Zambia has made important progress in prioritising primary health care, but increased budget allocations do not always translate into timely and effective services at facility level.

This policy brief presents findings from a study conducted in 2025 by the Ministry of Health, Zambia, in collaboration with the Financing Alliance for Health. It examines how primary health care financing moves from national allocation to service delivery within Zambia’s decentralised health system. Drawing on financial data and insights from national and subnational stakeholders, it highlights persistent challenges, including delayed fund disbursements, uneven public financial management capacity, fragmented digital systems and inequities in the distribution of resources. 

The brief proposes four priority reforms:

• Strengthen direct and predictable financing for health facilities
• Build public financial management capacity at subnational level
• Improve the timeliness and consistency of financial reporting
• Integrate digital financial systems and strengthen local accountability

Together, these reforms provide a practical pathway towards improving the effectiveness, equity and accountability of primary health care financing, particularly for rural and underserved communities.