Uganda Antimicrobial Resistance National Action Plan 2024/25-2028/29

1.1 Background.................................................................................................................................... 5

1.2 Drivers of AMR. ............................................................................................................................. 5

1.3 AMR Diagnostics. ......................................................................................................................... 6

1.4 AMR Burden in Uganda. .............................................................................................................. 7

1.5 Progress towards AMR Containment (2018-2023). .............................................................. 9

1.6 Review of NAP-AMR I (2018-2023)......................................................................................... 10 2. Revision of the plan . ............................................................................................................11 3. Principles ofApproach of the NAP........................................................................................12 4. Goals and Strategic objectives ............................................................................................14 5. Governance ..........................................................................................................................16

5.6.1 Core Functions................................................................................................................ 16

5.6.2 Governance Structure. .................................................................................................. 16

5.6.3 Inclusivity and Representation. ................................................................................... 17 6. Coordination.........................................................................................................................19

6.1 Objectives..................................................................................................................................... 19

6.2 Core Coordination Mechanisms.............................................................................................. 19

6.2.1 Sector-Specific AMR Technical Working Committees (TWCs)............................. 19

6.2.2 Regular Coordination Meetings................................................................................... 20

6.2.3 AMR Focal Points........................................................................................................... 20

6.2.4 Cross-Sectoral Collaboration Platforms.................................................................... 20 Uganda Antimicrobial Resistance National Action Plan

6.2.5 Communication and Data-Sharing Protocols........................................................... 21 7. Strategic Interventions. ........................................................................................................22 Strategic Objective 1: Promote Public Awareness, Training,and Education. ........................ 23 Strategic Intervention 1.1 Improve Public Awareness........................................................... 23 Strategic Intervention 1.2 Enhance Education and Training of Human, Animal and Environment Professionals. ......................................................................................... 24 Strategic Intervention 1.3.Promote Awareness on Infection Prevention and Control (IPC) Practices in Communities. ........................................................................................... 24 Strategic Objective 2: Strengthen Infection Prevention and Control(IPC) Measures........... 24 Strategic Intervention 2.1 Strengthen IPC Programs at the national, subnational, health facility and community levels . .................................................................................... 24 Strategic Intervention 2.2 Establish systems for controlling multidrug resistant organism (MDRO). ......................................................................................................... 25 I Strategic Intervention 2.3 Promote Farm Biosecurity Measures . ...................................... 25 Strategic Intervention 2.4 Strengthen environmental waste management. .................... 25 Strategic Intervention 2.5 Expand and Optimize Vaccination Programs.......................... 25 Strategic Objective 3:Promote Antimicrobial Stewardship, Optimal Access, and Responsible Use of Antimicrobials. .......................................................................................................... 26 Strategic Intervention 3.1 Strengthening Antimicrobial Stewardship Programs. ............ 26 Strategic Intervention 3.2 Optimizing Access to Antimicrobials and Diagnostics. ......... 26 Strategic Intervention 3.3 Strengthen Diagnostic Stewardship for Microbiology Testing and Test Utilization in human, fish and livestock sectors. ...................... 27 Strategic Intervention 3.4 Promote Rational Prescribing, Dispensing, and Usage Practices.............................................................................................................. 27 Strategic Intervention 3.5 Ensure Quality, Safety, and Efficacy of Antimicrobials and Diagnostics...................................................................................................................... 27 Strategic Objective 4: Strengthen AMR Surveillance and Data Sharing.................................. 28 Strategic Intervention 4.1 Developing and Enhancing AMR Surveillance Infrastructure.28 Strategic Intervention 4.2 Monitoring Antimicrobial Use and Consumption. .................. 29 Strategic Intervention 4.3 Monitoring Antimicrobial Residues in foods, Environment, animal feeds........................................................................................... 29 Strategic Intervention 4.4 Promoting Cross-Sectoral Collaboration and Partnerships. . 29 Strategic Objective 5: Enhance Research and Innovation ........................................................ 30 Strategic Intervention 5.1 Set Priorities for AMR Research and Innovation...................... 30 Strategic Intervention 5.2 Enhance Operational and Systems Research. ........................ 30 Strategic Intervention 5.3 Strengthen Collaborations in AMR Research. .......................... 30 8. Implementation Framework. ................................................................................................31

8.1 Phased Rollout Plan................................................................................................................... 31

8.1.1 Phase 1: Short-Term Actions (Years 1-2) – Foundational Setup. ........................ 31

8.1.2 Phase 2: Medium-Term Actions (Years 3-4) – Scale-Up and Strengthening. .... 32

8.1.3 Phase 3: Long-Term Actions (Year 5 and Beyond) – Sustainability and Innovation. ....................................................................................................................... 32 Uganda Antimicrobial Resistance National Action Plan

8.2 Stakeholder Roles in Implementation. ................................................................................... 33

8.2.1 Government Ministries and Agencies........................................................................ 33

8.2.2 Research and Academic Institutions. ........................................................................ 33

8.2.3 Private Sector.................................................................................................................. 34

8.2.4 Civil Society and Community-Based Organizations................................................ 34

8.2.5 Development and implementing Partners. ............................................................... 34

8.2.6 Professional Organizations.......................................................................................... 34 9. Cost and Financing of the plan ............................................................................................35 10. Monitoring, Evaluation, and Learning (MEL) Framework......................................................37

10.1 Strategic Priorities of the MEL Function. ............................................................................... 37

10.1.1 Surveillance and Early Warning Systems.................................................................. 37 II

10.1.2 Tracking Implementation and Program Performance............................................ 37

10.1.3 Evaluating Effectiveness and Scaling Best Practices............................................. 38

10.1.4 Continuous Learning and Adaptive Program Management.................................. 38

10.1.5 Aligning MEL with Policy and Resource Planning. .................................................. 38

10.2 Governance of the MEL Function............................................................................................ 38

10.3 MEL Indicators and Tracking Mechanisms........................................................................... 39

10.4 Embedding MEL in National Governance and Sustainability............................................. 39 11. References (2020-2024).......................................................................................................49 12. Annex 1.................................................................................................................................54 Uganda Antimicrobial Resistance National Action Plan III Acknowledgments T he Government of Uganda (GoU) extends its sincere appreciation to the Fleming Fund through Baylor College of Medicine Children’s Foundation-Uganda and to the Food and Agriculture Organization (FAO) and World Health Organization (WHO) for their generous financial and technical support in revising Uganda’s National Action Plan on Antimicrobial Resistance (NAP-AMR 2024/25-2028/29). Their vital contributions enabled the update of the 2018-2023 plan and the development of the new NAP. The GoU is especially grateful to Professor Denis K. Byarugaba of Makerere University, whose expertise was crucial in facilitating stakeholder consultations and overseeing the drafting, revision, and costing of the new NAP-AMR. The GoU also acknowledges the invaluable coordination provided by the One Health Coordination Office, led by Mr. Musa Sekamatte, the leadership of Dr. Henry Kajumbula, Chair of the Uganda National Antimicrobial Resistance Sub-Committee (UNAMSC) and the indispensable expertise from various technical teams and stakeholders who participated in the development and validation of the NAP-AMR II (Annex 1) Special recognition is given to Ms. Carol Nyamor for her diligent efforts in compiling feedback from technical working committee members, stakeholders and NAP-AMR II development and validation workshops, ensuring that all elements were well- aligned, and to Mr. Isaac Musoke for his layout and design support, which contributed to the finalization of the NAP-AMR 2024/25-2028/29. The GoU acknowledges all individuals and stakeholders who offered expertise and feedback during the document review (Annex 1). The dedication of UNAMSC members and the technical working groups, who meticulously examined each activity, was instrumental in shaping a comprehensive plan to address the threat of antimicrobial resistance. Their contributions were key to safeguarding public, animal, and environmental health and promoting sustainable development in Uganda and globally over the coming five years. Lastly, the GoU recognizes the unwavering commitment of human, animal and environmental health professionals, researchers, and the general public to combating Uganda Antimicrobial Resistance National Action Plan antimicrobial resistance. Together, we are building a healthier, more sustainable future for all. THE REPUBLIC OF THE REPUBLIC OF THE REPUBLIC OF THE REPUBLIC OF UGANDA UGANDA UGANDA UGANDA MINISTRY OF MINISTRY OF MINISTRY OF MINISTRY OF HEALTH AGRICULTURE WATER AND TOURISM, ANIMAL INDUSTRY ENVIRONMENT WILDLIFE AND AND FISHERIES ANTIQUITIES 1 Foreword A ntimicrobial resistance (AMR) is a critical global issue impacting human, animal, and environmental health, diminishing the effectiveness of treatments for infections caused by bacteria, parasites, viruses, and fungi. The effects of AMR extend beyond health to affect global security, healthcare systems, international trade, agriculture, and environmental integrity. Unchecked, AMR poses a significant threat to Uganda’s progress toward achieving the National Vision 2040 and United Nations Sustainable Development Goals (SDGs), particularly those related to health, food security, clean water, and sustainable ecosystems. In 2018, the Government of Uganda launched the National Action Plan on Antimicrobial Resistance (NAP-AMR) for 2018–2023, aligning with international commitments and the One Health approach, which integrates human, animal, and environmental health responses. This collective effort brought together government ministries, departments, agencies (MDAs), and international organizations and partners to address AMR as a shared threat. Despite challenges, including the COVID-19 pandemic, Uganda made significant strides, such as establishing AMR awareness campaigns, initiating surveillance systems, and advancing antimicrobial stewardship and infection prevention across sectors. While AMR cannot be fully eradicated, its spread can be effectively managed and slowed. In pursuit of Uganda Vision 2040, the Government of Uganda is committed to building on past achievements with the revised NAP-AMR 2024/25-2028/29 (NAP- AMR II), which aims to intensify our response to AMR threats. We call on all stakeholders to engage actively with this plan, coordinating their efforts to collectively prevent, detect, and respond to AMR risks. Through these unified actions, we safeguard the health and future of all Ugandans and enhance global health security. Uganda Antimicrobial Resistance National Action Plan Hon. Dr. Jane Hon. Frank Hon. Cheptoris Hon. Col. Tom R. Ruth Aceng Ocero Tumwebaze Sam Mangusho Butime Minister of Minister of Health Minister of Minister of Water Tourism Wildlife Agriculture, Animal and Environment and Antiquities Industry, and Fisheries 2 Acronyms AMR Antimicrobial Resistance Ministry of Science, Technology, and MoSTI Innovation AMS Antimicrobial Stewardship MTC Medicines and Therapeutics Committee Antimicrobial Stewardship and Optimal ASO Ministry of Tourism, Wildlife and Use MTWA Antiquities ASP Antimicrobial Stewardship Programme MWE Ministry of Water and Environment BS/S Bio-safety/bio-security NAP National Action Plan The United States Centers for Disease CDC Control and Prevention NAPHS National Action Plan for Health Security Center for Disease Dynamics, Natural Chemotherapeutics CDDEP NCL Economics and Policy Laboratories CPHL Central Public Health Laboratories National Development Plan 2025/26 – NDPIV 2029/30 CQI Continuous Quality Improvement National Environment Management CSO Civil Society Organization NEMA Authority DAR Directorate of Animal Resources NGO Non Governmental Organization DCR Directorate of Crop Resources NWSC National Water and Sewage Corporation DFR Directorate of Fisheries Resources OHTWG One Health Technical Working Group Directorate of Water Resources OPM Office of the Prime Minister DWRM Management Public Awareness, Training, and ED Executive Director PATE Education FAO Food and Agriculture Organization PSU Pharmaceutical Society of Uganda GAP Global Action Plan RI Research and Innovations GARP Global Antibiotic Resistance Partnership South African National Accreditation GHSA Global Health Security Agenda SANAS System Global Antimicrobial Resistance SDGs Sustainable Development Goals GLASS Surveillance System SMTs Strategic Management Teams GoU Government of Uganda SURV Surveillance IDI Infectious Diseases Institute TWC Technical Working Group Information, Education, and IEC Uganda National Antimicrobial Communication materials UNAMRSC Resistance Sub-Committee IPC Infection Prevention and Control Uganda Antimicrobial Resistance National Action Plan UNAS Uganda National Academy of Sciences JEE Joint External Evaluation UNBS Uganda National Bureau of Standards KPIs Key Performance Indicators Uganda National Council for Science LMICs Low- and Middle-Income Countries UNCST and Technology M&E Monitoring and Evaluation UNGA United Nations General Assembly Ministry of Agriculture, Animal Industry UPDF Uganda People’s Defense Force MAAIF and Fisheries UPF Uganda Police Force MDAs Ministries, Departments and Agencies URSB Uganda Registration Services Bureau MDR Multi-drug resistant UWA Uganda Wildlife Authority MDR TB Multi-drug resistant Tuberculosis WASH Water, Sanitation, and Hygiene MDROs Multi Drug Resistant Organisms WHA World Health Assembly Ministry of Gender Labour and Social MGLSD WHO World Health Organization Development MoES Ministry of Education and Sports WOAH World Organization for Animal Health MOH Ministry of Health XDR-TB Extensively Drug-Resistant Tuberculosis 3 Executive Summary A ntimicrobial resistance (AMR) is a significant global threat to public health, economic stability, and sustainable development. It requires urgent and coordinated action to mitigate its impact. Resource limitations pose major challenges for low- and middle-income countries (LMICs), including Uganda, in addressing AMR. These limitations affect access to quality healthcare services, socioeconomic equity, awareness, surveillance systems, data collection, regulatory frameworks, quality control, healthcare infrastructure, and infection prevention practices. AMR is integral to human, animal, and environmental health, demanding a comprehensive and integrated response. Interventions such as promoting responsible antimicrobial use, enhancing surveillance, ensuring the quality of antimicrobial drugs, and fostering global collaboration are critical and needed more than ever. The revised NAP-AMR 2024/25-2028/29 builds upon the significant Interventions such progress made in the first NAP-AMR of 2018–2023 and seeks to as promoting strengthen those gains further and prioritize interventions for the next responsible five years. The NAP-AMR II outlines the process of its development, antimicrobial discusses the implementation arrangements under which strategies will use, enhancing be implemented, and provides the interventions and a budget developed surveillance, using the WHO AMR Costing and Budgeting Tool. AMR remains a One ensuring the quality Health challenge, and the plan’s implementation will continue to be of antimicrobial anchored under the One Health platform, bringing together relevant drugs, and fostering stakeholders to act in harmony. The NAP-AMR 2024–2028 will be aligned with global action plans, focusing on the following strategic objectives: global collaboration are critical and 1. Promote Public Awareness, Training, and Education needed more than 2. Improve Infection Prevention and Control (IPC) measures ever. 3. Promote Antimicrobial Stewardship, Optimal Access, and Uganda Antimicrobial Resistance National Action Plan responsible Use of Antimicrobials 4. Strengthen AMR surveillance and data sharing 5. Enhance Research and Innovation The National One Health Platform (NoHP) through the Uganda National Antimicrobial Resistance Sub Committee (UNAMRSC) will continue to coordinate and oversee the implementation of this plan. The committee will also monitor the progress of the interventions and their impacts. While successful implementation relies heavily on the government’s commitment, the private sector, civil society organizations, and the public are expected to significantly support government efforts and implement some of the proposed interventions. Uganda can effectively combat AMR, protect public health, promote sustainable development, and secure a healthier future for all by working together across sectors and disciplines. 4 1. Introduction

1.1 Background Antimicrobial resistance (AMR) is a growing global threat that hinders the effective management of infectious diseases. AMR occurs when bacteria, parasites, viruses and fungi change over time and no longer respond to medicines making infections harder to prevent and treat, increasing the risk of disease spread, severe illness and death. Many low- and middle- income countries (LMICs) face significant challenges in combating AMR, The impact of including a high burden of infectious diseases, poverty, weak health systems, and low awareness. The use of antimicrobials in humans, plants AMR is not evenly and animals all contribute to the environmental load of antimicrobial distributed across resistant bacteria, genes, residues and their metabolites populations. Women, children, The impact of AMR is not evenly distributed across populations. Women, and marginalized children, and marginalized groups are disproportionately affected. They groups are face greater challenges due to a complex interplay of social and biological factors, including wealth, education, occupation, race, ethnicity, disability, disproportionately and age. These intersecting disparities, rooted in gender and equity, affected. limit their access to healthcare, increase their economic hardships, and exacerbate their vulnerability to the effects of AMR. Global efforts to address AMR must consider these unique challenges. Furthermore, humans and animals share habitats and several infectious diseases. Some of these diseases may have originated in animals and later evolved to infect humans. AMR has increased with the growing global population and increased antimicrobial use. This has exerted selection pressure on microbes, resulting in larger populations of antimicrobial- resistant strains of pathogenic organisms. Uganda Antimicrobial Resistance National Action Plan

1.2 Drivers of AMR Healthcare Practices: Poor antimicrobial stewardship practices contribute significantly to the AMR crisis. This includes inappropriate prescribing, such as using antibiotics for viral infections or providing inadequate dosage or treatment duration. Additionally, limited access to appropriate antimicrobials can lead to the use of less effective or broader-spectrum options, further driving resistance. Patient Behavior: Patient behavior also plays a role in the AMR crisis. Driven by the desire for quick and affordable treatment, patients often demand antibiotics even when unnecessary, avoiding essential investigations. This pressure on healthcare providers can lead to inappropriate prescribing and contribute to the development of resistance. 5 Pharmaceutical Industry Practices: The pharmaceutical industry’s practices considerably influence the AMR landscape. The decline in new antibiotic development has created a shortage and increased the cost of existing ones, limiting access, particularly in LMICs. Moreover, pharmaceutical companies often incentivize healthcare providers to Lack of suitable prescribe specific antimicrobials, escalating both use and cost. This diagnostics can practice can lead to over-prescription and contribute to resistance. hinder accurate Additionally, many LMICs lack access to affordable vaccines that could and timely help prevent infections and reduce the need for antibiotics, hindering diagnosis, leading efforts to curb AMR. to inappropriate Public Health Infrastructure: Inadequate public health infrastructure, antimicrobial use. including limited access to clean water, sanitation, and hygiene (WASH) facilities, further contributes to the spread of infections. Lack of suitable diagnostics can hinder accurate and timely diagnosis, leading to inappropriate antimicrobial use. Additionally, poor infection prevention and control practices in healthcare settings and communities contribute to the spread of resistant organisms. Finally, the release of effluents containing antibiotic residues from hospitals and the pharmaceutical industry can contaminate the environment and promote the development of AMR. Non-human use of antimicrobials: misuse and overuse of antimicrobial agents in animals, especially in food-producing animals has consequences for both human and animal health as it can result in the development of resistant bacteria. These resistant bacteria (with resistance genes) in animals can be transferred to humans through the consumption of food or through direct contact with food-producing animals or through environmental spread.

1.3 AMR Diagnostics Accurate detection of antimicrobial resistance (AMR) depends on adequate laboratory capacity. However, the current state of diagnostic Uganda Antimicrobial Resistance National Action Plan capability needs further enhancement. Investments in laboratory infrastructure improvements, equipment management, supply chain reliability for reagents and consumables, specimen/isolate transport and storage, data management, quality assurance and data management are critical in the detection of AMR. Conventional methods for AMR diagnostics and Antimicrobial Susceptibility Testing (AST) are often tedious, expensive, and have long turnaround times and are not widely accessible. This leads to empirical antimicrobial therapies, contributing to AMR spread, higher mortality rates, and increased healthcare costs. While new time-saving technologies are available, classic methods like culture-based are the most commonly used. Several commercial automated methodologies, such as VITEK 2 compact 6 system (bioMérieux, France) and BD Phoenix (Becton Dickinson), are on the market. More recently, microscopy-based and spectrometry-based approaches, including sequencing, Matrix Assisted Laser Desorption/ Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS), and Fourier Transform Infrared (FTIR) spectroscopy, have been incorporated into AMR diagnostics. Promising point-of-care (POC) tools for AMR diagnostics and phenotypic AST have been developed with faster turnaround times and the ability to detect and quantify bacterial concentrations. However, these tools are not Recent data (2020– yet readily accessible. 2023) highlights high resistance Reliable, sensitive, and affordable diagnostics are crucial to combat AMR. Rapid diagnostic technologies could significantly enhance commonly used targeted treatment, especially in primary care settings. Furthermore, antibiotics such advanced monitoring systems, like mobile applications and surveillance as penicillins and programs, are essential for tracking antimicrobial consumption. Emerging cotrimoxazole approaches, such as machine learning and data mining combined with exceeding 80% automation, will play a key role in the next generation of diagnostics. presenting These advancements and improved surveillance programs will be vital in significant minimizing the detrimental effects of AMR. challenges in managing infections

1.4 AMR Burden in Uganda effectively. Antimicrobial resistance (AMR) places a significant and growing burden on Uganda’s health, economy, and society. Infections caused by drug- resistant bacteria lead to increased morbidity and mortality, limiting treatment options and forcing reliance on more expensive, less accessible drugs. The health system faces escalating challenges, with prolonged illnesses, higher risks of complications, and a growing prevalence of healthcare-associated infections. Recent data (2020–2023) highlights high resistance levels among ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella Uganda Antimicrobial Resistance National Action Plan pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species), with resistance to commonly used antibiotics such as penicillins and cotrimoxazole exceeding 80% in some cases (Byarugaba et al., 2023). Methicillin-resistant Staphylococcus aureus (MRSA) prevalence ranges from 2% to 50%, while extended-spectrum beta-lactamase (ESBL)- producing gram-negative bacteria are present in 10% to 75% of analyzed isolates (Ackers-Johnson et al., 2021). Resistance to carbapenems, a last-line treatment, ranges from 4% to 30%, severely restricting treatment options (Tuhamize et al., 2023; Lubwama et al., 2024). These figures indicate the emergence of resistance and significant challenges in managing infections effectively. 7 The economic burden of AMR in Uganda is profound. Resistant infections lead to prolonged hospital stays, additional diagnostic procedures, and costly second-line treatments, straining already limited healthcare resources. The financial burden disproportionately affects low-income households, where accessing advanced treatment options is often impossible. Furthermore, productivity loss due to prolonged illness or premature death negatively impacts Uganda’s economic growth, particularly in the agricultural and informal sectors where daily productivity is critical (Muleme et al., 2023). Socially, AMR exacerbates inequalities and disproportionately affects vulnerable populations, including children, women, and immunocompromised individuals. In rural and underserved areas, limited access to healthcare and sanitation increases exposure to resistant pathogens. Additionally, the potential for AMR-related outbreaks erodes public trust in healthcare systems, reducing the likelihood of timely healthcare-seeking behaviors and further compounding health inequities. Health of humans, animals, plants and the environment is inextricably linked and actions against AMR requires a One Health approach to address drivers at the animal-human-environment interface. Uganda faces challenges with AMR in animals as well, although data remains limited. Studies report resistance rates of 30-60% in common pathogens (e.g., E. coli, Salmonella) isolated from livestock against tetracyclines, sulfonamides, and beta-lactams (Odoch, T. et al., 2021). Various reports document mastitis-causing multi-drug resistant (MDR) Staphylococci bacterial species in dairy, causing reduced milk yield, increased health management costs and making milk less suitable Residues of beta-lactam and tetracycline residues have been detected in beef, while sulfonamide residues have been found in eggs. These residues not only threaten international trade but also contribute to the development of AMR, as well as potentially causing allergic reactions and even cancers Uganda Antimicrobial Resistance National Action Plan in humans (Ahmad, I. et al., 2021). Additionally, antimicrobial resistance (AMR) is also significantly linked to water pollution, with the presence of antibiotic-resistant bacteria found in various water sources, primarily due to poor wastewater management, improper disposal of human and animal waste, and overuse of antibiotics, which contributes to the spread of resistant microbes within the environment and potential health risks for the population. Moreover, AMR can spread between wildlife and domestic animals through water, soil, and arthropod vectors. In essence wildlife can act as reservoirs and spreaders of AMR, which can pose risks to other animals and humans. The burden of AMR in Uganda extends beyond its immediate health impacts to threaten the sustainability of its healthcare systems and broader economic and social stability. Addressing this crisis requires 8 urgent multisectoral investments in strengthening surveillance, improving antimicrobial stewardship, and increasing public awareness. These interventions must be inclusive and context-specific, ensuring that Uganda’s most vulnerable populations are not left behind in the fight against AMR.

1.5 Progress towards AMR Containment (2018-2023) Despite receiving Uganda has progressed in addressing AMR through guidelines and less than optimal policies aligned with international strategies along the different strategic funding (<20%), objectives in NAP-AMR-I (2018-2023). This was achieved through the NAP-AMR multisectoral coordination of AMR containment measure by the Uganda (2018-2023) National AMR Sub-Committee (UNMRSC) under the National One Health achieved significant Platform (NOHP). Regarding infection prevention and control, Uganda has milestones, as National Infection Prevention and Control Guidelines (last updated in 2013) reported by the 2023 implemented across the country, with Infection Prevention and Control JEE report Committees established in most tertiary healthcare facilities. However, these committees need further strengthening, including infrastructure, supplies, and regular performance monitoring. The National Drug Authority (NDA) is primarily responsible for ensuring optimal access to and use of antimicrobials in the public and private sectors. The NDA’s mandate, enshrined in the National Drug Policy and Act, is supported by several guidelines, including the National Treatment and Clinical Guidelines, which guide antimicrobial use for treating infectious diseases. To monitor AMR and the effectiveness of these documents, a Supervision Performance Assessment and Recognition Strategy (SPARS) is being implemented at the district level to assess adherence to these guidelines in human health facilities. Surveillance of antimicrobial resistance is generally increasing in Uganda. According to the 2017 Joint External Evaluation (JEE), 25 human health Uganda Antimicrobial Resistance National Action Plan facilities regularly perform Antimicrobial Susceptibility Testing (AST), and monthly reports on AMR are provided to the National Animal Disease Diagnostic and Epidemiology Center (NADDEC). Additionally, a Technical Working Group on AMR Surveillance developed a National Antimicrobial Resistance Surveillance Plan. Research and innovation on AMR are growing priorities in Uganda, with opportunities for further improvement. Establishing the Ministry of Science, Technology, and Innovation (MoSTI) signals government interest in supporting research in areas including AMR. Several strong research institutions, such as the National Chemotherapeutics Laboratories, higher education institutions, and research organizations, continued to undertake AMR research, providing evidence to inform interventions. 9

1.6 Review of NAP-AMR I (2018-2023) After five years of implementation, several reviews were conducted to assess the NAP-AMR’s performance, including the GoU review, the JEE review, and the FAO Performance of Veterinary Services (PVS) Pathway review. These reviews evaluated progress in funding and implementation, identified key barriers to implementation, and highlighted opportunities. Despite receiving less than optimal funding (<20%), the NAP-AMR I (2018- 2023) achieved significant milestones, as reported by the 2023 JEE report including: • A One Health governance framework with various technical working groups established. • Development of guidelines and plans for infection prevention and control (IPC) implementation, antimicrobial use, and surveillance in human and animal health sectors. • Designation of reference laboratories, including the National Microbiology Reference Laboratory at Butabika (accredited by the South African National Accreditation System [SANAS]) for the health sector and NADDEC for animal health. • Participation and regular data sharing in the WHO Global Antimicrobial Resistance Surveillance System (GLASS). • Establishment of subnational microbiology surveillance laboratories across the country in both human and animal health sectors. • National awareness campaigns, including regular national AMR conferences and participation in World Antimicrobial Awareness Week. (WAAW) Despite these achievements, limitations needing attention include: Uganda Antimicrobial Resistance National Action Plan • Funding constraints • Weak coordination of NAP-AMR implementation and dissemination of findings across sectors. • Unclear key performance indicators (KPIs) and lack of integration of KPIs at the national level, hindering effective monitoring. • Unclear budget allocation for NAP-AMR I (20218-2023) operations in the sector policy statements. • Limited data utilization and feedback to local users. Data for GLASS was collected, but not locally shared. 10 2. Revision of the plan F ollowing the implementation and review of Uganda’s first NAP- AMR (2018-2023), a second NAP-AMR (2024/25-2028/29), also known as NAP-AMR II, was developed. The revision process emphasized integration of gender and equity as a guiding principle, ensuring that activities address the diverse needs of all populations, including marginalized and vulnerable groups. Stakeholder consultations, coordinated by the National Antimicrobial Resistance Sub-Committee with support from FAO Uganda and the UK Fleming Fund Phase II Country Grant II Project, were conducted in six phases: 1. Stakeholder mapping and consultative workshops to review NAP- The revision process AMR I (2018- 2023) implementation progress (situation analysis) emphasized and provide input for NAP-AMR II. integration of gender 2. Drafting of NAP-AMR II and equity as a 3. Training on the WHO Costing and Budgeting tool for rational guiding principle, budgeting and costing of activities. ensuring that 4. Costing of NAP-AMR activities using the WHO tool. activities address 5. Presentations and consultations with Directors from the Ministries the diverse needs of Health, Water and Environment, Agriculture, Animal Industry and of all populations, Fisheries, and One Health Platform members. including 6. Review of the plan and input from the UNAMRSC. marginalized and 7. Validation workshop with all key stakeholders. vulnerable groups. These workshops brought together stakeholders from various sectors, MDAs, and subject matter experts across human, animal, and environmental Uganda Antimicrobial Resistance National Action Plan health, including UNAMRSC members, AMR Technical Working Group Committee members, and key stakeholders involved in AMR containment in Uganda. Participants discussed NAP-AMR I implementation progress, lessons learned, and generated strategies and activities for NAP-AMR II, costing them according to six strategic interventions. They also cost NAP- AMR II activities using the WHO AMR Costing and Budgeting Tool. Through breakout and plenary sessions, stakeholders reviewed NAP-AMR I implementation and deliberated on prioritizing NAP-AMR II activities. Consensus was built on prioritizing activities across sectors (human, animal, and environmental health) for all NAP-AMR II objectives and strategic interventions. Prioritized timelines for NAP-AMR II activities, indicating completion timing, were based on sector-specific capacities and resources. 11 3. Principles of Approach of the NAP T he NAP-AMR II is guided by principles aligned with international standards and recommendations from the World Health Organization (WHO), the World Organization for Animal Health (WOAH), and the Food and Agriculture Organization (FAO). These principles establish a foundation for a robust, sustainable, and inclusive response to AMR in Uganda. Preventing a. Whole-of-Society Engagement and One Health Approach: infections is the Containing AMR requires a One Health approach, emphasizing most effective “the collaborative effort of multiple disciplines working locally, and economical nationally, and globally to attain optimal health for people, approach to animals, and our environment.” This principle recognizes the reducing the need interconnectedness of human, animal, and environmental health. Implementing the NAP-AMR II involves mobilizing all sectors of for antimicrobials society—government agencies, healthcare providers, veterinarians, and curbing the environmental experts, academia, industry, and the public— spread of resistance fostering a shared responsibility that maximizes the impact of interventions across sectors. b. Prevention First: Preventing infections is the most effective and economical approach to reducing the need for antimicrobials and curbing the spread of resistance. Emphasizing prevention requires robust infection prevention and control (IPC) measures and targeted health promotion and disease prevention efforts across human, animal, and environmental sectors. Effective IPC practices Uganda Antimicrobial Resistance National Action Plan help preserve the efficacy of antimicrobials and contribute to the broader public health goal of minimizing infections, thereby decreasing the demand for antimicrobial treatments. Prevention Ensuring equitable strategies must be inclusive, benefiting men, women, individuals of all gender identities, marginalized communities, and people with access to effective disabilities. antimicrobials is essential to c. Equitable Access to Effective Antimicrobials: Ensuring equitable access to effective antimicrobials is essential to prevent resistance prevent resistance from becoming entrenched in underserved communities. from becoming This principle extends beyond availability, promoting optimal entrenched in antimicrobial use and rational prescribing practices. Achieving underserved equity in access requires strengthening healthcare infrastructure, communities. expanding access to trained professionals, providing diagnostic 12 tools, and ensuring the availability of accurate health information— especially in rural and underserved areas where access barriers are often greatest. d. Sustainability: Achieving long-term AMR containment requires sustained, inclusive efforts supported by strong national Achieving long-term commitment and international collaboration. Embedding AMR AMR containment interventions into routine practices across sectors ensures requires sustained, continuity and integrates these efforts into daily operations. Dedicated governance structures and a comprehensive inclusive efforts sustainability plan—emphasizing national leadership and global supported by partnerships—will strengthen sustainability and secure vital strong national financial and technical resources. Political commitment and commitment international collaboration are essential, focusing on sharing and international gender-responsive best practices, building capacity, and mobilizing collaboration. resources to support these interventions effectively. e. Incremental Targets and Measurable Progress: The NAP-AMR II adopts a phased approach with immediate, medium-term, and long-term targets to reach AMR containment goals effectively. Incremental targets allow Uganda to track measurable progress and adjust interventions according to resource availability. This approach facilitates ongoing monitoring and evaluation, identifying successes and areas for improvement while fostering The private sector accountability and commitment to sustainable AMR containment. contributes to f. Private Sector Involvement: The private sector is a critical surveillance data, partner in AMR containment. Engaging private entities across policy development, interventions brings innovation, resources, and expertise to AMR resource efforts. The private sector contributes to surveillance data, policy mobilization, development, resource mobilization, antimicrobial alternatives, antimicrobial and advancements in stewardship practices. This collaboration alternatives, and broadens the reach and enhances the effectiveness of AMR advancements containment strategies. in stewardship g. Gender Equity: AMR containment efforts must consider the practices. Uganda Antimicrobial Resistance National Action Plan gender-related risks and vulnerabilities in implementing all interventions under each strategic objective. The NAP-AMR II integrates gender equality and equity principles to ensure that interventions are inclusive and meet the needs of marginalized and vulnerable populations. This approach promotes fair access to resources, recognizes the varied impacts of AMR across gender and social groups, and ensures that AMR initiatives do not unintentionally exacerbate existing inequalities. 13 4. Goals and Strategic objectives N AP-AMR II aims to slow the emergence and spread of resistant organisms while ensuring the availability of safe, effective, efficacious, and quality-assured antimicrobials and their optimal use. This will be achieved through collaborative action between partners in human health, agriculture, the food industry, the environment, teaching and research institutions, civil societies and associations, the pharmaceutical industry, and global stakeholders to synergize efforts and resources. This action plan is consistent with the guiding principles and strategic objectives of relevant global action plans and is part of the overall National Action Plan for Health Security (NAPHS) II. The NAP-AMR II is aligned to the long-term national development goals and objectives as spelt out in Vision: A society the Vision 2040, National Development Plan 2025/26 – 2029/30 (NDPIV) where infectious and Sustainable Development Goals (SDGs). A One Health approach will diseases can be be adopted across all relevant sectors to implement actions and leverage treated effectively synergies to combat AMR effectively. with antimicrobial Vision: A society where infectious diseases can be treated effectively with agents. antimicrobial agents. Goal: To slow down the emergence and spread of resistant organisms and maintain the efficacy of antimicrobials to treat infectious diseases effectively. Strategic Objectives Uganda Antimicrobial Resistance National Action Plan The plan maintains strategic interventions with a multi-sectoral approach comprising effective communication, coordination, and collaboration between different sectors, Ministries, Departments, and Agencies, locally Goal: To slow down and globally. The plan leverages the strengths of the public, private, civil the emergence and society, academia, and research partners. It also focuses on strengthening spread of resistant national systems by utilizing existing structures and avoiding the creation organisms and of new parallel institutions for implementation. The following strategic maintain the efficacy objectives are proposed to address the AMR challenge: of antimicrobials 1. To promote public awareness and understanding of antimicrobial to treat infectious use, resistance prevention, and containment through effective diseases effectively. communication and training. 14 2. To improve infection prevention and containment of resistant microorganisms in human healthcare, the community, and animal health through individual and environmental sanitation, hygiene, infection prevention, and biosecurity measures. 3. To optimize the use of antimicrobial drugs in human and animal healthcare 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. Vision: A society where infectious diseases can be treated effectively with antimicrobial agents. Goal: To slow down the emergence and spread of Promote public resistant organisms and maintain awareness and the efficacy of antimicrobials Invest in understanding to treat infectious diseases research and of antimicrobial effectively. innovations use Improve Strengthen the infection knowledge and prevention and Optimize evidence base containment the use of of antimicrobial of resistant antimicrobial use and microorganisms drugs antimicrobial Uganda Antimicrobial Resistance National Action Plan resistance 15 5. Governance

5.6.1 Core Functions The governance framework performs five key functions: Strategic Oversight: Defines AMR objectives aligned with national and international priorities. Policy Direction: Develops and harmonizes legal frameworks, policies, and guidelines. Accountability: Establishes monitoring, evaluation, and reporting systems for AMR interventions. Resource Mobilization: Advocates for sustained financial, political, and technical support. Collaboration: Facilitates multisectoral partnerships under the One Health framework.

5.6.2 Governance Structure The governance structure (illustrated in Figure 1) consists of the following key entities: National One Health Platform (NOHP): Oversees high-level coordination among sectors, ensuring AMR strategies align with global standards and national priorities. Uganda National Antimicrobial Resistance Subcommittee (UNAMRSC): Operates under the One Health Technical Working Group (OHTWG), coordinating multisectoral efforts for NAP-AMR II implementation. Leadership rotates annually among the Ministry of Health (MOH), Ministry of Agriculture, Animal Industry and Uganda Antimicrobial Resistance National Action Plan Fisheries (MAAIF), Ministry of Water and Environment (MWE), and Uganda Wildlife Authority (UWA). Specialized Technical Working Committees (TWCs): These committees provide expert guidance to ensure AMR interventions are evidence- based. Their focus areas include: Public Awareness, Training, and Education (PATEac) TWC: Enhancing public understanding and promoting behavior change. Infection Prevention and Control (IPC) TWC: Strengthening infection control measures in healthcare and community settings. Optimal Access and Use of Antimicrobials (ASO) TWC: Promoting responsible antimicrobial use and ensuring equitable access. Surveillance (SURV) TWC: Strengthening AMR data collection, analysis, and reporting systems. Research and Innovation (RI) TWC: Identifying research gaps, setting priorities, and fostering innovation. 16 Parliamentary Oversight Committee: Ensures AMR policies align with national goals, cultivate visibility of AMR issues at policy level, advocates for resource allocation, implementation and monitors governance performance. Strategic Management Teams (SMTs): Provide sector-specific insights, governance and strategic leadership, linking operational realities with high-level governance. Consistent with the NOHP rotational Chair arrangement, the Chair of the UNAMRSC will alternate between the technical departmental heads/commissioners of respective line ministries (MAAIF, MOH, MWE and UWA under the Ministry of Wildlife, Tourism and Antiquities on a annual basis. The alternating Chairs/delegated technical leads of UNAMRSC will have overall oversight for the implementation of the NAP-AMR II. Technical work related to coordinating implementation and monitoring of NAP-AMR II activities will be conducted through the five Subcommittees of the UNAMRSC as depicted in Figure 1. Administrative and secretarial work relating to NAP-AMR II coordination and monitoring will be led by the One Health Coordination office. Sector specific AMR TWC will include experts and collaborating partners across the five NAP-AMR objectives

5.6.3 Inclusivity and Representation The governance framework ensures diverse stakeholder engagement, including: Stakeholder Category Entities (Examples) Role in AMR Governance Lead sectoral contributions, policy MOH, MAAIF, MWE, Government direction, and mainstream gender & UWA, Ministry of Ministries, equity in AMR response. Regulatory Gender, Labour & Social Departments & Agencies provide regulatory oversight & Development (MGLSD), Agencies technical expertise in antimicrobial use NDA, and NEMA and environmental impact. Research & Generate scientific evidence for AMR UNHRO, NARO, Academic policy, integrate AMR topics in curricula, Universities, UNAS Institutions and train professionals. Pharmaceutical Promote responsible antimicrobial use, Uganda Antimicrobial Resistance National Action Plan Private Sector companies, Healthcare support AMR innovation, and contribute providers, Agribusinesses to surveillance. Civil Society & National & local NGOs, Raise awareness, advocate for Community-Based VHCs, Community responsible AMR use, and mobilize Organizations Leaders communities. WHO, FAO, WOAH, USAID, Development & Provide funding, technical assistance, US CDC, Fleming Fund Implementing and align Uganda’s AMR response with and their respective Partners national and global priorities. implementing partners Uganda Medical & Dental Professional Set professional standards and ethical Council, Veterinary Board, Organizations guidelines for AMR containment. Pharmacy Council 17 MAAIF MOH MWE MTWA National One Health DAR; DFR; DCR; DDA DGHS DWRM ED/UWA Platform (NOHP) One Health Technical Working Group (36 members) One Health Coordination Office Uganda Policy, Strategy, Surveillance, Antimicrobial Advocacy & Preparedness & Research & Training Resistance Communication Response Sub-Committee Sub-Committee Sub-Committee Sub-Committee Public Awareness, Optimal Access & Use Infection Prevention & Surveillance Research and Training & Education of Antimicrobials Control (IPC) TWC (SURV) TWC Innovation (RI) TWC (PATE) TWC (ASO) TWC ▪ Parliamentary support: Parliamentary Forum on AMR that links to three committees of parliament [Health; Agriculture, Animal Industries & Fisheries; and Environment and Natural Resources] ▪ Office of the Prime Minster (OPM) support: Inclusion of IHR focal point [at OPM] for alignment with National Action Plan for Health Security II (NAPHS II) implementation across Government Ministries, Departments and Agencies ▪ Linkages between UNAMRSC and sectors: The One Health Coordination office shall facilitate the coordination between the five sector specific TWCs under UNAMRSC with representation across the five NAP-AMR objectives. . Members of the each subcommittee are drawn from sector TWCs, MDAs, the academia, professional associations, collaborating partners and relevant experts (as needed). ▪ Linkage with National One Health Strategic Plan (NOHSP): The Uganda National AMR Subcommittee of the National One Health Technical Working Group (OHTWG) directly supports technical work related to coordinating and monitoring implementation of NAP-AMR II activities aligned to the NOHSP. Other Subcommittees of the OHTWG address other strategic focus areas of the NOHSP include Policy, Strategy, Advocacy & Communication; Surveillance, Preparedness & Response; Research & Training. Figure 1: NAP-AMR II Governance Arrangements Uganda Antimicrobial Resistance National Action Plan 18 6. Coordination T he Coordination function complements governance by operationalizing the priorities and policies set under the NAP- AMR II. While governance focuses on leadership, oversight, and accountability, coordination ensures that these directives are implemented effectively through structured mechanisms that promote collaboration, integration, and real-time decision-making across all sectors. Coordination is central to implementing the One Health approach to AMR National One containment. It fosters cross-sectoral collaboration, enables synchronized Health Platform responses, and effectively implements national AMR strategies. Role: The NOHP through

6.1 Objectives the one health The coordination mechanisms aim to: coordination office is the central • Facilitate cross-sector collaboration across human, animal, environmental, and wildlife health sectors under the One Health administrative approach. and coordinating body structure • Establish communication systems and shared data platforms for timely and evidence-based decision-making. coordinating all cross-sectoral • Harmonize monitoring and evaluation processes to track progress and ensure accountability. engagements for Uganda’s • Align national AMR strategies with global standards while fostering AMR response. regional and international partnerships. Through the

6.2 Core Coordination NOHP’s guidance UNAMRSC leads Mechanisms initiatives spanning government Uganda Antimicrobial Resistance National Action Plan

6.2.1 Sector-Specific AMR Technical Working ministries, regulatory Committees (TWCs) agencies, and • Each line ministry—MOH, MAAIF, MWE, MTWA (through UWA) external partners, and collaborating MDA’s —will establish TWCs to develop and ensuring that implement sector- specific AMR operational plans, aligned to all engagements with the NAP-AMRII strategic objectives. each sector align • The TWCs will align operational plans with NAP-AMR II objectives under a unified AMR and collaborate with the Uganda National Antimicrobial Resistance Subcommittee (UNAMRSC) , development and implementing strategy. partners to harmonize actions with national priorities and avoid duplication. • They will focus on achieving outcomes in areas such as infection prevention, antimicrobial stewardship, surveillance, research, and public awareness. 19

6.2.2 Regular Coordination Meetings • Monthly Technical Review Meetings: Convened by sectoral teams to address operational challenges, review progress, and refine strategies. • Quarterly AMR Multisectoral Meetings to review plans, progress, share lessons learned and address challenges: • At the national level, the National One Health Platform (NOHP) through the One Health Coordination office will convene quarterly UNAMRSC and its TWC meetings, bringing together stakeholders to review AMR and AMU/C trends, ensure alignment and monitor implementation across sectors, resolve cross- sectoral issues, and foster collaborative problem-solving.. • At the subnational level, designated regional AMR focal persons will work closely with district and facility AMR focal persons to convene quarterly regional TWCs to review regional AMR and AMU/C trends, ensure alignment and monitor regional implementation , resolve regional issues, and foster collaborative problem-solving at regional level • At the facility level, designated facility AMR focal persons will work closely with facility leadership to convene quarterly facility AMR TWCs to review facility AMR and AMU/C trends, ensure alignment and monitor facility implementation, resolve facility issues, and foster collaborative problem-solving at facility level • At the community level, designated subcounty AMR focal persons will work closely with subcounty leadership to convene quarterly subcounty AMR TWCs to review community AMR and AMU/C trends, ensure alignment and monitor community implementation, resolve community issues, and foster collaborative problem-solving at community level

6.2.3 AMR Focal Points • Each line Ministry, department and agency will designate AMR Focal Points, who will: • Coordinate AMR activities within their sectors. • Report progress, challenges, and updates to the UNAMRSC. • Facilitate the collection and integration of surveillance data into national monitoring frameworks. • These Focal Points are the critical link between governance structures and sectoral implementation teams, ensuring consistency in achieving the plan’s objectives. Uganda Antimicrobial Resistance National Action Plan

6.2.4 Cross-Sectoral Collaboration Platforms • Joint planning sessions, intersectoral workshops, integrated implementation of activities including training, mentorship and surveillance programs will foster • Harmonization and promote knowledge, data and resource-sharing within and across sectors. • These platforms will support the integration of innovative approaches and strengthen stakeholder engagement to improve AMR responses. 20

6.2.5 Communication and Data-Sharing Protocols • Centralized and sector specific data management and sharing systems will enable the timely exchange of AMR-related data/information, ensuring transparency, consistency, and evidence-based decision-making within and across sectors. • Standardized reporting formats will streamline information flows, enabling stakeholders to access critical data efficiently. Regular Coordination Meetings Sector-Specific AMR Technical Working 2 Committees (TWCs) 3 AMR Focal 1 Points Coordination Mechanism Matrix 4 Cross-Sectoral Collaboration 5 Platforms Communication and Data-Sharing Protocols Uganda Antimicrobial Resistance National Action Plan 21 7. Strategic Interventions S trategic interventions have been prioritized for the next five years (2024/25-2028/29) to address each objective outlined above. The plan details priority actions to guide government AMR efforts across five objectives: awareness, stewardship, infection prevention, surveillance, and research. The government prioritized these actions with partners based on relevance to current health contexts, the feasibility of implementation, and ensuring the greatest impact within the five-year action plan timeline. Various MDAs and partners will implement actions within their areas of responsibility based on their needs and capacities. While grouped into five objectives for this action plan, the priority interventions are mutually reinforcing and designed as a suite of actions for maximum collective impact. Global Action Plan on AMR Uganda NAP GOAL Overall Goal: slowdown the emergence and spread of resistant organisms OBJECTIVES Promote public Strengthen infection Promote antimicrobial Strengthen AMR Enhance Research awareness, Training prevention and control stewardship, optimal surveillance and data and Innovation and Education (IPC) measures access, and responsible sharing use of antimicrobials Strengthening IPC Developing and Enhancing Strategic Awareness Support coordination for Strengthening Programs at National, AMR Surveillance Initiatives antimicrobial stewardship Antimicrobial Stewardship Subnational, Health Facility, Infrastructure and optimal use (AMS) Programs and Community Levels INTERVENTIONS Capacity Building in Establishing Systems for Optimize access to Optimizing Access to Monitoring Antimicrobial Education and Media Controlling Multi Drug effective medicines and Antimicrobials and Use (AMU) and Resistant Organisms diagnostics Diagnostics Consumption (MDROs) Uganda Antimicrobial Resistance National Action Plan Community-Based Promote optimal Strengthening Diagnostic Monitoring Infection Prevention and Promoting Farm prescribing, dispensing, Stewardship for Antimicrobial Residues Control (IPC) Awareness Biosecurity Measures and use of antimicrobials Microbiology Testing and in Food, Environment, Test Utilization and Animal Feeds Strengthening Promoting Rational Foster collaboration Promoting Cross-Sectoral Environmental Waste Prescribing, Dispensing, and partnerships Collaboration and Management and Use of Partnerships Antimicrobials Expanding and Ensuring Quality, Safety, Optimizing Vaccination and Efficacy of Programs Antimicrobials and Diagnostics 22 Strategic Objective 1: Promote Public Awareness, Training, and Education The goal of Strategic Objective 1 is to increase awareness and understanding of antimicrobial resistance (AMR) among the public, healthcare professionals, and policymakers, addressing the root cause of AMR’s persistence as a public health threat. To achieve this, the objective focuses on bridging the knowledge gap through comprehensive risk communication and community engagement initiatives grounded in behavioral science and social and behavior change (SBC) approaches. By fostering lasting behavior changes, this objective aims to reduce antimicrobial misuse and slow the spread of AMR. Emphasizing a community-centered approach, it seeks to empower individuals to actively prevent AMR across human, animal, and environmental health sectors. The following priority strategies and actions are proposed: Strategic Intervention 1.1 Improve Public Awareness

1.1.1 Update and improve functionality of the national coordination PATE TWC, ensuring inclusiveness and representation

1.1.2 Establish and implement a communication strategy to increase awareness, ensuring that messages are culturally appropriate and accessible to diverse groups, including those with disability, the marginalized and vulnerable

1.1.3 Promote the institutionalization of NAP-AMR II priorities and strategies in MDAs including integration in MDA plans, national risk register and any other related frameworks to ensure its visibility

1.1.4 Create AMR awareness among stakeholders (health professionals, decision makers, opinion leaders, NGOs, CSOs, the media, private sector players, and other stakeholders)

1.1.5 Establish multisectoral mechanisms to coordinate AMR communication and public awareness across all relevant sectors Uganda Antimicrobial Resistance National Action Plan

1.1.6 Develop and disseminate tailored AMR information, education, and communication (IEC) materials and tools suitable for diverse

1.1.7 Develop and disseminate AMR IEC materials and tools suitable for diverse stakeholders

1.1.8 Conduct regular public awareness campaigns on AMR and antimicrobial use, targeting behavior change

1.1.9 Partner with NGOs, civil society organizations, and other stakeholders to enhance outreach and amplify AMR messaging.

1.1.10 Define and engage vulnerable groups on AMR issues to promote inclusive awareness.

1.1.11 Disseminate relevant AMR research findings promptly to the public for awareness, including aspects of differential impact of AMR in diverse populations.

1.1.12 Engage key decision-makers at different levels to discuss AMR data, promoting data- driven policy actions.

1.1.13 Engage vulnerable groups and establish advocacy networks to enhance awareness on AMR at the national, subnational and community level 23 Strategic Intervention 1.2 Enhance Education and Training of Human, Animal and Environment Professionals

1.2.1 Integrate AMR topics into curricula for primary, secondary, university, and in-service training for professionals in human, animal, plant, and environmental health sectors, ensuring the curriculum includes content on the differential impact of AMR across diverse population groups

1.2.2 Train media professionals on accurate and effective reporting of AMR and its impact on various/diverse groups to support informed discourse. Strategic Intervention 1.3 Promote Awareness on Infection Prevention and Control (IPC) Practices in Communities

1.3.1 Develop/update/adopt and disseminate IPC IEC materials for AMR containment ensuring that messages are culturally appropriate and accessible to diverse groups, including those with disability, the marginalized and vulnerable

1.3.2 Adapt, disseminate and implement social and behavior change (SBC) tools specific to IPC practices to support awareness in various community settings, including schools and public places

1.3.3 Collaborate with local leaders and influencers to champion IPC practices and encourage community-led AMR prevention initiatives

1.3.4 Facilitate community dialogues and training to raise awareness of IPC practices, focusing on hygiene, sanitation, and responsible antimicrobial use in daily activities, ensuring inclusivity and representation of divers groups Strategic Objective 2: Strengthen Infection Prevention and Control (IPC) Measures Uganda Antimicrobial Resistance National Action Plan Effectively combating antimicrobial resistance (AMR) in Uganda requires a comprehensive infection prevention and control (IPC) strategy across all sectors. This strategy prioritizes personal and environmental hygiene and implements robust biosecurity measures across the entire value chain, from farms to food production to plate. The following interventions are proposed: Strategic Intervention 2.1 Strengthen IPC Programs at the national, subnational, health facility and community levels

2.1.1 Update and improve functionality of the national coordination IPC TWC, ensuring inclusiveness and representation 24

2.1.2 Update and improve functionality of the health facility IPC committees

2.1.3 Strengthen, and monitor IPC programs across national and local healthcare facilities through standardization of procedures and practices, regular assessments CQI, performance recognition and recognition/reward, inclusive training and mentorship.

2.1.4 Ensure compliance with IPC, hand hygiene and water management protocols through regular monitoring, and inclusive training and mentorship.

2.1.5 Improve and expand infrastructure and resources in healthcare facilities to support safe practices across all geographical locations, ensuring accessibility to all.

2.1.6 Ensure consistent availability of essential IPC supplies, such as disinfectants and protective Gear across all geographical locations.

2.1.7 Promote food hygiene practices in all public places and communities.

2.1.8 Improve access to safe and clean water at the community levels Strategic Intervention 2.2 Establish systems for controlling multidrug resistant organism (MDRO)

2.2.1 Establish and implement diagnostic, treatment, notification, tracking and response protocols for patients with Multi Drug Resistant infections, based on evidence-based practices, including colonization screening for priority MDRO pathogens

2.2.2 Train health care workers on infection prevention and control protocols for the containment and management of MDROs, ensuring inclusiveness Strategic Intervention 2.3 Promote Farm Biosecurity Measures

2.3.1 Develop, disseminate and support implementation of biosecurity guidelines tailored for various agricultural settings, promoting hygiene, sanitation, and safe waste management practices.

2.3.2 Support food safety campaigns.

2.3.3 Implement minimum biosecurity infrastructure standards across agricultural and animal production facilities.

2.3.4 Distribute biosecurity materials and train agricultural workers on their proper use, safeguarding animal health and measure for minimizing cross-contamination risks, ensuring inclusiveness. Strategic Intervention 2.4 Strengthen environmental Uganda Antimicrobial Resistance National Action Plan waste management

2.4.1 Establish/update and promote compliance to safe discharge guidelines to limit microbial and antibiotic waste from health care facilities, farms, manufacturing units and the public Strategic Intervention 2.5 Expand and Optimize Vaccination Programs

2.5.1 Strengthen vaccination initiatives to cover vaccine-preventable human, fish and livestock diseases, particularly in underserved regions.

2.5.2 Diversify the range of vaccines available nationwide, enhancing distribution to ensure timely access to vaccines across Uganda. 25 Strategic Objective 3: Promote Antimicrobial Stewardship, Optimal Access, and Responsible Use of Antimicrobials Strategic Objective 3 seeks to promote responsible antimicrobial use to preserve the efficacy of these essential medicines, extend their lifespan, and limit resistance development. This objective focuses on establishing sustainable antimicrobial stewardship (AMS) practices across human, animal, and environmental health sectors. Targeted interventions will address stewardship frameworks, rational prescribing practices, and quality assurance. The ultimate goal is to maintain the effectiveness of antimicrobials for human, animal, and environmental health by promoting controlled access, effective stewardship, and appropriate usage. Strategic Intervention 3.1 Strengthening Antimicrobial Stewardship Programs

3.1.1 Update and enhance functionality of the Technical Working Committee (TWC) for Antimicrobial Stewardship and Optimal Use (ASO) to provide cohesive AMS leadership, ensuring inclusiveness and representation.

3.1.2 Update and improve functionality of the health facility Medicines and Therapeutics Committee (MTC) committees and their related subcommittees, ensuring inclusiveness and representation

3.1.3 Institutionalize Antimicrobial stewardship (AMS) practices at national and subnational levels, ensuring

3.1.4 Availability and adherence to up-to-date AMS guidelines and protocols across One Health sectors. Uganda Antimicrobial Resistance National Action Plan Strategic Intervention 3.2 Optimizing Access to Antimicrobials and Diagnostics

3.2.1 Monitor the availability and access to essential antimicrobials and diagnostics to prevent shortages and maintain ensure rational use.

3.2.2 Enhance financing systems to make antimicrobials and diagnostics affordable and accessible to all, across all one sectors health sectors.

3.2.3 Strengthen supply chain management to ensure continuous availability and quality of antimicrobials and diagnostics.

3.2.4 Support local production of antimicrobials to reduce dependence on imports and increase local accessibility.

3.2.5 Establish systems to restrict broad or generalized use of antimicrobials as growth promoters or as feed additives 26 Strategic Intervention 3.3 Strengthen Diagnostic Stewardship for Microbiology Testing and Test Utilization in human, fish and livestock sectors

3.3.1 Develop and implement standardized diagnostic protocols, guidelines, SOPs and Job aids

3.3.2 Train health care workers including laboratory personnel, clinicians, pharmacists, and nurses and veterinary practitioners on diagnostic stewardship principles, ensuring inclusiveness

3.3.3 Mentor healthcare providers on the use/implementation of standardized diagnostic protocols, guidelines, SOPs and Job aids, ensuring inclusiveness

3.3.4 Support facilities to conduct regular Continuing Medical Education (CME) sessions with health and veterinary practitioners focusing on the importance of microbiology diagnostics, correct test ordering practices, and interpretation of results

3.3.5 Establish regular interdisciplinary meetings and case discussions between laboratory staff and clinicians or veterinary partitioners to review test results, discuss diagnostic challenges, and optimize patient management strategies

3.3.6 Conduct periodic audits of microbiology testing practices and use the findings to provide feedback and drive quality improvement initiatives

3.3.7 Create and integrate clinical decision support tools within the hospital information system to assist clinicians in selecting appropriate microbiology tests based on clinical guidelines and patient symptoms

3.3.8 Develop and disseminate hospital-specific and veterinary antibiograms to guide empiric antimicrobial therapy and support stewardship efforts Strategic Intervention 3.4 Promote Rational Prescribing, Dispensing, and Usage Practices

3.4.1 Enforce regulations on over-the-counter sales and self-medication to reduce unauthorized antimicrobial use.

3.4.2 Regularly update guidelines to support rational prescribing, dispensing, and use of antimicrobials in clinical and agricultural settings.

3.4.3 Implement systems to detect and manage errors in antimicrobial prescribing, dispensing, and use, including agrochemical applications.

3.4.4 Strengthen treatment protocols for Multi Drug Resistant organisms (MDROs), focusing on consistent and evidence-based practices.

3.4.5 Conduct mentorship and supervision to improve prescribing and dispensing practices in human and animal sectors, ensuring inclusiveness Uganda Antimicrobial Resistance National Action Plan

3.4.6 Assess prescription practices, , institute Continuous Quality Improvement (CQI) and reward systems to ensure compliance to established standards Strategic Intervention 3.5 Ensure Quality, Safety, and Efficacy of Antimicrobials and Diagnostics

3.5.1 Strengthen national quality control laboratories to verify antimicrobial and diagnostic product quality.

3.5.2 Train pharmacy and retail outlet owners on AMS principles to promote informed dispensing practices, ensuring inclusiveness.

3.5.3 Monitor antimicrobial residues across sectors and geographical regions to prevent environmental contamination, particularly in water and food sources.

3.5.4 Improve pharmaceutical and antimicrobial waste management practices to reduce pollution and prevent environmental AMR risks across all geographical regions. 27

3.5.5 Strengthen detection mechanisms to identify and address substandard or counterfeit antimicrobials, agrochemicals, diagnostics, and other health technologies.

3.5.6 Collaborate with regional/regulatory agencies to ensure these products meet quality and safety standards before entering the market.

3.5.7 Update and disseminate guidelines for pharmaceutical and antimicrobial waste management Strategic Objective 4: Strengthen AMR Surveillance and Data Sharing Effective AMR surveillance is essential for tracking and addressing the growing threat of antimicrobial resistance in Uganda. Strategic Objective 4 focuses on creating a comprehensive monitoring system to produce reliable data on AMR trends, antimicrobial use, and residue levels across human, animal, and environmental sectors. By enhancing surveillance infrastructure, improving data management, and fostering cross-sector collaboration, Uganda can make data-driven decisions, respond proactively to AMR threats, and guide evidence-based policy adjustments. The following interventions are proposed: Strategic Intervention 4.1 Developing and Enhancing AMR Surveillance Infrastructure

4.1.1 Update and improve the functionality of the Technical Working Committee (TWC) for AMR surveillance, ensuring inclusiveness and representation

4.1.2 Establish and implement a national framework for AMR data management and sharing within and across sectors.

4.1.3 Update and standardize AMR surveillance plans, protocols and Standard Operating Procedures (SOPs).

4.1.4 Train Health care workers, environmentalists, conservation and veterinary teams on AMR Uganda Antimicrobial Resistance National Action Plan surveillance plans, protocols and mitigation measures

4.1.5 Adopt and implement a framework for monitoring and improving microbiology laboratories within the AMR surveillance network

4.1.6 Assess and strengthen microbiology/AMR testing capacity and across sectors to improve testing and quality capacity focusing on priority pathogens.

4.1.7 Enroll and monitor labs in external quality assurance programs to ensure accuracy in AMR data.

4.1.8 Enhance laboratory infrastructure, human resources, equipment management and ensure supply chain reliability of essential reagents and commodities.

4.1.9 Conduct regular AMR surveillance data collection, analysis, interpretation and reporting (at the national and international level)

4.1.10 Regularly disseminate/share generated AMR surveillance data and information disaggregated to represent diverse population and geographical locations to promote utilization for policy making and evidence-based practices at all levels

4.1.11 Establish an early warning system to monitor trends of AMR and initiate public health actions

4.1.12 Establish and implement procedures and guidelines for the Early detection and response to multi-drug-resistant infections 28 Strategic Intervention 4.2 Monitoring Antimicrobial Use and Consumption

4.2.1 Revise/ update and implement AMU/C surveillance plans in human and animal health and environment

4.2.2 Develop and Implement procedures to monitor antimicrobials imported, used and disposed- off.

4.2.3 Strengthen and monitor antimicrobial stewardship interventions

4.2.4 Support AMU/C surveillance data collection, analysis, interpretation and reporting at the national and international levels

4.2.5 Regularly disseminate/share generated AMU/C surveillance data and information to promote utilization to promote utilization for policy making and evidence based practices at all levels Strategic Intervention 4.3 Monitoring Antimicrobial Residues in foods, Environment, animal feeds

4.3.1 Design/update and implement surveillance plans, protocols and SOPs to monitor and report antimicrobial residues in food products, water sources, herbal products, and animal feeds

4.3.2 Facilitate regular antimicrobial residue data collection, analysis, interpretation and reporting (at national and international levels)

4.3.3 Regularly disseminate/share generated antimicrobial residue data and information to promote utilization for policy making and evidence-based practices at all levels

4.3.4 Adopt and apply national and international standards that align with international guidelines for monitoring and reporting antimicrobial residues Strategic Intervention 4.4 Promoting Cross-Sectoral Collaboration and Partnerships

4.4.1 Establish regular communication channels between across sectors and stakeholders (including multilateral and bilateral organizations, CSOs, the private sectors) to harmonize AMR data collection, analysis, interpretation, dissemination and share surveillance data and best practices. Collaborate with regional and global partners to align surveillance systems to global and regional standards, conduct data sharing forums, share best practices, and optimize data sharing protocols.

4.4.2 Collaborate with regional and global partners to align surveillance systems to global and regional standards, conduct data sharing forums, share best practices, and optimize data Uganda Antimicrobial Resistance National Action Plan sharing protocols.

4.4.3 Establish collaborations with WHO/FAO Codex Alimentarius and other regional/global partners to promote information exchanges and sharing of best practices

4.4.4 Establish and implement integrated AMR surveillance protocols 29 Strategic Objective 5: Enhance Research and Innovation Uganda must invest in research and innovation to combat AMR effectively. This includes developing new diagnostics, preventive measures, therapeutics, and innovative strategies to reduce transmission and prevent infections. This strategic objective aims to foster innovation and advance research to discover technologies that can slow the emergence and spread of AMR. The following interventions are proposed: Strategic Intervention 5.1 Set Priorities for AMR Research and Innovation

5.1.1 Establish mechanisms for regular prioritization of research areas that address Uganda’s AMR challenges. Strategic Intervention 5.2 Enhance Operational and Systems Research

5.2.1 Improve reporting and publication on AMR epidemiology and drug efficacy to inform policy and strengthen AMR management.

5.2.2 Enhanced antimicrobial product development by the Natural Chemotherapeutics Laboratories (NCL) and other partners

5.2.3 Establish linkages between indigenous technical knowledge (ITK) groups to improve product development system

5.2.4 Conduct studies to estimate Strategic Intervention 5.3 Strengthen Collaborations in AMR Research

5.3.1 Update and support the functionality of Research TWC, ensuring inclusiveness and Uganda Antimicrobial Resistance National Action Plan representation

5.3.2 Build and expand partnerships with national and international institutions to support basic and applied AMR research.

5.3.3 Facilitate research collaborations focused on developing alternative therapies, vaccines, and antimicrobial agents.

5.3.4 Support and expand biorepositories and enhance bioinformatics and next-generation sequencing capabilities within the country.

5.3.5 Evaluate AMR containment interventions to guide future interventions, practices and policy decisions.

5.3.6 Establish linkages between indigenous technical knowledge (ITK) groups to improve product development system

5.3.7 Enhance genomics and bio-informatics on AMR data management and analysis 30 8. Implementation Framework

8.1 Phased Rollout Plan I mplementing the NAP-AMR II will follow a structured, phased approach to ensure systematic progress and sustainable impact. Each phase is defined by specific milestones to guide targeted actions across sectors, allowing for gradual scale-up and improvement in addressing AMR. Summary of the implementation plan

8.1.1 Phase 1: Short-Term Actions (Years 1-2) – Foundational Setup Short-Term Key Focus: Establish governance, regulatory mechanisms, awareness, Actions and surveillance infrastructure. (Years 1-2): Foundational • Governance and Coordination: Strengthen the One Health Structure Setup Secretariate multisectoral AMR coordination function, Uganda National AMR Sub-Committee (UNAMRSC) and Technical Working Committees (TWCs) with clear mandates and performance indicators. • Public Awareness and Education: Develop, disseminate and implement a national AMR communication strategy targeting human, animal, and environmental sectors. Establish a national multi-sectoral AMR awareness campaign platform. • Regulatory Enforcement: Develop and enforce a private-sector Medium-Term Actions regulatory framework for pharmacies, agro-vets, and healthcare (Years 3-4): providers to control antimicrobial misuse. Scale-Up and Strengthening • Surveillance and Laboratory Capacity-Building: Prioritize national Uganda Antimicrobial Resistance National Action Plan laboratory capacity-building for AMR surveillance with clear data- sharing mechanisms and quality assurance protocols. • Biosecurity and Infection Prevention: Conduct nationwide training for food producers, veterinarians, and farmers on AMR-related biosecurity measures. • Stakeholder Engagement: Establish collaborative networks with CSOs, NGOs, media, and industry players to disseminate AMR information. Long-Term Actions • Financing and Resource Mobilization: Establish a financial (Year 5 and Beyond): sustainability roadmap for AMR initiatives, including donor Sustainable Impact mapping and engagement with the private sector. and Evaluation 31

8.1.2 Phase 2: Medium-Term Actions (Years 3-4) – Scale-Up and Strengthening Key Focus: Expand surveillance, enforce antimicrobial stewardship, and strengthen regulatory oversight. • AMR Surveillance Expansion: Achieve full national AMR surveillance coverage with standardized regional reporting mechanisms and an early warning system for emerging resistance threats. • Regulatory Compliance and Enforcement: Implement full restrictions on over-the-counter sales of antimicrobials, with strengthened regulatory oversight for prescribing and dispensing practices. • Antimicrobial Stewardship: Roll out incentive-based antimicrobial stewardship programs for healthcare providers, veterinarians, and pharmacists to improve prescribing behaviors. • Biosecurity Enforcement: Scale up enforcement of biosecurity standards in livestock, aquaculture, and food industries, with targeted inspections and compliance measures. • Research and Development: Launch targeted funding mechanisms for local antimicrobial production and diagnostic innovation. • Policy Integration: Institutionalize AMR interventions into national policies across health, agriculture, and environmental sectors.

8.1.3 Phase 3: Long-Term Actions (Year 5 and Beyond) – Sustainability and Innovation Key Focus: Evaluate interventions, ensure financial sustainability, and integrate AMR programs into national health, agriculture, and environmental systems. • Evaluation and Policy Refinement: Conduct comprehensive impact Uganda Antimicrobial Resistance National Action Plan assessments of AMR interventions and use findings to refine national policies and strategies. • Financial Sustainability: Develop long-term financing models for AMR initiatives, including public-private partnerships and government budget allocations. • Institutionalization of AMR Programs: Fully integrate AMR containment measures into routine national health, agricultural, and environmental programs. • Innovation and Research Expansion: Scale up Uganda’s involvement in regional and global AMR research collaborations, particularly in antimicrobial alternatives, vaccine development, and transmission pathway studies. 32

8.2 Stakeholder Roles in Implementation The successful implementation of the NAP-AMR relies on a coordinated effort from a diverse set of stakeholders, each with distinct responsibilities that leverage their strengths and areas of expertise:

8.2.1 Government Ministries and Agencies • Ministry of Health (MOH): Leads AMR initiatives in the human health sector,. • Ministry of Agriculture, Animal Industry, and Fisheries (MAAIF): Manages AMR-related efforts in agriculture, including biosecurity measures, antimicrobial use surveillance, and policy development for animal health. • Ministry of Water and Environment (MWE): Oversees environmental aspects of AMR, particularly in waste management, water safety, and pollution control, to limit AMR spread in natural ecosystems. • Uganda Wildlife Authority (UWA): Contributes to AMR monitoring within wildlife populations and addresses AMR-related biodiversity challenges. • Ministry of Gender Labour and Social Development: to provide technical expertise to UNAMRSC and collaborating partners to support the streamlining of Gender and Equity in the containment of AMR. • National Drug Authority (NDA): Regulates antimicrobial production, distribution, and usage across sectors, ensuring responsible access and safe use. • National Environment Management Authority (NEMA): Ensures that environmental regulations related to AMR are enforced, Uganda Antimicrobial Resistance National Action Plan particularly those concerning waste disposal and environmental contamination.

8.2.2 Research and Academic Institutions • Organizations like the Uganda National Health Research Organization (UNHRO) , the National Agricultural Research Organization (NARO) and the Uganda National Academy of Sciences conduct operational and systems research, generating data and evidence to support evidence-based decision- making. • Universities and academic institutions integrate AMR topics into educational curricula, train the next generation of AMR professionals, and support research initiatives. 33

8.2.3 Private Sector • Pharmaceutical companies: Participate in antimicrobial stewardship programs, promote responsible antimicrobial use, and support innovations in antimicrobial alternatives. • Healthcare providers and agribusinesses: Implement AMR prevention measures, adhere to best practices in antimicrobial use, and contribute to data sharing for surveillance purposes.

8.2.4 Civil Society and Community-Based Organizations • These groups are key in raising public awareness, advocating for responsible antimicrobial use, and engaging local communities in AMR prevention efforts. They work with Village Health Committees (VHCs) and other local structures to promote AMR knowledge and adherence to guidelines.

8.2.5 Development and implementing Partners • Multilateral Organizations like the World Health Organization (WHO), Food and Agriculture Organization (FAO), and World Organization for Animal Health (WOAH) provide technical support, funding, and access to international resources, aligning Uganda’s efforts with global standards and practices. • Bilaterial Organizations like the USAID, US CDC, Africa CDC provide providing development assistance including funding and access to international resources • Implementing organization provide technical assistance in implementation and monitoring of the NAP-AMR II

8.2.6 Professional Organizations • Professional organizations including associations, Councils and Boards such as the Uganda Medical and Dental Practitioners Council, Uganda Veterinary Board, Pharmacy Council, Allied Health Uganda Antimicrobial Resistance National Action Plan Professionals Council, Uganda Medical Laboratory Technology Association provide support in advancing of the knowledge and practice of professions through developing, supporting, regulating and promoting professional standards for technical and ethical competence in relation to AMR containment. 34 9. Cost and Financing of the plan T he implement national action plan was costed using the WHO pragmatic and modular costing tool for antimicrobial resistance (AMR) NAPs (WHO Costing tool, https://openwho.org/courses/AMR- NAP-costing-tool). Stakeholders involved in the costing were trained by WHO after which they were able to undertake the costing exercise. This tool provides a clear approach to planning, costing and budgeting NAPs on AMR and provides the foundation to identify funding gaps and mobilize additional resources to fill those gaps to allow for successful implementation of the activities and support from partners. The costs of each of the activities are provided in the detailed operational/implementation plan. Below is a summary of each objective and the strategic interventions identified achieve the objectives. The plan will be financed through government financing mechanisms including contributions from development partners and systems and in line with the Uganda national Development Plan (NDP-II). It is anticipated that the proposed activities will be streamlined into government mainstream planning, financing and implementation mechanisms. The UNAMSC will coordinate, support and advocate for sufficient financing of the plan. Below is a summary estimate of the plan that was generated in accordance with the WHO costing tools for AMR NAPS. Uganda Antimicrobial Resistance National Action Plan 35 Table 1: Estimated Costs for the implementation of the Plan. Description of the Strategic Objective and Intervenion 2024 2025 2026 2027 2028 Total UGX Governance and Coordination 105,028,096 146,829,116 115,793,476 115,793,501 100,245,427 583,689,616 Strategy 1: Public Awareness, Training and Education 312,842,305 1,090,308,398 517,099,368 393,912,747 300,514,425 2,614,677,243 Intervention 1.1: Improve Public Awareness and capacity 161,822,574 665,368,601 367,669,355 333,896,958 296,526,516 1,825,284,003 Intervention 1.2: Support Education and Training of Human, Animal and Environment 69,898,389 299,601,822 3,617,152 0 3,987,909 377,105,272 Professionals Intervention 1.3: Promote awareness on Infection Prevention and control practices in 81,121,342 125,337,975 145,812,862 60,015,789 0 412,287,968 communities Strategy 2: Infection Prevention and Control (IPC) measures 197,566,978 1,309,363,729 1,383,062,019 754,779,753 663,413,186 4,308,185,665 Intervention 2.1: Strengthen IPC Programs at the national, subnational, health facility and 90,036,687 139,797,029 318,214,504 71,470,312 72,043,777 691,562,310 community levels Intervention 2.2 Establish systems for the detection and Control of multidrug resistant 38,587,152 59,913,012 136,377,645 30,630,134 30,875,905 296,383,847 organism (MDRO) Intervention 2.3: Promote on Farm Biosecurity Measures 41,050,800 415,485,110 293,606,845 280,705,302 219,942,946 1,250,791,002 Intervention 2.4: Strengthen environmental waste management procedures and practices 10,262,700 103,871,277 73,401,711 70,176,326 54,985,736 312,697,750 Intervention 2.5: Expand and Optimize Vaccination Programs 17,629,638 590,297,301 561,461,314 301,797,679 285,564,823 1,756,750,755 Strategy 3: Promote Antimicrobial Stewardship, Optimal Access, and Responsible Use of 132,044,739 838,670,645 595,635,655 476,447,752 214,556,835 2,257,355,627 Antimicrobials Intervention 3.1: Strengthening Antimicrobial Stewardship 30,357,987 84,715,288 36,292,823 50,960,484 40,012,838 242,339,420 Uganda Antimicrobial Resistance National Action Plan Intervention 3.2: Optimizing Access to Antimicrobials and Diagnostics 0 170,701,410 84,539,891 98,261,909 6,565,461 360,068,671 Intervention 3.3: To promote Optimal Prescribing, Dispensing and Use of antimicrobials and 30,850,117 234,166,456 168,833,861 68,783,337 102,095,351 604,729,121 chemicals Intervention 3.4: Strengthen Diagnostic Stewardship for Microbiology Testing and Test 13,221,479 100,357,053 72,357,369 29,478,573 43,755,150 259,169,623 Utilization in human, fish and livestock sectors Intervention 3.5: Ensure Quality, Safety, and Efficacy of Antimicrobials and Diagnostics 57,615,158 248,730,438 233,611,711 228,963,450 22,128,036 791,048,792 Strategy 4: Strengthen AMR Surveillance and Data Sharing 154,440,632 4,439,633,517 1,896,115,296 1,500,051,529 1,481,386,860 9,471,627,834 Intervention 4.1: Developing and Enhancing AMR Surveillance Infrastructure 97,025,526 4,130,789,264 1,056,936,118 699,922,149 750,675,362 6,735,348,419 Intervention 4.2: Enhance Monitoring of Antimicrobial Use and Consumption 0 229,548,392 65,064,618 11,579,296 0 306,192,306 Intervention 4.3: Monitoring Antimicrobial Residues in foods, Environment, animal feeds 40,810,737 54,089,230 774,114,561 788,550,084 730,711,498 2,388,276,109 Intervention 4.4: Promoting Cross-Sectoral Collaboration and Partnerships 16,604,368 25,206,632 0 0 0 41,811,000 Strategy 5: Enhance Research and Innovation 5,361,411 4,764,525,993 2,209,991,424 2,516,644,276 1,483,307,867 10,979,830,970 Intervention 5.1: Set Priorities for AMR Research and Innovation 5,361,411 29,617,792 0 6,252,820 0 41,232,023 Intervention 5.2: Enhance Operational and Systems Research 0 4,673,729,605 1,206,452,404 140,109,486 0 6,020,291,495 Intervention 5.3: Strengthen Collaborations in AMR Research and evaluate interventions 0 61,178,595 1,003,539,020 2,370,281,969 0 4,918,307,451 Total 907,284,160 12,589,331,397 6,717,697,238 5,757,629,557 4,243,424,602 30,215,366,954 36 10. Monitoring, Evaluation, and Learning (MEL) Framework T he Monitoring, Evaluation, and Learning (MEL) Framework provides the strategic foundation for tracking, assessing, and continuously improving the implementation of Uganda’s National Action Plan on Antimicrobial Resistance (NAP-AMR II). This framework defines how evidence will be collected, analyzed, and used to support accountability, adaptation, and effectiveness in reducing AMR risks across human, animal, environmental, and policy sectors. The NAP-AMR II MEL Plan operationalizes this framework by outlining specific indicators, data sources, and reporting mechanisms. It is directly linked to the NAP-AMR II Results Matrix, ensuring monitoring and evaluation activities align with expected outputs and outcomes across all strategic objectives.

10.1 Strategic Priorities of the MEL Function The MEL Framework for NAP-AMR II is structured around five core strategic priorities that ensure AMR containment efforts are evidence-based, data-driven, and continuously improving.

10.1.1 Surveillance and Early Warning Systems • Establishes a national AMR surveillance system across One Health sectors. Uganda Antimicrobial Resistance National Action Plan • Uses real-time alerts and automated dashboards to detect AMR trends. • Ensures timely risk assessment and response coordination. • Lead Entities: UNAMRSC, Line Ministries, AMR Surveillance TWC.

10.1.2 Tracking Implementation and Program Performance • Conducts quarterly reviews to assess program progress and identify bottlenecks. • Integrates routine site-level mentorship to enhance implementation quality. • Strengthens cross-sectoral collaboration to improve AMR response delivery. • Lead Entities: One Health Secretariat, UNAMRSC, Line Ministries. 37

10.1.3 Evaluating Effectiveness and Scaling Best Practices • Conducts periodic impact assessments to measure effectiveness and cost-efficiency. • Identifies best practices for AMR containment and facilitates national scale-up. • Strengthens evidence-based policy recommendations. • Lead Entities: UNAMRSC, Independent Evaluators, Research TWC.

10.1.4 Continuous Learning and Adaptive Program Management • Uses M&E insights to inform real-time policy and program adjustments. • Conducts quarterly scenario planning exercises to improve AMR preparedness. • Ensures continuous program learning and refinement. • Lead Entities: UNAMRSC, One Health Secretariat, Line Ministries.

10.1.5 Aligning MEL with Policy and Resource Planning • Uses M&E findings to guide AMR policy development and national decision-making. • Aligns AMR priorities with Ministry of Finance & Parliament for sustained funding. • Ensures resource allocation is evidence-driven and transparent. • Lead Entities: UNAMRSC, One Health Secretariat, Line Ministries.

10.2 Governance of the MEL Function The National AMR Sub-Committee (UNAMRSC) is the lead technical structure responsible for: Coordinating MEL activities across human, animal, and environmental health sectors. • Ensuring AMR surveillance data informs national decision-making. • Aligning MEL processes with global AMR monitoring frameworks (WHO, FAO, OIE). • Engaging Parliament and MFPED to secure long-term AMR financing. Cross-sectoral MEL integration is operationalized through: • The One Health Secretariat, which provides technical oversight and ensures data-sharing across ministries. Uganda Antimicrobial Resistance National Action Plan • Technical Working Committees (TWCs) on AMR surveillance, stewardship, and policy, which generate M&E insights for program improvement. • Independent evaluators who assess the effectiveness, scalability, and cost-efficiency of interventions. 38

10.3 MEL Indicators and Tracking Mechanisms The NAP-AMR II MEL Plan defines performance indicators and reporting mechanisms, ensuring that tracking occurs at the national and sectoral levels. These indicators are aligned with the Results Matrix, ensuring that MEL activities reinforce the achievement of intended outcomes across all sectors. At a high level, the following priority MEL indicators will be tracked: Strategic Area Key Indicator Responsible Data Source Tracking Entity Mechanism Governance & Functional AMR One Health TWG, Policy reviews, Document Coordination coordination UNAMRSC, One One Health TWG review, key mechanisms Health Secretariat reports informant operational across interviews One Health sectors. Public Awareness % of population UNAMRSC, PATE National surveys, Household & Competencies demonstrating TWC, One Health media monitoring surveys, accurate knowledge of Secretariat focus group AMR. discussions Infection Reduction in UNAMRSC, IPC DHIS2, Routine Prevention & healthcare-associated TWC, One Health surveillance data surveillance, Control (IPC) resistant infections. Secretariat patient record reviews Antimicrobial % of health facilities UNAMRSC, ASO Facility self- Checklist- Stewardship implementing TWC, One Health assessments, based (AMS) stewardship Secretariat AMU/AMC assessments programs. surveillance Research & Number of new UNAMRSC, Research Literature Innovation AMR solutions Research TWC, publications, reviews, patent developed & tested One Health patent filings databases (vaccines, diagnostics, Secretariat antimicrobials). Uganda Antimicrobial Resistance National Action Plan

10.4 Embedding MEL in National Governance and Sustainability To ensure Uganda’s sustained progress in AMR containment, the NAP-AMR II MEL framework is fully institutionalized within national governance structures through: • A dedicated AMR MEL budget, aligned with annual government planning cycles. • Integration of MEL into Uganda’s national development frameworks, ensuring policy and financial sustainability. • Operationalization of a national One Health data-sharing platform to enhance multi-sectoral coordination. • Engagement with Parliament and Ministry of Finance, Planning and Economic Development (MFPED), reinforcing government commitment to MEL-driven AMR governance. 39 Ultimate Outcome/ Impact: The emergence and spread of drug-resistant infections is slowed, and antimicrobials remain effective for treating infectious diseases in the human and animal health sectors GOVERNANCE AND COORDINATION MECHANISMS FOR AMR RESPONSE Planning Input Outputs Immediate Outcomes Intermediate Outcomes Governance, • Personnel time • Functional National One Health Platform • Enhanced governance and • Well-governed, coordinated and coordination and • Office space and (NOHP), ensuring cross-sector AMR coordination within and across unified national AMR response Strategic Oversight operational resources governance and coordination Ministries, Departments, and across One Health sectors • Uganda National Antimicrobial Resistance Agencies (MDAs) in AMR response • Increased multisectoral • Budget allocation for governance and Subcommittee (UNAMRSC) structure • Enhanced multisectoral collaboration collaboration for AMR activities coordination structures established, ensuring inclusiveness and in AMR response • Improved stakeholder representation engagement on AMR • Operational One Health Secretariat to containment support UNAMRSC and its five TWCs Technical Working • Personnel time • Sector-Specific TWCs (Human, Animal, • Improved technical oversight and • Enhanced implementation of Committees (TWCs) • Meeting resources Environmental, Wildlife) established and implementation of AMR activities AMR action plans within sectors and Implementation functional, ensuring equitable representation • Strengthened capacity of TWCs • Reduced duplication of AMR- • Technical expertise for Uganda Antimicrobial Resistance National Action Plan Support and inclusivity to align AMR plans with national related interventions across TWC support • TWC membership updated with designation priorities MDAs letters and Terms of Reference (TORs) Regular • Personnel time • Quarterly UNAMRSC and TWC Meetings at • Timely and evidence-based decision- • Strengthened cross-sectoral Coordination • Digital infrastructure for National, Sectoral, and Subnational levels to making on AMR containment collaboration for AMR Meetings and Data- data management and review NAP-AMR II implementation • Improved AMR surveillance, containment Sharing Platforms reporting • Established AMR focal points at the reporting, and response mechanisms • Increased use of real-time AMR • Budget for national and national, regional, district, and facility levels data for decision-making and regional meetings • NAP-AMR II MEL plan developed and policy development • M&E system operationalized • Multisectoral AMR data management and sharing platform developed and operationalized 40 Planning Input Outputs Immediate Outcomes Intermediate Outcomes Legislative, Policy • Personnel time • AMR economic studies conducted to • Strengthened AMR financing • Sustained national investments and Financial • Engagement with generate an investment case for increased mechanisms in AMR response Support for AMR policymakers and funding • Strengthened AMR policy direction • Increased political commitment Response budget committees • Budget allocations for AMR response and legislative oversight and funding for AMR activities • Funding for AMR strengthened • Increased legislative support for AMR • Improved regulatory frameworks implementation • Advocacy for greater resource mobilization policies and enforcement for AMR containment from development partners strengthened • Parliamentary Forum on AMR established and linked to oversight sectoral health committees STRATEGIC OBJECTIVE #1: PROMOTE PUBLIC AWARENESS, TRAINING, AND EDUCATION Planning Input Outputs Immediate Outcomes Intermediate Outcomes Strategic • Personnel time • Functional National Coordination PATE TWC in • Enhanced coordination • Enhanced coordination of public Awareness • Stationery place, ensuring equitable representation and of public awareness, awareness, training and education Initiatives inclusiveness training and education interventions • Funds for media and • National AMR Communication Strategy interventions • Strengthened national AMR messaging campaign outreach developed and operationalized, ensuring • Strengthened national AMR and advocacy Uganda Antimicrobial Resistance National Action Plan that messages are culturally appropriate and messaging and advocacy • Increased awareness and understanding accessible to diverse groups including persons • Increased awareness and of AMR among stakeholders (the public, with disability understanding of AMR policymakers, health professionals, • AMR priorities integrated into MDAs, national risk among stakeholders (the farmers, and the food industry) register, and other frameworks public, policymakers, health • Culturally appropriate AMR IEC materials professionals, farmers, and developed and disseminated the food industry) • Regular public awareness campaigns on AMR and responsible antimicrobial use conducted • Partnerships with NGOs, civil society, and other stakeholders strengthened to support awareness on AMR • Relevant AMR research findings disseminated to the public, including the differential impact of AMR in diverse populations • Key decision-makers engaged on AMR data for policy action • Advocacy networks established for AMR awareness at all levels 41 Planning Input Outputs Immediate Outcomes Intermediate Outcomes Capacity Building • Training resources • AMR topics integrated into primary, secondary, • Improved capacity of • Increased professional knowledge in Education and • Curriculum experts university, and in-service training curricula media to disseminate on AMR awareness and containment Media • Media professionals trained in accurate accurate AMR information measures • Training funds and responsible AMR reporting, ensuring • Strengthened skills for • Strengthened role of media in educating inclusiveness AMR prevention among the public on AMR risks professionals Community- • Personnel time • IPC IEC materials updated, developed, and • Increased awareness • Strengthened community adoption of Based Infection IEC materials and disseminated of IPC practices among IPC and biosecurity measures Prevention and SBC tools • Culturally appropriate SBC tools for IPC and communities • Reduced spread of infections due to Control (IPC) • Partnership WASH developed and implemented in schools • Enhanced community improved hygiene and sanitation Awareness engagement and public places, taking into considerations engagement in IPC resources persons with disability activities • Collaboration established with local leaders and influencers for IPC awareness • Community dialogues and training sessions facilitated on hygiene, sanitation, and antimicrobial use, ensuring inclusiveness • Partnerships with NGOs, civil society, and community leaders established for enhanced IPC community engagement Uganda Antimicrobial Resistance National Action Plan STRATEGIC OBJECTIVE #2: STRENGTHEN INFECTION PREVENTION AND CONTROL (IPC) MEASURES Planning Input Outputs Immediate Outcomes Intermediate Outcomes Strengthening • Personnel time • Functional IPC Technical Working Committee (TWC) in place, • Improved compliance • Reduced incidence of IPC Programs • Training materials ensuring equitable representation and inclusivity with IPC standards across infections in health care at National, • Functional Health facility IPC committees in place health facilities facilities and communities • Funding for IPC Subnational, infrastructure and • Standardized IPC procedures implemented and monitored in • Increased adherence to • Improved infection control Health Facility, and supplies healthcare and community settings hand hygiene and waste across healthcare and Community Levels management protocols community settings • Routine monitoring and supportive supervision for IPC programs, ensuring inclusiveness • Strengthened institutional capacity for IPC • Infrastructure and resources in healthcare facilities enhanced implementation and expanded to support safe practices across all geographic locations, ensuring access to all • Consistent availability of IPC supplies (disinfectants, PPE, water, soap, etc.) 42 Planning Input Outputs Immediate Outcomes Intermediate Outcomes Establishing Systems • Surveillance tools • National diagnostic, treatment, and reporting protocols for • Improved early detection • Reduced spread of for Controlling Multi • Diagnostic patients with MDR infections developed and response to MDR MDROs in hospitals and Drug Resistant laboratory • Routine screening for y MDR infections in healthcare facilities infections communities Organisms (MDROs) equipment established • Strengthened laboratory • Increased capacity • Training • Healthcare workers trained in the management and containment capacity for MDRO for MDRO outbreak resources for of MDR infections, ensuring inclusiveness surveillance preparedness and response healthcare staff Promoting Farm • Agricultural • Biosecurity guidelines developed and disseminated for various • Increased adoption of • Reduced incidence of Biosecurity extension agricultural settings farm biosecurity measures zoonotic infections and Measures services • Agricultural workers trained on farm biosecurity guidelines, among farmers and antimicrobial use in • Biosecurity ensuring inclusiveness veterinarians livestock materials and • Minimum farm biosecurity infrastructure standards enforced in • Strengthened compliance • Increased consumer access training livestock and aquaculture with safe waste disposal to safer food products • Engagement and hygiene in animal • Food safety campaigns conducted targeting farmers and with farmers farming agribusinesses and veterinary professionals Strengthening • Regulatory • National guidelines for safe disposal of antimicrobial waste • Reduced release of • Lower environmental Environmental Waste enforcement established antimicrobial residues contamination with Uganda Antimicrobial Resistance National Action Plan Management • Investment in • Routine environmental monitoring for antimicrobial into water bodies and soil microbial and antimicrobial wastewater contamination ecosystems residues treatment • Enforcement mechanisms to reduce pharmaceutical and hospital • Increased compliance • Decreased AMR • Stakeholder waste pollution with waste management transmission through water engagement policies and soil ecosystems Expanding and • Vaccine • Expanded immunization coverage for vaccine- preventable • Increased vaccination • Reduced incidence of Optimizing procurement and diseases in humans and livestock uptake in rural and urban infections requiring Vaccination distribution • Diversified range of vaccines available and accessible nationwide populations antimicrobial treatment Programs • Cold chain • Routine community vaccination drives implemented • Improved herd immunity • Strengthened population infrastructure against key infectious resilience against infectious • Community diseases diseases outreach for immunization awareness 43 STRATEGIC OBJECTIVE #3: PROMOTE ANTIMICROBIAL STEWARDSHIP, OPTIMAL ACCESS, AND RESPONSIBLE USE OF ANTIMICROBIALS Planning Input Outputs Immediate Outcomes Intermediate Outcomes Strengthening • Personnel time • Functional AMS Technical Working Committee (TWC) • Improved compliance with AMS • Reduced inappropriate Antimicrobial • Training materials for in place, ensuring equitable representation and guidelines in human, veterinary, antimicrobial prescribing and Stewardship (AMS) healthcare professionals inclusivity and agricultural sectors dispensing Programs • Functional Health facility Medicine and Therapeutics • Increased awareness and • Increased adoption of AMS • Funds for AMS committees and Committees (MTCs) in place, ensuring equitable knowledge of AMS among best practices across One supervision representation and inclusivity prescribers Health sectors • AMS guidelines updated and disseminated • AMS mentorship and supervision programs implemented, ensuring inclusiveness Optimizing Access • Supply chain resources • Essential antimicrobial and diagnostic available to all • Reduced stockouts and • Improved equitable access to Antimicrobials • Funding for , monitored and used rationally shortages of essential to high-quality, affordable and Diagnostics procurement and • Procurement and supply chain management antimicrobials and microbiology antimicrobials and regulation systems for antimicrobials and diagnostic supplies diagnostics microbiology diagnostics strengthened • Strengthened national capacity across healthcare and • Distribution to regulate antimicrobial and veterinary sectors infrastructure • Local production capacity of antimicrobials and diagnostic supplies enhanced to reduce dependence microbiology diagnostics supply on imports and increase local accessibility Uganda Antimicrobial Resistance National Action Plan • Policies for antimicrobial importation, production, and use enforced Strengthening • Laboratory reagents and • Standardized diagnostic protocols, guidelines, and • Improved microbiology test • Reduced empirical and Diagnostic equipment • SOPs developed and disseminated utilization to support inappropriate use of Stewardship for • Diagnostic stewardship • Healthcare and veterinary professionals trained • Appropriate ct antimicrobial antimicrobials Microbiology training for health prescribing practices • Strengthened capacity for and mentored on diagnostic stewardship, ensuring Testing and Test workers evidence based antimicrobial inclusiveness • Increased adoption of evidence- Utilization therapy • Laboratory Quality • Regular hospital and veterinary antibiograms based antimicrobial therapy assurance systems developed to guide empiric therapy • Optimized use of microbiology tests in human • Regular multidisciplinary diagnostic stewardship/ and animal health clinician-laboratory meetings conducted to review practices and cases • Periodic audits of microbiology testing cascade conducted to drive quality improvement initiatives • Clinical decision support tools created and integrated within the hospital information system to assist clinicians in selecting appropriate microbiology tests based on clinical guidelines and patient symptoms 44 Planning Input Outputs Immediate Outcomes Intermediate Outcomes Promoting Rational • Funds for supervision • Regulations enforced on over-the-counter • Improved rational prescribing • Increased adherence to Prescribing, and monitoring antimicrobial sales and dispensing practices antimicrobial use guidelines Dispensing, • Training materials • Prescribing and dispensing guidelines updated and • Reduced unauthorized in human and animal health and Use of for prescribers and implemented antimicrobial sales and self- • Strengthened compliance Antimicrobials dispensers medication with prescription regulations • Monitoring systems for antimicrobial use established • Regulatory frameworks in the human and animal health sectors • Optimized use of • Training, Mentorship and supervision programs for antimicrobials in human and prescribers and dispensers implemented, ensuring animal health inclusiveness Ensuring Quality, • Regulatory enforcement • National quality control laboratories strengthened for • Increased detection and removal • Reduced environmental Safety, and Efficacy • Surveillance tools for antimicrobial and diagnostic product testing of substandard or counterfeit contamination with of Antimicrobials antimicrobial quality • Regulatory framework for counterfeit and antimicrobials antimicrobial residues and Diagnostics control substandard antimicrobials enforced • Improved waste disposal • Increased consumer and • Funding for laboratory • Pharmaceutical waste management guidelines practices in healthcare, public safety from counterfeit testing updated and disseminated veterinary, and pharmaceutical drugs sectors • Environmental monitoring for antimicrobial residues strengthened Uganda Antimicrobial Resistance National Action Plan 45 STRATEGIC OBJECTIVE #4: STRENGTHEN AMR SURVEILLANCE AND DATA SHARING Planning Input Outputs Immediate Outcomes Intermediate Outcomes Developing and • Personnel time • Functional AMR Surveillance Technical Working Committee (TWC) in place, • Increased • Strengthened Enhancing AMR • Laboratory ensuring equitable representation and inclusivity standardization and monitoring of AMR Surveillance equipment and • National framework for AMR data management and sharing developed and harmonization of trends across Infrastructure reagents implemented AMR surveillance human, animal, and across sectors environmental sectors • Digital • AMR surveillance plans, protocols, and SOPs updated and implemented, infrastructure for including mapping and monitoring of AMR spillover risks between wildlife, • Improved capacity • Increased capacity for data management livestock, and humans for laboratory-based timely AMR response AMR detection and • Strengthened • Funding • reporting knowledge and for training, • Health care workers, environmentalists, conservation and veterinary teams mentorship and evidence base on AMR trained on AMR surveillance plans, protocols and mitigation measures supervision trends used for policy • Microbiology/AMR testing capacity in health and veterinary laboratories, and practical decisions • Laboratory Quality monitored and strengthened management • Microbiology External Quality Assessment program implemented, monitored Systems and strengthened • Funding for • Procurement and supply chain management systems for microbiology External Quality laboratory reagents enhanced across all sectors Assessment program • Microbiology equipment management systems enhanced, across all geographical locations Uganda Antimicrobial Resistance National Action Plan • Laboratory infrastructure • Regular AMR data collected and trends desegregated to represent diverse populations reported at facility, subnational, national and international levels • Early warning system for AMR trends and MDROs • Established Monitoring • Personnel training • AMU/C surveillance plans in human, animal, and environmental sectors updated • Improved tracking • Increased Antimicrobial • Funding for AMU/C • Systems developed for tracking imported, locally manufactured antimicrobials, of antimicrobial accountability Use (AMU) and surveillance used, and disposed use and potential and regulation Consumption implementation misuse of antimicrobial • Sector-specific monitoring of antimicrobial consumption conducted • Strengthened consumption • Regular AMU/C data collected and trends reported at facility, sunnational, sectoral and • Reduced indiscriminate national and international levels cross-sectoral use of antimicrobials antimicrobial use across all sectors reporting • Strengthened knowledge and evidence base on AMU/C trends used for policy and practical decisions 46 Planning Input Outputs Immediate Outcomes Intermediate Outcomes Monitoring • Laboratory • Antimicrobial Residues Surveillance plans, protocols, and SOPs developed and • Increased • Reduced antimicrobial Antimicrobial infrastructure implemented awareness of contamination in food Residues • Field surveillance • Regular monitoring of antimicrobial residues in food, water, and animal feeds antimicrobial systems and water in Food, tools conducted residue risks in food sources Environment, and water • Increased consumer • Regulatory • Data shared with policymakers and regulators to inform actions and Animal • Strengthened and public health enforcement • International standards (e.g., Codex Feeds regulatory protection resources • Alimentarius) applied for residue monitoring enforcement • Strengthened to reduce knowledge and contamination evidence base on antimicrobial residuals used for policy and practical decisions Promoting • Stakeholder • Regular AMR data-sharing platforms established across sectors • Increased • Improved global Cross-Sectoral engagement funds • Cross-sectoral meetings conducted with regulatory agencies, private sector, and harmonization of alignment with AMR Collaboration • Policy development partners AMR data collection surveillance and and Partnerships development and reporting response mechanisms • Regional and global collaborations strengthened (WHO, FAO, WOAH, etc.) resources • Strengthened • Enhanced data-driven • Integrated AMR surveillance protocols established and implemented • Data-sharing collaboration policymaking for AMR platforms between public and control private sectors Uganda Antimicrobial Resistance National Action Plan 47 STRATEGIC OBJECTIVE #5: ENHANCE RESEARCH AND INNOVATION Planning Input Outputs Immediate Outcomes Intermediate Outcomes Setting Priorities for • Research personnel • Functional AMR Research and Innovation Technical • Increased alignment of AMR • Enhanced evidence-based AMR Research and • Funding for research grants Working Committee (TWC) in place, ensuring research with national needs decision-making for AMR Innovation equitable representation and inclusivity • Strengthened stakeholder policies • Policy engagement resources • National AMR research priorities defined and engagement in AMR research • Strengthened national disseminated agenda-setting capacity for AMR-related • Funding mechanisms developed for priority AMR research research areas • Annual research dissemination meetings held Enhancing • Data collection tools • Epidemiological studies on AMR burden • Increased understanding of • Improved effectiveness of Operational and • Research funding • Conducted, including the differential impact of AMR AMR trends and drivers AMR response strategies Systems Research in diverse populations • Strengthened capacity to • Strengthened monitoring of • Institutional partnerships • Research on antimicrobial drug efficacy and evaluate AMR interventions antimicrobial effectiveness stewardship implemented in human and veterinary medicine • Collaborative studies with regional and global research institutions established • Integration of research findings into AMR policies and guidelines Uganda Antimicrobial Resistance National Action Plan Strengthening • Institutional research • National AMR Research TWC fully operational • Increased collaboration • Improved capacity for rapid Coordination and networks • Collaborations established with universities, between researchers, response to emerging AMR Collaboration in • Knowledge-sharing research institutes, and international partners policymakers, and threats AMR Research platforms practitioners • Increased uptake of research • Capacity-building programs for early-career AMR • Capacity-building programs researchers implemented • Strengthened AMR research findings into AMR programs infrastructure and human and policies • Bioinformatics and genomic surveillance resource capacity capabilities enhanced Developing • Research facilities • Studies on alternative antimicrobials (e.g., • Increased availability of • Diversified treatment options and Scaling • Laboratory resources probiotics, bacteriophages) conducted alternative treatment options to reduce reliance on Up Alternative • Indigenous technical knowledge (ITK) research on for infections conventional antimicrobials • Private sector partnerships Therapies and traditional antimicrobials integrated • Strengthened collaboration • Increased adoption of locally Innovations between researchers and developed AMR solutions • New AMR diagnostic tools and technologies developed and piloted industry in antimicrobial innovation • Local production of antimicrobial alternatives supported 48 11. 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Annex 1 AMR NAP II List of Contributors SN NAME INSTITUTION 1 Hon. Dr. Jane Ruth Aceng Ocero Ministry Of Health 2 Hon. Frank Tumwebaze Ministry of Agriculture, Animal Industry, and Fisheries 3 Hon. Cheptoris Sam Mangusho Ministry of Water and Environment 4 Hon. Col. Tom R. Butime Ministry of Tourism Wildlife and Antiquities 5 Dr. Henry Mwebesa Ministry of Health 6 Dr. Charles Olaro Ministry of Health 7 Dr. Allan Muruta Ministry of Health 8 Dr. Anna Rose Ademun Ministry of Agriculture, Animal Industry, and Fisheries 9 Mr Sam Mwandha Ministry of Tourism Wildlife and Antiquities, UWA 10 Dr. Susan Nabadda Ministry of Health, NHLDS 11 Dr. Akello Harriet Ministry of Health 12 Mr. Simon Etimu Ministry of Water and Environment 13 Dr. Patrick Atimnedi Ministry of Tourism Wildlife and Antiquities, UWA 14 Dr. Kajumbula Henry Makerere University 15 Prof. Denis Byarugaba Makerere University 16 Mr. Musa Sekamatte National One Health Platform 17 Ms. Carolyne Nyamor National One Health Platform 18 Mr. Ibrahim Mugerwa National Health Laboratory and Diagnostic Services 19 Dr. Saudah Namubiru Ministry of Health, NHLDS 20 Mr. Rogers Kisame Baylor College of Medicine Children’s Foundation-Uganda 21 Dr. Ceaser Adibaku Nyomliti Baylor College of Medicine Children’s Foundation-Uganda 22 Dr. Moses Mukiibi Baylor College of Medicine Children’s Foundation-Uganda 23 Dr. Joseph Mpagi Busitema University Uganda Antimicrobial Resistance National Action Plan 24 Dr. Willington Bessong Ojong Food and Agriculture Organization of the United Nations 25 Dr. Alice Namatovu Food and Agriculture Organization of the United Nations 26 Ms. Prima kazoora HEPS-Uganda 27 Mr. Richard walemwa Infectious Diseases Institute 28 Dr. Peter Wanyama Ministry of Agriculture, Animal Industry, and Fisheries 29 Rodgers Kalanda Ministry of Agriculture, Animal Industry, and Fisheries 30 Emmanuel isingoma Ministry of Agriculture, Animal Industry, and Fisheries 31 Ezra tumukunde Ministry of Agriculture, Animal Industry, and Fisheries 32 Michael kimanga Ministry of Agriculture, Animal Industry, and Fisheries 33 Dr. Fred Monje Ministry of Agriculture, Animal Industry, and Fisheries 34 Prof. Clovice Kankya Makerere University 35 Mr. Pius Mukisa Makerere University 54 36 Dr. Kajumbula Henry Makerere University 37 Dr. Henry Mwebesa Ministry of Health 38 Dr. Opolot John Ministry of Health 38 Dr.Vivian Bazanye Twemanye Infectious Diseases Institute 40 Prof. Esther Buregyeya Makerere University 41 Dr. David Muwanguzi Ministry of Health 42 Dr. Elizabeth Katwesige Ministry of Health 43 Mr. Tabley Basajatebadiba Ministry of Health 44 Mr. Godfrey Katumba Ministry of Water and Environment 45 Mr. Stephen Mugabi Ministry of Water and Environment 46 Mr. Abraham Otai Ministry of Water and Environment 47 Ms. Phiona Kebirungi Ministry of Water and Environment 48 Ms. Betty Mbolanyi Ministry of Water and Environment 49 Mr. Dadino Ndibarema Ministry of Water and Environment 50 Dr. Sheila Ampaire National Drug Authority 51 Dr. Brian Sekayombya National Drug Authority 52 Dr. Abubakar Moki Office of the President 53 Mr. Kabaliisa Peace National One Health Platform 54 Mr. Abdulrazak Sekamatte National One Health Platform 55 Mr. Steven Aupal Lira Regional Referral Hospital 56 Dr. Laura Lydia Adong Mbale District Local Government 57 Mr. Timothy Lubanga Office of the Prime Minister 58 Ms. Bibaze Assumpta U.S. Agency for International Development (USAID)-Uganda 59 Dr. Joseph Ojwang U.S. Centers for Disease Control and Prevention -Uganda 60 Ms. Gloria Akurut Ministry of Tourism Wildlife and Antiquities, UWA 61 Ms. Lorna Nabukwasi Ministry of Tourism Wildlife and Antiquities, UWA 62 Dr. Annet Alenyo World Health Organization-Uganda 63 Ms. Winnie Agwang World Health Organization-Uganda 64 Dr. Grace Asiimwe Ministry of Agriculture, Animal Industry, and Fisheries 65 Dr. James Muleme Makerere University 66 Dr. Philip Katabarwa National Medical Stores 67 Dr. Moses Wwanja Ministry of Agriculture, Animal Industry, and Fisheries Uganda Antimicrobial Resistance National Action Plan 68 Dr. Alfred Wejuli Ministry of Health 69 Mr. Julius Mafumbo Ministry of Water and Environment 70 Ms. Anita Kisakye Baylor College of Medicine Children’s Foundation-Uganda 71 Ms. Pamela Kjumba i-Train and Evaluate Center 72 Mr. Ekuka Godfrey Ministry of Health 73 Ms. Glory Mkandawire Johns Hopkins Center for Communication Programs 55