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 to strengthen the health system at national, provincial, district, and community levels. With an adult HIV prevalence rate of approximately 11 percent, Zambia receives significant support from USAID under the United States 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 help to prevent and treat other diseases, including malaria, tuberculosis, cervical cancer, and, most recently, COVID-19. USAID’s health-related investments and initiatives in Zambia also focus on increasing access to family planning, improving maternal and child health and nutrition, and preventing and responding to gender-based violence.
COVID-19 Response
Since the start of the pandemic, the United States government has provided $40 million (as of February 2022) in funding to respond to COVID-19 and mitigate its impacts in Zambia. USAID’s COVID-19 relief in Zambia uses multiple approaches including supporting the clinical care and management of patients with COVID-19 by strengthening laboratory systems and ensuring healthcare workers are able to care for patients. USAID is also aiding in COVID-19 infection prevention control as well as risk communication and community outreach initiatives, including increasing COVID-19 vaccine awareness and access to help drive demand and uptake throughout the country.
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 five percent.
Through USAID, PEPFAR concentrates its Zambian 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-funded initiatives also improve the quality and reach of clinical HIV services at public health facilities across Zambia.
The primary goal of USAID and PEPFAR support in Zambia 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 at-risk populations with 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 (VMMC) for boys and young men, community-level initiatives to combat gender-based violence (GBV), and peer-to-peer health and HIV education. USAID surpassed their initial target and reached nearly 90 percent of mean ages 15-29 years with VMMC.
Supporting Healthy Mothers and Children
In partnership with the Government of Zambia, USAID improves access to sustainable, quality health care services for Zambian women and children through high impact interventions to reduce maternal and child illness and death. In doing so, USAID strengthens health services at all levels to advance quality, respectful maternal health care. USAID support also enables 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 enable them to better thrive during their childhood years. These programs build the skills of health care providers and community health workers so they may better prevent illness, identify and manage sick children, and provide timely referrals to services. Additionally, USAID continues to support the strengthening of services to ensure children receive life-saving, routine immunizations.
Increasing Access to Voluntary Family Planning
Voluntary family planning with informed choice is recognized by the Ministry of Health 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. In 2021, USAID contributed approximately $2 million toward the procurement of FP commodities. 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 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 strengthen leadership and governance in the Zambian health sector, USAID works with the MOH to bolster a leadership, management, and training strategy and guidelines for Ministry staff.
To ensure that high-quality, accurate health information is available in the market, USAID contributes to the Zambia District Health Information Software and national surveys. USAID also 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
Through both the private and public sectors, USAID procures and distributes 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 helped procure equipment to establish a central commodities distribution warehouse in Lusaka and regional distribution hubs located in Chipata, Choma and Mpika. 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 U.S. President's Malaria Initiative (PMI) - led by USAID and implemented in partnership with the U.S. Centers for Disease Control and Prevention (CDC) - works with the Zambian government to support a comprehensive package of evidence-based malaria control programs, targeting the five high-burden provinces of Copperbelt, Eastern, Luapula, Muchinga, and Northern. 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 initiatives. In 2021, USAID distributed over 2.6 million insecticide-treated bed nets, and sprayed approximately 650,000 structures, representing 94 percent of structures located within the target areas. These actions have contributed to a significant decline in malaria deaths in PMI target areas.
Enhancing Nutrition
USAID projects aim to reduce child stunting due to malnutrition by focusing on increasing access to, and availability of, safe, diverse, nutritious foods, and the adoption of healthier child-feeding habits and household hygiene practices. Our 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 Control
With a prevalence rate of 638 cases per 100,000 people, tuberculosis (TB) continues to be a leading cause of illness and death in Zambia. In response, USAID works with the Zambian government 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.
Gender-Based Violence Prevention and Response
According to the 2018 Zambia Demographic and Health Survey, 47 percent of women aged 15-49 years have experienced some form of physical violence in their lifetime. In close partnership with the Zambian government and MOH, USAID uses a multi-sectoral approach to provide gender-based violence (GBV) prevention and response services by partnering with traditional and religious leaders, and other key entities across 16 districts. USAID programs include community mobilization initiatives to promote a change to gender norms, strengthen the capacity of local systems to respond to GBV, and support of one-stop center post-GBV response care. USAID also strengthens and expands opportunities for all Zambians, regardless of age or gender, to live free of GBV and enjoy healthy, gender-equitable relationships.