Under Strategic Initiative (SI) in Zambia, the Financing Alliance for Health has supported both the revision of the 2024–2026 RMNCAH Roadmap and the development of this new 2027–2031 roadmap. This process marks an important step toward aligning national priorities with the next phase of financing and implementation.
The next critical milestone is validation. Once finalised, the roadmap will play a central role in shaping Zambia’s Global Fund GC8 grant writing process.
This partnership marks a renewed commitment to improving the health and well-being of women, new-borns, children, and adolescents in Zambia, aiming to save lives, reduce inequalities, and strengthen the health system for the long term.
Progress Worth Building On:
Over the past decade, the country has made meaningful progress. Fewer mothers are dying during childbirth, more children are surviving beyond their early years, and overall life expectancy is improving. These gains reflect sustained investment and commitment:
- Maternal mortality has declined significantly, from 278 deaths per 100,000 live births in 2018 to 195 in 2024, a decline of 30% in 5 years.
- Under-five mortality is now around 48 deaths per 1,000 live births, a 20% decline from 61 per 1,000 (ZDHS 2018 trend data) in 2018
- Neonatal mortality (deaths within the first 28 days) stands at about 21 deaths per 1,000 live births compared to 27 per 1,000 representing a 22% decline.
SOURCE: UNICEF/WHO/ZDHS
These improvements reflect sustained investment and commitment to expanding access to care and strengthening services.
Yet, the reality remains complex:
- Nearly half of under-five deaths occur in the first month of life, reflecting persistent gaps in newborn care [
- Adolescent fertility remains high, with 116 births per 1,000 girls aged 15–19
- Stunting (under 5): ~32–35% – About one in three children are too short for their age due to chronic undernutrition, which can limit their physical growth and cognitive development over time.
- Wasting: ~4.2% of children under 5 – A smaller but critical proportion of children are too thin for their height due to acute undernutrition, putting them at immediate risk of illness and death without timely treatment.
- Malnutrition also remains a critical challenge. While comprehensive updated figures vary by source, undernutrition and micronutrient deficiencies continue to undermine child survival and development, reinforcing the need for a multi-sectoral approach.
- Health system constraints continue, including workforce shortages, supply chain gaps, and uneven service access between rural and urban populations
Malnutrition also remains a critical challenge. While comprehensive updated figures vary by source, undernutrition and micronutrient deficiencies continue to undermine child survival and development, reinforcing the need for a multi-sectoral approach.
At its core, the roadmap sets out a clear and ambitious vision:
Universal and equitable access to quality, integrated RMNCAH&N services across the life course.
Ambition Toward 2030 and Beyond
Zambia’s trajectory is expected to align with SDG and national health strategy benchmarks, including:
- Reduce MMR to below 70 per 100,000 live births (SDG target)
- Reduce neonatal mortality to at least 12 per 1,000 live births
- Reduce under-5 mortality to at least 25 per 1,000 live births
- Reduce stunting to below 20%
- End preventable child deaths and malnutrition as public health threats
These targets reflect a shift from incremental progress to accelerated, equity-focused gains.
Financing the Roadmap: A Critical Enabler
A key determinant of success will be how the roadmap is costed and financed.
While full costing figures will be confirmed during validation, three key financing questions will shape implementation:
- What is the total investment required?
(RMNCAH&N strategies typically require substantial multi-year financing aligned with national health plans)
- What share will be domestically financed?
Zambia has made progress in increasing domestic health spending, but fiscal pressures remain.
- What role will Development Assistance for Health (DAH) play?
External financing—including through the Global Fund GC8 cycle—will be critical to closing gaps, particularly for:
- Health systems strengthening
- Commodity security
- Community health platforms
Ensuring sustainable financing, with a gradual shift toward domestic resource mobilization, will be essential for long-term impact.
What makes this roadmap particularly transformative is its emphasis on the continuum of care. This approach recognizes that health needs are interconnected across different stages of life, from pre-pregnancy to adolescence and across different levels of care, from communities to primary facilities to referral hospitals. By linking these services, the system becomes more responsive, more efficient, and ultimately more effective in improving health outcomes.
The strategy focuses on strengthening key areas that directly impact survival and well-being. Improving maternal and new-born health remains a priority, with a focus on quality antenatal, delivery, and postnatal care, alongside stronger emergency obstetric and new-born services. For children, the emphasis is on preventing illness through immunization, integrated case management, and supporting early development.
For adolescents, the roadmap acknowledges a critical gap: services exist, but access and utilization are still shaped by social norms, stigma, and structural barriers. Addressing teenage pregnancy and expanding youth-friendly services will require going beyond the health sector to tackle underlying social and economic drivers.
Nutrition is another central pillar, recognizing that malnutrition, whether undernutrition or micronutrient deficiencies, continues to undermine health outcomes across all age groups. At the same time, strengthening the health system itself remains essential. Investments in the workforce, infrastructure, supply chains, and data systems are key to ensuring that services are not only available but also reliable and of good quality.
Importantly, the roadmap does not treat health in isolation. It acknowledges the broader context in which people live. Economic pressures, population growth, climate-related shock such as drought and persistent social barriers all shape both the demand for and delivery of health services. Addressing these realities requires coordinated action across sectors, health, education, nutrition, and social protection.
Implementation will take a decentralized approach, placing provinces and districts at the centre of delivery. This shift is critical for ensuring that solutions are responsive to local needs, while also strengthening accountability and ownership. Partnerships with communities, civil society, and cooperating partners will be essential to sustain progress.
Ultimately, the message of this roadmap is both practical and urgent. Reducing preventable deaths and improving well-being is within reach, but only if efforts are coordinated, data-driven, and centred on people’s real needs.
Because beyond policies and systems, this roadmap is about something more fundamental:
ensuring that no woman, no child, and no adolescent is left behind.
