Case Study: Breaking down AMR barriers in Uganda

The Fleming Fund is working with Uganda’s health care system to break down the barriers to disease surveillance by strengthening laboratory and diagnostic capacity in antimicrobial resistance (AMR) - leveraging in-country infrastructure and sustainability - for global health security.

By supporting the integration of bacteriology services in regional laboratories to study bacteria and form a national surveillance system in Uganda, the Fleming Fund injects sustainability into efforts to combat AMR.

Strengthening Uganda’s AMR surveillance system will involve the production of high quality, robust data to influence government policy and trigger action.

The East and Southern Africa (ESA) Fleming Fund hub, managed by Mott MacDonald, is working with the Infectious Diseases Institute to ensure the provision of required training, equipment, reagents, and consumables to enhance Uganda’s bacterial diagnostic capacity.

This support is aligned with Uganda’s Health Sector Strategic Development Plan (HSSDP), which outlines public health priorities, including the country’s AMR National Action Plan (NAP).

The NAP was developed, costed, and is being implemented by the One Health Secretariat to ensure that AMR surveillance is prioritised by the diagnostic departments within different One Health sectors.

Jinja Regional Referral Hospital. Credit: Mott MacDonald.

Barriers to investment

Facing several barriers to investment in AMR infrastructure, Uganda’s laboratories are largely dependent on donor support.

The bulk of government spending is directed toward building low-level health centres (under district hospitals) to improve primary health care. These investments could be undermined if AMR is not considered as a major health problem.

In Uganda, the financing of capital investments for AMR surveillance has come from a combination of donor support for improving global health security preparedness and the Government’s own investments.

For example, Uganda’s Central Public Health Laboratory was recently elevated to the National Health and Laboratory Services Department within the Ministry of Health, allowing access to more domestic funding, and heightened public awareness.

The department has also benefitted from external funding, including the Global Fund to fight AIDs, Tuberculosis and Malaria, the President's Emergency Plan for AIDS Relief (PEPFAR) and the US Centers for Disease Control and Prevention (CDC).

These partners have supported the recruitment of staff, the procurement and servicing of equipment, and the supply of reagents and consumables. The East Africa Public Health Laboratory Networking Project (EAPHLNP), funded by the World Bank, has also provided improvements to several regional referral hospitals.

Sector vulnerability

Despite these developments, laboratories were under-resourced and required support from the Fleming Fund to improve AMR diagnostics and surveillance.

The Fund has contributed to skills and equipment to establish and support laboratory services at 12 sites across the ESA region, including the national reference laboratories.

To help improve sustainability, the Fleming Fund is working within the structures of the wider governmental plans and providing support while the Government finds alternative, more permanent funding streams. Long-term support is important to continue to provide diagnostic services and surveillance data.

“Sustainability is a key principle of the Fleming Fund’s investments.

“Commitment to contribute funding is an important first step, and to make that commitment, governments need the right data to help with decision-making and prioritisation; that’s what the Fleming Fund hopes to support.”

Dr Toby Leslie, Global Technical Lead for the Fleming Fund at Mott MacDonald.

Lab tech recording results of bacterial growth at the Jinja Referral Hospital. Credit: Mott MacDonald.

In the animal health sector, the National Animal Disease Diagnostics and Epidemiology Centre (NADDEC) sits under the Chief Veterinary Officer but is challenged by a lack of resources and skills.

In addition to the Fleming Fund’s input, infrastructure investments have been supported by the Food and Agriculture Organisation (FAO) and the Danish International Development Agency (DANIDA).

These investments primarily focus on animal health, which the Fleming Fund has provided essential support through their investment in laboratory development and bacteriology services.

Staff provision

The Ministry of Health and Ministry of Agriculture Animal Industry and Fisheries (MAAIF) have stretched budgets, and the majority is dedicated to standing costs such as human resources.

In the MAAIF, the government is working towards increasing staffing levels at the NADDEC, pledging to absorb all the external staff costs which are currently being paid for by donors.

This is an important recognition of the importance of animal health surveillance, and a major step towards sustainability.

Lab tech taking a blood sample at the Jinja Referral Hospital. Credit: Mott MacDonald.

10-year Roadmap

In progressing the AMR project, the Government of Uganda has worked with partners to set up a 10-Year Roadmap for Health Supply Chain Self-Reliance, promoting a sustainable supply of quality reagents and consumables.

They have also set up a biomedical engineering department and created new positions for consultants within the human health laboratory units, encouraging the retention of highly qualified staff.

In cementing these gains and turning them into a functioning and beneficial surveillance system, it’s vital advocacy is sustained. In the next phase of the Fleming Fund Country Grant for Uganda, Mott MacDonald will work with the UK Foreign & Commonwealth Office (FCDO) and the INTOSAI Development Initiative to support the use of AMR evidence in decision-making and promote such sustainability.

This will involve working with the AMR community and the Ugandan government to encourage the mobilisation of health resources nationally and integrate AMR surveillance within the financing of wider infrastructure systems. These efforts will help push AMR to the forefront of public health policy.

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