The global health landscape is undergoing significant changes, necessitating innovative solutions to sustain progress. In this dynamic context, the Lusaka Agenda stands as a beacon of hope, directing us toward a more effective, efficient, and equitable approach to Global Health Initiatives (GHIs).
Born from a multi-stakeholder dialogue and culminating from the Future of Global Health Initiatives (FGHI) process, the Lusaka-Agenda was launched on 12 December 2023, which is observed as Universal Health Coverage Day. It encapsulates both long-term shifts and immediate actions such as joint work and oversight, simplifying grant processes, and ensuring transparency over financial flows, aiming to create an efficient health financing system that delivers impact, especially in times of constrained resources.
Lusaka Agenda – how does it work?
The Lusaka Agenda sets a timeline for GHIs to jointly engage in pathfinder countries, showcasing different levels of systems maturity. The Lusaka conclusions have elicited varied reactions, with concerns raised about the predominant role of government entities in its implementation and the perceived limited space for Civil Society Organizations (CSOs) and communities. Additionally, there has been a misconception regarding the “consolidation role” attributed to GHIs within the framework of the Lusaka Agenda. Contrary to such interpretations, the Agenda underscores five specific long-term shifts that each GHI is expected to independently accelerate, moving away from any consolidation approach (see Box 1 below).
Box 1: Lusaka Agenda’s Checklist for Global Health Initiatives
Make a stronger contribution to primary health care (PHC) by effectively strengthening systems for health
Play a catalytic role towards sustainable, domestically financed health services and public health functions
Strengthen joint approaches for achieving equity in health outcomes
Achieve strategic and operational coherence
Coordinate approaches to products, research and development, and regional manufacturing to address market and policy failures in global health
Significantly, some of these proposed shifts align with elements already outlined in the Global Fund’s six-year strategy, complete with Key Performance Indicators (KPIs). However, critiques have arisen regarding the agenda’s lack of clarity on the issues it aims to address. There is a call for a greater emphasis on understanding how to enhance efficiency at the country level and ensuring improved coordination across these institutions. The focus should be on addressing these practical challenges to enhance the impact of global health initiatives.
What is the relevance for Africa?
For Africa, the Lusaka Agenda highlights the changing times in global health, marked by shifting funding priorities and the looming risk of reduced donor funding. The initiative serves as a clarion call, urging prioritization and urgency to avert potential disruptions to programs at the country level, which could result in severe consequences for the progress made thus far. This Agenda also presents an opportunity to address the disempowered position of many countries in negotiating with GHIs, emphasising the need for enhanced African engagement on priority issues for the continent.
African civil society organizations and communities have also been given the opportunity to play a crucial role in the implementation of the Lusaka Agenda by actively engaging in coordination and collaboration at the country level, contributing in GHI boards such as the Global Fund to oversee the agenda’s implementation, and incorporating the five shifts in their own operations.
Steering the Lusaka Agenda
Lusaka Agenda Co-Chairs from Ghana, Canada, and Amref Health Africa are forming an informal Steering Group, drawing members from both within and beyond the FGHI Steering Group. The collective action aims to anchor the Agenda within GHI boards and the African Union’s agendas. Their primary objectives include initiating the Lusaka Agenda’s implementation and engaging stakeholders such as GHIs, civil society organizations, and a broader spectrum of donors and implementing countries.
By working together, the proposed key shifts of GHIs can avert program disruptions, empower countries, increase efficiency and impact, and break down silos, leading to more effective interventions. It therefore sets the stage for a transformative journey towards a jointly envisioned future of domestically financed health systems and Universal Health Coverage that leaves no one behind.
As the Lusaka Agenda takes center stage in global health discourse, it signals a paradigm shift towards more impactful, collaborative, and sustainable health initiatives. African representation in the interim Lusaka Agenda Steering Group and broader consultation processes will help shape future collaboration around global health financing alignment, ensuring a more inclusive and responsive approach to addressing global health challenges.