National Action Plan for Health Security 2019 - 2023

1.1 Country profile Background Uganda is a land locked country located in East Africa with a projected population of 41,215,593 (2019). It is bordered by South Sudan to the north, Kenya to the east, Tanzania and Rwanda to the south, and the Democratic Republic of Congo to the west. Over the past decade the country has experienced significant weather fluctuations, natural disasters and disease outbreaks which have affected most regions. On average, 200,000 people are affected by disasters every year (OPM, 2010). Public Health Risks Uganda is vulnerable to public health hazards and emergencies because of her geographical location in the meningitis and yellow fever belts, the filovirus triangle, and being a host to migratory birds coming from Europe. Uganda is also located in the volatile Great Lakes Region with a number of ongoing conflicts resulting in a large influx of refugees from neighbouring countries.

1.2 Progress in IHR implementation In view of these vulnerabilities, the government of Uganda in collaboration with partners has instituted prevention and control measures aimed at mitigating the effects of the public health emergencies. These include rolling out Integrated Disease Surveillance and Response (IDSR) with support from the World Health Organization (WHO) as a framework for implementing International Health Regulations (IHR), 2005. IDSR builds district level capacities for public health emergency response. More than 6,000 health workers have been trained across the country, leading to timely detection and response to disease outbreaks. In 2013, the Ministry of Health with support from CDC launched the Global Health Security Agenda (GHSA) Pilot Project to accelerate the country’s compliance with the IHR (2005). The project resulted in strengthening of capabilities related to prevention, detection, and response. The establishment of a Public Health Emergency Operation Centre (PHEOC) resulted in further infrastructural investment and attaining additional support related to capabilities for real-time surveillance, reporting, and laboratory investigation tracking systems. Uganda conducted a pilot assessment of the GHSA implementation progress in February 2015 using the IHR (2005) core capacities. The findings acknowledged the country was on course National Action Plan for Health Security (2019 – 2023) 14 14 National Action Plan for Health Security 2019 - 2023 with the implementation of GHSA and IHR (2005), especially in disease surveillance, health information, and the PHEOC. That clear definition existed for the major elements of health security around the themes prevent, detect and respond to communicable diseases. An action plan was developed to address gaps identified in the assessment. In addition to these vast monitoring exercises, Uganda requested for a Joint External Evaluation in December 2016 and subsequently undertook the exercise in June 2017. A multi-sectoral international External Evaluation Team of 15 members selected on the basis of their recognized technical expertise from a number of countries, and advisors representing international organizations conducted the assessment jointly with the Ugandan counterparts. Uganda completed the Joint External Evaluation (JEE) in June 2017. The purpose of the JEE was to assess the country’s capacity to prevent, detect and rapidly respond to public health emergencies (PHEs). Nineteen technical areas were assessed and scored on a scale of 1-5; with the score 1 suggesting no capacity, and 5 sustainable capacity. The technical areas were grouped under following four thematic areas; Prevent, Detect, Respond, other IHR related hazards and PoE (Figure1 below) Figure 1 Distribution of the 19 technical areas across the Four Thematic Areas National Action Plan for Health Security (2019 – 2023) 15 National Action Plan for Health Security 2019 - 2023 15

1.3 Joint External Evaluation results The situation analysis is informed by the findings of the Joint External Evaluation conducted in June 2017. The recommendations of the JEE report formed the basis for the formulation of the NAPHS. The findings from JEE are found in Annex II. Table 1: Summary of capacity level for implementation of IHR (2005) core functions Score Capacity level No of indicators % of total indicators 5 Sustained capacity 0 0% 4 Demonstrated capacity 10 20% 3 Developed capacity 20 40% 2 Limited capacity 15 30% 1 No capacity 5 10% Total 50 100% Source: World Health Organisation, Uganda Joint External Evaluation Report 2017. The assessment showed that Uganda has demonstrated capacity in: • Immunization • Laboratory system • Workforce development • Real time surveillance • Response operations • Risk communication. However, the country scored “no capacity” in: • National legislation, policy and financing, • Preparedness, and • Points of entry. The JEE recommended priority actions to address these gaps have been included in the Uganda National Action Plan for Health Security. National Action Plan for Health Security (2019 – 2023) 16 16 National Action Plan for Health Security 2019 - 2023 2. VISION, MISSION, OBJECTIVES, GUIDING PRINCIPLES AND CORE VALUES OF THE NAPHS

2.1 Vision Healthy, wealthy and resilient communities in Uganda by 2040

2.2 Mission To strengthen Uganda’s health security capacity and community resilience against public health threats in compliance with International Health Regulations (2005).

2.3 Objectives 1. To strengthen the country’s capacity to prevent, detect and respond to public health threats. 2. To strengthen the collaboration and coordination mechanism for NAPHS implementation through application of multi-sectoral and one health approaches. 3. To map and align existing and potential domestic and external financing to support NAPHS implementation.

2.4 Guiding principles • The One Health Approach: The majority of emerging and re-emerging infections are zoonoses. Increasing human and animal interactions are the major drivers of emergence of zoonotic diseases and anti-microbial resistance. Furthermore, human-animal- environment interface may lead to other public health events which require multi- disciplinary collaboration by human, animal and environmental health experts to prevent and control such diseases or events. • Multi-sectoral approach: Building the IHR core capacities requires collaboration and communication towards shared responsibility among multiple sectors. Effective partnerships and cooperation among the different ministries will be encouraged throughout implementation. • Collective responsibility: Addressing public health threats should be based on values of solidarity, humanity and sustainable development. Health security is a collective responsibility for all stakeholders including government, civil society, private sector and the general population. National Action Plan for Health Security (2019 – 2023) 17 National Action Plan for Health Security 2019 - 2023 17 • Collaboration and Partnerships: Health security requires strong collaboration, partnerships and information sharing with actors within and outside the country’s borders.

2.5 Core values • Shared responsibility • Transparency • Information sharing • Accountability • Respect of each actor’s jurisdiction National Action Plan for Health Security (2019 – 2023) 18 18 National Action Plan for Health Security 2019 - 2023 3. METHODOLOGY/PROCESS FOR THE DEVELOPMENT OF THE ACTION PLAN

3.1 Development of the NAPHS Multidisciplinary and multi-sectoral subject matter experts convened and held a series of meetings between August 2017 to May 2019. The technical experts reviewed all the available national assessments including the 2017 JEE country report, the 2007 PVS, laboratory assessments and literature. The technical team composition was multi-sectoral and multidisciplinary with representation from key Government of Uganda line Ministries, Departments, Agencies and development partners. Priority actions identified during the 2017 JEE were included in the NAPHS as targets for interventions in order to improve the overall scores. The draft NAPHS was shared with stakeholders for technical input and suggested changes were incorporated. Review meetings between stakeholders were held for final input and buy-in. The planning process was coordinated by the Office of Prime Minister, operationally supported by the Ministry of Health, and included stakeholders from all relevant sectors. The full list of participants is available in Annex I.

3.2 Identification of Priority Activities During the NAPHS validation and costing workshop in May 2018, technical working groups developed activities that were critical for stepping up their JEE score levels. The draft NAPHS was shared with stakeholders for technical input and suggested changes were incorporated. In addition to technical working group input, Uganda validated their activities using the GHSA & IHR Standardized Milestone Library which defined steps that needed to be taken to move from the current JEE level of capacity score to the next JEE level of capacity score. After developing these activities, technical working groups prioritized strategic activities that could realistically be implemented during the first 18 months of implementation (2018-2019). The strategic activities were prioritised by country-specific risks and hazards, strategic plans and priorities of participating MDAs, and existing or potential funding sources. Recommended priority activities were presented to key stakeholders for approval and subsequently incorporated into the NAPHS. The final document was then shared with key ministries and the OPM for final input, approval, revisions and printing. Based on the successful cross-government joint prioritization process, the Government of Uganda plans to routinely conduct a NAPHS progress check and identify priority activities every 6 months until the next JEE is conducted. National Action Plan for Health Security (2019 – 2023) 19 National Action Plan for Health Security 2019 - 2023 19

3.3 Linkage to other government frameworks The NAPHS operational framework references the work in the national vision 2040, National Development Plan (NDP III), technical guidelines, strategic plans and relevant policies of the various sectors and implementing MDAs. The different sector specific strategic plans shall contribute to the attainment of the NAPHS that subscribes to the NDP II and Uganda’s Vision 2040. The NAPHS has been developed with the sole purpose of improvement of national capacities to implement IHR. The stakeholders shall implement all activities outlined in the NAPHS resulting from the JEE 2017 recommendations. The NAPHS operationalization is envisioned to involve various Ministries, Departments and Agencies that contribute to the different technical areas outlined in the plan (see fig.1above). The different sectors will be coordinated through the Office of the Prime Minister (OPM) to ensure national health security in regard to human, animal and environmental health. NAPHS implementation shall use an all government approach drawing on the Public Private Partnership linkages. Resources will be integrated in the sector budgets and additional resources mobilized from within government and partners. Accountability and reporting on progress made will be in line with the Joint Sector Reviews coordinated by the OPM. Uganda is a signatory to IHR (2005) and World Organisation for Animal Health (OIE) which requires regular reporting to WHO and OIE respectively. The National IHR Focal Point within the MoH and the OIE country delegate based in Ministry of Agriculture, Animal Industries and Fisheries (MAAIF) will be informed of all progress made in attainment of IHR competences in addition to any major events in humans and animals respectively. Linkages with these strategic and operational plans is critical to ensuring that domestic financing is made available for health security. National Action Plan for Health Security (2019 – 2023) 20 20 National Action Plan for Health Security 2019 - 2023 Figure 3: Diagram showing relation of MDAs and national plans relation to the NAPHS COMPONENTS OF ACTION PLAN This section describes priority strategic actions selected by technical area from 2019 to 2023, based on the prioritization process described earlier. Each strategic action described consists of more detailed activities along with the coordinating MDAs. National Action Plan for Health Security (2019 – 2023) National Action Plan for Health Security 2019 - 2023 21

4.1 National Legislation, Policy and Financing Targets • An adequate legal framework for the country to support and enable the implementation of all its IHR obligations and rights. • Revision, or when necessary, creation, of legislation and supporting instruments to properly facilitate implementation of IHR. • Provision of adequate funding for IHR implementation through the national budgeting or other mechanisms to ensure availability of resources for implementation and response to public health emergencies at all times. JEE Scores P1.1 Legislation, laws, regulations, administrative requirements, policies or other government instruments in place are 3 sufficient for implementation of IHR (2005) P1.2 The State can demonstrate that it has adjusted and aligned its domestic legislation, policies and administrative 3 arrangements to enable compliance with IHR (2005) P1.3 Financing is available for the implementation of IHR capacities 2 P1.4 A financing mechanism and funds are available for the timely response to public health emergencies 1 Current status Uganda has several laws governing public health to support and enable the implementation of her obligations and rights to comply with and implement the IHR (2005).These include legislative instruments governing public health surveillance and response; Cross- border agreements, protocols or memoranda of understanding (MoUs) with neighbouring countries with regard to public health emergencies in place within East African community.. These legislative instruments, however, are not yet in full alignment with the IHR. National NationalAction ActionPlan Planfor forHealth Security 2019 Health Security (2019- –2023 2023) 22 The Contingencies fund at Ministry of Finance is not easily accessible during emergencies, and thus the structures to access the emergency funds need to be more clearly defined. In addition, the pathway for accessing national funding to support public health emergencies is not clearly. Budget Strategic Actions Responsible Authority (UGX) 2019 2020 2021 2022 2023 Obj 1: Update in-country legal and policy framework to support implementation of IHR and OIE requirements Review key existing legislation and policies (Public Health Act, MoH, MAAIF, MoWE, Animal Diseases Control Act, and Food Safety) that impede 238,578,250 UWA compliance with the International Health Regulations Develop National One Health Policy, to incorporate animal and MOH, MAAIF, MoWE, 147,802,500 human health surveillance MoTA, MoGLSD Obj 2: Advocate for revision of legal instruments and policies to address existing gaps and challenges within the national administrative environment Develop and implement a national advocacy strategy to support MoH, MoJCA 408,350,345 revision of legal instruments and policies Obj 3: Develop an IHR advocacy and funding strategy for Parliament, Ministry of Finance, and other key decision-makers for increased government funding to support IHR implementation and emergency funding to all relevant sectors MoFPED, MoH, Advocate for domestic funding, equipment and staffing for IHR MAAIF, MoWE, 265,687,500 implementation. MoTA, partners Advocate for funding, equipping and staffing for the National MoH, MAAIF, MoWE, 755,243,595 One Health Platform and Coordination Office UWA, Establish and fund a budget line in relevant ministries for MoH, MAAIF 480,000,000 coordination activities between OIE and IHR focal points Obj 4: Establish an effective rapid response fund to support outbreak investigations and respond National NationalAction ActionPlan Planfor forHealth Security 2019 Health Security (2019- –2023 2023) 23 MoFPED, OPM, MoH, Review mechanism on accessing funds for public health MAAIF, MoWE, 50,428,665 emergency response from the MoFPED MoTWA TOTAL 2,346,091,355 NationalAction National ActionPlan Planfor for Health Health Security Security2019 (2019- 2023 – 2023) 24

4.2 IHR Coordination, Communication and Advocacy Targets • Multisectoral and multidisciplinary approaches through national partnerships that allow efficient, alert and responsive system for effective implementation of the IHR. • Coordinate nationwide resources, including sustainable functioning of a National IHR Focal Point – a national centre for IHR communication that is accessible at all times. • Provide WHO with contact details of National IHR Focal Points, continuously update and annually confirm them. JEE Scores P2.1 A functional mechanism is established for the coordination and integration of relevant sectors in the implementation 2 of IHR Current Status IHR coordination operates through the IHR National Focal Point (IHR NFP) at the MoH National Disease Control Department Office. A multi-sectoral, multidisciplinary coordination and communication mechanism exists through the National Task Force (NTF) for public health emergencies. Public Health Emergency Operation Centre (PHEOC) under the Director General Health Services provides the platform and is the information centre for all PHEs. However, NTF does not meet regularly outside outbreaks situations. Furthermore, there is no well-established IHR coordination mechanism for the other technical areas. The National One Health Platform was established, although the human resource and funding to coordinate the platform is inadequate. NationalAction National ActionPlan Planfor for Health Health Security Security2019 (2019- 2023 – 2023) 25 Budget Strategic Actions Responsible Authority (UGX) 2019 2020 2021 2022 2023 Obj 1: Establish an efficient IHR-OIE coordination mechanism to monitor progress towards implementation of IHR activities PRIORITY YEAR 1: Develop TOR and SOPs for IHR focal MOH 28,105,000 points for each sector contributing to the NAPHS Determine structure and function of national IHR implementation: Training nominated IHR focal points and functionalize MOH 67,188,750 national IHR implementation PRIORITY YEAR 1: Implement specified IHR & IDSR MOH, MAAIF 359,955,000 activities by NFPs, sectoral FPs, and senior management Ensure relevant offices and agencies which are coordinating IHR implementation are fully capable of 24/7 functionality MOH 737,225,000 (equipment, human resources and infrastructure) PRIORITY YEAR 1: Advocate for senior management in relevant sectors to commit to supporting IHR core capacity- MOH 81,615,000 building efforts Equip national focal points to verify emergencies and rumours of MOH 265,725,625 public health events Conduct monthly IHR-OIE coordination meetings 14,400,000 MOH, MAAIF, MoWE, Operationalize One Health policy at national and district levels 420,189,040 UWA MOH, MoES, UCDC, Review pre-service public health training curricula to include a NCHE, UNCST, 54,504,140 component for public health laws MakSPH National National ActionPlan Action Planfor forHealth Health Security Security 2019 (2019- –2023 2023) 26 MOH, MoES, UCDC, Advocate for increased number of public health professionals in NCHE, UNCST, 24,611,250 the staffing norms MakSPH TOTAL 2,053,518,805 National National ActionPlan Action Planfor forHealth Health Security Security 2019 (2019- –2023 2023) 27

4.3 Antimicrobial Resistance Target: A functional system in place for the national response to combat antimicrobial resistance (AMR) with a One-Health approach, including: • Multi-sectoral work spanning human, animal, crops, food safety and environmental aspects. This comprises developing and implementing a national action plan to combat AMR, consistent with the Global Action Plan (GAP) on AMR, • Surveillance capacity for AMR and antimicrobial use at the national level, following and using internationally agreed systems such as the WHO Global Antimicrobial Resistance Surveillance System (GLASS) and the OIE global database on use of antimicrobial agents in animals, • Prevention of AMR in health care facilities, food production and the community, through infection prevention and control measures and, • Ensuring appropriate use of antimicrobials, including assuring quality of available medicines, conservation of existing treatments and access to appropriate antimicrobials when needed, while reducing inappropriate use. JEE Scores P3.1 Antimicrobial resistance detection 2 P3.2 Surveillance of infections caused by antimicrobial-resistant pathogens 2 P3.3 Healthcare-associated infection (HCAI) prevention and control programs 3 P3.4 Antimicrobial stewardship activities 3 Current Status The Uganda National Action Plan (NAP) on AMR (2018-2022) has been developed to guide the AMR response. The health facilities and laboratories participating in the detection and surveillance of AMR were mapped and will be supported on an ongoing basis. National Action National Plan Action Planfor forHealth HealthSecurity (2019-–2023 Security 2019 2023) 28 Gradual enrolment of veterinary laboratories to the surveillance network is being undertaken. The human health surveillance network is linked to sample transportation and isolate referral system from lower health facilities to regional and national laboratories. Infection Prevention and Control (IPC) and antimicrobial stewardship activities, including antibiotic use and consumption measurement among humans, are supported at selected regional referral hospitals with routine national audits conducted by the MoH and partners. Since the last JEE (conducted in 2017), the National AMR NAP monitoring and evaluation plan with indicators have been developed. Plans to include AMR surveillance and response in the water, environment and animal health sectors need to be developed and implemented. The national IPC program lacks a Health Care Associated Infections (HCAIs) control program and the national IPC committee is not functional. In addition, regulation of antibiotic use is not yet implemented as per the National Drug Act. Budget Strategic Actions Responsible Authority (UGX) 2019 2020 2021 2022 2023 Obj 1: Strengthen the capacity of designated laboratories to conduct detection and reporting of all priority AMR pathogens for five years with a system of continuous improvement DG - MoH/MAIF, Finalize and disseminate NAP and M&E Plan that addresses all Uganda National 1,287,704,355 five strategic areas in a One Health approach Academy of Science (UNAS), AMR-TWG Develop an implementation plan and M&E Plan for each of the four sectors (human, animal, environment/water, and wildlife) MoH, MAAIF, MoWE 365,501,170 addressing all five strategic areas of the NAPH and public-private & UWA partnerships Procure laboratory equipment, reagents, supplies, and NMS, MAUL, JMS, consumables to enhance laboratory testing capacity for detection UNHLS, NADDEC, 618,301,380 and surveillance of AMR pathogens in the animal & human Implementing partners sectors National Action National Plan Action Planfor forHealth HealthSecurity (2019-–2023 Security 2019 2023) 29 Develop a curriculum and train laboratory staff on detection and characterization of AMR pathogens for both human and animal UNHLS (MoH), 191,713,190 health with a system of CQI – including training of NMRL to NADDEC (MAAIF) perform reference-level antimicrobial resistance testing Complete the development of testing SOPs and protocols for laboratory-based AMR and a system for reporting from facility to UNHLS, NADDEC 16,000,000 national for both human and animals Strengthen sample referral systems for detection of AMR priority UNHLS, NADDEC 4,872,960,000 pathogens Establish internal and external QA programs for designated UNHLS, NADDEC 1,504,000,000 animal health laboratories Obj 2: Strengthen laboratory information systems for improved surveillance of antimicrobial resistant pathogens UWA, NADDEC Assess the national zoonotic disease burden in the AMR context (MAAIF), CPHL, 92,186,320 and zoonotic AMR surveillance capacity UVRI, (MoH), OHCO Strengthen the national laboratory capacities to store and manage UNHLS, IDI, MAAIF 5,352,132,000 AMR pathogens and maintain a national biorepository of isolates Designate farms for AMR surveillance MAAIF and AMR TWG 56,189,250 National AMR Facilitate a National AMR Surveillance Coordination Committee 193,740,000 coordination centre Build capacity of sentinel surveillance site personnel through National AMR 66,988,125 training and mentoring coordination centre Develop an optimal AMR surveillance information system at National AMR (NCC)/ 211,984,140 NMRL/NCC/NADDEC NADDEC Create a national framework for collecting, collating, reviewing, National AMR 913,167,190 and reporting AMR reports from facility to national and global coordination centre National National ActionPlan Action Planfor forHealth Health Security Security 2019 (2019- –2023 2023) 30 levels Conduct an annual national multisectoral AMR conference for experiences and data sharing among researchers, practitioners, UNAMRC 656,712,500 etc. Build subject matter expertise at the National AMR Coordination National AMR 2,385,301,867 Centre coordination centre Obj 3: Strengthen the Healthcare-Associated Infection Prevention and Control program Develop a national HCAI policy MoH, MAAIF 192,722,760 Develop a national HCAI strategic plan MoH, MAAIF 60,937,500 Develop National IPC technical guidelines for animal health MoH, MAAIF 56,507,500 Reactivate the National IPC Committees with representatives DG-MOH, CAH- 87,420,000 from all sectors MAAIF National IPC Focal Routinely assess facilities with HCAI programmes 83,920,000 Person, IDI Establish surveillance systems for HCAI programs for animal health in five sites to include AMR prevention and airborne MoH 13,059,375 infection control Scale up surveillance systems for HCAI programs from 14 to 25 MoH 74,160,000 sites National IPC Build animal and human health workforce expertise/competencies Committee, IPC Focal 1,046,505,000 on HCA IPC Person, IDI Obj 4: Increase political engagement and advocacy for improved AMR programs National National ActionPlan Action Planfor forHealth Health Security Security 2019 (2019- –2023 2023) 31 Develop an AMR stewardship policy OH platform 40,023,750 Strengthen antimicrobial stewardship programs (ASP) for animal health to include monitoring of antimicrobial use, MAAIF, MoWE and 17,535,750 education/communication, and other interventions to improve UWA antibiotic use at designated centres Scale up Antimicrobial Stewardship Program for human health MoH 47,693,750 from 6 to 25 sites Develop facility specific SOPs, protocols, and databases for MoH, MAAIF, MoWE 72,066,380 monitoring antimicrobial use in humans and animals and UWA Identify areas or sectors for baseline survey on selected NDA, MoH, MAAIF 12,108,750 antimicrobial consumption NDA, MoH, MAAIF, Assess antimicrobial consumption levels across animal and NMS, JMS, MAUL, 310,017,535 human health sectors at national and facility level health facilities Identify antimicrobial agents for residual testing surveillance in MOH Pharmacy 2,915,207 human, animals, and agriculture Division MoH, MAAIF, MoWE Conduct multisectoral Training of Trainers (TOT) at national, UWA, One Health 38,432,500 regional and district levels on AMR stewardship platform MoH, MAAIF, MoWE Develop a harmonized multisectoral AMR training curriculum and UWA, One Health 3,642,500 platform Conduct advocacy meetings at national, regional, council and MoH 201,812,500 community levels on AMR MoH, MAAIF, One Provide IPC supplies to 30 facilities 3,609,600,000 health platform NationalAction National ActionPlan Planfor forHealth Health Security Security 2019 (2019- 2023 – 2023) 32 Improve infrastructure for water systems, isolation facilities and MoH, MAAIF, One 2,500,000,000 waste management health platform TOTAL 27,255,662,244 NationalAction National ActionPlan Planfor forHealth Health Security Security 2019 (2019- 2023 – 2023) 33

4.4 Zoonotic Diseases Target: Functional multi-sectoral, multidisciplinary mechanisms, policies, systems and practices are in place to minimize the transmission of zoonotic diseases from animals to human populations. JEE Scores P4.1 Surveillance systems in place for priority zoonotic diseases/pathogens 2 P4.2 Veterinary or animal health workforce 3 P4.3 Mechanisms for responding to infectious and potential zoonotic diseases are established and functional 2 Current Status The National One Health Platform coordinates the control and prevention of zoonotic diseases and other public health priorities. The One Health strategic plan focuses on the seven prioritized zoonotic diseases: Anthrax, Zoonotic Influenza, VHFs, Plague, Brucellosis, Human African Trypanosomiasis and Rabies. However, a One Health policy to establish legal and regulatory structures and funding mechanisms for OH activities at national and sub-national level is lacking. The country has a strong passive surveillance system for trypanosomiasis, plague, influenza, Viral haemorrhagic fevers (VHFs). In the recent past, the country registered outbreaks of zoonotic Public Health Emergencies such as RVF, CCHF, EVD, Anthrax and Yellow Fever through the human health surveillance and later animal surveillance systems. This strengthened the One Health approach during response. Performance of Veterinary Services (PVS) is occasionally conducted and is used to guide decisions on control of zoonotic disease outbreaks. However, active integration of human and animal surveillance systems is required to institute a sustainable zoonotic disease control. Formal integrated zoonoses data sharing and a joint outbreak response mechanism among various agencies at national and sub-national levels need to be established. Comprehensive training needs assessment and integrated training programs across the relevant sectors have not been developed. National NationalAction ActionPlan Plan for Health Security for Health Security2019 (2019- – 2023) 2023 34 Budget Strategic Actions Responsible Authority (UGX) 2019 2020 2021 2022 2023 Obj 1: Develop a national integrated priority zoonotic disease surveillance system Assess gaps in existing surveillance systems (animal and human) NOHP (MoH, MAAIF, 215,886,035 for priority zoonotic diseases MWE, UWA) Conduct validation and dissemination workshop to collect inputs NOHP (MoH, MAAIF, 145,169,500 to the surveillance system situation report MWE, UWA) PRIORITY YEAR 1: Develop operational plans for NOHP (MoH, MAAIF, 157,379,250 strengthening priority zoonotic disease surveillance systems MWE, UWA) PRIORITY YEAR 1: Strengthen national capacities for NOHP (MoH, MAAIF, surveillance data management, collection, analysis, and sharing 1,862,823,280 MWE, UWA) on priority zoonotic diseases Train IHR Focal Points in all relevant ministries and competent NOHP (MoH, MAAIF, Covered in authorities on their roles and responsibilities MWE, UWA) D.4.1 See Workforce Development D4.1 for progress Obj 2: Create a workforce that is conversant with IHR, PVS, the One Health Approach, and surveillance PRIORITY YEAR 1: Define the competencies required for NOHP (MoH, MAAIF, 24,999,000 advanced, intermediate, and frontline OH practitioners MWE, UWA)/OHCO NOHP (MoH, MAAIF, Address competency gaps among OH practitioners 2,260,271,897 MWE, UWA)/ OHCO NOHP (MoH, MAAIF, Create a One Health focal person for each district 212,666,500 MWE, UWA)/ OHCO National NationalAction ActionPlan Plan for Health Security for Health Security2019 (2019- – 2023) 2023 35 Obj 3: Establish a functional and effective system for responding to priority zoonotic diseases Strengthen participation in regular monthly meetings of One NOHP (MoH, MAAIF, 131,130,000 Health Coordination Office and quarterly meetings of OH TWG MWE, UWA)/ OHCO Evaluate and update the existing emergency response plan for NOHP (MoH, MAAIF, 72,788,570 priority zoonotic diseases MWE, UWA)/ OHCO Formulate a national One Health policy to effectively guide NOHP (MoH, MAAIF, 66,412,000 response to priority zoonotic diseases MWE, UWA)/ OHCO Develop risk communication strategy for priority zoonotic NOHP (MoH, MAAIF, 27,352,070 diseases (including AMR) MWE, UWA)/ OHCO Strengthen the response capacity of One Health Coordination NOHP (MoH, MAAIF, 18,216,375 Office MWE, UWA)/ OHCO TOTAL 5,195,094,477 NationalAction National ActionPlan Planfor for Health Security Security2019 (2019- 2023 – 2023) 36

4.5 Food Safety Target A functional system is in place for surveillance and response capacity of the country for food-borne disease and food contamination risks or events with effective communication and collaboration among the sectors responsible for food safety. JEE Scores P5.1 Mechanisms for multi-sectoral collaboration are established to ensure rapid response to food safety emergencies 2 and outbreaks of food-borne diseases Current Status Several agencies currently regulate food safety in the country, including the Uganda National Bureau of standards (UNBS) and the Directorate of Government Analytical Laboratory (DGAL). Despite existence of the Food and Drug Act (1964) and the Drug Act (1993) - which establishes the National Drug Authority (NDA) - there is poor coordination of stakeholders contributing to food and drug safety. Currently, response to outbreaks of food-borne diseases is through the national Rapid Response team at the Ministry of Health. However, there is inadequate awareness of food safety measures across the food chain continuum and lack of a national plan to monitor food safety. Recommendations have been made for the country to develop regulations on food safety, join International Food Safety Authorities Networks (INFOSAN), create national platforms on food safety, set national food standards, promote good agricultural practices, and sensitize the population on food safety. NationalAction National ActionPlan Planfor for Health Security Security2019 (2019- 2023 – 2023) 37 Budget Strategic Actions Responsible Authority (UGX) 2019 2020 2021 2022 2023 Obj 1: Develop a national integrated food safety framework and system Finalize legislation and regulations covering safe production, MOH, MAAIF, UNBS, storage, distribution and monitoring of food MoWE, DGAL, MTIC, 22,522,070 Refer to Legislation and Policy for progress on this activity NDA, MoJCA PRIORITY YEAR 1: Conduct a stakeholder analysis to identify MOH, MAAIF, UNBS, key stakeholders and focal points for food-borne disease MoWE, DGAL, MTIC, 28,647,500 surveillance and food contamination monitoring NDA PRIORITY YEAR 1: Prepare a Memoranda of Understanding MOH, MAAIF, UNBS, between sectors of government relevant to food safety for MoWE, DGAL, MTIC, 9,106,250 purposes of harmonization NDA MOH, MAAIF, UNBS, MoWE, DGAL, MTIC, PRIORITY YEAR 1: Create a platform for coordination of food NDA, Private Consumer 441,731,288 safety activities in line with international and national standards Authorities, MoES, academic and partners Assess the entire food production system to identify areas which compromise food safety and carry out risk assessments of priority OPM 108,808,208 food hazards Develop a 5-year national food safety strategic plan in line with OPM 133,186,035 NDP Develop a national food safety surveillance and monitoring MOH, MAAIF, UNBS, guidelines, including thresholds for triggering investigations and MoWE, DGAL, MTIC, 22,522,070 responses NDA Develop an operational national surveillance and monitoring plan MOH, MAAIF, UNBS, 82,272,160 NationalAction National ActionPlan Planfor for Health Health Security Security2019 (2019- 2023 – 2023) 38 for food safety MoWE, DGAL, MTIC, NDA MOH, MAAIF, UNBS, Develop a risk communications strategy across the food chain for MoWE, DGAL, MTIC, 648,731,375 food safety emergencies NDA Create a reporting system for timely and systematic information exchange regarding food safety events between food safety OPM 196,990,000 authorities, surveillance units and other relevant stakeholders Implement monthly monitoring and surveillance of identified OPM 1,954,335,000 food risks across the food chain Implement integrated food safety risk analysis according to OPM 189,327,500 commodity value chains Strengthen international collaboration in INFOSAN PHEOC 290,152,500 Strengthen support to Directorate of Government Analytical Laboratory and other relevant labs to carry out food safety DGAL 5,260,000,000 analysis for public health emergencies MOH, MAAIF, UNBS, Align the food value chain with the Global GAP MoWE, DGAL, MTIC, 856,289,000 NDA, MoJCA TOTAL 10,244,621,028 NationalAction National ActionPlan Planfor for Health Health Security Security2019 (2019- 2023 – 2023) 39

4.6 Biosafety Biosecurity Targets • A multi-sectoral national biosafety and biosecurity (BSBS) system with dangerous pathogens identified, held, secured and monitored in a minimal number of facilities according to best practices. Continued training on biological risk management and educational outreach to be conducted to promote a shared culture of responsibility, reduce dual-use risks, mitigate biological proliferation and deliberate use threats, and ensure safe transfer of biological agents. • Ensure that country specific biosafety and bio-security legislation, laboratory licensing and pathogen control measures are in place as appropriate. JEE Scores P6.1 Whole-of-government biosafety and bio-security system is in place for human, animal and agriculture facilities 3 P6.2 Biosafety and bio-security training and practices 3 Current Status Uganda has a National Biotechnology and Biosafety Policy (2008), the National Health Laboratory Policy (2009), and the Biosafety Bill (2012). A Laboratory Biosafety Biosecurity Manual 2015 (2nd edition) and a national bio-risk training curriculum exists for in- service personnel. Biological risk management training and educational outreach are conducted to promote BSBS. A National Inventory of select agents has been developed and housed at the Biosecurity secretariat. The national BSBS system is in place, ensuring that especially dangerous pathogens are identified, held, secured and monitored in a minimal number of facilities according to best practices. The Biosafety and Biosecurity Association of Uganda has been formed with the Biosecurity secretariat at UNCST. BSBS legislation to provide a framework for guiding the sector is not yet in place. The harmonized national guidelines for licensing and regulation of National NationalAction ActionPlan Planfor forHealth (2019- –2023 Health Security 2019 2023) 40 laboratories across sectors are not yet finalised. There is no integrated BSBS training into pre-service curricula and a comprehensive pathogen consolidation plan across sectors. Budget Strategic Actions Responsible Authority (UGX) 2019 2020 2021 2022 2023 Obj 1: Establish and implement laws and standards for national biosafety & biosecurity systems MoSTI, UNCST, MAAIF, MoH, PRIORITY YEAR 1: Review the Draft MoES, UWA, OPM, Office of the 35,569,000 Biosecurity Bill and policy President, MOD, academia and private sector Sensitize the Biosecurity Bill & corresponding MoSTI, MOH, MAAIF, UNCST, 237,470,000 policies among political leaders MOWE, MOD, MOIA MOH, MAAIF, MOWE, MOD, MOIA, Finalize and enact the Biosecurity Bill 17,712,500 MOSTI, MOTA, Parliament PRIORITY YEAR 1: Strengthen the National MOH, MAAIF, UNCST, MOWE, 147,431,822 Multisectoral Biosecurity Secretariat MOD, MOIA Update national inventory of dangerous pathogens UNCST 1,100,713,125 and toxins UNCST, MoSTI, MOH, MAAIF, Develop a biosecurity risk communication strategy 112,151,640 MOWE, MOD, MOIA Support enforcement and inspections of MOH, MAAIF, MOSTI 95,153,000 laboratories PRIORITY YEAR 1: Review and harmonize UVB, Allied Professionals Council, framework, guidelines, and processes for licensing 25,200,500 MOH, UNHLS, UNCST, MAAIF all labs in the country National NationalAction ActionPlan Planfor forHealth (2019- –2023 Health Security 2019 2023) 41 Obj 2: Strengthen national biological risk management training and practices to promote a shared culture of responsibility Provide continuous professional development for all employees in health facilities of both human NOHP, MOH, MAAIF, Biosafety & 416,109,375 and animal sectors, including field health Biosecurity Association Uganda practitioners in both fields MOES, UNCST, BSBS Secretariat, Incorporate BSBS considerations into pre-service MOH, MAAIF, MOSTI, NCHE and 38,175,000 training curricula academia TOTAL 2,225,685,962 National NationalAction ActionPlan Planfor Security2019 for Health Security (2019- 2023 – 2023) 42

4.7 Immunisation Target A national vaccine delivery system with nationwide reach, effective distribution, easy access for marginalized populations, adequate cold chain and ongoing quality control that is able to respond to new disease threats. JEE Scores P7.1 Vaccine coverage (measles) as part of national programme 3 P7.2 National vaccine access and delivery 4 Current Status The National Expanded Program on Immunization (UNEPI) is currently implemented in line with the Immunization Act (2016), the Global Vaccine Action Plan 2011- 2020, and the National Health Sector Strategic Plan 2015/16 -2019/2020. A number of human vaccine preventable diseases including zoonoses are covered in the immunization program. Commodity forecasting, cold chain maintenance, procurement and distribution are undertaken with support of the Uganda National Medical Stores. MAAIF runs a vaccination program against selected priority diseases in the animal health sector, although some diseases are categorised as public and private good animal disease vaccines. This leads to inadequate coverage of vaccination in the animal populations. Despite this progress, limited cold chain capacity and poor vaccine stock management often result in vaccine stock outs at national and district level in both human and animal sector. In addition, there is need to develop the Uganda National Immunization Plan as well as strengthen animal immunization systems. National NationalAction ActionPlan Planfor Security2019 for Health Security (2019- 2023 – 2023) 43 Budget Strategic Actions Responsible Authority (UGX) 2019 2020 2021 2022 2023 Obj 1: Improve capacity of the One Health platform in vaccine management Support the development of a statutory instrument to include the priority zoonotic diseases as MAAIF, MoJCA, MOH 103,675,000 responsibility of national and subnational levels for their prevention, detection and control PRIORITY YEAR 1: Coordinate cross-sector implementation of activities to strengthen MOH, MAAIF 400,150,000 capacities for immunization against priority zoonotic diseases PRIORITY YEAR 1: Increase human and animal health workforce capacity in vaccine management MOH, MAAIF 934,436,006 at national and subnational levels Strengthen cold chain management capacities MOH, MAAIF 7,155,097,150 across animal and human health sectors. PRIORITY YEAR 1: Develop and implement a national vaccination plan for vaccine preventable MAAIF, MOH 294,602,070 priority zoonoses, highlighting rabies vaccination and elimination programme TOTAL 8,887,960,226 National NationalAction ActionPlan Planfor for Health Security Security2019 (2019- – 2023) 2023 44

4.8 National Laboratory Systems Target Surveillance with a national laboratory system, including all relevant sectors, particularly human and animal health, effective modern point of care and laboratory-based diagnostics. JEE Scores D1.1 Laboratory testing for detection of priority diseases 4 D1.2 Specimen referral and transport system 3 D1.3 Effective modern point-of-care and laboratory-based diagnostics 3 D1.4 Laboratory quality system 3 Current Status The country has designated seven national laboratories for detection of priority diseases. The laboratories have varying levels of capacity to test for various human and animal health related hazards. These labs include: UVRI, NADDEC, CoVAB, DGAL, DMM, UBOS, and NDA. Capabilities to conduct proficiency tests for zoonoses and trade sensitive diseases is available at MAAIF and the national animal health laboratory network that is able to test, identify, and field products for diagnosis zoonotic diseases. Areas for strengthening the national laboratory network are highlighted in the National Laboratory Strategic Plan, including human resource and infrastructure development, quality management, supply chain management, specimen referral, results-reporting and laboratory information systems, and integration and coordination of the national laboratory network. National NationalAction ActionPlan Planfor for Health Security Security2019 (2019- – 2023) 2023 45 Budget Strategic Actions Responsible Authority (UGX) 2019 2020 2021 2022 2023 Obj 1: Expand capacity to detect and share results of all ten WHO Core tests, including priority zoonotic diseases PRIORITY YEAR 1: Conduct capacity assessment for zoonotic disease diagnosis within MOH, MAAIF 270,343,710 the laboratory networks Develop and pre-test the assessment tool for MOH, MAAIF 13,970,000 MAAIF labs Discuss accreditation of tests in the designated UNHLS, NADDEC, UVRI, UNBS & 9,106,250 reference laboratories for zoonotic diseases academia Adopt and implement on Laboratory information MOH, MAAIF sharing systems by all laboratories Obj 2: Implement One Health system to collect, package, and transport priority biological specimens to national laboratories from at least 80% of districts within the country for advanced diagnostics Obj 2.1: Integrate the transportation of animal samples into the human health National Specimen Referral and Transport network Update Hub Specimen Transportation Guidelines MAAIF, MOH, UWA 606,777,500 to include animal samples Develop Veterinary sample referral guidelines MAAIF, MOH-CPHL, UWA 82,577,500 Train veterinary workers on sample collection MAAIF, MOH, UWA 1,445,928,000 guidelines at regional level PRIORITY YEAR 1: Integrate transport of animal samples into the national specimen referral MAAIF, MOH, UWA 3,628,000,000 and transport network Conduct supervision of laboratories MOH-CPHL, MAAIF 2,555,800,000 National NationalAction ActionPlan Planfor Health Security for Health Security2019 (2019- – 2023) 2023 46 Conduct Specimen Transportation Network MOH, MAAIF, UWA 179,170,000 Review meeting Draft Memoranda of Understanding for integrated MOH, MAAIF, UWA 10,927,500 sample shipment Create feedback mechanisms on Hub activities at MOH, MAAIF, UWA 203,980,000 Regional level Obj 3: Implement point of care (POC) diagnostics for applicable priority diseases Review POCT policy to integrate MAAIF MOH-CPHL, MAAIF 17,412,500 Stakeholders meeting to disseminate POC Policy MOH-CPHL, MAAIF 119,585,000 Conduct CPD trainings for lab personnel on point MOH-CPHL, MAAIF 893,175,000 of care testing Develop SOPs, guidelines and manuals for POC MOH-CPHL, MAAIF 75,225,000 diagnostics Conduct technical supervision and mentorships for MOH-CPHL, MAAIF 1,486,680,000 POC diagnostics Obj 4: Expand licensing and appropriate quality management systems to 80% of public health laboratories in both animal and health sector by December 2022 PRIORITY YEAR 1: Develop a strategic plan for MOH, MAAIF 343,579,140 animal health laboratories Designate official Lab Quality officers in existing MAAIF 575,384,890 MAAIF structures at the national level Update Quality Management policies and MOH, UHBS, DGAL, MAAIF 145,365,000 guidelines Develop quality management system at the MOH, MAAIF 570,730,000 national referral level National NationalAction ActionPlan Planfor Health Security for Health Security2019 (2019- – 2023) 2023 47 Roll out quality management systems in human MOH, MAAIF 148,810,000 and animal health laboratories Integrate animal disease surveillance into the MOH-ESD, OHCO, MAAIF 34,632,500 current national IDSR guidelines Train key MAAIF staff on conducting Lab Quality Management System (LQMS-PT) at a national MAAIF 71,905,000 level Build national capacity for calibration of laboratory equipment at UNBS and CPHL CPHL, UNBS Calibration Centres Develop a national accreditation system for testing, inspecting, certificating, and calibrating all UNBS, MOH, MTIC, MAAIF medical, veterinary, and pharmaceutical labs TOTAL 13,484,064,490 National NationalAction ActionPlan Planfor forHealth Health Security (2019- –2023 Security 2019 2023) 48

4.9 Real time Surveillance Targets • Strengthened indicator-based and event-based surveillance systems that are able to detect events of significance for public health and health security • Improved communication and collaboration across sectors and between sub-national, national and international levels of authority regarding surveillance of events of public health significance; and • Improved national and sub-national level capacity to analyse and link data from the strengthened early warning surveillance, including interoperable, interconnected electronic tools. This would incorporate epidemiological, clinical, laboratory, environmental testing, product safety and quality and bioinformatics data. JEE Scores D2.1 Indicator- and event-based surveillance systems 4 D2.2 Interoperable, interconnected, electronic real-time reporting system 3 D2.3 Integration and analysis of surveillance data 3 D2.4 Syndromic surveillance systems 3 Current Status Real-time surveillance systems, though inadequate, are in place for both MAAIF and MoH and have been rolled out countrywide. The system for real-time surveillance reporting particularly within the animal sector requires strengthening. Periodic environmental surveillance is undertaken. Event-based electronic system are limited at MAAIF, leading to ineffective response. National NationalAction ActionPlan Planfor forHealth Health Security (2019- –2023 Security 2019 2023) 49 The human resource capacity requires strengthening for effective data handling, disease detection and response in all sectors. Similarly, the involvement of private sector facilities is critical in surveillance and linking to national reporting systems. Electronic surveillance systems have to be strengthened to improve interoperability and information sharing between sectors. There is also need to enhance environmental surveillance and improve availability of surveillance tools and linkage of the surveillance data between human, environment, water and animal health. Budget Strategic Actions Responsible Authority (UGX) 2019 2020 2021 2022 2023 Obj 1: Strengthen human health surveillance systems at all levels to ensure they are electronic, interoperable and interconnected with laboratory and animal health surveillance data PRIORITY YEAR 1: Update IDSR strategic plan MOH-ESD 44,357,500 and incorporate the JEE recommendations Conduct training on IDSR for public and PNFP facilities in new districts and include untrained MAAIF, MOH 990,302,000 health workers and armed forces Conduct training of trainers for animal, wildlife, and environment sectors in IDSR and field MAAIF, MOH, UWA 89,317,500 epidemiology Conduct trainings on IDSR for private, for-profit MOH, MAAIF, UWA 992,234,000 human and animal health sector practitioners Conduct training on EBS and IBS for the DVOs MAAIF, UWA, MOH 1,611,562,500 and the DHT before the rollout to new districts Develop IDSR curriculum for pre-service National Curriculum Development 136,886,250 institutions Centre National NationalAction ActionPlan Planfor for Health Security Security2019 (2019- – 2023) 2023 50 Include IDSR training curriculum into the pre- MOH 227,928,750 service public health training institutions Conduct IDSR for health facilities of the armed MOH 537,187,500 forces PRIORITY YEAR 1: Conduct training of village volunteers in community surveillance (VHTs, MOH, MAAIF 479,436,000 CHWs) Consistently update, print and distribute tools for data collection and reporting for human health MOH 2,700,000,000 sector Consistently update, print and distribute tools for data collection and reporting for animal and MAAIF, UWA, MWE 3,553,928,750 environment health sectors Develop system for linking suspect case reports and laboratory data supporting both detection and MOH, MAAIF, MOD 145,365,000 response activities for at least three notifiable priority diseases Carry out water quality and sanitation surveillance MOH, MWE 80,000,000 and report to relevant authorities Obj 2: Strengthen animal health surveillance; develop an electronic surveillance system at the national and sub-national levels that includes routine review of animal health surveillance data to identify and address reporting, analysis and feedback gaps Procure ICT equipment for EBS surveillance MOH 1,981,440,000 Procure ICT equipment for animal disease MAAIF, UWA 2,726,000,000 surveillance National NationalAction ActionPlan Planfor for Health Security Security2019 (2019- – 2023) 2023 51 Roll out electronic reporting system (EMPRESI) MAAIF, UWA 1,458,320,625 in the animal sector Link human health, animal health, and other electronic reporting systems to a single MOH, MAAIF, MWE, UWA 43,643,312 interoperable system Develop training materials for the users of the MOH, MAAIF, UWA, MWE 194,628,750 interoperable electronic surveillance system Train trainers in the interoperable, electronic MOH, MAAIF, UWA, MWE 44,658,750 surveillance system Print training materials MOH, MAAIF 245,000,000 Conduct trainings for district data managers, DHOs, DVOs, VHOs, and health facility MOH, MAAIF 4,494,062,500 leadership Conduct support supervision MOH, MAAIF 563,760,000 Conduct quarterly review meetings for system developers and users to review and improve the MOH, MAAIF, UWA 563,815,000 performance of the interoperable, electronic surveillance system Obj 3: Promote use of surveillance data at all levels to enhance early detection and response and to improve reporting rates, timeliness, and quality for animal and human health sectors Conduct training of district staff on real-time MOH-ESD, MAAIF 2,731,875,000 surveillance data use and reporting Conduct regular data quality assessment exercises MOH-ESD, MAAIF 469,800,000 Develop and disseminate SOPs for surveillance MOH, MAAIF, UWA 1,078,891,250 data validation National NationalAction ActionPlan Planfor for Health Security2019 Health Security (2019- 2023 – 2023) 52 PRIORITY YEAR 1: Publish weekly One Health MOH, MAAIF, UWA 35,000,000 Epidemiological Bulletin Obj 4: Create a syndromic surveillance system Define 10 syndromic events of public importance MAAIF, MOH, UWA 3,642,500 that are reportable Print and disseminate priority syndromic MAAIF, MOH, UWA 500,000,000 reportable events TOTAL 28,723,043,437 National NationalAction ActionPlan Planfor for Health Security2019 Health Security (2019- 2023 – 2023) 53

4.10 Reporting Target Timely and accurate disease reporting according to WHO and OIE requirements and consistent relay of information to FAO. JEE Scores D3.1 System for efficient reporting to FAO, OIE and WHO 3 D3.2 Reporting network and protocols in country 3 Current Status Uganda has an active PHEOC with leadership, staff and technology to rapidly coordinate the response to public health emergencies. The PHEOC has effective situational awareness systems linked to all districts, all One Health stakeholders, and is fully connected to the National Emergency Coordination and Operations Centre (NECOC). However, it has been observed that there are low reporting rates in animal and human health sectors which lead to inefficiency in the implementation of activities. There is a need to strengthen surveillance and reporting systems for both human and animal health, including the private sector, to achieve ≥80% reporting rate; strengthen coordination between all relevant actors and ensure electronic reporting systems that are interoperable and interconnected for animal health, human health and food-safety surveillance; and provide the necessary facilitation to enable the IHR/OIE focal point to perform their duties. Budget Strategic Actions Responsible Authority (UGX) 2019 2020 2021 2022 2023 Obj 1: Strengthen coordination between all relevant actors and ensure electronic reporting systems are interoperable for animal and human health, and build capacity of IHR/OIE focal points to perform their duties National NationalAction ActionPlan Planfor forHealth (2019- –2023 Health Security 2019 2023) 54 Train IHR and OIE national focal points and relevant personnel in their obligations of reporting MAAIF, MoH, UWA, MoWE, OPM 181,253,328 to WHO and OIE Train IHR and OIE national focal points at high level their obligations of reporting to WHO and 300,000 OIE Hold quarterly IDSR/IHR/OIE meetings MoH, MAAIF 321,387,500 PRIORITY YEAR 1: Orient the district staff (DVO, DHT, Water and Environment, and UWA) on One Health strategy to address zoonotic OHCO 18,170,625 diseases (See Zoonotic disease) PRIORITY YEAR 1: Conduct training of trainer workshops in disease reporting and data collection MoH, MAAIF, UWA, MoWE 62,916,875 (medical and veterinary) Train licensed medical practitioners on data collection tools for diseases and other public health MoH 2,121,157,500 events PRIORITY YEAR 1: Train licensed private veterinary practitioners on data collection tools for MAAIF, UWA 1,101,900,000 diseases and other public health events Support professional bodies to carry out supportive MoH 187,920,000 supervision (human health) Support professional bodies to carry out supportive MAAIF, UWA 165,792,000 supervision (animal health) Obj 2: Strengthen surveillance and reporting systems for both human and animal health with a special attention to the private sector to achieve >80% reporting rates for both public and private sectors National NationalAction ActionPlan Planfor forHealth (2019- –2023 Health Security 2019 2023) 55 Develop an integrated supervisory checklist MoH, MAAIF, MoWE, UWA 17,412,500 Develop a national reporting protocol to WHO, MoH, MAAIF, MoWE, UWA 17,412,500 OIE, and FAO Provide continuous mentorship and supportive MoH, MAAIF, MoWE, UWA, UPF, supervision on surveillance reporting for private 939,600,000 UPDF and public medical practitioners Provide continuous mentorship and supportive MoH, MAAIF, MoWE, UWA, UPF, supervision on surveillance reporting for private 939,600,000 UPDF and public veterinary practitioners Conduct quarterly surveillance review meetings for all DHOs, DSFPs, DLFPs, Biostats, and DVOs MoH, MAAIF, MoWE, UWA 995,062,500 at a regional level Update regularly the list of reporting facilities MoH, MAAIF, MoWE, UWA 211,920,000 (private and public) into DHIS2 TOTAL 7,281,805,328 National NationalAction ActionPlan Planfor for Health Security2019 Health Security (2019- 2023 – 2023) 56

4.11 Human Resources / Workforce development Target Country has skilled and competent health personnel for sustainable and functional public health surveillance and response at all levels of the health system for the effective implementation of the IHR. Human resources (HR) shall include but not limited to nurses and midwives, physicians, public health and environmental specialists, social scientists, communication, occupational health, laboratory scientists/technicians, biostatisticians, information technology (IT) specialists and biomedical technicians. There is a corresponding workforce in the animal sector of veterinarians, animal health professionals and para-veterinarians, epidemiologists. JEE Scores D4.1 Human resources available to implement IHR core capacity requirements 3 D4.2 FETP or other applied epidemiology training programme in place 4 D4.3 Workforce strategy 3 Current Status The Field Epidemiology Training Program (FETP) has been supporting capacity building for the last seven years. It does, however, lack the multi-sectoral approach to build IHR capacity. The existing in-service curricula are skewed to the human sector and are not adequate to address the needs of Veterinary Public Health or One Health Platform in general. Although tracking of personnel scores highly in the JEE, Uganda lacks a database that clearly documents personnel to prevent, detect, and respond to PHEs or for surge capacity at national or international levels. Composition of teams is ad hoc, not multi-sectoral, and with personnel that are non-verifiable. There is need to develop the ability to track, map and trace multi-sectoral IHR personnel. National NationalAction ActionPlan Planfor for Health Security2019 Health Security (2019- 2023 – 2023) 57 Personnel tracking, mapping, and tracing will also further allow for measurement of effectiveness and impact to prevent, detect and respond to PHEs. There is, therefore, a need to evaluate the FETP, map HR for IHR, review progress in achieving the HR requirements for IHR, develop a harmonized certified training curriculum and establish the National Institute of Public Health. Budget Strategic Actions Responsible Authority (UGX) 2019 2020 2021 2022 2023 Obj 1: Update multisectoral managers and implementers on IHR knowledge, understanding and core capacities Train IHR focal points in all relevant ministries and competent authorities on their roles and OPM, all relevant ministries 20,412,750 responsibilities PRIORITY YEAR 1: Update Senior Line Ministry officials and program managers on IHR OPM, all relevant ministries 29,090,000 core capacity PRIORITY YEAR 1: Update mid-level program managers in relevant ministries on IHR core OPM, all relevant ministries 55,852,750 capacity requirements Conduct regular multisectoral IHR focal point OPM, all relevant ministries 14,409,375 meetings Orient the private sector health, trade and travel OPM, MOH, MOTA 192,445,000 partners on IHR reporting Orient the media on IHR reporting requirements OPM, all relevant ministries 384,890,000 and risk communication Obj 2: Streamline frontline in-service training programs and institute a comprehensive FETP workforce Evaluate ongoing phase 1 integrated District MOH/ESD, MAAIF, MOD, MWE, Frontline FETP/EOC operations/eIDSR/IPC One MOES, NCHE, UNCST, CDC, UWA, 209,491,140 Health training curriculum and its impact on IDI, training institutions National NationalAction ActionPlan Planfor forHealth Health Security (2019- –2023 Security 2019 2023) 58 improving Uganda’s capacity to prevent, detect, and respond to public health threats and hazards Multi-sectoral TWG (MoH/ESD, Map trained human resources through existing MAAIF, MoD, MoWE, MoES, NCHE, professional bodies UNCST, CDC, UWA, OHCEA, IDI, academia) PRIORITY YEAR 1: Review integrated Frontline FETP training curriculum and develop national implementation plan in alignment with MoH, MAAIF, Multi-sectoral TWG, 45,222,500 evaluation and HR mapping exercises, including NCDC and Academia the healthcare private sector and the community health workers PRIORITY YEAR 1: Evaluate impact of integrated Frontline FETP/EOC activation/eIDSR Multi-sectoral TWG (MoH/ESD, One Health training curriculum on improving MAAIF, MoD, MoWE, MoES, NCHE, 22,522,070 Uganda’s capacity to prevent, detect, and respond UNCST, CDC, IDI, academia) to public health threats and hazards Multi-sectoral TWG (MoH/ESD, Conduct annual review to assess progress in MAAIF, MoD, MoWE, MoES, NCHE, achieving milestones in frontline training programs 131,445,000 UNCST, CDC, OHCEA, IDI, at all levels, including parish and village levels academia) Obj 3: Strengthen multisectoral workforce planning and development for global health Review and update existing strategic plans for Uganda’s workforce development for health MoH/OPM, MoWE, MoD, MoTWA, security in all relevant sectors, including human, 30,162,760 MAAIF animal, wildlife, environmental, and security workforce National NationalAction ActionPlan Planfor forHealth Health Security (2019- –2023 Security 2019 2023) 59 Advocate for and support filling identified gaps in the existing strategic plans for Uganda's MOH, OPM 143,237,500 multisectoral workforce development for health security Conduct annual review to assess progress in MOH 91,825,000 achieving milestones in frontline training programs Advocate for the establishment of a National MOH, OPM 93,720,000 Institute of Public Health TOTAL 1,464,725,845 National NationalAction ActionPlan Planfor forHealth Health Security (2019- –2023 Security 2019 2023) 60

4.12 Preparedness Target Development and maintenance of national, intermediate (district) and local/primary level public health emergency response plans for relevant biological, chemical, radiological and nuclear hazards. This covers mapping of potential hazards, identification and maintenance of available resources, including national stockpiles and the capacity to support operations at the intermediate and local/primary levels during a public health emergency. JEE Scores R1.1 National multi-hazard public health emergency preparedness and response plan is developed and implemented 1 R1.2 Priority public health risks and resources are mapped and utilized 1 Current Status Uganda has a National Policy for Disaster Preparedness and Management (2011) which provides the country’s preparedness strategy for any events of public health importance. Some hazard and contingency plans have also been developed for specific diseases such as Ebola Virus Disease, Red eye Disease, and Avian Influenza. The national District Health Information System (DHIS-2) at the MoH contains an inventory of all public and private health facilities. A database exists of some experts, national and district rapid response teams, district surveillance coordinators and partners. This database is maintained at the PHEOC; however, this could be expanded to be more comprehensive. Uganda has institutions and mechanisms for training multi-disciplinary field epidemiologists and other frontline staff to prevent, detect and respond to PHEs and has been conducting regular simulation exercises. However, the current national multi-hazard emergency preparedness and response plan should be revised and updated to meet IHR and PVS core capacity requirements. It is important that surge capacity plans and procedures to respond to national and international events of public health concern at all levels should be clearly articulated and disseminated. National NationalAction ActionPlan Planfor forHealth Health Security (2019- –2023 Security 2019 2023) 61 It is recommended that systems to regularly test the response plan and procedures in actual emergencies or simulation exercises and modify/update as needed are implemented / instituted. Budget Strategic Actions Responsible Authority (UGX) 2019 2020 2021 2022 2023 Obj 1: Review and update the current national multi-hazard emergency preparedness and response plan to meet IHR core capacity requirements, according to a risk assessment conducted PRIORITY YEAR 1: Draft National Multihazard Public Health Emergency Response and Preparedness Plan, including preparedness and MoH, MAAIF, OPM, UWA 181,545,585 response activities, based on existing strategic plans with relevant national and subnational stakeholders Conduct a comprehensive resource mapping for MoH, MAAIF, OPM, UWA 112,610,350 emergency response PRIORITY YEAR 1: Develop hazard-specific MoH, MAAIF, OPM, UWA, MoWE, 358,988,970 contingency plans and SOPs MoD, MoFPED Conduct biannual assessments (including simulations, tabletop exercises, surveys and MoH, MAAIF, OPM, UWA, MoWE, questionnaires for National, Regional, and District 175,260,000 MOD, MoFPED RRTs) to test preparedness and response capabilities for different hazards Conduct annual support supervision of the MoH, MAAIF, UWA 357,012,000 contingency plans in 14 health regions Preposition a minimum package of essential MoH, NMS, NDA, NECOC, WHO- 644,118,031 supplies for emergency response at regional CO, UNICEF National NationalAction ActionPlan Planfor for Health Security Security2019 (2019- – 2023) 2023 62 referral hospitals (cholera kits, investigation kits, PPEs, disinfectants, vaccines, specimen carriers, etc.) Conduct a consultative meeting with relevant stakeholders, including parliamentary committees, to agree on functional mechanisms to mobilize MOH, MAAIF, UWA, Parliament 9,106,250 available funding resources for emergency response within 24 hours Establish coordination mechanisms between OPM 50,010,000 emergency response partners and OPM Obj 2: Carry out comprehensive resource mapping for emergency response, according to the hazard profiles already done PRIORITY YEAR 1: Assess country readiness to OPM, NTF 116,360,000 respond to priority hazard emergencies TOTAL 1,950,922,906 National NationalAction ActionPlan Planfor for Health Security Security2019 (2019- – 2023) 2023 63

4.13 Emergency response operations Target Uganda has a coordination mechanism, incident management systems, exercise management programmes and public health emergency operation centre (PHEOC) functioning according to minimum common standards; maintaining trained, functioning, multi- sectoral rapid response teams, and trained EOC staff capable of activating a coordinated emergency response within 120 minutes of the identification of an emergency. JEE Scores R2.1 Capacity to activate emergency operations 4 R2.2 EOC operating procedures and plans 4 R2.3 Emergency operations programme 4 R2.4 Case management procedures implemented for IHR relevant hazards. 3 Current Status Uganda has an established and staffed Public Health Emergency Operations Centre (PHEOC). The PHEOC has an operational framework and coordinates with the relevant line ministries. The PHEOC is donor funded and housed in rented space, risking sustainability. Uganda has SOPs and guidelines for management of highly contagious pathogens such as VHFs; detailing clinical management of cases identified and isolated in appropriate facilities. The country also has a Uganda Clinical Guideline, that provides general guidance on management of various diseases (both communicable and noncommunicable). There is however need to update these guidelines and SOPs and expand focus to other disease conditions of public health concern. NationalAction National ActionPlan Planfor for Health Health Security Security2019 (2019- 2023 – 2023) 64 Budget Strategic Actions Responsible Authority (UGX) 2019 2020 2021 2022 2023 Obj 1: Strengthen the operational capability of the PHEOC PRIORITY YEAR 1: Conduct consultative meetings with relevant stakeholders to establish MOH 156,447,400 the National Institute of Public Health, where PHEOC will be housed and incorporated PRIORITY YEAR 1: Develop a strategic plan to MoH, Partners 69,265,000 incorporate PHEOC funding into MOH structures Identify and obtain a permanent physical space for MoH, MoFPED 46,884,375 the EOC Create public awareness about national EOC MoH 34,400,000 Establish 14 regional health EOCs, including MoH, EOC training of staff Obj 2: Test existing PHEOC business and continuity plans, including all relevant sectors Develop an exercise program to maintain MoH, EOC, Partners 115,578,000 sustainable capacity and routine exercises/testing PRIORITY YEAR 1: Train relevant officials and staff in public health emergency management, MoH, Partners 115,041,875 IMS, and EOC operations Conduct a two-day training exercise to test the MoH, PHEOC, AFENET 34,060,500 PHEOC business continuity plan National for Health Security National Action Plan for Security(2019 2019 -– 2023 2023) 65 Obj 3: Plan for and conduct Hot Wash exercises and After-Action Reviews for all events for which the PHEOC has been activated Conduct AARs, including hot washes, for all events for which the PHEOC was activated. MoH, PHEOC, MAAIF, Partners 166,416,875 Systematically integrated learnings into trainings and national plans. Obj 4: Review PHEOC SOPs with the relevant stakeholders to adequately address the multihazard principles, and develop a CONOPS covering the all hazards approach to emergency response Conduct a five-day meeting with the relevant MoH, PHEOC, MAAIF, AEC, stakeholders to review and update current SOPs to CBRNE, UPF, UPDF, DGAL, NARO, 78,356,250 include IHR relevant hazards UNBS, Partners Develop a finalized updated CONOPS for the MoH, PHEOC, Partners 40,928,105 PHEOC based on existing handbook Conduct one-day simulation exercise to validate MoH, PHEOC, MAAIF, Partners 28,554,250 approved CONOPS TOTAL 885,932,730 National NationalAction ActionPlan Planfor forHealth (2019- –2023 Health Security 2019 2023) 66

4.14 Linking public health and security authorities Target Country conducts a rapid, multisectoral response in case of a biological event of suspected or confirmed deliberate origin, including the capacity to link public health and law enforcement, and to provide and/or request effective and timely international assistance, such as to investigate alleged use events. JEE Scores Public health and security authorities (e.g. law enforcement, border control, customs) are linked during a suspect or R3.1 2 confirmed biological event Current Status Uganda has a draft general guidance on detaining/quarantining an individual who presents a public health risk. there is also guidance on identification and control of potential biological events or other public health events that may be intentional through Intelligence and Counterterrorism at the border. The MOH, MAAIF and security authorities to participant in joint activities aimed at improving preparedness and response. There are also public health experts involved in emergency response linked to the Biological and Toxins Weapons Convention (BTWC). Internationally, the country is connected to the INTERPOL through the Ministry of Internal Affairs INTERPOL National Central Bureau (NCB) for Uganda. There has been limited joint capacity building amongst the sectors on management of public health emergencies, particularly in regard to information sharing and joint investigations/responses. There is also a need to finalise and formalise joint response activities between the sectors through MoU’s, SOPs and a coordination platform for responsible ministries. There are no regular reports between Public Health and Security Authorities. More efforts and commitment should be invested in finalizing and approving the draft MoU to provide a strong focus on multi- sectoral mechanisms to deal with the various CBRNE incidents. National NationalAction ActionPlan Planfor forHealth (2019- –2023 Health Security 2019 2023) 67 Budget Strategic Actions Responsible Authority (UGX) 2019 2020 2021 2022 2023 Obj 1: To improve collaboration and coordination between security authorities and public health authorities PRIORITY YEAR 1: Develop and adopt a multisectoral LE/PH emergencies response plan for joint investigations national Chemical, MOS 44,729,570 Biological, Radiological, Nuclear and Explosives events Set up a multi-agency joint operational LE/PH MOS 352,293,577 coordination centre for CBRNE PRIORITY YEAR 1: Develop a multisectoral LE/PH joint CRBNE emergency investigation and MOS 46,111,380 response curriculum Conduct a joint training for LE and PH personnel MOS 44,710,000 in joint CBRNE investigations and response Develop multisectoral SOPs and response protocols for joint investigations for National MOS 83,985,000 CBRNE incidents Conduct a functional Simex to validate the MOS 496,260,000 coordination of SOPs and response protocols Set up a CBRNE emergency facility with 10,000,000,00 MOS deployable mobile rapid response capability 0 TOTAL 11,068,089,527 National Action Plan for Health Security (2019 – 2023) 68 National Action Plan for Health Security 2019 - 2023

4.15 Medical countermeasures and personnel deployment Target National framework for transferring (sending and receiving) medical countermeasures, and public health and medical personnel from international partners during public health emergencies; and procedures for case management of events due to IHR relevant hazards. JEE Scores R4.1 System in place for sending and receiving medical countermeasures during a public health emergency 2 R4.2 System in place for sending and receiving health personnel during a public health emergency 2 Current Status National guidelines to address quality assurance from international providers of MCM have been developed. A national budget for MCM is funded through the NMS and the OPM. Personnel deployment is coordinated at ministerial level. Stockpiling of supplies is ensured through the PHEOC and the NECOC. However, national MCM and NRRT plan have to be urgently developed to guide these processes. Budget Strategic Actions Responsible Authority (UGX) 2019 2020 2021 2022 2023 Obj 1: To strengthen National multi sectoral framework for implementing MCMs for PHEs Conduct a workshop to assess the risks, document MCM needs, and develop and MCM plan and MAAIF/OHCO 80,717,070 SOPs for the animal sector PRIORITY YEAR 1: Conduct a national risk OPM, MoH 69,274,140 National National ActionPlan Action Planfor forHealth Health Security Security 2019 (2019- –2023 2023) 69 assessment of public health threats Develop and exercise a policy for sending and MoH, MAAIF, OPM 36,208,320 receiving MCM in a public health emergency PRIORITY YEAR 1: Review and finalize the updated draft MCM plan and develop relevant SOPs including a One Health stock of relevant MoH, MAAIF, OPM 143,810,000 MCM and incorporate findings from animal health MCM workshop Conduct a tabletop exercise to validate updated SOPs and MCM plans for both human and animal MoH, MAAIF, OPM, UPDF 25,450,000 health Approve final draft of MCM plan and SOPs MoH, MAAIF, OPM, Partners 7,106,250 PRIORITY YEAR 1: Conduct two advocacy meetings with the relevant parliamentary MoH, MAAIF, OPM -- committees to expedite availability of contingency fund Develop operational manuals and emergency OHCO, MAAIF 44,764,570 procurement plans for MCM for animal health Obj 2: Establish an integrated framework for sending and receiving health personnel during public health emergencies Develop national personnel deployment guidelines and operational plan, including SOPs and training MoH, NECOC/PHEOC - OHCO 81,856,210 needs for both domestic and international deployment Validate draft MCM policy, plan and SOPs MoH, NECOC/PHEOC - OHCO 44,060,000 Obtain approval of and policy from NTF and MoH, NECOC/PHEOC - OHCO 7,106,250 relevant stakeholders National NationalAction ActionPlan Planfor forHealth Health Security (2019- –2023 Security 2019 2023) 70 Launch approved policy by senior top management MoH, NECOC PHEOC - OHCO 80,725,000 of relevant ministries Distribute final Personnel Deployment Policy and MoH, NECOC/PHEOC - OHCO 35,000,000 operational plan, including SOPs, nationally Test operational plan through the development and MoH, NECOC/PHEOC - OHCO 14,936,664 implementation of a TTX Preposition emergency supplies for response to 14,000,000,00 MoH, NECOC/PHEOC - OHCO emergencies 0 TOTAL 14,671,014,464 National NationalAction ActionPlan Planfor forHealth Health Security (2019- –2023 Security 2019 2023) 71

4.16 Risk communication Target States Parties use multilevel, multi-sectoral and multifaceted risk communication capacity for public health emergencies. Real-time exchange of information, advice and opinions during unusual and unexpected events and emergencies so that informed decisions to mitigate the effects of threats, and protective and preventative action can be made. This includes a mix of communication and engagement strategies, such as media and social media communications, mass awareness campaigns, health promotion, social mobilization, stakeholder engagement and community engagement. JEE Scores R5.1 Risk communication systems (plans, mechanisms, etc.) 2 R5.2 Internal and partner communication and coordination 4 R5.3 Public communication 4 R5.4 Communication engagement with affected communities 4 R5.4 Dynamic listening and rumour management 3 Current Status National risk communication plans have been developed and personnel to support risk communication exist at the MOH. Efforts to strengthen inter-partner risk communication should be strengthened with more government commitment to support risk communication. In Uganda, permanent and surge staff who are dedicated to risk communication during emergencies are in place. There are shared communication plans, agreements and/or SOPs between response agencies. Additionally, training is provided National Action National Plan Action Planfor forHealth HealthSecurity Security (2019 2019 -–2023 2023) 72 to the risk communications personnel for response to all health hazards. There exists an internal arrangement for the clearance of messages to the public. Multi-sectoral collaboration for risk communication is present and active within the NTF. Collaborative arrangements are in place with public and private media which guarantees access for the delivery of key risk communication messages. Risk communication during emergencies and outbreaks is availed to the communities using local languages. All communication materials are pre-tested by the Behavioural Change Committee (BCC) before being printed and approved for use in the field. In Uganda, risk communication coordination between all relevant partners is weak. There is need to strengthen coordination of risk communication between all relevant partners. There is lack of planned risk communication training for responders prior to emergencies. There is need to conduct risk communication training and simulation exercises at national and sub-national levels as well as with media houses (radios, TV, print, etc) and risk communication partners (Red Cross, UNICEF), so as to develop a consistent approach across the country. Additionally, risk communication messages to public are largely donor sponsored. There is urgent need for Government to fund risk communication messages to the public during emergencies, in support with partners. Lastly, the impact of risk communication messages and feedback to the public has never been assessed. There is need to design evaluation studies to assess the impact of risk communication activities and feedback to the community. Budget Strategic Actions Responsible Authority (UGX) 2019 2020 2021 2022 2023 Obj 1: Develop a national multi-sectoral risk communications strategy and train risk communication personnel to respond effectively during emergencies Develop a sustainable funding mechanism for Risk Communications using relevant government sector MoH, MAAIF, OHCO 132,843,750 resources PRIORITY YEAR 1: Mobilize relevant sectors MoH, MAAIF, OHCO 4,026,640,000 National Action National Plan Action Planfor forHealth HealthSecurity Security (2019 2019 -–2023 2023) 73 to support risk communication activities in their budgets (national and subnational levels) Develop a national multisectoral risk MoH, MAAIF, OHCO 199,294,140 communication strategy and a costed plan Train risk communication personnel to respond MoH, MAAIF 2,044,699,375 effectively during emergencies Obj 2: Establish a national coordination platform that coordinates all risk communication stakeholders, including private sector Develop SOPs for coordination of partners MoH, MAAIF 32,123,125 Establish and operationalize a national coordination platform that brings together all risk MoH, MAAIF, OHCO 693,367,500 communication stakeholders, including private sector Obj 3: Train and orient all designated spokespersons in risk communications prior to the emergency Strengthen risk communication programming MoH, MAAIF, OHCO 142,701,932 PRIORITY YEAR 1: Conduct assessments of risk communicators in human and animal health at MoH, MAAIF, OHCO 54,504,140 national and subnational level PRIORITY YEAR 1: Conduct trainings for risk communicators in human and animal health at MoH, MAAIF, OHCO 574,062,750 national and district level Obj 4: Strengthen feedback mechanisms with communities for effective risk communication Conduct training of sub-county leaders and social MoH/MAAIF 23,511,000 mobilizers on community engagement NationalAction National ActionPlan Planfor for Health Health Security Security2019 (2019- 2023 – 2023) 74 Strengthen feedback mechanisms with To be determined 1,469,173,125 communities for effective risk communication Obj 5: Conduct evaluation campaigns to assess effectiveness of risk communication channels used every year Strengthen the functionality of the call centres in MoH, MAAIF, OHCO 222,387,383 MOH and MAAIF Conduct evaluation campaigns periodically to assess effectiveness of risk communication MoH, MAAIF, OHCO 37,002,760 channels Conduct periodic KAPB studies on perceptions, risky behaviour, and misinformation among the MoH, MAAIF, OHCO 22,826,725 communities Obj 6: Conduct AMR awareness creation campaigns Develop AMR communication and advocacy MoH, MAAIF, Pharmaceutical 193,810,924 strategy Society, UMC, AHPC Develop IEC materials MoH, MAAIF 720,694,375 TOTAL 10,589,643,004 NationalAction National ActionPlan Planfor for Health Health Security Security2019 (2019- 2023 – 2023) 75

4.17 Points of Entry Targets The country designates and maintains core capacities at international airports, ports and ground crossings that implement specific public health measures required to manage a variety of public health risks. JEE scores PE.1 Routine capacities established at points of entry 1 PE.2 Effective public health response at points of entry 1 Current Status There is no central coordination and monitoring office in place for the delivery of public health services at points of entry. In addition, no POE is designated with respect to the IHR guidelines. The few PoEs that have public health hazards detection & response capacities (facilities & skilled human resources) for both humans and animals are weak. The majority of PoEs have no detection and response capabilities, especially those undesignated for revenue and immigration management. An assessment by WHO and MOH of IHR core capacities and implementation at nine ground crossing points (October 2016) concluded that core capacities for implementation of IHR at the ground crossing points were below the requirements for compliance and that effective public health response at the points of entry was lacking. In addition, the daily influx of refugees crossing the border into Uganda has remained high and the border particularly with DRC is porous. This increases the risk of spread of outbreak prone diseases to and from neighbouring countries. Entebbe International Airport screens all travellers through inspections of yellow fever vaccination papers and a thermal scanner. The International Airport also has access to equipment and personnel to examine and transport ill travellers to relevant medical facilities. National NationalAction ActionPlan Planfor forHealth (2019- –2023 Health Security 2019 2023) 76 Budget Strategic Actions Responsible Authority (UGX) 2019 2020 2021 2022 2023 Obj 1: Designate all POEs and implement IHR core capacities for detection and response to potential public health hazards PRIORITY YEAR 1: Designate Points of Entry MOH, MAAIF, MIA, MOS 198,652,375 and implement IHR core capacities at each of them Establish a multisectoral coordination centre for MOH, MAAIF 4,996,125 monitoring POE, according to IHR standards Obj 2: Develop a POE public health emergencies plan and capacities for detection and response that are linked to the regional and national public health emergencies plan and capacities PRIORITY YEAR 1: Develop a contingency plan for detection and response to human and MOH, MAAIF, MIA, MOS, MTIC 88,322,625 animal public health hazards at POEs with respect to IHR guidelines PRIORITY YEAR 1: Operationalize the detection and response plans to human and animal MOH, MAAIF 581,459,000 public health hazards at POEs with respect to IHR guidelines Increase animal health workforce at the POEs to MAAIF, MOH 2,378,814,375 carry out One Health IHR related activities TOTAL 3,252,244,500 . National NationalAction ActionPlan Planfor forHealth (2019- –2023 Health Security 2019 2023) 77

4.18 Chemical Events Target States Parties with surveillance and response capacity for chemical risks or events. This requires effective communication and collaboration among the sectors responsible for chemical safety, industries, transportation and safe disposal, animal health and the environment. JEE Scores CE.1 Mechanisms established and functioning for detecting and responding to chemical events or emergencies 2 CE.2 Enabling environment in place for management of chemical events 2 Current Status Uganda’s national coordinating body for chemical safety is the Department of Occupational Safety and Health at MoGLSD. The coordinating agency for multilateral environment agreements (MEAs) is Ministry of Water and Environment, which has established a clearing house in National Environment Management Authority (NEMA) on chemical management information exchange. Existing gaps include absence of a national multisectoral chemical response action plan, which should incorporate the training and exercises of relevant agencies. No institution has the mandate on all toxic industrial chemicals. Other recommended interventions include establishing a framework for licensing, building capacity for the management of hazardous chemicals, and enhancing laboratory capacity for detection of chemical threats. Budget Strategic Actions Responsible Authority (UGX) 2019 2020 2021 2022 2023 Obj 1: Build effective and lasting national chemical safety and chemical security management capabilities for detection and response to chemical events, according to IHR (2005) National Action National ActionPlan Planfor forHealth HealthSecurity (2019- –2023 Security 2019 2023) 78 Perform risk assessment, map resources, and MoD (NBC Regiment), DGAL MoWE, develop National Chemical safety and security 475,561,074 NEMA, UNBS plan Develop an inventory of the chemical stocks UNBS, MoD (NBC Regiment), DGAL, 74,484,011 within the country MoGLSD, MAAIF, MoWE, NEMA Develop a multisectoral chemical emergency response plan (subset of the National Chemical OPM/NECOC 112,184,949 Safety and Security Plan) NECOC, MoGLSD/Dept of Conduct joint functional and operational exercises Occupational Health, MOD, DGAL, 101,630,315 to validate and operationalize the above plans MAAIF, WHO, MoWE/NEMA Perform audits of 10% of selected chemical MoGLSD, MoWE/NEMA, UNBS, 325,473,750 factories nationally each year MTIC Train health and relevant sector personnel in high MoH, MoWE/NEMA, MGLSD, risk districts on investigation and response to 400,803,710 MAAIF chemical events Obj 2: Establish a National Focal Point and operationalize the National Poison Centre Establish national focal points for sharing DGAL & Police CBRN Unit, NECOC 2,017,412,500 information regarding chemical events Create awareness of, and link government and DGAL & Police CBRN Unit 270,109,375 private health facilities to, National Poison Centre Assess select chemical labs with handling capacity DGAL & Police CBRN Unit, MoH, 4,830,000 for chemical events and IHR (2005) compliance MAAIF, UNBS, NEMA Upgrade select chemical labs according to IHR DGAL & Police CBRN Unit, UNBS standards DGAL & Police CBRN Unit, UNBS Train chemical lab staff on analytical chemistry 249,795,750 National Action National ActionPlan Planfor forHealth HealthSecurity (2019- –2023 Security 2019 2023) 79 Adapt the EU CBRNE risk mitigation recommendations for strengthening the Uganda DGAL, Police CBRNE Unit 158,823,250 CBRNE legal framework TOTAL 4,191,108,684 National NationalAction ActionPlan Planfor forHealth Health Security (2019- –2023 Security 2019 2023) 80

4.19 Radiation emergencies Target States Parties should have surveillance and response capacity for radiological emergencies and nuclear accidents. This requires effective coordination among all sectors involved in radiation emergencies preparedness and response. JEE Scores RE.1 Mechanisms established and functioning for detecting and responding to radiological and nuclear emergencies 2 RE.2 Enabling environment in place for management of radiation emergencies 2 Current Status Uganda developed the Atomic Energy Act (2008) to mandate the Atomic Energy Council (AEC) and Atomic Energy Regulation Draft Atomic Energy (Nuclear Security) Regulations (2016) to improve the security of radioactive sources. The AEC was created under the Ministry of Energy and Mineral Development in a draft national nuclear security plan (2012) with both preventive and response attributes and guidelines. In addition, the national Multi-Sectoral Radiation Emergencies Committee (including the Ministry of Energy and Mineral Development, UPDF, UPF, Atomic Energy Council, and NEMA) is in place to respond to radiation emergencies. Uganda has not ratified and is not the signatory to the Convention on Early Notification of a Nuclear Accident. Management of radiological emergencies is underdeveloped. There is need to ratify the Convention on Early Notification of a Nuclear Accident, finalize the CBRNE policy, NNRERP and SOPs and human resource development for the management of radiation emergencies. National NationalAction ActionPlan Planfor forHealth Health Security (2019- –2023 Security 2019 2023) 81 Budget Strategic Actions Responsible Authority (UGX) 2019 2020 2021 2022 2023 Obj 1: Build national nuclear safety and security capacities in preparedness, detection and response to radiation emergencies Finalize the draft CBRNE policy, NNRERP and SOPs for detection, response and training of Ministry of Energy (AEC), MOGLSD 336,750,780 personnel for radiation emergencies PRIORITY YEAR 1: Sign the Convention on early notification of a nuclear accident and Ministry of Energy (AEC), Ministry of 259,187,500 Convention on assistance in case of radiological or Foreign Affairs nuclear emergencies Incorporate nuclear and radiological emergencies Ministry of Energy (AEC), MOH, into the national training and exercise program MAAIF, UNCST, MCHE, MOES, 197,838,625 under “One Health” approach UPF, UPDF, CBRNE, MOWE/NEMA Address gaps in infrastructure and equipment Ministry of Energy (AEC), OPM, 2,000,000 availability for radiological detection and response Ministry of Foreign Affairs Ministry of Energy (AEC), MOH, PRIORITY YEAR 1: Establish a function MOU UPF, CBRNE/UPDF, Ministry of and efficient information sharing and management Information, OPM-NECOC, URCS, 91,391,250 of radiation emergencies among all stakeholders MAAIF, UNBS, MOGLSD, NEMA, DGAL Obj 2: Create national radiation emergencies detection and response centres that are well-coordinated with other agencies capable of generating a timely radiation emergencies situation report PRIORITY YEAR 1: Identify health facilities at Ministry of Energy (AEC), MOH, the national and high-risk districts, and train and 810,543,842 OPM equip staff to manage radiation emergencies National NationalAction ActionPlan Planfor for Health Security2019 Health Security (2019- – 2023) 2023 82 Develop a calibration laboratory for the equipment used in detection and response to radiological and Ministry of Energy (AEC), UNBS 3,240,000,000 nuclear emergencies TOTAL 4,937,711,997 National NationalAction ActionPlan Planfor for Health Security2019 Health Security (2019- – 2023) 2023 83 Summary of cost analysis The total estimated cost of the Ugandan NAPHS is UGX 160,708,941,019 ($42,571,905 USD), covering all 19 technical areas in prevent, detect and response to public health events between 2019 - 2023. The major cost drivers of the NAPHS include 1) real-time surveillance, 2) AMR, 3) Medical countermeasures, and 4) the national laboratory system. Technical area Major initiatives (2019 – 2023) Conduct trainings for district and national level health workers from animal and human health on the newly established integrated real-time Surveillance surveillance system 4,494,062,500 UGX ($1,190,480 USD) Strengthen the national laboratory capacities to store and manage AMR AMR pathogens and maintain a national biorepository of isolates 5,352,132,000 UGX ($1,417,783 USD) National NationalAction ActionPlan Planfor forHealth Health Security 2019 (2019- –2023 2023) Preposition emergency supplies for response to enforce an integrated Medical framework for sending and receiving health personnel during human, countermeasures animal, and environmental public health events 14,000,000,000 UGX ($3,708,609 USD) Integrate transport of animal samples into the National Specimen National laboratory Referral and Transport Network, in order to effectively implement a One system Health system $3,628,000,000 UGX ($961,059 USD) National NationalAction ActionPlan Planfor forHealth Health Security 2019 (2019- –2023 2023) 4. Implementation of NAPHS

5.1 Governance of the NAPHS In its implementation, NAPHS shall use a multi-stakeholder, One Health approach. An implementation plan will be conducted each year for all pertinent stakeholders and ministries to understand key actions that will be needed to be prioritized. The NAPHS activities costing will be integrated into the pertinent ministries request for budget every year, and additional resources mobilized from within government and partners. The National IHR focal point housed in the MoH, and the OIE country delegate based in MAAIF, will be informed of all progress made in attainment of IHR competences. Oversight and monitoring will be a function of the Office of the Prime Minister while the chair of the OH TWG will provide technical leadership to implementation. (Refer to figure 2) Figure 4: Organogram for NAPHS implementation Office of the Prime Minister OPM will lead on coordination, accountability and reporting in line with the Joint sector reviews. National NationalAction ActionPlan Planfor forHealth Health Security 2019 (2019- –2023 2023) Technical working group A national steering committee comprising of representation from the pertinent NAPHS sectors will also support the coordinating activities of the OPM. The committee will have designated focal points from line ministries, departments, agencies, academia, UN agencies and private sector for each NAPHS technical area. The committee will be chaired by the chair of the OH TWG and work in collaboration with the National One Health Platform to strengthen its activities.

5.2 Monitoring and Evaluation strategy The purpose of the M&E strategy is to support the Government of the Republic of Uganda (GOU) to fully comply with the IHR (2005) by monitoring progress of activities for the 19 Technical Areas within the NAPHS. These activities have been identified as important contributors to increasing the country’s JEE health security capacity scores. The monitoring process will be coordinated by the OPM in collaboration with the IHR NFP and the chair of the OH TWG. This M&E strategy is aligned with the global IHR M&E Framework and incorporates supporting documents such as the WHO Benchmarks1, the IHR Self-Assessment Annual Reporting (SPAR)2 Tool, as well as data from After Action Reports (AARs) and Simulation Exercises (Simex). : IHR (2005) Monitoring & Evaluation framework https://apps.who.int/iris/bitstream/handle/10665/276651/WHO- WHE-CPI-2018.51-eng.pdf?sequence=1 1 https://www.who.int/ihr/publications/9789241515429/en/ 2 https://extranet.who.int/sph/news/ihr-self-assessment-annual-reporting-tool-spar-2018 National NationalAction ActionPlan Planfor forHealth Health Security (2019- –2023 Security 2019 2023) Monitoring and Evaluation plan The strategy will follow 3 prongs: 1. Monitoring Implementation of the NAPHS a. Creation on Technical Area focal teams: To promote a sense of ownership of the NAPHS implementation process by NAPHS stakeholders, create continuity in the reporting, and contribute to a national-level M&E strategy, a Focal Person (FP) for each Technical Area will be identified within the respective ministries. b. Self-reporting by stakeholders: A self-reporting monitoring tool will be used through a collaborative process to incorporate NAPHS stakeholder input and Technical area FPs on NAPHS activities. This will facilitate the tracking process for NAPHS activities by providing data on key variables (e.g. progress, funding updates and challenges) that are essential to successful implementation. c. Technical Area Review Meeting: Regularly scheduled one-on-one meetings will be held between monitoring team and each line ministry or implementing partner to discuss the Technical Areas that the ministry/implementing partner is contributing to. The Monitoring team will work with the FP in the respective ministries to convene representatives for each Technical Area from that ministry for these monitoring meetings. Within the technical monitoring meetings, monitoring data will drive discussion on NAPHS activity implementation. Identification of successes, bottlenecks or gaps, and areas for improvement will also be discussed to inform subsequent activity planning within the Technical Areas. This strategy will strengthen partnership engagement and improve the quality of subsequent reporting. This approach will also be used to identify and utilise other reporting channels in use by the different NAPHS stakeholders. 2. Identifying & Realigning Priority Activities a. Mid-year review meetings: This will be a one-day review engagement conducted mid- year following the calendar year attended by representatives from all the line ministries (including FPs), implementing partners, and other key stakeholders. The purpose for this meeting is to share progress, challenges and status updates on NAPHS implementation and discuss the planned activities. Best practices will be documented and shared with partners, which will increase awareness among NAPHS stakeholders about progress towards the JEE recommendations and strengthen cross-sectoral collaboration. b. Annual review meetings: This will be a two-day review meeting building upon results from the mid-year review process and other progress updates. Documents such as the WHO Benchmarks and SPAR, along with results from Simex and AARs will be used to guide this process. Suggested participants at this review will include; technical persons, National NationalAction ActionPlan Planfor forHealth Health Security (2019- –2023 Security 2019 2023) managers, commissioners, administrators, ministers, leadership representation from other implementing partners and representation from the development partners. Recommendations at this forum will facilitate selection and prioritization of activities for the following year to inform subsequent planning for NAPHS implementation. 3. Documentation and Disseminating of Results a. Monthly progress reports: The monitoring team will provide progress reports implementation and updates to Monitoring and Evaluation (M&E) for NAPHS. These reports will be shared with 1) Ministries and the Prime Minister; 2) Other Uganda-based organizations; 3) Development partners (i.e. CDC, WHO, RTSL) b. Quarterly Newsletter: This will be written to provide brief updates about the NAPHS implementation process to stakeholders. The Newsletter will be circulated through email to line ministries, sectors, and other partners supporting NAPHS implementation. c. Publications and Conferences: As appropriate, the monitoring team will work with key stakeholders to develop and share publications with the wider community (nationally and globally) that communicate Uganda’s progress with NAPHS implementation. These may include original scientific publications, contribution to bulletins and conference papers. Such publications will include but are not limited to innovations, successes, lessons learnt, best practices, and progressive status on the JEE recommendations in alignment with the IHR 2005. d. MDA Quarterly review meetings: The monitoring team participate in ministry quarterly review meetings. National NationalAction ActionPlan Planfor for Health Security2019 Health Security (2019- 2023 – 2023) 1. ANNEXES

Annex 1: Attendance List for members contributing to the NAPHS develoment NAME INSTITUTIN Ben Masiira AFENET Hasifa Bukirwa AFENET Herbert Kazoora AFENET Nulu Bulya AFENET Olivia Namusisi AFENET John Nuwagaba Airport Medical services Birungi Joshua Atomic Council Thomson Okello CAA Bao-Ping Zhu CDC Daniel Stowell CDC Dr. Jaco Homsy CDC Dr. Joseph Ojwang CDC Juliet Kasule CDC Lisa Nelson CDC Patricia Tanifum CDC Steven Balinandi CDC Thomas Nsibambi CDC Vance Brown CDC Patrick Banura CHAI Maureen Kyomuhendo Coca Cola Kabasa David COVAB Julius Okuni COVAB Denis K. Byarugaba COVAB Samuel Majalija COVAB David J. Kabasa COVAB Moses Joloba CWRU Ngonde Wilberforce DCIC Opolot Okaasai Dept. Crop Resources Andrew Ockenden DFID E. Burnett DFID Gema Redondo DFID Ms. Ritah Nakigudde DFID Robinah Lukwago DFID National Action Plan for Health Security 2019 - 2023 Kepher Kateu DGAL Rhoda Nauda DGAL Denis Kyabaggu EAPHLNP Namungo Patience B Energy and Mineral John Steven Okech European Union Chrisostom Ayebazibwe FAO Mubiru Sarah FAO Sam Okuthe FAO Susan Ndyanabo FAO Edith Nantongo FH1360 Eric Kakoole GAVI Vicent Mujune GOAL Christine Mwebesa Health Service Commission (HSC) Dr. Pius Okong Health Service Commission (HSC) Ddungu S HSC Immaculate Nakibuuka ICRC Francis Kakooza IDI Judith Nanyondo IDI Justine Bukirwa IDI Kenneth Mulindwa IDI Lydia Nakiire IDI Mohammed Lamorde IDI Peter Babigumira IDI Peter Mukiibi IDI Richard Walwema IDI Rogers Kisame IDI Solome Nantumbwe Mutumba IDI Joaniter Nankabirwa IDRC SimonPeter Mundeyi Immigration Victoria Kajja IOM Bildard Baguma JMS Acyeles Omodi KCCA Daniel Okello Ayen KCCA Emilian Ahimbisibwe KCCA Isaiah Chebrot KCCA Serukka David KCCA Alex Bambona MAAIF National Action Plan for Health Security 2019 - 2023 Carolyn Namatovu MAAIF Alfred Wejuli MAAIF Beatrice Nannozi Kasirye MAAIF Ben Senkeera MAAIF Bosco Okuyo MAAIF Dan Tumusiime MAAIF Emmanuel Isingoma MAAIF Fred Monje MAAIF Gloria Tamale MAAIF Juliet Ssentumbwe MAAIF Martin Kasirye MAAIF Merabu Acham MAAIF Michael Kimaanga MAAIF Micheal Omodo MAAIF Moses Mwanja MAAIF Paul Lumu MAAIF Robert Mwebe MAAIF Sam Richards Erechu MAAIF Thecphilus Mwesige MAAIF Deo Ndumu MAAIF Doris Kiconco MAAIF Jolly Hoona MAAIF Rose Ademun MAAIF John Okiror MAAIF Kyokwijuka Benon MAAIF Noeline Nantima MAAIF Ejobi Francis Mak.VET College Bosco Oruru MakSPH Steven Ssendagire MakSPH Sowedi Muyingo MAUL Moses Mwesigwa Min Gender Labour social Development Mr. Alex Asiimwe Min Gender Labour social Development Joaniter Nakacwa Min Justice and constitutional Affairs Sarah Mitanda Min Justice and constitutional Affairs Susan Odongo Min Justice and constitutional Affairs Arthur Ibaale Min of Internal Affairs Robert Kibuuka Min Science and Technology National Action Plan for Health Security 2019 - 2023 Juliet Kyokuhaire Min. Finance Planning and Economic Development Faye Bagamuhunda Min. of security Dinnah Apeduno Min. Trade and Industry Peter Odong Min. Trade and Industry Mrs. Doreen Katusiime Minister of Tourism Wildlife and Antiquities Prof. Ephraim Kamuntu Minister of Tourism Wildlife and Antiquities Boniface Amalla MoH Bernard Lubwama MoH David Mutegeki MoH Judith Ssemasaazi Amutuhaire MoH Alfred Driwale MoH Allan Muruta MoH Anne Nakinsige MoH Bernard Opar MoH Charles Olaro MoH Diana Atwine MoH Eldard Mabumba MoH Emmanuel Othieno MoH George Upenytho MoH Henry Mwebesa MoH Immaculate Ampeire MoH Jackson Amone MoH Jane Ruth Aceng MoH JB Waniaye MoH Johnbaptist Waniare MoH Joseph Okware MoH Okiror Stephen MoH Patrick Tusiime MoH Peter Okwero MoH Sarah Byakika MoH Susan Nabadda MoH David Muwanguzi MoH Emma Sam Arinaitwe MoH Emmanuel Ainebyoona MoH Fred Sebisubi MoH Harriet Miriam Atim MoH Harriet Akello MoH National Action Plan for Health Security 2019 - 2023 Harriet Mayinja MoH Hilda Barbara Wesonga MoH Hon. Moriku Kaducu MoH Joyce Mutesi MoH Jude Okiria MoH Julian Kyomuhangi MoH Kiiza Peter MoH Michael Kibuule MoH Mugisha James MoH Mukooyo Edward MoH Nabakooza Jane MoH Namugga Judith MoH Nguna Joyce MoH Nsungwa Jesca MoH Rebecca Akinzirwe MoH Richard Kabagambe MoH Richard Kabanda MoH Richard Okwir MoH Ronald Ssegawa Gyagenda MoH Safari Specioza Katusiime MoH Sam Nalwala MoH Sam Olumu MoH Scovia Ajidiru MoH Seru Morris MoH Stephen Akena Abwoye MoH Tabley Bakyaita MoH Usamah Kaggwa MoH Vivian Sserwanja Nakaliika MoH Walimbwa Ali MoH Paul Mbaka WHO Charles Isabirye MoH Celestin Bakanda MoH/IDI Doreen Gonahasa PHFP/MOH Herbert Bakiika MoH/IDI Immaculate Nabukenya MoH/IDI Johnbaptist Kibanga MoH/IDI Solome Okware MoH/IDI National Action Plan for Health Security 2019 - 2023 Pamela Zanika MOH/UNEPI Natukunda Passy Patricia MOH-ACP-HTS Maxwell Onapa Otim MoSTI Reuben Kiggundu MTaPs Peter Ourah MTIC Kajumbula Henry MUCHS Dr. Henry Kajumbula Mulago NRH, Microbiology Dept Derrick Mimbe MUWRP Jocelyn Kiconco MUWRP Aaron Kibirizi MWE Alfred Okot Okidi MWE Betty Mbolanyi MWE Collins Oloya MWE Dadinoh Ndibarema MWE Eng. Dominic Kavutse MWE Eng. Richard Cong MWE Etimu Simon S. E MWE Florence Adong MWE Gilbert Ituuka MWE Julia Kamala MWE Julius Mafumbo MWE Kamala Julia MWE Lillian Idrakua MWE Martha Naigaga MWE Mr. Watson Wakooli MWE Obubu J. Peter MWE Peter J. Obubu MWE Silvestre Gwanyi Herbert MWE Simon S. E. Etimu MWE Stephen David Mugabi MWE Joseph Mbihaye NARO Margaret Masette NARO Richard Ssewakiryanga National NGO Forum Juliet Awori Okecho NDA Paul Okware NMS Mary Akumu NTRL Alex Gisagara NWSC National Action Plan for Health Security 2019 - 2023 Dr. Irene Naigaga OHCEA Pamela Komujuni OPM Abdul Muwanika OPM Benjamin Kachwero OPM Florence Mbabazi OPM Gerald Menhya OPM Hadard Arinaitwe OPM Ibrahim Wandera OPM Isaac Mugera OPM Julius Mucunguzi OPM Leila Ssali OPM Mayanja Gonzaga OPM Pamela Gumisiriza Komujuni OPM Raymond Kirungi OPM Roland Bless Taremwa OPM Roy Mwanga Mugoya OPM Teddy Namara OPM Timothy Lubanga OPM Dorothy Nabunya PHEOC Dr. Issa Makumbi PHEOC Joshua Kayiwa PHEOC Milton Makoba Wetaka PHEOC Simon Kyazze PHEOC Daniel Kadobera PHFP Dativa Maria Alideki PHFP Alex Ario PHFP Juliet Namagulu PHFP Stephen Kabwama PHFP Bernard Atwine Presidents Office Dr.Arnold Ezama Red Cross Robert Kwesiga Red Cross Amanda McClelland RTSL Colby Wilkason RTSL Diana Kiiza SABIN Vaccine Institute David Treseder Samaritan Purse Winyi Kaboyo TDDAP Yeff Mecaskey TDDAP National Action Plan for Health Security 2019 - 2023 Rebecca Kengoro UCPA Sam Watasa UCPA ASP Joshua Oluka Ug. Prison Services ASP Nelson Wandera Ug. Prison Services James Mugoya Ug. Prison Services Kigenyi Saad Ug. Prison Services Oluka Joshua Ug. Prison Services Wandera Nelson Ug. Prison Services Grace Ssali Kiwanuka Uganada Health Care Foundation Josephine Okwera Uganda Red Cross Society Paul B. Okot Uganda Red cross Society Ahmed Katumba UHSC Ben Manyindo UNBS Moses Matovu UNBS Yasin Lameriga UNBS Ndifuna Abdul UNBS Yasin Lemeriga UNBS Mary Okwakol UNCHE Opuda Asibo UNCHE Beth Mutumba UNCST Aidah Nakanjako UNDP Julius Kasozi UNHCR Atek Kagirita UNHLS/CPHL Joseph Nkodyo UNHLS/CPHL David Matseketse UNICEF Doreen Mulenga UNICEF Eva Kabwongera UNICEF Miriam Lwanga UNICEF Aida Girma UNICEF Ambrose Oiko UPDF Joseph Mugagga Lubega UPDF Damian Kato UPDF Charles Nuwakuma UPDF Ambrose Musinguzi UPDF Godwin Bagash UPDF John Tagaswire UPDF Samuel Okurut UPDF National Action Plan for Health Security 2019 - 2023 Mubiru Andrew UPF Ndashimye Gregory UPF Peter Oumo UPF Justine Mirembe UPMB Hassan Wasswa URA Paul Okot URSC Deborah Malac US EMBASSY Patricia Rader USAID Wilberforce Owembabazi USAID David Mutongo USAID P&R Barnabas Bakamuntumaho UVRI Julius Lutwama UVRI Josephine Bwogi UVRI Robert Downing UVRI Ronald Seguya UVRI Patrick Atimnedi UWA Robert Aruho UWA Gloria Grace Akurut UWA Sam Mawanda UWA Florence Kyalimpa UWA Patrick Atim UWA Andrew Bakainaga WHO Collius Mwesigye WHO Edson Katushabe WHO Felix Ocom WHO Jayne Tusiime WHO Miriam Nanyunja WHO Bayo Fatumbi WHO Innocent Komakech WHO Maureen Nyonyintono WHO Nathan Natserie WHO Patrick Wokorach WHO Sandra Nabatanzi WHO William Lali Ziras WHO Yonas Tegegn Woldemariam WHO Musa Sekamatte ZDCO National Action Plan for Health Security 2019 - 2023

Annex II: JEE summary results Technical Indicators Score areas P.1.1 Legislation, laws, regulations, administrative requirements, policies or other 3 government instruments in place are sufficient for implementation of IHR (2005) National P.1.2 The State can demonstrate that it has adjusted and aligned its domestic legislation, legislation, policies and administrative arrangements to enable compliance with 3 policy and IHR (2005) financing P.1.3 Financing is available for the implementation of IHR capacities 2 P.1.4 A financing mechanism and funds are available for the timely response to 1 public health emergencies IHR coordination, P.2.1 A functional mechanism is established for the coordination and integration of 2 communication relevant sectors in the implementation of IHR and advocacy P.3.1 Antimicrobial resistance detection 2 Antimicrobial P.3.2 Surveillance of infections caused by antimicrobial-resistant pathogens 2 resistance P.3.3 Healthcare-associated infection (HCAI) prevention and control programs 3 P.3.4 Antimicrobial stewardship activities 3 P.4.1 Surveillance systems in place for priority zoonotic diseases/pathogens 2 Zoonotic P.4.2 Veterinary or animal health workforce 3 diseases P.4.3 Mechanisms for responding to infectious and potential zoonotic diseases are 2 established and functional P.5.1 Mechanisms for multi-sectoral collaboration are established to ensure rapid Food safety 2 response to food safety emergencies and outbreaks of food-borne diseases P.6.1 Whole-of-government biosafety and bio-security system is in place for Biosafety and 3 human, animal and agriculture facilities biosecurity P.6.2 Biosafety and bio-security training and practices 3 P.7.1 Vaccine coverage (measles) as part of national programme 3 Immunization P.7.2 National vaccine access and delivery 4 D.1.1 Laboratory testing for detection of priority diseases 4 National D.1.2 Specimen referral and transport system 3 laboratory system D.1.3 Effective modern point-of-care and laboratory-based diagnostics 3 D.1.4 Laboratory quality system 3 D.2.1 Indicator- and event-based surveillance systems 4 Real-time D.2.2 Interoperable, interconnected, electronic real-time reporting system 3 surveillance D.2.3 Integration and analysis of surveillance data 3 D.2.4 Syndromic surveillance systems 3 D.3.1 System for efficient reporting to FAO, OIE and WHO 3 Reporting D.3.2 Reporting network and protocols in country 3 Workforce D.4.1 Human resources available to implement IHR core capacity requirements 3 NationalAction National ActionPlan Plan for for Health Health Security Security(2019 2019– -2023) 2023 development D.4.2 FETP or other applied epidemiology training programme in place 4 D.4.3 Workforce strategy 3 R.1.1 National multi-hazard public health emergency preparedness and response 1 Preparedness plan is developed and implemented R.1.2 Priority public health risks and resources are mapped and utilized 1 R.2.1 Capacity to activate emergency operations 4 Emergency R.2.2 EOC operating procedures and plans 4 response R.2.3 Emergency operations programme 4 operations R.2.4 Case management procedures implemented for IHR relevant hazards. 3 Linking public R.3.1 Public health and security authorities (e.g. law enforcement, border control, health and 2 customs) are linked during a suspect or confirmed biological event security Medical R.4.1 System in place for sending and receiving medical countermeasures during a 2 countermeasur public health emergency es and R.4.2 System in place for sending and receiving health personnel during a public personnel 2 health emergency deployment R.5.1 Risk communication systems (plans, mechanisms, etc.) 2 R.5.2 Internal and partner communication and coordination 4 Risk R.5.3 Public communication 4 communication R.5.4 Communication engagement with affected communities 4 R.5.5 Dynamic listening and rumour management 3 PoE.1 Routine capacities established at points of entry 1 Points of entry PoE.2 Effective public health response at points of entry 1 CE.1 Mechanisms established and functioning for detecting and responding to Chemical 2 chemical events or emergencies events CE.2 Enabling environment in place for management of chemical events 2 RE.1 Mechanisms established and functioning for detecting and responding to Radiation 2 radiological and nuclear emergencies emergencies RE.2 Enabling environment in place for management of radiation emergencies 2 National National ActionPlan Action Planfor forHealth Health Security Security(2019 2019–-2023) 2023 OUR PARTNERS