Written by Molly Moss, United Nations Foundation
Last updated December 11, 2024
Throughout 2024, the Lusaka Agenda has been a hot topic in global health. What is it, and why is it generating so much buzz?
While the Lusaka Agenda actually refers to a specific document that was born out of a 14-month research and consultation process, the name has come to be interpreted in different ways. The document was launched on December 12, 2023, also Universal Health Coverage (UHC) Day, and its one-year anniversary serves as an opportunity to reflect on how the Lusaka Agenda has evolved from a list of policy recommendations to a multifaceted effort to transform health financing and accelerate progress toward UHC.
The Lusaka Agenda process began in late 2022, when a multisectoral group of stakeholders came together under the leadership of Kenya and Norway to form the Future of Global Health Initiatives (FGHI). FGHI consisted of a Steering Committee, a Research and Learning Task Team, and a Commitments Task Team. Each of these groups was composed of a diverse range of representatives from countries, civil society and philanthropic organizations, and global and regional health agencies, as well as financing partners. Their job: engage in research, dialogue, and deliberation to identify how financing for global health could be restructured to ensure that countries are in the lead when it comes to setting priorities for their own health systems.
Many of the ideas put forward in the Lusaka Agenda are not new. The Paris Declaration on Aid Effectiveness (2005) offered a practical roadmap to guide donors and recipient countries toward new modes of collaboration to achieve impactful development outcomes. Nearly two decades later, however, the landscape of global aid continues to be fragmented and neglectful of recipient countries’ priorities.
So, what makes the Lusaka Agenda different?
There are significant new political and economic pressures on donor and implementing countries, as well as global health initiatives (GHIs), to make every dollar count. The global health ecosystem has evolved, and new initiatives and actors continue to emerge, creating more fragmentation in financial flows. Power imbalances in decision making persist, and many countries’ efforts to achieve UHC through patient-centered primary healthcare are far from being realized. At the same time, disease burdens are changing and placing new and different demands on health systems. Non-communicable diseases and mental health condition diagnoses are on the rise, outbreaks of infectious diseases continue apace, and new health risks presented by climate change have proven to be unpredictable and often devastating.
By some accounts, the status quo of global health funding is unsustainable. The world may soon confront a situation where a growing number of organizations are competing for a shrinking pot of resources. The FGHI process that led to the development of the Lusaka Agenda sought to identify alternatives to the current situation, recognizing that any durable change to the ecosystem will realistically take years, if not decades, to achieve. And while this transition is expected to be gradual, there has already been a remarkable level of political commitment, including from G7 and African Union leaders, to the principles of the Lusaka Agenda.
The Lusaka Agenda – which is a presentation of conclusions from the FGHI process – proposes five key shifts to stimulate change in global health financing over the long-term. The recommendations give special attention to the role of GHIs that contribute substantially to financing global health, including Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and the Global Financing Facility for Women, Children and Adolescents (GFF), with additional consideration of the Coalition for Epidemic Preparedness Innovations (CEPI); Unitaid; and the Foundation for Innovative New Diagnostics (FIND).
In many ways, these objectives are self-evident when considering the evolution of global health priorities. Moreover, the fact that some of these ideas have been endorsed in other recent multilateral policy instruments (such as Paragraph 45 of the 2023 Political Declaration of the High-level Meeting on Universal Health Coverage and Joint Outcome 3.2 and Corporate Outcome 1 of the World Health Organization’s Fourteenth General Programme of Work) demonstrates that the Lusaka Agenda accurately reflects the current zeitgeist in global health. A range of activities are already underway to embed the five shifts into global health praxis, and this responsiveness is a testament to the fact that many stakeholders are prepared to make a real change in how business is done. That the agenda has been embraced by so many constituents is also a reflection of the sound consultative process to develop the recommendations.
Countries in Africa have been particularly active on the issue. The Central African Republic, the Democratic Republic of the Congo, Ethiopia, Ghana, Malawi, Mozambique, Senegal, and South Sudan are taking the lead as “champion countries,” driving implementation of the Lusaka Agenda in their countries and on the continent.
Prominent public health institutions in Africa are also moving quickly to initiate the key shifts. The Africa Constituency Bureau is focused on advocacy for the Lusaka Agenda, communities, and civil society and has identified their priorities for making the Lusaka Agenda successful. The World Health Organization’s Africa Regional Office (WHO AFRO) is scaling up technical assistance, including trainings on financial management for countries. It has also hosted Member State convenings, including to support the development of the Roadmap for Implementation of the Lusaka Agenda in Africa.
The Africa Centres for Disease Control and Prevention (Africa CDC) has been mandated by the African Union (AU) Commission to “support the establishment of an accountability mechanism within the AU architecture to ensure the effective implementation of the Lusaka Agenda in Africa.” In line with this, the organization recently announced the launch of the Continental Secretariat of the Lusaka Agenda, which will oversee a monitoring and accountability framework, as well as a scorecard for timely reporting to AU heads of state.
Meanwhile, Gavi, the Global Fund, and the GFF have also taken important steps to harmonize their business operations and streamline pathways for countries to obtain and manage grant funding. By establishing a joint committee working group to enhance collaboration and coordination, the GHIs are demonstrating responsiveness that is commendable, given the complicated administrative and decision-making structures of each of these organizations.
In the year following the launch of the Lusaka Agenda, considerable efforts have been made to embed its principles into practice. Many partners are exploring how best to leverage their comparative advantages and improve upon working models. But the global health community is large and diverse, and there is still work to be done to socialize these ideas with stakeholders across sectors. The Lusaka Agenda represents a paradigm shift, and it will take time to understand if the strong initial traction can be sustained.
The individuals and organizations that composed FGHI and the subsequent Lusaka Agenda Working Group have disbanded, based on the shared understanding that if the five shifts are to be successful, all partners must see themselves as owning part of the work. Relegating the entire scope of the agenda to a singular governance unit would be contrary to the spirit of the effort. That said, many desire to see some coordination across efforts. This has led to the development of a report commissioned by the Norwegian Agency for Development Cooperation titled Stewardship of the Post-Lusaka Agenda Global Process: Issues and Options. Others are also thinking critically about ways to measure progress against this ambitious new change agenda.
Time will tell how much Member States choose to embed the Lusaka Agenda principles into their policymaking efforts in multilateral fora like the United Nations General Assembly in New York, the World Health Assembly in Geneva, and meetings of the G7 and G20. These negotiating processes can be resistant to new terminology. However, it is likely the ideas expressed in the Lusaka Agenda will take root, because they’re good ideas that have been deeply considered by a large and diverse group of global health practitioners. The appetite has never been higher for new approaches to global health financing, and while there is no single solution to complex challenges like health systems financing, the Lusaka Agenda has already stimulated new thinking and catalyzed needed change.
Molly Moss covers policy issues related to global health governance, antimicrobial resistance, and Universal Health Coverage. Molly manages the Foundation’s official relations status with the World Health Organization and also supports engagement on health issues among UN Member States in New York. Prior to the UN Foundation, Molly worked for the Center for Global Health at the University of Colorado, focusing on immunization, pediatric infectious disease research, and research ethics. During her time at the University of Colorado, Molly earned her Master of Public Health in community and behavioral health. She holds a bachelor’s degree in medical anthropology from Hampshire College.
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