This work explored perceptions regarding the roles, norms and incentives influencing the performance of Clinical Officers (COs) in rural district hospitals in Kenya. In order to improve access to health care mainly in rural areas, COs are increasingly being used to perform tasks that were previously the preserve of physicians. The assumption underlying their use is that they are a viable option to doctors. Studies have shown with reference to HIV care and obstetric and gynaecological surgical tasks that COs’ performance is comparable to that of physicians. Other studies also show that the care offered by COs is cost effective when compared with the costs associated with physicians and obstetricians care. However, there is emerging work which shows that COs are not happy in their assigned role in the health system. These studies report CO’s dissatisfaction with the low remuneration, poor career progress and limited career options inherent their jobs as compared with those accorded to physicians. As revealed by a systematic review of mid-level worker literature, addressing these issues is at present difficult due to gaps in our understanding of CO functioning. The existence of these gaps is explained by the limited empirical work on COs in general. The aim of this thesis was to address this issue by exploring issues that affect their routine functioning in a typical rural hospital setting going beyond the fact that they are technically competent. To investigate these issues, a conceptual framework was adopted that explores the tension between what institutions demand and what individuals within them feel able to do. Qualitative methods comprising of interviews, participant observation, review of official policy and hospital level documents on COs, and review of hospital statistics were used. A comparative approach was adopted that sought to; (1) examine perceptions regarding influences on the performance of COs from a variety of sources (COs, doctors, nurses, supervisors, hospital managers, policy makers and policy documents); (2) compare perceptions of respondents based in three faith-based hospitals with those in three government facilities; and, (3), explore features of different work settings (outpatient department, specialist clinics and vertically supported clinics) within these hospitals that encouraged good CO performance. Preliminary findings were reported back to respondents in the six study hospitals. Analysis of the data showed three major issues. First, perceptions of CO roles are problematic despite an acknowledgement of the important function performed by COs in the health system. This is revealed by the variety of images regarding their roles that highlights the need for a redefinition of CO roles. An example of this is shown by the inconsistency between their importance as the ‘backbone of the health system’ versus the poor remuneration and career prospects that their position attracts. Second, there were differences in the norms of CO performance that have resulted in variations regarding what is expected of them. While there was much attention paid to norms of performance about technical aspects of work, less attention focussed on non-technical aspects of work. The adoption of a holistic approach to the notion of CO performance is needed that will enable facilities and the system to meet the needs of the CO which should prompt COs to reciprocate by working better. Third was the issue that there were minimal incentives were attached to COs work. In the public sector, there were some incentives but their availability depended on the work settings. For example, while COs in vertical clinics got training their colleagues in the outpatient department had few chances to get training opportunities. Faith-based hospitals did provide performance related bonuses that encouraged health workers to perform better although notably basic salaries in faith-based hospitals were no better than those given in the government sector. However, major incentives such as salary and promotions in the public sector are handled by the central government giving public sector hospital managers little opportunity to utilise such incentive mechanisms. Where hospital managers may have some leeway in implementing actions at the local level to improve performance, for example through improving CO recognition and working conditions, it was observed that public sector managers were generally less engaged in utilising such incentives. Therefore while it is important to consider and address system level factors that influence CO performance such as salaries and promotions, among others, facility managers would also appear to have some scope to improve performance. In discussing these issues, it is becoming clear that the assumption that COs are altruistic and will continue to work flawlessly in their assigned niche presents a naïve view of COs. This thesis shows that COs are also influenced by self–interest and find ways to overcome or work around any perceived barriers to their growth, some of which may work against the institution. This calls for a re-examination of who COs are, what they do and how they should be managed. Ways of resolving the tension that exists between COs and the health institution exist and can be derived from examining the coping mechanisms that COs have adopted to make their lives better. These coping mechanisms show areas that need attention. Further, there should be greater consideration of the important role that facility managers play in mediating and/or modifying system level influences by creating local environments suitable for better staff performance. Underlying all this is the fact that a long term view of COs is needed. The long term view must go beyond the notion of ‘substitute physician’ as Kenya has made huge investments in this cadre over the last 40 years or more and, with other countries, is likely to continue to rely on such a cadre for much clinical care. This thesis therefore concludes with recommendations that seek to address issues identified with the performance of COs in the Kenyan health system focusing on potential hospital level and system level solutions. Also included is a reflection of the relevance of findings for countries similar to Kenya that are currently using or seek to use COs as a physician substitute.

Student Number : 0302215H - PhD thesis - School of Language and Literature Studies - Faculty of Humanities / This study explores the meaning of contemporary Kenyan popular music by undertaking literary interpretations of song lyrics and musical styles. In making these interpretations, the fabric of popular song is shown to be a network of referents and associations with texts situated both within and outside of the song-texts. As polyphonic discourse, these vast range of textual and paratextual referents opens up various points of engagement between artiste, songtext and audience and in the process, the surplus meanings generated by both the poetry of the text and the referents embedded within it account for the significance of popular songs as concrete articulations that mediate the realities of modern Kenya. Through the six chapters that make up the core of the study we see the mini-dramas that are played out in the material conditions within which the songs are produced; in the iconographies that are generated by artistes' stage names and album titles; in the strategies of memory work that connect present-day realities to old cultural practices; in the soundtracks of urban spaces and in those of domesticated global cultural trends and finally, in the mediation of the antinomies surrounding the metanarrative of the nation and the realization of political transition. I conclude by suggesting that Kenyan popular music demonstrates how contemporary postcolonial texts inform one another, opening up a dialogue between texts and also between local events, experiences and knowledges. Equally important, the study defines contemporary Kenyan culture by working out the sources of the images and idioms built up in this music and accepting the complexities of postcolonial existence as a site of fluid interaction between various cultural practices and competing modernities.

In both Kenya and Botswana, wildlife is a valuable natural resource in terms of its economic value, nutritional value, ecological value, medicinal value, educational and scientific value, as well as recreational and socio-cultural value. Despite this beneficial value, however, wild animals in both countries also cause damage and impose heavy losses on society. They also disrupt peaceful existence in local communities living in close proximity to wildlife areas. The damage they cause includes attacks on people and livestock, destruction of crops and other property as well as infrastructure. This has resulted in a human-wildlife conflict, with people having negative attitudes towards wildlife. Initially people seem to be the victims when wild animals attack them or destroy their property. Later, the animals are the real victims when people in retaliation start attacking, ensnaring or poisoning them. Contrary to the belief that it contributes to poverty alleviation, many people in the local communities in wildlife areas strongly believe wildlife has contributed to their poverty. Unless the governments of both Kenya and Botswana maintain efficient legal and institutional arrangements for wildlife damage, the future of wildlife conservation in both countries is bleak. These arrangements, if effectively enforced, have the potential to: reduce retaliatory killing of wildlife; ensure incidents of wildlife damage are reported; alleviate the losses and suffering associated with wildlife damage; and bolster public support for conservation programmes. It is encouraging that both countries recognize wildlife damage as a major problem and have put in place legal and institutional arrangements to address this problem. This study evaluated the legal and institutional arrangements in Kenya and Botswana on wildlife damage, assessing their suitability, adequacy as well as their effectiveness. While several studies have been conducted on wildlife damage, most of them mainly focus on institutional arrangements and the actual abatement measures adopted, few of them approach the subject from a legal standpoint, in the way this study does. Those studies do not, for instance, discuss the legal basis of the need for legal arrangements for wildlife damage alleviation and the various approaches and actual forms of legal intervention. This author through the use of semi-structured interviews, self-administered questionnaires, focus group discussions, and literature survey investigated the problem of ii wildlife damage in Kenya and Botswana. A central part of this investigation was on the types of damage, the animals involved, whether and how this problem has influenced public attitudes towards wildlife conservation, and suggestions for solution. Research for this study was conducted in the Laikipia region of Kenya and the Okavango delta region of Botswana between January and December 2006. This researcher interviewed 44 respondents from each country, comprising households from the local communities within wildlife areas, senior ranking government officials, leaders of NGOs that actually work on wildlife issues, experts in natural resource management as well as eminent scholars in environmental and natural resources law and policy. Research for this study established that while the governments of both Kenya and Botswana have established certain legal and institutional frameworks on wildlife damage, there are factors that hamper their efficient operation. These factors include the relevance and suitability of the existing laws, as well as their acceptability to stakeholders; lack of appropriate policy framewoks and dispute resolution mechanisms to support the regulatory regime; institutional problems such as overlapping responsibilities, lack of adequate resources and lack of motivation among staff. These factors together with others have continued to be a major challenge to the quest for appropriate and effective legal and institutional response to the problem of wildlife damage in both countries. The study found that in both countries the law vests in the state the power to manage wildlife wherever it occurs within the national boundaries. Botswana’s community-based wildlife management model, however, offers more incentives for conservation to local communities than Kenya’s state-centered system which largely disregards the role of local communities in wildlife matters. This author has argued that local communities are critical stakeholders and the success of any conservation programmes will depend on their goodwill. Besides, while the state has a duty to protect wildlife from harm by humans, it also has a corresponding duty to protect humans and their property from damage by wild animals and to ensure that wildlife does not undermine the people’s livelihoods and development. This is, however, not usually the case as in practice the state in both countries, and especially in Kenya, iii seems to favour wild animals at the expense of the people. The study has recommended certain reforms which need to be undertaken if Kenya and Botswana have to maintain appropriate and efficient legal and institutional arrangements on wildlife damage.

Thesis advisor: Can Erbil / Violence against women and subsequent gender-based violence are issues that plague the world, harming women’s wellbeing as well as that of their families. Thirty-nine percent and twenty-one percent of Kenyan women have experienced physical and sexual violence, respectively, in their lifetimes. While there have been contested studies showing that employment can both increase and decrease the risk of suffering from violence, particularly in domestic settings, this study examines how a Kenyan woman’s experience of violence is likely to affect her level (formal or informal) of employment in the future. The results of this study indicate that emotional abuse, having a partner that drinks, educational attainment, living in a rural setting, and age are significant factors in a woman’s probability of working. Conditioned on working, experiencing controlling behaviors from a partner, educational attainment, justification of violence, ethnicity, income rank, partner’s occupation, and age at first marriage influence a woman’s probability of working informally. These results vary based on the type of employment studied, but can have wide-ranging consequences for the economic development of Kenya and empowerment of Kenyan women. / Thesis (BA) — Boston College, 2016. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Departmental Honors. / Discipline: Economics.

This dissertation consists of three different essays evaluating solutions to postharvest challenges faced by farmers in Kenya and Tanzania. In the first essay we see that demand for a new storage technology the Purdue Improved Crop Storage (PICS) bags in Western Kenya, a completely new technology for almost the entire sample, was highly elastic and that a small proportion of the population would buy at the current market price. In the second essay we find evidence that farmers, who are primarily growing for maize consumption are more concerned about food safety in maize than traders, who are willing to pay less to keep the maize safer. In the third essay in Tanzania, we find that liquidity concerns at harvest prevent farmers from optimizing maize storage and sales decisions.

Thesis (M.A.)--Boston University / Great Britain has adopted two definitive yet different political goals in Africa, each of which has been controlled in large part by the internal situation of the territories. In West Africa, colonial policy has granted power of decision to African political leadership, while in Central Africa, political authority has been given in large measure to the local European minority. Contrasted to these two major decisions, Britain has not adopted specific definitive policy goals for Kenya. The general goal of self-government is too vague to be meaningful to the different members of its disparate multi-racial population. The immediate question is "self-government for whom?" To what racial or ethnic group does the 'self' refer? In West Africa it certainly meant Africans and in Central Africa it has meant Europeans. What accounts for the unwillingness of Britain to define specific and immediate policies in Kenya? It is believed that an answer to this problem through analysis of the internal political and social situation will reveal not only the distinct problems that Kenya poses for policy, but will suggest that the present policy of traditional empiricism may not be able to meet the critical problems of this territory. [TRUNCATED]

Using mixed methods and multiple sites, this thesis reflects on how water acts as a connective material through which socio-cultural, ritual, economic, and ecological relationships are formed and played out. By adopting a New Materialities approach the brute physicality of relationships is drawn into the foreground to illustrate the agency of materials and people as they co-produce each other together. By focusing on water's behaviours, this thesis demonstrates that distinctions typically placed between people and other materials are problematic and consequently require reconsideration. Therefore, in rejection of a human exceptionalist focus, this thesis attempts to level the representational 'playing field' between bodies and water so as to bring water into discourse as multi-species ethnographies have done for other entities. My research is geographically situated in both rural Wales and an outlying location in the Eastern Coastal Province of Kenya where creeping desertification is increasingly troubling subsistence for a group of Giriama horticultural-pastoralists. It examines the socio-economic, cultural and material consequences of regular piped water flowing into a community that until 2015 relied exclusively on a climatically governed water supply, alongside a series of phenomenological experiences had with water in Wales. I establish the role water plays in co-constructing Giriama authenticity and social life whilst simultaneously producing what can be loosely called an 'ethnography' of water. In combination, this thesis demonstrates how the material behaviours of water reveal it to be an active agent that co-produces the materiality, and the behaviours, of being human. The Wenner Gren Foundation supported the fieldwork for this research, under the title The Role of 'New' Water in Shaping and Regulating Futures in Rural Kenya.

No description available.

This thesis seeks to investigate what shapes climate change policies in Kenya. Using Peter Haas' concept of usable knowledge, it argues the need to move beyond conventional perspectives on knowledge and power and provides a framework for understanding what knowledge and mechanisms are usable for policy makers. I argue that Kenyan climate policy is shaped by the interaction of knowledge and power across three crucial levels of influence - global, regional and national. As climate change forces us to rethink how we combine economic policies with environmental realities in Africa, each level encompasses distinct policy narratives where critical actors have an impact on national climate change policy. First, I argue that the standards, norms and regulations established by the global climate regime are directly reflected in national climate strategies of African countries, not only in terms of diplomatic moves to adhere to commitments made, but also in respect to benefiting from international mechanisms put in place to aid developing countries. Second, I examine the One Voice, One Africa narrative. This looks at the rise of the African Group of Negotiators within the global climate regime and their ability to influence Kenyan policy. Third, Kenya's climate change policy is shaped by the interaction of economic, political, and environmental constructs in national policy-making. The principle goal of this thesis is to open African environmental scholars and climate change policy analysts to a rigorous and flexible questioning of how climate policy processes operate in the African context.

This thesis investigates the emerging policy vision and assumptions underlying the promotion of school self-evaluation (SSE) as an innovative strategy for school improvement in Kenya, and the ways in which they are understood and practiced by various stakeholders. My professional involvement in SSE policy development led me to think that too little was known about its practice. Therefore, I specifically explored the acceptability, feasibility and effectiveness of this evaluation process, focusing on social interaction and contextual factors at the school/community level through an exploratory qualitative case study and continuous professional reflection. By critically questioning linear, top-down policy assumptions, I sought multiple stakeholder viewpoints within contextual specificities in order to capture and understand the realities – complex, diverse and organic processes – on the ground. Accordingly, I employed interactionist and constructivist paradigms, and utilised interviews, observations and documentary analysis as sources. The findings suggest that there is a considerable gap between SSE policy expectations and its practice on the ground, while also highlighting some positive experiences and future potential. Stakeholders at all levels largely understand and accept the idea of participatory, inclusive and democratic SSE conceptually, but they have not yet embraced it practically. The education authority's monopoly on the power to evaluate schools is identified as a key systemic bottleneck that effectively restricts meaningful SSE practice on the part of school-level stakeholders who follow instructions from above in a regime of professional legitimacy. Conversely, study findings indicate that both collective and individual SSE approaches promoted in Kenya are feasible, policymakers' paternalistic concerns notwithstanding. Teachers were found to demonstrate their collective ability to apply the prescriptive SSE tool to fit their unique contexts and assess school quality. They also successfully engaged with individual SSE (action research) which, the thesis contends, can initiate a ‘positive spiral of change' through which teachers build their confidence based on small but real successes, transform perspectives and professional attitudes, and ultimately engage in self-reflective practices for school improvement. However, the thesis concludes that the Kenyan policy assumption of evidence-based school development remains largely theoretical, schools tending to engage in ad-hoc improvement through unsophisticated planning in the absence of systematic SSE. Overall, I argue that it is important to acknowledge and utilise the education authority's power and influence (i.e. the leadership of the Ministry of Education, and its Quality Assurance and Standards Directorate) in a positive manner that will lead to a more realistic and pragmatic approach to SSE promotion. Contending that institutionalising a ‘culture of learning' is the way forward, I present a scenario whereby SSE may lead to sustained school improvement with two key strategies: (i) merging individual and collective SSE; and (ii) combining internal and external school evaluation. Moreover, I argue that the education authority's monopoly on school evaluation should also be tackled so that an integrated system for quality improvement can be realised in Kenya. Based on the study findings, the thesis presents a number of policy recommendations including formal utilisation of the SSE tool; substantial stakeholder participation; enhanced teacher training; external quality assurance to validate SSE results; strengthened district-level peer learning and school leadership; and improved policy coordination and dissemination. Finally, I reflect on my professional position with renewed commitment to contribute to the achievement of quality education for all children.