The UK Fleming Fund: Developing AMR surveillance capacity in low- and middle-income countries

Abstract

Background: The Fleming Fund is a UK Overseas Development Aid programme aiming to improve Antimicrobial Resistance (AMR) surveillance in low-and middle-income countries in Africa and Asia. The Fund has placed Country Grants in over 20 countries, to support implementation of the surveillance component of country AMR National Action Plans. Grants provide funding and technical assistance to develop AMR governance systems, and to improve capacity for bacteriology diagnostics, AMR reporting and data analysis. In rolling out the programme, we have accumulated a substantial dataset on AMR surveillance capacity across a broad range of settings. Methods and materials: As part of the grant placement process, we undertook a series of visits to each country to assess their AMR surveillance system and identify gaps which could be filled by the programme. Visits followed a standardised approach, which included meetings with AMR coordination committees, Ministries of Health, Agriculture, Fisheries and the Environment, FAO and WHO, and other relevant AMR stakeholders. The visits reviewed the sectors involved in AMR surveillance, the governance structure, national policies and strategies, key actors and activities, and barriers to implementation of National Action Plans. Results: Although countries varied in the maturity of their AMR surveillance systems, none had a fully functioning, integrated system. Common factors preventing implementation of surveillance were: a lack of coherent governance systems, lack of clarity regarding roles and responsibilities of different ministries, budget constraints, lack of technical expertise in surveillance design and data analysis, and poor IT and reporting systems. Conversely, we found differences in the rapidity of implementation, often related to the complexity of clinical and public health service governance. Conclusion: We have developed a comprehensive approach to assessing country capacity for AMR surveillance. Whilst the majority of countries have developed National Action Plans for AMR, implementation is universally hampered by lack of funding, poor inter-ministerial coordination, and limited technical expertise. Systematic identification of these issues will enable the Fleming Fund to adapt its programme to a wide range of situations and levels of capacity.