Introduction
Gender inequality remains a significant global challenge, particularly in healthcare access, where women and girls face structural and socio-cultural barriers. Despite the Alma-Ata Declaration of achieving Universal Health Coverage (UHC) through Primary Health Care (PHC), disparities persist, with the COVID-19 pandemic exacerbating gender inequalities, and increasing risks like sexual and gender-based violence. PHC systems often overlook women’s unique needs, including mobility and resource constraints, contributing to inequities in service delivery. Gender-responsive budgeting (GRB) is crucial for addressing these challenges by ensuring equitable resource distribution and improving access to quality PHC (A Guide to Gender-Responsive Budgeting, n.d). Integrating GRB into health planning, as seen in countries like Rwanda and South Africa, can transform public health systems and promote inclusive health development, particularly for vulnerable populations.
Ghana’s Health Budgeting
In Ghana’s health sector, government spending has consistently fallen short of international commitments like the Abuja Declaration, which recommends allocating at least 15% of the national budget to health. This has led to underfunding critical areas such as PHC. Gender-responsive budgeting has been introduced but remains in its early stages, with inconsistent implementation across sectors. Prioritizing gender equity in budgeting processes could greatly improve PHC and health outcomes for vulnerable populations, especially women and girls in underserved areas.
Gender-Responsive Budgeting: Rwanda and South Africa’s Case
Since its introduction in 2008, GRB has improved primary health care in Rwanda by ensuring budget allocations address the different needs of men and women, especially in health services. The Rwandan government implemented GRB as part of its commitment to gender equality, with the Ministry of Finance issuing guidelines to integrate gender considerations into budget planning across multiple sectors. This approach has led to significant health improvements, such as a dramatic reduction in maternal mortality rates and a halving of adolescent fertility rates, highlighting the positive impact of GRB on women’s health outcomes.
In South Africa, GRB has become a key tool for addressing gender inequalities in PHC. Despite progress since the end of apartheid, significant gender-based disparities in health outcomes and access remain, which GRB aims to address through frameworks like the Gender Responsive Planning, Budgeting, Monitoring, Evaluation, and Auditing Framework (GRPBMEAF). GRB has increased awareness of women’s specific health needs (Advancing Gender Responsive Budgeting in South Africa, n.d.), improved transparency and accountability in health spending, and enhanced capacity for gender analysis within government departments (Combaz, 2013), contributing to better maternal care, reproductive health services, and responses to gender-based violence.
The Role of Gender-Responsive Budgeting in Primary Health Care
Gender disparities in access to health services can significantly impact health outcomes, particularly for women and children. GRB addresses these disparities by allocating resources to health programs that benefit women and children, as seen in South Africa, where GRB has increased funding for reproductive and maternal health services, improving health outcomes and reducing economic strain on families (Sharp, 2003).
Benefits of GRB in Improving Health Outcomes
Promoting Economic and Social Equity through GRB
Integrating GRB into national and sub-national health budgets promotes social equity by directing resources to underserved populations and addressing specific community needs, such as maternal health facilities and accessible transportation. In Rwanda, GRB has increased women’s access to health services by providing vocational training and enhanced economic resilience, leading to improved health outcomes and greater social equity for women (Budlender & Hewitt, 2003).
Enhancing Public Health Services with Infrastructure Improvements through GRB
GRB supports direct health interventions and drives improvements in health-related infrastructure, addressing gender-specific needs to enhance access to health services. In Kampala, Uganda, integrating GRB principles into urban planning improved transportation options for women, making it easier for them to access essential healthcare services (Mukhopadhyay & Singh, 2007). These practices illustrate how GRB can create a more inclusive health system by tackling the logistical barriers that disproportionately affect women’s healthcare access.
Fostering Sustainable Health Development
By ensuring equitable resource distribution, GRB aligns with the principles of sustainable development and contributes to health systems resilience. GRB will ensure that development initiatives consider the contributions and needs of both genders, fostering a balanced approach to health care provision. In Morocco, the government implemented GRB to improve transparency in public finance management, leading to a more equitable distribution of resources across health, education, and social services (OECD, 2016). This approach has strengthened governance and supported sustainable health practices, as resources are allocated in ways that consider long-term population health outcomes.
Strengthening Governance and Accountability
Implementing GRB in the health sector will promote transparency and accountability in budgetary decisions, as it highlights the differentiated impacts of health budget allocations on men and women. This visibility will allow policymakers to make data-driven, equitable decisions that align with broader health objectives. GRB encourages participatory governance, which includes communities and stakeholders in the budgetary process, fostering a sense of shared responsibility and trust. In South Africa, gender-based budgeting has contributed to better tracking of health expenditures, improving transparency and ultimately leading to better health outcomes for underserved populations (Sharp, 2003).
Enhancing Human Development Through Health and Education
One of the greatest advantages of GRB is its contribution to human development. It emphasizes the importance of investing in health, education, and social services that support women and girls. Health investments through GRB improve access to maternal care, vaccinations, and preventive services, which have long-term benefits for society. Ghana has already seen the positive impacts of GRB in the education sector, where gender-sensitive budgeting has funded scholarships, school facilities, and sanitation improvements, leading to higher school enrollment rates for girls (UNICEF, 2019). Applying GRB principles in the health sector can further promote human development by enhancing health outcomes for women which in turn fosters community well-being.
Conclusion
GRB represents a transformative opportunity to enhance the accessibility and quality of PHC in Ghana. By addressing gender disparities and targeting resources to meet the distinct health needs of men and women, GRB aligns with global aspirations for equity and sustainability in health systems. The experiences of countries like Rwanda and South Africa underscore the significant potential of GRB to reduce maternal mortality, improve health indicators, and foster economic and social equity. To fully realize the benefits of GRB in the health sector, Ghana must prioritize the integration of gender-sensitive planning into its budgeting processes. This effort will contribute to a more inclusive and resilient health system, advancing the nation’s progress toward Universal Health Coverage and sustainable development goals. Ultimately, GRB is not merely a financial tool but a commitment to inclusive growth and the empowerment of all individuals to achieve their full potential.
References
A Guide to Gender-Responsive Budgeting. (n.d.). Oxfam Policy & Practice. https://policy-practice.oxfam.org/resources/rough-guide-to-gender-responsive-budgeting-620429/
Dept, I. M. F. A. (2017). Staying the Role Model: Advancing Gender Equality in Rwanda1. IMF Staff Country Reports, 2017(214). https://doi.org/10.5089/9781484309889.002.A002
Advancing Gender Responsive Budgeting in South Africa. (n.d.). PFM. https://blog-pfm.imf.org/en/pfmblog/2021/10/advancing-gender-responsive-budgeting-in-south-africa
Combaz, E. (2013). Helpdesk Research Report Impact of gender-responsive budgeting. http://gsdrc.org/docs/open/hdq977.pdf
