UGANDA ONE HEALTH STRATEGIC PLAN 2018 - 2022 OHSP Final Laun… · OHCEA One Health for Central and East Africa OH One Health OHSP One Health Strategic Plan OHTWG One Health Technical

UGANDA ONE HEALTHSTRATEGIC PLAN

2018 - 2022

REPUBLIC OF UGANDA

THE REPUBLIC OF UGANDA

Uganda One Health Strategic Plan

2018-2022

January, 2018



Uganda One Health Strategic Plan

2018-2022

January, 2018


Prepared by: The One Health Platform: A collaboration between Ministry of Health (MoH), Ministry of Agriculture Animal Industry and Fisheries (MAAIF), Uganda Wildlife Authority (UWA) and Ministry of Water and Environment (MWE) with financial and technical support from USAID/EPT-2 Preparedness and Response (P&R) Project.

January, 2018

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Table of Contents Table of Contents ............................................................................................................................. i Acronyms and Abbreviations ......................................................................................................... ii Foreword ........................................................................................................................................ iv

Executive Summary ........................................................................................................................ 2

Introduction ..................................................................................................................................... 3

One Health .................................................................................................................................. 3

Vision, Mission, Goal and Objectives ........................................................................................ 4

Implementation of the Strategic Plan .......................................................................................... 4

Framework for operationalizing the One Health Strategic Plan ................................................. 5

Policy and Resource Implications ............................................................................................... 7

Situation Analysis ........................................................................................................................... 8

Zoonotic Disease ......................................................................................................................... 8

Antimicrobial Resistance .......................................................................................................... 10

Biosecurity ................................................................................................................................ 11

Prior Analyses ........................................................................................................................... 12

SWOT Analysis ........................................................................................................................ 13

One Health Strategy ...................................................................................................................... 15

Guiding Principles .................................................................................................................... 15

Strategic Objectives & Rationale .............................................................................................. 16

Accomplishing the Strategic Objectives: Sub-objectives and Activities .................................. 16

Financing................................................................................................................................... 20

Monitoring Plan ............................................................................................................................ 22

Conclusion .................................................................................................................................... 26

Annex 1: Country profile .............................................................................................................. 28

Annex 2: Administrative structures of line ministries responsible for One Health in Uganda .... 34

Annex 3: Leadership and Governance organogram of the Ministry of Health (MoH) ................ 37

Annex 4: Organization of human health services delivery in Uganda ......................................... 38

Annex 5: Structure for Ministry of Agriculture, Animal Industry and Fisheries (MAAIF) ......... 39

Annex 6: Organizational structure of Uganda Wildlife Authority (UWA) .................................. 41

Annex 7: Organizational structure of Ministry of Water and Environment ................................. 42

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Acronyms and Abbreviations AFENET African Field Epidemiology Network AMR Antimicrobial resistance CAO Chief Administrative Officer CCHF Crimean Congo Haemorrhagic Fever CDC United States Centers for Disease Control and Prevention CDO Cotton Development Organization COCTU Coordinating Office for the Control of Trypanosomiasis in Uganda COVAB College of Veterinary Medicine Animal Resources and Biosecurity DDA Diary Development Authority DVO District Veterinary Officer EPT Emerging Pandemic Threats ESBL Extended-spectrum beta-lactamase FAO Food and Agriculture Organization of the United Nations GARP Global Antibiotic Resistance Partnership GHSA Global Health Security Agenda IDSR Integrated Disease Surveillance and Response IHR International Health Regulations LVEMP Lake Victoria Environment Management Project M&E Monitoring and Evaluation MAAIF Ministry of Agriculture Animal Industry and Fisheries MoTW&A Ministry of Tourism, Wildlife and Antiquities MDAs Ministries, Departments and Agencies MDR Multi-Drug Resistant MOH Ministry of Health MOU Memorandum of Understanding MRSA Methicillin-resistant Staphylococcus aureus MWE Ministry of Water and Environment NAADS National Agricultural Advisory Services NAGRC&DB National Animal Genetic Resource Centre and Data Bank NADDEC National Agricultural Disease Diagnostics and Epidemiology Centre NEMA National Environment Management Authority NFA National Forestry Authority NGO Non-government Organization NOHP National One Health Platform NOHTA National One Health Technical Advisor OHCEA One Health for Central and East Africa OH One Health OHSP One Health Strategic Plan OHTWG One Health Technical Working Group OIE World Organization for Animal Health P&R Preparedness & Response Project PHE Public Health Emergency PHEIC Public Health Emergency of International Concern PVS Performance of Veterinary Services RVF Rift Valley Fever

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SWOT Strengths, Weaknesses, Opportunities, Threats TB Tuberculosis UNAS Uganda National Academy of Sciences UNESCO United Nations Education, Scientific and Cultural Organization UTCC Uganda Trypanosomiasis Control Council UVRI Uganda Virus Research Institute UWA Uganda Wildlife Authority VHFs Viral Haemorrhagic Fevers VHT Village Health Team WHO World Health Organization WESWG Water and Environment Sector Working Group ZDCO Zoonotic Disease Coordination Office

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Executive Summary Uganda brings a long history of multi-sectoral responses to disease outbreaks and public health threats. With the formalization of the One Health Platform, Uganda is now poised to turn this history into a strategic, forward-looking approach to integrated, multi-sectoral preparedness and response. The One Health Strategic Plan will serve as the roadmap to make this approach a reality.

STRATEGIC PLANNING PROCESS With support from the USAID-funded Preparedness and Response (P&R) Project, the One Health Platform engaged stakeholders from the Ministry of Health (MOH), Ministry of Agriculture, Animal Industry and Fisheries (MAAIF), Ministry of Water and Environment (MWE), and the Uganda Wildlife Authority of the Ministry of Tourism, Wildlife and Antiquities (MoTWA) in a series of strategic planning workshops and meetings. This document captures the priorities, outputs, and commitments from those engagements.

SITUATIONAL ANALYSIS In considering Uganda’s One Health priorities, stakeholders analysed key multi-sectoral public health risks, including zoonotic disease, antimicrobial resistance (AMR), and biosecurity. Given the occurrence of endemic and emerging zoonotic diseases such as Rabies and Ebola respectively, and the exacerbation of outbreaks caused by climate change, zoonotic disease prevention and preparedness will be a high priority for the One Health Strategic Plan. Furthermore, many of the zoonotic diseases endemic to Uganda are also biosecurity threat agents of high concern, necessitating a unified approach to preparing and responding to them. Finally, while AMR is a global issue, due to the importance of the livestock sector to Uganda’s economy, ensuring effective cross-sectoral prevention and control will be crucial.

STRATEGY IMPLEMENTATION The implementation of the One Health Strategic Plan will be the responsibility of the government with support from partners and other stakeholders. The Uganda National One Health Platform (NOHP) will be responsible for oversight and coordination of the implementation of the Plan. Implementation of the One Health Strategic Plan shall be based on the existing One Health Framework, Memorandum of Understanding (MOU) among the One Health sectors, the Terms of Reference of the One Health Platform structures, and other protocols and sectoral policies that exist or may be put in place to support implementation of the One Health approach in Uganda. The Plan is aligned around five strategic objectives, which together cover commitment to One Health among high-level government stakeholders; institutionalization and capacity building to ensure effective operation of the One Health Platform; strengthened preparedness and response to zoonotic diseases, AMR, and biosecurity threats; and communications and outreach to enhance awareness of the value of the One Health Approach. These strategic objectives will lead to the goal of building resilient, sustainable systems to prevent and respond to zoonotic diseases and address AMR and biosecurity. By accomplishing the strategic objectives and the goal Uganda will be able to reach its vision: By 2022, reduce the burden of prioritised zoonoses and AMR by 50% through visionary leadership to enhance coordination and innovation, with shared responsibility and accountability.

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Since the 1980s, Uganda has had several successful multi-sectoral disease response initiatives. While many of these efforts predate the One Health concept, they demonstrate its effectiveness in action. Some key initiatives include:

In the early 1980s, Uganda recognised the importance of linkages between human and animal health, and established a Veterinary Public Health division within the MOH.

The Uganda Trypanosomiasis Control Council, established in 1992, with the Coordinating Office for Control of Trypanosomiasis in Uganda (COCTU) as its secretariat was one of the earliest high-level multi-sectoral coordinating bodies for disease response.

Despite the severity of the HIV/AIDS epidemic in Uganda, strong political leadership and civil society participation were hallmarks of its successful multi-sectoral approach to disease response.

Following effective multi-sectorial responses to the avian Influenza outbreaks in 2009, Uganda worked with the World Bank on the Avian and Human Influenza Prepared-ness and Response Project, further fostering collaboration.

In 2013, the Ugandan veterinary and medical associations hosted a One Health Conference, which resulted in the signing of a One Health MOU.

This was followed in 2016 by a One Health Framework and the establishment of the NOHP, the foundation for this plan.

MULTISECTORAL DISEASE RESPONSE:

UGANDA’S SUCCESSES

Introduction As Uganda faces shifting dynamics of health threats due to population growth, economic development, climate change, and human migration and displacement, the multi-sectoral nature of these threats necessitates a departure from traditional, vertical public health responses. To address this need, the Government of Uganda will adopt a One Health approach to addressing three priority public health threats: zoonotic diseases, AMR, and biosecurity, drawing on experience and lessons from Uganda’s rich history of multi-sectoral disease response (see sidebar).

ONE HEALTH The One Health approach is an innovative strategy to promote multi-sectoral and interdisciplinary application of knowledge and skills of medical, public health, veterinary and environmental experts by working together to address animal, human and environmental health challenges. The approach is recognised by the World Health Organization (WHO), Food and Agriculture Organization of the United Nations (FAO), World Organization for Animal Health (OIE) and the Global Health Security Agenda (GHSA) as a strategy for promoting the collaborative effort of multiple disciplines, working locally, nationally and globally, to attain optimal health for people, animals and the environment. Priority public health threats that can be addressed using the One Health Approach include, among others: emerging and re-emerging zoonotic and infectious diseases of epidemic and pandemic potential, antimicrobial resistance, pollutants and environmental contaminants, food safety and dietary health risks. In Uganda in March 2016, a One Health Framework was developed, agreed upon and endorsed by the technical heads of the three line ministries: MoH, MAAIF, MWE and the UWA, an agency under the Ministry of Tourism Wildlife and Antiquities. In November 2016, the One Health Framework was formalised through signing of a MoU between the three (3) line Ministries and one agency (UWA), leading to the establishment of the Uganda NOHP. The platform was launched on 3 November 2016, presided over by the Right Honourable Prime Minister and attended by senior government officials, the US Ambassador, WHO Representative and development partners. The One Health Strategic Plan lays emphasis on seven priority zoonotic diseases, antimicrobial resistance, public health threats and related bio-security issues in its initial 5-year period (2018-2022). This emphasis will help focus and guide the use of limited resources for optimal impact.

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VISION, MISSION, GOAL AND OBJECTIVES The One Health Strategic Plan is based on the following framework:

Strategic Objectives The Plan has five strategic objectives each with sub-objectives and activities that will be implemented to achieve the goal and realise the vision. 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.

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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:

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The private sector has an important role to play in strengthening the One Health approach for better prevention, detection and response to endemic and emerging zoonoses and other infectious diseases of known and unknown origin and AMR. Strong preparedness and response capacities will protect the private sector from economic losses that may be caused by disease outbreaks and AMR.

Some of these private sector players have already been engaged by the line ministries (MoH, UWA, MAAIF and MWE) through the NOHP. Key private sector stakeholders have realised that closer collaboration and information-sharing with government through the One Health Platform was critical in protecting their businesses from the negative consequences of disease outbreaks. When outbreaks occur, businesses are sometimes interrupted by drastic measures like quarantines, bans on exports, absenteeism and loss of workers due to illness or death.

Under this Strategic Plan, individual private sector entities will be engaged directly or through their umbrella associations to play an advisory function and contribute to policy development and to provide budgetary and other support to respond to an outbreak and other public health events.

PRIVATE SECTOR INVOLVEMENT IN ONE

HEALTH

OIE Veterinary Legislation WHO International Health Regulations 2005 Uganda Public Health Act, 1962 Local Government Act, 1997. Animal Diseases Act – Chapter 38 (1964, partially revised

in 2006); Uganda Disaster Preparedness and Management Policy Uganda Health Sector Investment Plan, 2015-2020 Uganda IDSR Strategic Plan, 2012-2018 MAAIF Strategic Plan, 2018-2022 Uganda Wildlife Authority Strategic Plan, 2018-2022 Uganda Ministry of Water and Environment Strategic Plan,

2018-2022 Uganda National Action Plan on AMR, 2018-2022 The strategic documents above highlight initiatives aimed at building Uganda’s One Health capacity, including preparedness, zoonotic emergencies and pandemics, control of prioritised zoonotic diseases, and addressing AMR. Previously, such initiatives from different Ministries, Departments and Agencies, despite having the same goal, were not harmonised and instead were implemented in an uncoordinated manner. Besides consuming huge resources, this limited their potential impact on overall health. Implementation of the One Health Strategic Plan will contribute to harmonised prevention and control of zoonotic diseases and better coordination of implementation of AMR and biosecurity activities across sectors. Under this Strategic Plan the private sector will be engaged to play an advisory function and contribute to policy and development of response plans, guidelines, manuals and protocols; dissemination of information on disease prevention measures; conduct One Health related trainings for their staff and to provide budgetary and other support to respond to an outbreak (see sidebar). Implementation of the One Health Strategic Plan shall be based on the existing One Health Framework, MOU among the One Health sectors, the Terms of Reference of the NOHP structures, and other protocols and sectoral policies that exist or may be put in place to support implementation of the One Health approach in the country.

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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.

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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

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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

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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)

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An important consideration in national coordination to prevent, detect, and respond to any public health emergency is the particular set of risks and vulnerabilities experienced by different population groups. Differences in and intersections of age, ethnicity, income, and gender, among others, affect not only disease exposure and risk, but also how each of these populations may benefit from or be harmed by prevention, surveillance, preparedness and response efforts. Overlooking or misunderstanding the experiences of different populations can have a profoundly negative impact not only on those populations, but also on the overall effectiveness of the response.

The strategic plan considers the specific roles of women in Uganda, particularly with respect to caring for livestock and in providing and accessing health services. 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 developing the strategic plan, stakeholders reviewed best practices in gender integration to ensure that the plan reflects gender equity issues and priorities; drafts of the plan were also shared with Makerere University’s Department of Gender and Women’s studies.

Finally, the strategic plan includes a Monitoring and Evaluation Plan that disaggregates gender data wherever relevant.

GENDER, SOCIAL INCLUSION, & ONE

HEALTH

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 problem of AMR. The 2014 Global Health Security Agenda (GSHA) further subscribes mechanisms to contain the same with leadership from the United States Centers for Disease Control (CDC). Prior to that, the 2014 country assessment by GHSA reported absence of coordinated actions in Uganda to address the problem. Since then progress has been made, and per the June 2017 WHO Joint External Evaluation (JEE) report, the Government of Uganda has put in place a National Strategy for Antimicrobial Resistance and an Antimicrobial Resistance Surveillance Plan (2017-2022), which incorporates a multi-sectoral approach toward combating AMR in Uganda. The AMR National Action Plan (NAP) is intended to be a guide for Ugandan stakeholders contributing to efforts to confront and contain the problem. The NAP sets out a coordinated and collaborative One Health approach involving key stakeholders in government and other sectors to confront the threat, and shall be coordinated through the One Health Platform by the AMR Sub-committee of the OHTWG. The Government will also work together with other governments, international organizations and partners to address the AMR threat at regional and global level. Although AMR cannot be eradicated, it can be reasonably slowed down and contained. The Ugandan Government is confident that this plan will help respond to the threats of AMR. The Government urges all stakeholders to develop specific plans of action in their respective institutions and sectors and to coordinate with the national effort to prevent, detect, and respond to the threat posed by AMR pathogens so that the people of Uganda are not subjected further to the burden of drug-resistant infections.

BIOSECURITY Zoonotic diseases raise bio-security concerns where biological agents or their products can be intentionally used to infect animals (domestic or wildlife) with the aim of infecting humans, animals and plants in massive proportions. Many of potential biosecurity agents of concern are zoonotic with Anthrax, Botulism, Plague, Smallpox, Tularemia and Viral haemorrhagic fevers in highest category. In some diseases, clinical signs may manifest in animals prior to humans. Pets can act as important sentinels because they are present in large numbers and often live in close contact with humans. Livestock are also present 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

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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;

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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 mobilise resources, advise gov’t and coordinate implementation of OH initiatives is in place

Previously, there has been no strategic plan to guide coordinated implementation of One Health activities

The ZDCO, secretariat of OHTWG, already has temporary workspace and guidelines on staffing

The One Health Platform is in its early stages and has 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 responsibilities of each of the line ministries under the OH Platform is in place

The line ministries are yet to fully implement their obligations, roles and responsibilities as spelt out in the MoU.

Quarterly OHTWG and monthly ZDCO meetings are already ongoing

The OH platform has no permanent physical and institutional home

More than 20 MDAs, International agencies and donors are already members of the OHTWG

The ZDCO does not have permanent staff

MakSPH, COVAB, OHCEA/OHW, FETP are already implementing OH related training programmes

No legal instrument for establishment of the One Health Platform has been obtained

Numerous capacity related assessments like IHR, IDSR and JEE have been conducted; their recommendations support implementation of OH approach

Limited practitioners with OH core competences

Absence of a specific OH research agenda to inform policy/ practice

MakSPH, COVAB, OHCEA, FETP, AFENET & P&R already have some capacity to support OH-related activities in Uganda

Limited ability (financial, structural) of line ministries to engage in collaborative activities

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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 surveillance for some zoonotic agents, like Influenza

No previous assessment to prioritise zoonotic agents with PHEIC and pandemic potential in Uganda

Uganda has some capacity for conducting risk assessment of agents with zoonotic pandemic potential

Limited integration of laboratory diagnostic services for animal and human samples Inadequate capacity for zoonotic disease detection, reporting and investigation by MAAIF

Ministry of Health already has a system for routine analysis of surveillance data

Preferred tendency to develop different Ministry-specific contingency plans for the same zoonotic agents

Ministry-specific contingency plans for some of the zoonotic agents are available

Limited financial capacity to establish and maintain sentinel surveillance sites for zoonotic agents

WHO and CDC have previously trained multidisciplinary teams in planning, implementing and testing contingency plans

Strict funding regulations that do not allow utilization of ministry-specific financial resources for joint inter-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 have already agreed on a list of 7 prioritised zoonoses

Absence of basket funding for investigation and response to possible outbreaks of prioritised zoonoses

Ministry-specific case definitions, guidelines for responding to the prioritised zoonoses are available

Absence of Ministry-specific response plans for each of the prioritised zoonotic diseases

For some of the prioritised zoonoses, ministry-specific response plans are available

Absence of OHTWG Pandemic preparedness, Response and Research plan for prioritised zoonotic diseases

Ministry-specific surveillance systems for some of the prioritised zoonoses are available and functional

Uncoordinated implementation of prevention and control activities by the different ministries

Ministries have previously collaborated in investigation and response to some of the prioritised zoonoses

Limited opportunities to integrate and jointly review surveillance data for the prioritised zoonotic diseases

Joint After Action Reviews have been conducted for some of the prioritised zoonoses e.g. CCHF

Limited resources to implement known effective 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.

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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.

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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

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

Goal: Build resilient, sustainable systems to prevent and respond to Zoonotic diseases, address AMR and biosecirity

Objective 1:Objective 2:

Objective 3: Objective 4:Objective 5:Establish and

maintain high-levelcommitment at allrelevant levels ofgovernment andkey stakeholders

including theprivate sector

Institutionalize OneHealth within GoU

structures toachieve

sustainability andlegitimacy of the

One HealthPlatform to

coordinate multi-sectoral

collaboration

Strengthenprevention,

preparedness andresponse to

zoonotic diseases,AMR and bio-

security threats

Strengthencapacities of OH

platform and otherstakeholders to

effectively addresszoonotic diseasesthreats, AMR andbio-security issues

Enhance behaviorchange

communication andawareness of the

value of OHapproach

Vision: By 2022,reduce the burden ofprioritised zoonoses

and AMR by 50%through visionary

leadership toenhance

coordination andinnovation, with

shared responsibilityand accountability

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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 governance structure

Obtain a legal instrument to establishment of OH governing structure Build an effective and efficient OH infrastructure for governance

1.2 Mainstream OH in all relevant sectors

Develop policy to mainstream OH in all relevant sectors Develop costed 10 year national OH master plan

1.3 Provide an enabling environment for private sector participation

Develop OH policy, plans, public-private partnerships and MOUs to mainstream OH in all relevant sectors Provide technical support and training to the participating private sector enterprises

1.4 Mainstream gender and other vulnerable subpopulation issues in OH Initiative

Address and include gender and other vulnerable subpopulation issues in the OH policy, plans and activities

1.5 Support the academic sector to enhance science – based interventions

Sensitization and training in One Health at various educational levels

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 component of the GoU entity with OHTWG and ZDCO structures

Create directorate within a legally established entity or institute such as UNIPH Strengthen OH multi-sectoral Committees including OHTWG, its Sub-committees and ZDCO

2.2 Functionalise OH Platform by strengthening the structure and operations of the OHTWG and ZDCO

Recruit the right mix of technical expertise Continuous professional development, skilling and retooling

2.3 Establish budgetary provisions for the OH activities, including Monitoring and Evaluation

Effectively raise and manage funding

2.4 Establish an emergency fund to support 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

Prepare and submit proposal to government and partners for emergency fund Elaborate mechanisms for stakeholders to access the fund

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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 multi-sectoral preparedness and response plans.

Review and harmonise existing plans Develop joint monitoring and evaluation framework Integrate multi-sectoral after action reviews into OH programming

Conduct regular joint Table Top and field simulation exercises

3.2 Effectively utilise new surveillance methods and data to drive decision-making

Establish integrated, multi-sectoral surveillance system with centralised database

3.3 Build capacity for multi-disciplinary research

Establish community-based vulnerability and risk assessment mapping network

3.4 Harmonise sectoral activities for effective and efficient response to prioritised zoonoses, AMR and related bio-security issues

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 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 National Action Plan (NAP) with the OH Approach

Raise awareness and understanding of AMR and containment options Improve prevention, detection and control of infectious agents Optimise proper use of antimicrobial medicines Generate knowledge and evidence through surveillance Strengthen research and innovation on AMR

3.6 Mainstream biosecurity issues related to zoonotic diseases into the One Health Approach

Strengthen Cross-sectoral (Stakeholder) collaboration, coordination and linkages

3.7 Create sustainability by equipping OH Stakeholders with the capacity to develop and lead their own bio-security programmes against intentional contamination/ introduction with biological (zoonotic) agents

Capacity building: training and raise awareness on biosecurity Establish liaison with the national Bio-security Oversight Committee Conduct vulnerability assessments for weaknesses in zoonotic diseases control programmes for intentional contamination with biological agents Align the national bio-security framework, infrastructure, capacity, 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)

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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 experts

Select and train staff from all stakeholder sectors Establish an inventory of OH experts across the stakeholder sectors

4.2 Establish key competencies required for multi-sectoral coordination and collaboration

Conduct sector analysis for required OH competencies Conduct regular capacity needs assessments*

4.3 Develop and implement a training programme for OH platform and other stakeholders

Develop a OH training curriculum for pre-service and in-service cadres Conduct trainings*

4.4 Enable OH Experts with technology and tools

Provide the required tools and equipment*

*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 comprehensive One Health communication strategy to the public

Create awareness and support for One Health through effective advocacy, communication and training Develop a OH training curriculum for pre-service and in-service cadres

5.2 Create awareness and support for OH through effective advocacy, communication and training

Develop and implement a OH communication and advocacy plan

5.3 Sensitise interest groups (i.e. private sector, business enterprises, food vendors and media houses) on their roles and responsibilities in OH

Conduct sensitization activities based on the OH communication and advocacy plan Scale-up stakeholder membership and involvement

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

1.1 Establish/strengthen OH governance structure 180.0M 1.2 Mainstream OH in all relevant sectors 42.0M 1.3 Provide an enabling environment for private sector participation

30.0M


180.0M

1.5 Support the academic sector to enhance science-based interventions

100.0M

Total Budget SO 1 532.0M Strategic Objective 2: Institutionalise the One Health platform within Government of Uganda structures to achieve sustainability and legitimacy to coordinate multi-sectoral collaboration.

2.1 Establish OH platform as a component of the GoU entity with OHTWG and ZDCO structures

260.0M


160.0M

2.3 Establish budgetary provisions for the OH activities

90.0M

2.4 Establish an emergency fund readily accessible 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

35.0M

Total Budget SO 2 545.0M Strategic Objective 3: Strengthen prevention, preparedness and response to zoonotic diseases, AMR and bio-security threats.

3.1 Develop, implement, and monitor preparedness and response plans

991.0M

3.2 Effectively utilise new surveillance methods and data to drive decision-making

540.0M

3.3 Build capacity for multi-disciplinary research 320.0M 3.4 Harmonise sectoral activities for effective and efficient response to prioritised zoonoses, AMR and related bio-security issues

186.0M

3.5 Harmonise and align the AMR National Action 400.0M

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Strategic Objective Sub-Objective Budget (U SHS)

Plan (NAP) with the OH Approach 3.6 Mainstream biosecurity issues related to zoonotic diseases into the One Health Approach

55.0M


495.0M

Total Budget SO 3 2.987B Strategic Objective 4: Strengthen capacities of OH platform and other stakeholders to effectively address zoonotic diseases threats, AMR and bio-security issues

4.1 Recruit and build capacity of OH experts 180.0M 4.2 Establish key competencies required for multi-sectoral coordination and collaboration

180.0M


35.0M

4.4 Enable OH Experts with technology and tools 120.0M Total Budget SO 4 515.0M Strategic Objective 5: Enhance behaviour change communication and awareness of the value of the OH Approach

5.1 Develop and implement a comprehensive One Health communication strategy to the public

320.0M

5.2 Create awareness and support for OH through effective advocacy, communication and training

250.0M

5.3 Sensitise interest groups on their roles and responsibilities in OH

70.0M

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.

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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.

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Table 8: Summary of Indicators

Sub-Objective Indicator, Unit & Disaggregation 1.1 Establish/strengthen OH governance structure

Progress against the structure establishment plan 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 relevant sectors

National OH Policy Unit: progress toward implementation (draft, final, passed, implemented) 10 year national OH master plan established Unit: Yes/No

1.3 Provide an enabling environment for private sector participation

# of private sector entities involved in national or provincial One Health platforms or activities Unit: number


# of gender (or women's) ministries or focal persons participating in the NOHP Inclusion of gender situational analysis and gender integration (or gender mainstreaming) guidance in preparedness and response plans

1.5 Support the academic sector to enhance science-based interventions

#, level of educational institutions that have OH incorporated in their curricula Unit: Number, disaggregated by level

2.1 Establish OH platform as a component of the existing GoU structures through the OHTWG and ZDCO

Well defined organogram/structure Unit: Yes/No Well-equipped and maintained permanent office Unit: Yes/No


Number of permanent staff recruited (target = 10) Unit: Number % staff attending additional professional courses Unit: percentage

2.3 Establish budgetary provisions for the OH activities

Number of grant proposals that are developed across multiple sectors Unit: Number

2.4 Establish an emergency fund readily accessible 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

Number of proposals submitted Unit: Number Value of funds committed Unit: U SHS % of committed Funds released Unit: Percentage

3.1 Develop, implement, and monitor preparedness and response plans

% of surveillance methods allowing inter-sectoral linkage Unit: percentage # policy briefs produced from the surveillance data Unit: number, disaggregated by sector # new projects based on the surveillance data Unit: number, disaggregated by sector

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Sub-Objective Indicator, Unit & Disaggregation 3.3 Build capacity for multi-disciplinary research

# of multi-disciplinary research proposals produced 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 activities for effective and efficient response to prioritised zoonoses, AMR and related bio-security issues

% of joint simulations (all sectors represented) Unit: percentage # joint planning and budgeting meetings Unit: number, disaggregated by sector # joint budgets and plans produced Unit: number # public private partnerships for the project Unit: number, disaggregated by sector

3.5 Harmonise and align the AMR National Action Plan (NAP) with the OH Approach

# of awareness programmes disseminated in print and electronic media Unit: number # 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 biosecurity issues related to zoonotic diseases into the One Health Approach

% Stakeholders integrating biosecurity concerns in their policies, plans and activities Unit: percentage, disaggregated by sector


# of trainings conducted Unit: #, participants disaggregated by gender Functional liaison with Biosecurity Oversight Committee Unit: Yes/No Documented list of critical nodes (specific points) Unit: Yes/No Functional biosecurity network Unit: Yes/No

4.1 Recruit and build capacity of OH experts

# trainings that include more than one sector Unit: Number, participants disaggregated by gender % of sectoral curricula that include One Health concepts Unit: percentage, disaggregated by sector

4.2 Establish key competencies required for multi-sectoral coordination and collaboration

Analysis Report Unit: Yes/No Needs assessment reports Unit: Yes/No


Training curriculum Unit: curriculum # of cadres trained

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Sub-Objective Indicator, Unit & Disaggregation Unit: number, disaggregated by sector, gender

4.4 Enable OH Experts with technology and tools

% of required technology / tools available for One Health Experts Unit: percentage (calculated as # of available tools/# of WHO/OIE-recommended tools)

5.1 Develop and implement a comprehensive One Health communication strategy to the public 5.2 Create awareness and support for OH through effective advocacy, communication and training

# of communication meetings held Unit: Number, disaggregated by region # of communication products used Unit: Number, disaggregated by region, language # of institutions that have OH incorporated into training Unit: Number, disaggregated by sector

5.3 Sensitise interest groups on their roles and responsibilities in OH

% of Interest groups implementing the OH initiatives Unit: Percentage, disaggregated by sector # 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

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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.

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Annexes

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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.

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Figure 2: The Lake Victoria Basin and its boundaries, including elevations.

Source: EAC LVEMP 11 Project, 2003

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Figure 3: Wild bird migration into Africa

Figure 4: Potential hotspots for Avian Influenza in Uganda

Migration and waterfowl monitoring/resting sites in Uganda

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Lake George and Edward and

Kazinga channel

Lake Opeta and Bisina complex

Lake Victoraia Basin(Lutembe Ramssa site and wild bird sancturay)

Lake Mburo and surrounding mash wetlands

Lake Albert Marchison Fall National

Park

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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.

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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).

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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.

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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

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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.

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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.

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Annex 3: Leadership and Governance organogram of the Ministry of Health (MoH)

OFFICE OFTHE MINISTER

PERMANENTSECRETARY

DIRECTORGENERAL

RESOURCECENTRE

POLICY ANALYSISUNIT

DIRECTORATE OF PLANNINGAND DEVELOPMENT

DIRECTORATE OFCLINICAL AND COMMUNITY

HEALTH SERVICES

COMMISSIONERNURSING

DEPARTMENTOF NATIONAL

DISEASE CONTROL

DEPARTMENTOF COMMUNITY

HEALTH

DEPARTMENTOF CLINICAL

SERVICES

DEPARTMENTOF

PLANNING

DEPARTMENTOF QUALITYASSURANCE

DEPARTMENTOF FINANCE ANDADMINISRATION

HEALTH SERVICESCOMMISSION

National Level Institutions

Professional CouncilsMedical &Dental Practitioners CouncilNurses & Midwives CouncilPharmacists CouncilAllied Health Practitioner’s Council

National Drug AuthorityNational Medical StoresUganda Health Research OrganizationUganda Virus Research InstituteUganda Cancer InstituteNational Referral HospitalsNational Blood Transfussion ServicesNational Public Health Laboratory ServicesNational Chemotherapeutic Research Labaratory

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Annex 4: Organization of human health services delivery in Uganda

Village Health Committees

HealthCenter II

HealthCenter II

HealthCenter II

HealthCenter III

HealthCenter III

Health Centre IV & Laboratory (Publicor Private)

National Referral Hospitals &National Reference Laboratories

Regional ReferralHospitals & Laboratories

Ministry of HealthHeadquarters & NFP

District Health Services Headquarters&

General Hospital & Laboratory (Public or Private)

WHO & otherHealth Partners

National Level

Regional Level

District Level

County Level

Parish Level

Commuity Level Services 1,000 people (participate in PHC)

Provide free PHC services (outpatient &community interventions) to 5,000 people

Provide free PHC services (all above plusinpatient, and laboratory) to 20,000 people

Provide free PHC services (all above plusemergency surgery & blood transfusion)to 100,000 people

Provide free PHC & 2ND care servicesto 500,000 people (user fees charged inprivate wings of the hospital)

Provide free tertiary care for 2,000,000 people (userfees charged in private wings of the hospital)

Free specialized care for 30,000,000 people (userfees charged in private wings of the hospital)

Other Sectors & PortHealth Serices

Sub-county Level

District H

ealth Service

Health Sub D

istrict

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Office of the Minister

Permanent Secretary

Resource Center

National Agriculture Advisory Service(NAADS) Uganda Coffee Development Authority

Diary Development Authority Cotton Development Organisation

Directorate of Crop Resources

Crop Rotation Crop Protection FarmDevelopment

AnimalProduction

FisheriesResources

Finance & &Administration PMA Secretariat Agricultural Planning

Livestoke Health& Entomology

Directorate of AnimalResources & Fisheries

National AnimalGeneric Resource CenterNational Agriculture Research Organisation

Policy Analysis Unit

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Annex 5: Structure for Ministry of Agriculture, Animal Industry and Fisheries (MAAIF)

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International & RegionalOrganisations

Development PartnersBilateral

AgricultureSector

WorkingGroupMultilateral

Agriculture Services andGoods ProvidersCivil Society OrganizationsNon-GovernmentOrganizationsFarmer Organizations

Private Sector and CivilSociety

Ministry of Agriculture, AnimalIndustry and Fisheries

& the MAAIF Semi-AutonomousAgencies

Coordinating Office for theControl of Tripanosomiasis inugandaCotton DevelopmentOrganizatonDairy Development AuthorityNational Agriculture AdvisoryServicesNational Agriculture Research OrganizationNational Genetic ResourceInformation Center and DataBankUganda Coffee DevelopmentAuthority

LGsDistrictsSub Counties

FarmersCommercial, Medium & Small

AcademiaUniversitisAgricultural TrainingInstitutions

MinistriesEnergy and MineralDevelopmentEducation and SportsFinance Planning &Econimic DevelopmentGender Labour and SocialDevelopmentHealthLocal GovernmentLands Housing and UrbanDevelopmentPublic ServiceTourism, Wildlife andAntiquitiestrade Industry andCooperativesWater & EnvironmentWorks and Transport

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Annex 6: Organizational structure of Uganda Wildlife Authority (UWA)

Board ofTrustees

ExecutiveDirector

Director Tourismand Business

Director Finance

ED’S Secretary

Secretary

Monitoring andEvaluation

PartnershipCordinator

PublicRelationsManager

ICTManager

PrincipleLegal

CommunicationsManager

MarketingManager Concessions

ManagerBusiness Devt

Manager

Senior Warden ICT

Warden ICT Warden L:egal

Ass WardenMaintenanceRetail

ExecutiveProduct

Dev’tExecutive

Marketing &Research

O�cer

Senior WardenReservations

WardenReservations

Ass. WardenReservations (2)

WebsiteExecutive

Senior WriterProcurement

Manager

WardenProcurement

Ass. WardenProcurement

HRManager

SeniorWarden HR

SeniorWarden LE

Secretary

Warden HR

LawEnforcementCoordinator Monitoring &

ResearchCoordinator

O�ceAttendants (5)

Admin Sec

AccountsClerk (2)

Support Sta�

RangersDrivers

Senior Drivers (2)

Transport O�cer

Mechanical &Maintenance Engineer

VeterinaryCoordinator

Pilot

Ass. Wardens

Wardens

Senior Wardens

Conservation Area Manager (7)

Receptionist

Stores Clerk

Ass WardenInternal Audit

WardenInternal Audit

ManagerInternal Audit

ManagementAccountant

FinancialAccountant

WardenAccounts (4)

WardenAccounts (2)

Senior WardenAccounts

Senior WardenMonitoring &Research (2)

Planning & E/ACoordinator

Senior WardenPlanning & E/A (2)

ProblemAnimal

O�cer (2)

CommunityConservationCoordinator

CommunityConservation

Warden (2)

Senior WardenLegal

Secretary Secretary Secretary

Secretary

Director ConcervationDirector Legaland Corporate A�airs

Chief Conservationarea manager

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Annex 7: Organizational structure of Ministry of Water and Environment

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Annex 7: Organizational structure of Ministry of Water and Environment

Ministry of Water andEnvironment

Directorate of WaterDevelopment

(DWD)

Directorate of WaterResources Management

(DWRM)

Directorate of Environment Affairs

(DEA)

Departments:. Urban Water Supply and Sewerage. Rural Water Supply and Sanitation. Water for Production

Departments:. Water Resources Monitoring and Assessment. Water Resources Planning and Regulation. Water Quality Management. International & Transboundary Water Resources Mgt. Dept

Departments:. Environmental Support. Wetland Management. Forestry Sector Support

(Reporting to the Minister). National Forestry Authority (NFA). National Water & Sewerage Corporation (NWSC). National Environmental Management Authority (NEMA)

. Uganda national Met Authority (UNMA)

Reporting to the PS

. Finance & Admin Dept. Internal Audit

. Policy & Planning dept

. Procurement & Disposal Unit

Climate Change Dept

Human Resources Mgt. Unit

Water & EnvironSector Liaison Dept.

DEPARTMENT AND UNITS

AGENCIES

. Water Utility Regulation

Documents

UGANDA ONE HEALTH STRATEGIC PLAN 2018 - 2022 OHSP Final Laun… · OHCEA One Health for Central and East Africa OH One Health OHSP One Health Strategic Plan OHTWG One Health Technical