By Thenjiwe Sisimayi
International Women’s Day (IWD) must become more than a symbolic reaffirmation of commitment to gender equality. It must function as a fiscal accountability checkpoint. Across Africa, policy commitments to gender equity in health remain strong. Yet the translation of these commitments into public financial management systems remains inconsistent.
Primary Health Care (PHC) represents the most critical platform for operationalizing gender equity. Nearly 90% of essential health services can be delivered at PHC level (World Health Organization [WHO] & UNICEF, 2018). Sub-Saharan Africa continues to account for approximately 70% of global maternal deaths (WHO, 2023). Meanwhile, women comprise roughly 70% of the global health and social workforce yet occupy a minority of senior leadership roles (WHO, 2019).
These outcomes are not solely clinical challenges. They are financing architecture challenges.
This paper highlights three gender-responsive budgeting (GRB) tools that governments can deploy to align PHC financing with gender equity objectives.
1. Gender Budget Tagging and Expenditure Tracking
Gender Budget Tagging (GBT) integrates gender markers within budget classification systems to track allocations contributing to gender equality outcomes (UN Women, 2015). In PHC systems, this enables governments to monitor investments in:
- Maternal and reproductive health
- Community health worker (CHW) remuneration
- Preventive and outreach services
- Adolescent girls’ health services
Countries including Rwanda and Uganda have implemented gender budgeting frameworks that allow systematic reporting on gender-related expenditures. When linked to PHC reforms, such as Rwanda’s performance-based financing and community health insurance expansion, measurable improvements in maternal and child health outcomes followed (Basinga et al., 2011).
2. Gender-Responsive Medium-Term Expenditure Frameworks (MTEFs)
MTEFs link policy priorities to multi-year budget ceilings. Integrating gender-disaggregated targets within MTEFs ensures sustained financing for PHC services essential to women’s health.
Rwanda’s multi-year financing alignment around PHC reforms coincided with a decline in maternal mortality exceeding 75% between 2000 and 2020 (WHO, 2023). While context-specific, this illustrates how predictable financing aligned with PHC delivery structures can accelerate progress.
Embedding maternal mortality reduction targets, contraceptive prevalence rates, and CHW professionalization within MTEFs enhances accountability and sustainability.
3. Gender-Sensitive Strategic Purchasing
- Incentivize antenatal and postnatal care completion
- Reward integrated reproductive health services
- Formalize CHW compensation structures
- Adjust capitation rates to reflect higher service utilization by women of reproductive age
Gender-responsive budgeting strengthens allocative efficiency, enhances transparency, and operationalizes Universal Health Coverage commitments. International Women’s Day should catalyse fiscal reforms that embed gender within PHC financing systems. Financing women in PHC is not charity. It is macroeconomic and human capital investment.
References
- Basinga, P., et al. (2011). Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: An impact evaluation. The Lancet, 377(9775), 1421–1428.
- UN Women. (2015). Training manual on gender-responsive budgeting.
- WHO. (2010). Health systems financing: The path to universal coverage.
- WHO. (2019). Delivered by women, led by men.
- WHO. (2023). Trends in maternal mortality 2000–2020.
- WHO & UNICEF. (2018). Primary health care: Transforming vision into action.
