Addressing gender (in)equality in the health sector: gender-responsive budgeting as an accounting process for creating public value

Purpose - This study aims to explore the facilitating and hindering conditions that interact in the implementation of a gender-responsive budgeting (GRB) process for incorporating a gender perspective into the accounting system to improve gender equality (GE) in the health sector. Design/methodology/approach - A case study approach applying multi-qualitative methods was adopted to analyse the GRB initiative implemented jointly by three Italian health organisations. Hindering and facilitating conditions and managing types were identified through the lens of the public value (PV) strategic triangle of Moore (1995) and a crystallisation perspective. Findings - The GRB initiative studied contributes to PV creation by considering the alignment of the three dimensions of Moore’s PV strategic triangle. The centrality of political and governance commitment to legitimise the GRB process emerges. Moreover, the operational capacity of organisations is supported by civil servants’ engagement. The GRB initiative has steered the three organisations towards achieving GE goals. Consequently, their strategies and programmes align with collective interests, fostering trust institutionally and within the community. However, some resistance to introducing a new accounting practice emerged, highlighting how GRB requires a high level of commitment from both governance and civil servants to contribute to the improvement of GE and, thus, PV creation. Originality/value - This research adds to the accounting literature, providing an original contribution to GRB as a process for PV creation within the health sector. It also discusses the conditions favouring and hindering the implementation of a GRB process.