How the Fleming Fund has worked to build surveillance capacity in LMICs across human and animal health sectors

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Building surveillance capacity to address AMR is a global priority. It is particularly important in low- and middle-income countries (LMICs) where human and animal health systems rely more heavily on antibiotics in human and veterinary medicine, and in agricultural production. These countries are also less able to cope with the consequences of resistance. In essence, this is why the Fleming Fund exists.

So, where do you start with a problem as complex as AMR?

We decided to "start small and do it well". At the start of the first phase of the Fleming Fund, most countries had produced National Action Plans (NAPs) to address AMR - an action mandated by the UN General Assembly and the World Health Assembly. Each NAP included AMR surveillance as one of five “pillars” of the plan. So, our starting point was to ask, “What do the countries themselves want to do?”. We discussed options with government counterparts in each country to come up with a bespoke plan in line with their NAP. This sometimes involved delicate negotiation to balance ambition and scale with the practicalities on the ground, so the investments made in phase I stand a better chance of being sustained in the long-term.

There are many ingredients in a surveillance system, but they fall into two main categories:

1. Sites (laboratories) that can safely carry out good quality tests for bacteria and resistance
2. A data component where test results can be analysed to provide information at a local and national level.

This data should then be shared so that actions can be taken.

What happened next?

We approached the Fleming Fund countries to look at their starting capacity, capability, and motivation. Whilst you need equipment and other items in the laboratory, you can’t build a surveillance system without a well-trained and motivated workforce; if the staff are not adequately trained and supported, then the system won’t work no matter how much equipment is delivered. Therefore, we have focused on improving both equipment and training so that laboratories can operate safely and to a high standard.

The second component, which brings together AMR data from human and animal health sectors, requires the right governance structures and human resource capacity to analyse, interpret and make sense of the data, turning it into evidence for action. In this area of the programme, we have provided support to the One Health approach, engaging with policymakers, and strengthening and empowering the national AMR Coordination Committees and staff within it.

Through this approach, we have provided support for more than 240 laboratories across our 21 countries, funding over 25,000 training attendances and 170 Fleming Fellows. There are encouraging signs of progress, such as gradual improvements in both quantity and quality of data, and also in data use and data sharing. But the gains are fragile and need to be cemented into national systems to help ensure that AMR surveillance becomes a normal part of service delivery across the One Health disciplines.