Fleming Fund Implementation in Kenya: What Have We Learned About Strengthening One Health Antimicrobial Resistance Surveillance for Decision-making?
Evelyn Wesangula, Nkatha Gitonga, Emmanuel Tanui, Romona Ndanyi, Susan Githii, Bridgit Syombua Muasa, Eunice Omondi, Eric M Fèvre, Dishon M Muloi, Ali Kassim, Josiah Mwenda, Christine Minoo Mbindyo, Irungu John Kamau, Loice Achieng Ombajo, Gunturu Revathi, Veronica Chuchu, Anafi Mataka, Moctar M M Mouiche, Arshnee Moodley, Stanley Fenwick, Deborah Nanjebe, Lillian Bibangamba, Patrick Mubangizi, Toby Leslie, John A Crump, Zulfiqar Ahmed Bhutta, Tim Walsh, Kate Macintyre, Rebecca Maudling, Solomon Mugabe, Raheelah Ahmad, Lamiaa Shehata, Tim ShortenAbstract
Background
Kenya has moved from fragmented, pilot-based antimicrobial resistance (AMR) surveillance toward a coordinated One Health system, and its experience, pathways of change, and remaining gaps are relevant for other low- and middle-income settings working to operationalize One Health AMR surveillance.
Methods
Here, we report a narrative overview of programmatic learning using 2018 as the pre-Fleming Fund baseline, drawing on national and global surveillance reports, monitoring frameworks from the Quadripartite indicators, qualitative evidence on governance, implementation and policy evolution across the One Health sectors, and Fleming Fund documentation.
Results
Since 2018, AMR surveillance expanded from 2 human health sites to 30 human, animal, and environmental sites by 2025. National reports evolved to integrate AMR, antimicrobial consumption, and antimicrobial use data; routine reporting to global platforms matured; and outputs such as dashboards, reports, and policy briefs informing stewardship, Infection Prevention and Control, regulatory action, and policy decisions. External benchmarks showed improvement in AMR-related capacity, with World Health Organization Joint External Evaluation scores moving from limited to demonstrated capacity for surveillance and multisectoral coordination.
Conclusions
Kenya's experience suggests that sustainable progress depends on embedding AMR surveillance within government-led governance structures, technical systems, and coordinated partner support, but sustaining gains will require predictable financing and routine data use.