Four Ways Countries and Communities are Working to Accelerate Health Equity for Women and Girls INTERNATIONAL WOMEN'S DAY 2023

While the last two decades saw progress in women and girls’ health, recent data and trends show that gains are stagnating and equity gaps in access to healthcare are widening.

But pockets of progress exist. A look at programs and policies in Global Financing Facility (GFF) partner countries shows what is working to close health equity gaps and accelerate progress in gender equality.

Health progress is stalling, highlighting equity gaps in access to health care for women, children and adolescents

  • A woman dies every two minutes during pregnancy and childbirth – with most deaths concentrated in low-income countries, highlighting equity gaps in access to healthcare.
  • A child or youth dies once every 4.4 seconds
  • The number of pregnant women and girls suffering from malnutrition has soared by 25% in the last two years
  • By 2030, there will be more than 89 million additional women and adolescents who will need access to contraceptives in GFF eligible countries (GFF)
  • At least 10 million unintended pregnancies among adolescents each year (GFF)

1. Investing more in community-centered health

Across GFF partner countries, investments in community-centered care helped deliver quality and affordable services to women and girls, especially in hard-to-reach communities.

For example, Cote d’Ivoire channeled more funding to primary health care across districts, strengthening the ability of community health facilities to deliver more and better services to women and girls.

“After giving birth, the midwives took good care of me and ensured that everything was fine . . . they advised my parents on how to take care of me and my baby at home. I am well cared for. “ —ZIALE NAOMIE, Cote d’Ivoire

Uganda offered financial incentives to primary health care providers to offer contraceptives and counseling. More than 1,000 community health workers were trained in adolescent and youth friendly services and community. In addition, youth advocates were trained in family planning. Now, more women and adolescents are visiting health facilities for their contraception needs.

In Burkina Faso, efforts to strengthen the health workforce are paying off. Regions that invested more in training community health workers in family planning and youth friendly services saw the largest increase in contraceptive prevalence rate, compared to other regions in the country.

"After receiving training on family planning, I am now better placed to advocate for young people’s health to ensure they have a favorable environment to access quality youth friendly services. As a result of this advocacy, the district decided to allocate drugs and designate a health worker to the youth center. “ —Specioza Nayiga, Youth Representative, District Committee of Adolescent Health (DICAH), Wakiso, Uganda

2. Protecting women and adolescents thought legal reforms

Reforming harmful laws and norms that hinder women’s and girls’ choice, access, voice and agency over their own health can help close equity gaps.

Take Cameroon, for example, where the teenage pregnancy rate is the highest in Central Africa but for many decades, pregnant girls were not allowed to stay in school, resulting in high dropout rates. In collaboration with the GFF, the World Bank and other partners, the government amended a national regulation allowing pregnant girls to remain in school –a step towards closing gender gaps and protect the health and well-being of adolescent girls, shielding pregnant girls against discrimination and social stigmatization.

Left: School Girls in Cameroon © Odilia Hebga / World Bank. Center and right: Young women during a community health worker visit in Niger © Olivier Girard / World Bank

Niger is spearheading a similar effort. As part of the government’s commitment to create more equitable and gender-oriented health and social systems, changes to national laws now allow married girls to access to family planning services without being accompanied by a parent or husband. Secondary-school-age girls can now attend school health clubs to receive comprehensive reproductive health information, helping them to better understand their health and their bodies.

3. Engaging youth for transformative change in health

Civil society and youth advocates are crucial in ensuring that the most hard-to-reach communities have a say in shaping health investments to drive equitable health outcomes.

Open day with adolescents to discuss pregnancy care family planning, Kolda district, Senegal © ANJSRPF

With GFF support, youth advocates in Senegal set up a community social accountability mechanism that allows youth, health workers and community members to work together to ensure quality health services, including SRHR, can reach those most in need. Youth advocates led policy dialogue on health financing for sexual and reproductive health services. Within a year, young people went from not being part of the discussion to securing more funding for adolescent health, leading to the creation of safe spaces for adolescents, community dialogue around early marriage and facilities and equipment to benefit women and girls of reproductive age.

Through the Joint Learning Agenda initiative supported by the GFF, women-led organizations WACI Health (Kenya) and Impact Santé Afrique (Cameroon) have increased women’s participation in capacity building programs. In addition, the GFF’s country leadership program, in collaboration with Femleague works with female leaders in GFF partner countries to increase their voice in decision making within the health sector.

“The only way we can build efficient and sustainable health care systems for adolescents is through collective action and empowering young people to act. By working with partners, such as the GFF and the World Bank, we can place young people at the center of country efforts to build resilient health systems that can respond to adolescent needs.” —Aminata Badiane Thioye, Gender and Advocacy coordinator, National Alliance of Youth for Reproductive Health and Family Planning (ANJSRPF)

4. Strengthening registration systems for equal rights and protections

Strong national civil registration and vital statistics (CRVS) systems are a key tool to help combat child marriage and ensure women and girls have access to health and education benefits.

Many GFF partner countries are leading efforts to modernize CRVS systems. For example, DRC’s government is investing in catch-up campaigns in pre-primary and primary schools to ensure a legal identity for all children. Trained registration agents and electronic systems made registration efficient and simple both in urban areas and rural communities. As a result, nearly 2.5 million children were registered and 1.3 million issued birth certificates. With a birth certificate in hand, girls will have easier access to education, health and other social services, and a legal document that can protect them from early marriage and child labor. In Kenya, transformation of the CRVS system led to an 82% increase in birth registrations in 2021, giving thousands of newborn girls a fair opportunity to access their basic rights.

The GFF supports countries to strengthen data systems and indicators that call attention to persistent gender inequalities. A new partnership between the GFF and Johns Hopkins University Bloomberg School of Public Health - the Monitoring and Action for Gender and Equity (MAGE) initiative aims to equip decision makers with the gender data they need.