Bangladesh—Fleming Fund Phases I and II

The Fleming Fund is a U.K. Department of Health and Social Care program administered through Mott Macdonald to help low- and middle-income countries fight antimicrobial resistance (AMR).

AMR is a leading cause of death globally, research shows that 1.27 million deaths annually are attributable to drug resistance, higher than HIV/AIDS or malaria. DAI’s Fleming Fund program in Bangladesh is a collaboration with the Bangladesh government to strengthen systems using a “One Health” approach—a multisectoral approach to complex health problems that reaches across human health, animal health, and environment sectors. As a global leader in the approach, DAI helps incorporate One Health across program interventions, supporting Bangladesh to become a leader in combating AMR and a model for better management of antimicrobials in human and animal populations.

In Bangladesh, Phase I focused on enhancing laboratory infrastructure, strengthening human resources, improving the AMR and antimicrobial use (AMU) surveillance system, building foundations for using AMR data and promoting the rational use of antimicrobial medicines. Phase II is building on this work to achieve four outcomes: producing high-quality AMR, AMU, antimicrobial consumption, and burden data; developing high-quality analyses of data; sharing the analyses and data with relevant decision-makers; and promoting sustainable investment to counter AMR.

Sample Activities for Phase II

• Review and update the National AMR surveillance strategy
• Review and update the AMR surveillance protocols in the animal health, human health, and aquaculture sectors.
• Develop AMR surveillance protocols in the food and environmental sector.
• Assess and strengthen AMR reporting to the national AMR dashboard by seven new laboratories (three human health, two animal health, and two aquaculture).
• Support internal procurement systems at laboratories to quality assure equipment maintenance and supply of consumables across sectors.
• Train laboratory staff on microbiology, epidemiology, quality management, and data collection to improve the quality of Phase I data.

Select Results

• Finalised the National AMR Surveillance Strategy using a One Health approach, which the Bangladeshi Government endorsed.
• Refurbished six Human Health (HH) and 5 Animal Health (AH) laboratories, and maintenance works completed.
• Procured equipment, consumables, and reagents for 12 laboratories (5 in AH, 6 in HH, and 1 in the aquatic sector).
• Developed national AMR Data Dashboard with a One Health approach. Live AMR data from all sentinel sites (HH, AH and Aqua sectors) and private sector is now available at the website of the Institute of Epidemiology, Disease Control and Research (IEDCR).
• Supported the development of sectoral surveillance protocols, sampling strategies, and laboratory protocols on biosafety, biosecurity, and standard operative procedures for laboratory functioning.
• Increased AMR data quantity achieved through the inclusion of the private sector in the passive AMR surveillance (public-private partnership).
• Finalized sector-specific surveillance plans for human, animal, and aquatic sectors, using a One Health approach.
• Strengthened AMR governance and coordination through functioning committees and working groups. Regular committee meetings are now held, and members are engaging in key activities that support better decision-making.
• Conducted antimicrobial usage (AMU) Study with a One Health approach and follow-up Point Prevalence Surveys (PPS).
• Facilitated the production of seven issues of the AMR Newsletter by the National AMR Coordination Centre.
• Completed 18 trainings on basic and advanced microbiology (249 participants), biosafety and biosecurity, and laboratory data management.
• Developed National External Quality Assessment Services (EQAS) Program and completed training for National Reference Laboratories (NRLs) to build their capacity as National EQAS providers.