Adolescent health and wellbeing remains one of the most underfunded areas in global health, and a new study of the Global Financing Facility for Women, Children, and Adolescents (GFF) shows why closing that gap is proving so difficult. The collective case study, published in BMC Global and Public Health, examined how the GFF’s in-country approach to financing adolescent health and wellbeing (AHW) has worked in Bangladesh, Ethiopia and Nigeria, combining document reviews, key-informant interviews and focus group discussions with adolescents, teachers and healthcare workers, alongside a global review of GFF investment cases.
The GFF, set up in 2015 and hosted by the World Bank, is a country-led partnership for reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH-N). It operates in more than 36 countries as of 2026 and works through country-led investment cases developed by governments with development partners, civil society, the private sector and youth representatives. At the heart of its model is co-financing: mobilizing additional domestic resources, linking with concessional financing and connecting with private capital markets. The researchers set out to examine what these processes have achieved for adolescents and what barriers limit their impact.
The evidence base for the study was substantial. The team reviewed 73 national documents, including 28 from Bangladesh, 22 from Ethiopia and 23 from Nigeria, and conducted 33 key-informant interviews and 16 focus group discussions across the three countries, with fieldwork running between August 2023 and November 2024. The global benchmark came from a review of investment cases in 30 of the 36 GFF partner countries, the six remaining countries having no publicly available investment case at the time of extraction. Qualitative transcripts were analysed using content analysis, and document data were triangulated with the qualitative findings.
The global review produced a stark picture of structural under-prioritisation. Adolescents are less prioritised than mothers, newborns and children under five in country investment cases, and AHW is predominantly mentioned in relation to female sexual and reproductive health. Other topics, such as adolescent mental health, are mentioned only briefly, if at all, with no targeted interventions or indicators. Only four of the investment cases identify vulnerable adolescent populations, such as adolescents living in rural communities or with disabilities. Among the 13 investment cases providing a full funding breakdown, investments in AHW averaged 7 percent, ranging from 0.15 to 28 percent, of total RMNCAH-N funding, considerably lower than maternal and newborn health at 21 percent, child health at 14 percent and nutrition at 10 percent, although these categories are not mutually exclusive.
The three country cases revealed both gains and persistent gaps. Across Bangladesh, Ethiopia and Nigeria, the GFF has contributed to increased attention to AHW: adolescent health priorities are incorporated into national investment cases, policies and strategic plans in all three countries, and GFF-supported multisectoral stakeholder platforms are active in each setting. Disbursement-linked indicators tied to adolescent health milestones have created financial accountability mechanisms. Yet the funding picture is opaque. Bangladesh’s investment case totals USD 15,008,000,000 with no explicit allocation for RMNCAH-N or AHW, while Ethiopia dedicated 7.8 percent of investment case funds to RMNCAH-N without specifying the share for AHW, and Nigeria allocated 6.7 percent, or USD 10,000,000, directly to AHW. Across all three countries, the amounts actually disbursed for AHW and attributable to the GFF investment cases cannot be assessed or validated due to limited financial information.
Implementation challenges compounded the funding shortfalls. In Bangladesh, the GFF supports implementation through the health sector-wide approach, but key informants reported poor collaboration between sectors, notably between the Ministries of Health and Education. A school-based health and nutrition program with the potential to reduce girls’ dropout rates was reflected in a disbursement-linked indicator, but the Ministry of Education did not execute the program and did not spend the USD 10 million attached to it. In Ethiopia, adolescent-friendly health services are included in the national financial plan, but implementation faces sociocultural barriers, with many adolescents reluctant to seek care due to fear of stigma, disrespect and lack of privacy. In Nigeria, an extensive set of adolescent-specific policy frameworks exists, but poor coordination between federal and state levels hinders progress, and only a few states have committed budget lines to adolescent health.
Monitoring and evaluation emerged as one of the weakest links in all three countries, despite agreement on adolescent health indicators, particularly those related to adolescent pregnancy. Bangladesh has no M&E system that routinely monitors adolescent-specific indicators, and Ethiopia lacks systematic monitoring to routinely measure and report on progress, even though adolescent-specific indicators exist. Nigeria is the only one of the three with an adolescent M&E framework, yet historically poor implementation hinders its success, and the country lacks nationally representative disaggregated data for adolescents, meaning there are no baselines against which to measure progress. Nigeria launched a National Youth Index in August 2024 covering health, wellbeing, education, employment and access to finance, but interviewees believe it is not yet integrated into wider national monitoring tools.
Youth engagement, a core promise of the GFF model, also fell short. The GFF uses pre-existing multi-stakeholder platforms in all three countries, but civil society and youth involvement has been limited. In Bangladesh, only two interviewees had knowledge of the stakeholder platform, with one commenting that it is no longer available. In Ethiopia, platform members meet regularly but civil society and youth involvement remains limited. In Nigeria, adolescents participate in the platform through civil society, but the extent of their involvement is unknown. Although adolescents were mentioned in the development of most investment cases globally, their involvement and active engagement could not be validated through the qualitative data.
The study’s authors conclude that the GFF co-financing model has increased attention to AHW and aligned investors, but that progress is insufficient to drive transformative change. They argue the GFF can be optimized by overcoming coordination and measurement challenges, increasing the application of innovative financing instruments for AHW, and meaningfully engaging youth. Innovative instruments such as disbursement-linked indicators, Program-for-Results financing and social impact investment exist within the GFF portfolio, but these opportunities are yet to be specifically applied to adolescent health outcomes. With development financing globally in decline and unpredictable, the authors suggest countries can draw useful lessons from the GFF model to reduce the gap in adolescent health funding, particularly as the GFF launches its 2026 to 2030 strategy seeking to expand its reach to 50 countries.
The researchers acknowledge limitations, including participant selection mostly based in capital cities and lack of access to government financial data, which limits insights into actual budget allocations, disbursements and spending for AHW across sectors and at decentralised levels. In many contexts, they note, data disaggregated for adolescents simply does not exist. The findings are broadly consistent with earlier analyses of GFF planning documents, which found adolescents recognised rhetorically but weakly represented in investment cases and monitoring documents. This study extends that picture by showing that the gap persists beyond the planning stage, through implementation and monitoring, meaning that even where adolescents are written into national plans, the money and the measurement systems needed to deliver on those commitments have not followed.
Subject of Research: A collective case study of how the Global Financing Facility finances adolescent health and wellbeing in Bangladesh, Ethiopia and Nigeria.
Article Title: Financing of adolescent health and wellbeing in Bangladesh, Ethiopia and Nigeria: a case study of the Global Financing Facility
Article References: Biermann, O., Lindquist, E., Mitu, K., Olumide, A., Oyetunde, O., Yadete, W., Bylund, S., Luckenbill, S., Claeson, M., & Baird, S. (2026). Financing of adolescent health and wellbeing in Bangladesh, Ethiopia and Nigeria: a case study of the Global Financing Facility. BMC Global and Public Health, 4(1), Article 93. https://doi.org/10.1186/s44263-026-00332-4
Image Credits: AI Generated
DOI: 10.1186/s44263-026-00332-4
Keywords: adolescent health, Global Financing Facility, Bangladesh, Ethiopia, Nigeria, health financing, co-financing, investment cases, monitoring and evaluation, youth engagement, RMNCAH-N, World Bank
