Constituency Development Fund Investments in Primary Health Care: Stakeholder Perspectives from Lufwanyama District, Zambia
Abstract:
Zambia's Constituency Development Fund (CDF) provides a decentralised mechanism for financing local priorities, including projects that affect health service delivery. This qualitative single-case study explored stakeholder perspectives on the contribution of CDF investments to primary health care (PHC) in Lufwanyama District, Zambia. It examined stakeholders' understanding of CDF, their participation in implementation processes, and perceived factors that enable or constrain the contribution of Constituency Development Fund investments to Primary Health Care service delivery. In July 2026, 40 purposively selected participants from the local authority, District Health Office, health facilities and community structures took part in semi-structured key-informant and in-depth interviews. Relevant documents were also reviewed, and the data were analysed thematically using deductive and inductive procedures. Participants viewed CDF investments as important service-enabling inputs, particularly facility infrastructure, staff accommodation, maternity spaces, water and sanitation, ambulances, roads, facility rehabilitation and selected equipment. These investments were perceived to improve access, facility readiness and referral systems. Stakeholder-perceived enablers included timely funding, coordination, technical appraisal, community participation, monitoring, alignment with district health priorities and recurrent health-system support. Delayed implementation, procurement challenges, weak coordination, uneven feedback, staffing gaps, medicine shortages and limited recurrent support constrained the translation of completed projects into day-to-day PHC services. CDF should therefore be understood as an enabling financing pathway rather than a complete service-delivery intervention. Its contribution to PHC could be strengthened through alignment with district health priorities, technical review, recurrent health-system inputs, functionality-based monitoring and clearer community feedback and accountability mechanisms.References:
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