Zambia has made substantial progress in strengthening its health financing systems as part of its journey toward universal health coverage (UHC). Recent policy shifts and strategic reforms signal strong national intent to move closer to the Abuja Declaration target of allocating at least 15% of the national budget to health.

A decade of progress: Building Institutional Foundations for Reform.

Until recently, Zambia’s Ministry of Health (MoH) faced systemic gaps in health financing governance. Through support from the Advance Domestic Health Financing (ADHF) project, implemented by African Institute for Development Policy (AFIDEP) and Partners in Population for Development–Africa Regional Office (PPD-ARO), Zambia has made key structural reforms. These include the establishment of a Health Financing Unit (HFU) and the revitalisation of the Health Financing Technical Working Group (HCF-TWG), a multi-stakeholder platform that now guides health financing reforms, policies, and strategies.

Accountability and evidence: Strengthening Systems for Better Resource Use.

To address inefficiencies in financial management, Zambia rolled out new guidelines for managing Internally Generated Funds (IGFs) in January 2025. These guidelines introduce clearer mechanisms for fund allocation and reporting, aiming to boost transparency and optimise the use of public funds at health facilities.

ADHF also supported the Ministry in updating its National Health Accounts (NHA), a major milestone, considering these had not been updated since 2017. With new data in hand, the Ministry of Health (MoH) successfully lobbied for a 12% increase in the allocation for primary health care (PHC) between 2024 and 2025 from ZMW 7.5 billion (approx. $ 277 million) to ZMW 8.4 billion (approx. $310 million).

Commitments to Abuja: Steady Increases, but Gaps Remain.

Zambia’s commitment to the Abuja Declaration is visible in its steady increase in health allocations. The country has grown its health budget allocation from 8% to 12% and key officials have pledged to reach the 15% Abuja target in the near future.

However, Zambia still faces challenges. A recent analysis warns of the consequences of reduced U.S. government foreign support and, highlights the urgency of mobilising sustainable domestic financing to support critical services like HIV/AIDS treatment and maternal health.

The Health Financing Strategy 2017–2027 outlines how Zambia intends to close this gap. It includes strategies like scaling the social health insurance (SHI), leveraging “sin taxes,” and enhancing public-private partnerships.

Looking Ahead: Strengthening National Resilience.

The path forward demands bold investments in primary health care, data systems, human resources and strategic purchasing. Notably, Zambia’s experience with reallocating the Constituency Development Funds (CDFs) toward health facilities shows promise in localised, community-led solutions to bridge funding gaps.

As Zambia navigates an evolving global funding landscape, its focus on African-owned, sustainable and transparent health financing reflects a regional shift. The country’s reforms highlight the importance of political will, data-driven planning, and partnership alignment in sustaining health outcomes.