Impact of COVID-19 on neglected tropical diseases in Zambia: a qualitative study of stakeholder perspectives

BACKGROUND: Neglected tropical diseases (NTDs) remain a major public health challenge in Zambia and other low‑ and middle‑income countries, and there is concern that the COVID‑19 pandemic has further disrupted progress towards control and elimination targets. This study explored how COVID‑19 affected NTD programmes, funding, and partnerships in Zambia from the perspective of national‑level stakeholders. METHODS: We conducted a qualitative case study using semi‑structured interviews with key informants involved in NTD policy, programming, or surveillance in Zambia. Fourteen participants were purposively sampled from government ministries, the Zambia National Public Health Institute, international organisations, and academia. Interviews were conducted in person, audio‑recorded, transcribed verbatim, and anonymised. Data were analysed using inductive thematic analysis, with codes developed from the transcripts and iteratively grouped into themes through constant comparison. RESULTS: Five overarching themes were identified: (1) public health infrastructure; (2) disease prioritisation and surveillance; (3) resource allocation and funding challenges; (4) collaboration and partnerships; and (5) direct impacts of COVID‑19 on NTD activities. Participants reported that COVID‑19 exposed and intensified pre‑existing weaknesses in health system capacity, routine NTD surveillance, and financing, contributing to delays and reduced coverage of mass drug administration (MDA) and other interventions. Donor funding reallocation and the withdrawal or scaling back of some international partners created further uncertainty for NTD programmes, although various national institutions and the World Health Organization (WHO) helped sustain essential activities. At the same time, the pandemic period coincided with the strengthening of the Zambia National Public Health Institute and the development of updated NTD and One Health strategic plans. Stakeholders viewed these institutional changes as opportunities to build a more resilient NTD response. CONCLUSIONS: COVID‑19 disrupted NTD programmes in Zambia primarily by amplifying long‑standing structural vulnerabilities in funding, surveillance, and service delivery, rather than through complete programme collapse. Strengthening routine NTD data systems, securing more predictable domestic financing, operationalising One Health and NTD master plans, and building more resilient, locally owned partnerships will be essential to recover lost ground and protect NTD control efforts from future shocks.