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Antimicrobial resistance (AMR) is a critical global public health threat. When antimicrobials become ineffective against infections that were once treatable, health systems worldwide face severe challenges in managing even minor infections. This results in higher treatment costs and increased mortality and morbidity as infections become untreatable. A recent study on AMR’s burden estimated that nearly 5 million deaths were linked to bacterial AMR in 2019, with 1.3 million of those directly attributed to it. AMR now poses a threat comparable to HIV and malaria.
Among the regions most affected, Sub-Saharan Africa has the highest mortality rate from bacterial AMR, with 27.3 deaths per 100,000 people. This heavy burden is further worsened by a lack of trained professionals and limited microbiology laboratory capacity. Only 1.3% of the 50,000 medical laboratories in 14 African countries conduct bacteriology testing, severely limiting population-level AMR data. Without this critical data, it is difficult to create effective interventions to combat the spread of AMR.
Recognising the urgent need for improved AMR surveillance in Africa, Pfizer Inc., Wellcome Trust, and the Ministries of Health in Ghana, Kenya, Malawi, and Uganda launched the Surveillance Partnership to Improve Data for Action on AMR (SPIDAAR). This public-private partnership aims to enhance AMR surveillance by training clinical and microbiological staff at eight hospitals across the four countries. Each site was tasked with performing diagnostic testing on 100 bacterial isolates from key pathogens.
The SPIDAAR initiative established systems to collect, process, and analyse culture samples from hospital patients. These samples were then sent to the National Institute for Communicable Diseases (NICD) in South Africa for confirmation. This approach enabled accurate monitoring of AMR trends and provided feedback on the reliability of hospital testing.
In May 2021, Pfizer enlisted Innovations in Healthcare (IiH) to support the sustainability of SPIDAAR’s efforts. Over two years, IiH provided resources and strategic guidance to the AMR teams within the Ministries of Health and at SPIDAAR sites. This collaboration resulted in the creation of a sustainability framework that identified the essential components of a robust AMR surveillance system. A checklist was also developed to guide the teams toward long-term sustainability.
IiH applied quality improvement principles, designing and deploying a tool to assess the progress of national and site-level AMR teams. They also facilitated peer learning and collaboration sessions to address common challenges and share strategies for overcoming them. While progress varied across sites, significant advancements were made in several locations.
To offer practical insights, IiH developed a series of case studies detailing the experiences of AMR teams in Ghana, Kenya, and Uganda. These studies, based on desk research and in-depth interviews, provide a comprehensive overview of the implementation of AMR surveillance through the SPIDAAR initiative, the challenges encountered, and the strategies used to address them.
Each case study serves as a resource for other AMR teams working in low-resource settings. They outline the systematic steps needed for AMR surveillance and highlight areas that need further attention to ensure sustainable implementation. The experiences of these countries offer invaluable lessons for Ministries of Health, development partners, and healthcare leaders looking to strengthen AMR surveillance capabilities across Africa.
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