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Photo is of a Zambian mother and her child at a rural clinic supported by USAID.
USAID supports Zambia in strengthening its public health system at the national, provincial, and community levels.
Photo: John Healy for USAID

With the understanding that no country can be self-reliant without a healthy population, USAID works closely with the Government of the Republic of Zambia (GRZ) to strengthen the public health system at the national, provincial, district, and community levels. With an HIV prevalence rate of 12 percent, Zambia receives significant support from USAID under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). These PEPFAR investments focus on scaling up integrated HIV prevention, care, and treatment programs with the goal of reaching epidemic control by 2020.  

In addition to the HIV response, USAID’s programs also work to prevent and treat other diseases, including malaria, tuberculosis, and cervical cancer. Additional investment initiatives focus on increasing access to family planning, improving maternal, child health and nutrition, and preventing and responding to gender-based violence. To ensure sufficient availability of essential medicines and supplies, USAID also supports the procurement and distribution of commodities, such as condoms, HIV treatment, and tuberculosis test kits, to health facilities across Zambia. 

Supporting HIV/AIDS Prevention, Treatment, and Care

With support from PEPFAR, more than 900,000 Zambians are currently receiving daily life-saving antiretroviral treatment, compared to 3,500 in 2004. Within the general population, the incidence rate has fallen sharply in the last decade; and the infection rate for children born to HIV-infected mothers has dropped from 45 percent to less than 5 percent. 

Under PEPFAR’s Strategy for Accelerating HIV/AIDS Epidemic Control (2017-2020), Zambia is identified as one of ten high-HIV burden countries on course for achieving epidemic control by the end of 2020. This will be achieved in partnership with the GRZ, and through the achievement of the 90-90-90 framework — 90 percent of people living with HIV (PLHIV), know their status, 90 percent of people who know their status are accessing treatment, and 90 percent of people on treatment have suppressed viral loads. Additional focus is placed on preventing new HIV infections through high-impact, evidence-based programs.

In Zambia, PEPFAR concentrates its investments in the provinces and districts that reflect the highest HIV burden, based on national population estimates, demographic data, and public health facility data. High-impact, evidence-based programs target the populations at highest risk of contracting and/or transmitting HIV, which include discordant couples, people living with HIV, men aged 20-39, and adolescent girls and young women. 

PEPFAR invests approximately 57 percent of its annual budget in improving the quality and reach of clinical HIV services at public health facilities across Zambia. The primary focus of this support is to reduce HIV-related deaths, illness, and transmission through community and clinical testing, the connection of PLHIV to treatment, and support for treatment adherence. Examples of services include: targeting the most at-risk for testing through index tracing (testing biological children and sexual partners of PLHIV), providing alternative clinical hours for those hardest to reach, and establishing adherence support groups for those living with HIV.

USAID-related HIV investments also focus on preventing new infections through community-based behavioral and clinical programs, improved accessibility to prevention methods, and promotion of high-impact services. Examples of services include: Pre-Exposure Prophylaxis (PrEP), social asset/life skills building curriculum for adolescent girls and young women, voluntary medical male circumcision for boys and young men, community-level initiatives to combat gender-based violence, and peer-to-peer health and HIV education.

Supporting Healthy Mothers and Children

USAID’s portfolio for family health focuses on the development of sustainable, quality, accessible healthcare services for Zambian women, children, and youth. The USAID Safe Motherhood 360+ activity supports the reduction of maternal and newborn deaths through interventions targeting the three delays associated with maternal mortality: delay in seeking care, delay in reaching care, and delay in receiving care. During 2012 and 2018, USAID Safe Motherhood 360+ target areas experienced a reduction in infant, child, and maternal mortality by more than one third. Through the SARAI project, USAID aims to reduce unmet need for family planning (FP) by increasing the availability of planning and reproductive health services and by improving service delivery. To help reduce unmet need, SARAI helps provide FP services to unserved populations by using off-duty providers and task-shifting services to Community-Based Distributors.

Strengthening Health Systems

In partnership with the Ministry of Health (MoH), USAID works to strengthen systems that underpin the delivery of high-quality health services in Zambia. USAID helps develop the skills of health professionals through support for pre- and in-service training, mentoring, human resource information systems, and performance management. To improve procurement and supply-chain management, USAID works with the MoH to develop and operate information systems to manage health commodities, storage capacity, and logistics. To improve leadership and governance in the Zambian health sector, USAID works with the MoH to bolster a leadership, management, and training strategy and guidelines for MoH staff help.

USAID contributes to the Zambia District Health Information Software and national surveys to ensure high-quality, accurate health information is available in the market, and supports the national quality improvement program, performance assessment, and technical supervision of systems to improve service delivery in the Zambian health sector.  USAID resources also provide technical and material support to the MoH and General Nursing Council (GNC) to strengthen the pre-service training programs in six midwifery schools and two Community Health Assistant (CHA) Training Schools. Support has also been provided to the MoH to improve financial management systems in over 90 clinical sites in six provinces (Central, Eastern, Luapula, Muchinga, Southern, and Western).

Increasing Access to Health Products and Services

USAID procures and distributes, through both private and public sectors, health commodities and services for HIV/AIDS epidemic control, malaria elimination, family planning, and disease prevention and control. Products and services include HIV test kits, antiretroviral drugs, medical male circumcision supplies, water treatment solution, and malaria prevention and treatment commodities. In support of voluntary family planning, USAID procures and distributes male and female condoms, oral contraceptives, injectable contraceptives, and contraceptive implants.

USAID also supports the expansion of storage capacity for commodities and their distribution to service delivery points. USAID/Zambia helped to procure equipment to establish the central warehouse at Medical Stores Limited (MSL) and regional distribution hubs located in Chipata, Choma and Mpika. In 2018, with USAID support, ten additional prefabricated storage units were procured and installed, with an additional 40 proposed for 2019. USAID support aided in the roll out of an electronic logistics management information system to more than 575 facilities which has increased stock visibility and reduced the frequency of commodity stock-outs.

Combating Malaria

Through the United States President's Malaria Initiative (PMI), the majority of USAID/Zambia’s malaria-related programs target the highest-burden provinces (Eastern, Luapula, Muchinga, and Northern). Implementing partners support the scale-up of indoor residual spraying, training of healthcare staff, distribution of insecticide-treated bed nets, and the provision of rapid diagnostic test kits and life-saving medicines. These actions have contributed to a 76 percent decline in malaria deaths in PMI-target areas since 2010. Today, 80 percent of households own at least one insecticide-treated mosquito net, and 77 percent of children in rural areas sleep under bed nets.

Enhancing Nutrition

USAID/Zambia projects, such as Scaling Up Nutrition-Technical Assistance (SUN-TA) and Scaling Up Nutrition-Learning and Evaluation (SUN-LE), aim to reduce child stunting due to malnutrition across 30 districts in Zambia. The projects focuses on increasing access to, and availability of, safe, diverse, nutritious foods, and the adoption of healthier child-feeding habits and household hygiene practices. Additional activities focus on improved health, water, and sanitation infrastructure. The SUN projects prioritize sustainability by improving joint decision-making in the household and building the capacity of local government and stakeholders to support implementation.

Supporting Tuberculosis (TB) Control

With a prevalence rate of 638 cases per 100,000 people, TB continues to be a leading cause of illness and death in Zambia. In response, USAID works with GRZ and implementing partners to staff health facilities and strengthen infrastructure, improve case detection, procure critical equipment and supplies, and support operational research.  As a result, new diagnostic techniques have led to more efficient TB case identification and treatment, management of TB/HIV co-infection has improved, and services for multi-drug-resistant cases have been strengthened. In 2019/20, USAID will support the procurement of 3HP, a new drug to treat latent TB and prevent the development of active infections.

Combating Gender-Based Violence (GBV)

According to the Zambia Demographic and Health Survey, 43 percent of women aged 15-49 years have experienced some form of physical violence in their lifetime. Among girls between the ages of 13 and 17 years, almost 39 percent report experiencing physical violence and 20 percent, sexual violence. Through the STOP-GBV project, USAID aims to strengthen and expand opportunities for girls, women, boys, and men to live lives free of GBV and enjoy healthy, gender-equitable relationships. In close partnership with GRZ and DFID, project interventions focus on strengthening governmental and traditional leadership’s commitment to GBV prevention and response, mobilizing communities for gender norms change, strengthening the capacity of legal and law enforcement systems to respond to GBV, and providing quality one-stop GBV response care.

Current USAID/Zambia Health Activities