Understanding the Lusaka Agenda

Reimagining the Future of Global Health Initiatives (FGHIs) was a Wellcome-commissioned study of GHI’s which involved a research consortium and began in February 2023. The study brought together a number of stakeholders and drew on several data sources and released a report which primarily focused on the work of the country-focused GHIs (Gavi, the Vaccine Alliance), the Global Fund and the Global Financing Facility for Women, Children and Adolescents (GFF)), with consideration for the Coalition for Epidemic Preparedness Innovations (CEPI), Unitaid and the Foundation for Innovative New Diagnostics (FIND) in some areas.

This report was released in July 2023 without the endorsement of the GFHI Steering Group members or their organizations or governments and comments were invited as work began to “discuss and develop a set of commitments for collective action”.

That report gave birth to the Lusaka Agenda launched on UHC day 12 December 2023 – which marked the culmination of a 14-month process of engagement that included dialogues in Addis Ababa, Ethiopia (14 June), Wilton Park, UK (4-6 October) and Lusaka, Zambia (26 November). It highlights five key shifts for the long-term evolution of GHIs – and the wider health ecosystem – and highlights a number of near-term priorities to catalyse action towards the five shifts.”

The five shifts are:

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

Other key actors in the health ecosystem such as the World Bank, and World Health Organization (WHO) including WHO Afro are leading this with the African Constituency Beurer (ABC) Africa CDC, UN agencies and bilateral funders- all of whom have engaged in deliberations.

The process was not inclusive in any meaningful way of civil society and implementer governments beyond Africa. The findings and research did not even consider the Strategy of the Global Fund, nor did it take account of the ongoing collaboration between GAVI & the Global Fund, GFF & UnitAid which predates the study which produced the report. The final consultation at Winton Park did not even include civil society members living in the South because they couldn’t get a UK visa to attend.

The initial report prompted alarm and many questions from civil society organisations and the DCNGO delegation. We have asked some tough questions which continue to be discussed:

• Although more recently some civil society organisations have engaged in the process we are still now clear on what their role will be in the Lusaka Agenda?
• How will an Accountability Framework define the role of civil society organizations?
• Who is coordinating the involvement of civil society from implementing countries?
• How will human rights and equity be addressed in civil society and key populations are not a part of Lusaka? And will this now contribute to shrinking space for civil society and communities?
• How will funding flow – if at all – to civil society organizations?

AIDSPAN did an interesting article on this which is available here as did GFAN in addition to GFAN’s initial report highlighting red lines which echoed the DCNGO’s concerns.

Since then the Lusaka Agenda has put in place a steering group – which includes a few members from civil society. The Lusaka Agenda has been shared with the boards of the global health initiatives (GHIs) to put the next steps into practice and to work together to catalyse action towards the five shifts outlined in the Agenda. Indeed, the Global Fund has also taken steps including working closely with GAVI and the GFF and putting place an internal working group.

From January 2024, an informal, interim working group co-chaired by Ghana, Canada and Amref Health Africa began working together through June 2024 to: help anchor the Lusaka Agenda on the agendas of GHI boards and the African Union, and begin to drive its implementation; and engage with stakeholders to design arrangements for ongoing collaboration to advance the Lusaka Agenda conclusions, including embedding the five Lusaka Agenda shifts in the broader global health financing ecosystem.

WHO AFRO in collaboration with the African Constituency Bureau for the Global Fund (ACB), the AU and Africa-CDC organized a two-day technical consultation on June 12-13 2024, in Addis Ababa, Ethiopia. Aptly titled “Technical Consultation on Advancing African Leadership and Unified Voice towards realization of the Lusaka Agenda,” the meeting brought together representatives from the region including from ministries of health, GHIs (including Global Fund, Gavi, and GFF), the AU and Africa-CDC and civil society. Discussions cantered around priority actions to strengthen engagement at the country level, accountability frameworks, potential pathfinder countries and a roadmap to be developed ahead of the upcoming meeting of Ministers of Health in August.

To ensure an inclusive process, a group of CSO, including WACI Health, STOPAIDS, AMREF Health Africa, Friends of the Global Fight Against AIDS, TB and Malaria, Hope for Future Generations, Impact Sante, Aidspan, WOTE, CSEM, Gem Hub Initiative, Afya na Haki and others – created a survey to collect feedback on CSO priorities for the proposed five shifts of the Lusaka Agenda. The survey was widely shared via different CSO networks and helped share key priorities for civil society moving forward. See more about this here

This was shared at a side event in Brazzaville during the 74th session of the WHO Regional Committee for Africa titled “Advancing Africa’s Leadership and Unified Voice towards Realization of the Lusaka Agenda”, which can be viewed here

More recently the Center for Global Development just proposed a tracker for implementation of the Lusaka Agenda. We note that it does not include tracking civil society engagement, community services, ending AIDS, TB and malaria.

More on background if you are still here….

The Wellcome-commissioned ‘Reimagining the Future of Global Health Initiatives’ study has been produced by a research consortium as one of several independent inputs into the Future of Global Health Initiatives (FGHI) process.

The FGHI process brings together a group of global, regional, and national health stakeholders – including governments, global health institutions, civil society organisations, and academics – to reflect on and set out commitments for collective action to optimise GHIs to support countries’ progress on the path to universal health coverage (UHC). This is a time-bound process that aims to catalyse collective action to make the GHI ecosystem more efficient, effective, and equitable, and increase the impact of external investments in health.

The research consortium, led by the University of Geneva, Queen Margaret University, Stellenbosch University, Aga Khan University, Cheikh Anta Diop University, and French National Research Institute for Sustainable Development (IRD) began an intensive programme of research in February 2023. The study draws on several data sources, including the perspectives of over 200 experts at global, regional, and country level, with a particular focus on implementing countries.
While this report’s recommendations have not been endorsed by the FGHI Steering Group members or their organizations or governments, its findings and recommendations will provide valuable insights for the next phase of the FGHI process as stakeholders discuss and develop a set of commitments for collective action that will be published in December.