Building capacity to tackle antimicrobial resistance in Africa

Reflections on the work of the Fleming Fund Fellowship schemes in Uganda, Malawi and Kenya, that are building expertise in AMR surveillance.

March 2024:  The Fleming Fund is a UK aid programme supporting up to 25 countries across Africa and Asia to tackle antimicrobial resistance.  The Fund is managed by the Department of Health and Social Care, and was established by the UK Government in 2015 in recognition of the increased need to improve AMR surveillance, public awareness and responsible drug use.

The University of Edinburgh and Edinburgh Infectious Diseases have been working with the Fleming Fund Fellowship Scheme for the past 4 years as a Host Institution.  As Phase 1 draws to a close and we ready ourselves for an Phase 2, we are reflecting on the past 4 years.

The Fellowship schemes in Edinburgh during Phase 1 were directed by Prof Ross Fitzgerald, and we are very pleased that Prof Till Bachmanna and Dr Adrian Muwonge will be co-directors of the work as Phase 2 gets underway.

19 fellows across 3 countries

During Phase 1, The University of Edinburgh was host to 19 fellows, all of whom have now successfully completed their fellowships. The fellows were all professional working in roles that had a remit to tackle AMR, and were from both human and animal health sectors, committed to developing One Health approaches.

The first cohort of professional fellows in Uganda began their work in January 2019.  They undertook training with University of Edinburgh staff in Kampala in spring of that year, and then spent a month in Edinburgh further developing their knowledge and planninng an ambitious collaborative project.  The project investigated the links between antibiotic use in communities in Uganda, and the emergence of resistant infections in hospitals.

The Fleming Fund Phase 1 has been ground-breaking in terms of creating momentum for National Action Plans. In this regard, our Phase One has trained 19 fellows across three pillars: Surveillance, Diagnostics, and Stewardship in Kenya, Uganda, and Malawi. The collaborative research has allowed us to develop and pilot two blueprints for One Health AMR surveillance.

The fellowships in for professional fellows in Malawi and for policy fellows in Kenya, and the second cohorts in Uganda all started in 2020, during the Covid-19 pandemic.  This meant that the initial meetings for fellows and mentors, and the training events, were all run virtually.  All fellows were able to attend sessions on the Fundamentals on AMR, AMR diagnostics and surveillance, Antibiotic use and AMR policy and communications.  

It was a pleasure to be involved in the Fleming Fund Fellowship phase 1. The fellows have already gone on to have important impacts in addressing AMR in their own countries but it was a hugely enriching and educational experience for University of Edinburgh members who were involved. We now have well established collaborations that will allow us to together tackle the global crisis of AMR in the future.

The fellows visit Scotland

We were delighted when travel restrictions were lifted in March 2022 when 13 fellows were finally able to travel to Edinburgh.  During their time in Edinburgh, the fellows undertook many activities that allowed them to learn valuable skills that they were able to take back to their home countries and further promote the importance of AMR awareness.  They connected with AMR colleagues across the University of Edinburgh, with clinicians at the Royal Infirmary Edinburgh and the Western General Hospital and with staff at the Scottish Government and other partners.  

The visit concluded with a symposium where all fellows presented the progress on their fellowship activities. The symposium attracted significant attendance, highlighted by the participation of The Roslin Institute's director and representatives from Mott MacDonald, the Management Agent for the Fleming Fund.

Building meaningful communities to tackle AMR

It was understandably very important for the fellows to visit Edinburgh, but it was equally important for mentors and the University fellowship team to connect with the fellows in-country. This was achieved via the Fleming Fund colloquium which was held in Jinja, Uganda in June 2022.

The event further highlighted the importance of developing effective relationships and communication with all the stakeholders in the fellowship. The Director General of the Ministry of Health in Uganda Dr Henry Mwebesa addressed the colloquium on the closing day of the event.

Important achievements

All the fellows from Phase 1 have gone on to make significant contributions to wider capacity building that  tackles AMR. Their positions have allowed them to gain increased authority and a bigger platform to contribute to their local and national action plans addressing AMR. 

The Malawi Cohort 1 professional fellows were able to deliver a One Health project which assessed the level of antibiotic resistance of E. coli on poultry farms in central Malawi – the first study of its kind.

The policy fellows in human and animal health in Kenya have been strong advocates for AMR with one of their key activities been to develop and produce a documentary on the silent pandemic. The Silent Pandemic documentary has recently won the Regional AMR Champion Media House Award (will link to articles for this).

The policy fellows in Uganda have been working with the national One Health Platform to advocate for AMR with policy makers and other stakeholders and the Cohort 2 professional fellows in Uganda have also achieved all the targets of their workplans.

Silent Pandemic documentary receives Regional AMR Champion Media House Award

Malawi Fleming Fund fellows make further progress on AMR surveillance in poultry farms

Fleming Fund fellowships are increasing capacity for bioinformatics in Uganda

The fellows discuss their fellowships

Transitioning to Phase 2

Given the success of Phase 1, The University of Edinburgh and Edinburgh Infectious Diseases are again a Host Institute for Phase 2 of the Fleming Fund which will begin shortly. We hope that Phase 2 will also give countries a better understanding of AMR and equip them with the tools and resources to combat what is an increasingly challenging issue.

The Fleming Fund Fellowship phase 1 has created a whole range of tremendous opportunities for collaboration and capacity building for everyone involved. I had the pleasure to contribute and benefit as a mentor. Moving forward, I am delighted to come in as co-director for phase 2 and l look forward to further exceptional interactions with a growing network of alumni and new contacts in Malawi, Uganda, Kenya and Zambia.