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)

Background This study focuses on 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. Results Governance of AMR surveillance in low- and middle-income countries generally strengthened over the five years to 2024, converging with the reported status of high-income countries (HIC). South-East Asian countries reported relatively strong gains, a striking exception to limited global progress. Globally, from a set of fifteen indicators, clear progress was only reported in four: two 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 when accounting for income-group differences: there is a positive 0.11 standardised change score difference on ‘national surveillance system for AMR in humans’ between FF-supported and other Official Development Assistance (ODA)-eligible countries, to a 95% confidence level (p = 0.046). TrACSS responses also suggest greater progress in FF-supported countries on other topics such as uses of surveillance data for decision-making in AH (FF-supported countries approximately a quarter (25%) more likely to respond ‘yes’). Additional reflections on the strengths and weaknesses of TrACSS data are discussed in detail. Conclusion Our study adds to current literature through empirical observations about country governance systems as they relate to AMR surveillance efforts. From a global point of view, the idea of progressive 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 FF impact not not only in terms of strengthening country HH and AH surveillance systems but also in terms of institutional changes data in administrative decision-making processes and possible translation into policy, programmes and regulation.