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Paper short abstract

This paper analyses how donor project design shapes power and agency in gender-transformative health aid. Using qualitative comparative analysis of 100 health projects, it identifies conditions under which gender-transformative ambitions translate into outcomes across Global South health systems.

Paper long abstract

Despite strong rhetorical commitments to gender-transformative approaches, women’s health aid often fails to alter underlying power relations in Global South health systems. This raises a critical question for global public health governance: under what institutional and design conditions does gender-transformative health aid move beyond discourse to generate meaningful change?

This paper addresses this question through a comparative analysis of 100 donor-funded women’s health projects across Global South contexts. Drawing on qualitative comparative analysis, the study examines how specific combinations of donor institutional support, gender analysis, health system alignment, and participatory design features shape the translation of gender-transformative ambitions into practice.

The analysis focuses on donor-side governance choices visible in project documentation, including financing horizons, accountability requirements, partnership arrangements, and the extent to which gender objectives are embedded within health system interventions. Rather than treating agency as an assumed attribute, the paper conceptualises agency as structurally enabled or constrained through donor design and governance decisions.

Findings show that gender-transformative outcomes are not driven by single factors, but by distinct configurations of institutional commitment, financing structures, and health system integration. Projects that combine long-term financing horizons, embedded accountability mechanisms, and linkages to public health systems are more likely to support transformative shifts than fragmented or technocratic approaches.

By reframing gender-transformative health aid as a problem of public health governance and political economy, this paper contributes to debates on power, inequality, and empowerment in global health and offers practical insights for reimagining health aid design amid fiscal uncertainty and contested global health priorities.