A bottom-up, One Health approach to assessing progress in the implementation of a national action plan for combatting antimicrobial resistance: a case study from Uganda
Antimicrobial resistance (AMR) is one of the greatest threats to public health, and it is spreading across the human health, animal health, and environmental sectors. Sole reliance on desk reviews and national-level stakeholder engagement carries a risk of overestimating the country’s health security and AMR capacity. For a genuine evaluation, engaging frontline and last-mile implementers such as health care facilities and workers, farmers, and district local governments ensures a more accurate assessment of existing capabilities and implementation progress. Uganda utilized a bottom-up approach to assess the implementation status of the National Action Plan on AMR (NAP-AMR) to ensure the engagement of key stakeholders at the subnational level, who are often overlooked in NAP-AMR evaluation initiatives. This review revealed poor engagement of subnational stakeholders in the development, validation, dissemination, and implementation of the NAP-AMR as well as various issues at the national level—including gaps in government One Health policy, insufficient funding, and ineffective coordination—that resulted in the inadequate implementation of the NAP-AMR. Addressing these challenges should involve establishing a One Health policy and identifying sustainable funding sources for AMR activities. We recommend the legislation of dedicated policy to formally incorporate the National One Health Platform into government structures at the national and subnational levels. In our experience, a bottom-up approach to evaluating NAP-AMR implementation enhances the effectiveness of the review process and could be utilized by the WHO during the joint external evaluation of health security capacity.
By J.P. Waswa, Reuben Kiggundu, Hassan Kasujja, Patrick Vudriko, Hakim Sendagire, Henry Kajumbula, Musa Sekamatte, Francis Kakooza, Fozo Alombah, Mohan P. Joshi & Niranjan Konduri
