Mandated Actions, Legitimate Role-Bearers and Expected Actor Networks in the Management of Infectious Disease Epidemics: The Case of Marburg Virus Disease in Uganda.

Abstract Background In many Sub-Saharan Africa (SSA) countries, epidemic management is characterized with inaction, confusion and friction among a multitude of participating organizations. This is partially attributable to the inability to customize international epidemic management actions and guidelines to local institutional architecture, agencies and relational contexts. This results into poor coordination and suboptimal epidemic management outcomes. Using the case of Marburg Virus Disease (MVD) in Uganda, we explored how to clarify responsibility and collaboration across a multitude of inter-dependent actions and actors during epidemic management. Methods In July 2018, we reviewed MVD management literature and documents to identify key expected actions and actors/agencies. Data was summarized by phase and action area of MVD management. In March 2019, a 2-round Delphi survey was then undertaken to; 1) validate the identified actions and 2) assign legitimate role-bearers to each of the validated actions. We used NetDraw in UCINet to elaborate the expected network structure among legitimate role-bearers across all the phases and four selected action areas. Results We validated 304 mandated actions and 79 legitimate role-bearers in MVD management in Uganda. Across the four phases and selected action areas of MVD management, there is a high variation in the identity and number of mandated role bearers. Overall, Ministry of Health headquarters (MoH-HQs), National Task Force (NTF), District task Force (DTF) and National Rapid Response Team (NRRT) are expected to be the most central agencies during MVD management. Across the four phases and the selected action areas, actors are expected to be networked using a core-periphery network structure.Conclusions There is a multitude of agencies required to work inter-dependently to accomplish the mandated actions for MVD management in Uganda. MoH-HQs, NTF and DTF are most central in the Ugandan context. It is imperative to build/maintain the information processing, decision making and command and control capacity of these central agencies. The study findings can be used as the basis for exploring compliance and deviation in mandated actions in future MVD epidemics. The methodological approach could be replicated to other infectious disease epidemics in Uganda and beyond.