Financing of adolescent health and wellbeing in Bangladesh, Ethiopia and Nigeria: a case study of the Global Financing Facility

Abstract Background Adolescent health and wellbeing (AHW) remains largely underfunded with uneven progress across countries. This study investigates the Global Financing Facility for Women, Children, and Adolescents (GFF) in-country approach to AHW financing – including investment case prioritization, multisectoral stakeholder platforms, program implementation, monitoring and evaluation, and co-financing – examining what these processes have achieved for AHW, and the barriers limiting their impact, across Bangladesh, Ethiopia, and Nigeria. Methods This collective case study triangulates country data from document reviews, key-informant interviews with multisectoral stakeholders, focus group discussions with adolescents, teachers and healthcare workers, and a global review of GFF investment cases. Transcripts were analysed using content analysis. Document data were extracted in Excel, then triangulated with the qualitative data. Reporting follows the COREQ checklist. Results We identified five themes: (1) Adolescents are less prioritised than other age groups in country investment cases, with the limited attention to adolescents typically directed at female reproductive health. (2) The GFF uses pre-existing multi-stakeholder platforms in Bangladesh, Ethiopia, and Nigeria with limited involvement of youth. (3) The GFF supports implementation of AHW through the health sector-wide approach in Bangladesh, while engagement of the education sector is limited. In Ethiopia, adolescent-friendly health services are included in the national financial plan, but implementation faces sociocultural barriers such as perceived stigmatisation and lack of privacy. Nigeria has a national adolescent-specific implementation plan, but a lack of coordination between federal and state levels hinders progress. (4) Monitoring and evaluation (M&E) is weak, despite agreement on adolescent health indicators. Only Nigeria has an adolescent M&E framework. (5) The GFF supports co-financing through donor alignment. Domestic resources are key to progress, although the actual amount of the budget allocation and impact on AHW specific outcomes remain unknown. Conclusions The GFF co-financing model has increased attention to AHW and aligned investors, but progress is insufficient to drive transformative change. The GFF can be optimized by overcoming coordination and measurement challenges, increasing application of innovative financing instruments for AHW, and meaningfully engaging youth. Given the reduction in development financing globally, countries can draw useful lessons from the GFF model to reduce the gap in adolescent health funding.