Last week’s piece reflected on how the reduction in U.S. foreign aid—especially health funding through mechanisms such as USAID and PEPFAR—has exposed Zambia’s long-standing dependence on donor support to deliver essential health services. From HIV/AIDS treatment to maternal and child health, these programmes have relied heavily on external financing for years. With the sudden withdrawal of funding, and no assurance that these programmes will resume after the United States (US) government’s ongoing three-month review process, what is ultimately at stake is the country’s capacity to protect health outcomes and preserve the progress made over the years. In this follow-up article, we explore some of the steps Zambia can take—both in the short and long term—to reduce its vulnerability and build a more resilient and self-financed health system.
As a matter of urgency, Zambia must ensure continued access to essential medical supplies that were previously funded by U.S. support. This includes antiretrovirals, test kits, and maternal health commodities. The priority should be on on strengthening the existing procurement channels that already provide bulk medicines to the country. Ensuring timely disbursement of public funds would help to maintain a predictable and continuous supply of essential medicines, particularly those requiring consistent administration, such as antiretrovirals. Zambia can also explore temporary partnerships with multilateral agencies, including the Global Fund and Africa CDC, to fill funding gaps in priority health programmes. These engagements could help cushion the impact on service continuity while the country adjusts its financing strategy.
At the subnational level, there is room for the Constituency Development Fund (CDF) to play a more strategic role in the health sector. CDF can be optimized for health systems beyond its current political decentralization. A starting point would be the Ministry of Health to create health investment guidelines. Thus, a portion of the funds could be redirected—through appropriate guidance—to equip rural clinics, support mobile health outreach, or rehabilitate facilities affected by funding cuts. This approach would mirror examples from Kenya, where local funds have been used to construct dispensaries and maternity wards.
Community-level health promotion also requires renewed emphasis. The current shift in funding should be seen as an opportunity to scale up preventative health initiatives. Zambia already has a National Health Promotion Strategy, as part of the broader National Health Strategic Plan (2022–2026). However, implementation has been inconsistent. There is need to prioritise awareness campaigns focused on disease prevention, hygiene, nutrition, and lifestyle changes. These interventions are cost-effective and can reduce the pressure on curative services, particularly in overstretched rural areas.
From a broader fiscal standpoint, Zambia must do more to meet its health financing commitments. Under the Abuja Declaration, for example, countries—including Zambia—pledged to allocate at least 15% of their national budgets to health. As of 2025, Zambia’s health budget allocation stands at just 10.7%. Closing this gap will require serious efforts to mobilise more domestic revenue. One area that deserves urgent policy attention is illicit financial flows. According to the Financial Intelligence Centre’s (FIC) 2023 Trends Report, Zambia recorded over K13.58 billion in suspected financial crimes, including tax evasion and illegal externalisation of funds. This figure is equivalent to roughly 64% of the 2025 health budget, which stands at K21.2 billion. Such an amount could help fund health infrastructure, procure essential medicines, or support recruitment and retention of health workers. Strengthening oversight, improving enforcement, and enhancing transparency could help reduce these financial losses and free up more domestic resources for health.
In conclusion, the reduction in U.S. health aid is not just a fiscal issue—it is a wake-up call. It has exposed the fragility of our health system and the danger of over-relying on external funding. However, it also presents an opportunity to act—realistically, strategically, and deliberately. We must urgently strengthen domestic health financing and build institutional systems that can withstand global funding shifts. The path forward is definitely not easy, but it is within reach. What is required is clarity of purpose, commitment to reform, and strong political will that places the health of Zambians above short-term expediency.
About the Authors:
Elijah Mumba is a development economist specializing in public finance and policy analysis. He is a Senior Researcher at the Centre for Trade Policy and Development, where he also coordinates the Zambia Tax Platform and Civil Society Debt Alliance. He holds a master’s degree in development economics from the University of Cape Town as a Mandela Rhodes Scholar.
Natalie Kaunda is a development economist with expertise in public policy, advocacy, and economic research. She serves as the Head of Advocacy and Campaigns at the Centre for Trade Policy and Development. She holds a bachelor’s degree in development studies from the University of Zambia and a master’s degree in economics and finance, with additional studies in sustainable development at the University of Cambridge.
