Uganda One Health Strategic Plan, 2018-2022

1. Establish and maintain high-level commitment at all relevant levels of government and the key stakeholders including the private sector.

2. Institutionalise One Health within Government of Uganda structures to achieve sustainability and legitimacy of the One Health Platform to coordinate multi-sectoral collaboration.

3. Strengthen prevention, preparedness and response to zoonotic diseases, AMR and bio- security threats.

4. Strengthen capacities (competencies, tools, strategic thinking, leadership, coordination) of the One Health platform and other stakeholders to effectively address zoonotic disease threats, biosecurity and AMR.

5. Enhance behaviour change communication and awareness of the value of One Health Approach. IMPLEMENTATION OF THE STRATEGIC PLAN The implementation of the OHSP will be the responsibility of the government with support from partners and other stakeholders. The Uganda NOHP will be responsible for oversight and coordination of the implementation of the One Health strategic plan. The NOHP has two key structures. These are the One Health Technical Working Group (OHTWG) and the Zoonotic Diseases Coordination Office (ZDCO) each with clear terms of references. These structures will be charged with the management, leadership, monitoring and evaluation, and coordination of implementation of the Uganda One Health Strategic Plan. The OHTWG is responsible for advising government, partners and other agencies on One Health issues, technical guidance and oversight to ZDCO, advocacy and resources mobilization and reviewing and updating ZDCO plans and budgets and those of its subcommittees. The ZDCO is the secretariat of the NOHP in Uganda and is responsible for coordinating the implementation of One Health activities by government under the supervision of the OHTWG. Figure 1, below, demonstrates the approved governance structure for One Health initiatives in Uganda. 4 4 Figure 1: Approved One Health Governance Structure The Chair of the OHTWG will alternate between the technical heads of the collaborating line ministries (MAAIF, MoH, MWE and UWA, an agency under the Ministry of Wildlife, Tourism and Antiquities) on a semi-annual basis. The alternating Chairs of the OHTWG will have overall oversight for coordination of implementation of the strategic plan. The technical work related to coordinating and monitoring implementation of the strategic plan will be conducted through the four Subcommittees of the OHTWG namely; Policy, Strategy, Advocacy & Communication; Surveillance, Preparedness & Response; Research & Training and Antimicrobial Resistance. Administrative and secretarial work relating to strategic plan coordination and monitoring will be done by the ZDCO. Details of the structure of each collaborating line ministry are included as annexes to this strategic plan. FRAMEWORK FOR OPERATIONALIZING THE ONE HEALTH STRATEGIC PLAN The One Health Strategic Plan is a multi-sectoral and inter-agency strategic document. Consequently, the Vision, Mission, Goals and Objectives of the One Health Strategic Plan align with the strategy documents of the line Ministries, Departments and Agencies (Ministry of Health, Ministry of Agriculture, Animal Industry and Fisheries, Uganda Wildlife Authority and Ministry of Water and Environment) and the strategic documents of collaborating International Agencies such as WHO and OIE, including: 5 5  OIE Veterinary Legislation  WHO International Health Regulations 2005 PRIVATE SECTOR  Uganda Public Health Act, 1962 INVOLVEMENT IN ONE  Local Government Act, 1997. HEALTH  Animal Diseases Act – Chapter 38 (1964, partially revised in 2006);  Uganda Disaster Preparedness and Management Policy  Uganda Health Sector Investment Plan, 2015-2020 The private sector has an important role to play in  Uganda IDSR Strategic Plan, 2012-2018 strengthening the One Health  MAAIF Strategic Plan, 2018-2022 approach for better prevention,  Uganda Wildlife Authority Strategic Plan, 2018-2022 detection and response to endemic and emerging  Uganda Ministry of Water and Environment Strategic Plan, zoonoses and other infectious 2018-2022 diseases of known and  Uganda National Action Plan on AMR, 2018-2022 unknown origin and AMR. Strong preparedness and The strategic documents above highlight initiatives aimed at response capacities will protect the private sector from building Uganda’s One Health capacity, including economic losses that may be preparedness, zoonotic emergencies and pandemics, control of caused by disease outbreaks prioritised zoonotic diseases, and addressing AMR. Previously, and AMR. such initiatives from different Ministries, Departments and Some of these private sector Agencies, despite having the same goal, were not harmonised players have already been engaged by the line ministries and instead were implemented in an uncoordinated manner. (MoH, UWA, MAAIF and MWE) Besides consuming huge resources, this limited their potential through the NOHP. Key private impact on overall health. Implementation of the One Health sector stakeholders have realised that closer Strategic Plan will contribute to harmonised prevention and collaboration and information- control of zoonotic diseases and better coordination of sharing with government implementation of AMR and biosecurity activities across through the One Health Platform was critical in sectors. protecting their businesses from the negative consequences of Under this Strategic Plan the private sector will be engaged to disease outbreaks. When play an advisory function and contribute to policy and outbreaks occur, businesses development of response plans, guidelines, manuals and are sometimes interrupted by drastic measures like protocols; dissemination of information on disease prevention quarantines, bans on exports, measures; conduct One Health related trainings for their staff absenteeism and loss of and to provide budgetary and other support to respond to an workers due to illness or death. outbreak (see sidebar). Under this Strategic Plan, individual private sector entities Implementation of the One Health Strategic Plan shall be based will be engaged directly or on the existing One Health Framework, MOU among the One through their umbrella associations to play an advisory Health sectors, the Terms of Reference of the NOHP function and contribute to policy structures, and other protocols and sectoral policies that exist development and to provide or may be put in place to support implementation of the One budgetary and other support to respond to an outbreak and Health approach in the country. other public health events. 6 6 POLICY AND RESOURCE IMPLICATIONS Parliamentary approval of multi-Sector budgets should take into consideration the important contribution of these sectors to the overall delivery of human and animal health services and environmental protection in the context of overall national socio-economic development. It is critical to build technical capacity in the various sectors in line with requirements of implementing the One Health Strategic Plan. Funds will be mobilised and equitably allocated to support the key sectors and stakeholders to effectively implement their specific roles and responsibilities in the One Health Strategic Plan. Each stakeholder shall be allocated resources in accordance with the core capacities and the workload at hand as per approved work plans. Government will source funds internally and externally to support implementation of the One Health Strategic Plan through approved sector budgets and from additional budgetary allocations approved by the Parliament as well as from development partners and the private sector. Stakeholders should be aware that these are not additional requirements for the relevant sectors. Rather, this is a new prioritization of their already approved mandates, roles and responsibilities by the Government. The different stakeholder sectors should mainstream human and animal health and environmental protection in their plans, activities and budgets, ensure that their sector budgets include adequate resource allocations to all One Health-related programmes and activities. Implementation of the 5-year One Health Strategic Plan is estimated to cost UGS 5,219,000,000 (US$1,450,000). The budget figures are derived from current and future projections based on government rates; number of participating sectors; and frequency, duration and type of activity, some of which are more resource intensive than others. 7 7 Situation Analysis In analysing the current One Health situation in Uganda, this strategy focuses on three priority public health threats: zoonotic disease, antimicrobial resistance, and biosecurity. These threats have been identified as priorities due to the following factors specific to Uganda:  Numerous zoonotic diseases are endemic in Uganda. These include Anthrax, Rabies, Brucellosis and Trypanosomiasis. Furthermore, in the last ten years, Uganda has experienced outbreaks of Ebola, Marburg, Yellow Fever, Crimean Congo Haemorrhagic fever (CCHF), Rift Valley Fever (RVF), Plague and Avian Influenza. These zoonotic diseases have the potential for serious negative impacts on public health, economy (trade, tourism), food safety and food security, social impacts on vulnerable populations including refugees, and other related socioeconomic impacts.  Climate change is exacerbating zoonotic disease outbreaks. Over the last few decades, Uganda has experienced an increase in the frequency and intensity of extreme weather variability and events with serious upsurges of epidemics from vector – borne and other zoonotic disease outbreaks. For example, Rift valley fever is usually triggered by sustained heavy rains. For the first time in Uganda, an outbreak of RVF was confirmed in Kabale, (South western region of Uganda) in March 2016, following a period of heavy rains and extensive flooding.  Antimicrobial Resistance threatens Uganda’s achievement of the Sustainable Development Goals. Uganda has already put in place an AMR National Action Plan; this plan adopts a One Health approach to AMR, and will be coordinated through the NOHP; it is therefore a priority to integrate AMR into the One Health Strategic Plan to ensure effective coordination and implementation.  Zoonotic diseases raise bio-security concerns. Many potential biosecurity threat agents of highest global concern are present in Uganda, such as Anthrax, Botulism, Plague, Tularemia and Viral haemorrhagic fevers (VHFs). These zoonoses raise biosecurity concerns, as biological agents or their products can be manipulated and intentionally used to infect humans, animals (domestic or wildlife) and plants in massive proportions. ZOONOTIC DISEASES In March 2017, Uganda held a workshop to develop a list of priority zoonotic diseases using the CDC One Health zoonotic diseases prioritization tool. The five criteria used to prioritise and rank the zoonotic diseases included: 1) Severity of disease in humans, 2) Availability of effective control strategies, 3) Potential to cause an epidemic or pandemic in humans or animals, 4) Social and economic impact and 5) Bioterrorism potential. These criteria yielded seven priority zoonoses: Anthrax, Zoonotic Influenza viruses, VHFs, Brucellosis, Trypanosomiasis, Plague and Rabies. For Uganda, these are zoonotic diseases whose prevention, early detection and response can be effectively implemented through application of One Health principles. This strategic plan therefore addresses itself to the prioritised zoonotic diseases. The plan addresses their threats with respect to human, livestock, and wildlife health. Human health In humans, surveillance for all the prioritised zoonoses is generally through passive syndromic surveillance using the Integrated Disease Surveillance and Response (IDSR) strategy. The IDSR is a strategy for developing and implementing comprehensive public health surveillance and 8 8 response systems in African countries. The strategy was developed by the WHO Regional Office for Africa and adapted by member states in 2002. It has been updated since then by WHO-AFRO and its technical partners in light of changing disease epidemiology to address the current situation and future needs. Member States in the African Region recommended that the International Health Regulations (IHR) (2005) should be implemented in the context of IDSR. In implementing the IDSR strategy, the MOH developed case definitions for the major communicable diseases including some of the common zoonotic diseases. Health workers and Village Health Teams (VHTs) in the country are trained on how to apply the case definitions to identify and refer/or investigate suspect cases and to collect appropriate samples for laboratory analysis. Epidemic/pandemic prone diseases including most zoonotic diseases are investigated immediately. The MOH has a well-developed and fast hub and spoke system for referral of laboratory samples to reference laboratories for analysis. Over the years, laboratory diagnosis turnaround time has greatly improved from more than one month to less than one day in the case of VHFs. Routinely, lower health facilities compile and report surveillance data to the next level on a weekly, monthly, quarterly and annual basis. The next level analyses the surveillance data, forwards it to the next level and gives feedback to the lower level for action. Surveillance data collection, analysis, interpretation, feedback and its use for action is therefore continuous. Uganda also has over 15 sentinel sites for surveillance of Influenza in the human population and a National Influenza Centre (NIC) laboratory at the Uganda Virus Research Institute (UVRI). The current human disease surveillance system conducts surveillance for all the prioritised zoonotic diseases and other zoonotic agents of pandemic potential. Livestock Surveillance in the domestic animal sector in Uganda is not as developed as that in the human sector. Generally, when a farmer suspects a disease on his or her farm, he/she notifies the Sub- County veterinary officer who if available will come and attend to the case. If the suspected disease is of public interest, the Sub County veterinary officer will immediately notify the District Veterinary Officer (DVO). The DVO then informs the Commissioner for Animal Health, who in turn liaises with National Animal Disease Diagnostics and Epidemiology Centre (NADDEC) laboratory and the Epidemic-surveillance unit to constitute a team to go and collect samples and deliver them to NADDEC or any other collaborating laboratory like the College of Veterinary Medicine Animal Resources and Biosecurity (CoVAB) laboratory at Makerere University or UVRI for confirmatory diagnosis. There are very few functional veterinary diagnostic laboratories at Sub national level in Uganda. In the meantime, the District Veterinary officer in liaison with the Chief Administrative Officer and Resident District Commissioner would institute a temporary restriction on animal movement pending laboratory results from NADDEC. Otherwise, if the suspected condition is not of public interest, the farm owner will privately manage the condition with or without an animal health worker. Surveillance data collection is also passive and less frequent. The DVO annually summarises surveillance data and submits it to NADDEC where the data is electronically entered and stored without analysis. Wildlife Currently, there is no officer in charge of wildlife surveillance at district level in Uganda. UWA only has presence in districts that have protected game parks for wild animals. For these parks, UWA has an officer in charge of disease surveillance. Whenever a veterinary officer working 9 9 with UWA suspects any disease whether zoonotic or not, MAAIF is notified which then takes over the investigation and response. Disease detection and reporting mechanisms are slower in the animal sector. Even after receiving information about a suspected disease outbreak among domestic or wild animals, limited accessibility of finances and other logistics hinders rapid investigation of the suspected disease. ANTIMICROBIAL RESISTANCE Microbial resistance to pharmaceuticals, pesticides, acaricides and other antimicrobial agents is a global One Health—human, animal, and environmental—health concern. AMR has reduced the ability of antimicrobial agents to effectively control infectious diseases caused by bacteria, parasites, viruses and fungi impacting negatively on global health security, healthcare, global trade, agriculture, and the environment. The consequences of AMR threaten the attainment of the Sustainable Development Goals recently agreed upon by UN member countries. The Uganda National Academy of Sciences (UNAS) recently undertook a situational analysis on AMR in Uganda under the auspices of the Global Antibiotic Resistance Partnership (GARP)- Uganda (UNAS, 2015). The report found increasing trends in antimicrobial resistance to the most commonly-used antimicrobials (e.g. penicillins, tetracyclines, cotrimoxazole) which was in some cases above 80 percent. There was also high prevalence of multi-drug resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta- lactamase (ESBL)-producers. In healthcare settings, the prevalence of MRSA varied from as low as 2 percent to as high as 50 percent, while ESBL prevalence ranged from 10 to 75 percent among isolates analyzed. In addition, increasing resistance ranging from 4 to 30 percent was reported among gram negative enterobacteria against carbapenems, a last-line treatment The National Tuberculosis Reference Laboratory notes that resistance in TB is equally worrying, with some studies show varying levels of resistance to first-line treatments (5-20 percent resistance to isoniazid; 0.5-5 percent to rifampicin; to streptomycin 5-20 percent, to 0.5-10 percent; and MDR-TB, 0.5-10 percent) with most cases co-infected with HIV (50-80 percent). Among the subset of MDR isolates, 83 percent were resistant to ethambutol, 50 percent to pyrazinamide, 48 percent to streptomycin, 16 percent to ethionamide, 6 percent to ofloxacin, and 2 percent to kanamycin. The UNAS report noted a similar situation in animal health, with a high burden of bacterial diseases whose treatment is compromised by resistant organisms. A broad range of bacteria show high resistance (over 50 percent in many cases) to commonly used antimicrobials, and there is also high resistance in parasitic infections. Misuse of antimicrobials in both humans and animals was well noted with dispensing over the counter, in unlicensed drug stores and in open vans in markets. The transmission of common bacteria such as enterobacteriaceae and staphylococci between humans, animals and the environment in the same settings has been reported, and when these bacteria are resistant they cause a problem that requires collaborative action between all sectors to address. Despite all the above threats, there is limited awareness among the public, policy makers, prescribers and other professionals about the problem of AMR and its consequences. (Source: National Action Plan for AMR, 2017) 10 10 In May 2015, the WHO member countries passed a resolution and approved a Global Action Plan for combating AMR that clearly outlines actions member countries should take to combat the GENDER, SOCIAL problem of AMR. The 2014 Global Health Security Agenda INCLUSION, & ONE (GSHA) further subscribes mechanisms to contain the same with HEALTH leadership from the United States Centers for Disease Control (CDC). Prior to that, the 2014 country assessment by GHSA An important consideration in reported absence of coordinated actions in Uganda to address the national coordination to prevent, problem. Since then progress has been made, and per the June detect, and respond to any 2017 WHO Joint External Evaluation (JEE) report, the public health emergency is the particular set of risks and Government of Uganda has put in place a National Strategy for vulnerabilities experienced by Antimicrobial Resistance and an Antimicrobial Resistance different population groups. Surveillance Plan (2017-2022), which incorporates a multi- Differences in and intersections of age, ethnicity, income, and sectoral approach toward combating AMR in Uganda. gender, among others, affect not only disease exposure and The AMR National Action Plan (NAP) is intended to be a guide risk, but also how each of these for Ugandan stakeholders contributing to efforts to confront and populations may benefit from or contain the problem. The NAP sets out a coordinated and be harmed by prevention, surveillance, preparedness and collaborative One Health approach involving key stakeholders in response efforts. Overlooking government and other sectors to confront the threat, and shall be or misunderstanding the coordinated through the One Health Platform by the AMR Sub- experiences of different populations can have a committee of the OHTWG. The Government will also work profoundly negative impact not together with other governments, international organizations and only on those populations, but partners to address the AMR threat at regional and global level. also on the overall effectiveness of the response. Although AMR cannot be eradicated, it can be reasonably slowed The strategic plan considers the down and contained. The Ugandan Government is confident that specific roles of women in this plan will help respond to the threats of AMR. The Uganda, particularly with respect to caring for livestock Government urges all stakeholders to develop specific plans of and in providing and accessing action in their respective institutions and sectors and to coordinate health services. Gender gaps in with the national effort to prevent, detect, and respond to the threat health status, in access and use of health services, and in health posed by AMR pathogens so that the people of Uganda are not outcomes persist, signifying a subjected further to the burden of drug-resistant infections. need to address gender inequality. BIOSECURITY In developing the strategic plan, Zoonotic diseases raise bio-security concerns where biological stakeholders reviewed best practices in gender integration agents or their products can be intentionally used to infect animals to ensure that the plan reflects (domestic or wildlife) with the aim of infecting humans, animals gender equity issues and and plants in massive proportions. priorities; drafts of the plan were also shared with Makerere Many of potential biosecurity agents of concern are zoonotic with University’s Department of Anthrax, Botulism, Plague, Smallpox, Tularemia and Viral Gender and Women’s studies. haemorrhagic fevers in highest category. In some diseases, clinical Finally, the strategic plan includes a Monitoring and signs may manifest in animals prior to humans. Pets can act as Evaluation Plan that important sentinels because they are present in large numbers and disaggregates gender data often live in close contact with humans. Livestock are also present wherever relevant. in high numbers especially in certain areas of the country. Many areas depend on livestock for their livelihood and this puts them at biosecurity risk. Wildlife also plays an important role in our 11 11 communities because they could be important sources of infection for humans and animals, and could potentially contaminate large areas. Some factors that promote zoonotic disease transmission include frequent contact with domestic or wild animals, and people visiting or living in areas that overlap with wildlife habitats or intensive livestock production. Other factors such as poor animal sanitation, poor animal health, and poor personal hygiene can also promote transmission. It is therefore, important to consider animals, disease ecology, and public health in the preparedness plans. The four main components for addressing bio-security concerns are Prevention, Preparedness, Response, and Recovery. The primary focus is on prevention by minimizing the threat of intentional contamination because this is where the bio-security system has most control. PRIOR ANALYSES In June 2017, the government undertook a joint assessment of the IHR core capacities of Uganda using the WHO IHR JEE tool. This was carried out by an external team of technical experts and their Ugandan counterparts. The major findings:  There is a need to develop and enhance regulations, standards, and coordination mechanisms for Food Safety, Water and Environmental Health to properly ensure their implementation to efficiently manage chemical, radiation and microbiological contamination. The laws and regulations along with their implementation need strengthening.  The finalization and validation of standard operating procedures, plans, guidance, tools in specific technical and cross-cutting areas should be carried out as a priority, as this will allow application of consistent standards and practices for improved health security.  There is an urgent need to kick start the efforts to designate and strengthen core capacities for the points of entry into Uganda, required under the IHR (2005). While Entebbe International Airport has some capacities, at other major points of entry i.e. ground crossings and water ports, the capacity is very limited. This will offer the opportunity to develop a multi-sectoral health and surveillance plan at government level to incorporate human and animal health, food safety and environmental factors at the points of entry. Priority cross cutting actions:  Immediately establish and strengthen mechanisms for programmatic coordination, communication and better integration across sectors, and particularly focus on animal health to reinforce their capacities in preventing, detecting and responding to zoonotic diseases, and combat anti-microbial resistance in line with the One Health approach.  The government of Uganda is encouraged to strengthen sustainable funding across all technical areas, working with relevant sectors and decision makers including the Finance Ministry and the Parliament to implement a strategy for sustainable financing and include the establishment of an immediately accessible response fund within the Ministries of Health and Agriculture, Animal Industry and Fisheries, and enable initiation of rapid responses to public health emergencies (PHEs) in Uganda across relevant sectors.  Elaborate and cost a national action plan using the JEE Report as the basis for priority actions to be incorporated into the plan. JEE recommendations on implementation and coordination of zoonotic diseases, AMR and other One Health activities:  Establish an emergency fund readily accessible to support all relevant sectors to carry out immediate investigation of outbreaks, including the ZDCO and the One Health platform, to effectively carry out their roles in multi-sectoral support for OH implementation; 12 12  Develop a clear implementation plan for the National AMR Action Plan with Monitoring and Evaluation (M&E) indicators and clear timelines for Human, Animal, Food & Feed, Plant and Environmental Health Sectors;  Update the AMR Surveillance Plan to include zoonotic pathogens and M&E indicators to assess quality of data reported; and  Strengthen the capacity of MAAIF with human resource, equipment and direct budget allocation to detect and implement surveillance for AMR. SWOT ANALYSIS The following analysis summarises the strengths, weaknesses, opportunities, and threats (SWOT) with respect to Uganda’s One Health capacity, preparedness for zoonotic emergencies and possible pandemics, and control of prioritised zoonotic diseases. The analysis derives from a review of assessments including but not limited to: all previous performance of veterinary services (PVS) pathway activities in Uganda, the 2009 IHR core capacities assessment; the 2015 GHSA assessment, the 2016 assessment of veterinary diagnostic services needs in Uganda, the 2017 Zoonotic diseases prioritization, and the June 2017 JEE. A consultant for the P&R project reviewed pertinent documents and presented the SWOT analysis, which was reviewed during the consultative meeting to develop the strategic plan. The participants identified the following as the most relevant strengths and opportunities and weaknesses and threats for the One Health Strategic Plan. Table 1, below, provides a summary of the SWOT analysis findings. Table 1: SWOT Analysis Summary Strengths and Opportunities Weaknesses and Threats One Health Capacity OHTWG and its Subcommittees to advocate and Previously, there has been no strategic plan to guide mobilise resources, advise gov’t and coordinate coordinated implementation of One Health activities implementation of OH initiatives is in place The ZDCO, secretariat of OHTWG, already has The One Health Platform is in its early stages and has temporary workspace and guidelines on staffing not gained sufficient momentum Leadership of the OH platform is already structured Resources to support OH initiatives are limited A clear MoU defining the obligations, roles and The line ministries are yet to fully implement their responsibilities of each of the line ministries under the obligations, roles and responsibilities as spelt out in the OH Platform is in place MoU. Quarterly OHTWG and monthly ZDCO meetings are The OH platform has no permanent physical and already ongoing institutional home More than 20 MDAs, International agencies and The ZDCO does not have permanent staff donors are already members of the OHTWG MakSPH, COVAB, OHCEA/OHW, FETP are already No legal instrument for establishment of the One Health implementing OH related training programmes Platform has been obtained Numerous capacity related assessments like IHR, Limited practitioners with OH core competences IDSR and JEE have been conducted; their recommendations support implementation of OH Absence of a specific OH research agenda to inform approach policy/ practice MakSPH, COVAB, OHCEA, FETP, AFENET & P&R Limited ability (financial, structural) of line ministries to already have some capacity to support OH-related engage in collaborative activities activities in Uganda 13 13 Strengths and Opportunities Weaknesses and Threats Implementation of the Sector wide approach (SWAp) with active participation of the private sector and civil society A policy for public – private partnership for health has been developed which lays out a framework of coordination with the private sector (NGOs, Civil society, private sector and traditional medicine sector) Preparedness for zoonotic disease emergencies and possible pandemics Uganda has established sentinel and laboratory No previous assessment to prioritise zoonotic agents surveillance for some zoonotic agents, like Influenza with PHEIC and pandemic potential in Uganda Uganda has some capacity for conducting risk Limited integration of laboratory diagnostic services for assessment of agents with zoonotic pandemic animal and human samples potential Inadequate capacity for zoonotic disease detection, reporting and investigation by MAAIF Ministry of Health already has a system for routine Preferred tendency to develop different Ministry-specific analysis of surveillance data contingency plans for the same zoonotic agents Ministry-specific contingency plans for some of the Limited financial capacity to establish and maintain zoonotic agents are available sentinel surveillance sites for zoonotic agents WHO and CDC have previously trained Strict funding regulations that do not allow utilization of multidisciplinary teams in planning, implementing and ministry-specific financial resources for joint inter- testing contingency plans ministerial activities The government is scaling up implementation of the Village Health Team (VHTs) concept for health promotion in the MOH and Extension services in MAAIF. The scope of training of VHTs and Extension officers could be expanded to include aspects of OH. Control of Prioritised Zoonotic Diseases in Uganda Line ministries, International agencies and partners Absence of basket funding for investigation and have already agreed on a list of 7 prioritised zoonoses response to possible outbreaks of prioritised zoonoses Ministry-specific case definitions, guidelines for Absence of Ministry-specific response plans for each of responding to the prioritised zoonoses are available the prioritised zoonotic diseases For some of the prioritised zoonoses, ministry-specific Absence of OHTWG Pandemic preparedness, Response response plans are available and Research plan for prioritised zoonotic diseases Ministry-specific surveillance systems for some of the Uncoordinated implementation of prevention and control prioritised zoonoses are available and functional activities by the different ministries Ministries have previously collaborated in investigation Limited opportunities to integrate and jointly review and response to some of the prioritised zoonoses surveillance data for the prioritised zoonotic diseases Joint After Action Reviews have been conducted for Limited resources to implement known effective some of the prioritised zoonoses e.g. CCHF interventions to control the prioritised zoonotic diseases Finally, based on the SWOT analysis, participants at the consultative meeting identified some clear challenges the strategic plan must address. These challenges include:  Extension of One Health approach to other sectors who are not fully aware of their One Health roles and responsibilities;  Ineffective mainstreaming of One Health plans and activities in the budgets and work plans of the respective sectors; and  Inadequate resource allocations (financial, human and logistical) to implement One Health activities and tasks in government sectors. 14 14 One Health Strategy The section that follows details the Uganda National One Health Strategy. This strategy is the framework through which work plans, budget allocations, and monitoring plans will be developed. The strategy was developed through a series of stakeholder consultations supported by the USAID P&R Project. The consultations included meetings with individual members of the One Health platform by a senior consultant tasked with creating a first draft of the strategy and a three-day workshop in Kampala May 30-June 1. The workshop was attended by 41 participants, mainly government technical officers from members of the NOHP, as well as partner organizations. GUIDING PRINCIPLES In implementing this strategic plan, all stakeholders will adhere to the following guiding principles. These principles align with the Government of Uganda’s priorities as discussed above, and have been agreed upon by all strategy development participants.

1. A comprehensive, integrated approach One Health implementation shall be based on a comprehensive, integrated approach, institutional coordination, collaboration and linkages.

2. Harmonization National, EAC Regional and International Standards (FAO, WHO and OIE) shall be used in implementation of core elements of the OHSP namely; prevention, preparedness, response and control of zoonotic diseases and AMR.

3. Government Commitment and Responsibility for the One Health Strategic Plan  The establishment and maintenance of an effective zoonotic disease control system and the mitigation and reduction of AMR and bio-security threats are part of primary public health responsibilities of the national government.  The government’s primary role in control of zoonotic diseases and AMR is to set and enforce standards and regulations designed to prevent public health and other related impacts, based on engagement with the public, private sector business enterprises and other stakeholders.  Ensure the principle of transparency and accountability through effective and official communication on disease outbreak response activities to all One Health stakeholders.

4. Precautionary Principle  When a hazard raises threats of harm for human and animal health or the environment, precautionary measures should be taken even if causal relationships are not yet fully established.  Every effort shall be made to confirm the cause of the disease outbreak; however, in absence of absolute proof of a hazard, the authorities have the mandate to take an appropriate precautionary approach.  At the same time a public health scare shall be avoided. 15 15 STRATEGIC OBJECTIVES & RATIONALE The One Health Strategic Plan has five strategic objectives, which together will enable Uganda to achieve its goal of building resilient, sustainable systems that are able to prevent, detect and respond to zoonotic diseases, and address AMR and biosecurity. Together, these five strategic objectives cover key areas where improved capacity, knowledge, systems, and tools will address the weaknesses in the current system, build on the strengths of Uganda’s health system, and take advantage of opportunities to address One Health threats. These strategic objectives are:  Strategic Objective 1: Establish and maintain high-level commitment to One Health at all relevant levels of government and the key stakeholders including the private sector.  Strategic Objective 2: Institutionalise One Health within Government of Uganda structures to achieve sustainability and legitimacy of the One Health Platform to coordinate multi- sectoral collaboration.  Strategic Objective 3: Strengthen prevention, preparedness and response to zoonotic diseases, AMR and bio-security threats.  Strategic Objective 4: Strengthen capacities (competencies, tools, strategic thinking, leadership, coordination) of the One Health platform and other stakeholders to effectively address zoonotic disease threats and AMR.  Strategic Objective 5: Enhance behaviour change communication and awareness of the value of One Health Approach. Figure 2, below, demonstrates how the strategic objectives reinforce one another and together reach the goal and enable the vision. Figure 2: Coordination Among the Strategic Objectives Goal: Build resilient, sustainable systems to prevent and respond to Zoonotic diseases, address AMR and biosecirity Vision: By 2022, Objective 2: Institutionalize One reduce the burden of Objective 1: Objective 4: prioritised zoonoses Health within GoU Objective 3: Establish and Strengthen Objective 5: maintain high-level structures to Strengthen capacities of OH Enhance behavior and AMR by 50% achieve prevention, through visionary commitment at all platform and other change sustainability and preparedness and relevant levels of stakeholders to communication and leadership to legitimacy of the response to government and One Health zoonotic diseases, effectively address awareness of the enhance key stakeholders zoonotic diseases value of OH coordination and Platform to AMR and bio- including the threats, AMR and approach private sector coordinate multi- security threats bio-security issues innovation, with sectoral shared responsibility collaboration and accountability ACCOMPLISHING THE STRATEGIC OBJECTIVES: SUB-OBJECTIVES AND ACTIVITIES In the section that follows, we outline the sub-objectives that will support each of the strategic objectives, and provide a summary of activities that will contribute to their achievement. Detailed activity plans, including funding, ownership, indicators and timelines will be confirmed by stakeholders during annual work plan development based on this strategic plan. Strategic Objective 1: Establish and maintain high-level commitment to One Health at all relevant levels of government and the key stakeholders including the private sector SO1 will focus on ensuring the participation—and commitment of resources—from all key stakeholders to support the establishment and operationalization of the NOHP and associated bodies. To accomplish this objective, the plan addresses numerous sub-objectives that combine institutional development, capacity building, and the enabling environment for reform. SO1 will 16 16 also support the implementation of SO2 and SO3 by ensuring those strategic objectives are prioritised by stakeholders. Table 2 summarises the sub-objectives and provides illustrative examples of activities; activities that will be completed in year 1 are bolded. Table 2: SO 1 Sub-Objectives and Activities Sub-Objective Activities 1.1 Establish/ strengthen OH Obtain a legal instrument to establishment of OH governing governance structure structure Build an effective and efficient OH infrastructure for governance 1.2 Mainstream OH in all relevant Develop policy to mainstream OH in all relevant sectors sectors Develop costed 10 year national OH master plan 1.3 Provide an enabling environment Develop OH policy, plans, public-private partnerships and MOUs to for private sector participation mainstream OH in all relevant sectors Provide technical support and training to the participating private sector enterprises 1.4 Mainstream gender and other Address and include gender and other vulnerable subpopulation issues in vulnerable subpopulation issues in the OH policy, plans and activities OH Initiative 1.5 Support the academic sector to Sensitization and training in One Health at various educational levels enhance science – based interventions Strategic Objective 2: Institutionalise the One Health within Government of Uganda structures to achieve sustainability and legitimacy of the One Health Platform to coordinate multi-sectoral collaboration. SO2 will focus on institutionalization of One Health, including establishment of the National One Health Platform and its operational and legal structures. It will also establish funding for ongoing OH platform activities, including emergency funding for immediate outbreak response. SO2 will also support achievement of SO3 by providing the institutional framework that will enable improved response to zoonoses, AMR, and biosecurity threats. Table 3 summarises the sub-objectives and provides examples of activities; activities that will be completed in year 1 are bolded. Table 3: SO 2 Sub-Objectives and Activities Sub-Objective Activities 2.1 Establish OH platform as a Create directorate within a legally established entity or institute such as component of the GoU entity with UNIPH OHTWG and ZDCO structures Strengthen OH multi-sectoral Committees including OHTWG, its Sub- committees and ZDCO 2.2 Functionalise OH Platform by Recruit the right mix of technical expertise strengthening the structure and Continuous professional development, skilling and retooling operations of the OHTWG and ZDCO 2.3 Establish budgetary provisions for Effectively raise and manage funding the OH activities, including Monitoring and Evaluation 2.4 Establish an emergency fund to Prepare and submit proposal to government and partners for support relevant sectors to carry out emergency fund immediate investigation of outbreaks, Elaborate mechanisms for stakeholders to access the fund including the ZDCO and the OH platform, to effectively carry out their roles in multi-sectoral support for OH implementation 17 17 Strategic Objective 3: Strengthen prevention, preparedness and response to zoonotic diseases, AMR and bio-security threats. SO 3 will focus on directly improving preparedness and response to zoonoses, AMR, and bio- security threats. As such, it will directly build technical capacity among stakeholders and improve coordination among them by harmonizing planning, surveillance, and reporting. SO3 will also support achievement of SO2, by ensuring that the mechanisms institutionalised in the OH platform are functional and technically adequate. Table 4 summarises the sub-objectives and provides examples of activities; activities that will be completed in year 1 are bolded. Table 4: SO 3 Sub-Objectives and Activities Sub-Objective Activities 3.1 Develop, implement, and monitor Review and harmonise existing plans multi-sectoral preparedness and Develop joint monitoring and evaluation framework response plans. Integrate multi-sectoral after action reviews into OH programming Conduct regular joint Table Top and field simulation exercises 3.2 Effectively utilise new surveillance Establish integrated, multi-sectoral surveillance system with centralised methods and data to drive decision- database making 3.3 Build capacity for multi- Establish community-based vulnerability and risk assessment disciplinary research mapping network 3.4 Harmonise sectoral activities for Develop a clear implementation plan for the National AMR Action Plan effective and efficient response to with Monitoring and Evaluation (M&E) indicators and clear timelines for prioritised zoonoses, AMR and Human, Animal, Food & Feed, Plant and Environmental Health Sectors related bio-security issues Update the AMR Surveillance Plan to include zoonotic pathogens and M&E indicators to assess quality of data Initiate public private partnerships (simulations, planning and budgeting) Promote OH health activities within private sectors (esp. water and environment) 3.5 Harmonise and align the AMR Raise awareness and understanding of AMR and containment options National Action Plan (NAP) with the Improve prevention, detection and control of infectious agents OH Approach Optimise proper use of antimicrobial medicines Generate knowledge and evidence through surveillance Strengthen research and innovation on AMR 3.6 Mainstream bio- security issues Strengthen Cross-sectoral (Stakeholder) collaboration, coordination and related to zoonotic diseases into the linkages One Health Approach 3.7 Create sustainability by equipping Capacity building: training and raise awareness on biosecurity OH Stakeholders with the capacity to Establish liaison with the national Bio-security Oversight Committee develop and lead their own bio- security programmes against Conduct vulnerability assessments for weaknesses in zoonotic diseases intentional contamination/ control programmes for intentional contamination with biological agents introduction with biological (zoonotic) Align the national bio-security framework, infrastructure, capacity, agents mitigation and response plans and activities with the OH Initiative Strengthen research and development Establish/strengthen a bio-security information sharing and coordination network Establish a community based vulnerability and risk assessment mapping network Initiate public private partnerships (simulations, planning and budgeting) 18 18 Strategic Objective 4: Strengthen capacities (competencies, tools, strategic thinking, leadership, coordination) of the One Health platform and other stakeholders to effectively address zoonotic diseases threats, AMR and bio-security issues SO4 will focus on capacitating the NOHP so that it can function as designed. Sub-objectives and activities under this SO4 will focus on human capacity building, and will support the institutional development and response capacity under SO2 and SO3. Table 5 summarises the sub-objectives and provides examples of activities; activities that will be completed in year 1 are bolded. Table 5: SO 4 Sub-Objectives and Activities Sub-Objective Activities 4.1 Recruit and build capacity of OH Select and train staff from all stakeholder sectors experts Establish an inventory of OH experts across the stakeholder sectors 4.2 Establish key competencies Conduct sector analysis for required OH competencies required for multi-sectoral coordination Conduct regular capacity needs assessments* and collaboration 4.3 Develop and implement a training Develop a OH training curriculum for pre-service and in-service programme for OH platform and other cadres stakeholders Conduct trainings* 4.4 Enable OH Experts with Provide the required tools and equipment* technology and tools *Will repeat periodically after year 1 Strategic Objective 5: Enhance behaviour change communication and awareness of the value of One Health Approach. Through SO5, stakeholders will broaden the understanding of and appreciation for the importance of a OH approach beyond the government to the private sector and the public at large. SO5 will directly support the achievement of SO1, SO2, SO3, and SO4 by increasing demand for capacity, platforms, response, and funding. By committing resources to improving awareness, the OH platform will see more ready uptake throughout Uganda. Table 6 summarises the sub-objectives and provides examples of activities; activities that will be completed in year 1 are bolded. Table 6: SO 5 Sub-Objectives and Activities Sub-Objective Activities 5.1 Develop and implement a Create awareness and support for One Health through effective comprehensive One Health advocacy, communication and training communication strategy to the public Develop a OH training curriculum for pre-service and in-service cadres 5.2 Create awareness and support for Develop and implement a OH communication and advocacy plan OH through effective advocacy, communication and training 5.3 Sensitise interest groups (i.e. Conduct sensitization activities based on the OH communication and private sector, business enterprises, advocacy plan food vendors and media houses) on Scale-up stakeholder membership and involvement their roles and responsibilities in OH 19 19 FINANCING It is critical to build technical capacity in the various sectors in line with requirements of implementing the One Health Strategic Plan. Therefore, funds will as a matter of priority, be mobilised and equitably allocated to support the key sectors and stakeholders to effectively implement their specific roles and responsibilities in the One Health Strategic Plan in accordance with the MOU among the key One Health sectors. Each stakeholder shall be allocated resources in accordance with their core capacities and the workload at hand as determined by the work plans submitted and approved by the NOHP. Government will source for funds internally and externally to support implementation of the One Health Strategic Plan. The following are the proposed sources of funding:  Internal mobilization/domestic funding from approved sector budgets  Additional budgetary allocations approved by the Parliament and the Ministry of Finance Planning & Economic Development.  Support will also be solicited from development partners and the private sector Table 7, below, summarises the anticipated budget estimates for each strategic objective/sub- objective. Table 7: Indicative Budget Estimates by Strategic Objective Strategic Objective Sub-Objective Budget (U SHS) Strategic Objective 1: Establish and 1.1 Establish/strengthen OH governance structure 180.0M maintain high-level commitment at all 1.2 Mainstream OH in all relevant sectors 42.0M relevant levels of government and the key stakeholders including the private 1.3 Provide an enabling environment for private 30.0M sector sector participation 1.4 Mainstream gender and other vulnerable 180.0M subpopulation issues in OH Initiative 1.5 Support the academic sector to enhance science- 100.0M based interventions Total Budget SO 1 532.0M 2.1 Establish OH platform as a component of the 260.0M GoU entity with OHTWG and ZDCO structures 2.2 Functionalise OH Platform by strengthening the 160.0M structure and operations of the OHTWG and ZDCO Strategic Objective 2: Institutionalise the One Health platform within 2.3 Establish budgetary provisions for the OH 90.0M Government of Uganda structures to activities achieve sustainability and legitimacy to 2.4 Establish an emergency fund readily accessible 35.0M coordinate multi-sectoral collaboration. to support all relevant sectors to carry out immediate investigation of outbreaks, including the ZDCO and the OH platform, to effectively carry out their roles in multi-sectoral support for OH implementation Total Budget SO 2 545.0M Strategic Objective 3: Strengthen 3.1 Develop, implement, and monitor preparedness 991.0M prevention, preparedness and and response plans response to zoonotic diseases, AMR 3.2 Effectively utilise new surveillance methods and 540.0M and bio-security threats. data to drive decision-making 3.3 Build capacity for multi-disciplinary research 320.0M 3.4 Harmonise sectoral activities for effective and 186.0M efficient response to prioritised zoonoses, AMR and related bio-security issues 3.5 Harmonise and align the AMR National Action 400.0M 20 20 Strategic Objective Sub-Objective Budget (U SHS) Plan (NAP) with the OH Approach 3.6 Mainstream bio- security issues related to 55.0M zoonotic diseases into the One Health Approach 3.7 Create sustainability by equipping OH 495.0M Stakeholders with the capacity to develop and lead their own bio-security programmes against intentional contamination/ introduction with biological (zoonotic) agents Total Budget SO 3 2.987B Strategic Objective 4: Strengthen 4.1 Recruit and build capacity of OH experts 180.0M capacities of OH platform and other 4.2 Establish key competencies required for multi- 180.0M stakeholders to effectively address sectoral coordination and collaboration zoonotic diseases threats, AMR and bio-security issues 4.3 Develop and implement a training programme for 35.0M OH platform and other stakeholders 4.4 Enable OH Experts with technology and tools 120.0M Total Budget SO 4 515.0M Strategic Objective 5: Enhance 5.1 Develop and implement a comprehensive One 320.0M behaviour change communication and Health communication strategy to the public awareness of the value of the OH 5.2 Create awareness and support for OH through 250.0M Approach effective advocacy, communication and training 5.3 Sensitise interest groups on their roles and 70.0M responsibilities in OH Total Budget SO 5 640.0M Total Budget Strategic Plan 5.219B The total anticipated budget estimate for the strategic plan in US dollars, using an exchange rate of $1:USH 3,599.31 is $1,450,000.00. 21 21 Monitoring Plan To ensure the implementation of the strategic plan is transparent, timely, and effective, the NOHP, led by the OHTWG, will oversee monitoring of progress toward objectives. The OHTWG will define and undertake a programme of baseline surveys and studies, including those needed in support of ongoing evaluation, medium term and terminal review processes, and ensure that monitoring data is captured, analysed, and shared with key stakeholders. Strategies:  Develop an M&E plan capable of continuous observation, data collection and analysis, communication and reporting, data and information storage.  Develop indicators and measurement for all input, output, process and outcomes of the plan’s strategy and implementation  Monitor the status and progress of programme implementation based on the Logical Framework and Results Framework and the M&E Plan.  Liaise with and agree with stakeholders in each component/sub-component, within districts and in MOH, MAAIF, MWE, UWA and the private sector the respective reporting, monitoring and data collection needs and obligations. Activities:  Develop joint monitoring and evaluation framework  Domesticate joint external evaluation to make it an internal annual evaluation process  Develop indicators and measurement for all input, output, process and outcomes of the plan’s strategy and implementation  Pilot and test the M&E system among the participating sectors  Train all participating sectors in the M&E system  Collect data and information on the status and progress of programme implementation based on the Logical Framework and Results Framework and the M&E Plan.  Measure outputs (e.g. disease incidence)  Provide regular technical updates to the OHTWG Performance Monitoring and Evaluation will be overseen by the OHTWG as follows:  Short term: Regular, routine monitoring, data collection, analysis and reporting will be conducted.  Mid-term/long-term: Alongside regular, routine monitoring, the OH Platform will engage an external evaluator to conduct a mid-term and end line evaluation in years 2-3 and 5. The evaluator will be selected through a competitive solicitation. M&E Requirements:  Monitoring Indicators  Baseline data  Inputs (financing, human resources, infrastructure)  Process (policies, legal and institutional framework) Table 8, below, highlights an initial set of indicators by objective and sub-objective. Work planning will be conducted annually to finalise the activities, timelines and budget to implement the activities in that year. During the work planning phase, teams will validate this indicator list based on specific activity plans and timelines, and will provide details on data collection, sources, frequency, and targets. 22 22 Table 8: Summary of Indicators Sub-Objective Indicator, Unit & Disaggregation 1.1 Establish/strengthen OH Progress against the structure establishment plan governance structure Unit: Establishment plan milestones # sector plans that include One Health activities Unit: number, disaggregated by sector Functional One Health governance structure (leadership, staff, budget) Unit: Yes/No Sectoral budget contribution to the total One Health budget Unit: U SHS, disaggregated by sector 1.2 Mainstream OH in all National OH Policy relevant sectors Unit: progress toward implementation (draft, final, passed, implemented) 10 year national OH master plan established Unit: Yes/No 1.3 Provide an enabling # of private sector entities involved in national or provincial One Health platforms environment for private or activities sector participation Unit: number 1.4 Mainstream gender and # of gender (or women's) ministries or focal persons participating in the NOHP other vulnerable Inclusion of gender situational analysis and gender integration (or gender subpopulation issues in OH mainstreaming) guidance in preparedness and response plans Initiative 1.5 Support the academic #, level of educational institutions that have OH incorporated in their curricula sector to enhance science- Unit: Number, disaggregated by level based interventions 2.1 Establish OH platform as Well defined organogram/structure a component of the existing Unit: Yes/No GoU structures through the OHTWG and ZDCO Well-equipped and maintained permanent office Unit: Yes/No 2.2 Functionalise OH Number of permanent staff recruited (target = 10) Platform by strengthening Unit: Number the structure and operations of the OHTWG and ZDCO % staff attending additional professional courses Unit: percentage 2.3 Establish budgetary Number of grant proposals that are developed across multiple sectors provisions for the OH Unit: Number activities 2.4 Establish an emergency Number of proposals submitted fund readily accessible to Unit: Number support all relevant sectors to carry out immediate Value of funds committed investigation of outbreaks, Unit: U SHS including the ZDCO and the % of committed Funds released OH platform, to effectively Unit: Percentage carry out their roles in multi- sectoral support for OH implementation 3.1 Develop, implement, and % of surveillance methods allowing inter-sectoral linkage monitor preparedness and Unit: percentage response plans # policy briefs produced from the surveillance data Unit: number, disaggregated by sector # new projects based on the surveillance data Unit: number, disaggregated by sector 23 23 Sub-Objective Indicator, Unit & Disaggregation 3.3 Build capacity for multi- # of multi-disciplinary research proposals produced disciplinary research Unit: number # multi-disciplinary grants won Unit: number # of communities mapped Unit: number, disaggregated by region Reduced recovery time in mapped communities Unit: days, disaggregated by region 3.4 Harmonise sectoral % of joint simulations (all sectors represented) activities for effective and Unit: percentage efficient response to prioritised zoonoses, AMR # joint planning and budgeting meetings and related bio-security Unit: number, disaggregated by sector issues # joint budgets and plans produced Unit: number # public private partnerships for the project Unit: number, disaggregated by sector 3.5 Harmonise and align the # of awareness programmes disseminated in print and electronic media AMR National Action Plan Unit: number (NAP) with the OH Approach # of technical reports Unit: number, disaggregated by sector and gender of author # of assessment study reports Unit: number, disaggregated by sector and gender of author # of personnel re-trained in rational use of antimicrobials Unit: number, disaggregated by gender Number of research proposal and publications Unit: number, disaggregated by sector and gender of author 3.6 Mainstream bio- security % Stakeholders integrating biosecurity concerns in their policies, plans and issues related to zoonotic activities diseases into the One Unit: percentage, disaggregated by sector Health Approach 3.7 Create sustainability by # of trainings conducted equipping OH Stakeholders Unit: #, participants disaggregated by gender with the capacity to develop and lead their own bio- Functional liaison with Biosecurity Oversight Committee security programmes Unit: Yes/No against intentional Documented list of critical nodes (specific points) contamination/ introduction Unit: Yes/No with biological (zoonotic) agents Functional biosecurity network Unit: Yes/No 4.1 Recruit and build # trainings that include more than one sector capacity of OH experts Unit: Number, participants disaggregated by gender % of sectoral curricula that include One Health concepts Unit: percentage, disaggregated by sector 4.2 Establish key Analysis Report competencies required for Unit: Yes/No multi-sectoral coordination and collaboration Needs assessment reports Unit: Yes/No 4.3 Develop and implement Training curriculum a training programme for OH Unit: curriculum platform and other stakeholders # of cadres trained 24 24 Sub-Objective Indicator, Unit & Disaggregation Unit: number, disaggregated by sector, gender 4.4 Enable OH Experts with % of required technology / tools available for One Health Experts technology and tools Unit: percentage (calculated as # of available tools/# of WHO/OIE-recommended tools) 5.1 Develop and implement # of communication meetings held a comprehensive One Unit: Number, disaggregated by region Health communication strategy to the public # of communication products used Unit: Number, disaggregated by region, language 5.2 Create awareness and # of institutions that have OH incorporated into training support for OH through Unit: Number, disaggregated by sector effective advocacy, communication and training 5.3 Sensitise interest groups % of Interest groups implementing the OH initiatives on their roles and Unit: Percentage, disaggregated by sector responsibilities in OH # of private sector groups that have OH incorporated in their enterprises Unit: Number, disaggregated by category, sector, gender of owner/leader, region # of private sector groups participating in the OH Platform Unit: Number, disaggregated by category, sector, gender of owner/leader, region 25 25 Conclusion Uganda faces an array of multi-sectoral health challenges that can best be addressed using a One Health approach. This strategy has laid out a clear framework for how the country can address those challenges in a coordinated, collaborative way. Effective implementation of the Strategic Plan will require all stakeholders—both public and private—to allocate resources, commit to capacity building, and prioritise cross-sectoral collaboration. By prioritizing this coordinated approach to planning, preparedness, and response, Uganda will continue on the path toward its goal of building resilient systems to prevent and respond to Zoonotic diseases, address AMR and Eco-health. This work will enable Uganda’s vision of reducing the burden of prioritised zoonoses and AMR by 50% through visionary leadership to enhance coordination and innovation, with shared responsibility and accountability by 2022. 26 26 Annexes 27 27

Annex 1: Country profile Uganda is located in East Africa and lies across the equator. The country is landlocked, bordered by Kenya in the East, Sudan in the North, Democratic Republic of Congo in the West, Tanzania in the South and Rwanda in South West. The country enjoys equatorial climate with plenty of rain and sunshine moderated by the relatively high altitude. The mean annual temperature ranges from 16ºC to 30ºC and most of the country receives between 750 mm and 2100 mm of rainfall annually. Uganda has varying vegetation with tropical rain forest vegetation in the South and savannah woodlands and semi-arid vegetation in the North. Uganda’s economy is made up of Agriculture (24.2%), Industry (25.5%) and Services (50.3%) sectors. Uganda had sustained economic growth at an average rate of 7% per annum between 1997/98 and 2004/08. Based on the economic forecasts, GDP growth rate over the national Development Plan (NDP) period, 2010/11 – 2014/15 was projected at an average of 7.2 per cent per annum (NDP Report, April 2010). The percentage of Ugandans living below the poverty line decreased from 56.4% in 1992 to 19.7% in 2012. However, poverty remains deep-rooted in rural areas, where most of the population lives. The economy is transitioning from an agricultural one, to an industrial, service driven economy with key drivers of the economic growth shifting towards more industrialised activities. The Ministry of Agriculture, Animal Industry and Fisheries (MAAIF), together with the Uganda Bureau of Statistics (UBOS), conducted a National Livestock Census in all the 80 districts in 2007/2008. The national livestock was estimated as 11.4 million cattle, 12.5 million goats, 3.4 million sheep, 3.2 million pigs, and the chicken flock was 37.4 million (Source: A Summary Report of the National Livestock Census MAAIF/UBOS, 2009) Uganda lies in the Lake Victoria basin and adjacent to the Congo Basin, which are known to be rich ecological systems and hotspot for emerging and re –emerging outbreaks of zoonotic and vector-borne disease, and in particular the haemorrhagic fevers (Ebola, Marburg) , RVF, Malaria, Trypanosomiasis (sleeping sickness), especially along the border with DRC. The Lake Victoria ecosystem is characterised by a wide range of altitude and latitude related environmental conditions, from the extensive relatively cool highlands to hot lowland plains and gradients of humidity (from more or less permanently humid to arid and semi – arid). It includes the source of river Nile and large freshwater bodies and extensive wetlands. This environmental variability is matched by a rich diversity among human, animal and plant populations. Moreover, land use and land cover in the area are changing rapidly as a result of population growth and economic development. (EU/Healthy Futures, 2007). Figures 3 and 4 show hotspots for zoonotic diseases in Uganda. The same areas are also hotspots for the other priority zoonotic diseases. The Lake Victoria basin ecosystem is also favourable for many wild bird species and a hotspot for migratory birds. The birds seasonally migrate from Europe following the Mediterranean flyway following the Nile basin into Uganda and neighbouring countries. 28 28 Figure 2: The Lake Victoria Basin and its boundaries, including elevations. Source: EAC LVEMP 11 Project, 2003 29 29 Figure 3: Wild bird migration into Africa Figure 4: Potential hotspots for Avian Influenza in Uganda Migration and waterfowl monitoring/resting sites in Uganda • • 2 3 • U % • • • • • • • • A D J U M A N I • • 2 2 • • 3 0 • •• • • • K id • •• • • • K I T G U M • U % • • • • A R U A • • • • • • K O T I D O • U % • U % Lake Albert • • • • G U L U Marchison Fall National • U % • • 2 1 Park • • 2 0 • • • • • • M O R O T O • % U • % U • • • • • • • • • • • M• •u• r• •c h i s o n F a l l s • • • • • N E B B I • • • •• • • • • • • •N• a t io n a l P a r k • •• • • L IR A U % Lake Opeta and • • 2 9 Bisina complex • • 2 6 • U % • • • • •• • • % U M A S IN D I • • 1 9 • • • • • • S O R O T I • • 2 8 • • 2 7 • U % • • • • • H O I M A • • 2 5 • % U • • • • • M B A L E • • 1 0 • • • 2 4 • • 0 9 • • • • • • L U W E R O % U • • • • • • K A M U L I • U % Lake Victoraia Basin • • 1 2 • U % • • • • •• • • • • • • % U F O R T P O R T A L (Lutembe Ramssa site and wild bird sancturay) • • • • • % U • • T O R O R O Lake George and • U % • • 0 5 • • • • • • • M U B E N D E •• • • • • • IG A N G A •% U• • • • • B U G I R I • • Edward and % U % U • • 0 6 • U % • • • • • JI N J A • • • •• B U S IA • • • • • • • K •A •M •P • A L• A• M U K O NO • U % • • • • • • Kazinga channel K A S E S E • • •• • • M P I G I % U • % U • • 1 7 • • 1 8 • % U • • • • • • • E N T E B B E • • 0 7 • • 0 8 • • • • • • Q ue en • • •• • • • • • • E l iz a b e t h • • • •• • • • • N a t io n a l • • • • • • M A S A K A • % U • • •• Par k • • 1 1 • • 1 6 • • 1 5 • % U • • • • • • • M B A R A R A • • 1 3 • • 0 3 Lake Mburo and surrounding mash wetlands • U % • U % • • • • • • K A B A L E • • 0 2 30 30 Figure 5: Ebola and Marburg Outbreaks in Uganda 2000 to 2012 Uganda is home to a vast number of wild animal species, including a population of mountain gorillas in the Bwindi Impenetrable National Park, gorillas and golden monkeys in the Mgahinga Gorilla National Park, and hippos in the Murchison Falls National Park. The country has 60 protected areas, including ten national parks. These are Bwindi Impenetrable National Park and Rwenzori Mountains National Park (both UNESCO World Heritage Sites), Kibale National Park, Kidepo Valley National Park, Lake Mburo National Park, Mgahinga Gorilla National Park, Mount Elgon National Park, Murchison Falls National Park, Queen Elizabeth and Semuliki National Park. According to the 2014 Census, Uganda had a population of 34.9 million people. With an average annual growth rate of 3.03%, Uganda will have an estimated population of 42.4 million people by the year 2020. With Uganda’s small size, people and wildlife come into frequent contact. Whether it is animals raiding crops, poachers illegally hunting wildlife for bush meat, or people clear forests to make charcoal, these human-wildlife conflicts are some of Uganda’s biggest conservation challenges and zoonotic disease drivers. In addition, Uganda hosts one of the largest refugee populations in the world and is now the centre of the world's fastest growing refugee crisis. In the past 12 months Uganda has taken in around 1.3 million people from her neighbours especially along the south western and north- eastern borders. Despite not directly bordering Burundi, Uganda received on average some 30 Burundi refugees per day in September 2016, or 937 per month. The influx from the DRC to Uganda has been continuous since 2014. In 2016 alone; Uganda received almost 40,000 new DRC refugees. Refugees cite militia activities, general insecurity and harassment as the main reasons for flight. As of April 2017, Uganda hosts 227,413 DRC refugees, it is anticipated that some 60,000 new DRC refugees will flee to Uganda in 2017. These refugees sometimes cross with their animals. 31 31 Other migrations to the Northeastern regions of Uganda are as a result of natural disasters where the Turkana from Kenya have crossed to Uganda with their domestic animals searching for pasture and water following long and severe drought. It is estimated that in March 2017 over 60,000 Turkana pastoralists and 127,000 livestock moved to Uganda’s Karamoja sub-region with more 150,000 animals. The animals included goats, cattle, donkeys, camels and sheep. Far from Kenya's agricultural south, Turkana is a vast, poor northern region regularly ravaged by drought and is suffers from recurrent outbreaks of zoonotic disease, in particular Rift valley fever (RVF) which is endemic with epidemic outbreaks in this region. The explosive nature of epizootics of Rift Valley Fever (RVF) was first described in 1930, during an outbreak of sudden deaths and abortions among sheep along the shores of Lake Naivasha in the greater Rift Valley of Kenya (Daubney et al., 1931). The above scenario has been further compounded by illegal trafficking in endangered animal and plant species including game meat for human consumption, from the same unstable regions some of which are well known hotspots for zoonotic and other infectious diseases. Movements of these unstable communities are from regions where public health infrastructure and services (human, animal, plant and environment protection) do not exist or have been severely disrupted. There is a potential risk of importation of exotic, emerging and re – emerging microorganism that can trigger outbreaks of zoonotic and other infectious diseases. Outbreaks may occur following favourable climatic, environmental conditions and availability of susceptible host and competent vector populations. Epizootics are separated by inter-epizootic periods (OIE Terrestrial Animal Health Code, 2016). The above scenarios justify the need for a One Health (OH) approach in their management (prevention, detection and response). Zoonotic diseases, for example, RVF, Trypanasomiasis, non-typhoidal salmonellosis, anthrax, brucellosis, bovine tuberculosis and others are important food borne diseases in Uganda and have had serious negative impacts on public health, economy (trade, tourism), food safety & food security, and social impacts on vulnerable sub – groups (children, pregnant mothers, the immune-compromised, the elderly and those related to gender). However, the magnitude of these impacts has not been quantified and harmonised across the various affected sectors into a consolidated national database. Also other related socio – economic impacts, for example disruption in the tourism sector, were not quantified (Source: National Animal Diagnostic and Epidemiology Centre). 32 32 Figure 6: Human African Trypanosomiasis/Sleeping Sickness situation in Uganda (2000- 2012) Source: COCTU, 2014 Often, children act as herds men and interact with animals and thus are more prone to zoonotic diseases. Majority of women are involved in making cow ghee which might be exposing them to zoonoses like brucellosis. Women are often the caregivers but generally do not make decisions in the community. The men are involved hunting, in animal care and assisted calving. In rural areas, people tend to sleep with their chicken, goats, sheep, cats and cattle under the same roof increasing the risk of zoonotic diseases. The conflict between wildlife and humans is on the increase including using poison to kill wild animals that encroach on human settlements, domestic animal and agricultural farms. 33 33

Annex 2: Administrative structures of the line ministries responsible for One Health in Uganda MINISTRY OF HEALTH The Ministry of Health (MoH) is responsible for policy formulation, supervision of health sector activities, coordination of health development partners’ assistance, strategic planning, setting standards and quality assurance, resource mobilization, advising other Ministries, Departments and Agencies (MDAs) on health-related matters, and ensuring quality, health equity, and fairness in contribution towards the cost of health care. The Leadership and governance organogram of MoH is made up of Ministers, Permanent Secretary/Accounting Officer, a Director General and three directorates headed by directors and 8 departments which are headed by Commissioners. These departments are: Finance and Administration, Planning and Quality Assurance, Nursing, Community Health, Clinical Services, National Disease Control and the Human Resources department. The complementary structures to the governance and management structures in the health sector are the Health Service Commission, Regulatory Bodies, Professional Councils and Health Policy Advisory Committee. A detailed organogram of leadership and governance at the MoH is attached as annex one. Preventive, promotive and curative health services are organised right from community level starting with Village Health Teams (VHTs) as the lowest health services delivery level to national level where we find National Referral Hospitals, National Referral Laboratories and the Ministry of Health (MoH) Headquarters. A detailed organogram for organization of health services delivery is attached as annex two. MINISTRY OF AGRICULTURE, ANIMAL INDUSTRY AND FISHERIES (MAAIF) The agriculture sector is composed of Ministers, a Permanent Secretary/Accounting officer, directors of crop, animal and fisheries resources. An additional Directorate for Agriculture Extension was established in the Financial Year (FY) 2014/15.These four directorates are supported by the Policy Planning and Support Services Department and other units falling directly under the Permanent Secretary which include: Finance and Administration; Procurement and Disposal Unit; and Internal Audit. The Ministry also has specialised units and agencies including National Agriculture Research Organization (NARO), National Agricultural Advisory Services (NAADS), National Animal Genetic Resource Centre and Data Bank (NAGRC&DB), Coordinating Office for the Control of Trypanosomiasis in Uganda (COCTU), Diary Development Authority (DDA), Uganda Coffee Development Authority (UCDA) and Cotton Development Organization (CDO). Details of the organization of MAAIF are given in annex Three. MAAIF is the overseer of the Agricultural sector where it formulates, reviews and implement national policies, plans, strategies, regulations and standards and enforce laws, regulations and standards along the value chain of crops, livestock and fisheries. Among others, MAAIF’s mandate includes;  Control and management of animal disease epidemics and disasters, and support the control of sporadic and endemic diseases, pests and vectors.  Establishment of sustainable systems to collect, process, maintain and disseminate agricultural statistics and information  Development and promotion of collaborative mechanisms nationally, regionally and internationally on issues pertaining to the sector 34 34 UGANDA WILDLIFE AUTHORITY Uganda Wildlife Authority (UWA) is a semi-autonomous government agency under the Ministry Tourism, Wildlife and Antiquities and headed by an Executive Director who is the Accounting Officer. UWA is mandated to ensure sustainable management of wildlife resources and supervise wildlife activities in Uganda both within and outside the protected areas. UWA’s vision is to be the leading, self-sustaining wildlife conservation agency that transforms Uganda into one of the best ecotourism destinations in Africa. UWA’s mission is to conserve, economically develop and sustainably manage the wildlife and protected areas of Uganda in partnership with neighbouring communities and other stakeholders for the benefit of the people of Uganda and the global community. UWA conducts its business under four (4) directorates. These are Tourism and Business, Legal and Corporate Affairs, the Finance directorate and the Conservation directorate. In the structure of Uganda Wildlife Authority, conservation managers, veterinary coordinators, community conservation coordinators, wardens and rangers who are the key One Health staff are under the Directorate of Conservation. The details of the organization of Uganda Wildlife Authority are in annex Four. MINISTRY OF WATER AND ENVIRONMENT (MWE) The Ministry of Water and Environment (MWE) is headed by ministers and a Permanent Secretary/Accounting officer and has the overall responsibility of the development, managing, and regulating water and environment resources in Uganda. The mandate of MWE includes initiating legislation, policy formulation, setting standards, inspections, monitoring, and coordination and back up technical support in relation to water and environment sub sectors. MWE has three directorates: Directorate of Water Resources Management, Directorate of Water Development and the Directorate of Environmental Affairs. The Water and Environment Sector consists of two sub-sectors: The Water and Sanitation sub-sector and the Environment & Natural Resources sub-sector. The Environment and the Natural Resources Sub-Sector comprises Environmental Management; management of forests and trees; management of Wetlands and aquatic resources; and Meteorology; Weather and Climate Change. Water and Environment Sector Working Group (WESWG) provides policy and technical guidance for the sector. It comprises representatives from all key sector institutions (Government, Development Partners and NGOs). Ministry of Water and Environment (MWE) has institutions and authorities working under it. These include The National Water and Sewerage Corporation (NWSC), National Environment Management Authority (NEMA), National Forestry Authority (NFA) and Uganda National Meteorological Authority (UNMA). The Ministry also works closely with other Government Ministries, Local Governments, the Private Sector and Non-Governmental Organizations (NGOs) and other stakeholders at Community, District, regional and National levels. The details of the structural organization of Ministry of Water and Environment are given in Annex Five. There are inextricable linkages between health and the environment (HELI). Environmental factors are major public health determinants and contributors to the burden of disease especially in areas of:  Control of communicable disease for example diarrhoeal diseases, water – borne & water based and vector – borne related diseases  Environmental health issues related to safe water supply, Food Hygiene & Safety, Sanitation, Indoor & Outdoor Air Quality, Waste management among others. 35 35  Prevention & Control of non – communicable diseases due to chemical pollutants, noise  These linkages have to be effectively addressed under the ONE Health initiative. In this regard MWE and its agencies (NEMA, NWSC, DWD) has to develop and implement environmental policies, regulations, standards and guidelines to protect human and animal health and the environment. Over the last few decades, Uganda has experienced an increase in the frequency and intensity of extreme weather variability and events with serious upsurges of epidemics from vector – borne and other zoonotic disease outbreaks. For example, Rift valley fever is usually triggered by sustained heavy rains. For the first time in Uganda, an outbreak of RVF was confirmed in Kabale, (South western region of Uganda) in March 2016, following a period of heavy rains and extensive flooding. ANALYSIS OF SECTOR MANDATES, ROLES AND RESPONSIBILITIES Analysis of the various sector mandates, roles and responsibilities highlights overlaps and duplication of efforts which negatively impact on effective prevention and control of zoonotic diseases and justify the need for the One Health approach. For example, Zoonotic disease have serious impacts food safety and security, however Uganda does not have a single agency responsible for food safety. Food safety control is characterised by a multi-agency system whereby food safety and quality infrastructure is shared between several ministries, departments and agencies. The government needs to strengthen disease surveillance networks along the food production chain in order to prevent adversities, improve prediction rates for epidemics and promote Integrated Management of human and animal disease outbreaks. It is vital to detect zoonotic and food borne disease outbreaks as early as possible in order to limit spread. GENDER AND THE ONE HEALTH INITIATIVE Women have the right to enjoy the highest attainable standard of physical and mental health. Their enjoyment of this right is vital to their life and well-being and their ability to participate in all areas of public and private life. Women are visible in the health care system both as caregivers and as clients. Gender gaps in health status, in access and use of health services, and in health outcomes persist, signifying a need to address gender inequality in the country. This situation not only directly affects the health of girls and women, but also places disproportionate responsibilities on women. Their multiple roles, including their roles within the family and the community, are often not acknowledged; hence, they do not receive the necessary social, psychological, and economic support. Women’s health is affected by their economic and social status; therefore, improving women’s health depends, among other factors, on improving their standard of living, education, and working conditions. 36 36

Annex 3: Leadership and Governance organogram of the Ministry of Health (MoH) OFFICE OF THE MINISTER HEALTH SERVICES COMMISSION National Level Institutions National Drug Authority PERMANENT National Medical Stores SECRETARY Uganda Health Research Organization Uganda Virus Research Institute Uganda Cancer Institute National Referral Hospitals National Blood Transfussion Services National Public Health Laboratory Services National Chemotherapeutic Research Labaratory DIRECTOR Professional Councils GENERAL Medical &Dental Practitioners Council Nurses & Midwives Council Pharmacists Council Allied Health Practitioner’s Council RESOURCE POLICY ANALYSIS CENTRE UNIT DIRECTORATE OF DIRECTORATE OF PLANNING CLINICAL AND COMMUNITY AND DEVELOPMENT HEALTH SERVICES DEPARTMENT DEPARTMENT DEPARTMENT DEPARTMENT DEPARTMENT DEPARTMENT COMMISSIONER OF COMMUNITY OF CLINICAL OF OF QUALITY OF FINANCE AND OF NATIONAL NURSING HEALTH SERVICES PLANNING ASSURANCE ADMINISRATION DISEASE CONTROL 37 37

Annex 4: Organization of human health services delivery in Uganda Commuity Level Village Health Committees Services 1,000 people (participate in PHC) Health Sub District Parish Level Health Health Health Provide free PHC services (outpatient & Center II Center II Center II community interventions) to 5,000 people District Health Service Provide free PHC services (all above plus Sub-county Level Health Health inpatient, and laboratory) to 20,000 people Center III Center III Provide free PHC services (all above plus County Level Health Centre IV & Laboratory (Public emergency surgery & blood transfusion) or Private) to 100,000 people District Health Services Headquarters Provide free PHC & 2ND care services District Level & to 500,000 people (user fees charged in General Hospital & Laboratory (Public or Private) private wings of the hospital) Regional Level Regional Referral Provide free tertiary care for 2,000,000 people (user Hospitals & Laboratories fees charged in private wings of the hospital) National Level National Referral Hospitals & Free specialized care for 30,000,000 people (user National Reference Laboratories fees charged in private wings of the hospital) WHO & other Ministry of Health Other Sectors & Port Health Partners Headquarters & NFP Health Serices 38 38

Annex 5: Structure for Ministry of Agriculture, Animal Industry and Fisheries (MAAIF) Office of the Minister Permanent Secretary Resource Center Policy Analysis Unit National Agriculture Advisory Service Uganda Coffee Development Authority (NAADS) Diary Development Authority Cotton Development Organisation National Agriculture Research Organisation National AnimalGeneric Resource Center Directorate of Animal Directorate of Crop Resources Resources & Fisheries Crop Rotation Crop Protection Farm Animal Livestoke Health Fisheries Development Production & Entomology Resources Finance & & Administration PMA Secretariat Agricultural Planning 39 39 International & Regional Ministry of Agriculture, Animal Ministries Organisations Industry and Fisheries Energy and Mineral & the MAAIF Semi-Autonomous Development Agencies Education and Sports Coordinating Office for the Finance Planning & Development Partners Agriculture Control of Tripanosomiasis in Econimic Development Sector Bilateral uganda Gender Labour and Social Working Multilateral Group Cotton Development Development Organizaton Health Dairy Development Authority Local Government National Agriculture Advisory Lands Housing and Urban Services Development National Agriculture Research Public Service Organization Tourism, Wildlife and Private Sector and Civil National Genetic Resource Antiquities Society Information Center and Data trade Industry and Agriculture Services and Bank Cooperatives Goods Providers Uganda Coffee Development Water & Environment Civil Society Organizations Authority Works and Transport Non-Government Organizations Farmer Organizations LGs Academia Districts Universitis Sub Counties Agricultural Training Institutions Farmers Commercial, Medium & Small 40 40

Annex 6: Organizational structure of Uganda Wildlife Authority (UWA) Board of Trustees Executive ED’S Secretary Director Director Tourism Director Legal Director Finance Director Concervation and Business and Corporate Affairs Secretary Secretary Secretary Secretary Chief Conservation area manager Manager Management Financial Internal Audit Pilot Accountant Accountant Secretary Senior Warden Veterinary Accounts Coordinator Partnership Public ICT Principle Monitoring and Conservation Area Manager (7) Cordinator Relations Manager Legal Evaluation Manager Warden Warden Warden Accounts (4) Mechanical & Internal Audit Accounts (2) Maintenance Engineer Senior Warden ICT Senior Warden Senior Wardens Legal Ass Warden Internal Audit Transport Officer Communications Marketing Wardens Concessions Business Devt Manager Manager Manager Manager Warden ICT Warden L:egal Stores Clerk Senior Drivers (2) Ass. Wardens Receptionist Accounts Ass Warden Clerk (2) Product Maintenance Retail Drivers Dev’t Executive Rangers Executive Admin Sec Marketing & Research Officer Office Support Staff Attendants (5) Senior Warden Website Senior Writer Reservations Executive HR Procurement Law Manager Manager Enforcement Coordinator Monitoring & Planning & E/A Community Research Coordinator Conservation Warden Secretary Coordinator Coordinator Reservations Warden Procurement Senior Senior Warden LE Community Warden HR Senior Warden Senior Warden Conservation Ass. Warden Ass. Warden Monitoring & Planning & E/A (2) Warden (2) Reservations (2) Procurement Research (2) Warden HR Problem Animal Officer (2) 41 41

Annex 7: Organizational structure of Ministry of Water and Environment AGENCIES . National Forestry (Reporting to the Minister) . National Water & Authority (NFA) Ministry of Water and Environment Sewerage Corporation . National Environmental (NWSC) Management Authority (NEMA) Directorate of Water Development Directorate of Water Resources Management Directorate of Environment Affairs . Uganda national Met Authority (UNMA) (DWD) (DWRM) (DEA) . DEPARTMENT AND UNITS Departments: Urban Water Supply and . Departments: Water Resources Monitoring . Environmental Support Departments: Reporting to the PS . Sewerage . and Assessment . Wetland Management . Finance & Admin Dept Rural Water Supply and Water Resources Planning . Forestry Sector Support . Sanitation . and Regulation Water Quality Management . Internal Audit Water for Production . International & . Water Utility Regulation Transboundary Water . Policy & Planning dept . Procurement & Disposal Unit Resources Mgt. Dept Climate Change Dept Water & Environ Sector Liaison Dept. Human Resources Mgt. Unit 42 42