Lessons Learnt - Sustaining AMR Surveillance Beyond Fleming Fund

The Fleming Fund is a UK Department of Health and Social Care (DHSC) initiative to support up to 25 low- and middle-income countries (LMICs) to strengthen national surveillance systems for antimicrobial resistance (AMR). Since 2017, much progress has been made towards building country-owned AMR surveillance systems, through investments by the Fleming Fund, working with in-country partners and grantees. The main challenge now is how to sustain these systems without ongoing support from the Fleming Fund which is due to end at the beginning of 2026. The prospects for sustainability in some countries are good but there will inevitably also be gaps in terms of continuation of specific activities. This paper provides information to support continuation of AMR surveillance by identifying enablers that help country programmes to transition to full country ownership and challenges (blockers) to sustainability, specific sustainability gaps and ways to mitigate these. Country case studies of Indonesia, Vietnam, Bangladesh, Pakistan, Kenya, Nigeria, and Uganda provide snippets of lessons learnt from implementing the Fleming Fund. Findings in this report are organised in three thematic sections, each important pillars of sustainability. Below is a summary of the enablers and blockers identified for each thematic area.