Faced with a cervical cancer crisis and zero infrastructure, Zambia launched a "build-while-doing" program in 2006. By empowering nurses to perform screenings and integrating services into HIV clinics, the country bypassed specialist shortages to reach over 1.5 million women. This success was solidified by traditional leaders who championed local uptake. Zambia's model demonstrates that life-saving health scale is possible even under severe resource constraints.
In the early 2000s, Zambia like many African countries, faced a stark reality: cervical cancer prevention barely existed. This realization was amidst a growing burden of cervical cancer morbidity and mortality and with HIV driving a surge of cervical disease. A rapid assessment at the national referral hospital showed that nearly four decades after independence, only around 10,000 women had ever been screened, there was almost no oncology workforce, and a single cytology technician served a population of 12 million. The burden was high, and the system was unprepared
What Zambia chose to do next has made them an example for other countries in the region.
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Rather than waiting for a complete system, a full workforce pipeline, or dedicated financing, the Ministry of Health and partners acted. In 2006, they created what would become the Cervical Cancer Prevention Program in Zambia (CCPPZ), starting small and refining the approach as they went. From the beginning, the program was intentionally pragmatic, targeting high-volume and HIV clinics with low-cost screening tests. The program also leveraged the workforce, task-shifting cervical screening and management to committed nurses, rather than relying on scarce specialists--an early decision that has made Zambia a reference in cervical cancer management on the continent.
The build-while-doing approach has continued to scale: by 2011, more than 56,000 women had been screened through CCPPZ; by 2013, among those offered screening services, uptake was up to 95%, and by 2019 the more accurate HPV DNA screening had been introduced and incorporated into cervical screening protocols across Zambia's 10 provinces. Today, government reports estimate that more than 1.5 million women in Zambia have been screened at least once, reflecting a scale and consistency that few countries in the region have achieved, enabled by the government's model of locally committing staff and infrastructure while drawing on partner support for inputs like Human Papillomavirus (HPV) screening tests and treatment devices.
But the targeted infrastructure and workforce efforts alone does not explain why women come. From the outset, Zambia treated community engagement as intrinsic, prioritising engagement and collaboration with traditional and community leaders who were recruited as early advocates, shaping messages in language that resonated locally. In districts like Chongwe, Senior Chieftainess Nkomeshya Mukamambo II, leader of the Soli people, has been a visible champion for cervical cancer prevention; with her grand-daughters receiving the first HPV vaccination doses when roll-out began in 2013. Her public support of HPV vaccination and cervical screening, standing alongside health workers successfully raised awareness and signalled strongly that the service belongs to the community, not just the clinic.
Taken together, these choices re-imagine the building of a program. And for countries across Eastern and Southern Africa, especially as fiscal space for health tightens, Zambia's experience is less a template than a way of thinking. Progress does not come from ideal conditions. It comes from refusing to wait, from shaping the systems you know to fit the lives of the women they are meant to serve, and from designing services around real constraints instead of waiting for them to disappear.
That was the spirit behind the World Bank's Regional Study Tour to Zambia from the 12-15th of November 2025. Ministry of Health Delegates from across eight Eastern and Southern Africa countries observed the cervical screening journey and met with health workers and community leaders; not to celebrate a perfect model, but to understand how a country moved from almost no screening to millions of women reached. Countries participating included Eswatini, Ethiopia, Kenya, Uganda, Burundi, the Democratic Republic of Congo, Mozambique, and Tanzania
Delegates observed and learned how strong community structures facilitated screening uptake, despite systemic constraints. Community mobilization was robust, driven by organized women's groups, traditional leaders, and proactive community health workers. These actors played critical roles in raising awareness, dispelling myths, and encouraging women to participate in both facility-based and outreach screening activities.
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We are going to take this knowledge and implement it in our country where it can assist lots of women that require it.
Dr. Bisrat Fantaye Ministry of Health Ethiopia
Community engagement also helped compensate for infrastructure and logistical gaps, enabling continuity of services. Follow-up was communicated and coordinated through community health workers and primary facilities. Although persistent challenges continue to constrain screening quality and follow-up treatment, the Zambia experience provides valuable insights into adaptive capacity and service delivery under resource-constrained conditions.
This feature was written by Xiaohui Hou, Senior Economist, Health Nutrition and Population, Eastern and Southern Africa, World Bank, and Dr. Karima Chiuri, Consultant, Health Nutrition and Population, Eastern and Southern Africa, World Bank
