Guest article by Dr Andrew Kambugu, CAMO-Net Uganda Lead
Over the past five years, Uganda has made significant progress in responding to the growing threat of antimicrobial resistance (AMR). The country’s first National Action Plan on AMR (NAP-AMR I, 2018-2023) provided a solid foundation for coordination across human, animal, and environmental sectors. It marked Uganda’s formal commitment to the One Health approach, recognising that resistant pathogens move freely between people, animals, and the environment.
Independent evaluations, including the Government of Uganda’s Joint External Evaluation (JEE) – an assessment based on international standards- and the FAO’s Performance of Veterinary Services (PVS) Pathway assessment, confirmed that NAP-AMR I catalysed important institutional and policy changes, even with limited resources. These reviews also identified critical gaps that continue to shape the design of Uganda’s second AMR strategy (NAP-AMR II, 2024-2029).
National Action Plan progress
Despite receiving less than one-fifth of its planned funding, NAP-AMR I achieved several foundational milestones. Uganda established a functioning One Health governance structure supported by multi-sectoral technical working groups and partners such as the Fleming Fund Country Grants, managed under the Infectious Diseases Institute (IDI). National guidelines were developed to guide infection prevention and control (IPC), antimicrobial use, and AMR surveillance in both human and animal health sectors.
Two national reference laboratories, the Central Public Health Laboratories for Human Health and the National Animal Disease Diagnostics and Epidemiology Centre (NADDEC) for animal health, were designated. Uganda began submitting data regularly to the WHO Global AMR Surveillance System (GLASS), expanding the country’s visibility in global surveillance efforts.
At the same time, microbiology surveillance capacity was strengthened at regional referral hospitals, and AMR awareness activities reached new audiences through national campaigns and annual conferences. Together, these initiatives helped build a sense of shared responsibility across the health system and encouraged a data-driven understanding of AMR.
Yet, key challenges remain. Limited and unpredictable financing remains the most significant barrier. Many sectoral budgets lack specific allocations for AMR-related activities, leaving the implementation of critical interventions dependent on external funding. Coordination across sectors is often inconsistent, and there are still no integrated national performance indicators to track progress. Feedback loops from surveillance systems to frontline facilities are weak, limiting the use of data for clinical and infection control decision-making. These gaps underscore why the next phase, NAP-AMR II, must focus not just on expanding systems but ensuring their long-term sustainability and integration.
CAMO-Net Uganda’s contribution to the national AMR effort
At the IDI, the CAMO-Net Uganda Hub is translating research into action by directly addressing these implementation challenges. The hub’s work spans clinical research, data analytics, and community engagement, linking scientific innovation to national policy priorities.
Optimising Antibiotic Use in HIV Care
People living with HIV (PLHIV) are among the most frequent users of antibiotics, yet prescribing practices in this population are often empirical and unstandardized. CAMO-Net Uganda has assessed prescribing patterns in HIV care and is implementing a quality improvement program across selected sites. The intervention combines prescriber education based on the Uganda Clinical Guidelines, structured antibiotic prescription checklists, and patient engagement sessions. Early feedback suggests that this approach improves adherence to national standards and enhances patient understanding of appropriate antibiotic use (AMU).
Therapeutic Drug Monitoring and Pharmacokinetics
To ensure antibiotics and anti-TB drugs are used effectively, the team is studying how these medicines are absorbed and metabolised among PLHIV in Uganda. Recruitment and sample analysis are ongoing, but initial findings will inform optimised dosing strategies tailored to local populations. This work is particularly valuable in settings where pharmacokinetic data from African populations remain scarce.
Data-Driven AMR Analytics
Data integration and analysis are critical for evidence-based decision-making. CAMO-Net Uganda has developed a dynamic AMR data warehouse that consolidates laboratory AMR and AMU data from nine regional referral hospitals. The platforms interactive machine learning models that enable hospital stewardship teams and national policymakers to explore data, run forecasts, and predict resistance trends in real time. This initiative demonstrates how data science can strengthen public health responses in low- and middle-income countries.
Community Engagement and Public Awareness
Behavioural change is central to AMR containment. The CAMO-Net Uganda team has collaborated with a wide range of partners, including health institutions, academic organisations, local government, faith-based groups, and community networks. Key collaborators include Makerere University School of Public Health, the Community Health and Information Network (CHAIN), community health extension workers, Watoto Church, and local government authorities. Through these partnerships, we have reached thousands of households through health talks, radio sessions, community outreach programmes, and creative approaches such as music, dance and acting. These activities highlight the dangers of antibiotic misuse and encourage responsible behaviour. Our efforts have led to the establishment of the inaugural Parliamentary Forum on AMR in Uganda.
Looking Ahead
Uganda’s second NAP-AMR II, 2024-2029, shifts the focus from building systems to making them sustainable. The plan emphasises predictable domestic financing, stronger cross-sector coordination, and the use of real-time data to guide clinical and policy actions. Embedding AMR metrics within broader health system performance frameworks will also be critical to maintaining accountability.
As Uganda marks World Antimicrobial Awareness Week 2025, the country’s experience reflects both resilience and realism. Sustained progress against AMR requires persistence, investment, and cooperation across disciplines. CAMO-Net’s model, linking clinical science, pharmacology, data analytics, and community engagement, illustrates how research can directly inform national strategy while contributing to global understanding.
Uganda’s journey demonstrates that even in resource-limited settings, meaningful advances are possible when science, policy, and community action align. Continued investment in data systems, laboratory capacity, and human capital will determine how well the country and the region meet the next phase of the AMR challenge.
