One health laws, policies and governance in Uganda: What's on paper and what's really happening.

This paper explores how current national legal, policy and governance structures have affected implementation of Uganda's original National One Health Strategic Plan (NOHSP), with the aim of identifying opportunities for strengthening Uganda's approach to One Health moving forward. We conducted a legal and policy review between August 2022 and May 2023 to assess Uganda's regulatory and institutional landscape for operationalizing One Health. To understand One Health implementation in practice, we conducted 68 semi-structured interviews with participants representing the agriculture, environment, health, policy, and veterinary sectors. The patchwork of antiquated and unrelated laws and policies underpinning Uganda's current NOHSP leaves stakeholders with no legal mandate for implementation. The NOHSP established national-level coordination mechanisms, but across sectors and administrative levels, interview participants indicated a lack of clarity on the existence or structure of subnational One Health mechanisms and their interaction with national structures. Although the NOHSP emphasizes multisectoral collaboration, it lacks specific guidance on how such coordination should be implemented. Interview data indicate that, typically, collaboration is catalyzed by outbreaks, where sectors come together to devise strategies tailored to the immediate crisis rather than based on established protocols. Across all sectors, interview participants pointed out several persisting capacity issues that impact their ability to engage in One Health activities, including understaffing, inadequate funding, and insufficient equipment and facilities. Any One Health accountability measures were primarily described as dictated by donor procedures and sector-specific annual reports, rather than One Health guidelines. While technical guidance for One Health exists at global, regional and sub-regional levels, it often overlooks the reality that One Health is a new paradigm being implemented within pre-existing legal and policy frameworks with a dominant history of sectoral divisions of responsibility, budgets and activities. Operationalizing One Health at a national and subnational level will not only require structural adaptations but also shifts in institutional mindsets.