Surveillance Data Use Through the Fleming Fund: Informing Action on Antimicrobial Resistance in Low- and Middle-Income Countries.

Abstract

Drawing on the Fleming Fund's work to strengthen antimicrobial resistance (AMR) surveillance across Africa and Asia during 2018-2026, this article provides one of the first syntheses of AMR surveillance data use in low- and middle-income countries. A participatory synthesis for narrative review was conducted to summarize experience across administrative levels (facility, subnational, national, and regional). Data use was most evident at the facility level, in human health systems where resistance patterns, antimicrobial use, and clinical data increasingly informed antimicrobial stewardship, infection prevention and control, and other quality improvement initiatives. Data use in other sectors required different approaches. At the national level, Fleming Fund investments were associated with revisions of treatment guidelines, updates of essential medicines lists, and regulatory measures, primarily through improved governance and policy communities. Regional platforms supported member country data use at the national level. Subnational data use was undertaken in countries with decentralized health systems. Across levels, data use pathways driven by local priorities helped surveillance inform action. Fleming Fund experience suggests that surveillance is more likely to inform action when data use is built into system design. Continued investment will be needed if AMR surveillance is to improve policy and practice in low- and middle-income countries.