (MOH) and Livestock Health and Entomology (MAAIF), NMS 3,000,00 0 Government/ Partners Uganda National Action Plan for Antimicrobial Resistance 26 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 3.7 Promote hand hygiene and other hygienic practices and behaviors that prevent transmission of infectious diseases. 3.7.1 Train health care workers at facility level on hand hygiene and other hygienic practices and behaviors that prevent transmission of infectious diseases Health care workers 7,168 Year 1-5 Facility Level Departments of Clinical services (MOH), Quality assurance (MOH) 139,447 Government/ Partners 3.7.2 Under take health talks to patients about IPC behaviors to protect themselves from acquisition and transmission of infectious diseases Health talks 10,00 0 Year 1-5 Facility Level Department of health promotion (MOH), health facility in charges, QA (MoH) 13,889 Government/ Partners 3.7.3 Train personnel on correct use of Personal Protective Equipment and materials for standard and transmission based precautions Health care workers 14,33 6 Year 2-5 Facility Level Departments of Clinical services (MOH), CPHL 79,644 Government/ Partners 3.8 Promote campaigns for IPC at healthcare facilities 3.8.1 Train health care workers on IPC health care workers 14,33 6 Year 2-5 Facility Level Departments of Clinical services (MOH), QA (MoH) 79,644 Government/ Partners 3.8.2 Under take support supervision visits to reinforce infection control practices health care facilities 3,854 Year 2-5 Facility Level Departments of Clinical services (MOH), QA (MoH) Government/ Partners 3.9 Institute systems of incentives or rewards that uphold and monitor good IPC practices. 3.9.1 Develop guidelines for awards Guidelines 1 Year 1 national Departments of Quality Assurance (MOH) 10,486 Government/ Partners 3.9.2 Provide incentives for operationalizing the awards Set of incentives assorted Year 2-5 national Department of Quality assurance (MOH) and HR (MOH) 50,000 Government/ Partners 3.10 Promote safe waste disposal and waste treatment practices in healthcare facilities. 3.10.1 Train health care workers on safe waste disposal and waste treatment practices for healthcare Workers. health care workers 14,33 6 Year 2-5 Facility Level Departments of Clinical services (MOH), QA (MoH) 79,644 MOH/Partners Uganda National Action Plan for Antimicrobial Resistance 27 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 3.11 Create and strengthen communication platform for IPC related committees at all levels from local level facilities to the Ministry of Health 3.11.1 Establish a communication platform among IPC related committees e.g. medicines & therapeutics committee, AMR stewardship Coordination committee 3,854 Year 2-5 Facility level Facility management, MoH 107,056 Government/ Partners committee, infection prevention Control committee, Laboratory Committee and Clinical Committee 3.11.2 Develop guidelines for the functioning of the communication platform Guidelines 20 Year 2-5 Facility level IPC TWC, Local IPC Committees 458 Government/ Partners 3.12 Improve health worker knowledge and skills on IPC 3.12.1 Con duct survey on training needs for health professionals regarding IPC Training needs report 1 Year 1 national department of Quality assurance (MOH) and HR (MOH) 20,000 Government/ Partners 3.12.2 Con duct regular continued profession development (CPD) training regarding IPC health care workers 2,000 Year 2-5 Facility level Healthcare facilities 55,556 Government/ Partners 3.12.3 Integrate IPC content in the curriculum/ education for all health training institutions updated curriculum 100 Year 2-5 national clinical services (MOH) and Health training institutions 16,871 Government/ Partners Objective 4: Promote Infection Prevention and Control Practices in Communities 4.1 Develop and disseminate tools for information, education and communication/behavior change communication on IPC in communities, Including schools and public places. 4.1.1 Under take a survey on the knowledge/ attitudes/ perceptions and practices in the com munity survey 1 Year 1 national Department community health (MOH) 20,000 Government/ Partners Uganda National Action Plan for Antimicrobial Resistance 29 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 4.1.2 Develop tools for information, education and communication /behavior change communication on IPC in communities, including schools and public places. behavioral change Communication strategy Tools 40 Year 2 national Department of health promotion (MOH) 20,257 Government/ Partners 4.1.3 Dissemination of information on infection control in the community public awareness campaigns 500 Year 2-5 communit y level Department of health promotion (MOH) 277,778 Government/ Partners 4.2 Promote food hygiene practice s in all public places and communities. 4.2.3 Develop minimum standards for food hygiene, handling and preparation Guidelines 1 Year 1 National department of community health (MOH) 10,486 Government/ Partners 4.2.1 Train food vendors and supervisors for proper food handling practices Food vendors and supervisors 5,000 Year 2-5 Countrywide Local Government and MoLG 27,778 Government/ Partners 4.2.2 Enforce regular checkups of food handlers for infectious diseases of public health importance related to food Food handlers examined 5,000 Year 2-5 communit y level Local Government, MoLG, community health (MOH) 72,806 Government/ Partners 4.2.4 Undertake food inspection of foods and food products for public consumption Facilities inspected 5,000 Year 2-5 districts Local Government and MoLG 138,889 Government/ Partners 4.3 Improve access to safe and clean water throughout the country. 4.3.1 Carry out a baseline to obtain information on safe water usage in relation infection control and prevention is concerned survey 1 Year 1-5 national community health (MOH)/ UNBS /QAD (MOH), MoWE, NEMA 20,000 Government/ Partners Uganda National Action Plan for Antimicrobial Resistance 30 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 4.3.2 Increase safe water coverage in communities safe water sources each community Year 1-5 Countrywide MoWE 30,000,0 00 Government/ Partners 4.3.3 Review standards and guidelines for assessing water safety in the context of AMR Guidelines 1 Year 1-5 communi ty level department of quality assurance and inspection (MOH), community health (MOH)/ UNBS, MoWE, NEMA 10,486 Government/ Partners 4.3.4 Conduct periodic water safety analyses at consumption points Water Consumption points 2,000 Year 1-5 communi ty level community health (MOH)/ local government/ UNBS 114,472 Government/ Partners 4.4 Promote safe waste disposal an d waste treatment practices. 4.4.1 Revie w and update IEC materials on safe waste disposal Set of IEC materials 1 Year 1-5 National community health (MOH), health promotion (MOH) 10,486 Government/ Partners 4.4.2 Procure and make available waste disposal materials for infectious wastes wherever generated Materials assorted Year 1-5 Facility level Department of community health (MOH), QAD (MOH)/ NEMA, Planning (MoH) 2,000,00 0 Government/ Partners 4.4.3 Conduct training of trainers (TOT) for waste hand ers ToT trained 121 Year 1-5 National Department of community health (MOH), QAD (MOH)/ NEMA 59,831 Government/ Partners 4.4.3 Conduct mentorships sessions for waste handlers Health facilities 1,740 Year 1-5 Facility level Department of community health (MOH), QAD (MOH)/ NEMA 48,333 Government/ Partners 4.4.4 Set up health care waste treatment facilities at each health facility Health care facility 3,854 Year 1-5 regional Department of community health (MOH), QAD (MOH)/ NEMA 19,270,0 00 Government/ Partners 4.5 Reduce transmission of AMR at the household level. 4.5.1 Sensitization of the public on AMR Public awareness campaigns 50 Year 1-5 national community health (MOH), health promotion (MOH), local educational institutions 69,444 Government/ Partners Uganda National Action Plan for Antimicrobial Resistance 31 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 4.5.3 Contact tracing and management of patients with drug resistant microorganisms Patients with MDR 1,000 Year 1-5 household level NDC (MOH) and local government 138,889 Government/ Partners 4.5.4 Support adherence to antibiotic treatment at household level Individuals 1,000 Year 1-5 household level NDC (MOH) and local government 138,889 Government/ Partners Objective 5: Promote Farm Biosecurity Measures in Agriculture 5.1 Develop and disseminate farm biosecurity guidelines to different categories of animal farms, slaughter facilities, abattoirs and aquaculture Facilities. 5.1.1 Revie w and update biosecurity guidelines f or different categories of animal farms, slaughter facilities, abattoirs and aquaculture facilities. Guidelines 1 Year 1 National Department of Livestock Health and Entomology, MAAIF Fishery Department 10,486 MAAIF/partners 5.1.2 Print and distribute biosecurity guidelines to veterinarians and other stakeholder s Copies of the guidelines 5,000 Year 1 National Department of Livestock Health and Entomology 27,778 MAAIF/partners 5.1.3 Sensitize stakeholders on biosecurity guidelines Stakeholders 5,000 Year 1 National Department of Livestock Health and Entomology 97,292 MAAIF/partners 5.1.4 Train district veterinary officers on biosecurity guidelines DVOs 121 Year 1 National Department of Livestock Health and Entomology 23,827 MAAIF/partners 5.1.5 Promote biosecurity practices on farms and animal facilities (e.g. abattoirs) Radio/TV segments 50 Year 2-5 National Department of Livestock Health and Entomology 69,444 MAAIF/partners 5.2 Promote hygiene, sanitation and infection prevention practices on farms. 5.2.1 Train farmers in on-farm sanitation and good hygiene practices Farmers 5,000 Year 2 National Department of Livestock Health and Entomology 97,292 MAAIF/partners 5.2.2 Under take regular checks on sanitation and hygiene on animal facilities and farms Animal facilities and farms 500 Year 2-5 Farm level District veterinary office, District Veterinary Officers 134,222 MAAIF/partners 5.2.3 Regular checks on animal feeds for contamination feed checks 2,000 Year 2-5 Farm level District veterinary office 114,472 MAAIF/partners 5.3 Promote food safety campaign s and programmes. Uganda National Action Plan for Antimicrobial Resistance 32 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 5.3.1 Sensitize farmers and the general public on production of safe animals for human consumption Public awareness campaigns 100 Year 2-5 National Department of Livestock Health and Entomology 55,556 MAAIF/partners 5.4 Promote good biosecurity practices in the agricultural, livestock and animal production industries. 5.4.1 Train farmers in standard animal husbandry practices that reduce the need to use antimicrobial agents Farmers 5,000 Year 2-5 districts District Veterinary office, QA (MAAIF) 97,292 MAAIF/partners 5.4.2 Provide regular advisory extension services to farmers Follow up visits 2,000 MoLG, MAAIF 55,611 MAAIF/partners 5.5 Ensure minimum standards for infrastructure in animal and agricultural facilities that promote biosecurity 5.5.1 Develop/update standards for farm infrastructure that promote infection prevention in animal handling facilities and farms Standards 1 Year 1 National Department of Livestock Health and Entomology, Planning (MAAIF) 10,486 MAAIF/partners 5.5.2 Print and distribute animal facility and farm infrastructure standards Copies of the guidelines 2,000 Year 1 National Department of Livestock Health and Entomology, MoES 11,111 MAAIF/partners 5.5.3 Train district veterinary officers on facility and farm infrastructure standards DVOs 121 Year 2 National Department of Livestock Health and Entomology 20,369 MAAIF/partners 5.5.4 Conduct regular advisory/support supervision /inspection of abattoirs/slaughter houses and aquaculture facilities Facilities 2,000 Year 2-5 National Department of Farm infrastructure and Department of Vet Public Health, MoLG, KCCA 55,611 MAAIF/partners Uganda National Action Plan for Antimicrobial Resistance 33 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 5.5.5 Sensitize stakeholders on the need for ante-mortem and post-mortem inspection meetings 1,000 Year 2-5 National/region al Department of Farm infrastructure and Department of Vet Public Health, MoLG 19,514 MAAIF/partners 5.6 Ensure availability and proper use of infection prevention materials and supplies in agricultural and animal facilities 5.6.1 Develop/disseminate guidelines for infection prevention materials for animal facilities an d farms Guidelines 1 Year 1 National Department of Livestock Health and Entomology, MoLG 10,486 MAAIF/partners 5.6.2 Sensitize farmers and animal facility operators on the guidelines Animal facility operators and farmers 1,000 Year 2-5 National Department of Livestock Health and Entomology 19,514 MAAIF/partners 5.7 Promote safe waste disposal and waste treatment practices from agricultural and animal facilities. 5.7.1 Conduct a baseline assessment of the current status of animal facility and farm waste disposal Baseline report 1 Year 2-5 National Department of Livestock Health and Entomology, MAAIF 20,000 MAAIF/partners 5.7.2 Develop/disseminate guidelines for safe waste disposal for animal facilities and farms Guidelines 1 Year 2-5 National Department of Livestock Health and Entomology, MoLG 10,486 MAAIF/partners 5.7.3 Sensitize farmers and animal facility operators on safe waste disposal and treatment practices Farmers and animal facility operators 1,000 Year 2-5 National Department of Livestock Health and Entomology 19,514 MAAIF/partners 5.7.4 Sensitize stakeholders and farmers on animal facility and farm waste recycling Farmers and animal facility operators 1,000 Year 2-5 National Department of Livestock Health and Entomology, MoLG 19,514 MAAIF/partners 5.7.5 Procure incinerators for abattoirs and sick animals Incinerators 20 Year 2-5 National Department of Livestock Health and Entomology, MAAIF 400,000 MAAIF/partners Uganda National Action Plan for Antimicrobial Resistance 34 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING Objective 6: Increase and Optimize Use of Vaccines to Prevent Infectious Diseases 6.1 Strengthen vaccination programs in human and animal health. 6.1.1 Procure vaccine and supply vaccines for humans an d animals Vaccines 5,000, 000 Year 2-5 National Department of national Disease Control (NDC) and livestock health and entomology (MAAIF), MoH 25,000,0 00 Government/ Partners 6.1.2 Develop/review regulations for vaccination s for animals with vaccination schedules Regulations 1 Year 1 National Department of national Disease Control (NDC) and livestock health and entomology (MAAIF) 10,486 Government/ Partners 6.1.3 Conduct campaigns to provide information , awareness and schedules about vaccination s in Uganda public awareness campaign 50 Year 2-5 National Department of national Disease Control (NDC) and livestock health and entomology (MAAI F), Community Health (MoH) 69,444 Government/ Partners 6.1.4 Under take vaccination of individuals against a broader range of diseases vaccinated individuals 15,00 0,000 Year 2-5 National Department of national Disease Control (NDC) 75,000,0 00 Government/ Partners 6.1.5 Under take vaccination of animals against a broader range of diseases vaccinated animals 5,000, 000 Year 2-5 National Department of national Disease Control (NDC) and livestock health and entomology (MAAIF) 25,000,0 00 Government/ Partners 6.2 Improve coverage of vaccination programs across the country for vaccine preventable diseases in humans and livestock. 6.2.1 Conduct a baseline assessment for animal and human vaccines program and services coverage baseline study 1 Year 1 National Department of national Disease Control (NDC) and livestock health and entomology (MAAIF), NDA, UNEPI 20,000 Government/ Partners Uganda National Action Plan for Antimicrobial Resistance 35 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 6.2.2 Develop a vaccine stock management tool to monitor vaccine stocks to prevent stock outs Tool 1 Year 1 National Department of national Disease Control (NDC) and 10,486 Government/ Partners livestock health and entomology (MAAIF) 6.2.3 Review vaccine schedules to optimize uptake (combination vaccines to increase uptake and reduce cost) Revised vaccination schedule 1 Year 1 National Department of national Disease Control (NDC) and livestock health and entomology (MAAI F), UNEPI 10,486 Government/ Partners 6.2.5 Support routine maintenance of a functional cold chain Cold chain 4 per facility per year Year 2-5 health facility level Department of national Disease Control (NDC) and livestock health and entomology (MAAIF) 50,000 Government/ Partners 6.3 Increase the range of vaccines and their availability across the country. 6.3.1 Revie w and recommend introduction of new vaccines for both human and animals Updated vaccine list 1 Year 1 National Department of national Disease Control (NDC) and livestock health and entomology (MAAIF) 10,486 Government/ Partners 6.3.2 Under take research to measure the impact/best methods of vaccinating animals study 1 Year 2 National Department of national Disease Control (NDC) and livestock health and entomology (MAAIF) 50,000 Government/ Partners Strategic Objective 3: Optimal Access and Use of Antimicrobials Objective 7: Promote Optimal Prescribing and Use 7.1 Create mechanisms for coordination and support of Antimicrobial Stewardship and ensuring Optimal Use Uganda National Action Plan for Antimicrobial Resistance 36 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 7.1.1 Establish a Technical Working Group (TWC) Antimicrobial Stewardship and Optimal Us e (ASO TWC) ASO TWC 20 Year 1 National NAMRSC 458 MOH/MAAIF/ Partners 7.2 Regularly update and ensure availability of prophylactic, prescribing/treatment guidelines and protocols for infectious diseases in human health 7.2.1 Review and update prescribing guidelines for formulaic and essential medicines Prescribing guideline 1 Every 2 years National Departments of Clinical services (MOH) and NDA 40,000 MOH/MAAIF/ Partners 7.2.2 Disseminate prescribing guidelines in both print and online to all health facilities Copies of the guidelines 5,000 Year 1-5 National/ District level Departments of Clinical services (MOH) and NDA 3,778 MOH/MAAIF/ Partners 7.2.3 Training prescribers and dispensers on the guidelines Prescribers and dispensers 3,000 Year 2-5 National/ Regional Departments of Clinical services (MOH) and NDA 70,000 MOH/MAAIF/ Partners 7.2.4 Sensitize regulatory agencies and policymakers to improve Regulatory bodies 2 Year 1 national Departments of Clinical services (MOH) and Livestock Health and Entomology (MAAIF) 5,486 MOH/MAAIF/ Partners 7.3 Facilitate continued education and training to promote responsible prescribing practices, dispensing and administration principles for antimicrobials. 7.3.1 Conduct a needs assessment to inform AMR-related CME trainings for relevant professions Report with lists recommendation for AMR related CMEs 1 Year 1 National Professional associations and councils and boards 5,000 Universities, health and veterinary professionals councils 7.3.2 Organize ToT sessions for different professionals ToT sessions 20 Year 1 National Departments of Clinical services (MOH) and Livestock Health and Entomology (MAAIF) 50,000 MOH/MAAIF/ Partners adherence to prescribing guidelines Uganda National Action Plan for Antimicrobial Resistance 37 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 7.3.3 Conduct AMR-specific CMEs through the professional associations CMEs/CPDs 25 Year 1-5 National Departments of Clinical services (MOH) and Livestock Health and Entomology (MAAIF) 12,929 MOH/MAAIF/ Partners 7.4 Incorporate courses on antimicrobial stewardship and AMR into the continuous professional development curricula for all health, agriculture, animal and environmental professionals with a system of ensuring accountability. 7.4.1 Share findings of needs assessment to stakeholder s Stakeholders 500 Year 1 National Professional associations and regulatory councils and boards 5,000 Universities, health and veterinary professionals councils 7.4.2 Develop training manuals for the health professional CME on AMR Training manuals 1 Year 2 National Professional Councils, Universities 10,486 Universities, health and veterinary professionals councils 7.4.3 Sensitise relevant professional boards and council s on the training needs of their professions Professional boards and councils 4 Year 2 National Professional associations and regulatory councils and boards 15, 000 Universities, health and veterinary professionals councils 7.5 Institute/strengthen and support proper functioning of Medicines and Therapeutics committees in all health care facilities 7.5.1 Activate Medicines and Therapeutic Committees (MTCs) at national and health facility levels with clear TORs MTCs 348 Year 1-5 Regional Departments of Clinical services (MOH) and NDA 70,000 MOH/MAAIF/ Partners 7.5.2 Train MTCs in their functions MTC members 1,740 Year 2-5 National Directorate of Clinical services (MOH) 20,000 MOH/Partners 7.5.3 Regularly undertake performance monitoring and mentoring of the therapeutic committees Mentoring sessions for MTCs 348 Year 1-5 Facility Directorate of Clinical services (MOH) 50,000 MOH/Partners 7.6 Support the development and dissemination of antimicrobial stewardship working manuals and procedures. Uganda National Action Plan for Antimicrobial Resistance 35 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 7.6.1 Develop the antimicrobial stewardship working manuals and procedures MOP 1 Year 1 National Departments of Clinical services (MOH) and Livestock Health and Entomology (MAAIF) 10,486 MOH/Partners 7.6.2 Print and distribute antimicrobial stewardship working manuals Copies 5,000 Year 1 National Departments of Clinical services (MOH) and Livestock Health and Entomology (MAAIF) 2,857 MOH/Partners 7.6.3 Train healthcare workers on antimicrobial stewardships for both public and private workers Healthcare workers on antimicrobial stewardships 1,000 Year 2-5 National/ Regional and healthcare facilities (including clinics, pharmacies Departments of Clinical services (MOH) and Livestock Health and Entomology (MAAIF) 200,000 and drug shops) 7.7 Provide up-to-date and unbiased medicine information services to human and animal health providers. 7.7.1 Share susceptibility and antimicrobial use data regularly to stakeholders AST and Antimicrobial usage data shared Monthly (12) Year 1-5 National and facility based Departments of Clinical services (MOH), NDA and Livestock Health and Entomology (MAAIF) 20,000 MOH/Partners 7.7.2 Provide and share other update scientific and popular literature to improve prescribing practices Information shared Monthly (12) Year 1-5 National and facility based Departments of Clinical services (MOH), NDA and Livestock Health and Entomology (MAAIF) 20,000 MOH/Partners 7.8 Strengthen supervision of prescribing and dispensing outlets for human and animal antimicrobials Uganda National Action Plan for Antimicrobial Resistance 39 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 7.8.1 Develop a tool for more efficient supervision and monitoring of healthcare facilities and pharmacies/drug stores Supervision tool Year 1 National Departments of Clinical services (MOH), NDA and Livestock Health and Entomology (MAAIF) 10,486 MOH/MAAIF/ Partners 7.8.2 Train professional councils and licensing organs on supervision and monitoring dispensing outlets Professional councils and licensing organs members trained 20 Year 1 National Departments of Clinical services (MOH), NDA and Livestock Health and Entomology (MAAIF), Professional Councils 20,000 MOH/MAAIF/ Partners 7.8.3 Conduct CMEs to improve prescription and good pharmacy practice for health and veterinary prescribers Health and veterinary prescribers 1,000 Year 2 Departments of Clinical services (MOH), NDA and Livestock Health and Entomology (MAAIF), Professional Councils 200,000 MOH/MAAIF/ Partners 7.8.4 Review and update regulations on prescription of antimicrobials Updated regulations 1 Year 1 National Departments of Clinical services (MOH), NDA and Livestock Health and Entomology (MAAIF), Professional Councils 10,486 MOH/MAAIF/ Partners 7.8.6 Develop digital/manual tools for tracking and tracing prescriptions at dispensing facilities Prescription tracking tool 2 Year 1 National Departments of Clinical services (MOH), NDA and Livestock Health and Entomology (MAAIF), Professional Councils 2,000,00 0 MOH/MAAIF/ Partners 7.8.7 Disseminate the tools for tracking and tracing prescriptions Shared tools 2 Year 1 Regionals Departments of Clinical services (MOH), NDA and Livestock Health and Entomology (MAAIF), Professional Councils 140,000 MOH/MAAIF/ Partners 7.9 Initiate incentives and reward systems for excellence in adherence to best practices and standards Uganda National Action Plan for Antimicrobial Resistance 40 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 7.9.1 Develop tools for the Licensing bodies and Professional Councils to track performance of adherence to best practices and standards Performance monitoring tool 1 Year 1 National Professional Councils 10,486 MOH/MAAIF/ Partners 7.9.2 Develop guidelines for award of incentives for excellence in prescription practices Guideline Year 1 National Professional Councils 10,486 MOH/MAAIF/ Partners/MPS 7.10 Institute/strengthen stewardship committees 7.10.1 Develop procedures and protocols for antimicrobial prescriptions at both public and private facilities MOP 1 Year 1 National Departments of Clinical services (MOH), UNHLS 50,000 local protocols developed 7.10.2 Establish stewardship committees at health care facilities Stewardship committees 348 Year 1 Health facility level Hospital Administration Hospital 7.10.3 Update National guidelines for handling resistant microorganism to prevent transmission MOP 1 Year 1 National Departments of Clinical services (MOH), UNHLS 50,000 Hospital 7.10.4 Integrate data from different committees (IPC, MTC, QA etc.) to inform best practices for containment of resistant organisms a t health facilities Integrated data 12 (monthly) Year 1 Health facility level Departments of Clinical services (MOH), UNHLS 50,000 Hospital 7.10.5 Develop a tool for auditing antimicrobial prescriptions practices at health care facilities Audit tool 1 Year 1 Health facility level Departments of Clinical services (MOH), UNHLS 2,500 Hospital 7.10.6 Con duct audits of antimicrobial prescription s practices at health care facilities Facilities adhering to prescription guidelines 5 (one per annum Year 1-5 Health facility level Departments of Clinical services (MOH), UNHLS 2,500 Hospital Objective 8: Optimize Access to Effective Antimicrobial Medicines and Diagnostics in Human and Animal Health Uganda National Action Plan for Antimicrobial Resistance 41 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 8.1 Ensuring availability of affordable and accurate diagnostic tools to all health facilities 8.1.1 Procure adequate diagnostic tools (equipment, supplies, services) for infectious diseases at both public and private facilities and animal health facilities including Point of Care diagnostics Procured diagnostic supplies and equipment assorted Year 1-5 National and facility based Departments of Clinical services (MOH), NADDEC, Livestock Health and Entomology (MAAIF), UNHLS, 3,200,00 0 MOH/MAAIF/ Partners 8.1.2 Establish a subcommittee that evaluates/re commends appropriate/affordable and accurate diagnostic tools Committees at health facilities 348 Year 1 National and facility based Departments of Clinical services (MOH), NADDEC, Livestock Health and Entomology (MAAIF), UNHLS, 5,000 MOH/MAAIF/ Partners 8.2 Enhance systems for financing access to antimicrobial medicines or preventative AMR programs. 8.2.1 Identify optimal financing mechanisms for antimicrobial medicines or preventive AMR programs recommendations on Financing Year 1 National Departments of Clinical services (MOH), Livestock Health and Entomology (MAAIF), 50,000 MOH/MAAIF/ Partners 8.2.2 Lobby for financing for adequate antibiotics at all health care facilities Lobbying activities TBD Year 1-5 National ASO TWC TBD MOH/MAAIF/ Partners 8.3 Enhance and strengthen the distribution mechanisms for provision of antimicrobials to human health providers in a timely and efficient way. 8.3.1 Expand support to human health stakeholder s engaged in medication distribution Assessment on implementation best practices 1 Year 1 National Departments of Clinical services (MOH), Livestock Health and Entomology (MAAIF), 75,000 MOH/MAAIF/ Partners 8.4 Improve the supply chain for antimicrobials by creating a coordinating mechanism to manage the storage, pricing, selection and procurement of appropriate antimicrobials at the national, regional and local levels in order to reduce the costs, wastage and inappropriate selection of antimicrobials 8.4.1 Train suppliers of antimicrobials at national levels in efficient supply chain management National supplies managers trained 50 Year 1 National Departments of Clinical services (MOH), Livestock Health and Entomology (MAAIF), 20,000 MOH/MAAIF/ Partners Uganda National Action Plan for Antimicrobial Resistance 42 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 8.4.2 Train health facility procurement officers in procurement management of antimicrobials to ensure availability of appropriate antimicrobials and related supplies Facility Procurement officers trained 348 Year 1 National Departments of Clinical services (MOH), Livestock Health and Entomology (MAAIF), 20,000 MOH/MAAIF/ Partners 8.4.3 Train facility pharmacists in antimicrobial chain management and forecasting of need antimicrobials at their facilities Trained pharmacists 348 Year 1 National Departments of Clinical services (MOH), Livestock Health and Entomology (MAAIF), NDA, NMS, JMS, Private distributors 20,000 MOH/MAAIF/ Partners 8.5 Enhance capacity and support f or local producers/manufacturers of antimicrobials. 8.5.1 Expand support to existing incentive structures for local production of antimicrobials and compliance with standards of current good manufacturing practices Funds provided 5 Year 1 National NDA 500,000 NDA, MOFPED 8.5.2 Train local producers of antimicrobials in compliance with standards of current good manufacturing practices Drug manufacturers trained 100 Year 1 National NDA 50,000 NDA, Partners 8.5.3 Train regulators to enhance turnaround time for registration process for all producers of antimicrobials Regulators trained 50 Year 1 National NDA 20,000 NDA, Partners Objective 9: Promote Access to and Prudent Us e of Antimicrobials in Agriculture and Veterinary Medicine 9.1 Develop and disseminate prescription guidelines for improving appropriate use of antimicrobials in agriculture and veterinary medicine 9.1.1 Develop Prescribing/treatment guidelines in animals Prescribing guidelines 4 Year 1 National Department Livestock Health and Entomology (MAAIF) 100,000 MAAIF/Partners Uganda National Action Plan for Antimicrobial Resistance 43 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 9.1.2 Print and distribute the prescribing guidelines to all health facilities Copies of the guidelines 5,000 Year 1-5 National/ District level Communications department of MOH and MAAIF, faith based organisations, CSO 12,778 MOH/MAAIF/ Partners 9.1.3 Train veterinarians on prescription guidelines veterinarians trained 500 Year 1 National Department Livestock Health and Entomology (MAAIF) 50,000 MAAIF/Partners 9.1.4 Share digital animal prescribing guidelines to improve the usability Digital copies available 5 Year 1 National Department Livestock Health and Entomology (MAAIF), NDA 5,000 MAAIF/Partners 9.2 Support the development and dissemination of antimicrobial stewardship working manuals and procedures for the agriculture and veterinary sector 9.2.1 Develop antimicrobial stewardship programs f or the agriculture and veterinary practice MOPs 1 Year 1 National Department of Livestock Health and Entomology (MAAIF) and NDA 10,000 MAAIF/Partners 9.2.2 Print and distribute antimicrobial stewardship working manuals Copies 5,000 Year 1 National Department of Livestock Health and Entomology (MAAIF) and NDA 12,857 MAAIF/Partners 9.2.3 Train veterinary and agriculture practitioners on antimicrobial stewardships for both public and private practitioners Veterinary and agriculture practitioners 500 Year 2-5 National/ Regional and veterinary facilities Department of Livestock Health and Entomology (MAAIF) and NDA 100,000 MAAIF/Partners 9.3 Restrict broad or generalized u se of antimicrobials as growth promoters or as fee d additives Uganda National Action Plan for Antimicrobial Resistance 44 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 9.3.1 Conduct a risk assessment on the use of growth promoters and use of antimicrobial agents as feed additives Risk assessment report 1 Year 1 National Department of Livestock Health and Entomology (MAAIF) and NDA 20,000 MAAIF/Partners 9.3.2 Develop regulations/guidelines on the use of growth promoters and use of microbial agents as feed additives Regulations 1 Year 1 National Department of Livestock Health and Entomology (MAAIF) and NDA 20,000 MAAIF/Partners 9.3.3 Print and distribute the regulation/guidelines on growth promoters and feed additives Copies of the guidelines 5,000 Year 1 National/ District level Department of Livestock Health and Entomology (MAAIF) and NDA 12,778 MOH/MAAIF/ Partners 9.3.4 Sensitize farmers/animal health professionals and feed producers on growth promoters Farmers/anima l health professionals and feed producers 1,000 Year 2-5 Regional Department of Livestock Health and Entomology (MAAIF) and NDA 55,000 MAAIF/Partners 9.4 Strengthen regulation and over sight for the supply chain and use of antimicrobials in agriculture and veterinary medicine. 9.4.1 Conduct a situational analysis of the existing regulations and their implementation / enforcement Baseline status 1 Year 1 National Department of Livestock Health and Entomology (MAAIF) and NDA 50,000 MOH/MAAIF/ Partners 9.4.2 Train drug supplier, pharmacists, veterinarian s and agricultural suppliers to in supply chai n management of the agricultural and veterinary antimicrobials Report with recommendations 1 Year 1 National Department of Livestock Health and Entomology (MAAIF) and NDA 50,000 MOH/MAAIF /Partners 9.4.3 Train drug distributors and animal health work ers on distribution mechanisms of antimicrobials Trained animal health workers and drug distributors 500 Year 2-5 National/ regional Department of Livestock Health and Entomology (MAAIF) and NDA 50,000 MOH/MAAIF/ Partners Uganda National Action Plan for Antimicrobial Resistance 45 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING Objective 10: Promote Use of Quality, Safe and Efficacious antimicrobial agents 10.1 Strengthen licensing, approval, regulation and oversight over the antimicrobial supply chain (pharmaceutical manufacturers, distributors, importation, wholesalers and retail ers) 10.1.1 Expand support to and recruitment of professionals in NDA to improve efficiency in their oversight and regulatory function Recruitment 100 Year 1-5 National and regional NDA 186,111 NDA 10.1.2 Expand support to automated system for improving processes Automated system effectiveness 6 Year 2-5 National and regional NDA 1 ,500, 00 0 NDA/Partners 10.1.3 Sensitize private providers of antibiotics of NDA regulations to increase compliance Private Sector awareness on regulations 5,000 Year 2-5 National and regional NDA 2 ,000, 00 0 NDA/Partners 10.2 Support capacity for regular quality assessment of antimicrobial agents in the NDA quality laboratories. 10.2.1 Procure supplies and equipment for testing quality of antimicrobials Supplies and equipment assorted Year 2-5 National NDA 5,000 NDA 10.2.2 Collaboration with external laboratories for testing quality of antimicrobials MOUs 5 Year 2- National NDA 5,000 NDA 10.2.3 Undertake routine QA/QC checks for sustained compliance to WHO prequalification QA/QC 4 Year 2-5 National NDA 20,000 NDA in chemical analysis and relevant international standards 10.2.4 Undertake infrastructure improvements for NDA quality control lab Renovated facilities 1 Year 2-3 National NDA 200,000 NDA 10.2.5 Procure and install a laboratory information management system (LIMS) Information management system 1 Year 2 National NDA 10,000 MOH/MAAIF/ Partners Uganda National Action Plan for Antimicrobial Resistance 46 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 10.3 Support supervision of Pharmacies and ensure adherence to Good Pharmacy Practices in all Pharmacy outlets 10.3.1 Con duct inspections on pharmacies against GP P and establish compliance to OTC and self medication prescribing Pharmacies inspected quarterly Year 1-5 National and regional NDA 40,000 NDA 10.4 Regulate over-the-counter availability and self-medication with antimicrobial medicines. 10.4.1 Enforce compliance to OTC dispensing guidelines Facilities inspected quarterly Year 1-5 National and regional NDA 40,000 NDA 10.5 Strengthen regulation of the pharmaceutical companies and adherence to Good Manufacturing Practices 10.5.1 Establish Harmonisation mechanisms with WHO and other NDA on the compliance assessment s for pharmaceutical companies MOUs 3 Year 1 National NDA 20,000 NDA 10.6 Regulate pharmaceutical and antimicrobial waste 10.6.1 Develop guidelines for disposal of pharmaceutical and antimicrobial waste by the health facilities and general public Guidelines 1 Year 1 National NDA 9,999 NDA 10.6.2 Print and disseminate disposal guidelines Copies of the guidelines 500 Year 1 National NDA 10,000 NDA 10.6.3 Sensitize pharmacies and drug dealers on pharmaceutical waste disposal Pharmacies and Drug handlers 500 Year 2-5 national NDA NDA Strategic Objective 4: Surveillance Objective 11: Support Surveillance of AMR 11.1 Support the implementation o f a national AMR surveillance programme to generate actionable data Uganda National Action Plan for Antimicrobial Resistance 47 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 11.1.1 Establish a national Technical Working Group (TWC) for AMR surveillance (SURV TWC) SURV TWC 1 Year 1 National NAMRSC 500 Government /Partners 11.1.2 Conduct a baseline survey and needs assessment on AMR surveillance system Baseline report Year 1 Countrywide National Health Laboratory Services (MOH) NADDEC (MAAIF) 15,000 MOH/MAAIF/ Partners 11.1.3 Develop an integrated AMR surveillance plan Integrated AMR Surveillance plan 1 Year 1 National National Health Laboratory Services (MOH) NADDEC (MAAIF) 10,057 MOH/MAAIF/ Partners 11.1.4 Print and distribute the AMR surveillance plan copies 1,000 Year 1 National National Health Laboratory Services (MOH) NADDEC (MAAIF) 5,556 MOH/MAAIF/ Partners 11.1.5 Select priority surveillance sites and agree on harmonized surveillance methodologies List of surveillance sites 14 Year 1 National National Health Laboratory Services (MOH) NADDEC (MAAIF) 833 MOH/MAAIF/ Partners 11.2 Develop/review Standard Operating Procedures (SOPs) for surveillance of AMR in humans, food, agriculture, veterinary medicine, environment and wildlife, consistent and harmonized with international standards 11.2.1 Develop a manual of SOPs for AMR surveillance Manual of Procedures (MOP) 1 Year 1 National National Health Laboratory Services (MOH) NADDEC (MAAIF) 10,057 MOH/MAAIF/ Partners 11.2.2 Identify priority organisms, samples and testing panels in coordination with international partners List 1 Year 1 National National Health Laboratory Services (MOH) NADDEC (MAAIF) 833 MOH/MAAIF/ Partners 11.3 Strengthen and support improvement of laboratory infrastructure, human resources, access to laboratory supplies and equipment for microbiological testing and quality data reporting platforms. Uganda National Action Plan for Antimicrobial Resistance 48 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 11.3.1 Undertake improvements in infrastructure and equipment for microbiological isolation and susceptibility testing Renovations 20 Year 2-3 National National Health Laboratory Services (MOH) NADDEC (MAAIF) 4,000,00 0 MOH/MAAIF/ Partners 11.3.2 Equip laboratories micro biological isolation and susceptibility testing Equipment 20 Year 2 National National Health Laboratory Services (MOH) NADDEC (MAAIF) 4,000,00 0 MOH/MAAIF/ Partners 11.3.3 Train laboratory staff in logistics and supply management Laboratory staff 40 Year 2 National National Health Laboratory Services (MOH) NADDEC (MAAIF) 10,629 MOH/MAAIF/ Partners 11.3.4 Procure and install a laboratory information management system (LIMS) LIMS software 20 Year 2-3 National National Health Laboratory Services (MOH) NADDEC (MAAIF) 10,000 MOH/MAAIF/ Partners 11.4 Support the routine use of microbiological culture and sensitivity tests on prioritized microorganisms and antimicrobials in health facilities and on farms 11.4.1 Re-train clinicians and veterinarians on appropriate sample collection and submission Clinicians 70 Year 2-3 National National Health Laboratory Services (MOH) NADDEC (MAAIF) 35,000 MOH/MAAIF/ Partners 11.4.2 Procure consumables for sample collection, microbiological materials and susceptibility testing panels and reagents materials assorted Year 2-5 National National Health Laboratory Services (MOH) NADDEC (MAAIF) 4,000,00 0 MOH/MAAIF/ Partners 11.5 Support mechanisms for quality assurance systems and supervision to improve availability and reliability of routine micro biology laboratory testing 11.5.1 Procure and make available control strains and reference materials Reference materials assorted Year 2-5 National National Health Laboratory Services (MOH) NADDEC (MAAIF) 10,000 MOH/MAAIF/ Partners 11.5.2 Train laboratory staff, veterinarians and clinicians on quality control and quality assurance Clinicians, veterinarians and lab staff 100 Year 2-6 National National Health Laboratory Services (MOH) NADDEC (MAAIF) 10,000 MOH/MAAIF/ Partners Uganda National Action Plan for Antimicrobial Resistance 49 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 11.6 Enroll the various participating laboratories in national and international Extern al Quality Assurance programs 11.6.1 Accredit the participating laboratories Laboratories 20 Year 3 National National Health Laboratory Services (MOH) NADDEC (MAAIF) 20,000 MOH/MAAIF/ Partners 11.6.2 Con duct annual review of the manual of SOPs Manual of Procedures 1 Year 3-5 National National Health Laboratory Services (MOH) NADDEC (MAAIF) 10,000 MOH/MAAIF/ Partners 11.6.3 Undertake regular supervision and mentorship of the hospital surveillance sites Surveillance sites 14 Year 3 Facility National Health Laboratory Services (MOH) NADDEC (MAAIF) 20,000 MOH/MAAIF/ Partners 11.6.4 Designate national microbiology reference labs Reference labs 4 Year 3 National National Health Laboratory Services (MOH) NADDEC (MAAIF) 1,000 MOH/MAAIF/ Partners 11.7 Analyze, disseminate and share surveillance data and information to facilitate decision making on diagnoses an d treatments in clinical public health, veterinary practice, environment and wildlife laboratories and food technologies 11.7.1 Procure and install computers for data management system for sharing and disseminating information to partners Computers 40 Year 2 National National Health Laboratory Services (MOH) NADDEC (MAAIF) 40,000 MOH/MAAIF/ Partners 11.7.2 Train personnel on data management and reporting Laboratory staff 40 Year 2 National National Health Laboratory Services (MOH) NADDEC (MAAIF) 8,000 MOH/MAAIF/ Partners 11.7.4 Share data locally, nationally and internally Reports Year 2- 5 National National Health Laboratory Services (MOH) NADDEC (MAAIF) 50,000 MOH/MAAIF/ Partners 11.8 Support One Health networks for data sharing at national and regional levels as well as systems for linking microbiology data to clinical and pharmaceutical data to support decisions for A MR prevention and control 11.8.1 Undertake an assessment to identify data needs for the various stakeholders to inform actions for minimizing AMR Assessment Report 1 Year 2 National National Health Laboratory Services (MOH) NADDEC (MAAIF) 10,000 MOH/MAAIF/ Partners 11.8.2 Develop a tool for sharing data at different levels and to different stakeholders Tool for sharing data at different levels and to different stakeholders 1 Year 2 National National Health Laboratory Services (MOH) NADDEC (MAAIF) 10,000 MOH/MAAIF/ Partners Uganda National Action Plan for Antimicrobial Resistance 50 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 11.9 Establish an early warning system and monitor trends to determine the risk factors and drivers of resistance, resistance burden and impacts on public and animal health and the economy 11.9.1 Adopt international standards for AMR early warning Adopted standards 1 Year 2 National National Health Laboratory Services (MOH) NADDEC (MAAIF) 5,000 MOH/MAAIF/ Partners 11.9.2 Sensitize laboratory staff, clinicians, and veterinarians on identification and evaluation of risks Staff sensitized 100 Year 2 National National Health Laboratory Services (MOH) NADDEC (MAAIF) 5,000 MOH/MAAIF/ Partners 11.9.3 Com pile and provide information on identified risks Risk events 4 Year 2 -5 National National Health Laboratory Services (MOH) NADDEC (MAAIF) 5,000 MOH/MAAIF/ Partners 11.10 Utilize data generated, including all regions of the country and hard-to-reach areas, to evaluate and improve A MR intervention outcomes 11.10.1 Disseminate AMR data throughout the country including remote and hard-to reach areas Reports 121 Year 2-5 Districts Departments of National Disease Control (MOH) and Livestock Health and Entomology (MAAIF) 5,000 MOH/MAAIF/ Partners 11.11 Ensure the inclusion of AM R as a priority in the risk register, MDA plans, and any other mechanisms as needed 11.11.1 Train risk registrars to incorporate risk reporting in to their registers Risk educators 100 Year 2 National Departments of National Disease Control (MOH) and Livestock Health and Entomology (MAAIF) 2,014 MOH/MAAIF/ Partners Objective 12: Support Surveillance of Antimicrobial Use 12.1 Design and implement a national antimicrobial use surveillance plan that defines activities and roles consistent with international surveillance standards 12.1.1 Undertake a baseline survey and needs assessment and identify gaps for implementing an antimicrobial use surveillance plan Baseline assessment report 1 Year 1 National Departments of Clinical services (MOH)/National Drug Authority/and Livestock Health and Entomology (MAAIF) 10,000 MOH/MAAIF/ Partners 12.1.2 Develop an integrated antimicrobial use surveillance plan AMR use Plan 1 Year 1 national Departments of Clinical services (MOH)/Nationa l Drug Authority/and Livestock Health and Entomology (MAAIF) 20,000 Uganda National Action Plan for Antimicrobial Resistance 51 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 12.1.3 Print and distribute antimicrobial use plan copies 1,000 Year 1 national Departments of Clinical services (MOH)/Nati onal Drug Authority/and Livestock Health and Entomology (MAAIF) 5,479 MOH/MAAIF/ Partners 12.1.4 Disseminate the national surveillance of antimicrobial use plan stakeholders 200 Year 2 National Departments of Clinical services (MOH)/NDA/and Livestock Health and Entomology (MAAIF) 10,486 MOH/MAAIF/ Partners 12.2 Develop and implement procedures and methodologies for monitoring antimicrobials imported, used and disposed of in Uganda 12.2.1 Develop and manual of procedures and methodologies for routine monitoring antimicrobial use Manual of Procedures 1 Year 1 National Departments of Clinical services (MOH)/NDA/and Livestock Health and Entomology (MAAIF) 10,486 MOH/MAAIF/ Partners 12.2.3 Train hospital, pharmacy and veterinary staff to collect and share antimicrobial use data routinely Health, Pharmacy and veterinary staff 1,000 Year 2 National Departments of Clinical services (MOH)/NDA/and Livestock Health and Entomology (MAAIF) 30,000 MOH/MAAIF/ Partners 12.2.2 Collect, collate and share antimicrobial use data regularly Reports 1,000 Year 2 National Departments of Clinical services (MOH)/NDA/and Livestock Health and Entomology (MAAIF) 30,000 MOH/MAAIF/ Partners 12.3 Monitor prescribing practices, dispensing practices, client/community use and consumption patterns in health care settings, veterinary health practice, agriculture, aquaculture, traditional herbalists (indigenous technical knowledge groups) and communities 12.3.1 Identify antimicrobial use and practice indicators List of indicators Year 1 National Departments of Clinical services (MOH)/NDA/and Livestock Health and Entomology (MAAIF) 5,000 MOH/MAAIF/ Partners 12.3.2 Develop a manual of procedures for monitoring prescription and dispensing practices Manual of Procedures 1 Year 1 Departments of Clinical services (MOH)/NDA/and Livestock Health and Entomology (MAAIF) Uganda National Action Plan for Antimicrobial Resistance 52 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 12.3.3 Regularly collect data on prescribing and dispensing practices Monthly Reports 12 Year 2-5 National Departments of Clinical services (MOH)/NDA/and Livestock Health and Entomology (MAAIF) 20,000 MOH/MAAIF/ Partners 12.4 Support collection and sharing of data to evaluate and monitor interventions aimed to improve appropriate use and access to antimicrobials in humans and animals 12.4.1 Undertake regular data collection on antimicrobial access and use Reports 1,000 Year 2-5 Countrywide Departments of Clinical services (MOH) NDA, and Livestock Health and Entomology (MAAIF) 20,000 MOH/MAAIF/ Partners 12.4.2 Analyze and share data with relevant stakeholder s Quarterly reports 4 Year 2-5 National Departments of Clinical services (MOH) NDA, and Livestock Health and Entomology (MAAIF) 5,000 MOH/MAAIF/ Partners 12.5 Monitor and evaluate the imp act of pharmaceutical promotion on antimicrobial use 12.5.1 Develop tools for monitoring the impact of pharmaceutical promotion Tools 1 Year 2-5 National Departments of Clinical services (MOH)/NDA/and Livestock Health and Entomology (MAAIF) 5,000 MOH/MAAIF/ Partners 12.5.2 Collect, evaluate, and disseminate data on the impact of pharmaceutical promotion on antimicrobial use Quarterly reports 4 Year 2-5 National Departments of Clinical services (MOH)/NDA/and Livestock Health and Entomology (MAAIF) 5,000 MOH/MAAIF/ Partners Objective 13: Support Surveillance for Antimicrobial Drug Residues in Foods 13.1 Design and implement a national surveillance plan for monitoring antimicrobial residues in foods and animal feeds 13.1.1 Undertake a baseline survey and needs assessment and identify gaps for surveillance of antimicrobial residues in foods and animal feeds Assessment Report 1 Year 1 National NADDEC/UNBS 20,000 MAAIF/Partners Uganda National Action Plan for Antimicrobial Resistance 53 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 13.1.2 Develop a national plan for monitoring of antimicrobial residues in foods and animal feeds Monitoring plan of antimicrobial residues in foods 1 Year 1 National NADDEC/UNBS 20,000 MAAIF/Partners 13.1.3 Print and distribute national surveillance plan for monitoring residues in foods and animal feeds copies 5,000 Year 1 National NADDEC/UNBS 27,397 MAAIF/Partners 13.1.4 Disseminate the national surveillance plan stakeholders 500 Year 2 National NADDEC/UNBS 10,000 MAAIF/Partners 13.2 Support the use of standard procedures in accordance with international standards including the WHO/FAO Co dex Alimentarius for monitoring antimicrobial residues in foods 13.2.1 Develop or adopt international standards f or antimicrobial residues in foods Manual of Procedures 1 Year 1 National NADDEC and UNBS MAAIF/Partners 13.2.2 Train veterinarians and laboratory personnel on monitoring antimicrobial residues in food and animal feeds Veterinary and laboratory staff 50 Year 2 National NADDEC and UNBS 10,000 MAAIF/Partners 13.2.3 Identify and prioritize samples and antimicrobial residues for testing List of priority samples 1 Year 1 National NADDEC and UNBS 5,000 MAAIF/Partners 13.2.4 Provide the appropriate infrastructure and renovations for the laboratories Renovations 2 Year 1 National NADDEC and UNBS 800,000 MAAIF/Partners 13.2.5 Equip national laboratories for monitoring antimicrobial residues Equipment assorted Year 2 NADDEC and UNBS 13.2.6 Train personnel in laboratory logistics and supply management Veterinary and laboratory staff 50 Year 1 National NADDEC and UNBS 20,000 MAAIF/Partners 13.2.7 Procure laboratory information management system LIMS software 2 Year 2 National NADDEC and UNBS 10,000 MAAIF/Partners Uganda National Action Plan for Antimicrobial Resistance 54 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 13.2.8 Procure and consumables and supplies procurement assorted Year 2 National NADDEC and UNBS 400,000 MAAIF/Partners 13.2.9 Enroll the various labs in national and international external quality assurance programs Labs 2 Year 2 National NADDEC and UNBS 5,000 MAAIF/Partners 13.3 Collaborate with the WHO/FAO Codex Alimentarius and other international efforts to generate and share actionable data 13.3.1 Summarise and share data in standardized formats regularly Reports 12 Year 2 National/ regional NADDEC 20,000 MAAIF/Partners 13.3.3 Hold regular dissemination meetings for sharing data summaries with stakeholders Stakeholders 100 Year 2 -5 National NADDEC 10,000 MAAIF/Partners Objective 14: Foster Collaboration and Partnerships 14.1 Collaborate with the WHO, O IE, FAO and other national, region al and international efforts focused on the development and implementation of harmonized surveillance and capacity to detect and monitor antimicrobial use and resistance in prioritized pathogens 14.1.1 Organize a harmonization workshop with international partners and other stakeholder s on the surveillance tools and methodologies International partners 5 Year 2 National Departments of National Disease Control (MOH) and Livestock Health and Entomology (MAAIF) 10,000 MOH/MAAIF/ Partners 14.1.2 Participate in regional and global data sharing plat forms, including GLASS Partners 5 Year 2 -5 National/ International Departments of National Disease Control (MOH) and Livestock Health and Entomology (MAAIF) 5,000 MOH/MAAIF/ Partners 14.2 Participate in mechanisms for national, regional and international communication of critical events that may signify new resistance trends with global One Health implications 14.2.1 Identify AMR critical events that are consistent with international standards Report 5 Year 2 National Departments of National Disease Control (MOH) and Livestock Health and Entomology (MAAIF) 5,000 MOH/MAAIF/ Partners 14.2.2 Institute global reporting mechanisms for critical events Reports 5 Year 2 -5 National Departments of National Disease Control (MOH) and Livestock Health and Entomology (MAAIF) 5,000 MOH/MAAIF/ Partners Uganda National Action Plan for Antimicrobial Resistance 55 14.3 Use national, regional and international quality assurance standards for generation of quality data SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 14.3.1 Develop manual of procedures for Quality assurance mechanisms for surveillance Manual of Procedures 1 Year 2 -5 National Departments of National Disease Control (MOH) and Livestock Health and Entomology (MAAIF) 10,000 MOH/MAAIF/ Partners 14.3.1 Train personnel in Quality assurance mechanisms for surveillance Laboratory staff 100 Year 2 -5 National Departments of National Disease Control (MOH) and Livestock Health and Entomology (MAAIF) 10,000 MOH/MAAIF/ Partners 14.3.2 Enroll all laboratory surveillance partners in relevant quality assurance mechanisms Enrollment 22 Year 2 -5 National Departments of National Disease Control (MOH) and 5,000 MOH/MAAIF/ Partners Livestock Health and Entomology (MAAIF) Focus Area 5: Research and Inn ovation Objective 15: Promote Innovation in the Search for Alternative Treatments and Drug Discovery 15.1 Support mechanisms for coordinated research and innovation 15.1.1 Establish a Technical Working Group (TWC) on Research and innovation (RI TWC) RI TWC 1 Year 1 National NAMRSC 500 MOH/MAAIF/ Partners 15.1.2 Provide hands-on training to researchers on grant writing Researchers 100 Year 1-5 National UNCST, MoSTI 10,000 UNCST, MoSTI 15.1.3 Advocate, lobby and share information and RFPs f or funding of AMR research Report continuous Year 1 National UNCST, RI TWC, MoSTI 10,000 UNCST, MoSTI 15.1.4 Sensitize researchers on intellectual property rights and patenting Report 200 Year 1 National UNCST, RI TWC, URSB 10,000 Workshop report 15.2 Facilitate and support the Natural Chemotherapeutics Laboratories (NCL) and other partners to expand their antimicrobial product Development Uganda National Action Plan for Antimicrobial Resistance 56 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 15.2.1 Con duct a baseline survey and needs assessment on antimicrobial resources in the country, an d identify opportunities and gaps to be filled Assessment Report 1 Year 1 National RI TWC in collaboration with NCL 40,000 MOH/MAAIF/ Partners 15.2.2 Con duct a study to identify challenges and opportunities for enhancing antimicrobial product development Report 1 Year 1 National NCL/Universities/NDA 30,000 MOH/MAAIF/P artners 15.3 Support the establishment of international col laborations in high through put screening of antimicrobial compounds 15.3.1 Develop governance structures and policies that encourage development and research of antimicrobial compounds Research network 1 Year 1-5 National MoH, MoSTI 5,000 List of researchers engaged 15.4 Support academia and other researchers in product development 15.4.1 Provide seed funding for proposal development Research groups 100 Year 1-5 National UNCST/Academic and partners 100,000 Minister of Science Technology and Innovation/UN C ST 15.4.2 Post calls for funding opportunities onto institutional websites and mailing lists of stakeholders Posts continuous Year 1-5 National UNCST/Academic and partners UNCST 15.4.3 Establish a database of biological materials, including plants, fungi, and other compounds with suspected antimicrobial properties Database compounds TBD Year 1-5 Countrywide Research institution s, UNCST, NCL, NDA, NaCOTHA 200,000 UNCST/NCL/ N DA 15.5 Support research in alternative treatments for infections 15.5.1 Explore and share innovative ideas about alternative treatments to infectious diseases Researchers 100 Year 1-5 National RI TWC, NaCOTHA, MoH, MAAIF, NFA 10,000 UNCST 15.6 Link the indigenous technical knowledge (ITK) groups to the product development system Uganda National Action Plan for Antimicrobial Resistance 57 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 15.6.1 Facilitate the establishment of MoUs between IT Ks, the National Chemotherapeutic Laboratories and other stakeholders MOUs 5 Year 1-5 National and regional MoH,NCL,NDA, THETA 1,000 UNCST/NCL/ N DA 15.6.2 Carry out country-wide survey of indigenous knowledge on antimicrobial solutions survey 1 Year 1 National THETA, Universities 20,000 UNCST/NCL/ N DA Objective 16: Promote Innovations in Diagnostic Technology 16.1 Support investments and collaborations and strength incapacity for research, development and testing of innovative diagnostic technologies for detection of resistance in real time. 16.1.1 Con duct a baseline survey and needs assessment to identify the opportunities and challenges in innovative diagnostics Report 1 Year 1 National MoSTI, Universities 300,000 UNSCT 6.1.2 Enhance the capacity of national regulatory bodies to assess and approve potentially innovative antimicrobial diagnostic technologies Regulatory bodies 1 Year 1 National NDA 10,000 MoSTI 16.2 Support validation of point-of -care diagnostic s for detection of infectious diseases and detection of resistance. 16.2.1 Undertake an assessment of the point of care diagnostics in different stages of development Assessmen t Report 1 Year 1 National MoSTI 20,000 MoSTI 16.2.2 Sensitize stakeholders on regulatory systems an d processes for approval of diagnostic technologies Stakeholders 100 Year 1-5 National NDA, URSB 10,000 MoSTI 16.2.3 Train regulatory agency staff in approval processes for diagnostics Report 20 Year 1-5 National NDA, UNCST 5,000 NDA, WHO, OIEC, IBA 16.3 Create linkages and support for Ugandan scientists to take leadership roles in international research partnerships targeting AMR. Uganda National Action Plan for Antimicrobial Resistance 58 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 16.3.1 Identify and disseminate opportunities for Ugandan scientists in international research partnerships and offer mentorship Opportunities TBD Year 1-5 National MoH/MAAIF 5,000 List of potential partnerships 16.3.2 Provide seed funding to support Ugandan scientists in research leadership Researchers in leadership TBD Year 2 National MoH, MAAIF, MoSTI TBD Researchers i n leadership roles Objective 17: Collaborate with International Partners in Basic Intervention Research 17.1 Promote research to identify high-risk and high-burden resistant strains, their resistance mechanisms and their transmission. 17.1.1 Organize workshops to share knowledge on high-risk and high burden resistant strains workshops 4 (1 per year) Year 1-5 National MoH, MAAIF, Academia 5,000 UNCST 17.1.2 Expand seed funding provided for pilot studies of new antimicrobials Pilot studies TBD TBD National UNCST, MoSTI TBD MoSTI, UNCST 17.2 Promote innovations for new antimicrobial drug development, vaccines, and other innovative therapies. 17.2.1 Identify and disseminate opportunities for participation in the development of antimicrobials, vaccines, and other innovative therapies Stakeholders 100 Year 1-5 National UNCST 5,000 UNCST 17.2.2 Identify and twin local laboratories with foreign lab oratories to support the local production of vaccines MOUs 5 Year 1-5 National MoH, MAAIF, RI TWC 5,000 UNCST 17.2.3 Establish and maintain microbial collections and other biological resources for research an d development of AMR solutions Biological Resource Centres 1 Year 1-5 National CPHL, Academia 5,000 UNCST Uganda National Action Plan for Antimicrobial Resistance 59 SUB-ACTIVITY UNIT QUANTITY TIMELINE LOCATION RESPONSIBLE ENTITY COST (USD) SOURCE OF FUNDING 17.3 Invest and support collaboration in high-throughput genomics and sequencing technologies that have the potential to enhance product development 17.3.1 Undertake a baseline survey and needs assessment to identify current capabilities and gaps in high-throughput genomics and sequencing in the country Assessme nt Report 1 Year 1 National RI TWC 5,000 UNCST 17.3.2 Establish a National Genomics and Bioinformatics Centre (NGBC) to support AMR research Genomic s center 1 Year 1-5 UNCST 3 ,000, 00 0 MoSTI 17.3.3 Identify and facilitate collaboration of the NGBC with other international centres of excellence MOUs 1 Year 1-5 UNCST 500 UNCST 17.4 Support research on the burden of AMR to inform policy for investment in interventions. 17.4.1 Undertake research to examine the burden of A MR in the country Report 1 Year 1 National MAAIF, MoH, Research Institutions 150,000 Government and partners 17.5 Establish a research innovation fund to support innovations that slow down AMR. 17.5.1 Advocate and lobby for funding support for research innovations from government and pharmaceutical companies Research and innovation fund 1 Year 1 National MoSTI 5,000,00 0 Funding support promises from government and other funders Objective 18: Enhance Operational and Health Systems Research at the Local Level 18.1 Support local research on resistance and transmission pathways between the environment, humans, animals and food supply chain 18.1.1 Organize One Health workshops to identify priorities for research on resistance and transmission pathways Report 1 Year 1 National MoH, UNHRO, MAAIF 5,000 One Health Platform 18.1.2 Identify and disseminate opportunities for One Health research funding Report continuous Year 1-5 National UNHRO, MoH, MAAIF 5,000 One Health Platform 18.2 Promote local research on antimicrobial use patterns with the goa l of producing more context specific stewardship approaches. 18.2.1 Identify priorities for research to establish and improve antimicrobial prescription and use patterns workshops 1 Year 1 national UNCST 5,000 UNCST National National Uganda National Action Plan for Antimicrobial Resistance 60 18.2.2 Conduct research to assess behavioral, cultural and anthropological practices on antimicrobial use in society, prescription practices and motivators research 5 Year 1 national MOH/NDA/RITWC 200,000 UNCST Uganda National Action Plan for Antimicrobial Resistance 61 5.0 Monitoring and Evaluation 5.1 Introduction The Monitoring & Evaluation Plan provides a guidance framework for evaluating progress made regarding the NAP-AMR. In accordance with the Strategic Plan and the Implementation Plan, the strategic actions are coupled with the relevant indicators that can provide insight and evidence to the NAMRSC. The usage of this Monitoring & Evaluation plan can thus provide an initial foundation to all stakeholders regarding pertinent and relevant indicators that can alert relevant stakeholders to failures and successes in the implementation of the NAP-AMR. 5.2 Goal and Objectives of the M&E Plan The AMR NAP M&E plan goal is aligned with GAP which is the global framework for the containment of AMR. These goals align with the goal of increasing stewardship of the health agenda by the MoH. The stewardship function of the MoH focuses around provision of appropriate guidance to implement health programs as well as priorities for implementation. In order to provide appropriate guidance, there is need for an M&E system that provides timely and accurate information to government and partners in order to inform performance reviews, policy discussions and periodic revisions to the national strategic and operational plans. Goal of the M&E The goal of the AMR NAP M&E plan is to establish a system that is robust, comprehensive, fully integrated, harmonized and well-coordinated to guide monitoring of the implementation of the AMR NAP and evaluate impact. Specific Objectives of the M&E The specific objectives of the AMR NAP M&E plan are: 1. To provide a framework for tracking progress and demonstrating results of the AMR NAP over the medium term. 2. To build capacity of the U N A M R C to regularly and systematically track progress of implementation of the NAP. 3. To facilitate NAMRSC and other stakeholders assess the performance in accordance with the agreed objectives and performance indicators to support management for results (evidence-based decision making), 4. To improve compliance with broader government policies 5. To facilitate continuous learning (document and share the challenges and lessons learnt) by stakeholders during implementation of the NAP Key Outputs of the M&E The expected key outputs of the M&E framework are: 1. A functional sector-wide unified integrated, harmonized and well- coordinated M&E system with effective and timely feedback to stakeholders. 2. Performance reports (baseline survey reports, periodic progress reports, annual performance reports, financial audit reports etc.) 3. Basic statistical data on health service delivery, resources, outputs and beneficiaries. 4. Regular updates on core performance indicators. 5. National infrastructure for M&E. M&E Outcomes The M&E Plan should result in: 1. Timely reporting on progress of implementation of the AMR NAP 2. Timely meeting of reporting obligations to government and partners 3. Objective decision making for performance improvement 4. Accountability to government, partners and citizens 5. Policy dialogue with stakeholders 6. Evidence-based policy development and advocacy 7. Institutional memory on AMR NAP implementation 5.3 Structural Framework The structure of the Monitoring & Evaluation matrix can be generally characterized as an out comer requirement model. This model establishes what the desired outcome for any focus area or objective is and pairs it with the respective strategic actions being taken. With each of these strategic actions being taken, the monitoring & evaluation indicators establishes how those actions contribute to the achievement of the desired outcome. In doing so, stakeholders can evaluate where there are bottlenecks to the desired outcome and/or highlight where the relationship between the desired outcome and the strategic activity did not create as much impact as desired. As a result, the NAP-AMR monitoring & evaluation framework provides critical information that can aide both in mid-course changes as the NAP-AMR is implemented and also guide planning in the future. 5.4 Methodology The development of the AMR NAP M&E plan was drafted by the UNAS Standing Committee on AMR. UNAS spearheaded the development of the NAP by undertaking the situational analysis in 2015 and the AMR strategy in 2017. With support from WHO, UNAS drafted the AMR M&E plan which was subjected to stakeholder review and approval by various stakeholders. The plan relied on the AMR strategy and implementation plan and aimed to provide a framework for monitoring performance of the implementation of the proposed interventions in the strategy. The process also took into consideration the Global Action Plan (GAP) on AMR approved by the Uganda National Action Plan for Antimicrobial Resistance 62 Uganda National Action Plan for Antimicrobial Resistance 63 global community and the various international agencies; in particular, WHO/OIE/FAO tripartite plans. In order to ensure uniformity with other national plans for ease of global monitoring, the plan followed the WHO guidance in development of the M&E plan. The plan provides a summary of the key outcome and output indicators while the process indicators are provided in the detailed M&E framework in Appendix 1. Uganda National Action Plan for Antimicrobial Resistance 64 5.5 Monitoring and Evaluation Framework Matrix The monitoring evaluation matrix summary below follows the standard programmatic M&E format that includes required inputs or basic resources needed, the process or activities, the outputs (results at the level of the programme), the outcomes (results at the level of the population) and their desired impact over the long term. This is in consonance with WHO format for ease of comparison with WHO member countries. The detailed matrix that follows in Appendix 1 gives more details of the indicators for the targets and their sources of verification according to the proposed activities. Planning Input Process Output Outcome Impact and Goals Basic resources Activities Results at level of the programme Results at level of populations Ultimate effect in long term Coordinated communication and public awareness on AMR A national coordination (PATE) committee in place Increased public awareness and knowledgeable public on AMR Increase in the public that complete antibiotic treatment courses Proportion of public who know use of antibiotics causes resistance Increase in the public that are not self-medicating Demonstrated competencies of health care workers, animal and environmental professionals in AMR related issues Strategic Objective 1: Public Awareness and professional competencies in AMR improved Communication strategy for all stakeholders Funding for communication to the public and the professionals secured A comprehensive communication strategy for AMR in place A comprehensive communication strategy in place Increased knowledge on AMR Responsible use of antibiotics Communication materials and tools for use by different stakeholders for different communication channels and/or platforms. Tailored communication materials on AMR for the public and farmers available Regular public awareness campaigns on antimicrobial use and resistance undertaken Proportion of planned public awareness campaigns implemented at district and national levels Awareness raising in primary, secondary and tertiary schools and other training institutions using specialized materials undertaken Percentage of veterinary and health training institutions that have incorporated AMR in their core curricular, Proportion of primary and secondary schools incorporating AMR in health education sessions Collaboration established with NGOs, Civil Society Organizations (CSOs), Faith Based Organizations (FBOs) the private sector, Functional coordination forum linking stakeholders established, Proportion of Uganda National Action Plan for Antimicrobial Resistance 65 Planning Input Process Output Outcome Impact and Goals Basic resources Activities Results at level of the programme Results at level of populations Ultimate effect in long term International organizations, law enforcement and the media to deliver messages on antimicrobial use. stakeholders participating in the forum Media trained to report on AMR. Percentage of media houses trained in AMR Number of media practitioners trained in AMR, Networks for the dissemination of information on antimicrobial use and resistance developed. Number of functional dissemination networks established by region AMR included as a priority in the risk register, MDA plans. Number of MDA plans with AMR as a priority in the risk registers Research findings translated to popular versions and disseminated Number of Research findings translated into popular versions Number of popular version research findings disseminated AMR courses for under and graduates on AMR prevention and containment developed Proportion of health care workers, animal and environmental professionals demonstrating AMR competencies AMR courses for under and graduates on AMR prevention and containment developed Proportion of undergraduate and postgraduate courses with updated AMR content AMR courses for under and graduates on AMR prevention and containment developed Proportion of undergraduate and postgraduate courses with updated AMR content Uganda National Action Plan for Antimicrobial Resistance 66 Planning Input Process Output Outcome Impact and Goals Basic resources Activities Results at level of the programme Results at level of populations Ultimate effect in long term Strategic Objective 2: Improved Infection Infections and Control Guidelines Strengthened coordination mechanisms for infection prevention and control A functional national coordination IPC TWC committee in place Reduction in Incidence of healthcare acquired Reduction in incidence of infections in health facilities, farms & Updated national infection prevention and control manuals and guidelines disseminated Proportion of health facilities with updated IPC manuals infections Prevention and Control Biosecuty Guidelines communities, and overall Planning Input Process Output Outcome Impact and Goals Basic resources Activities Results at level of the programme Results at level of populations Ultimate effect in long term Funding for IPC secured IPC compliant infrastructure in healthcare facilities Proportion of health facilities with IPC compliant infrastructure Reduced in incidence of infections in the community Reduced incidence of infectious diseases in animals and Agriculture Reduced incidence of vaccine preventable diseases in human s and animals environmental contamination Uganda National Action Plan for Antimicrobial Resistance 67 Planning Input Process Output Outcome Impact and Goals Basic resources Activities Results at level of the programme Results at level of populations Ultimate effect in long term Prescription and Treatment Guidelines Antimicrobial Strengthened coordination mechanisms for coordination and support of Antimicrobial Stewardship and ensuring Optimal Use A functional Technical working group (ASO TWC) in place Effectiveness and efficacy of antimicrobials preserved Successful treatment of infectious disease stewardship Guidelines Up-to-date prophylactic, prescribing/treatment guidelines and protocols for infectious diseases in human health Proportion of health care facilities with up-to-date Prophylactic, prescribing/treatment guidelines and protocols for infectious Effective and timely treatment of \ Focus Area 3: Antimicrobial Funding for IPC materials infectious diseases Effective and timely treatment of Stewardship and Optimal Use Responsible prescribing practices, dispensing and administration Proportion of health care workers adhering to prescribing practices, infectious diseases in animals and agriculture With a system of ensuring accountability. Institute/strengthen and support proper functioning of Medicines and Therapeutics committees in all health care facilities Proportion of health care facilities with functional MTCs Planning Input Process Output Outcome Impact and Goals Uganda National Action Plan for Antimicrobial Resistance 68 Support the development and dissemination of antimicrobial stewardship working manuals and ( l) Up-to-da the antimicrobial manuals and procedures (2) Proportion of health care workers with the manuals Procedures. Provide up-to-date and unbiased medicine information services to human and animal health providers. Proportion of human and animal health providers accessing up-to-date medical information Strengthened super vision of prescribing and dispensing outlets for human and animal antimicrobials Proportion of prescribing and dispensing outlets for human and animal antimicrobials adhering to guidelines and standards Incentives and reward sys terms for excellence in adherence to best practices and standards Proportion of healthcare rewards and sanctions committees that have included prescribing practices as a criteria Functional stewardship committees at all health care facilities Proportion of health care facilities with functional stewardship committees Affordable and accurate diagnostic tools available at all health facilities proportion n of healthcare facilities with diagnostic tools Financing mechanisms for antimicrobial medicines or preventative AMR programs Enhanced. proportion of the medicine budget allocated to financing antimicrobials medicine Timely and efficient distribution mechanisms for pro vision of Proportion of deliveries of a antimicrobials to health care facilities done on time Planning Input Process Output Outcome Impact and Goals Uganda National Action Plan for Antimicrobial Resistance 69 antimicrobials to health care providers Output 8.5: Capacity of local producers/manufacturers of Antimicrobials enhanced. Proportion of local antimicrobial manufacturers with increased capabilities Promote Access to and Prudent Use of Antimicrobials in Agriculture and Veterinary Medicine Effective and timely treatment of infectious diseases in animals and agriculture Up-to-date prescription guidelines Proportion of health care facilities with up-to-date prescription guidelines Up-to-date antimicrobial stewardship working manuals and procedures for the agriculture and veterinary sector Proportion of agriculture and veterinary practitioners with up-to-date antimicrobial stewardship working manuals and procedures Restricted broad or generalized use of antimicrobials as growth promoters or as feed additives Proportion of feed manufacturers not using antimicrobials in feeds Supply chain and use of Antimicrobials in agriculture and veterinary medicine strengthened. Proportion of agriculture and veterinary practitioners adhering to the regulations Promote Use of Quality, Safe and Efficacious antimicrobial agents Effective treatment of infectious diseases Capacity for regular quality assessment of antimicrobial agents in the NDA quality laboratories Strengthened. Number of analyses undertaken in a year and Rate of turnaround time for analyses Improved supervision of Pharmacies Proportion of pharmacy outlets adhering to GPP Planning Input Process Output Outcome Impact and Goals Uganda National Action Plan for Antimicrobial Resistance 70 Over-the-counter availability and self-medication with antimicrobial medicines adherence to regulations improved Proportion of drug outlets adhering to regulations regarding OTC Strengthened regulation of the pharmaceutical companies and adherence to Good Manufacturing Practices Proportion of pharmaceutical companies adhering to GMPs Strengthened regulation of the pharmaceutical and antimicrobial waste Proportion of facilities adhering to guidelines for pharmaceutical and antimicrobial waste disposal Manual of procedures for Surveillance of AMR Manual of procedures for Surveillance of antimicrobial use Manual of and for Surveillance of antimicrobial residues in foods A national AMR surveillance programme in place A fully functional surveillance programme Increased evidence based decisions on antimicrobial use Reduced levels of antimicrobial drug residues in foods Harmonized and coordinated AMR surveillance system Early detection and response to emerging MDR problems SOPs and methodologies for surveillance of AMR in place Proportion of laboratories adhering to standard procedures to generate AST data Laboratory infrastructure, human resources, supplies and equipment improved (1) Suitable infrastructure (2) Well trained human resource (3) Suitable equipment in place Microbiological culture and sensitivity tests performed routinely Proportion of laboratories undertaking microbiological culture and AST Strategic Objective 4: Surveillance Funds for AMR surveillance Quality assurance systems for microbiology laboratory testing in place Proportion of laboratories with QA/QC system in place Laboratories enrolled in national and international external quality Proportion of laboratories enrolled in external quality assurance programs assurance programs Proportion of health care and Surveillance data and information veterinary facilities utilizing disseminated to healthcare facilities AST data to inform their decision of choice of antimicrobials Planning Input Process Output Outcome Impact and Goals Uganda National Action Plan for Antimicrobial Resistance 71 One Health networks created to widely share data Number of One Health functional networks created An early warning system to monitor trends off AMR established Proportion of facilities with an early warning system in place Countrywide utilization of data Proportion of health care facilities utilizing AMR data Support Surveillance of Antimicrobial Use Evidence based decisions on antimicrobial use A national antimicrobial use surveillance plan in place A functional national antimicrobial use surveillance plan Procedures and methodologies for monitoring antimicrobials developed Proportion of facilities with and using standard procedures to monitor antimicrobial use Robust data on prescribing practices, dispensing practices, client/community use generated Proportion of facilities generating prescribing practices, dispensing practices data Antimicrobial use data generated and shared Proportion of facilities generating antimicrobial use data Data on impact of pharmaceutical promotion on antimicrobial use generated Amount of data about impact of pharmaceutical promotion Support Surveillance for Antimicrobial Drug Residues in Foods Reduced levels of antimicrobial drug residues in foods Uganda National Action Plan for Antimicrobial Resistance 72 Planning Input Process Output Outcome Impact and Goals A national surveillance plan for monitoring antimicrobial residues in foods and animal feeds in place A functional plan for monitoring antimicrobial residues in foods in place Standard procedures for monitoring antimicrobial residues in foods in place Number of laboratories with and using standard procedures for monitoring antimicrobial residues in foods Collaborating with WHO/FAO Codex Alimentarius and other international partner established An international platform for sharing data Foster Collaboration and Partnerships among AMR stakeholders Harmonized and coordinated AMR surveillance system Harmonized surveillance and capacity to detect and monitor antimicrobial use and resistance in prioritized pathogens established Increased capacity for surveillance AMR and use Mechanisms for participation international, regional and international communication of critical events established A platform for communicating AMR critical events National, regional and international quality assurance standards in place Proportion of facilities with QA/QC procedures in place Funds for Research and Mechanisms for coordinated research and innovation in place A platform (RI TWC)for coordinated research in AMR Effective control of resistant infections Accurate and cost effective diagnosis of infections Enhanced antimicrobial product development by the Natural Chemotherapeutics Laboratories (NCL) and other partners Number of new antimicrobial products developed by NCL and other partners and approved Planning Input Process Output Outcome Impact and Goals Uganda National Action Plan for Antimicrobial Resistance 73 Strategic Objective 5: Research and Innovation Innovation secured International collaborations in high-throughput screening of antimicrobial compounds established Number of international collaborations in high through putting screening of antimicrobial compounds established High quality basic intervention research Evidence-based health systems operations Reduced emergence and spread of AMR Academia and other researchers supported in product development Number of new antimicrobial products developed by academia and other researchers and approved Research in alternative treatments for infections supported Number f alternatives for treatment of infectious diseases developed Linkages between indigenous Number of ITKs developed into antimicrobial products Technical knowledge (ITK) groups to the product development system established Promote Innovations in Diagnostic Technology Accurate and cost effective diagnosis of infections Capacity for research, development and testing of innovative diagnostic technologies strengthened Number of new innovative diagnostics developed Point-of-care diagnostics for detection of infectious diseases and detection of resistance validated Number of point-of-care diagnostics validated and approved Ugandan science leaders in international research on AMR Number of Uganda scientists with leadership position in international research partnerships Planning Input Process Output Outcome Impact and Goals Uganda National Action Plan for Antimicrobial Resistance 74 Collaborate with International Partners in Basic Intervention Research High quality basic intervention research High-risk and high-burden resistant strains identified Number of high-risk and high burden resistant strains reported routinely Innovations for new antimicrobial drug development, vaccines, and other innovative therapies Number of innovative new antimicrobial drug development, vaccines, and other innovative therapies developed Collaborations in high-throughput genomics and sequencing technologies established Number of high-throughput genomics and sequencing technologies available The burden of AMR established The proportion of burden infectious diseases that is attributed to AMR A research innovation fund to support innovations that slow down AMR established. Transmission pathways between the environment, humans, animals and food supply chain established Elucidation of resistance transmission pathways Local Antimicrobial use patterns established Patterns and trends of antimicrobial use locally References 1. WHO Global Action Plan on Antimicrobial Resistance, 2015. Available at: www.wpro.who.int/entity/drug resistance/.../global action plan eng.pdf 2. The FAO Action Plan on Antimicrobial Resistance 2016-2020. Available at: www.fao.org/3/ai5996e.pdf 3. The OIE Strategy on Antimicrobial Resistance and the Prudent Use of Antimicrobials. Available at: http://www.oie.int/fileadmin/Home/eng/Media Center/docs/pdf/PortailAMR/EN OIEAMRstrategy.pdf 4. WHO global strategy for containment of antimicrobial resistance, 2001. Available at: www.who.int/drugresistance/WHO Global Strategy English.pdf 5. UNGA Political declaration of the high-level meeting of the General Assembly on antimicrobial resistance 2016. Available at: http://www.un.org/pga/71/wp content/uploads/sites/40/2016/09/DGACM GAEAD ESCAB-AMR-Draft-Political Declaration1616108E.pdf 6. O’Neil (2015). AMR Review UK Report. Available at : https://amr-review.org/ 7. UNAS (2015). Antibiotic Resistance in Uganda: Situational Analysis and Recommendations. Prepared by Mpairwe Yusuf, Wamala Samuel and GARP-Uganda Working Group. 8. Re Act Toolbox. Available at: www.reactgroup.org/toolbox 9. Uganda One Health Strategic Plan 2018-2022 http://www.fao.org/3/a-i5996e.pdf http://www.fao.org/3/a-i5996e.pdf http://www.fao.org/3/a-i5996e.pdf http://www.oie.int/fileadmin/Home/eng/Media Center/docs/pdf/PortailAMR/EN OIE-AMRstrategy.pdf http://www.oie.int/fileadmin/Home/eng/Media Center/docs/pdf/PortailAMR/EN OIE-AMRstrategy.pdf http://www.oie.int/fileadmin/Home/eng/Media Center/docs/pdf/PortailAMR/EN OIE-AMRstrategy.pdf http://www.oie.int/fileadmin/Home/eng/Media Center/docs/pdf/PortailAMR/EN OIE-AMRstrategy.pdf http://www.who.int/drugresistance/WHO Global Strategy English.pdf http://www.who.int/drugresistance/WHO Global Strategy English.pdf http://www.un.org/pga/71/wp-content/uploads/sites/40/2016/09/DGACM GAEAD ESCAB-AMR-Draft-Political-Declaration-1616108E.pdf http://www.un.org/pga/71/wp-content/uploads/sites/40/2016/09/DGACM GAEAD ESCAB-AMR-Draft-Political-Declaration-1616108E.pdf http://www.un.org/pga/71/wp-content/uploads/sites/40/2016/09/DGACM GAEAD ESCAB-AMR-Draft-Political-Declaration-1616108E.pdf http://www.un.org/pga/71/wp-content/uploads/sites/40/2016/09/DGACM GAEAD ESCAB-AMR-Draft-Political-Declaration-1616108E.pdf http://www.un.org/pga/71/wp-content/uploads/sites/40/2016/09/DGACM GAEAD ESCAB-AMR-Draft-Political-Declaration-1616108E.pdf https://amr-review.org/ http://www.reactgroup.org/toolbox Uganda National Action Plan for Antimicrobial Resistance 76 Appendix 1: Detailed Monitoring and Evaluation Matrix The following M&E matrix provides the framework for a more specific and detailed targets for monitoring the implementation of the plan. It was developed basing on the WHO recommended templates which enables a more uniform and standard way to monitor the AMR NAP implementation across countries. The table therefore provides the indicators for each target as defined in the implementation plan against the baseline values and proposes performance values either as proportions of the targets or yes or no statements, as well as the frequency of data collection, suggested data sources, and means of verification. It should be noted that most the baseline values were not accurately defined at the time of the design of this plan and it is expected that first activity in the M&E process will be to establish those baselines values (where there was no data available, or verify the estimates provided) against which progress will be measured. Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline Strategic Objective 1: Public Aware ness and professional competencies in AMR improved Desired Outcome: increase in (1) Proportion of the public aware and knowledgeable on AMR, (2) Pro portion of professional healthcare workers who know about AM R Objective 1: Public Awareness improved Desired Outcome: increase in (1) proportion of public who know use of antibiotics causes resistance (2) Proportion of the public of the not self-medicating (animal and humans) Output 1.1 Coordinated communication and public awareness on AMR Indicator: A national coordination (PATE) committee in place 1.1.1 Establish a Technical Working Committee (TWC) on public awareness, training, and education, with clear terms of reference (PATE TWC) TWC formed with list of members and ToR Yes/No 1 Once Report of inauguration with list of members Observation/Document review/Key informant interview No PATE TWC Output 1.2 A comprehensive communication strategy for AMR in place Indicator: (1) A comprehensive communication strategy in place 1.2.1 Conduct a needs assessment of communications needs List of communication needs for AMR identified Yes/No 1 Once Assessment report Observation/Document review/Key informant interview No KAP study Uganda National Action Plan for Antimicrobial Resistance 77 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 1.2.2 Develop a communications strategy for the AMR NAP Strategy draft complete and approved Yes/No 1 3 meetings Draft Report Observation/Document review/Key informant interview No Communication strategy 1.2.3 Print and distribute strategy # of copies printed and distributed Proportion 5000 once Copies of the strategy and distribution list Observation/Document review/Key informant interview TBD 1.2.4 Disseminate strategy among stakeholders # of stakeholders aware of the AMR communication strategy Proportion 100 once Dissemination Report Observation/Document review/Key informant interview Draft strategy Output 1.3 Communication materials and tools for use by Indicators: Tailored communication materials on AMR for the public and farmers available different stakeholders for different communication channels and/or platforms. 1.3.1 Develop core communication messages for different stakeholders # of and type communications messages available for different stakeholders Proportion 10 Annual Copies of the messages Observation/Document review/Key informant interview TBD 1.3.2 Print and/or distribute materials and tools # of copies printed and distributed Proportion 5000 1 Copies and list of distribution list Observation/Document review/Key informant interview Drafts available 1.3.3 Disseminate materials and tools among stakeholders through mechanisms such as National and District AMR Conferences # of stakeholders with appropriate communications materials and tools Proportion 100 2 Dissemination Report Observation/Document review/Key informant interview Drafts available Uganda National Action Plan for Antimicrobial Resistance 78 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline Output 1.4 Regular public awareness campaigns on antimicrobial use and resistance undertaken Indicators: Proportion of planned public awareness campaigns implemented at district and national levels 1.4.1 Conduct ToT for District health educators (including but not exclusive to DHOs, CAOs) # of district health educator trainees trained Proportion 280 7 Training reports Observation/Document review/Key informant interview Materials available 1.4.2 Conduct district-level # of health workers trained Proportion 140 Annual Training reports Observation/Document review/Key informant interview No data available communications training sessions for health and veterinary workers on AMR (including but not exclusive to DHOs, DVOs) 1.4. Organize activities to raise awareness during the World Antibiotic Awareness Week # and type of activities organized Proportion 5 Annual Reports Observation/Document review/Key informant interview No data available 1.4.4 Set up billboards along major travel routes # of Billboards set up Proportion 50 Annual Reports Observation/Document review/Key informant interview TBD 1.4.5 Print and distribute awareness raising Leaflets /flyers # of Flyers/leaflets created and delivered to regional hubs Proportion 50000 Annual Copies and distribution reports Observation/Document review/Key informant interview TBD 1.4.6 Air radio/TV segments with key messages # of Radio segments on the radio and TV Proportion 14 Annual Media monitoring reports Observation/Document review/Key informant interview TBD 1.4.7 Conduct public dramas (at major national events— Independence Day, Labor Day etc.) # of dramas conducted at national events Proportion 5 Annual Reports Observation/Document review/Key informant interview TBD Output 1.5 Awareness raising in primary, secondary and tertiary schools and other training institutions using specialized materials undertaken Indicators: 1) percentage of veterinary and health training institutions that have incorporated AMR in their core curricular, 2) proportion of primary and secondary schools incorporating AMR in health education sessions Uganda National Action Plan for Antimicrobial Resistance 79 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 1.5.1 Identify existing school health programs and determine integration of AMR messages into these. # of school health programs in which AMR has been integrated Proportion 5 Annual Copies of the new or updated reports Observation/Document review/Key informant interview TBD 1.5.2 Train focal persons at different levels and sectors of the education system # of Focal persons trained Proportion 5000 Once Training reports Observation/Document review/Key informant interview TBD 1.5.3 Disseminate materials and tools to focal persons # school focal persons to whom communications materials have been delivered Proportion 5000 Once Distribution lists to focal persons Observation/Document review/Key informant interview TBD 1.5.4 Train relevant education partners # of education partners trained on AMR issues Proportion 1000 Annual Training Report Observation/Document review/Key informant interview TBD Output 1.6 Collaboration established with NGOs, Civil Society Indicators: 1) Functional coordination forum linking stakeholders established, 2) proportion of stakeholders participating in the forum Organizations (CSOs), Faith Based Organizations (FBOs) the private sector, international organizations, law enforcement and the media to deliver messages on antimicrobial use. 1.6.1 Disseminate training materials and tools to partners # of partners to whom training materials have been delivered Proportion 100 Once Training reports Observation/Document review/Key informant interview TBD Output 1.7 Media trained to report on AMR. Indicators: 1) Percentage of media houses trained in AMR 2) Number of media practitioners trained in A MR, 1.7.1 Train media on AMR reporting # of journalists/people trained in AMR reporting Proportion 200 Annual Training reports Observation/Document review/Key informant interview TBD Uganda National Action Plan for Antimicrobial Resistance 80 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 1.7.2 Distribute communication materials and tools to the media # and type of communications materials and tools distributed to the media Proportion 200 Annual Delivery reports Observation/Document review/Key informant interview TBD Output 1.8 Networks for the dissemination of information on antimicrobial use and resistance developed. Indicators: 1) Number of functional dissemination networks established by region 1.8.1 Conduct a survey to identify existing networks to assist with dissemination of materials and tools to key List of existing and potential networks that can be used to disseminate information on AMR Yes/No 1 Annual Needs assessment report Observation/Document review/Key informant interview TBD 1.8.2 Design messages for social media networks for AMR awareness # of messages designed for social media networks Proportion 10 Annual Copies of the messages Observation/Document review/Key informant interview TBD 1.8.3 Include AMR data in weekly epidemiological reports for MoH/MAAIF #of reports that have AMR data or information included Proportion 104 Copies of the epidemiological reports Observation/Document review/Key informant interview TBD Output 1.9 Research findings translate d to popular versions and disseminated Indicators: 1) Number of Research findings translated into popular versions 2) Number of popular version research findings disseminated 1.9.1 Periodically review research findings and translate them into popular versions # of Popular versions of research synthesis published Proportion unlimited Annual Copies of synthesized versions Observation/Document review/Key informant interview TBD 1.9.2 Share latest research with relevant policymakers Amount of policy relevant information shared with policy makers Proportion 1 monthly Copies of materials shared with policy makers Observation/Document review/Key informant interview TBD Uganda National Action Plan for Antimicrobial Resistance 81 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline Objective 2: Support Education and Training of Human, Animal and Environmental Health Professionals Desired Outcome: (1) increased proportion of health care workers, animal and environmental professionals demonstrating AMR competencies (under development). Output 2.1 AMR courses for under and graduates on AMR prevention and containment developed Indicators: (1) Proportion of undergraduate and postgraduate courses with updated AMR content 2.1.1 Conduct a needs assessment of AMR-related Assessment conducted Yes/No Once Assessment report Observation/Document review/Key informant interview No data available gaps in the education system at different levels 2.1.2 Conduct a dissemination workshop on the e needs assessment findings to relevant educational and curriculum approval bodies Workshop held Yes/No 1 Disseminati on meeting report Observation/Document review/Key informant interview TBD 2.1.3 Conduct workshops to review or update curriculums based on gaps identified in needs assessment Meetings held Yes/No 8 Meeting reports with Updated curricula Observation/Document review/Key informant interview 50% content existing 2.1.4 Conduct training workshops for educators Number of trainings Yes/No 4 Training reports with list participants Observation/Document review/Key informant interview No data available 2.1.5 Convene training workshops of health professionals on AMR Workshop held Yes/No 1 Disseminati on meeting report Observation/Document review/Key informant interview TBD Uganda National Action Plan for Antimicrobial Resistance 82 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 2.2.1 Conduct a needs assessment for AMR related gaps in CPD trainings for relevant professions Assessment conducted Yes/No once Assessment report Observation/Document review/Key informant interview No data available 2.2.2 Convene a meeting to share findings of needs assessment in stakeholder dissemination meetings Meeting held Yes/No 5 Meeting reports Observation/Document review/Key informant interview TBD 2.2.3 Conduct meetings to develop training manuals of health professional CPD on AMR Meetings held Yes/No 1 Sensitizatio n meeting reports Observation/Document review/Key informant interview TBD 2.2.4 Conduct sensitization sessions for relevant professional boards and councils and facilitate revision of guidelines for prescriptions Sensitizatio n sessions held Yes/No 7 (I per region) Training workshops reports Observation/Document review/Key informant interview TBD Strategic Objective 2: Improved Infection Prevention and Control Desired Outcome: Reduction in incidence of infections in health facilities, farms & communities, and overall environmental contamination Objective 3: Strengthen Infection Prevention and Control Programs in Healthcare Facilities Desired Outcome: Reduction in incidence of healthcare acquired infections Output 2.1 Strengthened coordination mechanisms for infection prevention and control Indicators: A functional national coordination IPC TWC committee in place 3.0.1 Establish a Technical Working Group (TWC) on Infection Prevention and Control (IPC TWC) with TORs ToR signed, TWC formed with list of members Yes/No 1 1 NAMRS C minutes Observation/Document review/Key informant interview None Output 3.1 Updated national infection prevention and control manuals and guidelines disseminated Indicators: Pr oportion of health facilities with updated IPC manuals Uganda National Action Plan for Antimicrobial Resistance 83 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 3.1.1 Update the IPC policy Updated IPC policy Yes/No 1 Once Function al TWC with TOR, TWC Meeting minutes Observation/Document review/Key informant interview TBD 3.1.2 Revise IPC manual for infection prevention control Updated IPC manual for approved health facility structural designs Yes/No 1 Once Updated IPC policy Observation/Document review/Key informant interview 3.1.3 Print and distribute IPC Guidelines # of copies of the Guidelines printed and distributed Yes/No 4000 once Printed copies and distribution reports Observation/Document review/Key informant interview 3.1.4 Disseminate IPC and standards of professional practice guidelines at all health-care facilities # of health workers to whom the guidelines have been disseminated by facility Yes/No 5000 once Dissemination reports Observation/Document review/Key informant interview TBD Output 3.2 IPC compliant infrastructure in healthcare facilities Indicators: Proportion of health facilities with IPC compliant infrastructure 3.2.1 Undertake an assessment of the current status and needs of IPC in health facilities Baseline and needs for IPC at health facilities Yes/No 3584 annually Baseline report Observation/Document review/Key informant interview TBD 3.2.2 Update guidelines for health care facility infrastructure that support minimum IPC standards IPC compliant Infrastructure Guidelines Yes/No 1 once IPC compliant Infrastructure Guidelines Observation/Document review/Key informant interview TBD Uganda National Action Plan for Antimicrobial Resistance 84 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 3.2.3 Disseminate the guidelines # of stakeholders knowledgeable about the IPC guidelines Yes/No 500 once Dissemination reports Observation/Document review/Key informant interview TBD 3.2.4 Undertake support supervision to support implementation of IPC at health facility level # health facilities supported Yes/No 3584 annually Supervision reports Observation/Document review/Key informant interview TBD Output 3.3: Functional IPC committees in healthcare Facilities. Indicators: Proportion of healthcare facilities with functional IPC committees ( N= 3584) 3.3.1 Setup functional IPC committees with TORs # of health Facilities with Functional IPC committees Yes/No 3584 annually List of IPC committees and meeting minutes Observation/Document review/Key informant interview TBD 3.3.2 Train IPC committee members on their functions # of MTC members by facility trained Yes/No 3584 annually Training report with list of participants Observation/Document review/Key informant interview TBD 3.3.3 Regularly undertake performance monitoring and mentoring of the IPC committee members # of MTC members by facility mentored Yes/No 3584 annually Monitoring reports Observation/Document review/Key informant interview TBD Output 3.4 Guidelines for limiting the spread of multi drug resistant (MDR) organisms disseminated Indicators: Proportion of healthcare facilities with MDRO control guidelines ( N=3584) 3.4.1 Update guidelines for prevention and control of MDR organisms Updated guidelines for prevention of MDR Yes/No 1 once Copies of the updated guidelines Observation/Document review/Key informant interview TBD Uganda National Action Plan for Antimicrobial Resistance 85 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 3.4.2 Print and distribute the MDR control Guidelines # of copies of the Guidelines printed and distributed Yes/No 4000 once Printed copies and distribution reports Observation/Document review/Key informant interview TBD 3.4.3 Train health care workers at facility level on the control of MDR # of health workers trained in MDR control by facility Yes/No 2000 annually Training reports with list participants Observation/Document review/Key informant interview TBD Output 3.5: Proper use of infection prevention materials and supplies Indicators: (1) Proportion of health facilities using appropriate Infection prevention materials and supplies 3.5.1 Update lists of IPC products, including equipment and supplies Updated list of IPC materials and supplies Yes/No 1 Once Updated list of IPC materials Observation/Document review/Key informant interview TBD 3.5.2 Procure and distribute in a timely manner IPC supplies and equipment at health care facilities List of IPC supplies, materials and equipment procured by facility Yes/No assorted annually Delivery reports Observation/Document review/Key informant interview TBD Outputs 3.6: Timely diagnosis and treatment of drug-resistant microorganisms Indicators: (1) Proportion of healthcare facilities timely diagnosing MDRO (2) Proportion of healthcare facilities timely treating drug-resist ant infections 3.6.1 Procure and timely distribute tools for rapid diagnosis of drug resistant organisms List of diagnosis supplies for MDR procured by facility Yes/No assorted annually Delivery reports Observation/Document review/Key informant interview TBD 3.6.2 Train health care workers at facility level on the treatment and management of patients with MDR infections # of health workers trained on the treatment and management of MDR infections Yes/No 2000 annually Training reports with list participants Observation/Document review/Key informant interview TBD 3.6.3 Procure and timely distribute drugs for treatment of MDR List drugs for treatment of MDR procured by facility Yes/No assorted annually Delivery reports Observation/Document review/Key informant interview TBD Uganda National Action Plan for Antimicrobial Resistance 86 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline Output 3.7: Adherence to standards fo r hand hygiene and other hygienic practices health care facilities Indicators: (1) Proportion of health facilities adhering to standards of hand hygiene and other hygienic practices 3.7.1 Train health care workers at facility level on hand hygiene and other hygienic practices and # of health workers to whom the guidelines have been disseminated by facility Yes/No 7168 annually Training reports with list Observation/Document review/Key informant interview TBD behaviors that prevent transmission of infectious diseases participants 3.7.2 Undertake health talks to patients about IPC behaviours to protect themselves from acquisition and transmission of infectious diseases # Health talks to patients conducted Yes/No 10000 annually Training reports with list participants Observation/Document review/Key informant interview TBD 3.7.3 Train personnel on correct use of Personal Protective Equipment and materials for standard and transmission based precautions # Health workers trained on PPE use Yes/No 14336 annually Supervision reports Observation/Document review/Key informant interview TBD Output 3.8: Increased awareness about IPC at healthcare facilities Indicators: Proportion of healthcare facilities with workers adhering to IPC guidelines 3.8.1 Train health care workers on IPC # Health workers trained on IPC Yes/No 14336 annually Training reports with list participants Observation/Document review/Key informant interview TBD 3.8.2 Undertake support supervision visits to reinforce infection control practices # healthcare facilities supported Yes/No 3854 annually Supervision reports Observation/Document review/Key informant interview TBD Uganda National Action Plan for Antimicrobial Resistance 87 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline Output 3.9: IPC good practices included as criteria for rewards and sanctions in health care facilities Indicators: Proportion of healthcare rewards and sanctions committees that have included IPC good practices as a criteria 3.9.1 Develop guidelines for awards Guidelines available Yes/No 1 once Copies of the guideline s Observation/Document review/Key informant interview TBD 3.9.2 Provide incentives for operationalizing the awards List and type of incentives Yes/No assorted annually Report about the incentive s Observation/Document review/Key informant interview TBD Output 3.10: Safe waste disposal and waste treatment practices in healthcare facilities improved Indicators: Proportion of health care facilities with safe waste disposal and waste treatment practices 3.10.1 Train health care workers on safe waste disposal and waste treatment practices for healthcare workers. # of health care workers trained on waste disposal Yes/No 14336 annually Training reports with list participants Observation/Document review/Key informant interview TBD Output 3.11 Functional Communication platforms for IPC related committees at all health care administrative levels in place Indicators: Percentage of health care administrative levels with functional communication platforms for IPC 3.11.1 Establish a communication platform among IPC related # of Communication platforms established by facility Yes/No 3854 annually Reports/ minutes of joint meetings Observation/Document review/Key informant interview TBD committees e.g. medicines & therapeutics committee, AMR stewardship committee, infection prevention Control committee, Laboratory Committee and Clinical Committee 3.11.2 Develop guidelines for the functioning of the communication platform Guidelines for the communication platform in place Yes/No 1 annually Copies of the guidelines Observation/Document review/Key informant interview TBD Uganda National Action Plan for Antimicrobial Resistance 88 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 3.12 Improve health worker knowledge and skills on IPC Indicators: percentage of health workers in a facility with competencies to implement IPC 3.12.1 Conduct survey on training needs for health professionals regarding IPC Baseline and needs for health professionals regarding IPC Yes/No 1 annually Baseline report Observation/Document review/Key informant interview TBD 3.12.2 Conduct regular continued profession development (CPD) training regarding IPC # of health workers undertaking CPDs on IPC and how many Yes/No 2000 annually Training reports with list participants Observation/Document review/Key informant interview TBD 3.12.3 Integrate IPC content in the curriculum/education for all health training institutions # of revised curricula in health training institutions that reflects IPC strategies Yes/No 5 Once Copies of the revised curricula Observation/Document review/Key informant interview TBD Objective 4: Promote Infection Prevent ion and Control Practices in Communities Desired Outcome: (1) Reduced in incidence of infections in the community Output 4.1 IEC/BCC tools on IPC in communities, including schools and public places disseminated. Indicators: Proportion of sub counties with IEC materials in local language 4.1.1 Undertake a survey on the knowledge/attitudes/ perceptions and practices in the community Baseline IPC knowledge/attitudes/ perceptions and practices in the community and their needs Yes/No 1 annually Baseline report Observation/Document review/Key informant interview TBD 4.1.2 Develop tools for information, education and # of tools developed Yes/No 5 one Copies of the IEC tools Observation/Document review/Key informant interview TBD Uganda National Action Plan for Antimicrobial Resistance 89 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline Communication/behavior change communication on IPC in communities, including schools and public places. behavioral change communication strategy 4.1.3 Dissemination of information on infection control in the community # and type of public awareness campaigns conducted Yes/No 500 annually Dissemination meeting report Observation/Document review/Key informant interview TBD 4.2.3 Develop minimum standards for food hygiene, handling and preparation Guideline for food hygiene, handling and preparation developed Yes/No 1 annually Copies of the guidelines Observation/Document review/Key informant interview TBD Output 4.2: Adherence to food hygiene guidelines by food handlers Indicators: Proportion of public places adhering to recommended food hygiene practices 4.2.1 Train food vendors and supervisors for proper food handling practices # of food vendors and supervisors trained Yes/No 5000 annually Training reports with list participants Observation/Document review/Key informant interview TBD 4.2.2 Enforce regular checkups of food handlers for infectious diseases of public health importance related to food # of food vendors and supervisors examined for infectious diseases and how often Yes/No 5000 annually Medical examination reports Observation/Document review/Key informant interview TBD 4.2.4 Undertake food inspection of foods and food products for public consumption # of facilities inspected and how often Yes/No annually Inspection reports Observation/Document review/Key informant interview TBD Output 4.3: Communities with adequate access clean and safe water throughout the country. Indicators: Proportion of communities with access to safe water within 1 km Uganda National Action Plan for Antimicrobial Resistance 90 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 4.3.1 Carry out a baseline to obtain information on safe water usage in relation infection control and prevention is concerned Baseline on water safety Yes/No 1 Once Baseline report Observation/Document review/Key informant interview TBD 4.3.2 Increase safe water coverage in communities # of new safe water sources put in place Yes/No each community annually Report Observation/Document review/Key informant interview TBD 4.3.3 Review standards and guidelines for assessing water safety in the context of AMR Guidelines Yes/No 1 Once Copies of the guidelines Observation/Document review/Key informant interview TBD 4.3.4 Conduct periodic water safety analyses at consumption points #of water consumption points assessed for safety Yes/No 2000 annually Analysis reports Observation/Document review/Key informant interview TBD Output 4.4: Safe waste disposal and waste treatment Practices. Indicators: Proportion of communities practicing safe waste disposal and waste treatment 4.4.1 Review and update IEC materials on safe waste disposal Set of updated IEC waste disposal IEC materials Yes/No 1 Once Copies of IEC Observation/Document review/Key informant interview TBD 4.4.2 Procure and make available waste disposal materials for infectious wastes wherever generated List of waste disposal materials by facility Yes/No assorted annually Delivery reports Observation/Document review/Key informant interview TBD 4.4.3 Conduct training of trainers (TOT) for waste handlers # of trainee trainers trained in waste handling Yes/No 500 annually Training reports with list participants Observation/Document review/Key informant interview TBD 4.4.3 Conduct mentorships sessions for waste handlers # of health facilities mentored in waste disposal Yes/No 1740 annually Mentorship reports Observation/Document review/Key informant interview TBD 4.4.4 Set up health care waste treatment facilities at each health facility # of health care waste treatment facilities by facility Yes/No 3854 annually Reports Observation/Document review/Key informant interview TBD Uganda National Action Plan for Antimicrobial Resistance 91 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline Output 4.5: Reduced transmission of A MR at the household level. Indicators: Proportion of household transmissions of resistant infections 4.5.1 Sensitization of the public on AMR # and type of public awareness campaign conducted Yes/No 1000 annually Reports of the campaign Observation/Document review/Key informant interview TBD 4.5.3 Contact tracing and management of patients with drug resistant Micro organisms # of patients with MDR traced and managed Yes/No 1000 annually Reports Observation/Document review/Key informant interview TBD 4.5.4 Support adherence to Antibiotic treatment at house hold level # of individuals adhering to antibiotics Yes/No annually Reports Observation/Document review/Key informant interview TBD Objective 5: Promote Farm Biosecurity Measures in Agriculture Desired Outcome: Reduced incidence of infectious diseases in animals and Agriculture Output 5.1 Biosecurity guidelines for animal farms, slaughter facilities, abattoirs and aquaculture facilities developed and disseminated Indicators: Proportion of animal farms, slaughter facilities, abattoirs and aquaculture facilities with access to the guidelines 5.1.1 Review and update biosecurity guidelines for different categories of animal farms, slaughter facilities, abattoirs and Aquaculture facilities. Updated Biosecurity guidelines Yes/No 1 Once Copies of the guideline s Observation/Document review/Key informant interview TBD 5.1.2 Print and distribute biosecurity guidelines to veterinarians and other stakeholders # of copies of the Guidelines printed and distributed Yes/No 2000 once Copies of the guideline s Observation/Document review/Key informant interview TBD 5.1.3 Sensitize stakeholders on biosecurity guidelines # of stakeholders sensitized Yes/No 5000 annually Sensitization meeting reports Observation/Document review/Key informant interview TBD Uganda National Action Plan for Antimicrobial Resistance 92 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 5.1.4 Train district veterinary officers on biosecurity guidelines # of DVOs trained Yes/No 121 annually Training reports with list participants Observation/Document review/Key informant interview TBD 5.1.5 Promote biosecurity practices on farms and animal facilities (e.g. Abattoirs) # of visits undertaken Yes/No 500 annually Reports of the visits Observation/Document review/Key informant interview TBD Output 5.2: Adherence to Hygiene, sanitation and infection prevention standards Indicators: Proportion of farms adhering to hygiene, sanitation and infection prevention standards 5.2.1 Train farmers in on farm sanitation and good hygiene practices # of farmers trained Yes/No 5000 annually Training reports with list participants Observation/Document review/Key informant interview TBD 5.2.2 Undertake regular checks on sanitation and hygiene on animal facilities and farms # of facilities and farms checked for proper hygiene and sanitation Yes/No 100 annually Inspection reports Observation/Document review/Key informant interview TBD 5.2.3 Regular checks on animal feeds for contamination # feed samples checks Yes/No 100 annually Analysis reports Observation/Document review/Key informant interview TBD Output 5.3: Food safety campaigns and programs on farms implemented. Indicators: Number of food safety campaigns targeting food safety on farms by region 5.3.1 Sensitize farmers and the general public on production of safe animals for human consumption 3 and type of public awareness campaigns conducted Yes/No 50 annually Sensitization meeting reports Observation/Document review/Key informant interview TBD Output 5.4: Adherence to biosecurity standards in in the agricultural, livestock and animal production industries Indicators: Proportion of agricultural, livestock an d animal production industries adhering to biosecurity standards Uganda National Action Plan for Antimicrobial Resistance 93 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 5.4.1 Train farmers in standard animal husbandry practices that reduce the need to use antimicrobial agents # of farmers trained Yes/No 5000 annually Training reports with list participants Observation/Document review/Key informant interview TBD 5.4.2 Provide regular advisory extension services to farmers # of extension visits undertaken Yes/No 1000 annually extension service reports Observation/Document review/Key informant interview TBD Output 5.5: Biosecurity compliant infrastructure in animal and agricultural facilities Indicators: Proportion of animal and agricultural facilities with infrastructure compliant with biosecurity standards 5.5.1 Develop/update tstandards for farm infrastructure that promote infection prevention in animal handling facilities and farms Guidelines developed/updat ed Yes/No 1 once Copies of the guidelines Observation/Document review/Key informant interview TBD 5.5.2 Print and distribute animal facility and farm infrastructure standards # of copies of the Guidelines printed and distributed Yes/No 2000 annually Copies of the guidelines Observation/Document review/Key informant interview TBD 5.5.3 Train district veterinary officers on facility and farm infrastructure Standards Guidelines disseminat ed Yes/No 121 annually Training reports with list participants Observation/Document review/Key informant interview TBD 5.5.4 Conduct regular advisory/support supervision/inspection of abattoirs/slaughter houses and aquaculture facilities # facilities and frequency of supervision Yes/No 2000 annually Supervision reports Observation/Document review/Key informant interview TBD Uganda National Action Plan for Antimicrobial Resistance 94 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline v5.5.5 Sensitize stakeholders on the need for ante-mortem and postmortem inspection # of stakeholders sensitized Yes/No 5 per year annually Sensitization meeting reports Observation/Document review/Key informant interview TBD Output 5.6: Proper use of infection prevention materials and supplies in agricultural and animal facilities Indicators: Proportion of agricultural and animal facilities using appropriate Infection prevention materials and supplies 5.6.1 Develop/disseminate guidelines for infection prevention materials for animal facilities and farms Guidelines developed Yes/No 1 annually Copies of the guidelines Observation/Document review/Key informant interview TBD 5.6.2 Sensitize farmers and animal facility operators on the guidelines # of public awareness campaigns conducted Yes/No 1000 annually Sensitization meeting reports Observation/Document review/Key informant interview TBD Output 5.7: Adherence to safe waste disposal and Waste treatment practices in agricultural and animal facilities. Indicators: Proportion of agricultural and animal facilities adhering to safe waste disposal and waste treatment standards 5.7.1 Conduct a baseline assessment of the current status of animal facility and farm waste disposal Baseline on the waste disposal at animal facility and farms Yes/No 1 annually Baseline report Observation/Document review/Key informant interview TBD 5.7.2 Develop/disseminate guidelines for safe waste disposal for animal facilities and farms Guideline developed Yes/No 1 annually Copies of the guidelines Observation/Document review/Key informant interview TBD 5.7.3 Sensitize farmers and animal facility operators on safe waste disposal and treatment practices # of farmers and animal facility operators sensitized Yes/No 1000 annually Sensitization meeting reports Observation/Document review/Key informant interview TBD Uganda National Action Plan for Antimicrobial Resistance 95 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 5.7.4 Sensitize stakeholders and farmers on animal facility and farm waste recycling # of farmers and animal facility operators sensitized Yes/No 1000 annually Sensitization meeting reports Observation/Document review/Key informant interview TBD 5.7.5 Procure incinerators for abattoirs and sick animals # of incinerators procured by facility Yes/No 20 annually Delivery reports Observation/Document review/Key informant interview TBD Objective 6: Increase and Optimize Us e of Vaccines to Prevent Infectious Diseases Desired Outcome: Reduced incidence of vaccine preventable diseases in humans and animals Output 6.1 Vaccination programs in human and animal health strengthened. Indicators: Proportion of the human and animal population vaccinated disaggregated by disease 6.1.1 Procure vaccine and supply vaccines for humans and animals # and type of vaccines procured for humans and animals Yes/No ??? annually Delivery reports Observation/Document review/Key informant interview TBD 6.1.2 Develop/review regulations for vaccinations for animals with vaccination schedules Updated animal vaccination regulations Yes/No 1 annually Copies of the regulations Observation/Document review/Key informant interview TBD 6.1.3 Conduct campaigns to provide information, awareness and schedules about vaccinations in Uganda # and type of public awareness campaign conducted Yes/No 100 annually Reports of the campaign Observation/Document review/Key informant interview TBD 6.1.3 Undertake vaccination of individuals against a broader range of diseases # of individuals vaccine by disease Yes/No ??? annually Vaccination reports Observation/Document review/Key informant interview TBD 6.1.3 Undertake vaccination of animals against a broader range of diseases # of animals vaccinate by species and by disease Yes/No ??? annually Vaccination reports Observation/Document review/Key informant interview TBD Uganda National Action Plan for Antimicrobial Resistance 96 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline Output 6.2: Countrywide coverage of vaccination Programs for vaccine preventable diseases in human s and livestock. Indicators: Proportion of the country covered by vaccination programs against vaccine preventable disease 6.2.1 Conduct a baseline assessment for animal and human vaccines program and services coverage Baseline on vaccination services Yes/No 1 annually Baseline report Observation/Document review/Key informant interview TBD 6.2.2 Develop a vaccine stock management tool to monitor vaccine stocks to prevent stock outs Tool developed Yes/No 1 annually Copy of the management tool Observation/Document review/Key informant interview TBD 6.2.3 Review vaccine schedules to optimize uptake (combination vaccines to increase uptake and reduce cost) Optimized vaccine schedule Yes/No 1 annually Copies of vaccination schedule s Observation/Document review/Key informant interview TBD 6.2.5 Support routine maintenance of a functional cold chain Functional cold chains deployed Yes/No 4 per facility per year annually reports on cold chain management Observation/Document review/Key informant interview TBD Output 6.3: Broad range of vaccines and their availability across the country. Indicators: Number of vaccines available at various healthcare facilities and veterinary offices across the country 6.3.1 Review and recommend introduction of new vaccines for both human and animals List of updated vaccines for the country Yes/No 1 annually Copies of the list of updated vaccines for the country Observation/Document review/Key informant interview TBD 6.3.2 Undertake research to measure the impact/best methods of vaccinating animals Best methods for vaccinating animals recommendations Yes/No 1 annually Copies of the report with recommendations Observation/Document review/Key informant interview TBD Uganda National Action Plan for Antimicrobial Resistance 97 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline Objective 7: Promote Optimal Prescribing and Use of antimicrobials Desired Outcome: Effectiveness and efficacy of antimicrobials preserved 7.1 Strengthened coordination mechanisms for Indicators: A functional Technical working group (ASO TWC) in place Stewardship and ensuring Optimal Use support of Antimicrobial 7.1.1 Establish a Technical Working Group Antimicrobial Stewardship and Optimal Use (ASO TWC) TWC formed withlist of members and ToR Yes/No 1 Annual Reports Observation/Document review/Key informant interview None Output 7.2: Up-to-date prophylactic, prescribing/treatment guidelines and protocols for infectious diseases in human health Indicators: Proportion of health care facilities with up-to-date Prophylactic, prescribing/treatment guidelines and protocols for infectious 7.2.1 Review and update prescribing guidelines Published review of prescription guidelines Yes/No 1 Annual Reports Observation/Document review/Key informant interview 2016 version available 7.2.2 Print and distribute the prescribing guidelines to all health facilities # guidelines printed and delivered to regional hubs Proportion 5000 Annual Reports Observation/Document review/Key informant interview 200 7.2.3 Upload updated prescribing/treatment guidelines to the MOH and NDA website Guidelines available on websites Yes/No 2 Annual Reports Observation/Document review/Key informant interview ?? 7.2.4 Training prescribers and dispensers on the guidelines #prescribers and dispensers trainees Proportion 3000 Annual Reports Observation/Document review/Key informant interview TBD 7.2.5 Activate Medicines and Therapeutic Committees (MTCs) at national and health facility levels with clear TORs # of Drug and Therapeutic Committees formed Proportion 348 Annual Reports Observation/Document review/Key informant interview TBD coordination and Strategic Objective 3: Antimicrobial Stewardship and Optimal Use Desired Outcome: Successful treatment of infectious disease Uganda National Action Plan for Antimicrobial Resistance 98 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 7.2.6 Sensitize regulatory agencies and policymakers to improve adherence to prescribing guidelines # of staff by regulatory body sensitized Yes/No 2 Annual Reports Observation/Document review/Key informant interview TBD Output 7.3: Responsible prescribing practices, Dispensing and administration principles for antimicrobials. Indicators: Proportion of health care workers adhering to prescribing practices, dispensing and administration principles 7.3.1 Organize ToT sessions for professionals in relevant Fields # of professionals trained Proportion 20 Annual Reports Observation/Document review/Key informant interview TBD 7.3.2 Conduct AMR-specific CMEs through the professional associations # of CMEs and professionals attending Proportion 25 Annual Reports Observation/Document review/Key informant interview TBD 7.3.1 Train MTCs in their functions # of MTC members by facility trained Proportion 1740 Annual Reports Observation/Document review/Key informant interview TBD 7.3.2 Regularly undertake performance monitoring and mentoring of the therapeutic Committees # of MTC members by facility mentored Proportion 348 Annual Reports Observation/Document review/Key informant interview TBD Uganda National Action Plan for Antimicrobial Resistance 99 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 7.4 Incorporate courses on antimicrobial stewardship and AMR Indicators: Proportion of health, agriculture, animal and environmental professionals practicing antimicrobial stewardship into the continuous professional development curricula for all health, agriculture, animal and environ mental professionals with a system of ensuring accountability. 7.4.1 Develop the antimicrobial stewardship working manuals and Procedures MOP developed and in place Yes/No 1 Annual Reports Observation/Document review/Key informant interview TBD 7.4.2 Print and distribute antimicrobial stewardship working manuals # of copies printed and distributed Proportion 5000 Annual Reports Observation/Document review/Key informant interview TBD 7.4.3 Tran healthcare workers on antimicrobial stewardships for both public and private workers # of health workers trained Proportion 1000 Annual Reports Observation/Document review/Key informant interview TBD 7.5 Institute/strengthen and support pro per functioning of Indicators: Proportion of health care facilities with functional MTCs Medicines and Therapeutics committee s in all health care facilities 7.5.1 Share susceptibility data regularly to inform prescription # AST reports shared by facility Proportion Monthly (12) Annual Reports Observation/Document review/Key informant interview TBD Uganda National Action Plan for Antimicrobial Resistance 100 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 7.5.2 Share regularly information on Antimicrobial use to all stakeholders # of Antimicrobial use data reports shared by facility Proportion Monthly (12) Annual Reports Observation/Document review/Key informant interview TBD 7.5.3 Provide and share other update scientific and popular literature to improve prescribing practices # of other information by type shared Proportion Monthly (12) Annual Reports Observation/Document review/Key informant interview TBD 7.6 Support the development and dissemination of antimicrobial stewardship working manuals and procedures. Indicators: (1) Up-to-date antimicrobial manuals and procedures (2) Proportion of health care workers with the manuals 7.6.1 Develop the antimicrobial stewardship working manuals and procedures MOP developed and in place Yes/No 1 Annual Reports Observation/Document review/Key informant interview TBD 7.6.2 Print and distribute antimicrobial stewardship working manuals # of copies printed and distributed Proportion 20 Annual Reports Observation/Document review/Key informant interview TBD 7.6.3 Tran healthcare workers on antimicrobial # of health workers trained Proportion 1000 Annual Reports Observation/Document review/Key informant interview TBD Stewardships for both public and private workers 7.7 Provide up-to-date and unbiased medicine Information services to human and animal health providers. Indicators: Proportion of human and animal health providers accessing up-to-d ate medical information Uganda National Action Plan for Antimicrobial Resistance 101 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 7.7.1 Share susceptibilitydata regularly to inform prescription # AST reports shared by facility Yes/No Monthly (12) Annual Reports Observation/Document review/Key informant interview TBD 7.7.2 Share regularly information on Antimicrobial use to all stakeholders # of Antimicrobial use data reports shared by facility Monthly (12) Annual Reports Observation/Document review/Key informant interview TBD 7.7.3 Provide and share other update scientific and popular literature to improve prescribing practices # of other information by type shared Yes/No Monthly (12) Annual Reports Observation/Document review/Key informant interview TBD Output 7.8: Strengthened supervision of prescribing and dispensing outlets for human and animal antimicrobials Indicators: Proportion of prescribing and dispensing outlets for human and animal antimicrobials adhering to guidelines and standards 7.8.1 Develop a tool for more efficient supervision and monitoring of healthcare facilities and pharmacies/drug stores Supervision tool developed Yes/No 1 Once Copy of the tool Observation/Document review/Key informant interview TBD 7.8.2 Train professional councils and licensing organs on supervision and monitoring dispensing outlets # of members by organ trained Proportion 348 Annual Training reports with list of participants Observation/Document review/Key informant interview TBD Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 7.8.3 Conduct CMEs to improve prescription and good pharmacy practice for health and veterinary prescribers # of CMEs and health and veterinary prescribers trained Proportion 1 Annual Training reports with list of participants Observation/Document review/Key informant interview TBD 7.8.4 Review and update regulations on prescription of antimicrobials Updated guideline Yes/No 12 (monthly) Once Training reports with list of participants Observation/Document review/Key informant interview TBD 7.8.6 Develop digital/manual tools for tracking and tracing prescriptions at dispensing facilities Digital tool for tracking prescriptions Yes/No 5 (one per annum Once Copy of the tool Observation/Document review/Key informant interview TBD 7.8.7 Disseminate the tools for tracking and tracing prescriptions # of persons knowledgeable about the tools Proportion 1000 Annual Dissemination reports Observation/Document review/Key informant interview TBD Output 7.9: Incentives and reward systems for excellence in adherence to best practices and standards Indicators: Proportion of healthcare rewards and sanctions committees that have included prescribing practices as a criteria 7.9.1 Develop tools for the Licensing bodies and Professional Councils to track performance of adherence to best practices and standards Uganda National Action Plan for Antimicrobial Resistance 102 Performance monitoring tool Yes/No 1 Once Copy of the tool Observation/Document review/Key informant interview None Uganda National Action Plan for Antimicrobial Resistance 103 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 7.9.2 Develop guidelines for award of incentives for excellence in prescription practices Guideline Yes/No 1 Once Copy of the Guideline Observation/Document review/Key informant interview None Output 7.10: Functional stewardship committees at all health care facilities Indicators: Proportion of health care facilities with functional stewardship committees 7.10.1 Develop procedures and protocols for antimicrobial prescriptions at both public and private facilities MOP Yes/No 1 Departments of Clinical services Cope of the manual Observation/Document review/Key informant interview None (MOH), UNHLS 7.10.2 Establish stewardship committees at health care facilities Stewardship committees Proportion 348 Hospital Administration List of members and minutes Observation/Document review/Key informant interview TBD 7.10.3 Update National guidelines for handling resistant microorganism to prevent transmission MOP Yes/No 1 Departments of Clinical services (MOH), UNHLS Copy of the MOP Observation/Document review/Key informant interview TBD 7.10.4 Integrate data from different committees (IPC, MTC, QA etc.) to inform best practices for containment of resistant organisms at health facilities Integrated data Yes/No 12 (monthly) Departments of Clinical services (MOH), UNHLS Reports Observation/Document review/Key informant interview TBD Uganda National Action Plan for Antimicrobial Resistance 104 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 7.10.5 Develop a tool for auditing antimicrobial prescriptions practices at health care facilities Audit tool Yes/No 1 Departments of Clinical services (MOH), UNHLS Copy of the tool Observation/Document review/Key informant interview TBD 7.10.7 Conduct audits of antimicrobial prescriptions practices at health care facilities Facilities adhering to prescription guidelines Proportion 5 (one per annum Departments of Clinical services (MOH), UNHLS Reports Observation/Docum ent review/Key informant interview TBD 7.10.8 Training prescribers, pharmacists, nurses, and laboratory personnel about good antimicrobial prescribing practices and antimicrobial resistance Prescribing professionals trained Proportion 1000 Departments of Clinical services (MOH), UNHLS Training reports with list of participants Observation/Docum ent review/Key informant interview TBD Objective 8: Optimize Access to Effective Antimicrobial Medicines and Diagnostics in Human and Animal Health Desired Outcome: Effective and timely treatment of infectious diseases Output 8.1: Affordable and accurate diagnostic tools available at all health facilities Indicators: Proportion of healthcare facilities with diagnostic tools 8.1.1 Procure adequate diagnostic tools (equipment, supplies, services) for infectious diseases at both public and private facilities and animal health facilities Amount of supplies/equipment delivered by category by facility Proportion assorted Annual Reports Observation/Document review/Key informant interview TBD Uganda National Action Plan for Antimicrobial Resistance 105 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 8.1.2 Establish a subcommittee that evaluates/recommends appropriate/affordable and accurate diagnostic tools # Committees with list of members established by facility Proportion 348 Annual Reports Observation/Document review/Key informant interview TBD Output 8.2: Financing mechanisms for antimicrobial medicines or preventative AMR programmes enhanced Indicators: Proportion of the medicine budget allocated to financing antimicrobials medicine 8.2.2 Lobby for financing for adequate antibiotics at all health care facilities Amount of funds available for antibiotics Proportion TBD Annual Reports Observation/Document review/Key informant interview TBD Output 8.3: Timely and efficient distribution mechanisms for provision of antimicrobials to health care providers Indicators: Proportion of deliveries of antimicrobials to health care facilities do ne on time 8.3.1 Identify best practices for efficient medicines distribution system Report of best practices available Yes/No 1 Annual Reports Observation/Document review/Key informant interview TBD 8.3.2 Integrate antimicrobials into the commodities security group activities to ensure efficiency in supply chain management of antimicrobials Updated commodity activity plan Yes/No 1 Annual Reports Observation/Document review/Key informant interview TBD 8.3.3 Adopt digital automated system for timely ordering of drugs # of health facilities with digital drug ordering system Yes/No 1 Annual Reports Observation/Document review/Key informant interview TBD Uganda National Action Plan for Antimicrobial Resistance 106 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 8.3.4 Train distributors and health workers (from both public and private sector) on distribution mechanisms of antimicrobials # trained Proportion 1000 Annual Reports Observation/Document review/Key informant interview TBD Output 8.4: Supply chain management for antimicrobials at the national, regional and local levels improved Indicators: Proportion of facilities having all the required antimicrobials procured and available on time 8.4.1 Train suppliers of antimicrobials at national levels in efficient supply chain management # supplies managers trained at national level Proportion 50 Annual Reports Observation/Document review/Key informant interview TBD 8.4.2 Train health facility # of procurement officers trained by facility Proportion 348 Annual Reports Observation/Document review/Key informant interview TBD procurement officers in procurement management of antimicrobials to ensure availability of appropriate antimicrobials and related supplies 8.4.3 Train facility pharmacists in antimicrobial chain management and forecasting of need antimicrobials at their facilities Output 8.5: Capacity of local producer s/manufacturers of antimicrobials enhanced. Indicators: Proportion of local antimicrobial manufacturers with increased capabilities Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 8.5.1 Provide incentives (e.g. tax # incentives by type provided Yes/No 5 Annual Reports Observation/Document review/Key informant interview TBD holidays and BUBU) for local productions of antimicrobials and compliance with standards of current good manufacturing practices 8.5.2 Train local producers of antimicrobials in compliance with standards of current good manufacturing practices 3 of producers trained Proportion 100 Annual Reports Observation/Document review/Key informant interview TBD 8.5.3 Train regulators to enhance turnaround time for registration process for local Products # of staff by organization trained Proportion 50 Annual Reports Observation/Document review/Key informant interview TBD Objective 9: Promote Access to and Prudent Use of Antimicrobials in Agriculture and Veterinary Medicine Desired Outcome: Effective and timely treatment of infectious diseases in animals and agriculture Output 9.1: Up-to-date prescription guidelines Indicators: Proportion of health care facilities with up-to-date prescription guidelines 9.1.1 Develop Prescribing/treatment guidelines in animals Prescribing/treatment guidelines in animals developed Yes/No 1 Annual Reports Observation/Document review/Key informant interview TBD 9.1.2 Print and distribute the prescribing guidelines to all health facilities Uganda National Action Plan for Antimicrobial Resistance 107 # guidelines printed and delivered to regional hubs Proportion 5000 Annual Reports Observation/Document review/Key informant interview TBD Uganda National Action Plan for Antimicrobial Resistance 108 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 9.1.3 Train veterinarians on prescription guidelines # of veterinarians trained Proportion 500 Annual Reports Observation/Document review/Key informant interview TBD 9.1.4 Share digital animal prescribing guidelines to improve the usability Digital guidelines available Yes/No 5 Annual Reports Observation/Document review/Key informant interview TBD Output 9.2: Up-to-date antimicrobial stewardship working manuals and procedures for the agriculture and veterinary sector Indicators: Proportion of agriculture and veterinary practitioners with up-to-date antimicrobial stewardship working manuals and procedures 9.2.1 Develop antimicrobial stewardship programs for the agriculture and veterinary practice MOP available Yes/No 1 Annual Reports Observation/Document review/Key informant interview TBD 9.2.2 Print and distribute antimicrobial stewardship working manuals # MOPs printed and delivered Proportion 5000 Annual Reports Observation/Document review/Key informant interview TBD 9.2.3 Train veterinary and agriculture practitioners on antimicrobial stewardships for both public and private practitioners # of veterinarians and agricultural practitioners trained Proportion 500 Annual Reports Observation/Document review/Key informant interview TBD Output 9: Restricted broad or generalized use of antimicrobials as growth promoters or as feed additives Indicators: pro portion of feed manufacturers not u sing antimicrobials in feeds 9.3.1 Conduct a risk assessment on the use of growth promoters and use of antimicrobial agents as feed additives Risk Assessment Report with identified risks Yes/No 1 Annual Reports Observation/Document review/Key informant interview TBD Uganda National Action Plan for Antimicrobial Resistance 109 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 9.3.2 Develop regulations/guidelines on the use of growth promoters and use of microbial agents as feed additives Regulations and guidelines developed Yes/No 1 Annual Reports Observation/Document review/Key informant interview TBD 9.3.4 Print and distribute the regulation/guidelines on growth promoters and feed additives # guidelines printed and delivered Proportion 5000 Annual Reports Observation/Document review/Key informant interview TBD 9.3.5 Sensitize farmers /animal health professionals and feed producers on growth promoters # of farmers and professionals sensitized Proportion 1000 Annual Reports Observation/Document review/Key informant interview TBD Output 9.4: Supply chain and use of antimicrobials in agriculture and veterinary medicine strengthened. Indicators: Proportion of agriculture and veterinary practitioners adhering to the regulations 9.4.1 Conduct a situational analysis of the existing regulations and their implementation / Enforcement Baseline status of regulations Yes/No 1 Annual Reports Observation/Document review/Key informant interview TBD Uganda National Action Plan for Antimicrobial Resistance 110 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline # of drug dealers trained Yes/No 1 Annual Reports Observation/Document review/Key informant interview t TBD 9.4.2 Train drug supplier, pharmacists, veterinarians and agricultural suppliers to in supply chain management of the agricultural and veterinary antimicrobials 9.4.3 Train drug distributors and animal health workers on distribution mechanisms of antimicrobials Objective 10: Promote Use of Quality, Safe and Efficacious antimicrobial agents Desired Outcome: Effective treatment of infectious diseases Output 10.1: Licensing, approval, regulation and oversight over the antimicrobial supply chain (pharmaceutical manufacturers, distributors, importation, wholesalers and retailers) strengthened Indicators: Proportion of players in the antimicrobial supply chain adhering to standards and guidelines 10.1.1 Retrain NDA staff to improve efficiency in their oversight function for to undertake their regulatory functions # of staff recruited Proportion 100 Annual Reports Observation/Document review/Key informant interview TBD 10.1.2 Procure and install automated system for improving processes # Automated system procured and installed Yes/No 6 Annual Reports Observation/Document review/Key informant interview TBD 10.1.3 Sensitize the public on NDA regulations to increase compliance # of people in the public aware of regulation related to antimicrobials Proportion 5000 Annual Reports Observation/Document review/Key informant interview TBD Output 10.2: Capacity for regular quality assessment of antimicrobial agents in the NDA quality laboratories strengthened. Indicators: Number of analyses under taken in a y ear and Rate of turnaround time for analyses Uganda National Action Plan for Antimicrobial Resistance 111 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 10.2.1 Procure supplies and equipment for testing quality of antimicrobials Amount of supplies/equipment Procured and delivered by facility Yes/No assorted Annual Reports Observation/Document review/Key informant interview TBD 10.2.2 Collaboration with external laboratories for testing quality of antimicrobials # of MOU Yes/No 5 Annual Reports Observation/Document review/Key informant interview TBD 10.2.3 Undertake routine QA/QC checks for sustained compliance to WHO prequalification in chemical analysis and relevant international standards # of QA/QC checks conducted Yes/No 4 Annual Reports Observation/Document review/Key informant interview TBD 10.2.4 Undertake infrastructure improvements for NDA quality control lab Renovated laboratory facilities Yes/No 1 Annual Reports Observation/Document review/Key informant interview TBD 10.2.5 Procure and install a laboratory information management system (LIMS) LIMS procured and installed Yes/No 1 Annual Reports Observation/Document review/Key informant interview TBD Output 10.3: Improved supervision of Pharmacies Indicators: Proportion of pharmacy outlets adhering to GPP 10.3.1 Conduct inspections on pharmacies against GPP and establish compliance to OTC and self-medication prescribing # of Pharmacies complying with GPP Yes/No quarterly Annual Reports Observation/Document review/Key informant interview TBD Output 10.4: Over-the-counter availability and self medication with antimicrobial medicines adherence to regulations improved Indicators: Proportion of drug outlets adhering to regulations regarding OTC 10.4.1 Enforce compliance to OTC dispensing guidelines # of facilities adhering to OTC guidelines Yes/No quarterly Annual Reports Observation/Document review/Key informant interview TBD Uganda National Action Plan for Antimicrobial Resistance 112 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline Output 10.5 Strengthened regulation of the pharmaceutical companies and adherence to Good Manufacturing Practices Indicators: Proportion of pharmaceutical companies adhering to GMPs 10.5.1 Establish Harmonization mechanisms with WHO and other NDA on the compliance assessments for pharmaceutical companies # of MOUs Yes/No 3 Annual Reports Observation/Document review/Key informant interview TBD Output 10.6: Strengthened regulation of the pharmaceutical and antimicrobial waste Indicators: Proportion of facilities adhering to guidelines for pharmaceutical and antimicrobial waste disposal 10.6.1 Develop guidelines for disposal of pharmaceutical and antimicrobial waste by the health facilities and general public Guidelines for waste disposal available Yes/No 1 Annual Reports Observation/Document review/Key informant interview TBD 10.6.2 Print and disseminate disposal guidelines # of copies printed and distributed Proportion 500 Annual Reports Observation/Document review/Key informant interview TBD 10.6.3 Sensitize pharmacies and drug dealers on pharmaceutical waste disposal # of drug dealers knowledgeable about pharmaceutical waste disposal Proportion 500 Annual Reports Observation/Document review/Key informant interview TBD Strategic Objective 4: Surveillance Desired Outcome: Early detection and response to emerging MDR problems Objective 11: Support Surveillance of AMR Desired Outcome: Evidence-based decision on AMR Output 11.1 A national AMR surveillance programme in place Indicators: A fully functional surveillance programme 11.1.1 Establish a national Technical Working Group (TWC) for AMR surveillance (SURV TWC) SURV TWC formed with list of members and ToR Yes/No 1 Once UNAMR C meeting minutes Observation/Document review/Key informant interview SURV TWC in place Uganda National Action Plan for Antimicrobial Resistance 113 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 11.1.2 Conduct a baseline survey and needs assessment on AMR surveillance system Baseline data with list of the gaps and needs for AMR surveillance Yes/No 1 Once Baseline survey report Observation/Document review/Key informant interview 30% conducted 11.1.3 Develop an integrated AMR surveillance plan Approved integrated surveillance plan Yes/No 1 Once Copy of the plan Observation/Document review/Key informant interview 50% completed 11.1.4 Print and distribute the AMR surveillance plan # of copies printed and distributed Proportion 1000 Once Copies and delivery notes Observation/Document review/Key informant interview 0 11.1.5 Select priority surveillance sites List of prioritized list of surveillance site and harmonized methodologies Proportion 14 Once Reports Observation/Document review/Key informant interview TBD Output 11.2 SOPs and methodologies f or surveillance of AMR in place Indicators: Proportion of laboratories adhering to standard procedures to generate AST data 11.2.1 Develop a manual of SOPs for AMR surveillance Published MOP Yes/No 1 Once Copy of the MOP Observation/Document review/Key informant interview None 11.2.2 Identify priority organisms, samples and testing panels in coordination with international partners List of priority organisms, samples and testing panels Yes/No 1 Once Reports Observation/Document review/Key informant interview TBD Output 11.3: Laboratory infrastructure, human resources, supplies and equipment improved Indicators: (1) Suitable infrastructure (2) Well trained human resource (3) Suit able equipment in place 11.3.1 Undertake improvements in Infrastructure and equipment for microbiological isolation and susceptibility testing # of laboratories renovated Proportion 20 Once Renovation reports and delivery and Installation on reports of equipment Observation/Document review/Key informant interview 10% of basic facilities available Uganda National Action Plan for Antimicrobial Resistance 114 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 11.3.2 Equip laboratories microbiological isolation and susceptibility testing List of equipment for each laboratory procured and installed Yes/No 20 Once Workshop Observation/Document review/Key informant interview 10 % available 11.3.3 Train laboratory staff in logistics and supply management # of staff trained in laboratory logistics Yes/No 40 Once Delivery Reports Observation/Document review/Key informant interview 10 % have basic training 11.3.4 Procure and install a laboratory information management system (LIMS) # of LIMS copies procured and installed Yes/No 20 Once Reports Observation/Document review/Key informant interview None Output 11.4 Microbiological culture an d sensitivity tests performed routinely Indicators: Proportion of laboratories undertaking microbiological culture and AST 11.4.1 Re-train clinicians and veterinarians on appropriate sample collection and submission # of clinicians and veterinarians Proportion 70 Once Reports Observation/Document review/Key informant interview 20% knowledge able 11.4.2 Procure consumables for sample collection, microbiological materials and susceptibility testing panels and reagents List of sample collection, microbiological materials and susceptibility testing panels and reagents procured Proportion assorted Once Procurement/deli very reports of sample collection, microbiological materials and susceptibility testing panels and reagents Observation/Document review/Key informant interview 5% receive routine consumables Output 11.5: Quality assurance systems for microbiology laboratory testing in place Indicators: Proportion of laboratories with QA/QC system in place Uganda National Action Plan for Antimicrobial Resistance 115 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 11.5.1 Procure and make available control strains and reference materials List of control strains Proportion assorted Once Procurement reports of the control strains and reference materials procured and delivered to sites Observation/Document review/Key informant interview 10% available 11.5.2 Train laboratory staff, veterinarians and clinicians on quality control and quality assurance # of persons trained Proportion 100 Once Reports Observation/Document review/Key informant interview 20% knowledge able Output 11.6: Laboratories enrolled in national and international external quality assurance programs Indicators: Proportion of laboratories enrolled in external quality assurance programs 11.6.1 Accredit the participating laboratories # of laboratories accredited Proportion 20 Once Reports Observation/Document review/Key informant interview 10 % accredited by WHO SLMTA 11.6.2 Conduct annual review of the manual of SOPs Published revised MOP Yes/No 1 Once Copies Observation/Document review/Key informant interview None 11.6.3 Undertake regular supervision and mentorship of the hospital surveillance sites # sites supervised and mentored Proportion 14 Annual Meeting reports and SOP review logs Observation/Document review/Key informant interview TBD 11.6.4 Designate national microbiology reference labs List of reference laboratories with TOR Proportion 4 Once Reports Observation/Document review/Key informant interview TBD Output 11.7: Surveillance data and information disseminated to healthcare facilities Indicators: Proportion of health care and veterinary facilities utilizing AST data to inform their decision of choice of antimicrobials Uganda National Action Plan for Antimicrobial Resistance 116 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 11.7.1 Procure and install computers for data management system for sharing and disseminating information to partners # of computers procured and installed Proportion 40 Once Delivery Notes Observation/Document review/Key informant interview None 11.7.2 Train personnel on data management and reporting # of personnel trained Proportion 40 Once Reports Observation/Document review/Key informant interview 10% knowledge able 11.7.4 Share data locally, nationally and internally # of reports shared Yes/No 1 Once Reports Observation/Document review/Key informant interview None Output 11.8: One Health networks created to widely share data Indicators: Number of One Health functional networks created 11.8.1 Undertake an assessment to identify data needs for the various stakeholders to inform actions for minimizing AMR Data needs for the various stakeholders to inform actions for minimizing AMR Yes/No 1 Once Reports Observation/Document review/Key informant interview TBD 11.8.2 Develop a tool for sharing data at different levels and to different stakeholders Developed tool Yes/No 1 Once Reports Observation/Document review/Key informant interview None Output 11.9: An early warning system to monitor trends off AMR established Indicators: Proportion of facilities with an early warning system in place 11.9.1 Adopt international standards for AMR early warning Copy of the standards Yes/No 1 Once Reports Observation/Document review/Key informant interview 10% available 11.9.2 Sensitize laboratory staff, clinicians, and veterinarians on identification and evaluation of risks # of staff sensitized Proportion 100 Once Reports Observation/Document review/Key informant interview 10% aware Uganda National Action Plan for Antimicrobial Resistance 117 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 11.9.3 Compile and provide information on identified risks # risks identified routinely Yes/No 4 Once Reports Observation/Document review/Key informant interview TBD Output 11.10: Countrywide utilization of data Indicators: Proportion of health care facilities utilizing AMR data 11.10.1 Disseminate AMR data throughout the country including remote and hard to-reach areas # of reports shared Yes/No 121 Once Reports Observation/Document review/Key informant interview None Number of MDA plans with AMR as a priority in the risk register 11.11.1 Train risk registrars to incorporate risk reporting into their registers # of risk educators trained in AMR risk reporting Proportion 100 weekly Training Reports Observation/Document review/Key informant interview TBD Objective 12: Support Surveillance of Antimicrobial Use Desired Outcome: Evidence based decisions on antimicrobial use Output 12.1: A national antimicrobial use surveillance plan in place Indicators: A functional national antimicrobial use surveillance plan 12.1.1 Undertake a baseline survey and needs assessment and identify gaps for implementing an antimicrobial use surveillance plan Gaps for implementing an antimicrobial use surveillance plan Yes/No 1 Once Reports Observation/Document review/Key informant interview TBD 12.1.2 Develop an integrated antimicrobial use surveillance plan Approved published plan Yes/No 1 Once Reports Observation/Document review/Key informant interview None 12.1.3 Print and distribute antimicrobial use plan # of copies printed and distributed Proportion 1000 Once Copies Observation/Document review/Key informant interview None 12.1.4 Disseminate the national surveillance of antimicrobial use plan # of stakeholders knowledgeable of the plan Proportion 200 Once Distribution Lists Observation/Document review/Key informant interview None Output 12.2: Procedures and methodologies for monitoring antimicrobials developed Indicators: Proportion of facilities with and using standard procedures to monitor antimicrobial use Uganda National Action Plan for Antimicrobial Resistance 118 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 12.2.1 Develop and manual of procedures and methodologies for routine monitoring antimicrobial use Published MOP Yes/No 1 Once Reports Observation/Document review/Key informant interview None 12.2.3 Train hospital, pharmacy and veterinary staff to collect and share antimicrobial use data routinely # of health professionals trained # of risk events shared 1000 Once Reports Observation/Document review/Key informant interview 5% knowledge able 12.2.2 Collect, collate and share antimicrobial use data regularly # antimicrobial use data shared # of risk events shared 1000 Once Reports Observation/Document review/Key informant interview None Output 12.3: Robust data on prescribing practices, dispensing practices, client/community use genera ted Indicators: Proportion of facilities generating prescribing practices, dispensing practices data 12.3.1 Identify antimicrobial use and practice indicators Antimicrobial use and practice indicators Yes/No 1 Once Reports Observation/Document review/Key informant interview None 12.3.2 Develop a manual of procedures for monitoring prescription and dispensing practices Published MOP Yes/No 1 Once Copies Observation/Document review/Key informant interview None 12.3.3 Regularly collect data on prescribing and dispensing practices Data on prescribing and dispensing practices shared Yes/No 12 Annual Reports Observation/Document review/Key informant interview None Output 12.4: Antimicrobial use data generated and shared Indicators: Proportion of facilities generating antimicrobial use data 12.4.1 Undertake regular data collection on antimicrobial access and use # of Published Reports Proportion 1000 Annual Reports Observation/Document review/Key informant interview None 12.4.2 Analyze and share data with relevant stakeholders # of Published report Proportion 4 Once Reports Observation/Document review/Key informant interview None Output 12.5: Data on impact of pharmaceutical promotion on antimicrobial use generated Indicators: A mount of data about imp act of pharmaceutical promotion 12.5.1 Develop tools for monitoring the impact of pharmaceutical promotion Approved and disseminated tools Yes/No 1 Once Tools and report Observation/Document review/Key informant interview None Uganda National Action Plan for Antimicrobial Resistance 119 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 12.5.2 Collect, evaluate, and disseminate data on the impact of pharmaceutical promotion on antimicrobial use # of Published Report Yes/No 4 Annual Reports Observation/Document review/Key informant interview None Objective 13: Support Surveillance for Antimicrobial Drug Residues in Foods Desired Outcome: Reduced levels of antimicrobial drug residues in foods Output 13.1: A national surveillance plan for monitoring antimicrobial residues in foods and animal feeds in place Indicators: A functional plan for monitoring antimicrobial residues in foods in place 13.1.1 Undertake a baseline survey and needs assessment and identify gaps for surveillance of antimicrobial residues in foods and animal feeds Needs for surveillance of antimicrobial residues in foods and animal identified Yes/No 1 Once Reports Observation/Document review/Key informant interview TBD 13.1.2 Develop a national plan for monitoring of antimicrobial residues in foods and animal feeds Published national plan Yes/No 1 Once Reports Observation/Document review/Key informant interview None 13.1.3 Print and distribute national surveillance plan for monitoring residues in foods and animal feeds # of copies printed and distributed Proportion 5000 Once Copies Observation/Document review/Key informant interview None 13.1.4 Disseminate the national surveillance plan # of stakeholders knowledgeable of the plan Proportion 500 Once Reports Observation/Document review/Key informant interview None Output 13.2: Standard procedures for monitoring antimicrobial residues in foods in place Indicators: Nu mber of laboratories with and using standard procedures for monitoring antimicrobial residues in foods 13.2.1 Develop or adopt international standards for antimicrobial residues in foods Published MOP Yes/No 1 Once Copies of MOP Observation/Document review/Key informant interview None 13.2.2 Train veterinarians and laboratory personnel on monitoring antimicrobial residues in food and animal feeds # of personnel trained Proportion 50 Once Reports Observation/Document review/Key informant interview 5 % knowledge able Uganda National Action Plan for Antimicrobial Resistance 120 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline 13.2.3 Identify and prioritize samples and antimicrobial residues for testing Published list of priority samples and residues Yes/No 1 Once Reports Observation/Document review/Key informant interview None 13.2.4 Provide the appropriate infrastructure and renovations for the laboratories # of laboratories renovated Proportion 2 Once Reports Observation/Document review/Key informant interview 20% have basic infrastructur e 13.2.6 Equip national laboratories for monitoring antimicrobial residues List of equipment for each laboratory procured and installed Proportion assorted Once Reports Observation/Document review/Key informant interview 20% of equipment needs 12.2.5 Train personnel in laboratory logistics and supply management # of staff trained in laboratory logistics Yes/No 50 Once Reports Observation/Document review/Key informant interview 10% knowledge able 13.2.6 Procure laboratory information management system # of LIMS copies procured and installed Yes/No 2 Once Reports Observation/Document review/Key informant interview None 13.2.8 Procure and consumables and supplies List of consumables procured Proportion assorted Annual Delivery Notes/Re ports Observation/Document review/Key informant interview 10% of supplies available 13.2.9 Enroll the various labs in national and international external quality assurance programs # of labs enrolled labs in QA/QC programmes Proportion 2 Once Reports Observation/Document review/Key informant interview 20% enrolled Output 13.3: Collaborating with WHO/ FAO Codex Alimentarius and other international partner established Indicators: An international platform for sharing data 13.3.1 Summarise and share data in standardized formats regularly # of reports Proportion 12 Annual Reports Observation/Document review/Key informant interview None 13.3.3 Hold regular dissemination meetings for sharing data summaries with stakeholders # of stakeholders regularly receiving reports Proportion 100 Annual Reports Observation/Document review/Key informant interview None Uganda National Action Plan for Antimicrobial Resistance 121 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline Objective 14: Foster Collaboration and Partnerships among AMR stakeholders Desired Outcome: Harmonized and coordinated AMR surveillance system Output 14.1: Harmonized surveillance and capacity to detect Indicators: Increased capacity for surveillance AMR and useand monitor antimicrobial use and resistance in prioritized pathogens established 14.1.1 Organize a harmonization workshop with international partners and other stakeholders on the surveillance tools and methodologies Harmonized tools Proportion 5 Once Reports Observation/Document review/Key informant interview None 14.1.2 Participate in regional and global data sharing platforms, including GLASS # international platforms for sharing data Proportion 5 Annual Reports Observation/Document review/Key informant interview GLASS open Output 14.2: Mechanisms for participation international, Indicators: A platform for communicating AMR critical eventsregional and international communication of critical events established 14.2.1 Identify AMR critical events that are consistent with international standards # of events reported Proportion 5 Once Reports Observation/Document review/Key informant interview None 14.2.2 Institute global reporting mechanisms for critical events # of tools for global reporting Proportion 5 Annual Reports Observation/Document review/Key informant interview None Output 14.3: National, regional and international quality assurance standards in place Indicators: Proportion of facilities with QA/QC procedures in place 14.3.1 Develop manual of procedures for Quality assurance mechanisms for surveillance Published MOP Yes/No 1 Once Reports Observation/Document review/Key informant interview None 14.3.1 Train personnel in Quality assurance mechanisms for surveillance # of personnel trained Proportion 100 Annual Reports Observation/Document review/Key informant interview 10 % knowledge able 14.3.2 Enroll all laboratory surveillance partners in relevant quality assurance mechanisms # of laboratories enrolled quality assurance programmes Proportion 22 Once Reports Observation/Document review/Key informant interview 10 enrolled Strategic Objective 5: Research and Innovation Desired Outcome: Reduced emergence and spread of AMR Objective 15: Promote Innovation in Search for Alternative Treatments and Drug Discovery Desired Outcome: Effective control of resistant infections Uganda National Action Plan for Antimicrobial Resistance 122 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/means of verification Method of verification Baseline Output 15.1: Mechanisms for coordinated research and innovation in place Indicators: A platform (RI TWC)for coordinated research in AMR 15.1.1 Establish a Technical Working Group (TWC) on Research and innovation (RI TWC) TWC formed with list of members and ToR Yes/No 1 Once Inauguratio n meeting report Observation/Document review/Key informant interview NONE 15.1.2 Train researchers on grant writing # of researchers trained in grant writing Proportion 500 Annual Training Report Observation/Document review/Key informant interview 20% knowledge able in grant writing 15.1.3 Advocate, lobby and share information and RFPs for funding of AMR research # proposals funded by amount Proportion continu ous Annual Reports Observation/Document review/Key informant interview 10% funding 15.1.4 Sensitize researchers on intellectual property rights and patenting # of researchers knowledgeable in IPR and patenting Proportion 200 Annual Reports Observation/Document review/Key informant interview 10% researchers knowledge able in IPR and patenting Output 15.2: Enhance product development and laboratory capacity of the Natural Chemotherapeutics Laboratories (NCL) and other partners Indicators: Number of new antimicrobial products developed by NCL and other partners and approved 15.2.1 Conduct a baseline survey and needs assessment on antimicrobial resources in the country, and identify opportunities and gaps to be filled Baseline on antimicrobial resources Yes/No 1 Annual Reports Observation/Document review/Key informant interview TBD 15.2.2 Conduct a study to identify challenges and opportunities for enhancing antimicrobial product development Challenges and opportunities for enhancing product development Yes/No 1 Annual Reports Observation/Document review/Key informant interview TBD Output 15.3: International collaborations in high-throughput screening of antimicrobial compounds established Indicators: Number of international collaborations in high-throughput screening of antimicrobial compounds established Uganda National Action Plan for Antimicrobial Resistance 123 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/me ans of verificatio n Method of verification Baseline 15.3.1 Identify collaborators and partners in the development of antimicrobial compounds List of collaborators Proportion 3 Annual Reports Observation/Document review/Key informant interview TBD Output 15.4: Academia and other rese archers supported in product development Indicators: Number of new antimicrobial products developed by academia and other researchers an d approved 15.4.1 Provide seed funding for proposal development # of proposals developed and submitted Proportion 100 Annual Reports and copies of proposals Observation/Document review/Key informant interview TBD 15.4.2 Post calls for funding opportunities onto institutional websites and mailing lists of stakeholders including print media # of RFP posted Proportion 1000 Annual Copies of the RFPs Observation/Document review/Key informant interview 20% of RFP routinely posted 15.4.3 Establish database of biological materials, including plants, fungi, and other compounds with suspected antimicrobial properties # of biological materials with potential antimicrobial properties Proportion 1000 Annual Reports Observation/Document review/Key informant interview 5 % of biological materials with potential antimicrob ial properties known Output 15.5: Research in alternative treatments for infections supported Indicators: Number f alternatives for treatment of infectious diseases developed 15.5.1 Explore and share innovative treatments to infectious diseases # and list of alternative treatments for infectious diseases Proportion 100 Annual Reports Observation/Document review/Key informant interview 5% of possible alternative s known Output 15.6: Linkages between indigenous technical knowledge (ITK) groups to the product developme nt system established Indicators: Number of ITKs developed into antimicrobial products 15.6.1 Facilitate the establishment of MoUs between ITKs, the National Chemotherapeutic Laboratories and other stakeholders # of MoUs signed Proportion 5 Annual Reports and copies of MOUs Observation/Document review/Key informant interview 10% Uganda National Action Plan for Antimicrobial Resistance 124 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/me ans of verificatio n Method of verification Baseline 15.6.2 Carry out country-wide survey of indigenous knowledge on antimicrobial solutions # of ITKs on AMR solutions Yes/No 1 Annual Reports Observation/Document review/Key informant interview TBD Objective 16: Promote Innovations in Diagnostic Technology Desired Outcome: Accurate and cost effective diagnosis of infections Output 16.1: Capacity for research, development and testing of innovative diagnostic technologies strengthened Indicators: Number of new innovative diagnostics developed 16.1.1 Conduct a baseline survey and needs assessment to identify the opportunities and challenges in innovative diagnostics Baseline on diagnostics for AMR Yes/No 1 Annual Reports Observation/Document review/Key informant interview TBD 16.1.2 Enhance the capacity of # of approved diagnostics Yes/No 1 Annual Reports Observation/Document review/Key informant interview 10% diagnostics in use national regulatory bodies to assess and approve potentially innovative antimicrobial and diagnostic technologies Output 16.2: Point-of-care diagnostics for detection of infectious diseases and detection of resistance validated Indicators: Number of point-of-care diagnostics validated and approved 16.2.1 Undertake an assessment of the point of care diagnostics in different stages of development Baseline on the point of care diagnostics in different stages of development Yes/No 1 Annual Reports Observation/Document review/Key informant interview TBD 16.2.2 Sensitize stakeholders on regulatory systems and processes for approval of diagnostic technologies # of stakeholders knowledgeable about regulatory systems and approvals for diagnostic technologies Proportion 100 Annual Reports Observation/Document review/Key informant interview 10% 16.2.3 Train regulatory agency staff in approval processes for diagnostics # of staff knowledgeable in product approval processes Proportion 20 Annual Reports Observation/Document review/Key informant interview TBD Output 16.3: Ugandan science leaders i n international research on AMR Indicators: Number of Uganda scientists with leadership position in international research partnerships Uganda National Action Plan for Antimicrobial Resistance 125 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/me ans of verificatio n Method of verification Baseline 16.3.1 Identify and disseminate opportunities for Ugandan scientists in international research partnerships and offer mentorship # of scientists participating in international research related to AMR Proportion TBD Annual Reports Observation/Document review/Key informant interview TBD Objective 17: Collaborate with International Partners in Basic Intervention Research Desired Outcome: High quality basic intervention research Output 17.1: High-risk and high-burden resistant strains identified Indicators: Number of high-risk and high-burden resistant strains reported routinely 17.1.1 Organize workshops to share knowledge on high-risk and high burden resistant strains List of high burden and high risk resistant organisms Proportion 4 (1 per year) Annual Reports Observation/Document review/Key informant interview TBD Output 17.2: Innovations for new anti-microbial drug development, vaccines, and other innovative therapies Indicators: Number of innovative new antimicrobial drug development, vaccines, and other innovative the rapies developed 17.2.1 Identify and disseminate # and list of potential opportunities Proportion 100 Annual Reports Observation/Document review/Key informant interview TBD opportunities for participation in the development of antimicrobials, vaccines, and other innovative therapies 17.2.2 Identify and twin local laboratories with foreign laboratories to support the local production of vaccines # and list of potential twinning opportunities Proportion 5 Annual Reports Observation/Document review/Key informant interview TBD 17.2.3 Establish and maintain microbial collections and other biological resources for research and development of AMR solutions # and list Potential funders for microbial collections Yes/No 1 Annual Reports Observation/Document review/Key informant interview TBD Output 17.3: Collaborations in high-throughput genomics and sequencing technologies established Indicators: Number of high-through put genomics and sequencing technologies available Uganda National Action Plan for Antimicrobial Resistance 126 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/me ans of verificatio n Method of verification Baseline 17.3.1 Undertake a baseline survey Baseline on gaps in high-through-put screening capabilities Yes/No 1 Annual Reports Observation/Document review/Key informant interview TBD and needs assessment to identify current capabilities and gaps in high through put genomics and sequencing in the country 17.3.2 Establish a National Genomics and Bioinformatics Centre (NGBC) to support AMR research Functional NGBC Yes/No 1 Annual Reports Observation/Document review/Key informant interview NONE 17.3.3 Identify and facilitate collaboration of the NGBC with other international Centre’s of excellence # of MOUs signed with partners Proportion 3 Annual Reports and copies of MOUs Observation/Document review/Key informant interview TBD Output 17.4: The burden of AMR established Indicators: The proportion of burden infectious diseases that is attributed to AMR 17.4.1 Undertake research to examine the burden of AMR in the country Knowledge on the burden of AMR Yes/No 1 Annual Reports Observation/Document review/Key informant interview TBD Output 17.5: A research innovation fun d to support innovations that slow down AMR established. Indicators: Size of fund 17.5.1 Advocate and lobby for funding support for research innovations from government and pharmaceutical companies Amount of funds available for AMR research Yes/No 1 Annual Reports Observation/Document review/Key informant interview TBD Objective 18: Enhance Operational and Health Systems Research at the Local Level Desired Outcome: Evidence-based health systems operations Output 18.1: transmission pathways between the environment, humans, animals and food supply chain established Indicators: Elucidation of resistance transmission pathways 18.1.1 Organize One Health workshops to identify priorities for research on resistance and transmission pathways # and list of One Health AMR research priorities Yes/No 1 Annual Reports Observation/Document review/Key informant interview TBD Uganda National Action Plan for Antimicrobial Resistance 127 Planning Element Indicator (n) Performance Value (calculation of n/N)) Target (N) Frequency of data collection Data Source/me ans of verificatio n Method of verification Baseline 18.1.2 Identify and disseminate opportunities for One Health research funding List of funding opportunities for One health research on AMR Proportion continu ous Annual Reports Observation/Document review/Key informant interview TBD Output 18.2: Local Antimicrobial use patterns established Indicators: Pat terns and t rends of antimicrobial use locally 18.2.1 Identify priorities for research to establish and improve antimicrobial prescription and use patterns List of research priorities Proportion 1 Annual Reports Observation/Document review/Key informant interview TBD 18.2.2 Conduct research to assess behavioral, cultural and anthropological practices on antimicrobial use in society, prescription practices and motivators Research reports Yes/No 5 Annual Reports Observation/Document review/Key informant interview TBD