The construction industry in Zambia plays a crucial role in economic and health sector development but frequently encounters significant cost overruns. This study examines the factors contributing to these overruns and evaluates the effectiveness of current cost control mechanisms, focusing on the construction of first-level hospitals in Lusaka. The objective is to improve project cost management, reduce financial inefficiencies, and ensure timely project completion.A mixed-methods approach was utilized, engaging 100 participants through convenience sampling. Data collection involved structured questionnaires and semi-structured interviews, supplemented by secondary data from company publications. Qualitative data were analyzed using thematic content analysis, and quantitative data were processed with SPSS version 22, employing both descriptive and inferential statistics.The significance of Zambia's building industry for economic and health sector growth is undeniable, yet many projects, particularly in health, fail to meet cost objectives. Effective cost management is critical to addressing these challenges. This study specifically investigates cost overruns in Lusaka's first-level hospital construction projects. A diverse group of 100 participants, both male and female with various employment backgrounds, was selected. Data collection methods included structured questionnaires and semi-structured interviews, with secondary data from company publications. Thematic content analysis was used for qualitative data, and quantitative data analysis employed SPSS version 22, focusing on descriptive statistics like percentages, frequencies, means, and standard deviations. Results will be presented using tables, bar charts, and pie charts. Recommendations and conclusions will be given in the report.