Zambia is some way behind other countries in the study, with neither a Medium Term Expenditure Framework, nor established and functioning financial management systems at the national level for tracking sectoral expenditures in relation to budget. Public expenditure management is weak, and macroeconomic performance subject to concern which has resulted in failure to obtain renewed International Monetary Fund support for the country. This has already derailed achievement of the desired Highly Indebted Poor Countries (HIPC) completion point in 2003. Despite problems with macroeconomic performance, and a relatively high level of public expenditure as a proportion of Gross Domestic Product (GDP), the fiscal deficit is quite low, and there appear to be no expressed concerns at increasing inflows of external aid to support the budget, either as balance of payments or project support. In a context of such poor government expenditure management that parallel/additional systems have been established to track HIPC funding, the addition of funding from the Global Fund for AIDS, Tuberculosis and Malaria (GFATM) may not result in the same inefficiencies as in other countries, as the degree of harmonization is as yet limited. However, it does represent a move contrary to plans, both generally through the Framework for Harmonization in Practice, and sectorally as it relies on structures and procedures which are inconsistent with the Sector Wide Approach which cooperating partners in the health sector have signed up to. The interventions outlined in the GFATM proposal go beyond those included in the defined and costed Basic Health Care Package, yet no mention is made of the implications of this for the Zambian health system more generally.