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 health system at national, provincial, district, and community levels. With an adult HIV prevalence rate of 11 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 and sustaining integrated HIV prevention, care, and treatment programs. In addition to the HIV response, USAID’s programs also help to prevent and treat other diseases, including malaria, tuberculosis, cervical cancer and COVID-19. Additional health-related investments and initiatives also focus on increasing access to family planning, improving maternal and 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 preventive therapy and treatment, and laboratory reagents to health facilities across Zambia.

Supporting HIV/AIDS Prevention, Treatment, and Care

Zambia now has over 1.1 million people on lifesaving antiretroviral treatment and has achieved a significant milestone in HIV epidemic control having reached the UNAIDS 90-90-90 target — 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. Within the general population, the incidence has fallen sharply in the last decade; and the infection rate for children born to HIV-infected mothers has dropped to less than 5 percent.

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 to improve 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

In partnership with GRZ, USAID improves access to sustainable, quality healthcare services for Zambian women and children through high impact interventions to reduce maternal and child illness and death. USAID projects strengthen health services at all levels to advance quality, respectful maternal health care and support volunteers working in their communities to engage with women of reproductive age to increase demand for and improve access to services.

Examples of USAID maternal and child health initiatives include capacity building and mentorship of health care workers, focused prenatal care, emergency obstetric and newborn care, and postpartum family planning.

USAID also supports programs that reduce newborn mortality, save the lives of children under five, and helps them thrive. Examples include building capacity of health providers and community health volunteers to prevent illness, identify and manage sick children, and provide timely referrals to services. Given recent outbreaks of both measles and polio, USAID continues to support the strengthening of services to ensure children receive life-saving routine immunizations. Training and mentoring activities also strengthen outreach and community health services to manage childhood illness and increase awareness on good health-seeking behaviors.

Increasing Access to Voluntary Family Planning

Voluntary family planning with informed choice is recognized by the GRZ and USAID as a critical component to help meet the needs of families, improve nutrition, and prevent maternal and child deaths. USAID works with the Zambian government to provide high-quality voluntary family planning (FP) services responsive to people’s reproductive health needs. To expand access to sustainable FP commodities and services, USAID also works with private sector partners in urban and peri-urban settings. Programs include bolstering health worker skills to effectively counsel women and men on contraceptive options as part of a comprehensive package of health care services, procuring FP commodities, and increasing awareness of FP and reproductive health care through outreach by community volunteers and radio serial programs.

Strengthening Health Systems

In partnership with Zambia’s 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.

Increasing Access to Health Products and Services

USAID procures and distributes, through both private and public sectors, health commodities and services for HIV 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 procure equipment to establish the central warehouse at Medical Stores Limited and regional distribution hubs located in Chipata, Choma and Mpika. In 2018, with USAID support, 10 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

The United States President's Malaria Initiative (PMI) - led by USAID and implemented together with the U.S. Centers for Disease Control and Prevention - works with the GRZ to support a comprehensive package of evidence-based malaria control interventions, targeting the five high burden provinces of Eastern, Luapula, Northern, Muchinga, and Copperbelt. Examples of PMI activities include building the capacity of community health workers to test and treat malaria, procuring rapid diagnostic tests and life-saving drugs, distributing insecticide-treated bed nets, and conducting social behavior change interventions. These actions have contributed to a significant decline in malaria deaths in PMI target areas since 2008. Today, 80 percent of households own at least one insecticide-treated bed 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 focus 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, improved management of TB/HIV co-infection, and strengthened services for multi-drug-resistant cases.

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 its 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.

A mother and her child wait outside a USAID-supported clinic in Zambia.
A mother and her child wait outside a USAID-supported clinic in Zambia.
John Healy/USAID