1.0 Background

The battle against HIV, Tuberculosis, Malaria and other communicable and non-communicable diseases in Africa to achieve global health objectives by 2030 faces challenges, hindering Universal Health Coverage (UHC) across the continent. Global Health Initiatives (GHIs), including the Global Fund, Gavi the vaccine alliance, Global Financing Facility (GFF), Coalition for Epidemic Preparedness Innovations (CEPI), FIND, and Unitaid, have been crucial allies in providing resources to strengthen health systems and improve healthcare access in Africa. Yet, while the investments and efforts are commendable, the alignment and governance of these resources with country-specific priorities have unveiled challenges, primarily due to the fragmentation and overlapping donor focus across various GHIs. Coordinating these investments with country priorities to sustainably strengthen systems remains difficult. To optimize GHIs impact, strategic resource management, careful planning, and African representation in decision-making have been identified as essential. Partnerships with Ministries of Health, WHO, and technical experts are vital to address unique challenges and align investments with national and global health goals.

Report Sections

To catalyze collective action amongst African ministers and stakeholders for effectively leveraging GHI investments and hastening UHC progress in Africa, a side event, co-organized b the African Constituency Bureau (ACB), Global Fund, Gavi, Future of Global Health Initiative (FGHI), and WHO AFRO, was held during the seventy-third session of the WHO Regional Committee for Africa in Gaborone, Botswana. There was broad consensus on the opportunity presented by GHIs and the need to maximize the impact of these investments accelerate progress through increased flexibility, alignment with country priorities, and coordination. The Regional Committee meeting was agreed as an important platform for coming to a common position and agenda for GHIs coordination and alignment. Member states requested that WHOAFRO convene ministers of health to facilitate consensus on a framework for a common voice and future action. The Lusaka Agenda is a declaration of intent to leverage GHI investments towards achieving Universal Health Coverage (UHC), and to deliver sustained impact, highlighting the critical need for resilient health systems capable of addressing emerging threats and sustaining health advancements, including for the specific diseases and priority services they target. It outlines five strategic shifts to guide the GHI ecosystem’s evolution: Enhancing primary health care through integrated service delivery and resilient health system investments; acting as a catalyst for sustainable, domestic health financing; bolstering collective approaches to equitable health outcomes; streamlining strategic and operational coherence in GHI governance; and synchronizing efforts in product development, research, and regional manufacturing to address market and policy failures in global health.

The purpose of this technical consultation meeting is to convene stakeholders from across the region to socialize the Lusaka Agenda, develop a Roadmap, and foster collaboration for advancing Africa’s unified voice in the engagement of GHIs anchored in the Lusaka Agenda. This consultation presents an opportunity to harness the collective wisdom and expertise of a diverse range of stakeholders in shaping Africa’s engagement with GHIs.

1. Foster collaboration and engagement and facilitate discussions towards the
realization of the Lusaka Agenda.
2. Provide input to facilitate and inform framing of the Accountability Framework.
3. Facilitate country-led discussions on the ‘pathfinder country’ concept.
4. Develop an Africa roadmap towards the realization of the Lusaka Agenda.

  • Common actions towards engagement with GHIs at country level, reflecting shared values, principles, and strategic objectives.
  • Input to inform the development of an accountability framework.
  • A proposed African roadmap for the realization of the Lusaka Agenda.

Participants will include Global Fund, Gavi, PEPFAR, GFF, CEPI, FIND, RBM, STOP TB,

UNAIDS, Unitaid, AU, Africa CDC, WHO AFRO, Regional Economic Communities (RECs),

Africa Public Health Foundation, selected Ministries of Health at the level of permanent

secretaries and Directors of Public Health, African Constituency Bureau for the Global Fund

(ACB), civil society (CS4ME, AMREF, WACI), African Union Commission, Country-

Coordinating Mechanisms (CCMs), Africa Public Health Foundation (APHF), African board

members in GHIs, Lusaka Agenda Working Group).

1.Make a stronger contribution to primary health care by effectively strengthening systems for health

  1. Play a catalytic role towards sustainable, domestically financed health services and public health functions
  2. Strengthen joint approaches for achieving equity in health outcomes
  3. Improve efficiencies and reduce transaction costs on countries
  4. Coordinate approaches to products, R&D and regional manufacturing to address market and policy failures in global health Building
  • Addressing power imbalances through governance mechanisms
  • Developing common metrics, including for health system strengthening
  • Monitoring and understanding the impact of health systems and PHC funding
  • Aligning with and using government systems where feasible (Will require differentiated approaches)
  • Simplifying grant application and disbursement processes
  • Increasing transparency over external financial flows into, and within, countries
  • Accelerating and coordinating approaches to sustainability and transition
  • Developing a joint vision for R&D, manufacturing and market shaping
  • Developing a joint vision for the future of development assistance for health
  • Holders of seats on GHI governing bodies
  • Representatives of funders of GHIs
  • Representatives of governments of low and middle income countries working with GHIs Representatives of global and regional partners and alliance members including WHO , the wider UN and MDB/WB system
  • Representatives of civil society and communities Members of the research and learning community
  • Gavi and Global Fund Secretariats, with GFF, develop a joint workplan by end 2024
  • Joint Gavi and Global Fund board oversight mechanism, in collaboration with GFF governance, set up by end 2024
  • Cross board collaboration mechanism including GFF and other relevant stakeholders set up by end 2024
  • Country implementation set in motion by end 2024
  • CEPI, Unitaid and FIND, working with key stakeholders, convene a process to establish a joint vision for more coordinated R&D, manufacturing and market shaping by May 2024, with vision developed by May 2025
  • Health Institute


    Gavi, Global Fund, GFF

    GHI committees/boards are constituting a joint working group to collaborate on joint workstreams (malaria, HSS, country engagement, with Gavi/Global Fund back-office functions being advanced separately)

    Process underway to identify pathfinder countries to draw out and share learnings from joint work

    Will require consultation with and buy-in from countries, regional organization and CSOs: work in progress


    This Technical Consultation on the Lusaka Agenda is an important opportunity to socialize the Lusaka Agenda on the continent and to develop a roadmap to drive the 5 shifts in Africa


    WHO has launched a process with partners to develop a common set of metrics for health systems strengthening and measurement

    African Union

    Africa CDC


    The AU two weeks ago published a decision, endorsed by Heads of State and Government at their Summit in Feb to support the establishment of an accountability mechanism within the AU architecture to ensure effective implementation of the Lusaka Agenda in Africa

Lusaka Agenda: Conclusions of the Future of Global Health Initiatives process published on UHC Day on 12 Dec 2023 marked the culmination of a 14-month process of research and consultation

It captures consensus around 5 key shifts for the long-term evolution of global health initiatives and the wider global health financing ecosystem and highlights near term priorities to catalyze action towards the 5 shifts

It provides a foundation for coordinated action to support the shifts and a path towards a long-term vision of domestically financing health systems and universal health coverage

10. Lingering Questions?

1. Civil society and government seem not to be well sensitized on the Lusaka agenda?

2.The selection of the pathfinder countries and process was not clear

3. How does GHI benefit from this shift?

4.Who and how was the metrics set and what is the accountability framework

5.How do we socialize the shift and who is to do it: CSO/Governments