Bridging Governance Gaps in One Health: Uganda’s Model for Sustained Multisectoral Collaboration for Antimicrobial Resistance Response and Control

Abstract

Background: Antimicrobial resistance (AMR) remains a major global health threat, with low- and middle-income countries (LMICs) bearing the greatest burden due to weak health systems, fragmented surveillance, and inconsistent regulatory enforcement. Uganda recorded an estimated 5,620 AMR-attributable deaths in 2021, underscoring the urgency of coordinated action. Although Uganda has adopted National Action Plans aligned with the One Health platform, implementation remains hindered by siloed sectoral operations, limited financing, and weak multisectoral governance. This study aimed to develop a comprehensive Multisectoral Collaboration (MSC) model to strengthen AMR interventions in Uganda. Methods: A cross-sectional descriptive design was used. Quantitative data were collected from 167 purposively selected AMR stakeholders across government ministries, regulatory agencies, academia, research institutions, and civil society organisations using a structured questionnaire adapted from the WHO Tripartite AMR Country Self-Assessment Survey (TrACSS) and the EPICAP tool. Descriptive statistics were generated using SPSS 17. Qualitative data were obtained through semi-structured interviews, workshops, and key informant interviews, transcribed, coded, and analysed thematically. Empirical findings were integrated with literature and the Socio-Ecological Model (SEM) to develop the MSC model. Results: Respondents were predominantly male (60%) and aged 31–40 years (46%), with most holding master’s degrees (51%). Across thematic areas, stakeholder engagement was uneven: although 59.3% identified relevant stakeholders, only 10.8% reported frequent cross-sectoral collaboration. Policy presence was reported by 49.7% while compliance was reported by 6% of the stakeholders. Resource allocation favoured funding (82%), whereas infrastructure (3.6%) and human resources (14.4%) were minimally addressed. Data sharing (26.9%), innovation adoption (25.1%), and public awareness (37.1%) remained weak. Qualitative insights highlighted institutional support, actor involvement, and public awareness as critical drivers of effective AMR response. These findings informed the development of a four-component MSC model comprising shared leadership, pooled financing, sectoral action nodes, feedback mechanisms, and evaluation metrics. Conclusion: Uganda’s AMR response is constrained by fragmented coordination, weak shared leadership, and limited cross-sectoral data integration. Although foundational structures exist, they remain insufficiently operationalised. The proposed MSC model provides a theory-informed, context-responsive framework to strengthen AMR governance, enhance surveillance interoperability, and promote sustainable stewardship and regulatory functions. Its future implementation and empirical validation will support Uganda’s transition toward a more coordinated and resilient multisectoral AMR response.