Zambia’s efficient primary health care (PHC) performance was driven, over time, by consistently prioritizing PHC through resource allocation and a focus on close-to-community service delivery. Zambia successfully delegated planning and budgeting authority to officials at lower levels of its health system and relied on existing community participation structures for inclusion in priority setting processes, which ensured funding for PHC services matched local needs. It also established strong stakeholder coordination mechanisms at the national and district levels, aligning health sector goals and setting up joint monitoring and evaluation mechanisms using available data.
With these governance and financing structures in place, Zambia tested a series of evidence-based reforms in strategic and performance-based contracting and human resources for health optimization in pursuit of efficiency. In parallel, Zambia pursued equity by lowering financial barriers to access among people with low income, expanding PHC infrastructure in rural areas, and relying on community outreach.
Despite some remaining challenges, Zambia is a valuable case study for countries with similarly low levels of health sector resources looking to maximize the value of their PHC investments.