A bottom-up, One Health approach to assessing progress in the implementation of a national action plan for combating antimicrobial resistance: a case study from Uganda

Reliance on desk reviews and national-level stakeholder engagement carries a risk of overestimating the country’s health security and AMR capacity. The study’s authors conducted a bottom-up approach to evaluate Uganda’s National Action Plan on AMR (NAP-AMR), emphasizing the involvement of frontline implementers such as healthcare workers, farmers, and local governments. This method provided a more accurate assessment than relying solely on desk reviews and national-level engagement, which often overestimate health security and AMR capacity. The review highlighted poor engagement of subnational stakeholders in the development, validation, dissemination, and implementation of the NAP-AMR and identified national-level challenges, including gaps in One Health policy, inadequate funding, and weak coordination, which hindered effective implementation. To address these issues, the authors recommend establishing a One Health policy, securing sustainable funding, and legislating a policy to formally incorporate the National One Health Platform into both national and subnational government structures. This approach could also enhance the World Health Organization’s joint external evaluation of health security capacity.