With the recent decline in donor funding, particularly under the current U.S. administration, operationalizing the Lusaka Agenda has become even more urgent. African countries, alongside regional bodies such as the Africa CDC, African Union Commission (AUC), WHO-AFRO, and the African Constituency Bureau (ACB), are taking concrete steps to ensure its implementation.
Key focus areas for operationalizing the Lusaka Agenda include the development of an Accountability Framework, strengthening civil society engagement, and improving coordination between regional and global stakeholders. These steps are increasingly vital as the region faces greater pressure on donor support.
The Lusaka Agenda’s emphasis on “one plan, one budget, and one monitoring framework” is now more critical than ever, given the likely reduced funding from donors. Susan Mochache, Executive Director of ACB noted 70% of global health funding goes to Africa, but there is a pressing need for greater efficiency and sustainability in resource allocation and use.
This article explores the progress made in moving the Lusaka Agenda from commitment to action, highlighting regional leadership efforts and country-level implementation.
📌 The Five Key Shifts of the Lusaka Agenda
For readers unfamiliar with the Lusaka Agenda, here are its five key shifts:
1️⃣ Strengthening primary health care (PHC) by enhancing health systems.
2️⃣ Catalyzing sustainable, domestically financed health services.
3️⃣ Achieving equity in health outcomes through joint approaches.
4️⃣ Improving strategic and operational coherence among health actors.
5️⃣ Enhancing regional coordination on products, R&D, and local manufacturing.
Developing the Accountability Framework for the Lusaka Agenda
A major step in operationalizing the Lusaka Agenda is the development of an Accountability Framework, led by Africa CDC in collaboration with the AUC and the African Constituency Bureau (ACB). At the February 2024 AU Assembly of Heads of State, a key decision (Dec.880(XXXVII)) endorsed the establishment of a mechanism to track progress of the Lusaka agenda and align efforts with the AU Roadmap for 2030.
As part of this process, Africa CDC has conducted a series of consultations, including:
- Engagements with partners including global health institutions (GHIs) and UN agencies to develop the framework.
- A member state consultation to review the draft accountability framework ensuring country priorities are well reflected.
- A technical briefing with over 100 civil society representatives, to ensure community perspectives are reflected in scorecard indicators.
Country-Level Implementation: Turning Policy into Practice
WHO-AFRO, in collaboration with partners such as the African Constituency Bureau (ACB), has been supporting Lusaka Agenda champion countries in aligning their national health systems with the agenda’s priorities. Additionally, it has facilitated platforms for cross-country learning and exchange, allowing governments to share progress, challenges, and best practices.
Below are key examples of implementation at the country level.
Democratic Republic of Congo (DRC): Strengthening Emergency Response
The Lusaka Agenda is now integrated into national emergency responses in the DRC’s Eastern region. The government has initiated contingency planning and is leveraging Global Financing Facility (GFF) support to improve health financing. Additionally, high-level consultations with the Presidency, Ministry of Health, Ministry of Finance, and donors have led to the consolidation of two existing models (“Unique Contracts” for donor alignment and the “MoU” model for financing accountability) into a single national plan, budget, and M&E system.
Ethiopia: Overcoming Challenges to Align Health Plans
Despite challenges posed by donor aid freezes, Ethiopia continues its efforts to harmonize a unified health budget and national plan. While the aid freeze has impacted some NGOs and capacity-building initiatives, most health services remain operational through government systems. The country is also analyzing the financial status of its three main funding channels: direct government contributions to health, donor-managed grants, and partner funds.
A recent visit of a joint consultative working group (JCWG) composed of GAVI, Global Fund and GFF has assessed Ethiopia’s primary health care services, highlighting both achievements and areas for improvement in grant management and implementation efficiency.
South Sudan: Strengthening Coordination for Greater Impact
South Sudan views the Lusaka Agenda as a critical opportunity to unify health actors and has established a two-tier coordination structure:
✅ Strategic coordination at the leadership level (Ministry of Health and agency heads).
✅ Operational coordination to facilitate implementation.
The country has also identified the need for clear Terms of Reference (ToRs) for in-country Lusaka Agenda working groups to enhance collaboration.
Malawi: Advancing Health Sector Reforms with a Unified Approach
Malawi has been a frontrunner in embedding the Lusaka Agenda within its Health Sector Strategic Plan III (HSSP III) 2023-2030, which follows the “one plan, one budget, one report” principle. Key milestones include:
✅Strengthening district-based health system reforms.
✅ Conducting regular coordination meetings with district health managers, partners, and the Joint Committee Working Group (Gavi, Global Fund, GFF).
✅ Establishing three integration pathways to improve service delivery:
- Integrated screening services for early disease detection.
- Chronic care clinics for long-term patient management.
- Maternal and child health clinics for comprehensive reproductive health services.
Next steps include conducting a bottleneck analysis, finalizing operational plans, and strengthening coordination between the Ministry of Health and GHIs.
Central African Republic (CAR): A Leadership-Driven Approach to Health System Strengthening
CAR has launched a National Leadership Program to assess and accelerate health sector alignment. Key focus areas include:
✅ Enhancing evidence-based service delivery.
✅ Strengthening the health workforce through better training and coordination.
✅ Fostering a culture of accountability in health governance.
CAR is also developing a National Alignment Policy Document to institutionalize these reforms and advance the Lusaka Agenda’s objectives.
Civil Society Engagement: Ensuring the Lusaka Agenda Remains People-Centered
Civil society engagement is crucial to ensuring that the Lusaka Agenda prioritizes human rights, gender equity, and community needs. Rosemary Mburu of WACI Health highlighted that CSOs must push for the “how” of implementation to ensure meaningful progress.
Key recommendations from CSO consultations include:
✅ Enhancing government accountability for health commitments through clear tracking and reporting mechanisms.
✅ Prioritizing underfunded health areas with defined domestic allocation targets, aligned with national health financing cycles.
✅ Incorporating equity-focused indicators to measure and address disparities in health access and outcomes.
✅Establishing regular engagement mechanisms between CSOs and Africa CDC.
Enhancing Coordination Among Global Health Initiatives: Insights from the JCWG
The Joint Committee Working Group (JCWG) collaborative platform involving Gavi, the Global Financing Facility (GFF), and the Global Fund. It was established to enhance coordination among these global health initiatives, ensuring greater alignment in financing, implementation, and support for country-led health priorities. Recent discussions have identified key challenges, including complex fund application processes, multiple oversight structures, and varying reporting requirements.
Recommendations from the latest JCWG meeting include:
✅ Aligning funding cycles across global health initiatives.
✅ Exploring joint malaria and immunization strategies.
✅ Establishing flexible funding pools for malaria interventions.
Conclusion: The Road Ahead
The Lusaka Agenda has transitioned from rhetoric to action, with concrete steps taken at both regional and national levels. However, challenges remain, particularly in mobilizing domestic resources and ensuring accountability. Stronger engagement between governments, civil society, and global health partners will be critical in sustaining momentum.
As Dr. Landry Tsague of Africa CDC emphasized, “The Lusaka Agenda is a global agenda but, more importantly, an African agenda. It calls for a paradigm shift—greater reliance on domestic resources, improved accountability, fostering strategic partnerships, and aligning with Africa’s long-term health goals.”
Similarly, Rosemary Mburu cautioned, “Even with alignment and coordination, if we don’t remember the principles that have driven past progress, we risk falling short.”
The coming months will be crucial in determining whether the Lusaka Agenda delivers on its promise of stronger, more sustainable health systems in Africa.
