Is the Glass Half-Full or Half-Empty? A Content Analysis of Adolescent Sexual and Reproductive Health in Global Financing Facility Country Plans

Abstract

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background</jats:bold>: The Global Financing Facility (GFF) offers an opportunity to close the financing gap that holds back gains in women, children’s and adolescent health is recognised as a key priority by the GFF leadership. However, very little work exists examining GFF practice. As momentum builds for the GFF, we examine the initial efforts of the GFF in addressing adolescent health.<jats:bold>Methods</jats:bold>: We undertook a content analysis of the first 10 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. <jats:bold>Results: </jats:bold> While several country documents signal understanding and investment in adolescent health 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. <jats:bold>Conclusion</jats:bold>: There are important examples of how the GFF supports adolescent health as a priority area. 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.</jats:p>

Global Financing Facility investments for vulnerable populations: content analysis regarding maternal and newborn health and stillbirths in 11 African countries, 2015 to 2019

“…A growing body of work has begun to independently examine the investment of the GFF [ 12–16 ]. George and colleagues examined GFF documents for 11 countries regarding adolescent sexual and reproductive health, revealing differences between countries and between the two main GFF country policy documents available, the investment cases (ICs) and project appraisal documents (PADs) [ 17 ].…”

Adolescent sexual and reproductive health for all in sub-Saharan Africa: a spotlight on inequalities

“…Finally, data is only useful if it is used to inform policies and programmes. In many places, the growing body of abundant epidemiologic information and findings from social and behavioural studies, do not feed into policy formulation, programme design or-as George et al have shown-in investment case development [22]. This must change.…”