Tracking Delivery on the Lusaka Agenda

Launched in December 2023, the Lusaka Agenda laid out a set of shifts and actions to strengthen financing for universal health coverage (UHC). A process for establishing mutual accountability for delivery is ongoing, including within the African Union, but metrics for assessing progress have not yet been established. In this paper, we propose a Lusaka Agenda Tracker. Specially, we aim to provide an independent, technical perspective on indicators that may be useful to track progress on the Lusaka Agenda, focusing in particular on the three global health initiatives (GHIs)—the Global Fund, Gavi, and the Global Financing Facility (GFF)—which are most involved in the financing components of national health systems. Tracking these indicators can support the organisational changes that are needed to enable better alignment at country health system level. We developed a long list of 33 potential indicators and milestones, working from the Lusaka Agenda, other relevant documents, and using interviews with experts from a range of relevant organisations, including the Global Fund, Gavi, and the GFF. These were sorted into near-term milestones and medium-term indicators, and prioritised according to their importance, measurability, and coverage of key shifts and health system blocks. The near-term milestones help to prepare for the more important shifts covered in the medium-term. This includes establishing a cross-board governance mechanism, developing roadmaps to implement reforms in each GHI, completing pilots, and agreeing common definitions, baseline values, and transparent annual reporting across the GHIs on the suggested priority medium-term indicators. Seven in total, these indicators will be key to supporting progress on the Lusaka Agenda. We believe that this independent proposal addresses an important missing piece in discussions about taking forward the Lusaka Agenda to strengthen the effectiveness of the support GHIs provide to national health systems.