Country governance of antimicrobial resistance (AMR) surveillance: observations on global progress and aid programme effectiveness using data from the Tracking AMR Country Self-Assessment Survey (TrACSS).

backgroundAMR is an important global public health challenge, but there is a lack of good data on response progress. This study addresses country governance of antimicrobial resistance (AMR) surveillance, considering changes in responses to the Tracking Antimicrobial Resistance Country Self-Assessment Survey (TrACSS) between 2019 and 2024. Its first objective is to describe progress under the global action agenda on AMR. Its second objective is to assess the effectiveness of a major development aid intervention to encourage action against AMR, the United Kingdom (UK)-funded Fleming Fund (FF). The study applies a pragmatic approach to analysis, involving descriptive exploration and difference-in-differences methodology.

resultsGovernance of AMR surveillance in low- and middle-income countries generally strengthened over the five years to 2024, converging with high-income countries (HIC). South-East Asian countries reported relatively strong gains, a striking exception to limited global progress. Globally, over fifteen indicators, clear progress was only reported in four: two on strengthening underlying AMR surveillance systems, in both human health (HH) and animal health (AH); and two on regulatory frameworks in AH. FF-supported countries reported strengthening HH surveillance systems more than comparable countries, even accounting for income-group differences. The standardised change score for the 'national surveillance system for AMR in humans' was 0.11 higher in FF-supported than in other Official Development Assistance (ODA)-eligible countries (95% confidence level, p = 0.046). FF-supported countries also reported greater progress on other topics, such as use of surveillance data for decision-making in AH. FF-supported countries were approximately a quarter (25%) more likely to respond 'yes' on this topic. Additional reflections on the strengths and weaknesses of TrACSS data are discussed in detail.

conclusionOur study adds empirical observations about country governance systems as they relate to AMR surveillance efforts. The idea of progressive global momentum, with South-East Asia playing a key role, disrupts established perceptions of European leadership and obstacles to change. From an aid effectiveness perspective, this study indicates that FF strengthened country HH and AH surveillance systems. It also points to institutional changes in how data are used in administrative decision-making processes and, potentially, in the translation of evidence into policy, programmes and regulation. CLINICAL TRIAL NUMBER: Not applicable.