A coalition of Zambian civil society organisations has demanded that the government fully disclose the terms of a US$1.5 billion health financing agreement signed with the United States, citing a lack of transparency over the commitments undertaken and alleging possible links between the medical assistance and American access to the country's mineral resources.

The demand was set out in a statement issued on 30 October by a coalition that includes ActionAid Zambia, Publish What You Pay Zambia, Oxfam, the Fight Inequality Alliance, and the Zambia Alliance for Women, among other organisations. The agreement was signed on 8 October in Lusaka after several months of negotiations between the two governments, and provides for an American contribution of approximately US$1.5 billion over five years to strengthen Zambia's health system.

According to the US Department of State, the partnership represents a combined financial commitment of US$2.4 billion, including approximately US$975 million that Zambia is expected to invest in its own health system over the implementation period. The resources are intended to support programmes combating HIV/AIDS, tuberculosis, and malaria, as well as to strengthen maternal and child health services, vaccination, epidemiological surveillance, and emergency health response capacity.

Despite the significance of the funding, the civil society organisations say doubts persist over the conditions of the agreement and are calling for the official publication of the document, accompanied by clarifications regarding any clauses that cannot be disclosed for legally justified reasons.

The concern stems in part from earlier versions of the memorandum of understanding negotiated between Lusaka and Washington, which included provisions related to the sharing of medical data, biological samples, and other areas of technological and economic cooperation. Information disclosed during the negotiations raised fears about the protection of patients' personal data and the possibility that the financial assistance could be linked to commitments involving critical minerals, regarded as strategic to the technology industry and the energy transition.

Zambian authorities have since clarified that the controversial clauses on the mandatory sharing of individual data and biological samples were removed from the final version of the agreement. Zambia's Minister of Health, Roma Chilengi, also assured that the agreement contains no provisions related to critical minerals, stressing that any negotiations in that domain are conducted separately.

Nonetheless, the coalition considers that official publication of the document is necessary to allow an independent assessment of the obligations assumed by the government, and to ensure that medical assistance is not conditional on the granting of access to natural resources or other economic benefits. The organisations are also demanding clarification on negotiations for a possible separate agreement between Zambia and the United States concerning critical minerals, arguing that any such arrangement should be subject to public and parliamentary consultation before approval.

According to the groups, the absence of transparency could heighten the risks of weakened oversight mechanisms, reduced public revenues, and negative impacts on communities affected by mining activity and on the environment. The issue carries particular economic significance given the importance of the extractive industry to Zambia, one of Africa's leading copper producers — a raw material used in the manufacture of electrical equipment, energy infrastructure, and technologies associated with the energy transition.

The organisations argue that any commitments involving mineral resources must be assessed independently of health assistance programmes, ensuring that national economic interests are not compromised. In their statement, the coalition invokes the Zambian Constitution and the Access to Information Act No. 24 of 2023, along with its implementing regulations, to demand greater transparency in the negotiation and execution of international agreements.

Among the coalition's demands is also the creation of a government plan for compliance with access to information legislation, including the regular publication of official documents, improvements to archiving systems, and the setting of deadlines for responding to citizens' requests. The groups emphasise that they do not contest the importance of US financial assistance to the functioning of Zambia's health system, but consider it essential to know the conditions attached to the disbursement of those resources.

The transparency demand comes against a backdrop in which Washington is seeking to reshape the mechanisms of health cooperation with African countries through bilateral agreements that foresee growing financial participation from recipient governments. For Zambia's civil society, the full disclosure of the agreement represents an important condition for reinforcing public oversight, protecting national interests, and ensuring that resources earmarked for health are applied in a transparent and accountable manner.