Implementing the Global Health Security Agenda in Uganda: the Infectious Diseases Institute – Global Health Security Project

The Global Health Security Agenda (GHSA) is an effort by nations, international organizations, and civil society to accelerate progress toward a world safe and secure from infectious disease threats; to promote global health security as an international priority; and to spur progress toward full implementation of global health security frameworks (including International Health Regulations 2005). In 2015, the Infectious Diseases Institute (IDI) received funding from the United States Centers for Disease Control and Prevention (CDC) to implement a five-year project ‘Global Health Security Partner Engagement Project: Expanding Efforts and Strategies to Protect and Improve Public Health Globally’. The project supports the health system in Uganda by strengthening policy, leadership, organization and management structures at national and facility levels. Efforts are focused centrally at Uganda’s Ministry of Health (MOH) and at 14 regional referral hospitals, the Mulago National Referral Hospital, Uganda National Health Laboratory Services (UNHLS) and selected facilities in the Kampala area.

Biosafety and Biosecurity: In cooperation with Uganda’s Ministry of Health and CDC, IDI is working to establish a national
 biosafety and biosecurity system, using a whole-of-government approach that incorporates One Health principles. In November 2016 partnership with the Ministry of Health, the project funded and coordinated the first regional Biosafety and Biosecurity Conference with over 300 participants, including high level delegates from Uganda, Tanzania, Burundi, Kenya, South-Sudan and representation from the International Federation of Biosecurity Associations and the African Biosafety Association. This key meeting supported advocacy towards national legislation for biosecurity and provided a platform for the formal launch of the Biosafety and Biosecurity Association of Uganda, an initiative also supported by IDI. Furthermore, IDI has worked to provide a harmonized bio-risk management curriculum for multi-disciplinary health personnel and 48 national trainers have been trained on this curriculum. Moving forward the project will support laboratory design, facility access controls and national pathogen inventory efforts. 

Antimicrobial Resistance and Acute Febrile Illness Surveillance: The project is providing ongoing support to the
National Antimicrobial Resistance Surveillance Task Force to develop an antimicrobial resistance surveillance plan for Uganda that is aligned with WHO standards. Case-based surveillance of clinical syndromes for antimicrobial resistance has been activated at three health facilities targeting children presenting with non-malarial fevers. Working with a local partner (the Infectious Disease Research Collaboration) blood cultures are being obtained to test for bacteria and where blood cultures turn out negative samples are sent for further testing at the Uganda Virus Research Institute to rule identify possible viral causes including especially dangerous pathogens. At three facilities, the project has supported the reconstitution and routine activities of infection prevention and control committees and medicine therapeutics committees that will serve as sustainable vehicles to support infection control and antimicrobial stewardship efforts. In addition, antimicrobial resistance data management software (WHONET) has been installed at 6 sites to support national surveillance efforts.

Laboratory systems: Less than half of the target facilities reported capacity to conduct culture and sensitivity testing, a key investigation required to support efforts to prevent emergence and spread of antimicrobial resistance. Consequently, IDI
implemented a courier transportation system appropriate for blood culture samples to link health facilities to central laboratories for surveillance. Microbiology equipment including Bactec® machines and other supplies and materials were procured and distributed to three project sites. The project is providing technical assistance and buffer reagents and supplies to the national reference laboratory and health facility laboratories to ensure that vital microbiology services are available for direct patient care and to support national surveillance efforts.