As I write this on Zambia’s 62nd Independence Day, the flags are flying and the language of freedom is everywhere. By the time you read this, the celebrations may be over. But one question should remain: what does independence mean when the treatment, specialists or equipment that could save a life remain beyond the reach of many Zambians?

This is not an argument against partnerships. Zambia should not build its health system in isolation. The question is what those partnerships leave behind. Do they merely fund services and buildings, or do they build Zambian knowledge and capacity?

Two recent announcements make that question timely. On 8 October, Zambia and the United States signed a five-year health agreement worth US$2.49 billion. It covers HIV, tuberculosis, malaria, maternal and child health, outbreak preparedness, medicines, digital systems and the health workforce.

Days earlier, Zambia signed a memorandum of understanding with UAE-based DIHAD Sustainable Project Management for a proposed US$2 billion Medical City near Kenneth Kaunda International Airport. The vision is ambitious: specialist care, a paediatric cardiac centre, renal transplants, robotic surgery, neurosurgery, rehabilitation, a university and a school to train future specialists.

All of that sounds promising. We need investment, modern facilities and international cooperation. But a memorandum of understanding is a framework, not a completed hospital, and the announced value is not money already secured and spent. The Medical City must still move from headlines to financing, construction, staffing and affordable care.

Last night, over dinner, I listened to a young relative who works at the University Teaching Hospital speak about his work. It reminded me that Zambia does not lack intelligent, committed people. Our doctors, nurses, pharmacists, laboratory teams and other health workers often do remarkable work under pressure. What we lack is enough space, equipment, mentorship, specialist posts and reliable systems for that talent to grow.

UTH is not Zambia’s only public teaching or referral hospital. Levy Mwanawasa University Teaching Hospital, Ndola Teaching Hospital and other public institutions also provide specialist services and medical training. But UTH remains one of the most familiar doors for everyday Zambians seeking subsidised public care. The question is not whether specialist knowledge exists. It is whether our public health system has enough people, equipment, medicines and pathways to make that knowledge accessible when patients need it.

This is where independence becomes practical. A medical city cannot be judged only by the height of its buildings or the sophistication of its machines. We should ask how many Zambian specialists it will train, who will mentor them, whether nurses and technicians will receive advanced training, and whether young doctors from outside Lusaka will have a route into those opportunities.

We should also ask who will maintain the equipment when warranties end, who will own the data and research, and whether the knowledge behind the technology will be transferred. A machine we cannot repair without flying in an overseas team is useful, but it is not independence. A facility intended to position Zambia as a regional medical destination will mean far more if its expertise also reaches the Zambians already waiting for care.

Yesterday, a bank teller told me that her mother lives with Type 2 diabetes. Although she is covered by the National Health Insurance Management Authority, Metformin is not always available when she needs it, and buying it privately can feel painfully expensive. NHIMA officially covers generic medicines on Zambia’s Essential Medicines List. Yet coverage on paper offers little comfort when the medicine is not always available on the shelf. That small conversation brought the entire argument back to earth. Healthcare independence must eventually be felt at pharmacy counters, not only announced at international business forums.

The same test should apply to donor funding. The US agreement may strengthen essential services and protect millions of lives. That deserves recognition. But after five years, what will Zambia own that it did not own before? Will our supply chains be stronger? Will our health workers be better supported? Will our laboratories, digital systems and management structures continue without outside funding? Will chronic conditions such as diabetes, hypertension, cancer and kidney disease receive enough attention alongside infectious diseases?

These are not cynical questions; they are responsible ones. Independence is not refusing help. It means using every partnership to expand our own ability to teach, research, manufacture, maintain, manage and care.

Accountability must therefore begin before the ribbon-cutting ceremony. As the Medical City develops, clear public updates should explain what stage it has reached, how its training plans are progressing and how Zambians will access its services. The promise to develop the next generation of specialists should become visible through accredited programmes, teaching posts, clinical placements, research opportunities and clear routes for Zambian health professionals to advance.

We should also resist the idea that a magnificent facility in Lusaka automatically transforms healthcare across Zambia. A true centre of excellence must strengthen referral links, share knowledge with provincial hospitals and create training pathways beyond the capital. Its benefits should flow through the country, like the Zambezi, rather than collect in one privileged corner while communities elsewhere continue waiting.

At 62, Zambia is old enough to welcome investment without surrendering the right to question it. We can be grateful for international partners and still demand clarity. We can celebrate ambitious plans and still ask who owns them, who benefits and what remains when the partners leave.

Perhaps that is the next chapter of independence: not doing everything alone, but entering every partnership with a clear national purpose. The real measure of these health deals will not be the billions announced. It will be whether the next generation of Zambians can learn here, specialise here, innovate here and receive excellent care here. That is the freedom worth building now.

Kaajal Vaghela is a sportswear designer and cultural wellness consultant with over three decades of lived experience managing Type 1 diabetes in Zambia and the diaspora. Having previously served as Chairperson of the Lusaka branch of the Diabetes Association of Zambia, she remains a passionate advocate for breaking down myths and building awareness about diabetes. For more personalised coaching or corporate wellness workshops, visit: www.kaajalvaghela.com and for any feedback: [email protected])