Indonesia—Fleming Fund Phases I and II

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).

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

After the successful completion of Phase I, DAI was awarded the Fleming Fund Phase II Indonesia grant to continue to improve Indonesia’s ability to diagnose drug-resistant bacteria, generate data, and strengthen surveillance to inform policy and practice at national and international levels.

Phase I focused on laboratory infrastructure enhancement, human resource strengthening and workforce reforms, AMR and antimicrobial use surveillance systems strengthening, building foundations for AMR surveillance data use, 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, with the aim of progressing towards the long-term outcome of sustainable investment at country and global levels to counter AMR.

This 22-month Phase II initiative, administered through Mott Macdonald and led by DAI, includes a consortium comprising Utrecht University, the Liverpool School of Tropical Medicine, Health Security Partners, Prevalensi, the Koperasi Jasa Institut Riset Eijkman, and Ausvet.

Sample Activities

• Conduct a political economy analysis to create a formal stakeholder map, review current AMR activities, and consider various AMR governance models. This analysis will be used to conduct an advocacy strategy for sustained high-level ownership by the government to strengthen the capacity of multisectoral coordination.
• In collaboration with the human health technical working group, conduct antimicrobial use and resistance studies and identify a hospital cluster to study prescription patterns.
• Link existing systems in the animal health sector and create means of capturing disaggregated antimicrobial use data, including in-feed use, treatments, pharmacy dispensing for animal use, and public and private clinical usage.

Select Results

• Established the One Health AMR Taskforce, three technical working groups, and official endorsement of the National Action Plan on AMR 2020-2024 with the issuance of Coordinating Minister of Human Development and Culture Regulation No.7 of 2021.
• Conducted Antimicrobial Use Point Prevalence Survey of 1,236 patients in seven hospitals; survey of 600 poultry samples in eight provinces; ans aquaculture AMR surveillance of 600 samples in 16 provinces. The surveys gave key insights into the use practice and AMR pattern across the human and animal sectors informing policy and advocacy goals.
• Supplied equipment and National Referral Laboratory renovations. All lead Ministry of Agriculture labs now use improved and networked iVLabs laboratory information systems. The antimicrobial resistance information system (AMRIS) in AMR and AMU has been made ready for Government of Indonesia servers to be installed and utilized.
• Conducted genome sequencing for more than 200 human, chicken, and environmental strains that were extracted and shipped for commercial sequencing.
• Trained 1,310 participants including clinicians, lab personnel, vet, and policymakers on basic microbiology, advanced microbiology, biosafety and biosecurity, quality management, epidemiology of AMR, AMR data management, bioinformatics, and data collections on poultry and aquaculture.