LocationsHow Communities Are Sustaining Zambia’s Health System Where Infrastructure Falls Short
Built In From the Beginning
May 28, 2026
When communities already own the system, infrastructure investments last. Insights from Matanda and Mushitala highlight how investments can endure when they align with community-based approaches
Photo by: Vanessa Wematu Akibate
Community members are often the first to identify problems, follow up on cases, and keep services running where formal systems alone cannot.
Yet community involvement is frequently treated as a secondary consideration in development work, something to be added once systems are in place. In reality, it is foundational, shaped by existing community practices and social structures. Healthcare systems do not operate in isolation, they are embedded in existing social structures, local decision-making, and informal practices that long predate any programme intervention.
Development efforts that fail to recognise this tend to produce interventions that are technically sound but poorly rooted. When initiatives are genuinely anchored within community structures, they extend the reach of care far beyond the facility and sustain outcomes long after formal support ends.
This dynamic is already visible in how residents of Matanda engage with the Matanda Research Clinic. When the Smart Health Systems project team arrived with plans for solar power and connectivity, the conversation did not begin with what would be delivered, but with how it would be managed. A local leader had already identified a watchman, someone known and trusted, to take responsibility for safeguarding the equipment once installed. The nomination was made before any infrastructure was in place, reflecting a clear sense of ownership and accountability. In this context, the project’s intended investment in the community is already being integrated into the community’s own system where roles, trust and responsibility are clearly defined.
Residents of Matanda engage with the Smart Health Systems project team, before a single solar panel was installed at the Matanda Research Clinic. This is how genuine community engagement turns infrastructure into ownership.
At Mushitala Urban Health Centre, community involvement takes a more distributed form. The connection between the facility and the households it serves is sustained through a network of Community-Based Volunteers who operate across the catchment area. These are individuals embedded within the community, moving between households and the clinic — identifying cases early, following up on referrals, offering advice and ensuring that health information reaches households that facilities cannot easily access on their own. Their work continues beyond formal working hours, including during night-time emergencies, often under difficult conditions and with limited resources. Over time, they have become a consistent and reliable point of contact between the health system and the community, maintaining visibility on emerging needs and supporting continuity of care.
This collective effort extends the reach of the facility into everyday community life and plays a key role in making initiatives both sustainable and scalable.
The Smart Health Systems project, working alongside existing community structures, aims to strengthen the infrastructure needed to deliver reliable energy and connectivity to 48 health facilities in North-Western Province. By enabling frontline actors to carry out the roles they are already performing ,but with greater consistency, reach, and impact , and by reinforcing local ownership rather than replacing it, the project is ensuring that the system functions more reliably from the facility level down to the last mile.
The network behind the network — the Community-Based Volunteers at the Mushitala Urban Health Centre who keep care moving between facilities and households, long after formal working hours end.
Photo by: Vanessa Wematu Akibate/UNDP Zambia
The project is a Government-led initiative implemented by UNDP with financial support from the Global Fund, working in close partnership with the Ministry of Health as the primary grant recipient, and other key institutions and technical partners. It focuses on strengthening service delivery by addressing critical system constraints, particularly unreliable power and limited connectivity in health facilities. The scale of the project is significant, supporting the solarisation of 426 facilities nationwide, alongside the rollout of low Earth orbit satellite internet connectivity to over 750 sites. Beyond infrastructure, it also supports the integration of digital health systems, capacity building for health workers, and the development of policies and maintenance frameworks to ensure long-term sustainability. Through this multi-faceted approach, the project aims to improve the reliability, efficiency and resilience of healthcare delivery, particularly in underserved and off-grid communities.
A core strength of the project lies in how it builds capacity where it matters most. Healthcare workers are being trained as trainers of trainers, enabling them to cascade practical skills and knowledge to community actors such as Community-Based Volunteers and Ward Development Committees. Of those being trained, the project has set a target of 40% women, a deliberate effort to ensure that the technical knowledge needed to operate and maintain this infrastructure is held by the women already central to how care is delivered on the ground. This creates a multiplier effect, ensuring that the knowledge needed to operate, protect and sustain the new systems does not remain concentrated at facility level, but is distributed across the communities that will house the infrastructure. This approach promotes sensitisation around safeguarding the investments and encourages prioritisation of long-term operations and maintenance through devolved local funding mechanisms.
Altogether, this helps to ensures that project impacts do not cease upon closure.
"Communities are already the backbone of healthcare delivery, particularly in underserved areas," says Dr. Busiku Hamainza, Ministry of Health/Global Fund Coordinator, Project Coordination Unit. "Through our partnerships with the Global Fund and UNDP, we are reinforcing those existing systems, equipping community actors with the tools and infrastructure they need to deliver care effectively and sustainably, well beyond the life of programme support."
"Communities are already the backbone of healthcare delivery."— Dr. Busiku Hamainza, Ministry of Health/Global Fund Coordinator, Project Coordination Unit
“By strengthening existing community structures and integrating them into national systems, we are ensuring that investments translate into lasting system impact.”, adds Dr Saleban Omar, the UNDP Zambia Health, Energy and Climate Change Advisor.
Looking at the response by community members in Matanda and Mushitala, it is clear that communities are already organising around health service delivery and sustaining systems in the absence of reliable infrastructure, maintaining the link between facilities and households. By building on this existing foundation, the project is positioned for the long-term sustainability of its results, ensuring that new infrastructure is protected and integrated into daily practice. In this way, sustainability is built into the system from the very beginning.
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