Surveillance as a governance imperative: Renewing Zambia's commitment to non-communicable disease risk factor monitoring

Abstract

Background: Non-communicable diseases (NCDs) pose a severe threat to public health in Zambia, accounting for approximately 30% of all national deaths. Historically, data-driven responses have been hindered by weak surveillance systems and the prioritization of acute communicable diseases. While the inaugural 2017 World Health Organization (WHO) STEPwise Approach to NCD Risk Factor Surveillance (STEPS) survey established a critical baseline, effective long-term governance requires continuous monitoring to capture evolving trends.

Objectives: This editorial highlights the strategic importance of Zambia’s second national STEPS survey, launched in April 2026, as a governance imperative for evaluating current health milestones and shaping future national health frameworks.

Discussion: The 2017 baseline data revealed a stark NCD burden, including low fruit and vegetable consumption (90.4%), overweight/obesity (24.4%), and a heavy clustering of risk factors, particularly among urban populations, women, and older adults. Since then, rapid urbanization, changing diets, and the emergence of unregulated novel nicotine products (e.g., e-cigarettes and shisha) have shifted the epidemiological landscape. The 2026 survey, targeting 5,762 adults across all ten provinces, arrives at a critical juncture. It coincides with World No Tobacco Day 2026 ("Unmasking the Appeal") and marks the final year of Zambia's National Health Strategic Plan 2022–2026, making the data essential for replacing assumptions with evidence in the next strategic planning cycle.

Conclusion: The 2026 STEPS survey represents a vital step forward for the Zambia National Public Health Institute (ZNPHI) and the Ministry of Health. However, the ultimate utility of this surveillance exercise depends entirely on the rapid, widespread, and accessible dissemination of its findings to frontline clinicians, policymakers, and community health workers to successfully drive the next decade of Zambia's NCD response.