ArticleGlobal health action2025
Who is at the table and who has the power? Case study analysis of decision-making processes for the Global Financing Facility in Tanzania.
Article in Global health action, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Financing of adolescent health and wellbeing in Bangladesh, Ethiopia and Nigeria: a case study of the Global Financing Facility.BMC global and public health · 2026Article
- Disability-related care trajectories in a pluralistic health system: a qualitative study in urban Sierra Leone.BMC public health · 2026Article
- Advancing the Lusaka Agenda: the Global Financing Facility's missed opportunities for catalysing sustainable health investment.Global health action · 2025Article
- Behind the billions: policies, politics and power of the Global Financing Facility for women's, children's, and adolescents' health.Global health action · 2025Article
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Authors and funding
7 authors.
Funding
Abstract
backgroundIn 2015, Tanzania joined the Global Financing Facility (GFF), a global health initiative for Reproductive, Maternal, Newborn, Child, and Adolescent Health and Nutrition (RMNCAH-N). Despite its resource mobilization goals, little is known about power dynamics in GFF policy processes. This paper presents the first power analysis of Tanzania's GFF engagement.
objectiveTo examine policy processes in developing GFF documents during its first two phases in Tanzania.
methodsAn exploratory qualitative case study using document reviews (*n* = 22) and key informant interviews (*n* = 21) conducted in 2022-2023. Data were thematically analyzed and interpreted using Gaventa's power cube (levels, spaces, and forms of power).
resultsStakeholders praised the GFF's country-led, evidence-based approach and local autonomy. However, closed-door decision-making in phase one excluded civil society and the private sector. Invisible power imbalances in funding allocations left stillbirths and adolescent health without dedicated budgets, while vulnerable groups (e.g. people with disabilities) were overlooked. Disbursement-linked indicators emphasized measurable outcomes, reflecting visible power. Phase two showed adaptive learning, with improved inclusivity.
conclusionWhile government-led, global actors (e.g. World Bank, donors) heavily influenced decisions. Greater civil society engagement is needed for accountability. Future efforts must address power imbalances through meaningful citizen participation to strengthen RMNCAH-N services.
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