Submission ID 118459
| Issue/Objective | Adolescent sexual, reproductive, and mental health (ASRMH) is critical to health equity and sustainable development. Yet, in many low- and middle-income countries, ASRMH services are underfunded, fragmented, and deprioritized within national health budgets. Recent shifts in the global donor landscape, marked by reduced external funding and changing geopolitical priorities, have further highlighted the urgency of understanding funding sources, availability, and utilization at the primary healthcare (PHC) level. This study addresses this gap by examining the sources of ASRMH funding, how these resources are mobilized, and their use in service delivery in Burkina Faso, Ghana, and Niger. |
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| Methodology/Approach | This study employed a mixed-methods approach to examine the financing of ASRMH at the PHC level in Burkina Faso, Ghana, and Niger. A cross-sectional survey was conducted in 383 PHC facilities between August and December 2022 using multi-stage stratified sampling. Data on funding sources and expenditures were analyzed using STATA. Qualitatively, purposive sampling guided the selection of key informants and focus group participants, including policymakers, health managers, frontline workers and partners. Thematic content analysis explored patterns in resource availability, mobilization, and allocation. The study forms part of an IDRC/UK-MRC-funded regional initiative. |
| Results | From 2019 to 2021, over 70% of PHC facilities reported zero funding for ASRMH services, with Ghana showing the highest proportion (93-96%) lacking government or IGF allocations. Donor support, while higher in Niger and Burkina Faso, was inconsistent and unequally distributed, with some facilities receiving up to $20,821. Funding sources included government (≈70%), donors (25%), and IGF (≤10%). Qualitative interviews revealed that international donors-UNFPA, USAID, WHO-played a critical role in financing, though often dictated priorities. Resources were primarily used for outreach, education, contraceptives, and training. Health workers reported limited autonomy and resorted to personal funds, highlighting fragmentation and unpredictability in ASRMH financing across all countries. |
| Discussion/Conclusion | Fragmented and unpredictable financing weakens national ownership and the long-term sustainability of ASRMH services. With donor support becoming increasingly uncertain, countries must urgently enhance domestic resource mobilization, improve coordination among stakeholders, and allocate dedicated budgets for adolescent health. Strengthening internal systems will ensure more equitable, context-specific, and resilient service delivery at the primary healthcare level across West Africa. |
| Presenters and affiliations | Michel Amenah Ghana College of Physicians and Surgeons Ama Fenny University of Ghana Jacob Novignon University of Ghana Priscilla Prempeh Ghana College of Physicians and Surgeons Nassirou Ibrahim Laboratory for Studies and Research on Social Dynamics and Local Development, Ludovic Deo Gracias Tapsoba University of Montreal Borges da Silva Roxane University of Montreal Tolib Mirzoev London School of Hygiene and Tropical Medicine, Irene Agyepong Ghana College of Physicians and Surgeons |
