Are rhetorical commitments to adolescents reflected in planning documents? An exploratory content analysis of adolescent sexual and reproductive health in Global Financing Facility country plans

Abstract

Background The Global Financing Facility (GFF) offers an opportunity to close the financing gap that holds back gains in women, children’s and adolescent health. However, very little work exists examining GFF practice, particularly for adolescent health. As momentum builds for the GFF, we examine initial GFF planning documents to inform future national and multi-lateral efforts to advance adolescent sexual and reproductive health. Methods We undertook a content analysis of the first 11 GFF Investment Cases and Project Appraisal Documents available on the GFF website. The countries involved include Bangladesh, Cameroon, Democratic Republic of Congo, Ethiopia, Guatemala, Kenya, Liberia, Mozambique, Nigeria, Tanzania and Uganda. Results While several country documents signal understanding and investment in adolescents as a strategic area, this is not consistent across all countries, nor between Investment Cases and Project Appraisal Documents. In both types of documents commitments weaken as one moves from programming content to indicators to investment. Important contributions include how teenage pregnancy is a universal concern, how adolescent and youth friendly health services and school-based programs are supported in several country documents, how gender is noted as a key social determinant critical for mainstreaming across the health system, alongside the importance of multi-sectoral collaboration, and the acknowledgement of adolescent rights. Weaknesses include the lack of comprehensive analysis of adolescent health needs, inconsistent investments in adolescent friendly health services and school based programs, missed opportunities in not supporting multi-component and multi-level initiatives to change gender norms involving adolescent boys in addition to adolescent girls, and neglect of governance approaches to broker effective multi-sectoral collaboration, community engagement and adolescent involvement. Conclusion There are important examples of how the GFF supports adolescents and their sexual and reproductive health. However, more can be done. While building on service delivery approaches more consistently, it must also fund initiatives that address the main social and systems drivers of adolescent health. This requires capacity building for the technical aspects of adolescent health, but also engaging politically to ensure that the right actors are convened to prioritize adolescent health in country plans and to ensure accountability in the GFF process itself.

Any better? A follow-up content analysis of adolescent sexual and reproductive health inclusion in Global Financing Facility country planning documents

“…The GFF grant acts as an incentive for governments to prioritise RMNCAH-N in the credit or loans provided by the World Bank and signed for in Project Appraisal Documents (PADs) [ 8 ]. As per the previous work done by George et al [ 13 ], this study applied the same data collection tools and method of analysis and advances it by noting and describing how these aspects of planning documents are linked to country contexts.…”

“…Data were extracted using the same template and methods applied in the prior analysis of adolescent health (Supplementary file 1) [ 13 ]. Specific search terms were applied, and information gathered using a template to assess the placement and emphasis of adolescent-specific content in documents.…”

“…Comparative analysis of global health initiatives, including GFF, [FGH study] has led to recognition of the importance of further learning about policy and financing effects of donor assistance [ 12 ]. George et al [ 13 ] examined how commitments to adolescent health made by the GFF at global level translated into plans for the first 11 GFF partner countries through a content analysis of GFF country-level planning documents: investment cases (ICs) and project appraisal documents (PADs). George et al [ 13 ] found examples of adolescent health inclusion, especially relating to teenage pregnancy.…”

“…George et al [ 13 ] examined how commitments to adolescent health made by the GFF at global level translated into plans for the first 11 GFF partner countries through a content analysis of GFF country-level planning documents: investment cases (ICs) and project appraisal documents (PADs). George et al [ 13 ] found examples of adolescent health inclusion, especially relating to teenage pregnancy. However, discrepancies were evident between countries.…”

How gender is socially constructed in policy making processes: a case study of the Adolescent and Youth Health Policy in South Africa

“…This emphasises that categorical and binary understandings of gender are now inadequate and these can lead to zero-sum arguments for competing agendas and resources, and so diluted efforts to advance gender equality [5]. Moreover, the findings highlights the tensions in addressing gender in policy and programmes and that 'gender work' is both technical, but also about power and hence deeply political work [12,14,[58][59][60][61]. This talks to some of the global debates and paradigm shifts that have taken place over time from Women in Development (WID) to Gender and Development (GAD) approaches [10,62,63] as well as the overall challenges related to mainstreaming of gender.…”