Barriers to Facilitators of Multisectoral Collaboration of Antimicrobial Resistance Interventions in Uganda

Abstract

Introduction: Antimicrobial resistance (AMR) is a global public health challenge that threatens the effectiveness of essential medicines and global health security. The World Health Organization promotes a One Health–based multisectoral collaboration (MSC) framework to address AMR by integrating human, animal, and environmental health sectors. In Uganda, despite the establishment of coordination structures such as the National One Health Platform and the National AMR Sub-Committee, challenges to effective MSC persist. This study assessed the barriers affecting facilitators involved in promoting multisectoral collaboration for AMR interventions in Uganda. Methods: A cross-sectional descriptive mixed-methods study was conducted among 167 purposively selected stakeholders from institutions involved in AMR policy, surveillance, regulation, and implementation, including government ministries, regulatory authorities, academia, research institutions, and non-governmental organisations. Quantitative data were collected using a structured questionnaire adapted from the WHO Tripartite AMR Country Self-Assessment Survey (TrACSS v7.0) and the EPICAP tool. Responses to perceived barriers were measured using a four-point Likert scale. Descriptive statistics, including frequencies, proportions, means, and standard deviations, were generated using STATA version 17. Qualitative data were collected through semi-structured open-ended questions, key informant interviews, and workshop discussions, and were analysed thematically using NVivo. Quantitative responses were summarised using mean scores and standard deviations, with predefined categories: 1.00–1.74 = very low, 1.75–2.39 = low, 2.40–3.19 = moderate, and 3.20–4.00 = very high. A grand mean was computed to assess overall perceived barrier intensity. Results: Of the 167 respondents, 60% were male, and 46% were aged 31–40 years. Most participants held at least a master’s degree (51%). Individual barriers such as political influence (mean = 1.35, SD = 0.654), funding (mean = 1.05, SD = 0.252), and leadership (mean = 1.74, SD = 0.625) were perceived as very low, while distrust among stakeholders was low (mean = 2.03, SD = 0.872). The “others” category, capturing unanticipated barriers, was rated very high (mean = 5.0, SD = 0.0), and the grand mean across all items was 11.17 (SD = 2.43), reflecting a high overall perceived barrier intensity. Qualitative findings highlighted human resource gaps, institutional fragmentation, low community engagement, and parallel sectoral interests as additional challenges influencing MSC effectiveness. Conclusion: While individual barriers were generally perceived as low, structural and contextual factors continue to challenge multisectoral coordination for AMR. Strengthening leadership, fostering intersectoral trust, and enhancing institutional capacity are critical for sustainable MSC implementation. These findings provide actionable insights for policymakers, stakeholders, and donors to strengthen governance and collaborative AMR interventions in Uganda and similar settings.