The Fleming Fund: Key Features of Design and Approach to Strengthening Antimicrobial Resistance Surveillance in Low- and Middle-Income Countries.

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.