GEAR up, supported by the UK aid Fleming Fund, is a groundbreaking research consortium looking at links between gender, equity and antimicrobial resistance (AMR), which has been named as a finalist for the ReAct Africa Art Prize for their work presented in a collage.
This recognition highlights the importance of the project’s innovative communications approach. Using art to shed light and prompt discussion on complex scientific issues like AMR, illustrating its real-world impact on communities and health systems.
GEAR up has been invited to present at the ReAct Africa and South Centre AMR Conference in Lusaka, Zambia, on 11 – 12 June 2025, and will be represented by Sneha Paul, of BRAC James P Grant School of Public Health, who submitted the collage work.
The collage series was created earlier this year when the consortium team – comprised of researchers from Africa, Asia and Europe – came together in a series of meetings to visualise their work. Team members shared their hopes and fears in the context of their work, considered the impact they would like to have and tried to visualise a world where AMR is no longer a challenge and threat.
The vibrant and thought-provoking collages use all manner of materials, from magazines and newspapers to medication packaging, fabric and beads. They explore themes of health, illness, antibiotic use, gender, communication, and the interconnectedness of people and health systems. The collages invite a deeper reflection on how we see, speak, and respond to health, gender and equity in complex, integrated systems.
Lived experience
“Facts alone don’t move people—stories and visuals do,” says Bachera Aktar from GEAR up’s partner in Bangladesh, BRAC James P Grant School of Public Health, BRAC University. “Creative communication methods, like collage, don’t just illustrate science; they humanise it. Collages are more than just art; they’re a dialogue, a way of seeing and feeling. Layer by layer, it helps us uncover the deep connections between gender, AMR, inequality, and lived experience.”
Expressing humanity within research
“We are facing a wave of health misinformation and disinformation. It’s confusing, alienating and designed to foster mistrust,” says Kate Hawkins of Pamoja Communications, who led the creative process. “Expressing humanity within our research communication and recognising the complex feelings and standpoints of receivers of health messaging is essential to create the solidarity needed to face the challenge ahead.”
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About GEAR up
GEAR up seeks to catalyse action on gender and equity within AMR through supporting Fleming Fund country grantees to mainstream gender and equity within routine AMR systems and structures. We aim to increase awareness, and contribute to the knowledge, on structural inequities driving and shaping the AMR response. We also seek to facilitate South-South exchange through building a global community of practice to guide and inspire further action and global knowledge sharing.
GEAR up is funded by the Fleming Fund. The Department of Health and Social Care’s (DHSC) Fleming Fund is a UK aid programme supporting up to 25 countries across Africa and Asia to tackle antimicrobial resistance (AMR), a leading contributor to deaths from infectious diseases worldwide.
The Fleming Fund invests in strengthening AMR surveillance systems through a portfolio of country grants, regional grants, and fellowships managed by Mott MacDonald, and global projects managed by DHSC.
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.
Earlier this month GEAR up team members were invited to present to Fleming Fund Fellows – policy makers, practitioners and influencers who are participating in a scheme of professional development and capacity strengthening around AMR in Fleming Fund countries. In this blog Katy Davis reports back on the session’s panel discussion .
Gender and equity is one of the Fleming Fund’s key principles, and Toby Leslie – Global Technical Lead for Fleming Fund at Mott Macdonald – emphasised the need for a keen understanding of aspects of AMR relating to gender and equity and how to address these.
Dr Rosie Steege, Lecturer at Liverpool School of Tropical Medicine and gender and equity lead in GEAR up, introduced the GEAR up consortium, gave a background on principles of gender and equity in infectious disease and presented the initial results of our scoping review and importance of focus on structural drivers of inequities. She emphasised that surveillance data is the tip of the iceberg in terms of understanding the drivers of antimicrobial resistance, and that we need greater understanding and focus on the structural equity dimensions of AMR.
Three GEAR up panellists addressed questions on the importance of gender and equity for the work of the Fleming Fund Fellows and addressing AMR more widely:
Abriti Arjyal, research manager at HERD International, Nepal, emphasised the importance of understanding social roles that influence access to power, resources and opportunities when it comes to antimicrobial resistance and antibiotic access and use. She gave examples of where gender roles affect exposure to infection, awareness of AMR and decision-making power and highlighted that there is a limited understanding of how these factors interact at the interface of human, animal and plant health.
Tahmina Ahmed, a Senior Research Associate at BRAC University, Bangladesh, spoke to the importance of surveillance and antimicrobial use data that is disaggregated by factors such as sex and age. She explained how it is essential for understanding context-specific trends and drivers and for effective design of AMR interventions.
Susan Okioma, Lead Gender Technical Advisor at LVCT Health, Kenya, highlighted the importance of a gender and equity lens in policy and decision-making around AMR. She outlined GEAR up’s successes in mainstreaming gender and equity questions and considerations in the most recent Ugandan National Action Plan on AMR and emphasised opportunities to take this approach across Fleming Fund country grantees.
Participants identified gender and equity dimensions in their areas of work across lab, surveillance, policy and practitioners’ perspectives and reiterated the fact that policy makers and practitioners need to work together on equity issues. We answer some of the questions that we received from participants below:
How do gender and equity issues apply to AMR in disasters or emergency response?
In disaster and emergency response contexts, many of the complex social processes of inequity that influence exposure, access to treatment and antibiotic use are particularly exaggerated. For example, access to health systems and to safe water and sanitation are often constrained in disaster contexts, which can create particular exposure for those most likely to be responsible for collecting water or those working as frontline health workers. Women and gender minorities are often more at risk of sexual and gender-based violence in disaster contexts, which affects exposure to and spread of sexually transmitted infections, including resistant infections. Disaster contexts can also lead to significant refugee populations, and those living in refugee camps often have low access to healthcare and high risk of infection due to living conditions.
How is GEAR up inputting to countries’ AMR National Action Plans?
GEAR up seeks to inform countries’ National Action Plans on equity and gender issues that relate to AMR and policy making. This involves engaging with stakeholders to raise awareness around equity and gender dimensions of AMR, reviewing existing National Action Plans or AMR strategies for engagement with equity and gender issues, and building on windows of opportunity to incorporate equity considerations and policies or actions that strive for equity within the AMR space. If you have identified an opportunity to input into the development of a National Action Plan of strategy in your country, please do get in touch.
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.
