Background and objective:
Antimicrobial resistance (AMR) is a global health challenge and developing countries are more vulnerable to its impacts. High burden of infectious diseases, poverty, weak governance and health systems, and low awareness remain major challenges in the fight against AMR leading to increased prevalence of HAIs including fungal infections, and superbugs like _Candida auris_. Infection-Prevention-Control (IPC) is a key to reduce the emerging HAIs and enhance healthcare outcomes.

Methods:
This participatory design project study, led by the National Institutes of Health (NIH)-Pakistan and funded by the CDC, was to support and improve the early diagnosis and surveillance of _C. auris_. We focused on capacity building in laboratory diagnostics, IPC strategies and implementing robust learning data dashboards with provincial stakeholders to ensure effective implementation. After thorough Gap-assessments through site visits and detailed mixed methods at 12 sentinel sites, representing all regions/provinces of Pakistan, using a phase-wise approach, capacity at each site was enhanced by providing hands-on-training and materials to enhance fungal diagnostics, IPC and surveillance.

Results:
In Microbiology Diagnostics readiness we found, 2-advanced, 7-intermediate and 3-inadequate sites. IPC program audited using WHO tools indicated 4-advanced, 2-intermediate, 3-basic and 3-inadequate sites. Fungal pathogen identification and transport of samples was initiated. Data dashboards were developed and implemented ensuring robust data collection and sharing from all sites. 26 samples were received at NIH for final identification indicating different fungal pathogens in isolates. IPC program was initiated and enhanced at all sites.

Conclusions:
NIH devised a National Fungal Disease Surveillance System-(NFDSS) to enable rapid diagnosis and surveillance of prevalent fungal pathogens Nationwide. Antimicrobial stewardship involving robust IPC methods can be exploited towards containing AMR in low- and middle-income settings. Adoption of these strategies will assist developing countries overcome their increased vulnerability to growing AMR.