This paper examines the process of developing a health partnership between the United States and Zambia and prospects for a potential government-to-government financing mechanism within that.
Drawing on interviews, document review, and lessons from six direct financing models in Zambia, the paper finds that government-led partnerships and financing mechanisms can strengthen sustainability, national ownership, and efficiency when aligned with national priorities, phased realistically, supported by clear processes and systems, and underpinned by strong accountability and civil society engagement.
The paper offers twelve recommendations across four pillars: sustainability and alignment, government systems, governance and engagement, and a durable bilateral relationship. While focused on Zambia, the lessons offer broader guidance for how US partnerships can advance locally led development and strengthen local systems of delivery and accountability.