By: Maya Hayakawa and Thenjiwe Sisimayi
As countries shape their GC8 proposals, there is no shortage of ambition. Priorities are clear. Data is available. Commitments to equity and inclusion are strong.
But there is one place where all of this is truly tested: the budget.
Because at the end of the day, budgets tell the real story. They reveal what is prioritized, who is reached, and whether health systems will deliver impact—or fall short.
The Global Fund’s Eighth Replenishment closed at US$12.64 billion. From that, around US$10.78 billion has been approved as country allocations for the 2026–2028 period. And those allocations are already stretched across three epidemics: US$10.783 billion split as US$5.278 billion for HIV, US$1.964 billion for TB, and US$3.540 billion for malaria.
At the same time, GC8 is being shaped in an era of tightening fiscal space and shrinking external support. One Donor Tracker analysis forecasts that by 2026, development assistance from the top ten sovereign donors for RMNCH-N is expected to fall by at least 34%, from US$8.4 billion in 2023 to US$5.5 billion. In other words, the external cushion many countries have relied on is thinning, fast
This is why gender-responsive health financing is not a “nice to have” in GC8. It is a make-or-break determinant of whether the money on paper turns into lives saved in reality.
Where ambition often breaks down: the budget translation problem
Across many countries, gender is already recognized as important. It appears in national strategies, funding requests, and policy commitments. Yet when proposals are translated into budgets, something often gets lost.
- Gender is mentioned but not costed
- Barriers are acknowledged but not financed
- Equity is emphasized but not targeted
The result? Programs that are technically sound, but struggle to reach the people who need them most.
This is where gender-responsive health financing becomes essential not as an add-on, but as a way to ensure that investments actually deliver results.
The most underused opportunity in GC8: Matching Funds
One of the most strategic levers in GC8 is also one of the most misunderstood: Matching Funds.
Matching Funds are incentive-based resources designed to push countries toward specific priorities that the Global Fund considers essential for impact in a constrained environment. Importantly, they do not arrive automatically. They are awarded when countries meet financial and programmatic conditions, and they require countries to align their own allocation investments accordingly.
That is why Matching Funds matter for gender. They create a moment where countries can move from broad equity language to hard, costed decisions — because funding becomes conditional on doing so.
GC8 includes six Matching Funds priority areas: integrated community and health services for women and children; social contracting; integrated HIV prevention; digital solutions supporting integration; public financial management; and addressing human rights and gender barriers. If a country is serious about gender equity, these areas are not “extra.” They are the roadmap.
One Matching Fund stands out as a direct signal of strategic intent: Equitable, Resilient Integrated Community & Health Services for Women & Children.
The Global Fund has earmarked US$106 million for this Matching Fund, across 24 eligible countries. This is not symbolic. It is a financing instrument designed to reward countries for building integrated service delivery models that work for women and children across the life course — not just for disease programmes in isolation.
We already see how structural inequalities shape epidemic outcomes. The Global Fund notes that adolescent girls and young women in sub-Saharan Africa remain disproportionately affected by HIV, with prevalence three times higher than adolescent boys and young men, despite improvements. If budgets do not deliberately target women and girls — including through integrated delivery platforms — the result is not just unfair. It is ineffective.
This is where Matching Funds become strategic. They create a pathway for countries to finance what is often politically acknowledged but fiscally neglected: barrier removal, integrated delivery, community access, and rights-based services.
So what does this mean in practice?
Gender-responsive budgeting is not about creating separate budgets for women. It is about asking better questions and using the answers to shape how resources are allocated.
Three simple questions can make a significant difference:
- Who is being prioritized in the budget?
Are resources reaching the populations most affected women, adolescent girls, and key populations? Or are they distributed evenly in ways that overlook real disparities? - What barriers are being financed to be removed?
It’s not enough to fund services. Many people cannot access them due to costs like transport, stigma, or time away from work. Are these realities reflected in the budget?
- How will funds actually reach those most in need?
Do financing mechanisms support outreach, community-based delivery, and continuity of care? Or do they assume people will come to facilities on their own?
If these questions are not answered clearly, even well-designed programs may underperform.
What “good” can look like
Countries that are getting this right are not necessarily spending more they are spending more deliberately.
For example:
- Community health systems are funded properly, including fair remuneration and support for community health workers, many of whom are women
- Gender-based violence services are integrated into health programs, with dedicated funding not treated as optional add-ons
- Access barriers are addressed directly, through transport support, peer navigators, or community outreach
These are practical choices that make services more reachable, more relevant, and ultimately more effective.
Common pitfalls to watch for
Even with the best intentions, some patterns tend to repeat:
- Strong gender analysis in the narrative, but no reflection in the budget
- Reliance on “mainstreaming” without allocating dedicated resources
- Limited attention to the realities of the health workforce
- No explicit financing of access barriers
- Broad commitments to equity without clear targeting
Recognizing these early can help strengthen proposals before they are finalized.
A shift in mindset
One of the most important shifts is this:
Gender is not just a social consideration; it is a determinant of whether health financing works.
When financing decisions take gender into account, resources are more likely to reach those with the greatest need. When they don’t, gaps persist no matter how strong the overall investment.
As you finalize your GC8 proposal
A simple check can go a long way:
- Are gender gaps clearly identified?
- Are they translated into costed interventions?
- Are resources allocated to reduce real-world barriers?
- Will monitoring track who is actually being reached?
If the answer to these is yes, your proposal is not only equitable, it is also more likely to deliver impact.
Final thought
Countries are not starting from scratch. Many already have the data, the policies, and the commitment needed to advance gender equality in health.
The opportunity with GC8 is to ensure that these commitments are fully reflected in financing decisions.
Because ultimately, if a priority is not visible in the budget, it is unlikely to be implemented. And if it is not implemented, it will not change outcomes.
This article was originally published on Financing Alliance for Health
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