The Lusaka Agenda:Conclusions of the Future of Global Health Initiatives process

An Overview, July 2024

What is the Lusaka Agenda?

The publication of the Lusaka Agenda in December 2023 marked the culmination of the Future of Global Health Initiatives (FGHI) process, an informal, inclusive 14-month process of consultation and deliberation that reflected on how global health initiatives (GHIs) can more effectively and efficiently complement domestic financing to maximize health impacts in support of country-led priorities and trajectories to universal health coverage (UHC).

The FGHI process was chaired by the governments of Norway and Kenya and led by a multi-stakeholder Steering Group. It incorporated multi-stakeholder engagement through dialogues on-line and in Addis Ababa, Ethiopia (June 2023);  Wilton Park, UK (October 2023); and Lusaka, Zambia (November 2023).

As an entry point and catalyst for accelerating change in the broader global health ecosystem, the FGHI process โ€“ and the Lusaka Agenda โ€“ focus primarily on the work of Gavi, the Global Fund and the Global Financing Facility (GFF), with consideration for the Coalition of Epidemic Preparedness Innovations (CEPI), the Foundation for Innovative New Diagnostics (FIND) and Unitaid in some areas.

Why is this needed?

Over the last two decades, GHIs have contributed to enormous progress in protecting lives and improving the health of people globally, while also contributing to global public goods, strengthening global health security, and improving pandemic preparedness and response.

Experiences during the COVID-19 pandemic, changes in demographics and disease burden, climate change, conflict and political and economic shifts that present challenges for external and domestic resource mobilization for health all combine to create an urgency for changes in how GHIs and other external funders support the health systems of low- and middle-income countries.

The Lusaka Agenda responds to these challenges and to the need to address power imbalances in global health decision-making, improve in-country coordination of GHIs, and accelerate and coordinate efforts to place financial and operational sustainability at the core of the operations of GHIs and other partners.

Building on existing work, the Lusaka Agenda captures consensus around five strategic shifts for the long-term evolution of GHIs โ€“ and the wider global health financing ecosystem โ€“ and highlights near-term priorities and next steps to catalyze action towards the shifts. It provides a foundation for coordinated action to drive change and a path towards a long-term vision of domestically-financed health systems and UHC that leaves no-one behind. The realization of the shifts requires united and collective effort across stakeholder groups, underpinned by mutual accountability.

Five key shifts for the long-term evolution of the GHI ecosystem

At the heart of the Lusaka Agenda are five key shifts that need to be accelerated to shape the evolution of GHIs and the broader global health financing ecosystem:

  1. Make a stronger contribution to primary health care (PHC) by effectively strengthening systems for health.
  2. Play a catalytic role towards sustainable, domestically-financed health services and public health functions.
  3. Strengthen joint approaches for achieving equity in health outcomes.
  4. Achieve strategic and operational coherence.
  5. Coordinate approaches to products, research and development (R&D), and regional manufacturing to address market and policy failures in global health.

How will the Lusaka Agenda be implemented?

To successfully operationalize the Lusaka Agenda, joined-up working between GHI secretariats needs to be complemented by joint action across stakeholder groups, with each playing their respective role to support and be accountable for taking work forward.

GHI boards are now considering how they will put next steps into practice and how they will work together to catalyze action towards these five shifts. GHI board members โ€“ including implementing countries, donors, civil society and communities โ€“ have a pivotal role to play in driving implementation.

In particular, supporters of the Lusaka Agenda are now working with and through GHI governing bodies to ensure action on the following next steps:

  1. Joint work: Take as a jumping-off point the four Gavi/Global Fund workstreams (malaria, health systems strengthening, country engagement and back-office functions) and seek clarity on how they relate to, and advance, Lusaka Agenda near-term actions.
  2. Joint oversight: Establish a joint committee working group, comprised of members from existing Gavi and Global Fund committees, along with a representative of the GFF Trust Fund or Investors Group, to provide working-level oversight and advice, and to report back to their home committees.
  3. Cross-board collaboration: Gavi and the Global Fund to set up a collaboration mechanism โ€“ including the GFF and other relevant stakeholders โ€“ by end-2024.
  4. Country implementation: GHIs to jointly engage a set of pathfinder countries, identified under government leadership, and in consultation with other partners including regional organizations, to accelerate progress on the key shifts and capture learning.
  5. Joint vision for R&D, manufacturing and market-shaping: CEPI, Unitaid and FIND, working with key stakeholders, convene a process to establish a joint vision by May 2024, with vision developed by May 2025.

Regional and global collaboration and coordination is helping to build awareness and momentum behind the Lusaka Agenda and drive its implementation. Stakeholders are also working together to consider arrangements for ongoing collaboration to advance the Lusaka Agenda conclusions over the medium-term, including embedding the five shifts in the broader health financing ecosystem beyond GHIs.

An informal multi-stakeholder Lusaka Agenda Working Group co-chaired by Canada, Ghana and Amref Health Africa is working together from January โ€“ June 2024 to help support and coordinate these activities.

How can implementing countries and their in-country partners use the Lusaka Agenda to drive change?

Delivery of the Lusaka Agenda conclusions will require the leadership of implementing country governments, working closely with partners including WHO and the wider UN system, the World Bank, bilateral donors, regional entities, civil society, and community-led organizations.

The Lusaka Agenda โ€“ and the support behind it โ€“ provides an opportunity for implementing countries to address power imbalances in global health decision-making, to improve in-country coordination of GHIs, and to accelerate and coordinate efforts to place financial and operational sustainability at the core of the operations of GHIs and other partners.

Countries can use their voices to drive change though their representation on GHI board seats. Building on existing mechanisms at country level, governments โ€“ including Heads of State, Ministers of Health and Finance โ€“ can work with key stakeholders, including parliamentarians, development partners, civil society and communities โ€“ to use the Lusaka Agenda as a springboard to develop a roadmap for action. Regional organizations have a pivotal role to play to empower countries, to foster collaboration across countries and to drive the change agenda on a continental scale.

More information on the FGHI process can be found here and on the Lusaka Agenda here. For additional information, contact LusakaAgenda@unfoundation.org.