Landscape analysis of Uganda
Antimicrobial resistance (AMR) poses a major and growing threat to public health in Uganda, with significant implications across human, animal, and environmental sectors. While Uganda made notable progress in aligning their AMR strategies with global frameworks such as the WHO Global Action Plan and Global Antimicrobial Resistance and Use Surveillance System (GLASS), the integration of gender and equity (G&E) considerations into AMR policy and surveillance remained limited until 2024, when GEAR up supported G&E mainstreaming through the NAP 2.0. This landscape analysis assesses the extent to which G&E dimensions are embedded in AMR frameworks, identifies systemic gaps, and outlines opportunities for more inclusive action.
The analysis draws on a structured review of 12 national AMR policy documents and technical surveillance tools from Uganda. A 12-domain Gender and Equity assessment framework, informed by global guidance, was applied to assess the integration of inclusive principles into AMR governance, surveillance, and implementation. Insights from multisectoral stakeholder roundtables, which focused on gender and equity integration in AMR strategies contributed to the findings.
Findings show that while Uganda has developed technically sound AMR surveillance systems and multi-sectoral governance structures, they have not systematically considered who is most affected by AMR or who participates in designing solutions. Health facilities collect AMR data through routine monitoring and reporting mechanisms – they capture antimicrobial use (AMU) and AMR patterns observed in patients, the type of infection, antimicrobial agents used, and microbiological test results (e.g., pathogen resistance profiles). The surveillance tools rarely capture disaggregated demographic data beyond age and sex, and equity-relevant variables such as occupation, disability status, or caregiving roles are largely absent. While the data is aggregated annually, the analysis often lacks detailed demographic disaggregation, limiting its ability to fully assess the G&E dimensions of AMR. National action plans refer to inclusion in general terms but do not operationalise equity principles in goals or resource allocation.
The November 2024 launch of Uganda’s revised AMR National Action Plan was presented as a direct outcome of G&E engagement processes. Stakeholders noted that the updated NAP reflected a shift from a gender-blind to a more gender-sensitive document. However, the policy still requires further embedding of equity considerations into implementation, in relation to surveillance design, resourcing, and reporting. Women and caregivers, particularly in rural areas, often rely on informal sources for antimicrobials due to barriers such as cost and stigma. Despite this, they remain underrepresented in AMR governance and are rarely engaged in planning or monitoring efforts. Surveillance staff and technical working groups lack training and guidance on applying a gender or intersectional lens to data collection and programme design.
