Citizen-led gender-responsive budgeting in health: a theory-based approach to evaluating effectiveness

It is widely acknowledged that gender inequality impedes the attainment of development objectives. Specific to the health sector, inequality is evidenced through excess mortality of females and differences in life expectancy that are contrary to biological norms (Stotsky, 2006). Citizen-led gender-responsive budget initiatives have been undertaken in various sectors to promote gender equality in public resource allocation and utilization and to improve transparency and accountability in public service delivery. Thus far, existing literature on the effectiveness and impact of different kinds of gender-responsive budget initiatives is mostly policy-oriented or practitioner-oriented, and is largely descriptive; while empirical literature has focused on evaluating specific interventions rather than sectors. This paper focuses on the health sector in Uganda and explains an approach to empirically evaluate the effectiveness of citizen-led gender-responsive budget initiatives at local government level, taking due consideration of the question of causality. First, the paper adopts the theory-based evaluation approach to describe the causal step process and underlying assumptions that link citizen-led gender-responsive budget initiatives to the outcome of gender equality in health outcomes. Next, the paper proposes the use of theory-testing process-tracing methods to investigate whether the causal theory and mechanism leading to the outcome were present in the case and functioned as predicted. The paper further proposes evaluation of the counterfactual using congruence methods to enhance the internal validity of the mechanism, by ascertaining that no alternative explanations are more congruent in leading to the outcome than the theorised mechanism. Besides providing empirical evidence of the effectiveness and impact of citizen-led gender-responsive budget initiatives, the approach proposed in this paper enables the identification of specific stages along the causal chain that impede the achievement of the intended goal of gender equality in health outcomes.