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

DAI’s Fleming Fund program in Pakistan is a collaboration with the Pakistani government to strengthen systems using a “One Health” approach—a multisectoral approach to complex health problems that reach across human health, animal health, and environment sectors. As global leaders in One Health, the DAI team helps incorporate One Health across program interventions, supporting Pakistan in becoming a leader in combating antimicrobial resistance and a model for better management of antimicrobials in human and animal populations.

Upon completing Fleming Fund Phase I, the UK Department of Health and Social Care approved DAI’s application to lead the Fleming Fund Phase II Country Grant in Pakistan for another two years (January 2024 to December 2025).

Phase I focused on enhancing laboratory infrastructure, strengthening human resources and workforce reforms, strengthening AMR and antimicrobial use surveillance systems, building foundations for AMR surveillance data, and promoting rational use of antimicrobial medicines. Phase II will pursue intermediate outcomes relating to the quality data produced for antimicrobial resistance/consumption/use and burden, quality data analysis conducted, and quality data analysis shared with decision-makers to progress towards the long-term outcome of sustainable investment at country and global levels to counter AMR.

DAI is the lead grantee responsible for the project's overall technical, financial, and management implementation. Fleming Fund Pakistan’s other partners include the Liverpool School of Tropical Medicine, Health Security Partners, Indus Hospital Health Network, and Shifa International Hospital.

Sample Activities

• Provide quality assurance in the lab renovation and procurement activities.

• Improve the production of quality AMR/U/C and burden of disease data.

• Contribute to sustainable investments at the country and global levels to counter AMR.

• Use an evidence-to-action approach that builds on existing assessments to enable a nuanced understanding of the antimicrobial resistance and use (AMR/AMU) challenges and opportunities, entry points, and policy constraints.

• Foster a data for decision-making mindset, where decision-makers demand evidence for policy and stakeholders are empowered to hold those decision-makers accountable.

• Build a national-level multisectoral coordination mechanism to effectively address the complexities of AMR/AMU, strengthening information-sharing and coordination across public and private sectors and catalyzing political commitment and leadership to drive the AMR agenda.

Select Results

• Assessed and refurbished 22 animal and human health laboratories.

• Signed agreements with the Ministry of Health and the Ministry of National Food Security & Research.

• Developed operational cost plan for Pakistan’s National AMR Action Plan.

• Provided high-tech laboratory equipment to national reference laboratories.

• Conducted surveys of 164 in-service field veterinarians and 443 dairy farmers to assess knowledge, attitudes, and practices regarding AMR/AMU, herd health management, and laboratory use.

• Published a peer-reviewed research article titled “Quantification and Trends of Antimicrobial Use in Commercial Broiler Chicken Production in Pakistan” in the journal Antibiotics.

• Conducted point prevalence surveys identifying antimicrobial use patterns across human and animal health domains.

• Delivered training in basic and advanced AMR, biosafety and biosecurity, data analysis for whole genome sequencing, and laboratory quality management systems.

• Developed governance manual for One Health approach to AMR across Pakistan.

• Supported the microbiology department in Pakistan’s National Institute of Health Laboratory to pursue accreditation (ISO 15189) used by medical laboratories to certify quality management systems.

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