As Donor Money Shifts, Who Pays for Zambia's Vaccines? A Conversation with Expanded Program on Immunization Manager Dr. Jacob Sakala

On a field visit to Zambia, the Global Health Advocacy Incubator’s (GHAI) Associate Director of Communications for Health Systems Strengthening, Abel Akara Ticha, together with colleagues from the Churches Health Association of Zambia (CHAZ), met Dr. Jacob Sakala, Manager of Zambia’s Expanded Program on Immunization (EPI), in Lusaka. 

Their exchange covered Zambia’s evolving immunization financing landscape and what it will take to sustain progress as global health financing shifts toward locally led development. 

Below is a recap of that exchange. 

Abel: 

Dr. Sakala, thank you for meeting with us. GHAI works in partnership with CHAZ and other actors to advance advocacy for sustainable immunization financing so vaccines can reach children at the last mile. What has been the added value of this partnership with EPI? 

Dr. Sakala: 

Thank you, Abel, and welcome. 

The Expanded Program on Immunization is mandated to ensure that every eligible child and community in Zambia has access to life-saving vaccines. Partnerships like the one with GHAI and CHAZ strengthen the broader ecosystem that makes this possible. 

One key value is helping translate technical immunization priorities into clear, evidence-based advocacy messages that policymakers can act on. Immunization is highly technical, but decision-makers respond to clarity, impact and return on investment. 

Second, CHAZ’s nationwide faith-based network strengthens community trust and reach, which complements EPI’s service delivery mandate. 

Third, the partnership has helped elevate immunization financing within parliamentary and policy spaces. 

Abel: 

Zambia’s Constituency Development Fund (CDF) is increasingly supporting health financing, and this year approximately $2 million was directed toward immunization-related efforts. In Mbabala Constituency, we saw visible progress supported by the Honorable MP, who is also Chair of the Parliamentary Health Committee and part of the immunization caucus. 

How does this decentralized financing support your work, and where do you see it going? 

Dr. Sakala: 

The inclusion of immunization within the Constituency Development Fund is an important development. 

From a program perspective, localized financing helps address practical bottlenecks that affect service delivery, especially at the last mile. Constituencies can respond to immediate needs such as facility improvements, outreach support or equipment gaps that directly affect vaccine access. 

It also strengthens ownership and accountability. When Members of Parliament allocate CDF resources toward immunization, it signals that vaccines are a constituency-level priority. 

Looking ahead, the opportunity is to better align these constituency investments with national immunization priorities and planning frameworks. It is about coherence: ensuring local financing supports national strategy. 

Abel: 

Affordability and sustainability are increasingly central to the global health agenda. From your perspective, what must Zambia get right to ensure long-term sustainability? 

Dr. Sakala: 

Sustainability requires attention to three central areas. 

First is political leadership. Immunization financing must remain visible at the highest levels of decision-making: Parliament, Cabinet and the Ministry of Finance. When leaders understand the impact of immunization and the cost of underinvestment, it strengthens protection of funding allocations. 

Second is institutional strengthening. Sustainability is not only about identifying alternative funding sources. It is also about ensuring that the immunization program is efficiently delivered, well governed and integrated within broader health systems. 

Third is integration within the public financial management framework. Immunization financing must be embedded in predictable budgeting cycles, with timely releases and clear execution pathways. 

Abel: 

Across Africa and globally, countries are expected to assume greater responsibility for financing essential services, and we are hearing more about locally led development. How should we think about this transition in the context of immunization? 

Dr. Sakala: 

Historically, significant immunization financing has been supported by global partners. As that landscape evolves, countries must strengthen domestic ownership, both politically and financially. 

Locally led development means more than replacing one funding source with another. It requires deliberate change management. We must ensure that systems are ready, that budgets are protected and that accountability mechanisms are strong. 

For Zambia, the goal is to maintain and improve immunization coverage while strengthening domestic financing over time. Transition must be managed carefully to avoid disruptions in service delivery. 

Abel: 

Finally, what role do partnerships like ours play in navigating that change? 

Dr. Sakala: 

Partnerships are critical during transition. 

EPI provides the technical mandate and service delivery framework. Civil society partners help maintain community engagement and trust. Organizations like GHAI provide technical support in advocacy, financing analysis and policy engagement. 

Sustainability is not achieved by one actor alone. It requires coordination and shared responsibility. 

A Defining Moment for Immunization Financing 

Zambia’s experience reflects a reality facing many countries: domestic financing, political ownership and institutional resilience must now carry increasing weight. As Dr. Sakala emphasized, success will depend on political leadership, institutional strength and fiscal coherence. GHAI and its partners remain committed to supporting Zambia’s EPI and national stakeholders so that every child, especially those at the last mile, continues to receive life-saving vaccines.