Implementation status and challenges affecting antimicrobial stewardship programmes in private hospitals in Kampala, Uganda: Insights from a cross-sectional descriptive survey.

Abstract

Private hospitals are critical to healthcare delivery in Kampala, Uganda, where antimicrobial stewardship (AMS) programmes have been introduced as part of the Global Action Plan (GAP) to mitigate the growing threat of antimicrobial resistance (AMR). However, there is limited empirical data on the extent of AMS implementation and the specific barriers these facilities face in adopting such programmes. We therefore evaluated the implementation status and identified key barriers to AMS uptake in private hospitals across Kampala, Uganda. A cross-sectional survey was conducted from 9th January 2024-25th July 2024 in 17 private hospitals, using a mixed-methods approach. Quantitative data were collected using the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) Checklist and analysed descriptively. Qualitative data were gathered through key informant interviews and evaluated using content analysis. The findings revealed significant gaps in AMS implementation. Of the 17 hospitals surveyed, 70.6% (12/17) had not prioritised AMS initiatives in their operations. Besides, 88.2% (15/17) had no budget allocated for AMS activities and 82.4% (14/17) reported insufficient staffing. Additionally, 76.5% (13/17) had not provided AMS-specific training. Furthermore, 64.7% (11/17) lacked regular AMS reports, meeting minutes, or resources for antimicrobial prescribing optimisation, while 41.2% (7/17) had no designated AMS team lead. Besides, qualitative analysis showed structural and institutional challenges, including weak leadership commitment and a lack of sustainable financial planning for AMS programmes. The implementation of AMS programmes in selected private hospitals in Kampala was scanty and constrained by structural, financial, and institutional barriers, including inadequate budget allocation, insufficient staffing, limited training, and the lack of prioritisation of AMS activities. Strengthening institutional support through leadership engagement, funding, and embedding AMS as a core component of hospital policy is essential. Additionally, a multi-stakeholder approach is crucial to driving sustainable AMS adoption, aligning with global AMR mitigation efforts, and ensuring optimal patient outcomes.