By Dr.Thenjiwe Sisimayi, Gender Advisor at Financing Alliance for Health
1. Reframing International Women’s Day
International Women’s Day should not only be a celebration of women’s resilience.
It should be a financing accountability moment. If we are serious about women’s health and leadership, then we must follow the money. Because empowerment without financing is symbolism. And symbolism does not reduce maternal mortality, close gender gaps, or strengthen primary health care.
The real question is not whether we value women. The real question is: Are we financing the systems that sustain them?
2. PHC Is the Gender Equity Engine - If We Finance It
Primary Health Care is where gender equity either advances — or stalls. Nearly 90% of essential health services across the life course can be delivered at the PHC level. This is where women access antenatal care, family planning, cervical cancer screening, mental health support, and chronic disease management. For most women, PHC is the health system.
It is also where women work.
Globally, women make up about 70% of the health and social workforce, yet they hold only around 25% of senior leadership roles. At the frontline, especially in community health, women form the backbone of prevention and last-mile delivery. In many countries, however, they remain underpaid, unpaid, or informally contracted. That is not a labour issue alone. It is a financing architecture issue.
When PHC is underfunded:
- Maternal mortality reduction slows.
- Preventive services weaken.
- Female health workers subsidize the system through invisible labor.
- Gender strategies remain policy commitments without fiscal backing.
If we underfinance PHC, we are effectively institutionalizing gender inequity into the health system’s foundation. But when we finance PHC properly, the returns are extraordinary. Evidence consistently shows that investments in PHC generate some of the highest returns in health spending, improving productivity, preventing costly hospitalizations, and strengthening system resilience
Financing PHC is a macroeconomic strategy. It is not just a health reform. It is a structural gender reform.
3. The Financing Lens: What Must Change.
If we want transformation, we must shift three financing levers:
- First: Budget Design.
Gender integration must move from narrative to allocation. National health budgets should clearly reflect investments in maternal health, community health remuneration, supervision systems, and gender-responsive service delivery. What is not costed is not prioritized.
- Second: Fiscal Space and Protection.
Women-centered services are often the first to be squeezed in constrained fiscal environments. We need deliberate protection of PHC allocations—especially preventive and community-based services that disproportionately benefit women and girls. Expanding fiscal space for PHC is not optional; it is foundational to UHC.
- Third: Strategic Purchasing.
How we pay determines what we value. Payment systems should reward quality, continuity, and equity, not just volume. Performance frameworks must include gender-responsive indicators. Financing mechanisms should incentivize integration of services that women actually use across the life course.
This is where catalytic partners, global health funds, bilateral agencies, and philanthropic institutions, can accelerate reform. By aligning financing with domestic budget reforms and accountability mechanisms, external funding can crowd in sustainable national investment rather than substitute for it.
Gender equity will not be achieved through standalone programs. It will be achieved when gender is embedded in the financial architecture of PHC systems.
4. Accountability and Leadership
Financing women in PHC is not charity. It is smart economics.
Investing in frontline systems improves productivity, reduces preventable mortality, and strengthens resilience against shocks. It yields social and economic returns that compound over time. But accountability is essential. We must track not only outputs, but whether funds reach the frontline where women both serve and seek care. International Women’s Day should challenge us to ask:
- Where are the resources flowing?
- Who controls them?
- And who ultimately benefits?
5. If we truly believe in gender equality, then we must finance it.
If we truly believe in gender equality, then we must finance it.
Financing women in Primary Health Care means financing healthier families, stronger economies, and more resilient health systems.
- It means moving beyond rhetoric to reform.
- Beyond celebration to allocation.
- Beyond statements to structural change.
This International Women’s Day, let us commit to funding the frontline because that is where gender equality becomes real.
