Zambia’s government says it is now comfortable with a revised five-year health agreement with the United States and expects to sign it on October 8 after negotiators removed compulsory biological-specimen transfers and individual patient-data sharing requirements.

The United States will provide $1.5bn over five years, while Zambia has committed about $2.1bn in domestic co-financing under the agreement, Lusaka Times reported on October 6, citing Health Minister Roma Chilengi.

“As we speak now, we are completely aligned,” Chilengi said. “We are completely comfortable with the MOU that has been finalised now.”

Zambia suspended signing earlier this year while officials renegotiated provisions considered unacceptable by Lusaka, delaying completion of an agreement expected to provide substantial external financing for Zambia’s health system.

Chilengi said the original draft would have required Zambia to send specimens collected through its disease-surveillance system to the United States. That requirement has now been removed.

Requirements to share individual patient data have also been removed. Data sharing will remain limited to information required to monitor and evaluate programmes financed under the agreement.

Zambia also sought safeguards covering intellectual property and benefit sharing where research involving its health resources results in medicines or vaccines, as well as provisions supporting capacity building and skills exchange between Zambian and US scientists.

The Ministry of Health has said the partnership will cover HIV, tuberculosis, malaria, maternal and child health, disease surveillance and broader health-system strengthening.

Under the proposed agreement, US funding would decline annually while Zambia progressively raises domestic health expenditure to sustain those services as external support tapers.

Earlier negotiations had also become linked to discussions over critical minerals, but Foreign Affairs Minister Mulambo Haimbe said in September that Washington had agreed to separate the two tracks. Chilengi said the final health memorandum contains no reference to critical minerals.

“The MOU itself was broadly unpopular because it had clauses that were uncomfortable to ourselves,” Chilengi said, adding that repeated technical negotiations were required before agreement was reached.

He said the disagreements had not damaged relations with Washington.

“The US government are our biggest supporter to the health sector, and they are a very cherished partner to the health sector in this country,” Chilengi said.

The revised agreement has not ended calls for greater transparency. Opposition Democratic Progressive Party leader Antonio Mwanza has urged the government to publish the final memorandum before signing so that its financing, data-sharing and performance obligations can be independently scrutinised. Civil-society groups had raised similar concerns during earlier negotiations over data sovereignty, accountability and the attempted linkage between health funding and critical minerals.

Local media meanwhile reported Chilengi as saying the government does not intend to publish the MoU after signature, arguing that publication of government memoranda is not established practice.

William Moss, executive director of the International Vaccine Access Center at Johns Hopkins Bloomberg School of Public Health, argued during the earlier negotiating impasse that any reduction in US support for Zambia’s HIV, malaria and vaccination programmes should be gradual and planned.

Attention will now shift to implementation and Zambia’s domestic financing commitments. Zambia is expected to commit about $2.1bn in co-financing as US contributions decline over five years, making the annual domestic spending schedule an important measure of whether the country can preserve US-backed programmes while shifting towards greater national financing of essential health services.