CSO Budget academy / Advocating for a public health emergency fund in Zambia

Advocating for a public health emergency fund in Zambia

Civil Society Advocacy for Domestic Investment in Epidemic Preparedness

From 2018 to 2025, Resolve to Save Lives, the Global Health Advocacy Incubator and more than a dozen civil society organizations from nine countries—Ethiopia, Ghana, Kenya, Nigeria, Senegal, South Africa, Tanzania, Uganda and Zambia—partnered to increase domestic investment in epidemic preparedness.

Activities spanned coalition building and toolkit development, advocacy and media training and targeted engagement with political and financial leaders to make the case for investments in epidemic preparedness. The program is a testament to civil society’s potential to change policy, catalyze change, bolster domestic resources and safeguard communities.

Country context

In October 2023, Zambia conducted its second Joint External Evaluation (JEE), which highlighted several of the nation’s strengths including the Zambian National Public Health Institute (ZNPHI) and public health emergency operations center (PHEOC), an extensive lab network, and a strong immunization program. At the same time, however, a cholera resurgence in Lusaka illuminated many of the country’s ongoing challenges. As the outbreak spread, it infected nearly 20,000 people and killed almost 700¹ ² across 2023 and 2024.

Timeline and key achievements

Jul 2023	ZHECT participates in Tanzania CSO workshop developing lighter touch advocacy model
Oct 2023	ZHECT chosen to lead budget advocacy work in Zambia
Feb 2024	CSO Coalition on Emergency Epidemic Preparedness formed
Apr 2024	Coalition submits proposal on EPR funding to Ministry of Finance and Planning
May 2024	First high-level meeting with government officials to advocate for increased EPR funding
Jun 2024	First high-level meeting with parliamentarians regarding increased EPR funding
Mar 2024	CSOs and government hold meetings to finalize terms of public health emergency fund statutory instrument

An outbreak review identified lack of preparedness financing as a major issue. Because of budgetary shortcomings, health care settings had insufficient staff, supplies, and infection prevention and control (IPC) and water, sanitation and hygiene (WASH) measures. There were also delays in investigating outbreaks and insufficient public communication. The review concluded that “Zambia should prioritize health emergencies in budget allocations, despite financial constraints, because these crises weaken human capital essential for economic growth.”³

The review also noted that there was insufficient domestic funding earmarked for epidemic preparedness. Reliance on donor funding for key outbreak management tasks, including verifying and investigating public health emergencies and multisectoral coordination, was also identified as a major issue. In addition, because many relevant sectors did not participate in budgeting processes, their needs were not accounted for. When funding was available, it was often difficult to access, and spending was not tracked.

We realized after discussions with ZNPHI that the organization is ill-funded. We have faced a series of epidemics: COVID-19, cholera that has become endemic, and so many others, which almost all depend on seeking donor support to fight.
Mulako NabandaMonitoring and Evaluation Manager, Zambia Health Education and Communications Trust

To rectify this, the review offered three recommendations. First, the operationalization of a public health emergency fund to be established alongside the ZNPHI. The fund existed in law but needed a statutory instrument to become functional. Second, advocacy for increased budget allocations for epidemic preparedness. And third, a system to track spending of allocated funds to ensure accountability.⁴

A new approach to advocacy

In December 2023, Resolve to Save Lives (RSTL) and the Global Health Advocacy Incubator (GHAI) began advocacy work with local CSO partner Zambia Health Education and Communications Trust (ZHECT) to improve domestic funding for epidemic preparedness in Zambia.

Six months earlier, in July 2023, ZHECT was chosen to participate in a capacity building workshop held in Tanzania. This meeting was the culmination of many years of campaigning in Nigeria, Senegal, and Ghana and sought to field test new advocacy tools including the Budget Advocacy Toolkit for Epidemic Preparedness that had been developed based on campaign learnings. The meeting also sought to explore how a lighter touch model could work in practice. While the earlier campaigns had larger budgets—these ranged from US$200-300K—these amounts were not sustainable long-term and difficult to scale across new geographies, leading to a search for new models.

RTSL and GHAI invited CSOs from RTSL countries of interest—Ethiopia, Kenya, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe–with the view to identify potential new partners in these geographies, who could build upon a foundation in advocacy, their credibility and their network to implement the newly developing model and champion health security efforts. The workshop, which sought to test new training modules, leveraged experience from earlier campaigns by incuding CSO partners from Nigeria along with GHAI and RSTL staff as faculty.

Following the Tanzania workshop, ZHECT presented a proposal and was chosen in October to lead work in Zambia. The sister epidemic preparedness budget advocacy campaigns in Uganda, Kenya, and Zambia that began in 2023 and 2024 were the first to implement the lighter touch model. These new efforts in Kenya and Zambia were organized to operate in a leaner way and structured as “incubation grants”—between $50 to 70K—to demonstrate that a clear plan built on a proven model could produce meaningful impact with fewer resources. Zambia marked a further evolution of the advocacy model, proving that countries could operate without a local in-country coordinator. In this case, Zambia received remote support and visits from the in-country coordinator in Ghana.

Launching the campaign

Using the advocacy model developed in earlier campaigns and shared in the Toolkit, the team started with a landscape analysis to better understand the local health security context, identify the problem, and map stakeholders. This analysis identified the lack of dedicated epidemic preparedness funding and the still-inactive public health emergency fund.

The team then set a campaign goals to create an epidemic preparedness and response budget line and complete a statutory instrument to operationalize the public health emergency fund. Further, campaigners realized that once money was allocated accountability mechanisms would be needed to ensure funds were well-used and showed results; this became an additional goal. While the budget line needed to be handled via the executive and Parliament, the public health emergency fund needed to first have a statutory instrument developed by the ZNPHI, which had limited capacity due to competing priorities. The instrument would then need to be finalized by the Ministry of Justice, approved by the Ministry of Health, and thereafter presented to Parliament for approval.

The coalition was created specifically for this work because we felt it would be easier to reach out to our target audiences. We needed support not only from coalition members, but also their constituencies
Chilufya Mwaba PhiriCEO, Zambia Health Education and Communications Trust

ZHECT moved quickly to organize a formidable coalition of CSOs and media called the Coalition on Emergency Epidemic Preparedness. The coalition, which included organizations of people living with HIV, youth, women, and some focused on government accountability had expertise to support the development and amplification of policy briefs and coalition proposals, and networks to reach multiple stakeholders –public, policy makers, lawmakers, etc. Both CSOs and the media were given orientations on the issues to be better able to address them in advocacy and reporting.

At the campaign outset, GHAI conducted a capacity assessment to support ZHECT in developing organizational media and communications skills. The assessment helped ZHECT share its message more effectively through traditional and social media. And inclusion of media outlets in the coalition helped boost campaign visibility, keeping its goals in front of decision-makers and the public. Key meetings during the campaign were covered by television news, and coalition members regularly appeared on radio and wrote op-eds supporting epidemic preparedness funding goals.

In May, ZHECT convened a high-level meeting of government stakeholders to address the need for increased domestic funding for epidemic preparedness. The exchanges underscored the need for an inter-ministerial taskforce to further explore the issue, given the inherently multi-sectoral nature of epidemic preparedness. The following month, the team held a similar meeting with parliamentarians to lay the groundwork for an epidemic preparedness budget line and encourage eventual acceptance of a statutory instrument for the public health emergency fund.

There is a community in Lusaka called Kunyama built in an area that floods annually, causing cholera outbreaks. They lack proper water and sanitation. That is a factor that has to be addressed by the Ministry of Local Government and Housing. At the same time, the Ministry of Health needs to provide information, and the Ministry of Green Economy and Environment also plays a part. To solve this, you have to be strategic to bring together all the institutions that play a role.
Mulako NabandaMonitoring and Evaluation Manager, Zambia Health Education and Communications Trust

Throughout the campaign, ZNPHI was a key partner and ally, sharing information on their needs, reviewing policy briefs, and helping refine coalition asks. What became clear based on desk research and exchanges with ZNPHI, was that although Zambia was close to meeting the Abuja Declaration goal of spending 15% of the country budget on health, reaching 12% in 2023, there was no dedicated allocation for epidemic preparedness. Of the funds that went to the Ministry of Health, 4% went to the ZNPHI, and of that, 80% was spent on administrative costs. This left severe gaps, some of which were covered by international donors.

The coalition proposed a doubling of the ZNPHI budget along with a dedicated epidemic preparedness budget line and worked closely with parliamentarians, garnering ardent supporters who posed questions to the Minister of Health during parliamentary debates. While new funding for a budget line was proposed for the 2025 budget, it was never allocated by Parliament. However, significant progress was made in developing the statutory instrument for the public health emergency fund. In discussions with ZNPHI, it became clear that the Institute needed resources to complete the statutory instrument and ZHECT, along with another CSO, was asked to support a three-day meeting to finalize the terms of the instrument.

The suggestions we put in the statutory instrument as to where the sources of funds would come from are all sustainable sources. There is not a single suggestion of funds coming from outside the country.
Chilufya Mwaba PhiriCEO, Zambia Health Education and Communications Trust

In March 2025, meetings were held on how the funds would be used, disbursement mechanisms, best practices, and legal and policy considerations. Discussions also explored the issue of funding source, with a strong emphasis on identifying sustainable domestic sources. To operationalize the fund, the Ministry of Justice must now finalize the legal text before it is approved by the Ministry of Health, and then presented to Parliament for approval.

Lessons learned and legacy

When campaigns have a clear roadmap and thoughtful support, they can move quickly to make important changes. Along with its long track record in Zambia, ZHECT’s history in building capacity for epidemic preparedness budget advocacy long before the formal launch of activities in Zambia positioned it well to have a meaningful impact in a short time frame. Paired with specific capacity building exercises on media and communications as the campaign in Zambia launched, ZHECT was ready to lead the CSO coalition in making lasting improvements.
Finding the right model for advocacy success is an iterative process. The Nigeria campaign, which achieved notable wins over eight years, benefited from a long runway, consistent support, and a strong in-country presence by GHAI and RTSL. While countries like Zambia faced greater challenges in achieving similar breakthroughs, their experiences highlight the possibility of tailoring strategies to the resources and timelines available. Rather than suggesting that large-scale investment over many years is the only viable path, emerging models demonstrate that targeted strategic investments combined with sustained relationship-building can offer a more resource-efficient approach, pointing toward an adaptive and sustainable path to scale.
Supplementing desk research with early cooperative engagement of key government players is essential for success. At the outset, ZHECT understood that the public health emergency fund was a major win when it, and the ZNPHI, were enacted in 2020. But the promises of this win remain unfulfilled. Engagement with ZNPHI allowed them to understand the precise gap in operationalizing the public health emergency fund—lack of resources and competing priorities—so they could partner to fill that gap and fulfill a key advocacy goal.
Even if a country approaches the Abuja Declaration’s 15% target for health, this does not ensure support for epidemic preparedness. Zambia spent a greater proportion of its budget on health than many other African countries, but without specific advocacy on epidemic preparedness, outbreak activities were not prioritized and remained mainly reactive. This is a strong reminder that a well-trained, budget-minded ecosystem of CSOs is essential to ensure that governments make smart choices to protect their populations from outbreaks.

As much as we push, there are reasons that can delay and therefore timelines like 6 months may be a little bit too short. There are certain things that need to be looked at over a year. When looking at a dedicated budget, [we] can do a lot of prep work, but the government only looks at the budget once a year.
Chilufya Mwaba PhiriCEO, Zambia Health Education and Communications Trust

The sudden withdrawal of hundreds of millions of dollars in funding from the US government in early 2025 shook the Zambian government and ZHECT which was an implementing partner for PEPFAR. In the immediate aftermath, the Zambian government had to decide whether to prioritize support for many people living with HIV, those suffering with TB, Maternal and Child Health, and many other health needs that were covered by USAID funding. In the medium term, the Zambian government health investments will be impacted by new bilateral health partnership with the US government. While epidemic preparedness funding may not, in comparison, seem like a high priority, when outbreaks come, they often cripple other health functions, costing far more to respond to than to prevent. In the face of these tremendous challenges, it will be more important than ever that well-informed advocates continue to work to ensure epidemic preparedness remains central to budget priority conversations.

We are still fighting for it because it hasn’t specifically been established. The parliamentary health committee are still on board. They used the policy brief we had given to them to raise that issue on the floor of Parliament.
Mulako NabandaMonitoring and Evaluation Manager, Zambia Health Education and Communications Trust