Magister Artium - MA / The food security crisis which gripped the sub Sahara Africa after the drought in 1999/2000 threatened development initiatives in these countries. Zimbabwe’s situation has since worsened and the country has failed to recuperate from the food problems, even after an improvement in the climatic conditions. International and local food aid activities then became a priority in the fight to sustain the right to food for the affected regions. It is argued in this research that if food aid is distributed on the basis of need it will enable the vulnerable populations recuperate form food insecurity problems. It is also postulated that if well implemented, food aid programmes are also able to play the dual role of averting starvation and leading to long term development. This thesis departs from the allegations of food aid politicisation in Zimbabwe. Using the rational choice and neopatrimonial theories of individual behaviour, this research endeavored to ascertain whether political decisions influenced the government food aid distributions which were conducted through the Grain Marketing Board. In line with these theories, it is argued in this study that politicians behave in a manner that maximizes the fulfillment of their individual needs rather than the needs of the people who vote them in positions of power. A qualitative approach was adopted in this study and data was gathered through household interviews in the Seke and Goromonzi districts of the Mashonaland East province in Zimbabwe. Furthermore, interviews were conducted with food aid experts from the governmental and non governmental organisations dealing with food security issues in Zimbabwe. / South Africa

The non-discrimination obligation has existed since the twelfth century. It has been practiced since then, changing from a conditional to unconditional form with the passage of time. It became firmly applied unconditionally at the multilateral level in 1947 after the formation of the GATT trading system upon which several countries based their trading relations. In 1995 when the WTO was formed, the underlying principles of the GATT 1947 became part of the WTO trading system, including the non-discrimination obligation. When countries join the WTO they automatically become subject to the non-discrimination obligation. The ever increasing value of services and trade in the value of intellectual property has necessitated a look at the fundamental principles of world trade that countries have to adhere to in their trade relations. Incidentally, countries are not at the same level economically, hence one of the purposes of the WTO is to facilitate development in developing countries. Accordingly, this requires different application and/or interpretation of these fundamental principles in different situations, depending on the development level of each Member country. Amongst the five principles that underlie the international trading system, the non-discrimination principle is the focus of this study. The sustainability of the entire economic relations between WTO Member countries is dependent upon their fair compliance with this obligation. The obligation is found in Articles II and XVII of the GATS and Articles 3 and 4 of the TRIPS. The Membership of the WTO is made up of developed and developing countries. As a result of the fundamental nature of the obligation it is imperative that the scope and interpretation of this obligation, as developed by WTO adjudicating bodies, be analysed to determine if the obligation’s application and/or interpretation satisfies the above fundamental object and purpose of the multilateral system of trade. The intention here is at all times to show the importance that the non-discrimination obligation carries in international economic and legal interactions and how non-observance of this obligation would negatively affect relations between Member countries of the WTO.

Introduction: Bihar ranks among the most socio-economically disadvantaged states in India, and its public health system had long suffered from structural deficiencies which contributed to poor health outcomes. In November 2013, the Bihar government, with funding from Gates Foundation and technical support from CARE India, launched the state-wide Bihar Technical Support Program (BTSP) – seeking to address gaps in infrastructure, supply chain, and human resources, as well as the quality of service delivery, so as to improve reproductive, maternal, newborn and child health (RMNCH) and nutrition service provision. BTSP adopted a two-pronged strategy – conducting (i) periodic comprehensive facility assessments (CFAs) to identify and address the structural gaps; and (ii) nurse-mentoring programs to develop competency among nursing cadres in providing basic and comprehensive emergency obstetric and newborn care (BEmONC/ CEmONC) services. Through three inter-linked papers, the dissertation aimed to conduct an evidence-based assessment of this health system strengthening program. “Facility readiness” (structural readiness of public health facilities) was operationalized in terms of infrastructure, essential supplies, and human resources, while “facility performance” was operationalized based on the direct observation of normal vaginal deliveries and newborn care (including management of immediate complications if needed) and infection prevention practices in the labor rooms. The first paper describes the evolution of BTSP, and examines the initial progress made in facility readiness between 2015 and 2016. The second paper: (i) conducts a comparative assessment of facility readiness between 2017 (at end of the first four years of BTSP) and 2019, and describes the continuation of progress or lack thereof; (ii) quantifies facility readiness through a scoring system that reflects the readiness to provide maternal and newborn care (MNC) services; and (3) compares the change in this score over time (2015, 2017 and 2019) across different districts and levels of health facilities in Bihar. Thus, the first and second papers together examine the extent to which Bihar’s public health facilities were structurally strengthened in terms of physical infrastructure, supplies and workforce by utilizing data from all four rounds of CFAs conducted till date. The third paper asks the next logical question in a health system strengthening process – was facility readiness positively and significantly associated with facility performance? This is an important query, as it aims to provide evidence of synergistic progress, as envisioned under BTSP. First, the paper examines whether the facility-level performance changed, by comparing baseline (May-December, 2018) and endline (October-December, 2019) assessment data from the nurse-mentoring program (locally called AMANAT Jyoti). Second, it assesses the association of facility readiness (based on CFA 2019 data) with endline facility performance in providing MNC services. Methods: The first paper utilizes a structured, narrative review of scientific and grey literature to describe evolution of the BTSP since 2014, based on programmatic learnings through prior years (2011-2013) of collaborative vertical interventions. Subsequently, the paper measures the tangible change in select facility-level characteristics, utilizing quantitative data generated through two rounds of CFAs conducted by CARE India in 2015 (n=534 facilities) and 2016 (n=550 facilities). The second paper utilizes quantitative data generated through two rounds of CFAs conducted by CARE India in 2017 (n=550 facilities) and 2019 (n=552 facilities). Each CFAs covered all Level 2 (primary health centers) and Level 3 (higher-level facilities) public health facilities in Bihar that conducted at least 100 deliveries in the preceding year. Subsequently, the paper constructs a “facility-level MNC structural readiness score” – henceforth referred to as facility readiness score, based on a common set of indicators from CFA 2015, 2017 and 2019, to reflect human resources, infrastructure and essential supplies related to delivering MNC services. The paper uses this score to map the change at 2-year intervals, from 2015 to 2019, at both facility and district levels. The third paper utilizes quantitative data generated through two separate assessments conducted by CARE India – the 2019 CFA, and the 2018-2019 assessment of AMANAT Jyoti (nurse-mentoring program), which involved direct observation of normal vaginal deliveries, newborn care, and infection prevention practices in the labor rooms. The paper constructs baseline and endline facility-level MNC performance scores – henceforth referred to as facility performance scores based on data from AMANAT Jyoti assessments, and examines the association between endline facility performance and facility readiness scores. While descriptive statistics was used to present findings from the CFAs and AMANAT Jyoti assessments, paired t tests were used to test the mean change in scores over time and between the different levels of facilities. The association between endline facility performance and facility readiness scores was tested using simple as well as multiple linear and multinomial logistic regression modelling. Results: With a demonstrated intent to improve the ailing public health sector, the Bihar government in 2010 forged a collaboration with Gates Foundation to accelerate progress across RMNCH and nutrition programs. Through the Integrated Family Health Initiative program (IFHI, 2011-2013), outreach-based and facility-based solutions were implemented in eight programmatically-prioritized districts to address the stated goals. However, over this period, it became apparent that long-term success of such initiatives remained critically dependent on strengthening the foundational components of Bihar’s public health system –physical infrastructure, supply chain for drugs, consumables and equipment, and the skilled health workforce. These programmatic learnings motivated a re-think and consequent state-wide launch of the BTSP – characterized by a novel structure of health governance that was deeply embedded within the public health system, and a robust information management system that could generate, analyze and disseminate data on community- and facility-level services to support decision making. The quantitative analyses of CFA data (in first and second papers) provided an assessment of the changes that happened at the level of health facilities, likely supported by the policy-level modifications. There was a clear sense of prioritization of the limited resources – with constant focus on structurally preparing health facilities to deliver basic MNC services, more so at Level 2 (primary health centers). By 2019, at least 99% facilities at either level provided 24x7 delivery services and had designated labor rooms, 97% had designated newborn care corners which were mostly located inside the labor rooms, 70% or more had at least one functional fetal doppler, baby weighing machine, radiant warmer, and AMBU bag with neonatal oxygen masks. The improvement in availability of essential supplies like oxytocin, misoprostol, magnesium sulphate, antibiotics, and reproductive health commodities (condoms, intrauterine contraceptive devices, sanitary napkins, iron-folic acid tablets, contraceptive pills) were particularly notable during the 2017 and 2019 CFAs. However, the supply chain variably faltered for a number of other essential supplies like oral rehydration solutions, functional oxygen cylinders, normal saline and ringer lactate solutions. The data revealed that facility-level inefficiencies in utilizing the electronic inventory management system to accurately reflect actual status of supplies within the facility, likely compromised procurement and distribution. With regards to human resources, while a large number of auxiliary and general nurse midwives were available for service during CFA 2019, the BTSP faced continuing challenges (2015-2019) in recruiting and/or retaining physicians, especially the specialist physician cadres. By CFA 2019, these structural changes were also supported by remarkable improvements in two related services areas –availability of emergency transport, and laboratory services. The comparison of facility readiness scores (second paper) based on CFA 2015, 2017 and 2019 showed that while the mean scores increased sharply for both Level 2 (increase=1.51 (95% confidence interval: 1.39, 1.63)) and Level 3 (1.39 (1.1, 1.69)) facilities between 2015 and 2017, the progress was less pronounced at both levels between 2017 and 2019. 25 of the 38 districts in Bihar demonstrated a continuous increase in mean scores over the 3 CFAs. As for the remaining 13 districts, their 2019 mean scores remained higher than that during 2015. The analysis of AMANAT Jyoti assessment data (third paper) revealed improvements across 36 (80%) of the 45 performance parameters assessed through direct observation of deliveries between the baseline and endline. However, at least 80% compliance was observed for only 11 of 45 (24%) assessed parameters at baseline, and 16 of 45 (36%) at endline. The mean facility performance score increased significantly among both types and levels of facilities – but the increase was higher among Level 3 (mean increase = 1.56, p=0.0005, n=13) and CEmONC (1.82, p=0.0029, n=9) facilities, than among Level 2 (0.32, p =0.0288, n=121) and BEmONC (0.33, p=0.0168, n=125) facilities. The regression analysis failed to identify any linear relationship between facility readiness and performance scores. However, a significant positive association was observed between facility readiness score and the middle tertile of endline facility performance score (vs. lowest tertile as reference) in multiple multinomial logistic regression modeling (n=132 facilities). With increasing facility readiness score, the odds of a facility being in the middle tertile of the endline facility performance score relative to the lowest tertile was 1.68 (95% CI = 1.02, 2.76), after controlling for baseline facility performance score, mean delivery volume, and the facility level. Conclusion: The BTSP can be best described as a diagonal health system strengthening initiative –one that starts with a focus on specific programmatic (RMNCH) outcomes, but strives to achieve these through identifying and addressing bottlenecks across the health system. The efforts made to revamp health governance through creating structures for technical support from the state- to block-levels is particularly laudable, as is the remarkable capacity building in collecting and using facility-level data to inform programs and policies. The dissertation identified that BTSP has made appreciable progress in structurally preparing Bihar’s public health facilities to deliver basic MNC services – with improvements in related infrastructure, essential supplies, and supportive services like referral transport and laboratory facilities, as well as through recruitment of large number of ANM and GNM nurses. However, the process encountered a number of challenges, and it may be worthwhile to adopt a targeted approach to address some of these concerns. For example, it is important that the BTSP works to equip all facilities with electronic inventory management systems, while simultaneously training the personnel using such systems. To circumvent the chronic shortage of specialist physicians, a “task shifting” approach may help maximize utilization of existing health workforce to strengthen service delivery capacity. Further, the overall level of facility performance of MNC service delivery remained low at endline despite improvement from the baseline scores, and there was limited evidence of a significant positive association between facility readiness and performance scores. As these scores reflect the minimum essential requirements for a MNC service delivery setting, the BTSP clearly has challenges ahead. They must continue to address the persistent challenges in facility readiness and facility performance so that these two facility-level interventions will complement each other and influence outcomes. As the onus of this diagonal health system strengthening program incrementally shifts from development partners to the government, it will be important to recognize the significance and complexity of this effort.

The primary objective of this research was to assess the equity and efficiency of in-kind income transfers. The analytical framework employed incorporated key concepts of the utility interdependence paradigm from economic welfare theory. This paradigm views income transfers as social goods and suggests that social as well as private benefits may be derived from the redistribution of income. This study attempted to assess some of the empirical implications of the utility interdependence argument through the investigation of the low-income housing and Food Stamp programs in Multnomah County, Oregon for FY 1973. Data were drawn from agency files, published statistics and documents, interviews with program administrators, and a survey of the records of 498 Non-Public Assistance Food stamp households. The private and social benefits and costs of the programs were estimated. The program participation rates and the socio-economic characteristics of recipient households were ascertained. Particular attention was devoted to an evaluaLion of the efficacy of in-kind transfers in inducing substitution effects or producing social benefits through the alteration of the consumption patterns of the target population. In addition to an economic analysis of in-kind transfers, the political environment of welfare legislation was detailed. The results of this research suggest that in-kind income transfers are an inefficient and inequitable method of redistributing income. All programs investigated were characterized by high administrative costs. The administrative share of the public program budget ranged from 20% in the Food Stamp Program to over 50% in Public Housing. All programs were found to be inequitable in that households with similar socio-economic characteristics did not receive similar benefits. Housing programs discriminate among the equally needy by restricting supply. In the Food Stamp Program, a complex income determination formula, which is used to calculate program benefits, results in a considerable variation in the subsidies provided to households of equivalent size and income. The low-income housing and Food Stamp programs were also found to be ineffective in producing those social benefits which are specifically related to changes in the consumption patterns of the target population as a whole. While housing programs were found to induce substitution effects by furnishing large subsidies to a small number of households, only 5% of the eligible received benefits. Programs which leave the vast majority of the poorly housed untouched were judged unlikely to significantly diminish the external diseconomies presumed to be associated with the housing expenditure patterns of the entire population of eligible. In contrast, the Food stamp Program provides less generous subsidies to all eligible applicants. Food stamp subsidies were found to be insufficient to generate substitution effects; the food consumption patterns demanded of recipient households were not different from the food expenditure patterns of comparable households with income entirely in cash. While the distribution of benefits in the housing and Food stamp programs strongly favors the poor, large numbers of non-poor are officially eligible for assistance. It was estimated that 37% of the households in the country were eligible for low-income housing and approximately 46% were eligible for food stamps. While the tight supply of housing transfers limits the growth of program participation, an enormous expansion of participation in the open-ended Food Stamp Program is possible. The economic analysis of in-kind transfer programs emphasized their deficiencies as redistributive mechanisms. However, the political potency of in-kind programs was found to be considerable. Policy-makers appear to be responsive to pressures to perpetuate and expand established programs, rather than to empirically validate the assumptions on which they are based. In view of the political popularity of in-kind transfers and the public antipathy to transfers of cash, it is probable that transfers in-kind will command an increasing share of the welfare budget.

Little attention has been paid in the literature to participant perception of, and attitudes toward, program and service quality in the congregate meals program. Based upon the scarcity of knowledge in this area, managers and participants in the Title III C meals program in Montgomery County, Maryland were surveyed to explore how differences in perception of program and service quality affect participant acceptance and evaluation of the program. A nutrition monitoring instrument was designed for managers at 14 meal sites to assess major components of the food service operation. A survey addressing participant perception of meal quality, meal acceptance, program administration and management, and food service personnel was designed and administered to 264 participants. The two surveys contained 17 identical or similar questions to identify any perceptual differences. Several social variables such as age, educational level, sex, marital status, living arrangement and acquisition of information about the program were found to significantly influence participant response to certain questions. Significant differences in perception between managers and participants were found in response to questions regarding availability of nutrition education lessons, need for therapeutic diets, adequacy of program transportation, temperatures at which food was served, and the degree to which substitutions were made for posted menu items. The results of this research will be used to make suggestions for program planning and evaluation, as well as to aid in continuous quality assurance. / Master of Science

This study analyzes the factors influencing female food-for-work (FFW) participation in the Southern Shoa region of Ethiopia. The objectives are to determine the significant factors that affect women's participation in FFW projects and to explain this behavior with socio-economic and other factors. Using data from a public works project conducted in 1991 by the International Food Policy Research Institute (IFPRI), the Ethiopian Nutrition Institute (ENI) and the Institute of National Nutrition (INN), analyses were done on a sample of 655 females from three awrajas (districts) in Southern Shoa. The sample consisted of 28.4 percent females who participated in FFW and 71.6 percent who did not participate in FFW activities. More than 85 percent of the female sample had no education, over half were single and 48 percent of the women were unemployed. A logit probability model was used to explain women's participation in FFW projects. The results indicate that family size, occupation, marital status, reproductive status, total non-food expenditures, amount of output sold from agricultural production, women's wages from FFW and wages from other agricultural work were the most significant factors influencing female FFW participation. The family size variable had the most significant impact on increasing women's probability of participating in FFW projects. For the study's sample, women with larger family sizes are more likely to participate in FFW projects. Those who are not gainfully employed are also more likely to participate in FFW activities since they view FFW as a source of employment. Women in polygamous households are less likely to participate in FFW than women in monogamous households. In terms of a woman's reproductive status, those who are not pregnant and not lactating are more likely to participate in FFW programs. It was found that the greater the non-food expenditures incurred by the household, the more likely women participate in FFW; the less output sold from agricultural production, the greater the likelihood that women engage in FFW; the higher a woman's wages from FFW, the more they were attracted to FFW programs; and interestingly, the higher the wages from agricultural work (non-FFW), the more likely they participate in FFW activities. / Master of Science

Food-for-Work (FFW) was conceived as both a short-run assistance program for meeting basic food needs of low income households, and as a long-run developmental tool for building infrastructure and for providing income to ease capital constraints on farm production. However, it was feared that FFW might divert labor from own-farm production and reduce the level of locally produced food crops. The purpose of this dissertation was to empirically examine these hypotheses in the Ewalel and Marigat locations of Baringo District, Rift Valley Province, Kenya. A househoId-firm model that integrated both production and consumption concerns of FFW was developed. The model was block recursive. First, production decisions were made by maximizing net returns (net income) subject to production constraints. This output (income) was then substituted into the budget constraint, and household utility was maximized subject to this budget constraint and to a total time constraint. The data used in the study was drawn from a representative sample of 300 households were randomly selected in Marigat-Ewalel locations. Of these, 100 were found to be participants in the FFW Project supported by the UN/FAO World Food Program. Food items provided to the program in the study area are maize, beans, and vegetable oil. A two-year linear programming model was developed for the production segment of the model. ln this model, three crops under two technologies and two types of livestock were used. The household consumption component of the model was specified econometrically using systems of demand equations, the Almost ldeal Demand System. Seven commodities including FFW items, five foods, non-food and leisure, were used in the system. The analysis was conducted for both participant and non-participant households to compare levels of production activities, employment, income, and consumption patterns with and without the FFW program. The production component of the analysis revealed that the following results were associated with FFW in the study area: (a) augments own-farm output by contributing to the minimum nutrient 1 requirement, (b) eases the capital-constraint by the second year of participation, (c) increases the marketable surplus from both own-crop and livestock production, (d) increases hired labor in farm production, (e) causes a shift from maize to millet production, and (f) increases savings. As a result, the net income for the representative farm households with FFW is 52% higher than those without FFW; and participation in the FFW program declines by 11% from year 1 to year 2. Thus, disincentive effects on own-farm employment and output were not found in this study. In fact, according to the model used, the FFW Program could be expanded by either increasing the monthly participation hours or the number of participants without resulting in any production disincentive. The results of the entire household-firm model, which reveals the changes in consumption resulting from participation in FFW and changes in income, were derived in elasticity form. Most of the benefits to the representative participant households, as compared to non-participants, take the form of increased consumption of food items. Thus, the primary effects of FFW are to insure participants increased consumption and saving without creating disincentives to either own-farming or to local agricultural production. / Ph. D.

Thesis (M.Dev.) --University of Limpopo, 2009 / Food insecurity is one of the most important development challenges in Ethiopia. To reduce food insecurity, the current government has adopted various policies. Amongst policies employed by the government are, namely: Agricultural Development Led Industrialization (ADLI) of 1995, which focus on national level; and the Food Security Strategy (FSS) which gives emphasis to household food security. As partner in development process, the Kale Heywet Church Development Program (KHCDP) has been implementing development projects in Southern Ethiopia to improve household food security. In this study, an attempt is made to assess the role of Kale KHCDP on household food security in southern Ethiopia. The study used both quantitative and qualitative methods to collect data from 109 sample households in Baso and Kuto Peasant Associations (PAs) of the Kucha District in Southern Ethiopia. More specifically, household questionnaire, focus groups, and individual or key informant interviews were applied to gather primary data from the field. The study also used secondary sources to review relevant information. The study found that KHCDP has played a critical role in promoting household food security by implementing different strategies to increase food production and income. The study, however, pointed out that KHCDP household food security strategies are weak in terms of creating access to inputs and technologies; promoting water resource utilizations; and providing extension and follow-up support. The study also identified low level of household participation and risks in long-term sustainability of food security interventions. Therefore, this study suggests that KHCDP needs to review its strategies and extension approaches.