GEAR up colleagues Meenakshi Monga and Katy Davis give in-depth report back from last month’s ‘Gendered vulnerabilities to infectious disease: A call to action for global health equity’ webinar.
Gender profoundly influences health outcomes globally, with women and girls bearing a disproportionate burden of infectious disease, due to complex biological, social, and economic factors forming health obstacles. However, gender considerations often remain on the periphery of global health responses, with policies and programs frequently adopting a “one-size-fits-all” approach that overlooks the distinct needs and experiences of women and girls and non-binary people.
In a recent webinar that underscored the urgent need to dismantle these barriers, experts examined the current landscape of gender inequality and identified innovative and actionable strategies for progress. This included fresh perspectives on vulnerability as a crucial lens for understanding deeper systemic inequities in global health and the critical need for gender-responsive Universal Health Coverage (UHC). Speakers also explored how sustained financial investments are pivotal for closing gender health gaps, while our own GEAR up colleague Dr. Katy Davis spoke about how gender norms and power imbalances influence Antimicrobial Resistance (AMR).
Hosted by the Infectious Disease Alliance (IDA) the webinar served not only as a pivotal platform to examine the current landscape of gender inequality, but also a forum for identifying innovative and actionable strategies for progress.
The webinar featured compelling presentations from Dr. Jessica Ogden and Kinza Hasan, and a dynamic panel discussion with Dr. Irene Aninye, Debanjana Choudhuri, Dr. Katy Davis, and Dr. Michelle Remme, focusing on advocating for gender equity within the infectious disease sphere, particularly concerning equitable policy and the protection of vulnerable populations. A subsequent Q&A session fostered engaging dialogue and exploration of potential solutions.
Keynote highlights: Rethinking vulnerability and universal health coverage
Dr. Jessica Ogden challenged traditional public health frameworks by reframing vulnerability not as an individual deficit, but as a crucial lens for understanding deeper systemic inequities. Drawing lessons from the AIDS crisis, she emphasised the need to shift focus towards structural and social determinants of health. Dr. Ogden critiqued interventions that superficially label themselves “gender transformative” without addressing the underlying systemic issues, often placing the onus of change on marginalised populations. While acknowledging recent positive global developments, she stressed that these are insufficient amidst shrinking global health funding. Her powerful call to action urged collective, cross-sectoral coalition-building across gender, health, education, and economic development sectors.
Kinza Hasan underscored the urgent need for gender-responsive UHC amidst declining international aid and the rise of anti-rights movements. She highlighted the stagnation of progress in gender equality in health, exacerbated by the COVID-19 pandemic, political instability, and backlash against gender rights. Ms. Hasan emphasised that UHC must be inherently gender-responsive, integrating sexual and reproductive health and rights (SRHR) and addressing the unique barriers faced by marginalised groups at every level of care. Her recommendations included systemic transformation through primary health care, establishing accountability mechanisms for governments, and safeguarding multilateral spaces from anti-gender movements. She also advocated for intergenerational leadership and the meaningful inclusion of youth in shaping future health systems.
Panel discussion: Advocating for gender equity in infectious disease
The panel discussion, featuring Dr. Irene Aninye, Debanjana Choudhuri, Dr. Katy Davis, and Dr. Michelle Remme, delved deeper into how to promote gender equality across different sectors and at all levels of public health policy and programs.
Key insights from the panel
Dr. Aninye, Chief Science Officer, Society for Women’s Health Research: Sustained financial, temporal, and institutional investments are crucial for closing gender health gaps. Global health initiatives must be context-specific, and disaggregated data collection by sex, gender, and other social markers is essential for equitable interventions.
Debanjana Choudhuri, Executive Director, Women’s Global Network for Reproductive Rights: Gender norms and biases in the Global South significantly limit women’s access to healthcare, particularly SRHR. Addressing stigma, increasing information access, and building the capacity of healthcare providers are vital mitigation strategies, especially amidst global funding cuts impacting SRHR.
Dr. Katy Davis, Post-Doctoral Research Associate, Liverpool School of Tropical Medicine, GEAR up Consortium: Gender norms and power imbalances influence AMR, affecting exposure, care-seeking, and socioeconomic outcomes. AMR interventions should address social drivers of disease, led by community priorities, and health surveillance needs intersectional, community-led data collection.
Dr. Michelle Remme, Manager, Thematic Cluster for Human Rights, Gender and Health Equity, The Global Fund: Achieving UHC requires focusing on structural factors like gender inequality, rather than solely on individual behaviour. Addressing women’s lack of agency and investing in community-led organisations and multi-sectoral approaches are critical for tackling gender and social determinants of health.
The Q&A session further emphasised the importance of community-led responses, drawing lessons from HIV and TB activism, and the need for gender and equity considerations in AMR surveillance, including intersectional data analysis to reach marginalised populations.
Conclusion
The webinar underscored that embracing vulnerability could catalyse empathy and drive social change, while equitable health systems demand structural transformation centred on gender-responsive universal health coverage and intersectional justice. Achieving this requires dismantling entrenched inequities through cross-sector collaboration, context-specific interventions, and amplifying marginalised voices, particularly in the Global South. Prioritising disaggregated data, community-led solutions, and sustained investment in grassroots and feminist initiatives is vital to counter misinformation, address gender biases, and reverse setbacks in sexual and reproductive health rights. By reorienting health systems to tackle structural drivers—from antimicrobial resistance to agency barriers—and fostering multi-sectoral alliances, global health can progress towards inclusive, resilient outcomes. The path forward hinges on centring equity, challenging power imbalances, and ensuring that no community is left behind in the pursuit of health justice.
In this blog post, Michael Gaitho, a Gender Expert from LVCT Health with a deep passion for global health and sustainable development, shares his insights into Antimicrobial Resistance (AMR). He reflects on his recent time spent in Uganda, collaborating with colleagues to refine strategies that ensure effective interventions in AMR programming.
AMR is one of the most pressing global health threats, affecting both human and animal health. This multifaceted challenge needs innovative and urgent solutions, yet discussions often remain confined to the realms of pathogens and treatment efficacy.
As always, let’s start with the basics: What is AMR?
AMR occurs when bacteria and other microorganisms develop resistance to antimicrobial drugs, such as antibiotics, rendering these treatments less effective against infections.
All too often, the critical socio-behavioral aspects of antimicrobial consumption (AMC) and antimicrobial use (AMU) are overlooked. This is where the Human-Centered Design approach comes into play, prioritising a deeper understanding of the people behind the data. By exploring disparities based on age, sex, and various social determinants, we can cultivate a more equitable and effective response to AMR.
Getting It Right: Stakeholders Workshop in Uganda
In March 2025, a workshop was held in Uganda, bringing together key stakeholders to review essential AMR documents. The focus was on integrating gender and equity into strategies and refining approaches to ensure effective interventions.
Throughout the week-long event, participants discussed how to incorporate Human-Centered Design principles into AMR programming. The goal was to ensure that interventions address existing inequalities and are tailored to meet the diverse needs of various populations.
Why does a Human-Centered Design approach matter?
Traditional strategies to address AMR have often remained entrenched in the biomedical realm, focusing solely on pathogen surveillance and antibiotic efficacy. Unfortunately, this narrow lens overlooks critical social, economic, and gender-related factors influencing AMU, AMC, and ultimately, AMR outcomes.
The Human-Centered Design approach pivots this paradigm. Focusing in on individual behaviors, needs, and vulnerabilities, creates a richer understanding of how AMR manifests across different groups. This understanding enables better interventions that target inequities.
The approach extends beyond data collection; it’s a call to action. Disaggregating data by age, sex, and other social variables, ensures that no one is left behind in the crucial fight against AMR.
Key elements of Human-Centred Design in AMR programming
A human-centered approach takes into account the lived experiences and constraints of people within their communities, highlighting three key elements:
Gender sensitivity: Addressing gender disparities in access to antibiotics and healthcare is crucial. Research indicates that women often face significant barriers to appropriate AMU, influenced by societal norms and healthcare-seeking behaviors.
Age considerations: Different age groups, particularly children and the elderly, exhibit unique vulnerabilities to AMR. Understanding these differences is vital as physiological factors and access to healthcare can significantly influence outcomes.
Socioeconomic influences: Poverty and limited education exacerbate the misuse of antibiotics, fueling resistance. By understanding the interplay between these factors, we can design interventions that are more effective and sustainable.
By weaving these considerations into the fabric of AMR programming, we take steps toward creating interventions that are not only effective but just and sustainable in Uganda.
One Health and Human-Centered Design: A converging framework
The Human-Centered Design approach aligns seamlessly with the One Health framework, which emphasises the interconnectedness of human, animal, and environmental health.
Discussions led to revisions in animal health surveillance tools to include gender-sensitive and socioeconomic variables. Proposed changes to AMR reporting for cattle, for instance, aim to assess differential antibiotic access between smallholder farmers and commercial producers, an essential step given the significant role of livestock farming in AMR proliferation.
Human health and AMR surveillance
The recent meeting prioritised revising national microbiology data collection tools to incorporate gender and equity considerations. Dr Susan Nabadda Ndidde, Commissioner of Public Health Laboratories, highlighted the necessity of expanding AMR surveillance in private healthcare facilities.
Environmental Considerations in AMR Programming
While the discussions were primarily centered on human and animal health, the impact of environmental factors cannot be overlooked. Contamination through wastewater, agricultural runoff and improper disposal of antibiotics contributes to AMR. The meeting called for localised interventions that address specific community environmental risks.
Stakeholder meeting at Public Health Laboratories
Key outcomes from the stakeholder engagement meeting
Introduction of the BALANCE Study Protocol
A major highlight was the introduction of the BALANCE study, a prospective research initiative comparing the health and economic burden of AMR in low- and middle-income countries versus high-income countries. By generating robust demographic, socioeconomic and clinical data, this study will inform targeted antibiotic stewardship programmes.
Capacity building on gender and equity in AMR
LVCT Health led an interactive session on integrating gender and equity considerations into AMR programming. Participants were equipped with tools to assess gender disparities in AMU, reinforcing the importance of data disaggregation to enhance intervention effectiveness.
Revision of data collection tools
The revision of national microbiology and animal health data collection instruments to include gender and socioeconomic indicators was a significant achievement. This ensures that AMR surveillance aligns with equity-focused global health agendas.
Community engagement strategies
The Animal Health Unit emphasized a shift from policy and technical discussions to community awareness initiatives on AMR. This community-centered approach aligns with evidence from previous One Health studies, which highlight the importance of participatory engagement in AMR mitigation.
Next steps
The meeting concluded with actionable commitments:
Finalisation and Validation of the AMR report: The AMR/C/U draft report will be reviewed by the National Technical Working Committee (TWC) and is set to be published this year.
Completion of the AMR Monitoring & Evaluation Plan: This plan will be aligned with Uganda’s national and international AMR goals to ensure effective tracking of progress.
Continued stakeholder collaboration: Ongoing engagement with policymakers, practitioners, and researchers will ensure that gender and equity considerations remain central to AMR interventions.
Conclusion
Adopting a Human-Centered Design approach in AMR programming reflects a critical shift from pathogen-centric strategies and towards interventions that put people and communities first. The Uganda stakeholder engagement meeting emphasised the necessity of integrating gender, age and socioeconomic factors into AMR surveillance and mitigation strategies. Moving forward, incorporating Human-Centered Design principles in AMR research and policy implementation will be essential for achieving equitable and sustainable health outcomes.
As we address the AMR crisis, we must remember that every case of antimicrobial resistance involves a person; a patient, a farmer, or a child whose life is impacted. By designing AMR interventions that prioritise people, we can establish a more resilient and health-secure future.
The meeting was hosted by the Baylor College of Medicine Children’s Foundation Uganda, in collaboration with LVCT Health, the Liverpool School of Tropical Medicine, and the University of St. Andrews, this historic stakeholder engagement meeting took place at the Center of Excellence in Mulago, Kampala.
This International Women’s Day our colleague Meenakshi Monga explains that it’s a time to celebrate progress, but also an opportunity to confront the persistent inequalities that hold women back. One crucial, often overlooked, area is the gender-specific impacts of antimicrobial resistance (AMR) on women. AMR is a growing global threat, posing serious challenges to health, and its consequences influence women at every stage of life.
As GEAR up we seek to catalyse action on gender and equity within AMR by supporting Fleming Fund country grantees to mainstream gender and equity within routine AMR systems and structures. GEAR up aims to increase awareness, and contribute to the knowledge, on structural inequities driving and shaping the AMR response, including those affecting women.
What is AMR and why should we care?
AMR occurs when bacteria, viruses, fungi or other parasites become resistant to antibiotics. This makes infections harder to treat, sometime untreatable, thus increasing the risk of severe illness, disability and death. This can be increased by non-completion or non-recommended use of antibiotics (WHO).
The ways that people use antimicrobials are often due to persistent inequities that limit health seeking autonomy, purchasing power when it comes to appropriate medicines and access to diagnostic testing. This can particularly affect women whose choices are limited by social norms and economic inequalities (Gautron et al, 2023). This is not about women misusing medicines, but instead harmful power structures that affect the decisions they can make.
Understanding the impact of AMR on women across life course
AMR is not merely a global health crisis; it is a critical gender equity issue, profoundly impacting women throughout their life course.
Girl infancy and childhood: Vulnerability from the start
Malnutrition increases susceptibility to some resistant infections such as MDR-TB. In food-insecure households, girls may face unequal access to nutritious food and healthcare, compounding this vulnerability.
People can be exposed to AMR through water sources. Girls and women are often responsible for collecting water for households and are therefore more exposed to contaminated water. Furthermore, inadequate sanitation systems increase the risk of resistant infections spreading among girls.
Women in reproductive years: Bearing the burden
Women are largely responsible for household domestic labour, which includes cooking and food handling. Handling uncooked food increases the risk of exposure to resistant infections. Smoke inhalation while cooking can also increase susceptibility to resistant infections such as pneumonia.
Menstruating teenagers and women in many contexts are particularly vulnerable to drug resistant UTIs (Urinary tract infections) and RTIs (Reproductive Tract Infections).
Women often face greater barriers to accessing health information, and associated knowledge about antibiotic use, than men.
Rates of unnecessary prescribing of antimicrobials to pregnant women are very high. Increased exposure to antimicrobials, especially during pregnancy increases their risk of developing resistance.
Women may have to seek permission to access health services from men or older relatives, creating barriers to accessing timely diagnosis and treatment.
Frontline health workers are often predominantly women, and these roles increase exposure to resistant infections, particularly in hospital settings.
Gendered division of farming work may mean that women are particularly exposed to resistant zoonotic disease and antibiotics used in livestock yet may be least targeted in animal vaccination and agricultural or aquacultural AMR training initiatives.
Elderly women: Facing isolation and caregiving challenges
Elderly women have limited access to social networks, social media and health facilities hindering their access to vital information about AMR and antibiotic use.
Hormonal shifts during menopause can further increase susceptibility to infections, thus, highlighting the need for timely treatment.
In many contexts, older women take on caregiving roles of children and ill family members, which can increase their likelihood of exposure to resistant infections.
Accelerating action: A gender-transformative approach
The disproportionate burden of AMR on women and girls calls for serious actions and policy advancement. To effectively combat AMR, a gender-transformative approach can support in addressing the root causes of inequity.
Research on intersectional drivers: We must accelerate actions on the intersectional drivers of AMR, recognising the complex interplay of factors affecting women’s vulnerabilities. This means moving beyond simplistic gender analyses to consider how overlapping social locations, such as socioeconomic status, ethnicity, and geographical location, compound risks. This highlights the need to address social determinants of health in AMR responses (GEAR up).
Gender specific policies: National action plans for AMR should explicitly integrate gender and equity considerations to ensure that interventions are tailored to the diverse needs of all populations, thereby promoting effective and sustainable solutions. Furthermore, it is imperative to involve women leaders at the national level to ensure research-led policy decisions incorporate gender equity considerations into healthcare treatments and AMR national action plans (Lynch I et. al, 2024). This ensures the diverse needs and experiences of women are reflected in national strategies, leading to more effective and equitable outcomes.
Gender-transformative AMR interventions: We need to accelerate the development and implementation of gender-transformative AMR interventions that address the unequal drivers of AMR in human health and agriculture. This approach acknowledges that social and gender norms significantly influence human, environment and agricultural practices that contribute to AMR. For instance, research indicates that women in agricultural settings may have limited access to veterinary services or information on responsible antibiotic use, impacting livestock health and contributing to AMR spread (Bridging the Gender Gap in Animal Health Services, FAO 2024). Interventions that specifically address these unequal drivers of AMR across One Health will ensure equitable access to resources and knowledge.
The participation of women in decision-making: Women-led participation is essential for: Informing research on the intersectional factors driving AMR; shaping gender-specific policies; and delivering gender-transformative interventions for AMR. Their voices are central to addressing AMR in communities. This strategy aligns with the growing recognition that gender-transformative interventions are essential for public health initiatives. For example, in rural communities facing low rates of antibiotic continuation, a woman-led initiative could involve establishing local workshops where women, often primary caregivers, share knowledge about hygiene practices and responsible antibiotic use, fostering community-driven solutions (Barasa V, 2024 and Batheja et al, 2025).
This International Women’s Day, let’s commit to empowering women as change agents in the fight against AMR. By addressing their unique vulnerabilities, we can create a healthier future for all.
In this blog Susan Okioma and Anne Ngunjiri discuss their time spent in Uganda during World AMR Awareness Week, with the National AMR Sub-Committee, looking at Uganda’s National AMR Action Plan and integrating gender and equity into AMR programming.
Antimicrobial resistance (AMR) is one of the most pressing global health challenges, threatening decades of medical progress and disproportionately affecting low- and middle-income countries. In East Africa, AMR not only undermines public health systems but also exacerbates inequities in access to healthcare. Addressing AMR requires not just scientific innovation but also a people-centred approach that integrates gender and equity into programming.
Recognising this need, Uganda’s National One Health Platform took a significant step towards revolutionising its fight against AMR by hosting a transformative workshop that focused on integrating gender and equity into the country’s AMR surveillance frameworks and action plans. The meeting held from the13th to 15th November 2024 in Entebbe was attended by the Technical Working Group (TWG) members and the AMR Secretariat members.
In his opening remarks, the chairman of the National AMR Sub-Committee (NAMRSC) Ibrahim Mugerwa captured the essence of the workshop’s purpose by stating, “AMR isn’t just about pathogens and drugs—it’s about people and the systems that affect their lives. This workshop reminds us why it’s critical to include everyone in the fight against AMR, especially the most vulnerable ensuring no one is left behind in accessing the care and protection they deserve.” Similarly, the program manager at the Baylor College of Medicine, Rogers Kisame added, “This workshop marks a turning point in how we approach AMR programming. By integrating gender and equity considerations, we’re addressing the root causes of disparities and building a stronger, more inclusive foundation for combating antimicrobial resistance in Uganda.”
The TWG workshop brought together stakeholders to review and revise Uganda’s AMR National Action Plan and surveillance tools, ensuring that they address the unique vulnerabilities and disparities affecting different populations, thereby setting the stage for more inclusive and effective AMR responses.
Rogers Kisame, Program Manager at Baylor College of Medicine giving his welcome remarks during the meeting.
The workshop achieved several objectives:
Building capacity on gender, equity, and intersectionality: Stakeholders were equipped with essential knowledge on gender and equity concepts, emphasising the importance of incorporating these principles into AMR programming. Participants explored how social determinants such as gender, socio-economic status, and disability intersect to influence susceptibility to drug-resistant infections, health-seeking behaviours, and antimicrobial consumption. This session underscored the need for AMR surveillance to evolve beyond a focus on “bugs and drugs” toward people-centered, equitable practices grounded in effective governance, multisectoral collaboration, and evidence-based strategies.
Applying an intersectional lens to AMR risks: The workshop introduced participants to the concept of intersectionality, providing insights into how overlapping factors shape vulnerabilities to AMR risks. By recognising the varied risks faced by different populations, this approach ensures that AMR interventions do not inadvertently create inequities. Participants discussed practical applications, paving the way for solutions that promote gender equality and address social determinants in AMR strategies.
Strengthening Uganda’s AMR Action Plans and surveillance tools: Through a collaborative review process, stakeholders examined key national documents, including:
The Uganda Antimicrobial Resistance National Action Plan (2024–2029)The National Antimicrobial Resistance Surveillance Plan for Human Health (2019–2023)
Various implementation and monitoring tools, such as laboratory registers, test request forms, and point prevalence survey forms.
By applying a gender and equity lens, stakeholders identified gaps and proposed actionable recommendations to enhance inclusivity and responsiveness. The recommendations highlighted the need for disaggregated data beyond sex and age, incorporating variables such as education level, marital status, and disability. These refinements aim to improve the quality and relevance of AMR data for guiding interventions.
Fostering collaboration for inclusive AMR programming: Discussions emphasised the importance of partnerships among the Ministry of Health, private sector actors, and implementing partners to ensure sustained, inclusive AMR programming. These collaborations aim to create shared accountability and collective action in addressing AMR challenges across sectors.
Drafting a framework for gender and equity integration: The development of a draft terms of reference (ToR) for a gender and equity focal team marked a significant step forward. This team will serve as a guiding body to ensure that gender and equity considerations are systematically integrated into Uganda’s AMR programming, reflecting a long-term commitment to inclusivity and sustainability.
This workshop demonstrated that integrating gender and equity into AMR programming is not just an ethical imperative but also a practical necessity for effective interventions. By embracing intersectionality, fostering collaboration, and refining national plans, Uganda is setting the stage for a more inclusive and impactful response to antimicrobial resistance.
Role of LVCT Health in Uganda’s AMR Programming
LVCT Health, as the East Africa Regional Lead for the GEAR up project under the Fleming Fund’s Phase II, has been instrumental in driving the integration of gender and equity into Uganda’s AMR programming. Recognising the critical gaps in AMR frameworks and tools, LVCT Health provided targeted technical assistance during the workshop, ensuring that gender and equity considerations became central to Uganda’s AMR response strategies.
As part of its role, LVCT Health led by their gender and equity expert, facilitated the comprehensive capacity-building sessions for the TWG members. These sessions focused on equipping participants with foundational knowledge of gender and equity concepts, why they are essential for AMR programming, and how to apply them in practice. The team emphasised the importance of intersectionality, illustrating how overlapping factors such as gender, socio-economic status, and disability influence AMR risks, health-seeking behaviours, and treatment access. This holistic understanding enabled stakeholders to review key AMR documents and surveillance tools effectively using a gender and equity lens.
LVCT Health also guided the revision of critical documents, such as the Uganda AMR National Action Plan and surveillance tools, ensuring they addressed gaps in data disaggregation and incorporated variables beyond sex and age. By leading these efforts, LVCT Health strengthened Uganda’s capacity to adopt inclusive and responsive AMR programming. This initiative highlights LVCT Health’s commitment to embedding gender and equity considerations in a systematic and sustainable manner, not just in Uganda but across the East Africa region.
The Uganda and LVCT Health monitoring and evaluation team reviewing the AMR surveillance tools to incorporate gender and equity stratifications.
Launch of the Uganda AMR National Action Plan
On November 20, 2024, the Uganda National Action Plan for the Containment and Prevention of Antimicrobial Resistance 2024-2029 was officially launched alongside the AMR Strategic Plan at the 9th Antimicrobial Resistance Conference 2024, themed “Educate, Advocate, Act Now.” These documents were endorsed by the ministry directors of the One Health Platform, including the Ministry of Health, the Ministry of Agriculture, Animal Industry and Fisheries, the Ministry of Water and Environment, and the Ministry of Tourism, Wildlife and Antiquities. This significant milestone underscores Uganda’s commitment to a coordinated and inclusive approach in the fight against AMR, signaling the government’s dedication to taking decisive action against this critical public health threat.
Ugandan Minister of Health, Dr Jane Aceng, signs the new National Action Plan (NAP) 2024-2029, which incorporates gender and equity considerations.
The event brought together development partners, collaborators, implementing partners, academia, and community-level stakeholders, creating a platform to reflect on Uganda’s progress in addressing AMR. The conference provided an opportunity to align these plans with the outcomes of the recent workshop, particularly regarding the integration of gender and equity considerations into AMR programming. The revised National Action Plan (NAP), informed by the workshop outcomes, represents a significant transformation—shifting from a gender-blind framework to a gender-responsive one. By incorporating gender and equity considerations, the NAP now addresses the unique vulnerabilities and needs of diverse populations, ensuring that AMR interventions are inclusive and effective. Stakeholders emphasised that the reviewed plans and tools will guide Uganda in addressing vulnerabilities and ensuring that AMR interventions are equitable, evidence-based, and sustainable.
The LVCT Health GEAR UP Team poses for a photo with Uganda’s Minister of Health, Dr. Jane Aceng.
Additionally, the launch was celebrated as a call to action, encouraging stakeholders to advocate for the successful implementation of the AMR plans and foster multi-sectoral collaboration at every level. This significant step underscored the importance of aligning national efforts with global strategies for combating AMR, ensuring that Uganda remains at the forefront of inclusive and innovative AMR solutions in the region.
Stakeholder engagement, reflections, and lessons learned There was a general appreciation for the gender and equity component introduced during the workshops, with participants noting that AMR programming had initially been gender-neutral/blind. The sensitisation sessions on gender, equity and intersectionality to AMR provided the participants a clear understanding of why these elements are critical for effective and inclusive AMR programming. Participants widely appreciated the in-country technical support provided by LVCT Health as part of the GEAR up team, acknowledging their efforts in reviewing key documents, facilitating sessions, and providing actionable recommendations. This engagement laid the foundation for continued collaboration and strengthened the resolve to mainstream gender and equity into AMR programming at all levels. Participants strongly emphasised the need for continuous capacity-building efforts on gender and equity programming in AMR. They noted that sustained training and technical support are essential for embedding these principals into programming at all levels, ensuring long-term impact and inclusivity.
Participants working in groups to review and integrate gender and equity into the strategic documents.
This engagement also helped stakeholders recognise the importance of data disaggregation beyond sex and age to include variables such as education, marital status, and disability, enabling a more nuanced approach to addressing disparities. Many participants found the concept of intersectionality transformative, with one microbiologist reflecting, “Just sitting here and listening to the gender and equity angle of AMR and the concept of intersectionality is such an eye-opener. As a microbiologist, my focus has been on pathogens, specimen, samples and isolates. It would be beneficial to think beyond bugs and drugs, as you have mentioned, and to put a human face behind the samples collected.”
The workshop further emphasised the need for collaboration across sectors. Stakeholders agreed that sustainable and inclusive AMR programming requires collective action, drawing on the strengths of government bodies, private sector actors, and implementing partners. One doctor remarked “ This gender and equity component stayed too long in Nairobi, it should have come much earlier as it is going to change the direction and quality of AMR programming in this country in such a positive way; this is the paradigm shift needed for Uganda to make meaningful progress in AMR initiatives in this country.”
The outcomes highlighted the importance of sustained technical support, ongoing stakeholder engagement, and the systematic integration of gender and equity into AMR frameworks, ensuring that interventions are inclusive and address the diverse needs of affected populations.
The development of a draft Terms of Reference (ToR) for a Gender and Equity focal team was discussed, providing a framework to guide ongoing efforts in integrating gender and equity into AMR programming. This step reflects the commitment of stakeholders to embedding these principles systematically into future initiatives.
Looking ahead: Sustaining progress in gender and equity integration in Uganda’s AMR programming
Building on the achievements of the workshop and the launch of the revised AMR National Action Plan, Uganda is committed to deepening gender and equity integration within its AMR programming. To ensure sustained progress, several priority actions have been identified:
Building the capacity of the TWG on gender and equity through targeted training and resources enabling them to integrate strategic gender and equity consideration into all aspects of AMR programming.
Enhance continuous consultation and stakeholder engagement from diverse sectors to promote inclusive decision-making and foster collaboration.
Provide extended technical support from the GEAR up team aimed at fully integrating gender-responsive and equity-focused AMR programming in Uganda.
Establishing and empowering gender and equity champions to advocate for and drive the integration of gender and equity at every level of AMR programming
Acknowledgements: The content of this blog was reviewed by the following to ensure accuracy of content and relevance: Jane Thiomi, Dr Cleophas Ondieki, Pacific Owoundo, Anthony Mwaniki and Festus Mutua.
Last month GEAR up’s Rosie Steege presented on gender, equity and AMR at the 8th Global Symposium on Health Systems Research in Nagasaki, as part of a session on social, environmental and ecological justice concerns.
Rosie opened by highlighting the fact that ‘One Health’ centres the interconnectedness of animals, humans and the environment. In doing so, it rejects a reductionist approach, removes binaries and there is therefore significant overlap between One Health and intersectional, feminist thought.
Rosie then used AMR, as a quintessential One Health issue, to highlight the importance of an intersectional & bio-social approach to equitable healthcare.
AMR is it driven and shaped by environmental factors such as climate change, rapid urbanisation and environmental degradation. It also intersects with conflict which results in widespread disruption to healthcare systems, contamination from heavy metals and the establishment of refugee camps. In this way, it intersects with issues of environmental racism for those experiencing poor living conditions globally – including those living in urban informality who face crowded environments, poor access to water and sanitation and live and work in close proximity to animals and wastewater.
The current biomedical approach focusses on AMR surveillance data at facility levels. While we want to celebrate and recognise the amazing efforts in surveillance data globally, we also know that infrastructure has more impact on health than hospitals. So, we need to recognise a biomedical approach doesn’t pay due attention to the structural inequities that shape susceptibility, exposure, access to facilities and experiences of AMR.
Rosie also noted the biomedical approach doesn’t value the knowledge or agency of the communities it most affects. This knowledge is critical as One Health as an approach has been embodied by Indigenous communities for centuries. Therefore, this is also an issue of epistemic injustice, exacerbated by short term funding cycles that create knowledge hierarchies and power imbalances.
Through GEAR up we will be trying to uncover some of these structural inequities that shape AMR globally and work with communities and build a community a practice in this area.
Rosie added that while she had used the example of AMR to highlight this environmental injustice, it likely applies to many other areas in health.
She left attendees with a question, as well as a proposed solution…
What can we do to embed both social and environmental justice into One Health?
We need to support a knowledge shift towards truly transdisciplinary, biosocial, anti-colonial, intersectional approaches that recognise structural inequities. This requires:
reflecting on our own positionalities
questioning our assumptions and
engaging with critical social science work – including ethics, safeguarding and the nature of rights
A collaborative approach is essential but we need to expand our collaborations and recognise there are other types of scientific knowledge – valuing community and indigenous knowledge through co-design and participation to advance both social and environmental justice.
In October a diverse group of stakeholders in Indonesia came together for a productive workshop focused on addressing the intersections of gender, equity, and antimicrobial resistance (AMR). The workshop was hosted by the Ministry of Health with support from the Fleming Fund country Grant to Indonesia (FFCGI), and was coordinated by Desrina Sitompul, Senior Technical Programme Lead, FFCGI. As part of a broader discussion on One Health economic assessments and the burden of disease, the workshop explored crucial issues such as how gender dynamics influence AMR patterns, the role of women in AMR stewardship, and antimicrobial use across both human and animal health settings. Here Ralalicia Limato shares five key insights and outcomes from the workshop.
Domains of gender equity within AMR
Saraswati, the gender equity lead facilitator for Indonesian country grantee, presented a framework with three main domains for potential research and intervention:
Gender equity and drug-resistant organisms: The relationship between gender and the prevalence or transmission of AMR, including how specific groups of people are disproportionately impacted by AMR, and how norms, values or underlying beliefs in society maintain or perpetuate the different risks of drug-resistant organisms’ exposure among genders and other intersecting identities.
Women’s leadership and agency in AMR surveillance and stewardship: Understanding how cultural norms, beliefs and practices hinder or foster women’s meaningful participation; how women, both in healthcare facilities and community settings, are involved in AMR management, AMU decision-making, and how their roles can be strengthened; and how women have the access to and control of resources in AMR containment and stewardship initiatives.
Antimicrobial use (AMU) in human and animal health settings: Investigating how gender dynamics influence AMU practices in different contexts. This includes examining how cultural norms, beliefs, and practices influence AMU in the community, as well as how health-seeking behaviours differ between men and women and among other intersecting social stratifiers, such as age, socio-economic status, ethnicity and education level. Besides, it is crucial to understand the distinct roles and responsibilities of men and women in the purchasing, use, and administration of antimicrobial drugs
This framework serves as the foundation for further investigation and the integration of gender-sensitive indicators into AMR surveillance in Indonesia.
2. Integrating gender equity into burden of disease data
There is a plan to integrate gender-specific indicators and perspectives into broader burden of disease and AMR data collection. This integration will help capture nuanced insights on how AMR affects different populations, including women and marginalised groups, and how gender influences AMR risk and outcomes. In doing so, a further discussion will take place to plan the quantitative and qualitative data.
3. Stakeholder feedback: insights from both human and non-human sectors
There were initial concerns regarding the relevance of gender equity within AMR research in the Indonesian context. However, in this workshop, stakeholders were overwhelmingly supportive of studying AMR through a gendered lens. They suggested several avenues for further research to better capture the diversity of experiences and risks across different population groups, and emphasised the need for multi-sectoral studies that cut across different population groups and geographical contexts.
Stakeholders from the Ministry of Health recommended including the clinical aspects, for example, guideline compliance in the research framework. Understanding how gender influences adherence to clinical guidelines could reveal important gaps in AMU and stewardship, which would be crucial for improving treatment outcomes.
Stakeholders from the Ministry of Agriculture and Ministry of Marine Affairs and Fisheries pointed out the importance of studying farming communities, especially where the majority of farmers are male or female. By examining gender-specific roles in these communities, researchers can better understand the gendered dimensions of AMU and resistance in agriculture and livestock management.
A recommendation from the Chairperson of the Committee on AMR Control called for comparative studies between urban and rural populations. These studies could help illuminate the disparities in access to antibiotics, healthcare services, and public knowledge of AMR. Such research could provide critical insights into the barriers and opportunities for improving AMR governance and stewardship, especially in underserved or rural areas.
4. Way forward: continued consultation and stakeholder engagement
In light of the valuable feedback received during the workshop, Saraswati and the DAI team have given stakeholders a month to provide further input or specify any domains they wish to explore in more depth. This period will allow for a more comprehensive understanding of the nuances in gender and AMR, as well as refine research questions and methodologies.
Meanwhile, discussions with DAI are set to continue regarding the budget for data collection and analysis related to gender equity. The goal is to ensure that sufficient resources are allocated for gender-sensitive AMR research, allowing for the collection of high-quality data and the formulation of evidence-based policies and interventions.
5. Looking ahead: the One Health approach to AMR
The workshop reinforced the importance of adopting the One Health and gender-sensitive approach to tackling AMR. As AMR continues to threaten global health, it is essential to understand the diverse and often hidden ways in which gender influences both the causes and consequences of AMR. By considering gender alongside other factors like economics, healthcare access, and education, we can develop more equitable and effective strategies for combating AMR.
The next steps in this important work will involve refining the research agenda, collecting data, and continuing to engage with stakeholders from multiple sectors. The workshop has laid the groundwork for a more inclusive and comprehensive understanding of AMR, one that accounts for the lived realities of all affected populations. Stay tuned for more updates on the progress of this initiative.
GEAR up is funded by the Department of Health and Social Care (DHSC)’s Fleming Fund using UK aid.
The views expressed on this website are those of the authors and not necessarily those of the UK DHSC or its Management Agent, Mott MacDonald.
GEAR up is funded by the Department of Health and Social Care (DHSC)’s Fleming Fund using UK aid.
The views expressed on this website are those of the authors and not necessarily those of the UK DHSC or its Management Agent, Mott MacDonald.
