Strengthening regional capacity across Africa and Asia to support action against AMR

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The Fleming Fund’s Regional Grants programme has been instrumental in tackling antimicrobial resistance (AMR) and addressing the acute impact in low- and middle-income countries (LMICs) where surveillance systems, laboratory capacity, and skilled workforces have historically been limited.

By adopting a multi-country technical assistance approach, encouraging peer-to-peer learning and exchange, the Fleming Fund Regional Grants have strengthened support for sustainable, country-led AMR surveillance systems across Africa and Asia. Through regional training and the development of Centres of Excellence , shared tools and Communities of Practice, the programme has built enduring capacity and in-country expertise.

We profile examples of how the training programmes have contributed to strengthening the AMR workforce and fostering resilient regional networks ─ to support evidence-informed action against AMR.

Above image: MinION sequencing training at the Fleming Fund-supported site Noguchi Memorial Institute for Medical Research, Ghana.

The Fleming Fund Regional Grants programme enhances laboratory capability and workforce development by implementing training programmes, providing technical support and mentoring, and facilitating regional collaboration and quality assurance systems across Africa and Asia.

This has improved LMICs' ability to generate, analyse, share, and use AMR data by strengthening data collection and analysis, enhancing bacteriology and diagnostic services and genomic surveillance. The training approach has integrated human, animal and environmental health into national AMR systems to ensure alignment of expertise towards a One Health approach.

Standardising in-country training

The training programmes, tools, and resources for AMR surveillance are embedded and designed to support national systems. For example, the Qualifying the Workforce for AMR Surveillance in Africa and Asia (QWArS) Regional Grant, led by the African Society of Laboratory Medicine (ASLM), focused on building a qualified AMR workforce.

Building the workforce

536

AMR Professionals

301

AMR Surveillance Experts

58

Master Trainers

90

Subject Matter Experts

17

Countries

ASLM developed a skills-based qualification framework for AMR professionals in Africa and Asia and worked with Africa CDC to formulate a continental strategy to adopt the training model. They have trained over 530 professionals in microbiology, epidemiology, and AMR surveillance across 17 countries in Africa and Asia. With more than 300 qualified as AMR surveillance experts and 58 Master Trainers prepared to conduct in-country training, and over 90 Subject Matter Experts as regional mentors and supervisors.

The QWArS professionals are registered with national councils ─ recognised as AMR experts by Witwatersrand University and the African Society of Laboratory Medicine (ASLM) Academy, in line with Continuing Professional Development credits. The QWArS Regional Grant also sought to encourage adoption of the qualification framework.

“QWArS developed guidance for national programme uptake in-country; Nigeria has already adopted the programme (NiQWArS), embedding AMR competencies into national workforce training systems," said ASLM Regional Grant Lead, Anafi Mataka. “The Nigerian initiative aligned the QWArS curriculum with Nigeria’s Field Epidemiology and Microbiology Laboratory Training Programme, integrating AMR competencies into health workforce development.”

Reliable AMR data

The Regional Grants External Quality Assessment of Laboratory Data Africa (EQuAfrica) and External Quality Assessment of Laboratory Data Asia (EQAsia), led respectively by the African Society of Laboratory Medicine (ASLM) and the Technical University of Denmark (DTU), established External Quality Assurance (EQA) programmes for AMR surveillance in Africa and Asia.

Providing EQA services for AMR, the grants helped to improve bacteriology and laboratory management systems for over 360 laboratories across 25 countries. This strengthened the capacity and expertise of National Reference Laboratories (NRLs), Centres of Excellence and surveillance sites to provide ongoing quality assurance and build sustained regional and national capacity.

“The One Health AMR EQA provision strengthened laboratory quality assurance systems and improved confidence in AMR surveillance data across participating countries. The consortium-based delivery model, supported by international referee laboratories and a regional Technical Advisory Committee, ensured technical rigour, harmonisation, and sustainability, added Anafi.

“By embedding data-driven feedback and continuous improvement mechanisms, the intervention has positioned countries to generate more reliable AMR data to inform surveillance, policy, and public health action beyond the funding period.”

EQuAFRICA and EQASIA enabled regional and national institutes in Africa and Asia to become EQA providers and trainers for their regions. EQASIA also built capacity for NRLs in Bangladesh and Nepal to become national EQA providers.

Advanced genomics sequencing

The Regional Grant SeqAfrica: Whole Genome Sequencing and Bioinformatics Capacity Building in Africa, led by the DTU, provided technical assistance and training to build local expertise and sustain AMR genomic surveillance to inform government policy.

The grant expanded to five regional centres in South Africa, Ghana, Senegal, Nigeria, and Tanzania – installing laboratory equipment and conducting specialised training enabling the laboratories to generate advanced genomics data. These sites were established as hubs to serve as central reference points for outbreak investigations and tracking drug-resistance genes, as well as processing and analysing One Health pathogen isolates.

SeqAfrica has developed online training and tools to support ongoing local surveillance. For example, long‑read sequencing on the portable DNA sequencer MinION: “This enables smaller laboratories to carry out sequencing in house, reducing reliance on high throughput National Reference Laboratories due to its lower throughput requirements and relative ease of use,” said Christa Twyford Gibson, Policy and Program Manager at DTU.

From SeqAfrica’s training programme, more than 37,000 sequences were generated, including for COVID-19 genomic surveillance. Over 80% of genomes were uploaded to public databases and genomic repositories, providing a critical baseline for future outbreak investigations, AMR surveillance, and cross‑border public health preparedness.

On the sustainability of the programme, SeqAfrica Lead at DTU, Prof René S. Hendriksen , said: “To sustain skills, SeqAfrica started a Community of Practice for WGS and AMR surveillance, promoting collaboration and knowledge sharing. Improved capacity positioned these centres as regional WGS experts, capable of supporting national programmes, regional networks, and rapid data response.”

This SeqAfrica support will continue beyond the Fleming Fund through online resources and the Communities of Practice at the African Bioinformatics Institute.

Country-led surveillance systems

Other Regional Grants, such as Capturing Data on Antimicrobial Resistance Patterns and Trends in Use in Regions of Asia (CAPTURA); Regional Antimicrobial Resistance Data Analysis for Advocacy, Response and Policy (RADAAR), both led by the International Vaccine Institute (IVI); and Mapping Antimicrobial Resistance and Antimicrobial Use Partnership (MAAP), led by ASLM; and the Management and Analysis of Microbiology Laboratory Data (WHONET), led by the Brigham and Women's Hospital (BWH) have developed and deployed tools for AMR, AMC and AMU data collection, visualisation, and management to inform policy and practice.

These grants strengthened AMR surveillance capacity, built strong networks and Communities of Practice, and improved the production, analysis, and use of AMR data for data-driven decision-making ─ positioning LMICs in Asia and Africa to better respond to AMR threats through sustainable, country-led systems.

The Regional Grants improved countries’ ability for AMR surveillance data, strengthening foundational systems that support effective AMR responses. Building laboratory and surveillance capacity, establishing EQA systems, expanding genomic surveillance capability, and improving data management tools and digital platforms.

“This enabled the establishment of technical capacities that were once limited or absent, such as AMR workforce development in Africa, WGS hubs in Africa, regional AMR EQA providers in Africa, and two national AMR EQA providers in Asia ─ boosting technical and scientific independence”, said Luna Parry, Regional Grants Coordinator at Mott MacDonald.

Sustaining training capacity

This capacity will be sustained beyond the Fleming Fund. The NMIMR sequencing centre in Ghana recently launched AMR EDGE ─ an advanced, practical training for the African continent in diagnostics, genomics, bioinformatics, and AMR leadership.

ASLM has launched AfriEQA, an Africa-led regional platform designed to expand access to affordable, high-quality EQA services across the continent. Africa CDC has also included the QWArS training programme as the recommended training in their AMR strategy framework. Surveillance training protocols have been integrated into health systems and policies, for example, antimicrobial stewardship committees and gender equity, as part of the Uganda National Action Plan.

National ownership of quality assurance systems, with country NRLs and regional centres now capable of providing their own EQA through Fleming Fund support, has given long-term independence. Local genomic surveillance expertise has been expanded, with sequencing centres now able to deliver WGS services, train others, and advance AMR data use to influence policy.

Luna, added: “The Fleming Fund Regional Grants programme has supported long-term sustainability by institutionalising One Health training and accreditation, ensuring competencies remain embedded in national health systems to inform cross-sector action against AMR. The open-access tools and platforms developed remain freely available, enabling continued workforce skill development”.