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Fast-Tracking the Implementation of National Action Plan for Health Security (2018-2024) in Uganda: The Acceleration
Herbert Bakiika1, Immaculate Nabukenya1, Reuben Kiggundu1
1Herbert Bakiika, MPH, BVM, PGDM&E, is a Senior Technical Advisor, NAPHS & One Health; Immaculate Nabukenya, PhD, Reuben Kiggundu MPH, MSc, MBChB, and Lydia Nakiire, MPH, FETP, are Epidemiologists; Godfrey Bongole and Geraldine Mukesha, MPH, are Monitoring and Evaluation Officers; Martha I. Achan, LLB, LLM, MPH, is a Legal Advisor; Justine Bukirwa, MBS, is a Technical Officer, Laboratory Systems; Gloria Namiya, BBA is an Administrator; Dathan M. Byonanebye, MD, PHD, is Deputy Head of Department; and Francis Kakooza, PHD, is Head of Department; all in the Global Health Security Department, Infectious Diseases Institute, Kampala, Uganda. Godfrey Bwire, MD, PhD, is an Assistant Commissioner; Harriet Mayinja is a Research Officer; Anne Nakinsige, MD, is Principal Epidemiologist; Sunday Kithula, MPH, MD, is a Senior Medical Officer; Allan Muruta, MPH, MD, is a commissioner; all in the Department of Integrated Epidemiology, Surveillance and Public Health Emergencies, Ministry of Health, Kampala, Uganda. Betty Mbolanyi is Principal Environment Officer, Ministry of Water and Environment, Kampala, Uganda. Robert Mwebe, MVPM, BVM, is a Principal Veterinary Officer, and Rose Ademun, PHD, MVPM, BVM, is Commissioner of Animal Health; both in the Ministry of Agriculture, Animal Industries and Fisheries, Entebbe, Uganda. Patrick Atimnedi, MVPM, BVM, is a Senior Veterinary Officer, Uganda Wildlife Authority, Kampala, Uganda. Timothy Lubanga is Commissioner, Monitoring and Evaluation Department; Aggrey Ngobi and Enid Mbabazi, MD, are Medical Officers; Roland B. Taremwa is a Monitoring and Evaluation Specialist; and Emmanuel Turyatunga is an Assistant Commissioner; all at the Office of the Prime Minister, Kampala, Uganda. Issa Makumbi, MD, MSc, is Senior Advisor and Atek Kagirita MPH, MBS, BBLT is Manager, Public Health Emergency Operations Center, Kampala, Uganda. Henry Mwebesa, MPH, is Director General of Health Services, Ministry of Health, Kampala, Uganda.
Abstract:
Uganda's 2017 Joint External Evaluation (JEE) revealed critical gaps in International Health Regulations (IHR) implementation, with limited progress despite ongoing efforts. Coordination mechanisms failed to address multisectoral implementation challenges. To accelerate progress, in 2018, Uganda established a dedicated National Action Plan for Health Security Acceleration (NAPHS) Team (A-Team)-a multidisciplinary unit embedded within government structures to facilitate cross-sector coordination and reduce bureaucratic barriers. We conducted a multimethod evaluation using outcome harvesting, key informant interviews, and cost analysis to assess the team's contributions to health security implementation. Contribution analysis examined attribution challenges by documenting parallel initiatives and stakeholder verified causal pathways. They catalyzed measurable improvements in Uganda's 2023 JEE scores. Multisectoral coordination improved from 2 to 4, points of entry capacities from 1 to 3, IHR financing from 2 to 3, and surveillance early warning from 3 to 4. Achievements included Public Health Act amendments, One Health policy formulation, institutionalization of the 7-1-7 framework, and establishment of coordination mechanisms through the Office of the Prime Minister. They supported various ministries by developing policies and guidelines. They also monitored NAPHS implementation through the creation of the IHR NAPHS tracker and the NAPHS toolkit. The $3.5M investment was an enabling infrastructure, with stakeholders attributing 70% to 85% of coordination improvements to the team facilitation. The A-Team's support, aided by Resolve To Save Lives, helped Uganda secure US$150.5 million in funding, split between domestic and partner contributions, which resulted in an exceptional leverage ratio of 1:43. The embedded A-Team model addressed coordination challenges that commonly impede health security implementation in resource-constrained settings. By functioning as trusted boundary spanners, the team reduced transaction costs of multisectoral collaboration while maintaining government ownership. The model demonstrates promise for replication in similar contexts, requiring adaptation to local governance structures and sustainable financing mechanisms.
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