By Dr. Juliana Ndasi
LabVoice Issue 02
The end of a grant is not the end of a story. For countries strengthening antimicrobial resistance surveillance, the Fleming Fund’s (FF) regional portfolio has left behind more than activities and outputs it has helped build systems, skills, and confidence that continue to shape public health action across Africa and parts of Asia. Implemented in multiple phases between 2017 and 2025, the regional portfolio through initiatives such as EQuAFRICA, MAAP, TADE, QWArS, and the Fellowship programme deliberately moved beyond short-term capacity building. Instead, it focused on building durable systems, standards, and public tools that countries can own, adapt, and scale long after external funding has ended.
Across more than 15 African countries and three (3) Asian countries, Fleming Fund regional grants supported national AMR programmes to strengthen the entire surveillance value chain. This ranged from improving specimen quality and laboratory performance, to building workforce competence, strengthening data analysis, understanding costs, and ensuring evidence informs policy decisions. Several flagship outputs are already embedded within national, regional, and continental practice, ensuring continuity well beyond the life of the grants.
One of the portfolio’s most visible impacts has been the strengthening of laboratory quality and surveillance systems. Through EQuAFRICA, countries reviewed and implemented National Laboratory Quality Frameworks, strengthened External Quality Assessment (EQA), and launched Afri-EQA as a continentally relevant, African-led service. Together, these efforts improved the reliability and credibility of AMR data, an essential foundation for effective surveillance and action. Structured training and certification programmes, including TrEQAP(in full?), helped shift quality assurance from a project-based activity to a routine part of laboratory practice, with sustainability built in through business planning, cost analyses, and market-oriented EQA delivery.
On data, the MAAP grant helped turn AMR information into something countries can consistently use. Building on earlier phases, MAAP delivered the Antimicrobial Resistance Surveillance Guidance for the African Region, which now serves as a shared blueprint for AMR, antimicrobial consumption (AMC), and antimicrobial use (AMU) surveillance across the continent. Through the AMR Knowledge Hub and related digital platforms, guidance, tools, datasets, and learning resources were brought together in one accessible space, ensuring continued use beyond the grant. MAAP also strengthened the evidence base through peer-reviewed publications and high-level policy reports, including landmark African Union outputs that continue to shape advocacy, financing, and strategic direction.
One of MAAP’s most impactful innovations was AMDataNet, an open-source set of tools designed to make AMR, antimicrobial consumption (AMC), and antimicrobial use (AMU) data easier to analyse and act on. Piloted in countries including Uganda, Tanzania, Kenya, Zambia, Cameroon, and Gabon, AMDataNet reduced manual workloads, improved data quality, and shortened analysis timelines, enabling faster use of surveillance data for national reporting and policy decisions. Built as an open and adaptable platform and hosted on GitHub, AMDataNet remains a sustainable public good that countries and partners can continue to use, customise, and expand.
To support long-term sustainability, TADE focused on a challenge often overlooked in AMR surveillance: understanding what it truly costs. By providing practical costing methodologies, user-friendly tools, and clear protocols, TADE enabled countries to better quantify costs, identify investment gaps, and plan across One Health surveillance systems. This work has helped shift conversations from donor dependence toward evidence-based domestic financing and resource mobilisation.
One of the portfolio’s most far-reaching contributions has been its investment in people. Through QWArS, AMR workforce development moved from ad hoc training to a recognised, competency-based qualification. Across 14 African and three (3) Asian countries, more than 500 microbiologists and epidemiologists were trained through a blended learning model hosted on the ASLM Academy. The digital approach ensured continuity during COVID-19, expanded access to underserved professionals, and embedded training within a continental platform that remains active beyond the grant.
QWArS also prioritised sustainability through its Domestication Guidance Framework, supporting countries to integrate the qualification into national regulatory systems, CPD frameworks, and established programmes such as FELTP (in full). This approach gained continental traction, with the draft African Union Framework for AMR Control (2026–2030) explicitly calling for sustained investment in workforce initiatives like QWArS, signaling growing political and institutional ownership.
The Fellowship programme further demonstrated how targeted individual investments can deliver system-level impact. In Tanzania, fellows progressed from learning to leadership, contributing directly to national AMR governance, surveillance analysis, policy briefs, costing exercises, and continental advocacy. By embedding fellows within existing national structures, the programme ensured that skills, networks, and leadership capacity remain firmly rooted within country systems.
Collectively, the Fleming Fund regional portfolio leaves a coherent and mutually reinforcing legacy: stronger governance frameworks, quality-assured laboratories, harmonised surveillance guidance, skilled professionals, accessible data tools, and costed pathways for sustainability. More than a record of achievements, these legacy positions countries to sustain and advance AMR surveillance beyond project closure—marking a decisive shift toward domestically led, evidence-driven responses and a lasting return on investment.