Zambia: Score Justification Summary

2026

1.1 Antimicrobial resistance (AMR)

1.1.1 AMR surveillance, detection and reporting

1.1.1a National plan for AMR priority pathogens

Score: 100

There is publicly available evidence that Zambia has a national AMR plan for the surveillance, detection, and reporting of priority AMR pathogens.

The Multi-sectoral National Action Plan on Antimicrobial Resistance 2017–2027 provides a framework for combating AMR using the “One Health” approach, encompassing human, animal, plant, and environmental health. One of its key objectives is to strengthen the knowledge and evidence base through surveillance and research. To achieve this, the Plan outlines activities such as integrating AMR surveillance into the national surveillance system, establishing or integrating an early warning system for the public to report suspected AMR issues, identifying and designating national reference laboratories with the capacity to assay specific pathogens, and procuring equipment and supplies necessary for conducting AMR testing (Page 47). ¹

1.1.1b Capacity of national lab/lab system to test for AMR priority pathogens

Score: 100

There is publicly available evidence that Zambia has a laboratory system which tests for nine priority AMR pathogens.

According to the Baseline Information for Integrated Antimicrobial Resistance Surveillance in Zambia report, published in 2020 by the Centre for Science and Environment and the National Public Health Institute, routinely identified bacteria include the following priority pathogens: Acinetobacter baumannii, Enterococcus spp., Pseudomonas aeruginosa, Staphylococcus aureus, Salmonella spp., Shigella spp., Streptococcus pneumoniae, Haemophilus influenzae, and Enterococcus spp. (p. 10) ².

According to the Global Antimicrobial Resistance and Use Surveillance System (GLASS) dashboard, the pathogens reported by Zambia include four priority ones: Acinetobacter spp., Streptococcus pneumoniae, Salmonella spp., and Shigella spp. The platform also highlights that the country has a national reference laboratory, and that the percentage of laboratories reporting to GLASS, where External Quality Assessment is provided, reaches 72% ³.

The National One Health Strategic Plan 2022–2026 lists routine laboratory testing for epidemic-prone bacterial pathogens such as Salmonella Typhi, Shigella spp., Streptococcus pneumoniae, Enterobacteriaceae, and Staphylococcus aureus (p. 20). According to the plan, in the human health sector, laboratories expected to conduct antimicrobial susceptibility testing (AST) are available in most hospitals. However, in most laboratories, staff capacity to reliably isolate, identify, and conduct AST is poor due to a lack of training. In addition, the availability of reagents, SOPs, infrastructure, and specialised equipment required to conduct AST is inadequate and varies by facility level (pp. 20–21) ⁴.

According to the Joint External Evaluation, published in 2024, Zambia possesses laboratory capacity for detecting and identifying antimicrobial-resistant organisms in human health, although animal and environmental aspects remain underdeveloped (p. 16) ⁵.

According to a 2024 academic article, despite all hospitals assessed in the study having laboratory infrastructure, none of the facilities had full capacity to conduct AMR surveillance. This was due to a lack of trained microbiology staff, financial challenges, stock-outs of laboratory consumables, use of paper-based LISs, insufficient training in AMR and AMS, lack of antibiograms, absence of automated equipment for pathogen identification and susceptibility testing, and poor implementation of safety and biosecurity measures ⁶.

1.1.1c National environmental surveillance for AMR residues/organisms

Score: 0

There is no publicly available evidence that Zambia conducts environmental detection or surveillance activities for antimicrobial residues or AMR organisms. No evidence was found on the websites of the National Public Health Institute, Ministry of Health and Zambia Environmental Management Agency (ZEMA). ⁷⁸⁹

The Baseline Information for Integrated Antimicrobial Resistance Surveillance in Zambia report, published in 2020 by the Centre for Science and Environment and the National Public Health Institute, lists some point sources for environmental surveillance, such as waste generation sites and pharmaceutical manufacturing companies (Page 20). However, it does not state that the government conducts environmental detection or surveillance activities. Instead, it highlights that the ZEMA collaborates with laboratories that do not currently perform AMR testing on environmental samples, but could adapt or include AMR testing in the future (Page 20). ¹⁰

According to the Joint External Evaluation, published in 2024, Zambia possesses laboratory capacity for detecting and identifying antimicrobial-resistant organisms in human health, but animal and environmental aspects are still underdeveloped. It adds that the environment sector is still lagging behind in AMR monitoring (Page 18). ¹¹

The Integrated Antimicrobial Resistance Surveillance Framework, launched in 2020, proposes biannual sampling for the surveillance of antibiotic residues in the environment. However, it emphasises that ZEMA will need time and resources to build the necessary capacity for antibiotic resistance surveillance in environmental samples (Pages 22 and 24) ¹². No evidence was found on the websites of the National Public Health Institute, Ministry of Health, or ZEMA indicating that such surveillance is currently being conducted. ¹³¹⁴¹⁵

1.1.2 Antimicrobial control

1.1.2a National law(s) requiring prescription for antibiotic use (humans)

Score: 50

There is publicly available evidence that Zambia has national legislation or regulation in place requiring prescriptions for antibiotic use for humans, but there is evidence of gaps in enforcement.

According to the Medicines and Allied Substances Act, enacted in 2013, prescription-only medicines cannot be sold or provided without a prescription (Article 42). ¹⁶ Chapter 299 of the Pharmacy and Poisons Act, last updated in 1994, contains the Fourth Schedule, which lists substances that may be sold by retail only upon a prescription given by a duly qualified medical practitioner, dentist, or veterinary surgeon, including antibiotics. ¹⁷

However, according to the Joint External Evaluation, published in 2024, patients are still purchasing antibiotics without prescriptions from private pharmacies (Page 19). The document recommends that the country enforce regulations and laws against antimicrobial resistance to ensure compliance across all sectors, including the prohibition of over-the-counter antimicrobial sales (Page 19). ¹⁸

The National One Health Strategic Plan 2022–2026 notes that, although there are limitations, the Zambia Medicines Regulatory Authority, in collaboration with relevant professional bodies, enforces provisions related to the dispensing of prescription-only medicines (Page 20). ¹⁹

1.1.2b National law(s) requiring prescription for antibiotic use (animals)

Score: 50

There is publicly available evidence that Zambia has national legislation or regulation in place requiring prescriptions for antibiotic use for animals, but there is evidence of gaps in enforcement.

The Medicines and Allied Substances Act, enacted in 2013, includes medicines for animal use within its provisions by defining a “prescription” as a written direction given by an authorised prescriber for a person or animal (Article 2) and by including “veterinary surgeon” in the definition of an “authorised prescriber” (Article 42). ²⁰ Chapter 299 of the Pharmacy and Poisons Act, last updated in 1994, exempts from the prescription requirement only antibiotics contained in animal foodstuffs and animal feed supplements (Second Schedule). ²¹

However, according to the Joint External Evaluation, published in 2024, veterinary pharmacies sell antimicrobials without prescriptions. The report highlights the need to strengthen the regulation of antimicrobial use in animal health and agriculture, noting that capacities in these areas are currently lower compared to the human health sector (Page 19). ²²

1.2 Zoonotic disease

1.2.1 National planning for zoonotic diseases/pathogens

1.2.1a Laws/plans on zoonotic disease

Score: 100

There is publicly available evidence that Zambia has national legislation, plans, or equivalent strategy documents for zoonotic disease prioritization, detection and reporting.

The National One Health Strategic Plan (OHSP) 2022–2026 acknowledges that surveillance of zoonotic diseases in Zambia remains uncoordinated and that there is an urgent need to develop effective measures for surveillance, emergency response, diagnosis, prophylaxis, and therapy for zoonoses (Page 19). To address these challenges, one of its objectives is to achieve One Health surveillance among key stakeholders for the early detection of zoonotic diseases and other public health events by the end of 2024 (Page 47). To this end, it sets several actions, such as developing a prioritized list of zoonotic diseases and other threats of public health importance, creating an integrated surveillance system for the highest priority zoonotic diseases and public health threats, and holding workshops to develop a One Health list for priority zoonotic diseases (Page 47). ²³

The OHSP also sets objectives to strengthen and establish laboratory capacity to diagnose priority zoonotic diseases and public health events at all provincial levels by 2026, and to strengthen preparedness capacity to respond to zoonotic diseases and public health events of known and unknown etiology at all levels by 2026 (Pages 48 and 49). ²⁴

Within this framework, in 2023, the Zambia National Public Health Institute, in collaboration with the Africa Centres for Disease Control and Prevention, World Health Organization, and other partners, held a three-day One Health Zoonotic Disease Prioritization workshop. The workshop concluded with a consensus on the following ten priority zoonotic diseases for surveillance in Zambia: African trypanosomiasis, anthrax, enteric diseases (e.g., salmonellosis), viral haemorrhagic fevers (e.g., Ebola), rabies, plague, influenza-like illnesses (e.g., zoonotic avian influenza), zoonotic tuberculosis (ZTB), cysticercosis, and brucellosis. ²⁵

According to the Joint External Evaluation, published in 2024, zoonotic diseases have been prioritized through a multi sectoral approach using the CDC One Health Zoonotic Disease Prioritization (OHZDP) tool, and information exchange for surveillance is conducted through a multi sectoral approach, utilizing both indicator-based and event-based surveillance systems (Page 20). ²⁶

1.2.1b Laws/plans on zoonotic disease spillover from animals to humans

Score: 0

There is no publicly available evidence that Zambia has national legislation, plans or equivalent strategy document(s) which include measures for risk identification and reduction for zoonotic disease spillover events from animals to humans. No evidence was found on the websites of the Ministries of Health, Agriculture, Fisheries and Livestock, or the National Public Health Institute. ²⁷²⁸²⁹³⁰

The National One Health Strategic Plan 2022–2026 does not address preventive measures for identifying and reducing spillover risks. ³¹

However, according to the Joint External Evaluation, published in 2024, Zambia has conducted a Threats Hazards Identification and Risk Assessment (THIRA) using a One Health approach, as well as the Strategic Tool for Assessment of Risk (STAR) and Vulnerability and Risk Analysis and Mapping (VRAM) (Page 21). The evaluation recommends that Zambia develop or revise a comprehensive legal framework addressing disease prevention policies, contingency plans, and control strategies for priority zoonotic diseases (Page 22). ³²

Zambia has also held two Joint Risk Assessment Operational Tool (JRA OT) workshops. The first, in 2023, assessed anthrax, rabies, and avian influenza, while the second, in 2024, focused on African trypanosomiasis, plague, and cysticercosis. ³³³⁴

1.2.1c Laws/plans for surveillance & control of multiple zoonotic pathogens

Score: 100

There is publicly available evidence that Zambia has national legislation, plans, or guidelines that account for the surveillance and control of multiple zoonotic pathogens of public health concern.

The Animal Health (Notifiable Diseases) Regulations, 2019 provide a list of 51 notifiable diseases ³⁵. Under the Animal Health Act, 2010, notifiable diseases trigger control measures such as eliminating any associated risk (Article 8), seizing, detaining, and destroying without compensation any animal, animal product, animal by-product, or article removed from an infected area (Article 13), and declaring quarantine areas (Article 23) ³⁶.

The National One Health Strategic Plan 2022–2026 also addresses surveillance by setting the objective to achieve One Health surveillance among key stakeholders for the early detection of zoonotic diseases and other public health events by the end of 2024 (Page 47). To achieve this, the plan includes actions such as developing a prioritized list of zoonotic diseases and other threats of public health importance, creating an integrated surveillance system for the highest-priority zoonotic diseases and public health threats, and holding workshops to develop a One Health priority list for zoonotic diseases (Page 47) ³⁷.

1.2.1d Cross-ministerial department/agency/unit for zoonotic disease

Score: 100

There is publicly available evidence that Zambia has a department, agency, or similar unit functioning as a multi-sectoral co-ordinating mechanism dedicated to zoonotic disease that functions across ministries.

The National One Health Strategic Plan 2022–2026 establishes the creation of Technical Working Groups (TWG) composed of technical representation from various Ministries, non-governmental organizations and cooperating partners based on the following thematic areas: Governance and coordination, Surveillance, Preparedness and Response, Advocacy Communication and Training, and Research. ³⁸

According to the 2023 Annual Report of the Zambia National Public Health Institute, the five TWG were launched in 2023 (Page 19). ³⁹ The Joint External Evaluation, published in 2024, also highlight in its assessment on zoonotic diseases the establishment and operationalization of the One Health Surveillance Technical Working Groups, as stipulated in the One Health Strategic Plan (Page 21). ⁴⁰

In 2025, the One Health Coordinating Committee meet for first time, bringing together senior directors from various government ministries, government agencies, and key partners including the Food and Agriculture Organization (FAO), the UK Health Security Agency (UKHSA), World Health Organization (WHO), and the Centers for Disease Control and Prevention (CDC). ⁴¹

1.2.1e Presence of One Health strategic plan

Score: 100

Zambia has a One Health strategic plan in place. The National One Health Strategic Plan (NOHSP) 2022–2026, launched in 2023, aims to integrate human, animal, and environmental health through enhanced coordination and multi-sectoral collaboration to address public health threats like zoonotic diseases and antimicrobial resistance. The plan establishes platforms for collaboration, develops governance structures at district levels, and sets priorities for surveillance, preparedness, response, and research across key thematic areas. ⁴²

1.2.2 Surveillance systems for zoonotic diseases/pathogens

1.2.2a Surveillance/reporting mechanism for zoonotic disease for livestock owners

Score: 0

There is no publicly available evidence that Zambia has a national mechanism (either voluntary or mandatory) for owners of livestock to conduct and report on disease surveillance to a central government agency. No evidence was found on the websites of the Ministries of Health, Agriculture, Fisheries and Livestock, or the National Public Health Institute. ⁴³⁴⁴⁴⁵⁴⁶

However, the Animal Health Act of 2010 and the Animal Health (Notifiable Diseases) Regulations of 2019 establish a legal framework requiring the notification of animal diseases. The Act mandates owners of livestock suspected of being infected with any disease to immediately inform the nearest officer, police officer, agriculture officer, veterinary surgeon, district executive officer, chief or village headman (Article 17). ⁴⁷⁴⁸

1.2.2b Laws/regulations on data confidentiality to protect livestock owners

Score: 0

The Animal Health Act of 2010 and the Animal Health (Notifiable Diseases) Regulations of 2019 do not detail provisions on confidentiality or data protection related to surveillance information. ⁵³⁵⁴ The Data Protection Act, of 2021, establishes that a data controller or the data processor shall implement appropriate security safeguards including ensuring ongoing confidentiality, integrity and implementation of measures necessary to protect the integrity of personal data (Article 47). However, it does not address confidentiality in animal health surveillance. ⁵⁵

1.2.2c Wildlife zoonotic disease surveillance

Score: 0

There is publicly available evidence that Zambia conducts surveillance of zoonotic diseases in poultry and livestock, but not in wildlife.

According to the Joint External Evaluation (JEE) report, published in 2024, the country has both indicator- and event-based surveillance systems for zoonotic diseases, although there is a lack of substantiating evidence regarding wildlife involvement in surveillance activities (Page 20). The report also notes that, due to the generally underperforming national surveillance system, the true magnitude of zoonotic diseases remains largely unknown (Page 20). However, efforts are underway to strengthen Zambia’s One Health mechanism, such as utilizing DHIS2 as the primary national health information system platform, which enables the nationwide adoption of a One Health–based surveillance and early warning system for zoonotic diseases (Page 20). ⁵⁶

According to the National One Health Strategic Plan 2022-2026, surveillance of zoonotic diseases remains uncoordinated, and there is limited data sharing between the human health and animal health sectors (Page 19). The Plan aims to achieve One Health surveillance among key stakeholders for the early detection of zoonotic diseases and other public health events by the end of 2024. One of the steps listed to achieve this goal is the development of an integrated surveillance system for the highest-priority zoonotic diseases and public health threats (Page 47). ⁵⁷

Further evidence that Zambia conducts surveillance of zoonotic diseases comes from the Food and Agriculture Organization (FAO) website, which reports that the country’s early warning system draws on national surveillance datasets. ⁵⁸ Likewise, in a highly pathogenic avian influenza situation update published in 2025, FAO reports that Zambia conducted active surveillance from 1 January to 4 February 2025, during which 600 samples were collected from layer chickens on breeder farms in Lusaka, Central, Copperbelt, and Southern provinces. ⁵⁹

Additionally, an academic paper published in 2022 states that active surveillance for animal trypanosomiasis is carried out intermittently by the Ministry of Fisheries and Livestock. ⁶⁰

1.2.3 International reporting of animal disease outbreaks

1.2.3a Annual reporting to OIE on zoonotic disease incidence

Score: 100

There is publicly available evidence that Zambia has a mechanism for reporting notifiable diseases to the World Organisation for Animal Health (WOAH).

According to the Joint External Evaluation (JEE) report, published in 2024, the country’s availability of the signal list and notifiable priority diseases enables the rapid identification and reporting of key health threats (Page 40). ⁶¹

Since 2020, the IHR focal point has been the National Public Health Institute, as established by Article 4 of the Zambia National Public Health Institute Act. ⁶² The WOAH focal point, however, is within the Department of Veterinary Services of the Ministry of Fisheries and Livestock. ⁶³

The Animal Health (Notifiable Diseases) Regulations, from 2019, list notifiable diseases that must be reported by veterinarians and animal health officials. Among the diseases listed are African swine fever, anthrax, bluetongue, various forms of brucellosis, and bovine tuberculosis, among others. ⁶⁴

1.2.4 Animal health workforce

1.2.4a Number of veterinarians per 100,000 people

Score: 0

1.2.4b Number of veterinary para-professionals per 100,000 people

Score: 0

1.2.5 Private sector and zoonotic disease

1.2.5a Inclusion of private sector in national plan/law on zoonotic disease

Score: 0

There is no publicly available evidence that Zambia’s national plan on zoonotic disease or other legislation, regulations, or plans include mechanisms for working with the private sector in controlling or responding to zoonoses. No evidence was found on the websites of the Ministries of Health, Agriculture, Fisheries and Livestock, or the National Public Health Institute. ⁶⁵⁶⁶⁶⁷⁶⁸

The National One Health Strategic Plan 2022–2026 does not establish such mechanisms. ⁶⁹ The Animal Health Act of 2010 also does not provide for collaboration with the private sector. ⁷⁰

The National Livestock Development Policy and its Implementation Plan for 2020–2024 likewise do not include the private sector in controlling or responding to zoonoses. ⁷¹ The 2023 Report of the Committee on Agriculture, Lands and Natural Resources for the second session of the Thirteenth National Assembly states that the Committee was informed by stakeholders that this policy failed to acknowledge the role of the private sector in addressing animal health, and it was suggested that the policy should outline measures and incentives provided by the Government to encourage and guide private sector investments in the provision of veterinary drugs and services (Page 4). ⁷²

The report also emphasises the generally low level of private sector participation in disease prevention and control in the country. Stakeholders informed the Committee that there were inadequate incentives and limited collaboration between the Government and the private sector, especially in handling diseases of national economic importance (Page 13). ⁷³

1.3 Biosecurity

1.3.1 Whole-of-government biosecurity systems

1.3.1a Updated national records of especially dangerous pathogen/toxin inventories

Score: 0

There is no publicly available evidence that Zambia has in place a record, updated within the past five years, of the facilities in which especially dangerous pathogens and toxins are stored or processed. No evidence could be found on the websites of the Ministries of Health, Agriculture, Fisheries and Livestock or Defense, the National Health Research Authority or in the Verification Research, Training and Information Centre (VERTIC) legislation database. ⁷⁴⁷⁵⁷⁶⁷⁷⁷⁸⁷⁹

According to the Joint External Evaluation (JEE), published in 2024, Zambia has a national Biological Safety Cabinet (BSC) certification program and local technical expertise for certifying facilities that handle high-consequence pathogens and toxins (Page 26). Biological safety cabinets are serviced locally, as the country has three NSF-certified engineers within the Ministry of Health and one in the Ministry of Fisheries and Livestock (Page 26). However, the report also highlights the absence of a national legislative framework for biosafety and biosecurity, and notes that the country does not maintain an actively updated inventory of high-consequence biological agents (Page 27). JEE recommends that the country establish a national list and compile a consolidated national inventory of high-consequence biological agents (Page 27). ⁸⁰

No information on facilities record was found in the National Health Strategic Plan 2022–2026. ⁸¹ Although Zambia has submitted two Biological Weapons Convention (BWC), Confidence-Building Measures reports in 2024, they are not publicly available. ⁸² Likewise, the United Nations’ BWC National Implementation Measures Database states that no laws, regulations or other measures have been found regarding registration requirements for individuals or facilities. ⁸³

1.3.1b Biosecurity laws on facility security for especially dangerous pathogens

Score: 0

There is no publicly available evidence that Zambia has legislation and/or regulations related to biosecurity which address requirements such as physical containment, operation practices, failure reporting systems, and/or cybersecurity of facilities in which especially dangerous pathogens and toxins are stored or processed. No evidence could be found on the websites of the Ministries of Health, Agriculture, Fisheries and Livestock or Defense, or the National Health Research Authority. ⁸⁴⁸⁵⁸⁶⁸⁷⁸⁸

No information on such requirements was found in the Multi-sectoral National Action Plan on Antimicrobial Resistance 2017-2027, the National Health Strategic Plan 2022–2026, the VERTIC legislation database, or any of the health acts, such as the Act for Public Health 1995, the Animal Health Act 2010 or Environmental Management Act 2011. ⁸⁹⁹⁰⁹¹⁹²⁹³⁹⁴ Likewise, the United Nations’ Biological Weapons Convention National Implementation Measures Database states that no laws, regulations or other measures have been found regarding biosecurity requirements and cybersecurity measures. ⁹⁵

The Biosafety Act, of 2007, is focused on genetically modified organisms. The Act regulates the research, development, application, import, export, transit, contained use, release or placing on the market of any genetically modified organism whether intended for use as a pharmaceutical, food, feed or processing, or a product of a genetically modified organism. ⁹⁷

1.3.1c Agency for enforcement of biosecurity laws/regulations

Score: 0

There is no publicly available evidence that Zambia has an established agency (or agencies) responsible for the enforcement of biosecurity legislation and regulations. No evidence was found on the websites of the Ministries of Health, Agriculture, Fisheries and Livestock, or the National Public Health Institute. ⁹⁸⁹⁹¹⁰⁰¹⁰¹

According to the Joint External Evaluation published in 2024, Zambia does not have a national legislative framework for biosafety and biosecurity (page 27). ¹⁰²

As a result, different authorities are responsible for different provisions. For example, the Animal Health Act of 2010 designates the Director of Veterinary Services within the Ministry of Fisheries and Livestock as responsible for preventing and controlling animal diseases, controlling vectors that contribute to disease propagation in animals, and performing other functions necessary to implement the Act (Article 4). ¹⁰³

The Plant Health Act of 2025 regulates, among other matters, pest control, plant import and export, and pest containment and eradication. It establishes the Plant Quarantine and Phytosanitary Service Department within the Ministry of Agriculture as the authority responsible for administering the Act (Article 3). ¹⁰⁴

The Environmental Management Act of 2011 enforces pollution controls, as well as hazardous waste and chemical licensing and controls. It designates the Zambia Environmental Management Agency as the body responsible for its enforcement (Article 9). ¹⁰⁵

1.3.1d Consolidation of especially dangerous pathogens into minimum # of facilities

Score: 0

There is no publicly available evidence that Zambia has taken action to consolidate its inventories of especially dangerous pathogens and toxins into a minimum number of facilities. No evidence could be found on the websites of the Ministries of Health, Agriculture, Fisheries and Livestock or Defense, or the National Health Research Authority. ¹⁰⁶¹⁰⁷¹⁰⁸¹⁰⁹¹¹⁰

No information on such actions was found in the Multi-sectoral National Action Plan on Antimicrobial Resistance 2017-2027, the National Health Strategic Plan 2022–2026, the VERTIC legislation database, or the United Nations’ Biological Weapons Convention National Implementation Measures Database ¹¹¹¹¹²¹¹³¹¹⁴

According to the Joint External Evaluation (JEE), published in 2024, Zambia does not maintain an actively updated inventory of high-consequence biological agents. The report recommends that the country establish a national list and compile a consolidated national inventory of such agents (Page 27). ¹¹⁵

1.3.1e Capacity to conduct tests for anthrax/Ebola without culturing live pathogens

Score: 100

There is publicly available evidence that Zambia has in-country capacity to conduct Polymerase Chain Reaction (PCR)–based diagnostic testing for Ebola, which would preclude culturing a live pathogen.

A 2019 WHO report on Ebola assesses the status of the disease preparedness and readiness in African countries, highlighting that Zambia has both PCR and GeneXpert capacity in place and is able to use these tests to detect Ebola (Page 8 and 28). ¹¹⁶

A 2024 presentation from the Zambia Field Epidemiology Training Programme reports anthrax samples confirmed by PCR (Page 7). However, it is unclear whether this was a one-time effort or part of routine in-country PCR capacity. ¹¹⁷

There is further evidence of in-country capacity to conduct PCR, but not for anthrax and Ebola. According to the National Integrated Cholera Surveillance, Laboratory and Case Management Guidelines, of 2024, the Zambia National Public Health Reference Laboratory can conduct PCR testing for toxigenicity and further molecular testing for the characterization and genotyping of circulating Vibrio cholerae strains (Page 21). The document also lists PCR among the available tests for cholera, specifying that PCR targets for confirmation of Vibrio cholerae species include: ompW, toxR, and ISR (Pages 21 and 22). ¹¹⁸

The Clinical Guidance for Management of Patients with Coronavirus Disease 2019, published in 2023, also includes PCR among the available diagnostic tests (Page 5). ¹¹⁹ Additional evidence of Zambia’s PCR capacity comes from the 2016 Report of the Committee on Agriculture for the First Session of the Twelfth National Assembly, which records the acquisition of PCR equipment for trypanosomiasis diagnosis (Page 72) ¹²⁰.

1.3.2 Biosecurity training and practices

1.3.2a Biosecurity training using a standardised, required approach

Score: 0

There is no publicly available evidence that Zambia requires biosecurity training, using a standardized, required approach, such as through a common curriculum or a train-the-trainer program, for personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials with pandemic potential. No evidence could be found on the websites of the Ministries of Health, Agriculture, Fisheries and Livestock or Defense, the National Health Research Authority or in the Verification Research, Training and Information Centre (VERTIC) legislation database. ¹²¹¹²²¹²³¹²⁴¹²⁵¹²⁶

Although Zambia does not legally require biosecurity training, the Joint External Evaluation, published in 2024, states that the country has a standardized program for ongoing in-service biosafety and biosecurity training. This training is available in selected facilities that handle high-consequence agents in the human health sector and is delivered by a pool of certified trainers in accordance with the national curriculum (Page 27). The report recommends that Zambia develop pre-service biosafety and biosecurity training programs and expand training to laboratory professionals across the human, animal, and environmental health sectors at all levels (Page 28). ¹²⁷

The Multi-sectoral National Action Plan on Antimicrobial Resistance 2017-2027, the National Health Strategic Plan 2022-2026, and the One Health Strategic Plan 2022-2026 do not refer to biosecurity training requirements. ¹²⁸¹²⁹¹³⁰ Likewise, the United Nations’ Biological Weapons Convention National Implementation Measures Database states that no laws, regulations or other measures have been found regarding training of personnel on biosafety/biosecurity. ¹³¹

1.3.3 Personnel vetting: regulating access to sensitive locations

1.3.3a Personnel checks for permission to access to especially dangerous pathogens

Score: 0

There is no publicly available evidence that Zambia’s regulations or licensing conditions specify that security and other personnel with access to especially dangerous pathogens, toxins, or biological materials with pandemic potential are subject to the following checks: drug testing, background checks, and psychological or mental fitness checks. No evidence could be found on the websites of the Ministries of Health, Agriculture, Fisheries and Livestock or Defense, the National Health Research Authority or in the Verification Research, Training and Information Centre (VERTIC) legislation database. ¹³²¹³³¹³⁴¹³⁵¹³⁶¹³⁷

The Joint External Evaluation, published in 2024, the Multi-sectoral National Action Plan on Antimicrobial Resistance 2017-2027, the National Health Strategic Plan 2022-2026, and the One Health Strategic Plan 2022-2026 do not refer to check requirements. ¹³⁸¹³⁹¹⁴⁰¹⁴¹ Likewise, the United Nations’ Biological Weapons Convention National Implementation Measures Database states that no laws, regulations or other measures have been found regarding background checks for personnel. ¹⁴²

1.3.4 Transportation security

1.3.4a National transport regulations for Category A and B infectious substances

Score: 0

There is no publicly available evidence that Zambia has national regulations on the safe and secure transport of infectious substances (specifically including Categories A and B). No evidence could be found on the websites of the Ministries of Health, Agriculture, Fisheries and Livestock or Defense, the National Health Research Authority (NHRA) or in the Verification Research, Training and Information Centre (VERTIC) legislation database. ¹⁴³¹⁴⁴¹⁴⁵¹⁴⁶¹⁴⁷¹⁴⁸

Existing regulations focus on authorization rather than safety requirements and do not specifically refer to infectious substances. The Biosafety Act, of 2010, establishes only mandatory authorisation for the transport or transit of genetically modified organisms (Article 31). ¹⁴⁹ Similarly, the National Health Research (Material Transfer) Regulations, of 2018, establish that the transfer of a biological material for research purposes requires authorization from NHRA and the payment of the prescribed fee (Article 3). ¹⁵⁰

The United Nations’ Biological Weapons Convention National Implementation Measures Database states that no laws, regulations or other measures have been found regarding technical, security and accountability requirements for transfers and license or other control requirement for carriers. ¹⁵¹

However, the Joint External Evaluation, published in 2024, states that Zambia maintains an integrated national courier system for the local transportation of biological agents dedicated to the human health sector, adheres to International Air Transport Association (IATA) regulations for international transportation, and personnel responsible for transporting infectious substances undergo training in Infectious Substance Shipment Training (ISST) in line with IATA and WHO guidelines (Pages 26 and 28). ¹⁵²

1.3.5 Cross-border transfer and end-user screening

1.3.5a Laws/regulations on cross-border transfer and end-user screening

Score: 0

There is no publicly available evidence that Zambia has legislation and/or regulations in place to oversee the cross-border transfer and end-user screening of especially dangerous pathogens, toxins, and pathogens with pandemic potential. No evidence could be found on the websites of the Ministries of Health, Agriculture, Fisheries and Livestock or Defense, the National Health Research Authority or in the Verification Research, Training and Information Centre (VERTIC) legislation database. ¹⁵³¹⁵⁴¹⁵⁵¹⁵⁶¹⁵⁷¹⁵⁸

The Biosafety Act, of 2007, establishes only mandatory authorisation for the transport or transit of genetically modified organisms (Article 31). ¹⁵⁹ Likewise, the Public Health (Infectious Disease) Regulations, last amended in 2006, prohibit the import, convey or transmission without authorization into Zambia of any culture or preparation of any pathogenic microorganism or other material capable of causing disease in man (Article 52). ¹⁶⁰

The United Nations’ Biological Weapons Convention National Implementation Measures Database states that no laws, regulations or other measures have been found regarding technical, security and accountability requirements for transfers and end-user certification requirement for export of controlled items. ¹⁶¹

The Joint External Evaluation, published in 2024, states that Zambia adheres to International Air Transport Association (IATA) regulations for international transportation, and personnel responsible for transporting infectious substances undergo training in Infectious Substance Shipment Training (ISST) in line with IATA and WHO guidelines (Page 26). ¹⁶²

1.4 Biosafety

1.4.1 Whole-of-government biosafety systems

1.4.1a Biosafety laws/regulations

Score: 0

There is no publicly available evidence that Zambia has national biosafety legislation. No evidence could be found on the websites of the Ministries of Health, Agriculture, Fisheries and Livestock or Defense, the National Health Research Authority or in the Verification Research, Training and Information Centre (VERTIC) legislation database. ¹⁶³¹⁶⁴¹⁶⁵¹⁶⁶¹⁶⁷¹⁶⁸

According to the Joint External Evaluation published in 2024, Zambia does not have a national legislative framework for biosafety and biosecurity (page 27). ¹⁶⁹

1.4.1b Agency for enforcement of biosafety laws/regulations

Score: 0

There is no publicly available evidence that Zambia has an agency responsible for the enforcement of biosafety legislation and regulations. No evidence could be found on the websites of the Ministries of Health, Agriculture, Fisheries and Livestock or Defense, the National Health Research Authority or in the Verification Research, Training and Information Centre (VERTIC) legislation database. ¹⁷¹¹⁷²¹⁷³¹⁷⁴¹⁷⁵¹⁷⁶

According to the Joint External Evaluation published in 2024, Zambia does not have a national legislative framework for biosafety and biosecurity (page 27). ¹⁷⁷

The Biosafety Act of 2007 establishes the National Biosafety Authority, which is tasked with establishing control measures to ensure compliance with the Act and serves as the National Biosafety Focal Point (Article 5). However, the Act is focused on genetically modified organisms only. ¹⁷⁸ The body does not have a website, only a Facebook page. ¹⁷⁹

1.4.2 Biosafety training and practices

1.4.2a Biosafety training using a standardised, required approach

Score: 0

There is no publicly available evidence that Zambia requires biosafety training, using a standardized, required approach, such as through a common curriculum or a train-the-trainer program, for personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials with pandemic potential. No evidence could be found on the websites of the Ministries of Health, Agriculture, Fisheries and Livestock or Defense, the National Health Research Authority or in the Verification Research, Training and Information Centre (VERTIC) legislation database. ¹⁸⁰¹⁸¹¹⁸²¹⁸³¹⁸⁴¹⁸⁵

Although Zambia does not legally require biosafety training, the Joint External Evaluation, published in 2024, states that the country has a standardized program for ongoing in-service biosafety and biosecurity training. This training is available in selected facilities that handle high-consequence agents in the human health sector and is delivered by a pool of certified trainers in accordance with the national curriculum (Page 27). The report recommends that Zambia develop pre-service biosafety and biosecurity training programs and expand training to laboratory professionals across the human, animal, and environmental health sectors at all levels (Page 28). ¹⁸⁶

The Multi-sectoral National Action Plan on Antimicrobial Resistance 2017-2027, the National Health Strategic Plan 2022-2026, and the One Health Strategic Plan 2022-2026 do not refer to biosafety training requirements. ¹⁸⁷¹⁸⁸¹⁸⁹ Likewise, the Biosafety Act of 2007 does not establish mandatory training and the United Nations’ Biological Weapons Convention National Implementation Measures Database states that no laws, regulations or other measures have been found regarding training of personnel on biosafety/biosecurity. ¹⁹⁰¹⁹¹

1.5 Dual-use research and culture of responsible science

1.5.1 Oversight of dual-use research

1.5.1a Evidence of national assessment of dual-use research

Score: 0

There is no publicly available evidence that Zambia has conducted an assessment to determine whether ongoing research is occurring on especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research. No evidence could be found on the websites of the Ministry of Health, National Public Health Institute and National Health Research Authority (NHRA). ¹⁹²¹⁹³¹⁹⁴

According to the National Health Research Act of 2013, the NHRA shall, in performing its functions, maintain a database of research undertaken, facilitate the dissemination of research results, and establish and maintain a central health research repository (Article 5) ¹⁹⁵. However, no evidence of such a repository or database was found on the NHRA website, in the Zambia National Health Research Agenda 2022–2026, or in the NHRA Strategic Plan 2018–2021. ¹⁹⁶¹⁹⁷¹⁹⁸ The Zambia National Health Research Agenda 2022–2026 says that the NHRA will develop monitoring and evaluation tools to measure the the Agenda indicators, including a record of published studies that address national health research priorities (Page 30). ¹⁹⁹

Furthermore, the National Health Strategic Plan 2022–2026 notes that the country has a weak research information management system. While the plan outlines actions to strengthen research capacity, it does not include provisions for assessing ongoing research on especially dangerous pathogens or dual-use projects. ²⁰⁰

1.5.1b National law/regulation on oversight of dual-use research

Score: 0

There is no publicly available evidence that Zambia has legislation and/or regulation requiring oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research. No evidence could be found on the websites of the Ministry of Health, National Public Health Institute and National Health Research Authority (NHRA). ²⁰¹²⁰²²⁰³

According to the National Health Research Act of 2013, the functions of the NHRA include providing oversight and coordination of health research (Article 5). However, this mandate is broad and does not specifically address research involving especially dangerous pathogens, toxins, pathogens with pandemic potential, and/or other dual-use research. Similarly, the Act also establishes the National Health Research Ethics Board, which oversees and ensures adherence to health research ethics (Articles 13 and 14), but also does not focus on dual-use research. ²⁰⁴

The United Nations’ Biological Weapons Convention National Implementation Measures Database also states that no information on the oversight of life sciences dual-use research has been found in publicly available sources. ²⁰⁵

1.5.1c Existence of agency responsible for oversight of dual-use research

Score: 0

There is no publicly available evidence that Zambia has an agency responsible for oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research. No evidence could be found on the websites of the Ministries of Health, National Public Health Institute and National Health Research Authority (NHRA). ²⁰⁶²⁰⁷²⁰⁸

1.5.2 Screening requirements for providers of genetic material

1.5.2a Requirement to screen synthesised DNA against list prior to sale

Score: 0

There is no publicly available evidence that Zambia has an agency responsible for oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research. No evidence could be found on the websites of the Ministries of Health, National Public Health Institute, and National Biosafety Authority’s Facebook page. ²¹¹²¹²²¹³ The 2007 Biosafety Act also does not refer to screening of synthesized DNA. ²¹⁴

1.6 Immunization

1.6.1 Vaccination rates

1.6.1a Immunization rate for humans (measles/MCV2)

Score: 0

1.6.1b Availability of vaccination figures for livestock (FMD) through OIE database

Score: 0

There is no publicly available evidence that Zambia’s official foot-and-mouth disease (FMD) vaccination figures for livestock are publicly available through the OIE database. No evidence could be found on the websites of the Ministry of Health, National Public Health Institute, Ministry of Fisheries and Livestock, and World Organization for Animal Health. ²¹⁵²¹⁶²¹⁷²¹⁸

The World Animal Health Information System provides data on FMD vaccination from 2007 to 2015; however, it only reports vaccination figures for cattle vaccinated in the second semester of 2007 (41,539). ²¹⁹

More recent FMD vaccination figures are included in a 2023 Ministry of Fisheries and Livestock presentation, which states that from 2021 onward, approximately 3 million heads of cattle countrywide have been vaccinated, including booster doses (Page 11). ²²⁰ Additionally, the 2023 Livestock Survey reports the percentage of households by province that vaccinated their livestock against FMD (Page 52). ²²¹

1.6.1c Equitablenature of national immunization strategy/plan

Score: 100

There is publicly available evidence that Zambia has a national immunization plan that covers equitable distribution, however, the plan is not available online to assess the existence of strategies specifically aimed at overcoming socioeconomic inequalities, geography, cultural/linguistic differences and/or gender barriers to vaccination.

According to the Joint External Evaluation (JEE), published in 2024, Zambia has a well-established voluntary routine immunization programme, guided by a comprehensive multi-year National Immunization Strategy 2022–2026. This strategy is aligned with the Immunization Agenda 2030, Zambia's 8th National Development Plan, and the Zambia National Health Strategic Plan (Page 30). ²²² Both the JEE and the World Health Organization’s 2023/2024 Annual Report on Zambia refer to a National Immunization Strategy ²²³²²⁴; however, this document could not be found online. No evidence of it was located on the websites of the Ministry of Health, the National Public Health Institute, or Gavi. ²²⁵²²⁶²²⁷ Likewise, although the Immunisation Comprehensive Multi-Year Plan 2017–2021 is available online, the 2022–2026 version was not found on the same platforms. ²²⁸²²⁹²³⁰

The JEE further notes that Zambia's Expanded Programme on Immunization (EPI) has been in place since 1975. Its immunization schedule covers tuberculosis, poliomyelitis, rotavirus, pneumococcal disease, meningococcal disease, pertussis, diphtheria, tetanus, hepatitis B, measles, rubella, cervical cancer, and COVID-19 (Page 29). EPI has consistently achieved coverage rates above 90% for most antigens. The country employs a Reaching Every District (RED) approach and maintains cold chain and transport infrastructure at all national and provincial service delivery points (Page 30). The program uses effective vaccine delivery strategies, prioritizing provinces and districts with hard-to-reach areas and allowing sufficient time for last-mile distribution (Page 31). On the other hand, the country has experienced declining routine immunization coverage and suboptimal quality of Supplementary Immunization Activities (SIAs) (Page 30). ²³¹

The One Health Strategic Plan 2022–2026 does not directly address immunization. ²³² The National Health Strategic Plan 2022-2026 establishes strategic interventions such as strengthening SIAs, promoting immunization, and enhancing the provision of integrated outreach for immunisation services (Page 38). ²³³

1.6.1d Vaccine hesitancy and build public trust coverage in vaccines in national immunization strategy/plans

Score: 0

There is no publicly available evidence that Zambia’s national immunization plan includes measures to address vaccine hesitancy and build public trust in vaccines.

According to the Joint External Evaluation (JEE), published in 2024, and the World Health Organization’s 2023/2024 Annual Report on Zambia, the country has a National Immunization Strategy ²³⁴²³⁵; however, this document could not be found online. No evidence of it was located on the websites of the Ministry of Health, the National Public Health Institute, or Gavi. ²³⁶²³⁷²³⁸ Likewise, although the Immunisation Comprehensive Multi-Year Plan 2017–2021 is available online, the 2022–2026 version was not found on the same platforms. ²³⁹²⁴⁰²⁴¹

However, the JEE reports a significant decrease in vaccine refusals and hesitancy, demonstrated by the high vaccination uptake resulting from increased community engagement efforts. Nonetheless, hesitancy remains a persistent challenge in many areas due to religious reasons (Pages 30 and 32). ²⁴²

Furthermore, according to WHO’s Immunization Dashboard, Zambia conducted an assessment in 2024 to understand demand-related reasons for under-vaccination and has implemented strategies such as community engagement, digital and social listening, behaviorally informed interventions, and public communications to address these issues. ²⁴³

Finally, a 2023 academic article lists several interventions implemented in Zambia to encourage and reinforce vaccination uptake. These include the use of Community Health Workers (CHWs) to deliver health information at the community level; education efforts through CHWs, schools, and media; partnerships between the Ministry of Health and media outlets; the engagement of Neighborhood Health Committees (NHCs) to dispel myths and misconceptions about vaccines; and community meetings with local leaders. According to the article, the Ministry of Health played an active role in engaging with the media through strategic partnerships to disseminate vaccination information. ²⁴⁴

1.6.1e National advisory group for immunization strategy/plan

Score: 100

There is publicly available evidence that Zambia has a national advisory group that provides technical guidance and advice on the immunization strategy/plan to government.

According to the World Health Organization’s Report of External Assessment on the Zambia National Immunization Technical Advisory Group (ZITAG), published in 2023, the Minister of Health established ZITAG by Ministerial Statement in 2016 to advise policymakers and program managers on evidence-based immunization-related policy and program decisions (covering all ages and all vaccines) (Page 6). The core members consist of fourteen experts co-opted and appointed by the Ministry of Health: two paediatricians, a microbiologist, an anthropologist/sociologist, a vaccinologist, an epidemiologist, two public health experts, a virologist, a demographer/statistician, an ethics expert, a laboratory officer, a health economist, and a social scientist (Page 6). ²⁴⁵

The report further notes that ZITAG is an independent body and has an annual work plan, although it is not fully funded (Page 8). It also identifies as a challenge its limited visibility, as its recommendations and meeting minutes are not publicly available, although the Ministry of Health refers to ZITAG’s recommendations in official statements (Pages 8 and 15). ²⁴⁶

The most recent ZITAG meeting, held in July 2025, focused on reviewing critical evidence and developing updated, science-based recommendations regarding measles vaccine timing and enhanced protection for children living with sickle cell disease. ²⁴⁷

No further information was found on the Ministry of Health and National Public Health Institute websites. ²⁴⁸²⁴⁹

1.6.1f Presence of an immunization programme for influenza

Score: 0

There is no publicly available evidence that Zambia has an immunization programme for influenza. No evidence was found on the websites of the Ministries of Health, National Public Health Institute and Gavi. ²⁵⁰²⁵¹²⁵²

The Joint External Evaluation (JEE), published in 2024, the National One Health Strategic Plan 2022-2026 and the National Health Strategic Plan 2022-2026 do not contain evidence of such programme. ²⁵³²⁵⁴²⁵⁵

Furthermore, according to WHO’s Immunization Dashboard, Zambia does not have a formal national influenza vaccination policy and has not had influenza vaccines available since the data started to be collected, i.e., from 2020 to 2024. ²⁵⁶

1.7 Climate change adaptation and vector transmission

1.7.1 Health system resilience

1.7.1a Strategy/plan for resilience of health system

Score: 100

There is publicly available evidence that Zambia has a strategy or plan to develop a health system that is resilient to the challenges that climate change.

The National Adaptation Plan, published in 2023, identifies the increased incidence of climate-sensitive diseases, including water-borne, vector-borne, and airborne diseases, as a key vulnerability. To address this, it proposes actions such as strengthening public health emergency preparedness and response to climate-sensitive diseases, enhancing surveillance activities, and integrating health services and protection measures into climate vulnerability assessments (Page 25). Another identified vulnerability is the damage and loss of infrastructure, as well as increased maintenance costs. In response, the Plan outlines actions such as designing and constructing climate-resilient infrastructure for health services and promoting climate-resilient infrastructure development (Pages 45 and 52). ²⁵⁷

The National Health Strategic Plan 2022–2026 includes among its goals the reduction of environmentally related diseases through the promotion of Environmental Health Services at all levels of care. To achieve this, it sets objectives such as increasing disease surveillance and inspections at Points of Entry from 14 in 2021 to 24 by 2026; increasing the percentage of health care facilities implementing mitigation and adaptation measures to climate change from 55% in 2020 to 80% by 2026; and increasing the proportion of health care facilities complying with WASH/IPC standards from 45% in 2020 to 70% by 2026 (Pages 62 and 63). ²⁵⁸

One of the strategies outlined in the National Development Plan 2022–2026 is to increase access to quality health care. According to the Plan, this includes prioritising the development of climate-resilient health infrastructure (Page 53). ²⁵⁹

Early Detection

2.1 Laboratory systems strength and quality

2.1.1 Lab capacity for detecting priority diseases

2.1.1a Capacity of national lab system to conduct 5 or more WHO core tests

Score: 100

There is publicly available evidence that Zambia’s national laboratory system has the capacity to conduct diagnostic tests for at least 5 of the 10 WHO-defined core tests.

According to the Joint External Evaluation published in 2024, Zambia has developed diagnostic testing algorithms for priority diseases that align with global standards and has an extensive array of testing capabilities, spanning from point-of-care rapid testing to specialized techniques like next-generation sequencing within the human health sector (Page 36). Furthermore, the laboratory testing capacity modality is scored at level 4, indicating the ability to perform nucleic acid amplification testing, bacterial culture with antimicrobial sensitivity testing under a quality assurance process, some basic sequencing capacity, and that country can test for all its endemic and priority diseases (Page 36). ²⁶⁰²⁶¹

The National Health Research Authority Strategic Plan 2018–2021 reports testing capabilities for HIV (Pages 47 and 81), viral hepatitis (Page 52), tuberculosis (Pages 50 and 81), and malaria (Page 81). The plan also notes challenges faced by the country, such as having only 315 GeneXpert machines and recurrent stock outs of TB microscopy reagents (Page 50). ²⁶²

2.1.1b Plan to conduct testing during a public health emergency

Score: 0

There is no publicly available evidence that Zambia has a national plan, strategy or similar document for conducting testing during a public health emergency, which includes considerations for testing for novel pathogens, scaling capacity, and defining goals for testing. No evidence could be found on the websites of the Ministry of Health, National Public Health Institute, and Office of the Vice-President. ²⁶³²⁶⁴²⁶⁵

However, regarding antimicrobial resistance, JEE notes a lack of guidance on timely detection, reporting, risk assessment, and monitoring of novel and emerging resistance (Page 18). The report also says that limited modelling capability to support predictive surveillance affects the ability to forecast disease outbreaks and trends, particularly in the context of emerging health threats (Page 41). ²⁶⁷

2.1.2 Laboratory quality systems

2.1.2a Existence of an accredited national lab serving as a reference facility

Score: 100

There is publicly available evidence that Zambia has a national laboratory that serves as a reference facility which is accredited (e.g., International Organization for Standardization [ISO] 15189:2003, U.S. Clinical Laboratory Improvement Amendments [CLIA]).

According to the 2024 Joint External Evaluation, twelve medical laboratories have achieved accreditation to ISO 15189 standards, whereas one animal health laboratory and the Zambia Bureau of Standards Laboratory have been accredited to ISO 17025 standards (Page 36). ²⁶⁸ Among the accredited laboratories is the Tropical Diseases Research Centre Laboratory, defined by the National One Health Strategic Plan 2022-2026 as a national reference laboratory (Page 21). ²⁶⁹²⁷⁰

2.1.2b External quality assurance of a national lab serving as a reference facility

Score: 100

There is publicly available evidence that Zambia has a national laboratory that serves as a reference facility which is subject to external quality assurance review.

The Tropical Diseases Research Centre Laboratory, identified in the National One Health Strategic Plan 2022–2026 as a national reference laboratory (Page 21), reports that the majority of its tests participate in the External Quality Assessment (EQA) program. According to its 2021 Annual Report, laboratories in Haematology, Mycobacteriology, Parasitology, Immunology, Chemistry, Molecular Biology, and Microbiology have all been enrolled in the NHLS EQA programme (p. 29). These facilities consistently received EQA panels and generally demonstrated commendable performance, with the exception of the Microbiology laboratory, where reagent shortages negatively affected EQA results (Page 30). ²⁷¹

According to the 2024 Joint External Evaluation (JEE), there is a national external quality assessment program covering a wide range of testing areas, including bacteriology, virology, serology, parasitology, biochemistry, haematology, anatomical pathology, and transfusion medicine (Page 35). Additionally, the Ministry of Health in Zambia operates a Quality Assurance Coordinating Unit dedicated to adhering to approved quality management systems (p. 34). However, the JEE notes incomplete EQA coverage across all laboratories and test areas (Page 37). ²⁷²

The National Health Strategic Plan 2022–2026 acknowledges that EQA is not well coordinated (p. 82) and includes increasing its coverage as a strategic intervention (Page 84). ²⁷³

2.2 Laboratory supply chains

2.2.1 Specimen referral and transport system

2.2.1a Nationwide specimen transport system

Score: 100

There is publicly available evidence that Zambia has a nationwide specimen transport system.

According to the 2024 Joint External Evaluation (JEE), Zambia has an integrated national courier system for local transportation within the human health sector (Page 26). The JEE notes that there is an integrated specimen referral system across all health care levels and for all specimen types within the human health sector, which uses the Life application to track the transportation of shipped samples (Page 35). ²⁷⁴

The National Public Health Institute’s Environmental and Social Impact Assessment, updated in 2022, includes a protocol for the transportation of infectious substances, including human and animal specimens, in Annex 7 (Page 216). However, it is unclear whether this guidance is mandatory. ²⁷⁵

A 2022 news from the Ghanaian Centre for Health System Strengthening says that Zambian sample referral system is designed to consist of motorbike pickups from the spokes to the hubs and vehicle pickups from the hubs to the testing centers. ²⁷⁶

No further information was found on the websites of the Ministry of Health or the National Public Health Institute. ²⁷⁷²⁷⁸

2.2.2 Laboratory cooperation and coordination

2.2.2a Plan to rapidly authorize/license laboratories to scale-up testing during an outbreak

Score: 0

There is no publicly available evidence that Zambia has a plan in place to rapidly authorize or license laboratories to supplement the capacity of the national public health laboratory system to scale-up testing during an outbreak. No evidence could be found on the websites of the Ministry of Health, National Public Health Institute, and Office of the Vice-President. ²⁷⁹²⁸⁰²⁸¹

According to the National Public Health Institute’s Environmental and Social Impact Assessment, updated in 2022, the reliance on clinical laboratories for public health functions has often led to delays in establishing diagnoses, detecting outbreaks and reporting of results, highlighting a weakness in both the early-warning system and management of outbreaks (Page 17). ²⁸³

2.3 Real-time surveillance and reporting

2.3.1 Indicator and event-based surveillance and reporting systems

2.3.1a Evidence of ongoing event-based and indicator-based surveillance and analysis

Score: 50

There is publicly available evidence that Zambia is conducting ongoing event-based (EBS) and indicator-based (IBS) surveillance and analysis for notifiable and novel infectious diseases, however, there is no evidence that data is being analyzed on a daily basis.

According to the Zambia National Public Health Institute (ZNPHI), one of the core functions of its Surveillance and Disease Intelligence Cluster is event-based surveillance. This includes implementing and maintaining systems to capture and report public health events occurring outside of conventional health facilities, such as through community-based and informal sources of information. ZNPHI also states that Zambia's Integrated Disease Surveillance and Response (IDSR) strategy incorporates both IBS and EBS. ²⁸⁴

The Joint External Evaluation (JEE), published in 2024, confirms that Zambia employs both approaches. According to the report, the country has established EBS, IBS, and IDSR guidelines and has actively implemented them at the national, provincial, and district levels (Pages 20 and 39), allowing the generation of immediate and weekly epidemiological reports, incorporating laboratory results (Page 39). The report also highlights that weekly epidemiological bulletins and situation reports (sitreps) for specific events are produced and shared with a wide range of stakeholders (Page 39). ²⁸⁵

2.3.1b Evidence of a mechanism (such as IHR focal point) for reporting notifiable diseases to the WHO within the set timeline

Score: 100

There is publicly available evidence that Zambia has a mechanism for reporting notifiable diseases to the WHO within the set timeline.

Since 2020, the IHR Focal Point (NFP) has been the Zambia National Public Health Institute (ZNPHI), as established by Article 4 of the Zambia National Public Health Institute Act. ²⁸⁶ According to ZNPHI’s website, as the IHR Focal Point, the institute anchors IHR activities under the Emergency Preparedness and Response pillar, which coordinates implementation efforts, including policy and compliance, conducting State Party Annual Reports, and overseeing Joint External Evaluations. ²⁸⁷²⁸⁸

According to the Joint External Evaluation published in 2024, the NFP operates with on-duty officers stationed at the Public Health Emergency Operations Center (PHEOC), ensuring a prompt 24/7 response. However, it functions without Terms of Reference (ToRs) or Standard Operating Procedures (SOPs) outlining its roles and responsibilities (Page 14). ²⁸⁹

2.3.2 Interoperable, interconnected, electronic real-time reporting systems

2.3.2a Electronic national and sub-national reporting surveillance system

Score: 100

There is publicly available evidence that Zambia operates an electronic reporting surveillance system.

According to the 2024 Joint External Evaluation, the country has an electronic Integrated Disease Surveillance and Response (e-IDSR) system, which has been upgraded and rolled out from the national to district levels (Page 40), and uses DHIS2 for data collection, aggregation, and reporting (Page 41). It further notes that an electronic reporting system for animal diseases, based on DHIS2, is currently being piloted in three provinces: Western, Northern, and Central (Page 21). ²⁹⁰

According to the Presidential Delivery Unit’s website, prior to the DHIS2 pilot, the Ministry of Fisheries and Livestock captured and reported data from veterinary camps through a paper-based monthly reporting system. In the pilot areas, reporting levels have since increased, with each area expected to produce at least 20 event reports per month. ²⁹¹

According to its website, the National Public Health Institute developed the e-IDSR system using DHIS2 to collect, collate, and analyse public health data on all notifiable diseases and events. ²⁹²

The National One Health Strategic Plan 2022-2026 lists the availability of eIDSR/AMR DHIS2 for reporting surveillance data as one of the country’s strengths in surveillance (Page 34). ²⁹³

2.3.2b Collection of ongoing/real-time lab data by electronic surveillance system

Score: 50

There is evidence that Zambia’s electronic reporting surveillance system collects real-time laboratory data, however, there is no evidence that this data can be disaggregated and analysed by age, ethnicity, etc.

According to the Zambia National Public Health Institute (ZNPHI) website, the institute has developed an electronic Integrated Disease Surveillance and Response (eIDSR) system using the District Health Information System (DHIS2) platform, which has been deployed at the sub-national level. This system collects, collates, and analyzes public health data on all notifiable diseases and events. ZNPHI has full access to data on notifiable diseases of public health significance. The detailed analysis of this and other data enables the institute to prepare for and respond to public health emergencies in a timely manner, as well as to inform programmatic and policy decisions. ²⁹⁴

According to the Joint External Evaluation published in 2024, Zambia has utilized the DHIS2 as the primary National Health Information System platform, enabling the nationwide adoption of a One Health-based surveillance and early warning system (Page 20). The country utilizes DHIS2 for data collection, aggregation, and reporting (Page 41). However, although the data generated at national reference labs is transmitted to ZNPHI via a well-established data transfer system, laboratory information systems are not linked with epidemiological information systems such as DHIS2 and Livestock Information Management System (LIMS) across various sectors (Page 37). ²⁹⁵

The Digital Health Strategy 2022-2026 does not provide information on real-time laboratory data and availability of disaggregate data. However, it does identify as a country’s strength the existence of a national health information system for aggregated data collection, the DHIS2 (Page 18).

No further information was found on the Ministry of Health website, the National One Health Strategic Plan 2022-2026, and the National Health Strategic Plan 2022-2026. ²⁹⁶²⁹⁷²⁹⁸

2.3.3 Wastewater surveillance

2.3.3a National wastewater surveillance programme or initiative

Score: 100

There is evidence that Zambia has ongoing wastewater or environmental surveillance programmes at the national level.

In 2026, the Ministry of Health in Zambia confirmed that poliovirus type 2 was detected from an environmental sample collected in Lusaka District, following routine surveillance conducted in collaboration with local and international health partners.²⁹⁹ In February 2026, the Ministry of Health confirmed the detection of Circulating Vaccine-Derived Poliovirus Type 2 (cVDPV2) from an environmental sample collected in Lusaka District in December 2025.³⁰⁰

Moreover, following the outbreak of wild poliovirus in Malawi in February 2022, environmental surveillance teams in Zambia stepped up efforts for early detection as five countries in south-eastern Africa bolstered the drive to vaccinate children and halt the virus. The team at the Kaunda Square Waste Stabilisation Ponds, for example, started sampling twice a month in 2019 during an outbreak of vaccine-derived poliovirus type 2.³⁰¹

Support for integration of polioviruses environmental surveillance with other wastewater pathogens saw the region collaborate with partners in the Mpox wastewater surveillance project in Democratic Republic of Congo and the European Union Health Emergency Preparedness and Response Authority (HERA) wastewater project in AFRO that seeks to support Countries and development partners have clear guidance on minimum capacity need and investment requirements to establish and sustain a credible wastewater and environmental surveillance programme. This resulted in four pilot countries (Democratic Republic of Congo, Senegal, Uganda, and Zambia) being supported in selecting priority pathogens based on local context and public health significance, feasibility, acceptability, and how best to integrate with existing surveillance and response systems, as well as multi-target wastewater and Environmental surveillance. Scoping visits were conducted in the four pilot countries where the WHO prioritisation tool was applied to help countries select priority pathogens. Microplanning was conducted for its implementation, after which budgets were drawn up, and implementation is planned for 2026.³⁰² However, there is no evidence on whether this has been implemented yet, whether it is national/sub-national, or whether it is expected to be long-running.

Zambia is among six African countries participating in Project Stellar, a pilot initiative funded by the Global Fund and implemented via the Association of Public Health Laboratories (APHL). The project tests the feasibility of wastewater-based surveillance (WWBS) for molecular detection and whole-genome sequencing of SARS‑CoV‑2, and leaves room for future expansion to include other pathogens. The programme involved sampling occurs at six sewer sites managed by the Lusaka Water Supply and Sanitation Company, covering parts of Lusaka District that serve over one million residents. The programme has successfully used PCR and next-generation sequencing (NGS) to detect and characterize SARS‑CoV‑2 in wastewater. However, the programme ended in 2024 with no sign of continuation.

2.4 Surveillance data accessibility and transparency

2.4.1 Coverage and use of electronic health records

2.4.1a Common usage of electronic health records

Score: 100

There is publicly available evidence that electronic health records (EHR) are commonly in use in Zambia.

According to the SmartCare Resource Site, an EHR system was first implemented in Zambia in 2009 and is now in its third version, called SmartCare Pro, which has a centralized architecture, eliminating the need for traditional database systems and providing real-time data availability. ³⁰³

According to the SMART Zambia Institute, a division under the Office of the President, the latest iteration of the HER was developed by the institute in collaboration with IHM Southern Africa. SmartCare Pro incorporates features such as integrated clinical guidelines to support informed decision-making, rapid reporting capabilities, and specialized tools for tracking critical health metrics. It enables health care professionals to access medical records seamlessly, avoiding duplicate tests and procedures for each patient. Its rollout began in 2024, during which more than 8,000 health care professionals were trained and over 800,000 patient records were digitized. ³⁰⁴³⁰⁵

According to IHM Southern Africa, in 2025, 3,500 health facilities across Zambia had already activated the latest version of the EHR. ³⁰⁶ The Ministry of Health aimed to activate SmartCare Pro in 1,612 facilities during 2025 and has already reached 79.3% of this goal. ³⁰⁷

According to the National Health Strategic Plan 2022–2026, SmartCare captures and provides individual patient-level information on various illnesses and diseases. Along with the Health Management Information System, it routinely provides a large database of service and disease indicators that are used to inform programming and policy decisions (Page 98). ³⁰⁸

2.4.1b Public health system access to individual electronic health records

Score: 100

There is publicly available evidence that the national public health system has access to electronic health records of individuals in Zambia.

According to the SmartCare Resource Site, the SmartCare Health Information Exchange platform integrates various health care data systems with SmartCare, the country’s centralized Electronic Health Record (EHR) system. It has successfully integrated with systems such as DISA (Laboratory Information System), eLMIS (Logistics Management System), DHIS2 (Reporting System), and CBS (Case-Based Surveillance System). The “Zambia 360 Data Access and Sharing Portal” provides comprehensive health data, enabling stakeholders, including health care professionals and policymakers, to retrieve, analyze, and share critical health intelligence. ³⁰⁹³¹⁰

While SmartCare facilitates data sharing and access by different stakeholders, and enables patient information sharing across different health care providers, access to patient records is restricted to authorized health care professionals. ³¹¹³¹²

2.4.1c Existence of data standards for health record data comparability

Score: 0

There is no publicly available evidence that Zambia has data standards to ensure data is comparable (e.g., ISO standards). No evidence could be found on the websites of the Ministry of Health and the National Public Health Institute. ³¹³³¹⁴

The Digital Health Strategy 2022–2026 acknowledges that there is limited integration and interoperability between digital health solutions (Page 18). To address this issue, it outlines several actions, including developing eHealth standards and an accreditation body, creating an interoperability framework, and developing a national health systems architecture (Page 23). ³¹⁵

An academic article published in 2024 notes that the Ministry of Health has developed a comprehensive Interoperability Architectural Framework (IAF), which outlines principles and guidelines to help design and implement systems and processes that enable seamless information exchange. Implementation of components of the IAF commenced in 2024 with support from partners (Page 3). ³¹⁶ However, no information on this was found on the websites of the Ministry of Health and the National Public Health Institute. ³¹⁷³¹⁸ The study highlights that the use of DHIS2 as the underlying database for various information systems facilitates system integration and interoperability. Furthermore, the country has a National Data Warehouse, a centralized digital platform designed to aggregate and store health-related data from various health information systems. It is designed to be interoperable with multiple digital health systems, ensuring that data from different platforms can be standardized and consolidated for comprehensive analysis (Pages 4–5). ³¹⁹

According to the 2024 Joint External Evaluation, the electronic Integrated Disease Surveillance and Response system lacks effective integration and interoperability, hindering the sharing of quality data and analysis among different components of the system at the health facility level (Page 40). ³²⁰

The government has a 2024 E-Government Interoperability Standard and 2019 Data Interoperability Standards; however, these are aimed at government systems and databases in general, and do not specifically address health data. ³²¹³²² The Electronic Records and Data Management Guideline, published in 2023 by the Office of the President, lists ISO standards for electronic health records, but it is not clear whether these are mandatory (Pages 15, 19). ³²³

2.4.2 Data integration between human, animal and environmental health sectors

2.4.2a Data sharing mechanisms

Score: 100

There is publicly available evidence that Zambia has mechanisms at the relevant ministries responsible for animal, human, and wildlife surveillance to share data.

According to the 2024 Joint External Evaluation, the country utilizes District Health Information System 2 (DHIS2) for data collection, aggregation, and reporting, and surveillance data is consistently received, analysed, and disseminated across sectors and internationally (Page 41). It adds that the adoption of a One Health strategy fosters collaboration and data sharing across various sectors, including human and animal health, helping identify potential zoonotic threats and enabling a comprehensive response (Page 41). ³²⁴

This development is supported by the National One Health Strategic Plan 2022–2026, which includes as one of its objectives achieving One Health surveillance among key stakeholders for the early detection of zoonotic diseases and other public health events by the end of 2024 (Page 47). According to the plan, at the time of its launch, the human health and animal health sectors operated parallel zoonotic disease surveillance and control programs, resulting in limited data sharing between the sectors (Page 19). ³²⁵

According to the National Public Health Institute’s website, its Emergency Preparedness and Response Cluster is tasked with coordinating and collaborating with the animal and environmental health sectors and other stakeholders to implement a One Health approach to disease surveillance and control, and to develop a shared mechanism for surveillance and risk assessment of animal and environmental risks to human health. However, the Institute does not provide details on how these functions are being developed. ³²⁶

No further information was found on the websites of the Ministry of Health, the Ministry of Fisheries and Livestock, and the Ministry of Green Economy and Environment. ³²⁷³²⁸³²⁹

2.4.3 Transparency of surveillance data

2.4.3a Availability of de-identified health surveillance data on disease outbreaks

Score: 100

There is publicly available evidence that Zambia makes de-identified health surveillance data on infectious diseases publicly available via reports (or other format) on government websites.

The Zambia National Public Health Institute (ZNPHI) publishes the Health Press, a quarterly, open-access public health bulletin that includes an epidemiological bulletin of key notifiable diseases, such as cholera, measles, and anthrax. ³³⁰

ZNPHI also publishes situation reports, on non-defined intervals, of ongoing outbreaks, such as cholera, measles and Mpox. ³³¹

2.4.4 Ethical considerations during surveillance

2.4.4a Confidentiality legislation/regulations for identifiable health information

Score: 100

There is publicly available evidence that Zambia has legislation and/or regulations that safeguard the confidentiality of identifiable health information for individuals, such as that generated through health surveillance activities.

The Data Protection Act of 2021 regulates the collection, use, transmission, storage, and processing of personal data. The Act defines sensitive personal data to include a data subject’s physical or mental health, or physical or mental condition (Article 2). Article 14 prohibits the processing of sensitive personal data unless specific conditions are met, including for medical diagnosis, the provision of health treatment, or the management of health. It also states that, even in such cases, adequate measures must be put in place to safeguard the rights and freedoms of the data subject. The Act further requires that the processing of personal data include appropriate security safeguards, such as maintaining the integrity of personal data through methods including pseudonymisation and encryption, and ensuring ongoing confidentiality, integrity, and the implementation of measures necessary to protect the integrity of personal data (Article 47). ³³²

2.4.4b Inclusion of cyber protections in health data confidentiality law/regulation

Score: 0

There is no publicly available evidence that Zambia’s legislation and/or regulations safeguarding the confidentiality of identifiable health information for individuals, such as that generated through health surveillance activities, include protections from cyber-attacks.

The Data Protection Act of 2021 regulates the collection, use, transmission, storage, and processing of personal data. The Act defines sensitive personal data to include a data subject’s physical or mental health, or physical or mental condition (Article 2). Article 14 prohibits the processing of sensitive personal data unless specific conditions are met, including for medical diagnosis, the provision of health treatment, or the management of health. It also states that, even in such cases, adequate measures must be put in place to safeguard the rights and freedoms of the data subject. Although the Act establishes breach notification procedures (Article 49), it does not specifically mention protections against cyberattacks. ³³³

The Cybersecurity Act of 2025 includes several provisions for the protection of critical information, which includes computer data related to public health, and critical information infrastructure, defined as a computer system that is vital to the country or supports the processing of critical information (Article 2). The Act requires owners of such infrastructure to implement prescribed cybersecurity measures, such as reporting cybersecurity incidents (Article 17) and undergoing periodic security audits (Article 14). ³³⁴

2.4.5 International data sharing

2.4.5a Cooperative commitments or agreements within regions

Score: 100

There is publicly available evidence that Zambia has made a commitment via public statements, legislation and/or a cooperative agreement to share surveillance data during a public health emergency with other countries.

In 2025, according to the Africa Centres for Diseases Control and Prevention, Kenya is one of 12 countries that have joined together in collaboration to respond, prevent and control disease outbreaks, especially the recent monkeypox outbreaks, which includes "data-sharing mechanisms". It is unclear whether this is just for one or multiple diseases, and there is no evidence of any implementation of mechanisms yet³³⁵

The National Public Health Institute’s website reports that during the 2024-2025 cholera outbreak, it conducted cross-border coordination with Tanzania. This entailed facilitated real-time information sharing on epidemiological trends, outbreaks and affected areas and at-risk populations.

In 2024, Zambia hosted a cross-border simulation exercise and policy roundtable involving Angola, Namibia, Zambia, and Zimbabwe. According to the World Health Organization, the exercise culminated in the formation of a steering committee to explore enhancing cross-border coordination, data sharing, and response strategies to strengthen regional preparedness for future crises. ³³⁶

According to the Joint External Evaluation published in 2024, collaborative initiatives with neighbouring countries such as Malawi, Zimbabwe, Botswana, Namibia, the Democratic Republic of Congo, United Republic of Tanzania, and Mozambique facilitate the sharing of information and resources in responding to cross-border health threats (Page 63). ³³⁷

2.5 Case-based investigation

2.5.1 Case investigation and contact tracing

2.5.1a National support to conduct contact tracing in the event of a public health emergency

Score: 50

There is evidence that the national government supports sub-national systems, but only in response to active public health emergencies.

Situational reports published in 2025 by the ZNPHI for the measles and mpox outbreaks indicate that contact tracing was conducted as part of the response efforts. However, these reports provide no details on how this work was supported. ³³⁸³³⁹ Furthermore, according to the African Field Epidemiology Network, the Zambia Field Epidemiology Training Program (FETP) undertook contact tracing efforts during the 2024 cholera outbreak. ³⁴⁰ Although the FETP operates under the ZNPHI, no information on the management of these efforts was available on the ZNPHI website. ³⁴¹

No further evidence could be found on the websites of the Ministry of Health or the Zambia National Public Health Institute (ZNPHI) ³⁴²³⁴³.

2.5.1b Provision of wraparound services to enable self-isolation/quarantine as recommended

Score: 0

There is no publicly available evidence that Zambia provides wraparound services to enable infected people and their contacts to self-isolate or quarantine as recommended, particularly economic support (paycheck, job security) and medical attention. No such evidence could be found on the websites of the Ministry of Health, the Zambia National Public Health Institute, or the Ministry of Community Development and Social Services. ³⁴⁴³⁴⁵³⁴⁶.

2.5.2 Point of entry management

2.5.2a Strategy for tracing and quarantining international travelers

Score: 0

There is no publicly available evidence that Zambia has a joint plan or cooperative agreement between the public health system and border control authorities to identify suspected and potential cases in international travelers and trace and quarantine their contacts in the event of a public health emergency. No such evidence could be found on the websites of the Ministry of Health, the Zambia National Public Health Institute (ZNPHI), or the Department of Immigration. ³⁴⁷³⁴⁸³⁴⁹.

However, the 2024 Joint External Evaluation (JEE) reports that the country has infrastructure in place to identify, trace, and quarantine suspected and potential cases at Points of Entry (PoE). According to the JEE, the 14 designated PoEs have arrangements with nearby medical facilities to transport and provide medical support for ill travellers when dedicated transport is not available, and are equipped with facilities for triage, screening, and isolation, enabling effective responses to various health-related situations (Page 63). Furthermore, all authorized PoEs, including both designated and non-designated ones, are integrated into the national disease surveillance system (Page 63). ³⁵⁰

Similarly, the ZNPHI reports that its Surveillance and Disease Intelligence (SDI) Cluster is actively implementing cross-border surveillance by establishing structured surveillance mechanisms and collaborative actions that enable timely information sharing and coordinated responses to public health hazards with cross-border transmission potential. SDI also supports public health surveillance at PoEs through traveller screening for communicable diseases, implementation of examination and quarantine measures when necessary, coordination of transportation and referral of ill passengers, issuance of health certifications for travelers, and dissemination of travel advisories and public health information. However, ZNPHI does not indicate that these activities are carried out under a formal joint plan or cooperative agreement with border control authorities. ³⁵¹

2.6 Epidemiology workforce

2.6.1 Existence of applied epidemiology training program such FETP and FETPV

2.6.1a Access to field epidemiology training program in country and/or abroad

Score: 100

There is publicly available evidence that Zambia has an applied epidemiology training program, however, there is no evidence that resources are provided by the government to send citizens to another country to participate in applied epidemiology training programs.

The Zambia Field Epidemiology Training Program (FETP) is an applied epidemiology training initiative aimed at strengthening public health capacity within the Zambia National Public Health Institute (ZNPHI) and the Ministry of Health. Overseen by ZNPHI, the program currently operates two tiers: Frontline, which focuses on district-level health security, and Advanced, which addresses national-level health security, mirroring the structure of Zambia’s public health surveillance system. ³⁵²³⁵³

2.6.1b Existence of field epidemiology training for animal health professionals

Score: 100

There is publicly available evidence that Zambia’s epidemiology training programs are explicitly inclusive of animal health professionals, and that the country offers a specific animal health field epidemiology training program.

According to TEPHINET, a global network of Field Epidemiology Training Programs, the Zambia Field Epidemiology Training Program admits holders of health-related undergraduate degrees, including medical doctors, nurses, laboratory scientists, environmental health officers, and veterinarians, to develop expertise in applied epidemiology and public health laboratory practice, with an emphasis on addressing public health concerns. ³⁵⁴

In addition, Zambia offers the In-Service Applied Veterinary Epidemiology Training (ISAVET) Programme, a collaborative initiative led by the Food and Agriculture Organization in partnership with the Ministry of Fisheries and Livestock and the United States Agency for International Development. ISAVET is designed to strengthen capacity to detect, prevent, and respond to animal diseases in Zambian communities, thereby improving livelihoods and food security. In 2024, the programme graduated its first cohort and launched its second. ³⁵⁵³⁵⁶

2.6.2 Epidemiology workforce capacity

2.6.2a Evidence of at least 1 trained field epidemiologist per 200,000 people

Score: 100

There is publicly available evidence that Zambia has at least 1 trained field epidemiologist per 200,000 people.

According to the African Field Epidemiology Network, as of March 2025, the country had 481 health workers trained in the Frontline FETP. ³⁵⁷ With a population of 21,314,956, this equates to approximately 4.51 field epidemiologists per 200,000 people. ³⁵⁸

Rapid Response

3.1 Emergency preparedness and response planning

3.1.1 National public health emergency preparedness and response plan

3.1.1a National emergency response plan for diseases with pandemic potential

Score: 33.33

There is publicly available evidence that Zambia has an overarching national public health emergency response plan in place which addresses planning for multiple communicable diseases with epidemic or pandemic potential, but the plan is not publicly available.

According to the 2024 Joint External Evaluation (JEE), Zambia possesses a Multi-Hazard Emergency Preparedness and Response Plan, published in 2022 (Pages 15 and 23). The plan addresses various potential public health emergencies at the national, provincial, and district levels, including zoonotic diseases and radiological and nuclear emergencies (Pages 21, 47, and 68). ³⁵⁹ However, the plan is not available online. No evidence was found on the websites of the Zambia National Public Health Institute (ZNPHI), the Ministry of Health, or the Office of the Vice President confirming that the plan has been released. ³⁶⁰³⁶¹³⁶²

A 2023 news article from the World Health Organization (WHO) reported that ZNPHI, in collaboration with the Ministry of Health and WHO, conducted a dissemination meeting of the plan with multi sectoral health stakeholders, including the Zambia Police, town councils, and community representatives. ³⁶³

The only Multi-Hazard Preparedness and Response Plan for Zambia available online was published in 2024 by WHO. It covers cholera, communicable diseases, and environmentally related infectious diseases, among others. ³⁶⁴

3.1.1b National public health emergency response plan published in past 3 years

Score: 100

There is publicly available evidence that Zambia’s overarching national public health emergency response plan has been updated in the last 3 years.

According to the 2024 Joint External Evaluation (JEE), Zambia’s Multi-Hazard Emergency Preparedness and Response Plan was published in 2022 (Pages 15 and 23). The plan addresses various potential public health emergencies at the national, provincial, and district levels, including zoonotic diseases and radiological and nuclear emergencies (Pages 21, 47, and 68). ³⁶⁵ However, the plan is not available online. No evidence was found on the websites of the Zambia National Public Health Institute (ZNPHI), the Ministry of Health, or the Office of the Vice President confirming that the plan has been released. ³⁶⁶³⁶⁷³⁶⁸

3.1.1c One health principles by covering multiple threat types

Score: 100

There is publicly available evidence that Zambia has an overarching national public health emergency response plan in place, and that it follows one health principles by covering multiple threat types, e.g. antimicrobial resistance, zoonotic disease spillover, biological accidents or deliberate acts.

According to the 2024 Joint External Evaluation (JEE), Zambia possesses a Multi-Hazard Emergency Preparedness and Response Plan, published in 2022 (Pages 15 and 23). The plan addresses various potential public health emergencies at the national, provincial, and district levels, including zoonotic diseases and radiological and nuclear emergencies (Pages 21, 47, and 68). ³⁶⁹ However, the plan is not available online. No evidence was found on the websites of the Zambia National Public Health Institute (ZNPHI), the Ministry of Health, or the Office of the Vice President confirming that the plan has been released. ³⁷⁰³⁷¹³⁷²

3.1.1d Vulnerable populations in national public health emergency response plan

Score: 0

Although Zambia has an overarching national public health emergency response plan, it is not available online, making it impossible to assess whether it considers the impact of health equity or includes mechanisms for identifying and addressing the needs of vulnerable populations.

According to the 2024 Joint External Evaluation (JEE), Zambia possesses a Multi-Hazard Emergency Preparedness and Response Plan, published in 2022 (Pages 15 and 23). The plan addresses various potential public health emergencies at the national, provincial, and district levels, including zoonotic diseases and radiological and nuclear emergencies (Pages 21, 47, and 68). ³⁷⁵ However, the plan is not available online. No evidence was found on the websites of the Zambia National Public Health Institute (ZNPHI), the Ministry of Health, or the Office of the Vice President confirming that the plan has been released. ³⁷⁶³⁷⁷³⁷⁸

Although the plan is not available online, the JEE states that the plan does not incorporate considerations for potential unintended and inequitable consequences of policy measures, such as shutdowns and curfews, particularly on marginalized and vulnerable groups (Page 54). ³⁷⁹

3.1.2 Private sector involvement in response planning

3.1.2a Mechanism to engage private sector in outbreak preparedness/response

Score: 0

The National One Health Strategic Plan 2022–2026 and the National Health Strategic Plan 2022-2026 do not establish such mechanisms. ³⁸⁴³⁸⁵

The 2023 Report of the Committee on Agriculture, Lands and Natural Resources for the second session of the Thirteenth National Assembly emphasises the generally low level of private sector participation in disease prevention and control in the country. Stakeholders informed the Committee that there were inadequate incentives and limited collaboration between the Government and the private sector, especially in handling diseases of national economic importance (Page 13). ³⁸⁶

3.1.3 Non-pharmaceutical interventions planning

3.1.3a Policy/plan/guidelines in place to implement non-pharmaceutical interventions (NPIs)

Score: 0

There is no publicly available evidence that Zambia has a policy, plan and/or guidelines in place to implement non-pharmaceutical interventions (NPIs) during an epidemic or pandemic. No evidence was found on the websites of the Ministry of Health, the Ministry of Fisheries and Livestock, or the National Public Health Institute. ³⁸⁷³⁸⁸³⁸⁹

The National One Health Strategic Plan 2022–2026 and the National Health Strategic Plan 2022-2026 do not address non-pharmaceutical interventions. ³⁹⁰³⁹¹

Situation reports of outbreaks, such as cholera, measles and Mpox, note that the country implemented NPIs, i.e., contact tracing, during these emergencies in 2025. ³⁹²³⁹³³⁹⁴

3.2 Exercising response plans

3.2.1 Activating response plans

3.2.1a Completion of biological-focused IHR exercise with the WHO in past year

Score: 100

There is publicly available evidence that Zambia has completed a national-level biological threat-focused exercise in the past year. However, there is no publicly available evidence that Zambia has activated their national emergency response plan for an infectious disease outbreak in the past year. No evidence was found on the websites of the Ministry of Health or the National Public Health Institute (ZNPHI). ³⁹⁵³⁹⁶

According to the World Health Organization (WHO) Disease Outbreak News, the most recent outbreak notified in Zambia was the 2023 anthrax outbreak. ³⁹⁷ In August 2024, when WHO declared Mpox a Public Health Emergency of International Concern and Zambia had no confirmed cases, ZNPHI reported that it had activated a robust surveillance system to actively monitor potential Mpox cases and had developed a National Contingency Plan for Mpox. ³⁹⁸

Regarding threat-focused exercises, WHO reports that the most recent simulation exercise involving Zambia took place in 2024. ³⁹⁹ This included a cross-border simulation exercise aimed at strengthening regional coordination for handling complex One Health emergencies, such as droughts, transboundary animal diseases, and public health crises. ⁴⁰⁰ Also in 2024, the country participated in a functional Simulation Exercise (SimEx) organized by the International Health Regulations Strengthening Project to assess preparedness and response mechanisms in the event of a Mpox outbreak. ⁴⁰¹

In 2025, Zambia took part in immersive scenario-based exercises simulating chemical, biological, and radiological incidents to evaluate both operational and strategic response capabilities, organized by the European Union. ⁴⁰²

3.2.1b Evidence of bio-focused exercise to identify gaps/best practices

Score: 50

There is publicly available evidence that Zambia has undergone an exercise to identify a list of gaps and best practices, however, there is no indication that it has developed a plan to improve response capabilities. No evidence was found on the Ministry of Health and National Public Health Institute’s websites. ⁴⁰³⁴⁰⁴

The country participated in a World Health Organization (WHO) After-Action Review and an Intra-Action Review for cholera in 2024. ⁴⁰⁵⁴⁰⁶ However, no evidence was found indicating that these reviews resulted in a formal plan to enhance response capabilities. ⁴⁰⁷⁴⁰⁸

According to the WHO Zambia Annual Report 2023/2024, a notable feature of the Intra-Action Review process was the opportunity to revisit the recommendations made during the Early Action Review, using the 7-1-7 implementation framework to assess progress since then (Page 27). ⁴⁰⁹

According to the Joint External Evaluation published in 2024, the evaluation of Public Health Emergency Operations Center (PHEOC) procedures through simulation exercises and intra-/after-action reviews has not been conducted regularly (Page 47). ⁴¹⁰

3.2.2 Private sector engagement in exercises

3.2.2a Evidence of national-level biological threat-focused exercise that includes private sector

Score: 0

There is no publicly available evidence that Zambia has undergone, in the past year, a national-level biological threat-focused exercise that has included private sector representatives.

None of the exercises joined by Zambia included the private sector. ⁴¹¹⁴¹²⁴¹³

3.3 Emergency response operation

3.3.1 Emergency response operation

3.3.1a Existence of Emergency Operations Center (EOC)

Score: 100

There is publicly available evidence that Zambia has an Emergency Operations Center.

According to a National Public Health Institute press release, the official opening of the Public Health Emergency Operations Center (PHEOC) took place in 2023. ⁴¹⁴ A 2025 Situational Report on the measles outbreak notes that the PHEOC has been activated for the response efforts, is actively monitoring the situation, and is conducting surveillance in the affected districts. The report also states that the Incident Management System (IMS) structure is operational (Pages 1 and 5). ⁴¹⁵

According to the 2024 Joint External Evaluation, the PHEOC, located at the Zambia National Public Health Institute (ZNPHI), is adequately staffed, and technical officers responsible for performing core IMS functions have received training in public health emergency management competencies (Page 47). ⁴¹⁶

3.3.1b Requirement for EOC to conduct/evidence EOC conducts at least annual drills

Score: 0

There is no publicly available evidence that Zambia’s Emergency Operations Center (EOC) is required to conduct a drill for a public health emergency scenario at least once per year nor there is evidence that they conduct a drill at least once per year. No evidence was found on the websites of the Ministry of Health or the National Public Health Institute (ZNPHI). ⁴¹⁷⁴¹⁸

According to the 2024 Joint External Evaluation, evaluation of the Public Health Emergency Operations Center (PHEOC) procedures through simulation exercises and intra/after action reviews has not been conducted regularly (Page 47). ⁴¹⁹

Of the three exercises Zambia participated in during the past year, the PHEOC joined at least one, which involved immersive scenario-based exercises simulating chemical, biological, and radiological incidents to evaluate both operational and strategic response capabilities, organized by the European Union. ⁴²⁰⁴²¹⁴²²

In September 2025, the country launched the Simulation Exercise Framework to strengthen the country’s preparedness and response to public health emergencies. The framework provides a roadmap for designing, implementing, and learning from exercises that test readiness across the health system and other sectors. ⁴²³

3.3.1c EOC activation within 120 minutes of identification of emergency/scenario

Score: 0

There is no publicly available evidence that Zambia’s Emergency Operations Center (EOC) has conducted within the last year a coordinated emergency response or emergency response exercise activated within 120 minutes of the identification of the public health emergency/scenario. No evidence was found on the websites of the Ministry of Health or the National Public Health Institute (ZNPHI). ⁴²⁴⁴²⁵

According to the 2024 Joint External Evaluation, the country has limited capacity to activate the Public Health Emergency Operations Center within 120 minutes after onset of a public health emergency (Page 47). The document recommends the development of an Standard Operating Procedures to guide activation of the Incident Management System to respond to an event within 120 minutes of receiving an alert (Page 49) ⁴²⁶

3.4 Linking public health and security authorities

3.4.1 Public health and security authorities linked for a biological event

3.4.1a Joint exercise/procedures for potential deliberate biological events

Score: 0

There is no publicly available evidence that the public health, animal health, the private sector and national security authorities in Zambia have carried out an exercise to respond to a potential deliberate biological event. There is also no publicly available evidence of standard operating procedures, guidelines, memorandums of understanding (MOUs), or other agreements between the public health, animal health, the private sector and security authorities to respond to a potential deliberate biological event. No evidence was found on the Ministry of Health and the National Public Health Institute’s websites. ⁴²⁷⁴²⁸

According to the World Health Organization (WHO) website, the country participated in simulation exercises in 2017, 2018, 2019, 2020, and 2024. However, there is no evidence that these exercises focused on deliberate biological events. ⁴²⁹⁴³⁰⁴³¹⁴³²

According to the Joint External Evaluation, published in 2024, simulation exercises involving defence and security authorities have not been conducted, and there is no MoU between the Ministry of Home Affairs and security agencies regarding public health security (page 51).

3.5 Risk communication

3.5.1 Risk communication planning

3.5.1a Risk communication plan for specific use during a public health emergency

Score: 0

There is no publicly available evidence that Zambia has a risk communication plan that is specifically intended for use during a public health emergency, only plans to strengthen risk communication in general. No evidence was found on the Ministry of Health and the National Public Health Institute’s websites. ⁴³³⁴³⁴

According to the Joint External Evaluation, published in 2024, the national risk communication strategy is still in draft form and has not been fully implemented at either the national or subnational levels (page 59). On the other hand, Zambia’s Multi-Hazard Emergency Preparedness and Response Plan includes a risk communication section outlining key communication activities and channels to be used (page 58). ⁴³⁵ However, this plan is not available online.

The National One Health Strategic Plan 2022–2026 includes, as one of its actions, the development of risk communication plans based on priority zoonotic diseases (page 81) ⁴³⁶, while the National Health Strategic Plan 2022–2026 establishes the strengthening of risk communication and community engagement as a strategic intervention (page 28). ⁴³⁷

The National Disaster Risk Management Policy, published in 2024, addresses risk communication by establishing that both public and private media shall be used as platforms to promote risk communication and community engagement (RCCE) through a multi-pronged approach (page 30). ⁴³⁸ Its Implementation Plan 2024–2028 includes measures such as promoting risk communication for at-risk communities through the development of a communication strategy, conducting media sensitization, producing documentaries, and commemorating Disaster Risk Reduction Day (page 7). ⁴³⁹

Situational reports for the Mpox and cholera outbreaks of 2024 and 2025 include a list of RCCE actions implemented. These include conducting Rapid Quality Assessments on risk communication, sensitization in schools, churches, markets, door-to-door outreach, radio and TV broadcasts, messaging at bus stops, community meetings, and distribution of materials. ⁴⁴⁰⁴⁴¹⁴⁴²

3.5.1b Inclusion of different population & sector needs in risk communication plan

Score: 0

There is no publicly available evidence that Zambia has a risk communication plan. No evidence was found on the Ministry of Health and the National Public Health Institute’s websites. ⁴⁴³⁴⁴⁴

The National One Health Strategic Plan 2022–2026 includes, as one of its actions, the development of risk communication plans based on priority zoonotic diseases (page 81) ⁴⁴⁶, while the National Health Strategic Plan 2022–2026 establishes the strengthening of risk communication and community engagement as a strategic intervention (page 28). ⁴⁴⁷ None of them outlines how messages will reach populations and sectors with different communications needs.

The National Disaster Risk Management Policy, published in 2024, addresses risk communication by establishing that both public and private media shall be used as platforms to promote risk communication and community engagement (RCCE) through a multi-pronged approach (page 30). ⁴⁴⁸ Its Implementation Plan 2024–2028 includes measures such as promoting risk communication for at-risk communities through the development of a communication strategy, conducting media sensitization, producing documentaries, and commemorating Disaster Risk Reduction Day (page 7). ⁴⁴⁹ None of them outlines how messages will reach populations and sectors with different communications needs.

3.5.1c Designation of a specific government spokesperson during a public health emergency

Score: 0

There is no publicly available evidence that Zambia has a risk communication plan that is specifically intended for use during a public health emergency. No evidence was found on the Ministry of Health and the National Public Health Institute’s websites. ⁴⁵⁰⁴⁵¹

The National One Health Strategic Plan 2022–2026 includes, as one of its actions, the development of risk communication plans based on priority zoonotic diseases (page 81) ⁴⁵³, while the National Health Strategic Plan 2022–2026 establishes the strengthening of risk communication and community engagement as a strategic intervention (page 28). ⁴⁵⁴ None of the plans designates a specific position within the government to serve as the primary spokesperson to the public during a public health emergency.

The National Disaster Risk Management Policy, published in 2024, addresses risk communication by establishing that both public and private media shall be used as platforms to promote risk communication and community engagement (RCCE) through a multi-pronged approach (page 30). ⁴⁵⁵ Its Implementation Plan 2024–2028 includes measures such as promoting risk communication for at-risk communities through the development of a communication strategy, conducting media sensitization, producing documentaries, and commemorating Disaster Risk Reduction Day (page 7). According to the plan, these efforts will be led by Disaster Management and Mitigation Unit and supported by the Ministry of Information and Media. ⁴⁵⁶

3.5.2 Public health systems communication

3.5.2a Government use of media platforms to share info on public health emergencies

Score: 100

There is publicly available evidence that Zambia’s public health system has actively shared messages via online media platforms (e.g. social media, website) to inform the public about ongoing public health concerns and/or dispel rumors, misinformation or disinformation.

The Zambia National Public Health Institute maintains a Facebook page where it shares information about ongoing public health concerns, such as mpox, and the Health Press, its quarterly public health bulletin that includes an epidemiological summary of key notifiable diseases. ⁴⁵⁷

3.5.2b Evidence that senior leaders have shared mis/disinformation on infectious diseases

Score: 100

There is no publicly available evidence that Zambia’s senior leaders have shared misinformation or disinformation on infectious diseases in the past two years. No evidence was found on the websites and social media of the Ministry of Health, National Public Health Institute, Cabinet Office, and president. ⁴⁵⁸⁴⁵⁹⁴⁶⁰⁴⁶¹⁴⁶²⁴⁶³⁴⁶⁴

3.6 Access to communications infrastructure

3.6.1 Internet users

3.6.1a Percentage of households with Internet

Score: 56.61

3.6.2 Mobile subscribers

3.6.2a Mobile-cellular telephone subscriptions per 100 inhabitants

Score: 55.2

3.6.3 Female access to a mobile phone

3.6.3a Gender gap in access to a mobile phone (percentage points)

Score: 66.67

3.6.4 Female access to the Internet

3.6.4a Gender gap in access to the Internet (percentage points)

Score: 58.33

3.7 Trade and travel restrictions

3.7.1 Trade restrictions

3.7.1a Restrictions on export/import of medical goods due to an infectious disease outbreak

Score: 100

There is no publicly available evidence that Zambia has, in the past year, issued a restriction on the export/import of medical goods (eg: medicines, oxygen, medical supplies, PPE) due to an infectious disease outbreak. No evidence could be found on the websites of the National Public Health Institute, ministries of Health, Agriculture, Foreign Affairs or the Department of Immigration, or the WHO Disease Outbreak News or the WOAH event management database. ⁴⁶⁵⁴⁶⁶⁴⁶⁷⁴⁶⁸⁴⁶⁹⁴⁷⁰⁴⁷¹

3.7.1b Restrictions on movement and/or exports/imports due to disease outbreak

Score: 100

There is no publicly available evidence that Zambia has, in the past year, implemented restrictions on export/import of non-medical goods (e.g. food, textiles, etc) due to an infectious disease outbreak. No evidence could be found on the websites of the National Public Health Institute, ministries of Health, Agriculture, Foreign Affairs or the Department of Immigration, or the WHO Disease Outbreak News or the WOAH event management database. ⁴⁷²⁴⁷³⁴⁷⁴⁴⁷⁵⁴⁷⁶⁴⁷⁷⁴⁷⁸

3.7.2 Travel restrictions

3.7.2a Evidence of travel ban due to an infectious disease outbreak

Score: 100

There is no publicly available evidence that Zambia has, in the past year, implemented inbound or outbound travel restrictions due to an infectious disease outbreak. No evidence could be found on the websites of the National Public Health Institute, ministries of Health, Agriculture, Foreign Affairs or the Department of Immigration, or the WHO Disease Outbreak News or the WOAH event management database. ⁴⁷⁹⁴⁸⁰⁴⁸¹⁴⁸²⁴⁸³⁴⁸⁴⁴⁸⁵

3.7.2b Risk-based approach to international travel-related measures

Score: 100

There is publicly available evidence that Zambia uses a risk-based approach to international travel-related measures.

According to the Joint External Evaluation, published in 2024, Zambia has established a national multi sectoral framework for implementing risk-based strategies in planning international travel-related measures. This framework encompasses various aspects, including prevention, detection/investigation, response, and recovery. Additionally, the country has developed a national multi sectoral strategy for international travel-related measures, applying a risk-based approach with clearly defined and assigned responsibilities (page 62). Guidelines and Standard Operating Procedures (SOPs) have also been developed to support the effective implementation of this strategy (page 64). ⁴⁸⁶

However, no information on these strategies, guidelines, or SOPs has been found on the websites of the Zambia National Public Health Institute (ZNPHI), the Ministry of Health, the Ministry of Foreign Affairs, or the Department of Immigration. ⁴⁸⁷⁴⁸⁸⁴⁸⁹⁴⁹⁰

The ZNPHI website addresses only Point of Entry (PoE) measures. According to the site, the Surveillance and Disease Intelligence Unit collaborates closely with the Ministry of Health to strengthen port health services across the country, in line with Zambia’s commitment to the International Health Regulations (IHR 2005). Key port health activities include the screening of travelers for communicable diseases, the implementation of examination and quarantine measures when necessary, and the dissemination of travel advisories and public health information. The unit also works on preparedness and readiness, including the development and regular update of all-hazards preparedness plans for Points of Entry and the design of disease-specific emergency response plans tailored to likely threats. ⁴⁹¹

No further information was found on the National One Health Strategic Plan 2022-2026, 2024, National Health Strategic Plan 2022-2026 and National Disaster Management Policy. ⁴⁹²⁴⁹³⁴⁹⁴

Health System

4.1 Health capacity in clinics, hospitals and community care centers

4.1.1 Available human resources for the broader healthcare system

4.1.1a Doctors per 100,000 people

Score: 4.36

4.1.1b Nurses and midwives per 100,000 people

Score: 28.49

4.1.1c Updated health workforce strategy to address human resource shortfalls

Score: 0

There is no publicly available evidence that Zambia has a health workforce strategy in place (which has been updated in the past five years) to identify fields where there is an insufficient workforce and strategies to address these shortcomings. No evidence was found on the websites of the Ministry of Health and National Public Health Institute (ZNPHI). ⁴⁹⁵⁴⁹⁶

The National Human Resources for Health Strategic Plan 2018–2024 has not been updated in the past five years, but it identifies the country’s main gaps and projected requirements of the health workforce by field through 2025 (Pages 44 to 47). ⁴⁹⁷

According to the 2024 Joint External Evaluation, the country is conducting a multi sectoral human resource needs assessment led by ZNPHI, which will inform future plans (Page 42). ⁴⁹⁸ However, no evidence of such an assessment was found on ZNPHI’s website. ⁴⁹⁹

The National Health Strategic Plan 2022–2026 presents the number of professionals per field for 2021 and their proportion in relation to the Ministry’s projected needs for that year (Page 90). The plan also aims to increase the availability of a skilled, motivated, and equitably distributed health workforce, as well as effective support services. To reach this goal, it establishes strategic interventions, including scaling up recruitment of health workers in accordance with the approved staff establishment and treasury authority, strengthening retention mechanisms for health and teaching staff in health facilities and training institutions, and expanding specialized training for all health workers (Page 92). ⁵⁰⁰

The National Community Health Strategy and Operational Plan 2022–2026 identifies the inadequate health workforce at facilities as a key challenge (Page 16). One of its objectives is to build a motivated, responsive, and skilled community health workforce that is equitably distributed across the country by 2026 (Page 33). However, the plan focuses on community-level health workers (i.e., Community Health Assistants and community-based volunteers), so it does not identify fields with an insufficient workforce across the broader health sector or outline strategies to address these gaps. ⁵⁰¹

4.1.1d Health system capacity for essential health services

Score: 0

There is no publicly available evidence that Zambia has sufficient capacity within the health system to deliver essential health services.

According to the Joint external evaluation of International Health Regulations (2005) core capacities of Zambia, while a package of EHS has been outlined in the COVID-19 guidelines, there are not comprehensive for all public health emergencies, and there are no guidelines for continuity of EHS during emergencies. Furthermore, there are no specific guidelines and specified monitoring systems for ensuring the continuity of essential health services during emergencies.⁵⁰²

According to 2022 data, the country has 0.3 physicians per 1,000 people and 2.1 nurses and midwives per 1,000 people, totaling 2.4 medical staff per 1,000 people. This is slightly below the World Health Organization’s estimated threshold for providing adequate coverage of primary care interventions. ⁵⁰³⁵⁰⁴⁵⁰⁵

Zambia also scores below the global average on the Universal Health Coverage Service Coverage Index, reaching 56 in 2021. ⁵⁰⁶

4.1.1e Essential health services continuity plan for public health emergencies

Score: 0

There is no publicly available evidence that Zambia has a plan to ensure continuity of essential health services during a public health emergency. No evidence could be found on the websites of the National Public Health Institute (ZNPHI) and Ministry of Health. ⁵⁰⁷⁵⁰⁸

According to the Joint External Evaluation published in 2024, Zambia does not have comprehensive guidelines for maintaining essential health services during public health emergencies. The report recommends that the country develop these guidelines, along with mechanisms to monitor service continuity during such events (Page 54). ⁵⁰⁹

The World Health Organization’s (WHO) Country Cooperation Strategy 2024–2027 reports that during the COVID-19 pandemic, up to 70% of essential health services in Zambia were disrupted (Page 12). ⁵¹⁰

The National One Health Strategic Plan 2022–2026 includes, among its objectives, the goal of strengthening coordination of emergency preparedness and response among relevant ministries and agencies by 2026. To support this, it outlines an activity to develop integrated guidelines, SOPs, and contingency plans for coordinated responses to public health events (Page 50). ⁵¹¹ However, no evidence was found that these documents have been developed. ⁵¹²⁵¹³

According to the WHO Zambia 2023/2024 Annual Report, during the 2023-2024 cholera outbreak, the WHO Country Office supported the Ministry of Health to conduct a Rapid Assessment on the continuity and utilization of essential health services. The findings of the assessment led the Ministry and the ZNPHI to start the process of reviewing and developing guidelines for Continuation of Essential Health Services during public health emergencies (Page 11). ⁵¹⁴ No evidence was found on the websites of the Ministry and ZNPHI that this was published. ⁵¹⁵⁵¹⁶

No further information related to service continuity planning was found in the National Health Strategic Plan 2022–2026 or the 2024 National Disaster Risk Management Policy. ⁵¹⁷⁵¹⁸⁵¹⁹

4.1.2 Facilities capacity

4.1.2a Hospital beds per 100,000 people

Score: 51.34

4.1.2b In-country capacity to isolate patients with highly communicable diseases

Score: 100

There is publicly available evidence that Zambia has capacity to isolate patients with highly communicable diseases in a biocontainment patient care unit and/or patient isolation room/unit located within the country.

According to the World Health Organization’s Cooperation Strategy 2024–2027, Lusaka Province has the highest percentage of facilities in the country offering inpatient services with dedicated isolation beds, reaching 48% (Page 10). ⁵²⁰

However, according to the National One Health Strategic Plan 2022-2026, Zambia’s isolation facilities do not meet infection prevention and control standards (Page 30). ⁵²¹ The 2024 Joint External Evaluation also identifies a lack of adequate isolation facilities with necessary supplies and equipment, especially during non-emergency periods (Page 57). ⁵²²

The country also has the capacity to create isolation centres during emergencies, as shown in the 2022 Report of the Committee on Health, Community Development and Social Services, which noted that the Government began construction of an isolation centre in Mwembeshi during the COVID-19 pandemic (Page 27). ⁵²³ Similarly, a 2021 Facebook post from the Ministry of Health shows that it had designated the Maina Soko Medical Centre as an isolation centre. ⁵²⁴

4.1.2c Demonstrated capacity / evidence of plan to expand isolation capacity

Score: 0

There is no publicly available evidence that Zambia has demonstrated capacity to expand isolation capacity in response to an infectious disease outbreak in the past two years or has developed, updated or tested a plan to expand isolation capacity in response to an infectious disease outbreak in the past two years. No evidence was found on the websites of the Ministry of Health and National Public Health Institute. ⁵²⁵⁵²⁶

However, according to the 2024 Joint External Evaluation, isolation areas are typically only made available during disease outbreaks (Page 57). ⁵²⁷ Furthermore, the country has demonstrated capacity to expand isolation capacity during the COVID-19 pandemic, as shown in the 2022 Report of the Committee on Health, Community Development and Social Services, which noted that the Government began construction of an isolation centre in Mwembeshi during the pandemic (Page 27). ⁵²⁸ Similarly, a 2021 Facebook post from the Ministry of Health shows that it had designated the Maina Soko Medical Centre as an isolation centre. ⁵²⁹

4.2 Supply chain for health system and healthcare workers

4.2.1 Routine health care and laboratory system supply

4.2.1a National procurement protocol for the acquisition of routine laboratory/medical supplies

Score: 100

There is publicly available evidence that Zambia has a procurement protocol or contract framework in place which can be utilized by the Ministries of Health and Agriculture for the acquisition of laboratory supplies (e.g. equipment, reagents and media) and medical supplies (e.g. equipment, PPE) for routine needs.

The Zambia Medicines and Medical Supplies Agency (ZAMMSA) Act of 2019 defines “medical supplies” as products or materials used in the delivery of health care services. This includes pharmaceuticals, non-pharmaceuticals, nutraceuticals, vaccines and therapeutic antisera, medical equipment and devices, medical appliances and materials, health technologies, laboratory supplies and reagents, dental materials, hospital consumables, and any other material or equipment deemed necessary for health care delivery in Zambia (Article 2). According to Article 5, the Agency’s functions include the procurement, storage, and distribution of medicines and medical supplies. ⁵³⁰

Procurements carried out by a government agency, parastatal body, or any other entity established or mandated by the government to undertake procurement using public funds must comply with the Public Procurement Act of 2020 (Article 3). ⁵³¹

However, according to the Joint External Evaluation published in 2024, the integrated procurement function within ZAMMSA is still in its early stages, resulting in prolonged processes that delay access to emergency medical supplies (Page 49). ⁵³²

The National Health Strategic Plan 2022–2026 notes that, although the establishment of ZAMMSA has led to improvements in storage capacity across the country, the procurement and supply of essential medicines and medical supplies remain major concerns for the health sector in Zambia, and the issue of stock-outs of essential medicines and supplies has not yet been resolved (Page 6). The plan includes, among its strategic interventions, strengthening procurement processes (Pages 37, 84, 86, 87) and ensuring compliance with the Public Procurement Act and other relevant legislation (Page 109). ⁵³³

4.2.2 Stockpiling for emergencies

4.2.2a Stockpile of medical supplies for national use during a public health emergency

Score: 0

There is no publicly available evidence of a stockpile of medical supplies (e.g., MCMs, medicines, vaccines, medical equipment, PPE) for national use during a public health emergency as defined by the overarching national public health emergency response plan. There is also no publicly available evidence of a plan to ensure equitable distribution of such supplies in an emergency. No evidence was found on the websites of the Zambia National Public Health Institute (ZNPHI), the Ministry of Health, the Office of the Vice President, or the Zambia Medicines and Medical Supplies Agency (ZAMMSA). ⁵³⁴⁵³⁵⁵³⁶⁵³⁷

Although the 2024 Joint External Evaluation (JEE) does not specifically address the existence of a stockpile, it notes that Zambia has a Multi-Hazard Emergency Preparedness and Response Plan, published in 2022 (Pages 15 and 23). ⁵³⁸ However, this plan is not available online.

The National Health Strategic Plan 2022–2026 notes that, although the establishment of ZAMMSA has led to improvements in storage capacity across the country, the procurement and supply of essential medicines and medical supplies remain major concerns for the health sector in Zambia, and the issue of stock-outs of essential medicines and supplies has not yet been resolved (Page 6). The Plan does not establishes measures for stockpile of medical supplies. ⁵³⁹

The National One Health Strategic Plan 2022-2026 and the National Disaster Risk Management Policy also do not refer to stockpile for health emergencies. ⁵⁴⁰⁵⁴¹

4.2.2b Stockpile of laboratory supplies for national use during a public health emergency

Score: 0

There is no publicly available evidence that Zambia has a stockpile of laboratory supplies (e.g. reagents, media) for national use during a public health emergency. No evidence was found on the websites of the Ministry of Health and National Public Health Institute. ⁵⁴²⁵⁴³

In 2024, Zambia Medicines and Medical Supplies Agency reported that the country’s laboratory commodities stock level hit 70%, including consumables and reagents. ⁵⁴⁴

The National One Health Strategic Plan 2022-2026 and the National Health Strategic Plan 2022-2026 do not refer to stockpile of laboratory supplies for national use during a public health emergency. ⁵⁴⁵⁵⁴⁶

The 2024 Joint External Evaluation identifies an inconsistent supply and frequent stock outs of laboratory commodities (Page 18). ⁵⁴⁷

4.2.2c Annual review of national stockpile to ensure sufficient supply

Score: 100

There is publicly available evidence that Zambia conducts or requires an annual review of the national stockpile to ensure the supply is sufficient for a public health emergency.

The Zambia Medicines and Medical Supplies Agency (ZAMMSA) conducts an annual Stocktaking Exercise. This involves a comprehensive physical count and verification of inventory within the Warehouse Management System (WMS) at the central warehouse and its seven regional hubs. ⁵⁴⁸ However, ZAMMSA does not publish its findings on its website. ⁵⁴⁹

4.2.3 Manufacturing and procurement for emergencies

4.2.3a Plan/agreement to produce/procure medical supplies during a public health emergency

Score: 0

There is publicly available evidence that Zambia has a plan to leverage domestic manufacturing capacity to produce medical supplies. However, there is no publicly available evidence of a plan/mechanism to procure or expedite medical supplies for national use during such emergencies.

The National Health Policy (2012) states that the government shall ensure an enabling environment that promotes local production of medicines (Page 40). However, it does not outline a specific plan for achieving this goal. ⁵⁵⁰ The National Health Strategic Plan 2022–2026 recognizes the insufficient capacity of the local pharmaceutical manufacturing industry, with limited local production of essential medicines and commodities and a near-total dependence on imports (Page 94). One of its goals is to increase active local pharmaceutical manufacturing from 5 to more than 10 industries by 2026. To achieve this, it proposes strategic interventions to create an enabling environment for the sub-sector, including policy, regulatory, investment, and market measures, as well as ensuring the availability of locally produced essential medicines in line with quality and safety standards (Page 95). ⁵⁵¹

In 2022, the Ministry of Health (MoH) launched the Zambia Pharmaceutical Manufacturing Initiative. Although no official document on the Initiative was found, a news report about the launch highlighted points raised by the Minister to foster manufacturing, including partnership mentorship programmes and skilled human resources. ⁵⁵² In 2023, the MoH reported that the Medicines and Medical Supplies Agency (ZAMMSA) continued to engage local suppliers and pharmaceutical manufacturers for bulk essential medicines and medical supplies, and would maintain such engagement to help stabilise the supply chain. ⁵⁵³ In 2024, under the Pharmaceutical Manufacturing Initiative, Zambia signed a Memorandum of Understanding with China to establish the first cholera vaccine manufacturing plant in Africa. ⁵⁵⁴

Regarding procurement mechanisms for national use during a public health emergency, no evidence was found on the websites of the MoH, ZAMMSA, the Zambia National Public Health Institute, or the Office of the Vice-President. ⁵⁵⁵⁵⁵⁶⁵⁵⁷⁵⁵⁸ However, the ZAMMSA Act of 2019 establishes the Medicines and Medical Supplies Fund, which is tasked with procuring and distributing medicines and medical supplies for emergency purposes in public health facilities (Art. 18). ⁵⁵⁹

No evidence of a plan or mechanism to expedite medical supplies through points of entry during public health emergencies was found on the websites of the MoH, ZAMMSA, the Zambia National Public Health Institute, or the Office of the Vice-President. ⁵⁶⁰⁵⁶¹⁵⁶²⁵⁶³ Nonetheless, the Public Procurement Act of 2020 allows for direct bidding—aimed at achieving timely and efficient procurement—when an emergency creates an urgent need for goods, works, or services, making other procurement methods impractical due to time constraints (Art. 46). ⁵⁶⁴ Similarly, the Public Procurement Regulations of 2022 outline emergency procurement procedures that may be used in urgent, unforeseeable circumstances not caused by the procuring entity’s delay, including when the country is threatened by or confronted with a disaster, catastrophe, pandemic, or war (Art. 72). ⁵⁶⁵

4.2.3b Plan/agreement to produce/procure lab supplies during a public health emergency

Score: 100

There is no publicly available evidence that Zambia has a plan or agreement to leverage domestic manufacturing capacity to produce laboratory supplies, however, it has a procurement of laboratory essentials during a public health emergency.

The National Health Policy (2012) and the National Health Strategic Plan 2017–2021 do not refer explicitly to laboratory supplies manufacturing. While the first states that the government shall ensure an enabling environment that promotes local production of medicines (Page 40), the latter acknowledges the existence of disruptions in the supply chain management of laboratory supplies and reagents through stock outs (Page 81). However, none of the documents propose concrete measures to leverage domestic manufacturing capacity to address the issue. ⁵⁶⁶⁵⁶⁷

Regarding procurement mechanisms for national use during a public health emergency, no evidence was found on the websites of the MoH, ZAMMSA, the Zambia National Public Health Institute, or the Office of the Vice-President. ⁵⁶⁸⁵⁶⁹⁵⁷⁰⁵⁷¹ However, the ZAMMSA Act of 2019 establishes the Medicines and Medical Supplies Fund, which is tasked with procuring and distributing medicines and medical supplies for emergency purposes in public health facilities (Article 18). According to Article 2, medical supplies include laboratory supplies and reagents. ⁵⁷²

No evidence of a plan or mechanism to expedite laboratory supplies through points of entry during public health emergencies was found on the websites of the MoH, ZAMMSA, the Zambia National Public Health Institute, or the Office of the Vice-President. ⁵⁷³⁵⁷⁴⁵⁷⁵⁵⁷⁶ Nonetheless, the Public Procurement Act of 2020 allows for direct bidding, aimed at achieving timely and efficient procurement, when an emergency creates an urgent need for goods, works, or services, making other procurement methods impractical due to time constraints (Art. 46). ⁵⁷⁷ Similarly, the Public Procurement Regulations of 2022 outline emergency procurement procedures that may be used in urgent, unforeseeable circumstances not caused by the procuring entity’s delay, including when the country is threatened by or confronted with a disaster, catastrophe, pandemic, or war (Art. 72). ⁵⁷⁸

4.2.3c Mechanism emergency logistics and supply chain management

Score: 100

There is publicly available evidence that Zambia has a system for emergency logistics and supply chain management at both national and subnational levels. However, the system has not been reviewed, evaluated, and updated on a regular basis, and there is insufficient evidence to determine whether it covers specific considerations such as cold chain management for vaccines or includes both the public and private sectors.

According to the 2024 Joint External Evaluation, the country has a digitalized emergency logistics and supply chain management system in operation at both national and provincial levels. However, this system has not been reviewed, evaluated, and updated on a regular basis (Pages 48 and 49) ⁵⁷⁹.

The Zambia National Supply Chain Assessment Report, published by USAID in 2024, does not specifically refer to an emergency logistics and supply chain system. In evaluating Zambia’s strategic planning and management capabilities maturity, it notes that the Ministry of Health and the Zambia Medicines and Medical Supplies Agency (ZAMMSA) have formal coordination or engagement with private-sector companies (Page 27). It also states that the private sector could play an increasing role in the supply chain, with the aim of improving efficiency and reducing the need for initial capital investment by government and donors (page 28). The report further indicates that cold chain storage is widely available, present in 67% of health posts and 87% of health centers (Page 69). Additionally, it mentions that the country was finalizing the Health Sector Supply Chain Strategic Plan 2023–2026 (page vii) ⁵⁸⁰. However, no evidence of this plan was found on the websites of the Zambia National Public Health Institute (ZNPHI), the Ministry of Health, or ZAMMSA ⁵⁸¹⁵⁸²⁵⁸³.

The National Health Strategic Plan 2022–2026 refers to several supply chains and sets the goal of securing adequate, quality, efficacious, safe, and affordable essential medicines and medical supplies through an efficient and effective supply chain system (Page 94). However, it does not mention an emergency logistics and supply chain system ⁵⁸⁴.

Although not emergency-specific, ZAMMSA’s website describes how the agency supports logistics and supply chain management. This includes the use of inventory management systems to track stock levels, manage replenishments, and prevent stock outs or overstocking; a fleet of vehicles and partnerships with logistics providers to transport medicines and supplies to health facilities; and cold chain storage capabilities ⁵⁸⁵⁵⁸⁶. Furthermore, the USAID Supply Chain Assessment Report highlights the use of a Warehouse Management System by ZAMMSA (Page 74) and notes that the Electronic Logistics Management Information System (eLMIS) has covers almost 100% of all health facilities through the facility and central editions of the system (Page viii) ⁵⁸⁷.

4.3 Medical countermeasures and personnel deployment

4.3.1 System for dispensing MCMs during a public health emergency

4.3.1a Plan/program/guidelines for dispensing MCMs during a public health emergency

Score: 0

There is no publicly available evidence that Zambia has a plan, program, or guidelines in place for dispensing medical countermeasures (MCM) for national use during a public health emergency (i.e., antibiotics, vaccines, therapeutics and diagnostics). No evidence was found on the websites of the Ministry of Health and National Public Health Institute. ⁵⁸⁸⁵⁸⁹

The National One Health Strategic Plan 2022-2026 and the National Health Strategic Plan 2022-2026 do not refer to MCM dispensing. ⁵⁹⁰⁵⁹¹

The 2024 Joint External Evaluation notes that guidelines are currently being developed to address logistics, regulatory, and security considerations for procedures and decision-making related to sending and receiving medical countermeasures during public health emergencies, but it does not refer to MCM dispensing (Page 48). ⁵⁹²

4.3.2 System for receiving foreign health personnel during a public health emergency

4.3.2a Plan to receive foreign health personnel during a public health emergency

Score: 0

There is no publicly available evidence that Zambia has a public plan in place to facilitate workforce surge in an emergency. No evidence was found on the websites of the Zambia National Public Health Institute and the Ministry of Health. ⁵⁹³⁵⁹⁴

According to the 2024 Joint External Evaluation, Zambia does not have a national multi sectoral workforce surge strategic plan for public health emergencies. However, the report anticipates that the One Health Strategic Plan will play a vital role in enhancing multi sectoral human resource surge planning during emergencies (Page 44). ⁵⁹⁵

The National One Health Strategic Plan 2022–2026 includes as activity to create a one health human resource mobilizing mechanism for emergency response (Page 49) and establishes the number of One Health Human Resources surge activities for emergency response conducted as an indicator for its objective to strengthen capacity for preparedness and response to zoonotic diseases and public health events of known and unknown etiology at all levels by 2026 (Page 63). ⁵⁹⁶

There is no evidence on the websites of the Zambia National Public Health Institute or the Ministry of Health that the National Human Resources for Health Strategic Plan 2018–2024 has been updated. ⁵⁹⁷⁵⁹⁸ Furthermore, neither the outdated version nor the National Health Strategic Plan 2022–2026 incorporates workforce surge issues. ⁵⁹⁹⁶⁰⁰

4.3.2b Plan to facilitate workforce surge in an emergency

Score: 0

There is no publicly available evidence that Zambia has a plan in place to receive health personnel from other countries to respond to a public health emergency. No evidence was found on the websites of the Ministry of Health and National Public Health Institute. ⁶⁰¹⁶⁰²

The National One Health Strategic Plan 2022-2026 and the National Health Strategic Plan 2022-2026 do not refer to receiving health personnel from other countries. ⁶⁰³⁶⁰⁴

4.3.2c Plan to redeploy existing health personnel within the country

Score: 0

There is no publicly available evidence that Zambia has a public plan in place to redeploy existing health personnel within the country. No evidence was found on the websites of the Zambia National Public Health Institute and the Ministry of Health. ⁶⁰⁵⁶⁰⁶

According to the 2024 Joint External Evaluation, Zambia does not have a strategic plan in place for the deployment of surge health personnel (Page 48). ⁶⁰⁷

There is no evidence on the websites of the Zambia National Public Health Institute or the Ministry of Health that the National Human Resources for Health Strategic Plan 2018–2024 has been updated. ⁶⁰⁸⁶⁰⁹ Furthermore, neither the outdated version of the plan nor the National Health Strategic Plan 2022–2026 incorporates workforce surge issues. ⁶¹⁰⁶¹¹

A 2022 report by the Committee on Health, Community Development and Social Services of the National Assembly states that during the COVID-19 pandemic, most medical personnel had to be reassigned from routine essential health services to attend to the pandemic (Page 26). ⁶¹³

4.4 Healthcare access

4.4.1 Access to healthcare

4.4.1a Constitutional guarantee of citizens’ right to medical care

Score: 0

There is no publicly available evidence that Zambia’s constitution explicitly guarantee citizens’ right to medical care.

No evidence was found on the Constitution of Zambia, last amended in 2016. ⁶¹⁴

However, since the 1990s, the country has implemented universal health care reforms to increase access and utilization of health services. ⁶¹⁵

4.4.1b Access to skilled birth attendants (% of population)

Score: 91.18

4.4.1c Out-of-pocket health expenditures per capita, PPP (current international $)

Score: 98.18

4.4.1d Coverage of essential health services through universal health coverage

Score: 60.42

4.4.1e Total population pushed below a relative poverty line by household health expenditure (60% of media daily per capita consumption or income)

Score: 91.59

4.4.1f Rate of mortality amenable to health care

Score: 80.19

4.4.2 Paid medical leave

4.4.2a Guaranteed paid sick leave

Score: 66.67

There is publicly available evidence that Zambia guarantees paid sick leave for workers.

Under Article 38 of the 2019 Employment Code Act, employees who cannot work because of illness or injury must inform their employer and provide a medical certificate from a health practitioner. Those on short-term contracts receive full pay for up to 26 working days, then half pay for the next 26 days. Those on long-term contracts receive full pay for the first three months, then half pay for the following three months. The law does not say whether this includes mental health conditions. ⁶¹⁶

4.4.3 Healthcare worker access to healthcare

4.4.3a Government prioritisation of care for healthcare workers during response

Score: 0

There is no publicly available evidence that Zambia has legislation, a policy, or a public statement committing to provide prioritized health care services to health care workers who become sick as a result of responding to a public health emergency. No evidence was found on the websites of the Ministry of Health and National Public Health Institute. ⁶¹⁷⁶¹⁸

The National One Health Strategic Plan 2022-2026 and the National Health Strategic Plan 2022-2026 do not refer to such a commitment. ⁶¹⁹⁶²⁰

During the 2024 cholera outbreak, the vaccination campaign prioritized health workers, but there is no evidence of prioritized health care services for health care workers who become sick. ⁶²¹

4.5 Communications with healthcare workers during a public health emergency

4.5.1 Communication with healthcare workers

4.5.1a Existence of system for communication during a public health emergency

Score: 0

There is no publicly available evidence that Zambia has a system in place for public health officials and health care workers to communicate during a public health emergency. No evidence was found on the websites of the Ministry of Health and National Public Health Institute (ZNPHI). ⁶²²⁶²³

The National One Health Strategic Plan 2022-2026 and the National Health Strategic Plan 2022-2026 do not refer to such a system. ⁶²⁴⁶²⁵

According to the 2024 Joint External Evaluation, the country implements an Incident Management System (IMS) during emergencies to organize and manage responses, which has been actively utilized in six events, including COVID-19, cholera, measles, polio, anthrax, and rabies (Page 47). ⁶²⁶ ZNPHI highlights on its website that this platform allows all stakeholders to access timely information on epidemic status, strategies employed, and resources available or required. ⁶²⁷ However, no evidence was found that this mechanism enables communication between public health officials and health care workers on the Ministry of Health or ZNPHI websites, or within IMS organograms for the mpox and cholera responses. ⁶²⁸⁶²⁹⁶³⁰⁶³¹

4.5.1b Inclusion of public and private sector in healthcare communication system

Score: 0

The National One Health Strategic Plan 2022-2026 and the National Health Strategic Plan 2022-2026 do not refer to such a system. ⁶³⁴⁶³⁵

4.6 Infection control practices

4.6.1 Healthcare-associated infection (HCAI) monitoring

4.6.1a Evidence of national public health system monitoring and tracking of HCAIs

Score: 0

There is no publicly available evidence that Zambia has a national public health system is monitoring for and tracking the number of health care associated infections (HCAI) that take place in health care facilities. No evidence was found on the websites of the Ministry of Health and National Public Health Institute (ZNPHI). ⁶³⁶⁶³⁷

The National One Health Strategic Plan 2022-2026 and the National Health Strategic Plan 2022-2026 do not cover HCAI tracking system. ⁶³⁸⁶³⁹

The National Infection Prevention and Control Strategic Plan 2022–2032 includes, among its interventions, the establishment of a multidisciplinary HCAI surveillance taskforce at national and sub-national levels, as well as measures to strengthen the detection, recording, and reporting of all priority HCAIs (Page 20). However, it does not mention that a tracking system is currently in place. ⁶⁴⁰

4.6.1b Infection prevention and control programme

Score: 100

There is publicly available evidence that Zambia has an infection prevention and control (IPC) programme in place nationally.

The National Infection Prevention and Control Strategic Plan 2022–2032 provides a framework for developing and implementing guidelines and Standard Operating Procedures (SOPs) to foster a safety culture in health care facilities. It covers the eight core components of IPC recommended by the World Health Organization: IPC programme; IPC guidelines; education and training; health care-associated infections surveillance; multimodal strategies; monitoring, assessment, and feedback; workload, staffing, and bed capacity; and built environment and infrastructure (Page 1). Key interventions include establishing a multi-sectoral IPC Technical Working Group at the national level, designing a monitoring and evaluation system to assess the effectiveness of education and training, and developing data collection systems for health care-associated infections among health care providers and in the community (Pages 19–20). ⁶⁴¹

4.6.1c National plan to ensure a safe environment in health facilities

Score: 100

There is publicly available evidence that Zambia has a plan to ensure a safe environment in health facilities nationally.

The National Infection Prevention and Control (IPC) Strategic Plan 2022–2032 provides a framework for developing and implementing guidelines and Standard Operating Procedures (SOPs) to foster a safety culture in health care facilities. It covers the eight core components of IPC recommended by the World Health Organization: IPC programme; IPC guidelines; education and training; health care-associated infections surveillance; multimodal strategies; monitoring, assessment, and feedback; workload, staffing, and bed capacity; and built environment and infrastructure (Page 1). Key interventions include developing data collection systems for health care-associated infections (HCAI) among health care providers and in the community, developing and implementing specific SOPs based on transmission precautions to prevent the most prevalent HCAIs, and collaborating with experts in the design of inclusive, well-structured infrastructure to support IPC/ Water, Sanitation and Hygiene (WASH) (Pages 19–22). The plan outlines timelines, action items and indicators to achieve the planned objectives. ⁶⁴²

The IPC Water, Sanitation and Hygiene (WASH) in Health Care Facilities: Guidelines and Standard Operating Procedures, published in 2018 by the Ministry of Health, aims to support facility staff in adopting WASH practices. Its goal is to help health facilities improve performance to meet the recommended IPC with WASH standards and to integrate IPC and WASH into routine health care systems (Page 5). However, this document is not a plan; rather, it provides recommendations, such as ensuring the availability of adequate and clean water for clients through continuous equipment maintenance and disinfection, and storing drinking water in clean containers. It also includes tools, such as the Drinking Water Provision Form, which requires daily recording of drinking water provision (Page 7). ⁶⁴³

4.7 Capacity to test and approve new medical countermeasures

4.7.1 Regulatory process for clinical trials of unregistered interventions

4.7.1a Requirement for ethical review before beginning a clinical trial

Score: 100

There is publicly available evidence that Zambia requires ethical review before beginning a clinical trial.

The National Health Research Act of 2013 states that a clinical trial on human beings may only be carried out if the researcher obtains a letter of approval from the relevant research ethics committee and ethical approval from the National Health Research Ethics Board (Article 54). ⁶⁴⁴

4.7.1b Expedited approval for clinical trials of unregistered MCMs during epidemics

Score: 0

There is no publicly available evidence that Zambia has an expedited process for approving clinical trials for unregistered medical countermeasures (MCM) or mutual recognition of clinical trial results taking place elsewhere to treat ongoing pandemics or epidemics. No evidence was found on the websites of the Zambia National Public Health Institute, the Ministry of Health and Zambia Medicines Regulatory Authority (ZAMRA). ⁶⁴⁵⁶⁴⁶⁶⁴⁷

The Medicines and Allied Substances Act of 2013 regulates clinical trials (Part VI). The Act stipulates, among other provisions, that clinical trials involving a medicine or allied substance require a clinical trial certificate (Article 49), outlines grounds for rejecting a certificate application (Article 50), and allows for the inspection of clinical trial sites (Article 52). ⁶⁴⁸

The National Health Research Act of 2013 states that a clinical trial on human beings shall only be conducted in the prescribed manner; if the researcher holds a letter of approval issued by the relevant research ethics committee; has obtained a clinical trial certificate from ZAMRA and ethical approval from the Board; complies with the regulatory framework for health research; and has evidence of no-fault insurance for all research participants (Article 54). ⁶⁴⁹

Neither of these regulations includes provisions for an expedited approval process. ⁶⁵⁰⁶⁵¹

However, in 2021, during the COVID-19 pandemic, ZAMRA’s Senior Public Relations Officer stated that ZAMRA had adopted the African Vaccine Regulatory Forum (AVAREF) Strategy and Guidance for Emergency Preparedness, which provides an expedited time frame for processing clinical trial applications. ⁶⁵² No further information was found on ZAMRA’s website. ⁶⁵³

According to 2020 reports, Zambia participated in the COVID-19 global Solidarity Clinical Trials for therapeutic products. The Solidarity trial, coordinated by the WHO, was designed to achieve speed and scale in generating results by allowing multiple countries to participate using simplified procedures that enabled even the most overburdened hospitals to take part. ⁶⁵⁴

4.7.2 Regulatory process for approving medical countermeasures

4.7.2a Existence of agency responsible for approving new human MCMs

Score: 100

There is publicly available evidence that Zambia has a government agency responsible for approving new medical countermeasures (MCM) for humans.

The Medicines and Allied Substances Act of 2023 creates the Zambia Medicines Regulatory Authority (ZAMRA). ZAMRA functions include grant pharmaceutical licences and marketing authorisations, regulate and control the manufacture, importation, exportation, distribution and sale of medicines and allied substances and regulate and monitor the conduct of clinical trials (Article 5). ⁶⁵⁵

It was ZAMRA that, in 2021, reviewed and approved the COVID-19 vaccines for use during the pandemic. ⁶⁵⁶

4.7.2b Expedited approval for human MCMs during public health emergencies

Score: 100

There is publicly available evidence that Zambia has an expedited process for approving medical countermeasures (MCM) for human use or recognition of approval decisions taking place elsewhere during public health emergencies.

The Medicines and Allied Substances Act of 2013 stipulates that market authorisation regulations do not apply to medicines imported or exported in response to a declared health emergency (Article 39). Under these regulations, a medicine or allied substance may not be placed on the market, advertised, marketed, manufactured, sold, imported, supplied, administered, or otherwise dealt with without a marketing authorisation granted by the responsible authority in the prescribed manner and form (Article 39). ⁶⁵⁷

Furthermore, according to a 2025 academic article, Zambia Medicines Regulatory Authority has a fast-track review model used for products that are of high public health concern, in which applications are reviewed within 90 working days. ⁶⁵⁸

Commitment to International Norms

5.1 IHR reporting compliance and disaster risk reduction

5.1.1 Official IHR reporting

5.1.1a Submission of IHR reports to the WHO in past year

Score: 100

Zambia has submitted an IHR Self-Assessment Annual Report (SPAR) to the WHO for the last calendar year, with the latest submission in 2024.⁶⁵⁹

5.1.2 Integration of health into disaster risk reduction

5.1.2a Existence of specific risk reduction strategies for epidemics and pandemics

Score: 0

There is no publicly available evidence that Zambia has national risk reduction strategy or is there a standalone national disaster risk reduction strategy for epidemics and pandemics. No evidence was found on the websites of the Zambia National Public Health Institute, the Ministry of Health or the Office of the Vice President. ⁶⁶⁰⁶⁶¹⁶⁶²

The Zambia National Disaster Risk Management Framework 2017–2030 identifies epidemics (both human and animal) as key hazards (Page 1) but does not establish measures to address them, except for pest and disease surveillance for crops, fisheries, and livestock (Page 34). ⁶⁶³ The National Disaster Management Policy 2015–2020 also identifies epidemics as potential disasters but does not establish measures to reduce their risks. ⁶⁶⁴

5.2 Cross-border agreements on public health and animal health emergency response

5.2.1 Cross-border agreements

5.2.1a Existence of public health emergency agreements with regional neighbors

Score: 100

There is publicly available evidence that Zambia has cross-border agreements, protocols, or MOUs with neighboring countries, or as part of a regional group, with regards to public health emergencies.

In 2025, Zambia and 11 other African countries agreed to facilitate stronger cross-border collaboration to respond, prevent and control disease outbreaks amid an mpox outbreak. According to the Africa Centres for Disease Control and Prevention (Africa CDC), the agreement will further help streamline cross-border transmission challenges, data-sharing mechanisms among countries, and the movement of affected populations. ⁶⁶⁵

During the 2019 ebola outbreak, Congo and its nine neighboring countries, including Zambia, signed an agreement to facilitate cooperation and collaboration preparedness and response to the event, setting efforts such as cross-border case and laboratory surveillance, cross-border tracing and monitoring of contacts, and cross-border joint planning and implementation preparedness and response activities. ⁶⁶⁸

5.2.1b Existence of animal health emergency agreements with regional neighbors

Score: 50

There is publicly available evidence that Zambia has cross-border agreements, protocols, or MOUs with neighboring countries, or as part of a regional group, with regards to animal health emergencies.

In 2024, the Southern African Development Community, of which Zambia is a member state, signed a MoU with the World Organisation for Animal Health to provide strategic expertise and coordinate the harmonisation of policies and strategies to accelerate regional integration and sustainable development. One of the areas the parties agreed to cooperate on is animal health, including transboundary animal diseases, zoonoses, and emerging infectious diseases (Page 7). ⁶⁶⁹

In 2023, Angola, Botswana, Namibia, Zambia and Zimbabwe held a cross-border harmonisation meeting to discuss Transboundary Animal Diseases and rabies. The meeting aimed to develop a harmonisation strategy and implementation plan for the control and eradication of Contagious bovine pleuropneumonia (CBPP) and Peste des petits ruminants (PPR), through collaborative efforts across borders. However, there is no evidence that an agreement was established. ⁶⁷⁰

No further evidence was found on the websites of the Zambia National Public Health Institute, the Ministry of Health or the Ministry of Fisheries and Livestock. ⁶⁷¹⁶⁷²⁶⁷³

5.3 International commitments

5.3.1 Participation in international agreements

5.3.1a Biological and Toxin Weapons Convention status

Score: 100

Zambia acceded to the Biological Weapons Convention on 15 January 2008. ⁶⁷⁴

5.3.1b Submission of CBMs to the Biological and Toxin Weapons Convention

Score: 100

There is publicly available evidence that Zambia has submitted confidence-building measures (CBM) for the Biological Weapons Convention (CBM) in the past three years.

According to the Biological Weapons Convention National Implementation Measures Database, the country submitted a BWC CBM in 2023, 2024 and 2025. ⁶⁷⁵

5.3.1c Submission of UNSCR 1540 reports

Score: 100

There is publicly available evidence that Zambia provided the required United Nations Security Council Resolution (UNSCR) 1540 report to the Security Council Committee established pursuant to resolution 1540 (1540 Committee).

According to the Biological Weapons Convention National Implementation Measures Database, the country submitted national reports to the 1540 Committee in 2015 and 2020. ⁶⁷⁶

5.3.1d Extent of UNSCR 1540 implementation on public health emergencies

Score: 25

5.3.2 Voluntary memberships

5.3.2a Membership in global health security and/or biological weapons agreements

Score: 0

There is no publicly available evidence that Zambia is a member of the Global Partnership Against the Spread of Weapons and Materials of Mass Destruction and the Australia Group. ⁶⁷⁷⁶⁷⁸

Zambia has been a member of the Proliferation Security Initiative since 2024. ⁶⁷⁹⁶⁸⁰

5.4 JEE and PVS

5.4.1 Completion and publication of a JEE assessment and gap analysis

5.4.1a Completion and publication of JEE (or GHSA pilot external assessment) report

Score: 100

There is publicly available evidence that Zambia completed a Joint External Evaluation (JEE) and published a full public report in the last five years.

The latest JEE was completed in 2023 and published in 2024. ⁶⁸¹

5.4.2 Completion and publication of a PVS assessment and gap analysis

5.4.2a Completion and publication of PVS report (past five years)

Score: 100

There is publicly available evidence that Zambia completed and published a Performance of Veterinary Services (PVS) assessment in the last five years.

An evaluation of the Veterinary Services based on the World Organization for Animal Health (WOAH) PVS methodology was conducted from 12th to 26th June 2023. The follow-up report is available on the WOAH website. ⁶⁸²⁶⁸³

5.4.2b Completion and publication of PVS gap analysis (past five years)

Score: 0

There is no publicly available evidence that Zambia completed and published a Performance of Veterinary Services (PVS) gap analysis in the last five years.

There is no record for gap analysis on Zambia on the PVS Reports database of the World Organization for Animal Health (WOAH). ⁶⁸⁴ The PVS Evaluation Follow-Up Report of the Veterinary Services of Zambia, published in 2023, mentions a gap analysis conducted in 2009 (Page 17). ⁶⁸⁵

5.5 Financing

5.5.1 National financing for epidemic preparedness

5.5.1a Evidence of allocated national funds to improve capacity to address epidemic threats

Score: 100

There is publicly available evidence that the country has allocated national funds to improve capacity to address epidemic threats within the past three years.

According to the African Institute for Development Policy (AFIDEP), the country allocated approximately USD 530,000 in 2025 to the Zambia National Public Health Institute for surveillance and pandemic preparedness and response (PPR). ⁶⁸⁶

A 2025 AFIDEP report on surveillance and pandemic preparedness domestic financing finds that the national budget allocation for disease surveillance and PPR declined from ZMW 32.36 million (USD 1.3 million) in 2022 to ZMW 24.88 million (USD 1 million) in 2026 (Page 11). ⁶⁸⁷

Another 2025 AFIDEP report on budget execution for PPR states that Zambia’s PPR funding across 2020–2024 was multifaceted: domestic budgets supported core health system strengthening, while external partners financed specific PPR inputs such as vaccines, laboratories, and surge personnel (Page 11). Annual allocations peaked in 2020–2021 when emergency grants were received, but have since transitioned toward longer-term preparedness investments by 2024 (Page 11). ⁶⁸⁸

With the exception of the 2025 National Budget, which allocates ZMW 4.5 million (USD 193,462) to the National Livestock Epidemiology and Information Centre (Page 682), budget analyses and national budgets for 2023, and 2024 do not specify funding to address epidemic threats. ⁶⁸⁹⁶⁹⁰⁶⁹¹⁶⁹²⁶⁹³

5.5.2 Financing under JEE and PVS reports and gap analyses

5.5.2a National budget to address gaps identified in JEE, NAPHS or GHSA roadmap

Score: 0

There is no publicly available evidence that Zambia’s Joint External Evaluation (JEE) report, National Action Plan for Health Security (NAPHS), and/or national GHSA roadmap allocate or describe specific funding from the national budget (covering a time-period either in the future or within the past five years) to address the identified gaps. No evidence was found on the websites of the Zambia National Public Health Institute, the Ministry of Health or the Ministry of Fisheries and Livestock. ⁶⁹⁴⁶⁹⁵⁶⁹⁶

The 2024 JEE and the 2023 PVS Evaluation Follow-Up Report of the Veterinary Services of Zambia do not allocate or describe funding. ⁶⁹⁷⁶⁹⁸

While the National One Health Strategic Plan 2022-2026 also does not offer this information, the National Health Strategic Plan for Zambia 2022–2026 provides cost estimates, detailed costing by programme area, and lists sources of funding (Pages 121 to 125). ⁶⁹⁹⁷⁰⁰

5.5.2b National budget to address gaps identified in PVS assessment or gap analysis

Score: 0

There is no publicly available evidence that the Performance of Veterinary Services (PVS) gap analysis and/or PVS assessment allocate or describe specific funding from the national budget (covering a time-period either in the future or within the past five years) to address the identified gaps.

The PVS Evaluation Follow-Up Report of the Veterinary Services of Zambia, published in 2023, does not allocate or describe specific funding to address the identified gaps. ⁷⁰¹

5.5.3 Financing for emergency response

5.5.3a Emergency public financing during a public health emergency

Score: 100

There is evidence that Zambia can access a publicly identified special emergency public financing mechanism and funds in the face of a public health emergency.

Zambia is listed as an International Development Association (IDA) eligible borrowing country and therefore is eligible for World Bank initiatives like the pandemic financing facility, the Crisis Response Window, and the Global Crisis Management Platform, which brings together a range of crisis support instruments to IDA-eligible countries that face an outbreak. ⁷⁰²⁷⁰³⁷⁰⁴

5.5.4 Accountability for international commitments to address epidemic threats

5.5.4a Commitments to improve domestic or foreign capacity for epidemic threats

Score: 100

There is no publicly available evidence that Zambia’s senior leaders, in the past three years, have made a public commitment to support other countries to improve capacity to address pandemic or epidemic threats by providing financing or support, but they have requested support to improve the country’s domestic capacity.

No evidence of public commitment to support other countries was found on the websites of the National Public Health Institute, Ministries of Health or the African Health Observatory (AHO). ⁷⁰⁵⁷⁰⁶⁷⁰⁷

Regarding the country’s domestic capacity, in December 2023, during a cholera outbreak, the government activated a high-level outbreak response and requested increased support from partners, according to the UK Emergency Medical Team and the European Centre for Disease Prevention and Control, who responded to the call. ⁷⁰⁸⁷⁰⁹

5.5.4b Investments to improve domestic or foreign capacity for epidemic threats

Score: 100

There is evidence that Zambia has requested financing or technical support from donors to improve the country's domestic capacity to address epidemic threats. There is no evidence that it has provided other countries with financing or technical support to improve capacity to address epidemic threats in the past three years.

According to the Global Health Security Funding Tracking Dashboard, Zambia received USD 4,5 billion from 2014 to 2022. ⁷¹⁰ In 2023, Zambia was awarded a grant by the World Bank's Pandemic Fund to strengthen the national surveillance, laboratory systems, and workforce capacity for preparedness and response to public health events, especially those requiring a One Health approach. ⁷¹¹ Furthermore, during the 2025 mpox outbreak, the country received technical support from the Southern Africa Regional Coordinating Centre. ⁷¹²

5.5.4c Evidence that the country has fulfilled its full WHO contribution within the past two years

Score: 0

There is no evidence that Zambia has fulfilled its full contribution to the WHO within the past two years.

According to data from 2022, 2023 and 2024, the country has a balance outstanding of USD 522. ⁷¹³⁷¹⁴

5.6 Commitment to sharing of genetic & biological data & specimens

5.6.1 Commitment to share data and specimens in emergency/non-emergency research

5.6.1a Sharing of genetic/biological data and materials beyond influenza

Score: 0

There is no publicly available evidence that Zambia plan or policy for sharing genetic data, clinical specimens, and/or isolated specimens (biological materials) along with the associated epidemiological data with international organisations and/or other countries that goes beyond influenza.

No evidence was found on the websites of the Zambia National Public Health Institute and the Ministry of Health or the FAOLEX database. ⁷¹⁵⁷¹⁶⁷¹⁷

5.6.1b Evidence of non-compliance with sample sharing element of PIP framework

Score: 100

There is no publicly available evidence that Zambia has not shared samples in accordance with the Pandemic Influenza Preparedness (PIP) framework in the past two years.

No evidence was found on the Ministry of Health and National Public Health Institute’s websites. ⁷¹⁸⁷¹⁹ There have not been any reports of the country not sharing samples, according to the World Health Organisation. ⁷²⁰

5.6.1c Evidence of non-sharing of pandemic pathogen samples during an outbreak

Score: 100

There is no publicly available evidence that Zambia has not shared pandemic pathogen samples during an outbreak in the past two years.

No evidence was found on the World Health Organisation, Ministry of Health and National Public Health Institute’s websites. ⁷²¹⁷²²⁷²³

Furthermore, the European Nucleotide Archive contains Vibrio cholerae samples from Zambia that underwent whole-genome sequencing. According to the website, the samples were collected in 2023 by the Centre for Infectious Disease Research in Zambia. ⁷²⁴⁷²⁵

Risk Environment

6.1 Political and security risk

6.1.1 Government effectiveness

6.1.1a Policy formation

Score: 75

6.1.1b Quality of bureaucracy

Score: 25

6.1.1c Excessive bureaucracy/red tape

Score: 25

6.1.1d Vested interests/cronyism

Score: 25

6.1.1e Corruption

Score: 39

6.1.1f Accountability of public officials

Score: 25

6.1.1g Human rights risk

Score: 50

6.1.2 Orderly transfers of power

6.1.2a Orderly transfers of power

Score: 50

6.1.3 Risk of social unrest

6.1.3a Risk of social unrest

Score: 25

6.1.4 Illicit activities by non-state actors

6.1.4a Risk of terrorism

Score: 100

6.1.4b Level of illicit arms flows within the country

Score: 50

6.1.4c Risk of organized criminal activity

Score: 50

6.1.5 Armed conflict

6.1.5a Presence or risk of armed conflict

Score: 100

6.1.6 Government territorial control

6.1.6a Government territorial control

Score: 100

6.1.7 International tensions

6.1.7a International tensions

Score: 50

6.2 Socio-economic resilience

6.2.1 Literacy

6.2.1a Adult literacy rate (15+ years old, both sexes)

Score: 86.89

6.2.2 Gender equality

6.2.2a UNDP Gender Inequality Index score

Score: 34.85

6.2.3 Social inclusion

6.2.3a Poverty gap at $1.90 a day (2011 PPP) (%)

Score: 25.93

6.2.3b Share of employment in the informal sector

Score: 0

6.2.3c Coverage of social insurance programs (% of population)

Score: 0

6.2.4 Public confidence in government

6.2.4a Public confidence in government

Score: 100

6.2.5 Local media and reporting

6.2.5a Robust, open, diverse local media and reporting

Score: 100

6.2.6 Inequality

6.2.6a Gini coefficient

Score: 48.5

6.3 Infrastructure adequacy

6.3.1 Adequacy of road network

6.3.1a Adequacy of road network

Score: 25

6.3.2 Adequacy of airports

6.3.2a Adequacy of airports

Score: 50

6.3.3 Adequacy of power network

6.3.3a Adequacy of power network

Score: 0

6.4 Environmental risks

6.4.1 Urbanisation

6.4.1a Urban population (% of total population)

Score: 58.3

6.4.2 Land use

6.4.2a Change in forest area (percentage points)

Score: 46.41

6.4.3 Natural disaster risk

6.4.3a Natural disaster risk

Score: 25

6.5 Public health vulnerabilities

6.5.1 Access to quality healthcare

6.5.1a Total life expectancy (years)

Score: 53.92

6.5.1b NCD mortality rate

Score: 55.7

6.5.1c Population aged 65+

Score: 100

6.5.1d Tobacco use (% of adults)

Score: 45.66

6.5.1e Level of adult obesity (%)

Score: 78.88

6.5.1f Age-standardised prevalence of mental health disorders (per 100 000 people)

Score: 69.17

6.5.2 Access to potable water and sanitation

6.5.2a Access to potable water

Score: 72.96

6.5.2b Access to at least basic sanitation facilities

Score: 36.91

6.5.2c Percentage of health-care facilities with no access to any electricity supply

Score: 0

6.5.3 Public healthcare spending levels per capita

6.5.3a Domestic general government health expenditure per capita (PPP)

Score: 8.35

6.5.4 Trust in medical and health advice

6.5.4a Trust medical and health advice from the government

Score: 50

6.5.4b Trust medical and health advice from medical workers

Score: 100

Citations

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