Fast-Tracking the Implementation of National Action Plan for Health Security (2018-2024) in Uganda: The Acceleration Team Model.

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.