The Fleming Fund: Key Features of Design and Approach to Strengthening Antimicrobial Resistance Surveillance in Low- and Middle-Income Countries.
11 affiliations
- 1Itad Ltd, Brighton, United Kingdom.
- 2Independent Consultant, Redgrave, United Kingdom.
- 3Department of Health and Social Care, London, United Kingdom.
- 4Independent Consultant, Dar es Salaam, Tanzania.
- 5Independent Consultant, Bristol, United Kingdom.
- 6Department of Infectious Disease, Imperial College, London, United Kingdom.
- 7Department of Infectious Diseases and Tropical Medicine, University of Heidelberg, Heidelberg, Germany.
- 8Department of Infectious Diseases, Bristol NHS Foundation Trust, Bristol, United Kingdom.
- 9Department of Health and Social Care, Leeds, United Kingdom.
- 10Independent Consultant, Arusha, Tanzania.
- 11East Central and Southern Africa Health Community, Arusha, Tanzania.
Abstract
This paper examines the Fleming Fund as a major long-term investment in strengthening antimicrobial resistance (AMR) surveillance in low- and middle-income countries. Established by the UK Department of Health and Social Care in 2015, the Fund committed up to £498 million to support surveillance capacity across 25 countries in Africa and Asia through a One Health approach spanning human, animal and environmental health. The paper situates the Fleming Fund within wider global concern about AMR and highlights surveillance as essential for stewardship, policy and international coordination. It describes the Fleming Fund's design logic, governance arrangements, grant architecture and evolving strategic priorities, with particular attention to how the program combined laboratory strengthening, workforce development, data systems, quality assurance, sampling pathways and multisectoral coordination to generate credible and usable AMR data. The analysis also examines the Phase 2 shift from an initial emphasis on data generation toward greater attention to data interpretation, dissemination and use in policy and practice. Drawing on program documentation, evaluation evidence and stakeholder perspectives, the paper presents the Fleming Fund as an important case of large-scale surveillance system strengthening in resource-constrained settings. It argues that the Fund offers wider lessons on the time, coordination and institutional embedding required to move from externally supported capacity building toward sustainable national surveillance functions. These lessons are relevant to future AMR investments and to broader debates on global health security, health systems strengthening and One Health implementation.
Related
- Fleming Fund Implementation in Kenya: What Have We Learned About Strengthening One Health Antimicrobial Resistance Surveillance for Decision-making?
- Surveillance Data Use Through the Fleming Fund: Informing Action on Antimicrobial Resistance in Low- and Middle-Income Countries.
- Antimicrobial Resistance (AMR) Surveillance: Ten Years On.
- Economic Barriers to Antimicrobial Susceptibility Testing as a Structural Contributor to Antimicrobial Resistance in Low- and Middle-Income Countries: A Narrative Review.
- Antimicrobial resistance of bacteria isolated from blood cultures at a tertiary hospital in Papua New Guinea: implications for antimicrobial stewardship and surveillance
BibTeX
@article{shorten2026fleming,
title = {{The Fleming Fund: Key Features of Design and Approach to Strengthening Antimicrobial Resistance Surveillance in Low- and Middle-Income Countries.}},
author = {Tim Shorten and Jemima Clarke and Archibald Drake and Ankur Gupta-Wright and Milena von Und Zur Mühlen and Evelyn Wesangula},
journal = {Clinical infectious diseases : an official publication of the Infectious Diseases Society of America},
year = {2026},
month = oct,
doi = {10.1093/cid/ciag499},
url = {https://europepmc.org/article/MED/42895839},
note = {CC BY},
}
RIS
TY - JOUR
TI - The Fleming Fund: Key Features of Design and Approach to Strengthening Antimicrobial Resistance Surveillance in Low- and Middle-Income Countries.
AU - Tim Shorten
AU - Jemima Clarke
AU - Archibald Drake
AU - Ankur Gupta-Wright
AU - Milena von Und Zur Mühlen
AU - Evelyn Wesangula
PY - 2026
DA - 2026/10/01
JO - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
DO - 10.1093/cid/ciag499
UR - https://europepmc.org/article/MED/42895839
AB - This paper examines the Fleming Fund as a major long-term investment in strengthening antimicrobial resistance (AMR) surveillance in low- and middle-income countries. Established by the UK Department of Health and Social Care in 2015, the Fund committed up to £498 million to support surveillance capacity across 25 countries in Africa and Asia through a One Health approach spanning human, animal and environmental health. The paper situates the Fleming Fund within wider global concern about AMR and highlights surveillance as essential for stewardship, policy and international coordination. It describes the Fleming Fund's design logic, governance arrangements, grant architecture and evolving strategic priorities, with particular attention to how the program combined laboratory strengthening, workforce development, data systems, quality assurance, sampling pathways and multisectoral coordination to generate credible and usable AMR data. The analysis also examines the Phase 2 shift from an initial emphasis on data generation toward greater attention to data interpretation, dissemination and use in policy and practice. Drawing on program documentation, evaluation evidence and stakeholder perspectives, the paper presents the Fleming Fund as an important case of large-scale surveillance system strengthening in resource-constrained settings. It argues that the Fund offers wider lessons on the time, coordination and institutional embedding required to move from externally supported capacity building toward sustainable national surveillance functions. These lessons are relevant to future AMR investments and to broader debates on global health security, health systems strengthening and One Health implementation.
SN - 1058-4838
SN - 1537-6591
ER -